World Health Organization Risk Drinking Levels Among Mandated College Students: Associations with Alcohol Use, Mental Health, and Academic Performance.

OBJECTIVE: World Health Organization (WHO) risk drinking levels (i.e., low, moderate, high, or very high risk) have been used as a drinking reduction endpoint in clinical trials. Yet, prior work has not attempted to quantify reductions in WHO risk levels among mandated students, who may also benefit from reduced drinking. We sought to validate WHO risk drinking levels in differentiating students' alcohol-related outcomes, depressive symptoms, and academic performance. Defining risk via typical drinks per drinking day versus drinks per day was compared, and gender differences were examined. METHOD: Baseline data were drawn from three intervention trials for students mandated to intervention and who were not abstinent (N=1436). Sex-specific WHO risk levels were generated and dummy coded, with low risk as the reference. Regression models examined associations of risk levels with positive AUDIT scores, peak drinking, consequences, depressive symptoms, and grade point average. RESULTS: Defining WHO risk via drinks per drinking day evenly dispersed students across categories, whereas drinks per day categorized most as low risk. More women than men were classified as very high risk across definitions. Students classified as low risk differed from those classified as moderate, high, and very high risk in screening positive on the AUDIT, peak drinking, and consequences. WHO risk levels did not differentiate depressive symptoms. Differences in grade point average were inconsistent across risk definitions. CONCLUSIONS: WHO risk drinking levels differentiated alcohol use and consequences and, therefore, hold promise for clinical use and for quantifying drinking reductions among mandated college students.

Healthy Behaviors Among Non-Hispanic Black and Hispanic People Affected by Cancer During the Posttreatment Survivorship: A Qualitative Study.

BACKGROUND: There are disparities in health behaviors across racial and ethnic groups. However, limited studies focus on cancer survivors' experiences developing and maintaining healthy behaviors, particularly in non-Hispanic Black (NHB) and Hispanic people. OBJECTIVE: This study aimed to understand the experiences of NHB and Hispanic people affected by cancer in developing and maintaining positive health behaviors beyond a cancer diagnosis. METHODS: The data were collected in a mixed-method study through semistructured interviews with 29 NHB and Hispanic cancer survivors between June and October 2022. Conventional content analysis was used. RESULTS: The lived experiences of cancer survivors were narrated in 3 themes: impact of a cancer diagnosis on oneself, facilitators and barriers to health and health behaviors, and utilization of available sources for health. Facilitators and barriers to health and health behaviors were further explored as biological (eg, symptoms, comorbidities), behavioral (eg, help-seeking behavior, sleep pattern), physical/built (eg, available sources, neighborhood), and sociocultural environment (eg, income, transportation, knowledge, culture, upbringing, household and community composition, social and family network), and healthcare system-related factors (eg, insurance coverage, personal preferences, perceived discrimination, and stigma). CONCLUSION: Non-Hispanic Black and Hispanic people, specifically those living in disadvantaged neighborhoods with limited sources or where they feel discriminated and stereotyped, those with limited income and transportation, and those with physical, social, or mental health problems, seemed to have challenges prioritizing health behaviors and maintaining healthy living. IMPLICATIONS FOR PRACTICE: Biological, behavioral, and psychosocial determinants of health behaviors should be addressed through multilevel collaborations among different levels of partners.

Individual-Community Misalignment in Partisan Identity Predicts Distancing From Norms During the COVID-19 Pandemic.

This study investigated whether misalignment between an individual and their community in partisan identity predicted psychological and behavioral distancing from local COVID-19 norms. A nationally representative sample of Republicans and Democrats provided longitudinal data in April (N = 3,492) and June 2020 (N = 2,649). Democrats in Republican communities reported especially heightened better-than-average estimates, perceiving themselves as more adherent to and approving of non-pharmaceutical interventions (NPI; e.g., mask wearing) than their community. Democrats'better-than-average estimates reflected high approval and behavior in Republican communities and substantial norm underestimation. Republicans in Democratic communities did not evidence worse-than-average estimates. In longitudinal models, injunctive norms only predicted NPI behavior when individual and community partisan identity were aligned. The strong personal approval-behavior association did not depend on misalignment; there were no effects of descriptive norms. Normative messages may have limited efficacy for a sizable subpopulation in politically polarized contexts, such as the COVID-19 pandemic.

Community-level age bias and older adult mortality.

RATIONALE: As the older adult population increases, understanding the health effects of bias against older adults is increasingly important. Whether structural forms of age bias predict worse health has received limited attention. OBJECTIVE: We hypothesized that communities with greater age bias would have higher mortality among residents aged 65 and older. We expected the association to be unique to age bias, rather than general bias (i.e., sexual minority and racial bias), and that the age bias-mortality association would be strongest in predominantly White and younger communities. METHODS: Explicit and implicit attitudes toward older adults (N = 1,001,735), sexual minorities (N = 791,966), and Black Americans (N = 2,255,808) were drawn from Project Implicit. Post-stratification relative to U.S. Census demographics was executed to improve the representativeness of county-level explicit and implicit bias estimates. County older adult mortality, estimated cross-sectionally with and longitudinally relative to bias scores, served as outcomes. Models controlled for relevant county-level covariates (e.g., median age) and included all U.S. counties (N = 3142). RESULTS: Contrary to hypotheses but consistent with prior work, explicit age bias was cross-sectionally and longitudinally associated with lower mortality, over and above covariates and generalized community bias. The explicit age bias-lower mortality association only emerged in younger counties but did not depend on county ethnic composition. Implicit age bias was unassociated with outcomes. Post-hoc analyses supported that ageist communities may be associated with better health across the lifespan. Explicit age bias predicted lower mortality in young and middle adulthood; better mental health in middle adulthood, but not exercise or self-rated health, mediated the explicit age bias-older adult mortality association. CONCLUSIONS: Results highlight the uniqueness of older age relative to other stigmatized identities. Further examination of the association of community-level age bias with better health may improve longevity for all communities.

Embracing heterogeneity: Implications for research on stigma, discrimination, and African Americans' health.

There has been substantial progress in research on the roles of stigma and discrimination in African Americans' health. Yet, Black-White health disparities persist. Research must, therefore, build on and address the heterogeneity that exists in stigma- and discrimination-related pathways, experiences, interventions, and research methodology. Specifically, research is needed that identifies the unique versus common mechanisms linking various forms of stigma and discrimination with African Americans' health. Moreover, beyond gender, the role of intersectionality in stigma's health effects remains unclear, and interventions are sorely needed that both enhance coping and eliminate the existence of stigma. Finally, experimental designs, though underutilized, hold promise as a method for examining mechanisms, intersectionality, and intervention efficacy.

Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism?

OBJECTIVE: To examine whether anti-Black cultural racism moderates the efficacy of psychotherapy interventions among youth. METHOD: A subset of studies from a previous meta-analysis of 5 decades of youth psychotherapy randomized controlled trials was analyzed. Studies were published in English between 1963 and 2017 and identified through a systematic search. The 194 studies (N = 14,081 participants; age range, 2-19) across 34 states comprised 2,678 effect sizes (ESs) measuring mental health problems (eg, depression) targeted by interventions. Anti-Black cultural racism was operationalized using a composite index of 31 items measuring explicit racial attitudes (obtained from publicly available sources, eg, General Social Survey) aggregated to the state level and linked to the meta-analytic database. Analyses were conducted with samples of majority-Black (ie, ≥50% Black) (n = 36 studies) and majority-White (n = 158 studies) youth. RESULTS: Two-level random-effects meta-regression analyses indicated that higher anti-Black cultural racism was associated with lower ESs for studies with majority-Black youth (ß = -0.2, 95% CI [-0.35, -0.04], p = .02) but was unrelated to ESs for studies with majority-White youth (ß = 0.0004, 95% CI [-0.03, 0.03], p = .98), controlling for relevant area-level covariates. In studies with majority-Black youth, mean ESs were significantly lower in states with the highest anti-Black cultural racism (>1 SD above the mean; Hedges' g = 0.19) compared with states with the lowest racism (<1 SD below the mean; Hedges' g = 0.60). CONCLUSION: Psychotherapies tested with samples of majority-Black youth were significantly less effective in states with higher (vs lower) levels of anti-Black cultural racism, suggesting that anti-Black cultural racism may be one contextual moderator of treatment effect heterogeneity.

Does attending a college with more heavy drinking peers increase risk of heavy drinking and consequences? A prospective national analysis.

Heavy drinking in college increases risk for negative consequences. Among a national sample of high school abstainers and moderate drinkers, we hypothesized that the extent of heavy drinking among students on campus would be among the strongest predictors of first semester heavy drinking and consequences, relative to personal approval of alcohol use and sociability and impairment outcome expectancies. We expected these psychological factors to moderate effects of campus heavy drinking. Data from 90,455 abstainers and 97,168 moderate drinkers matriculating at 245 and 242 universities, respectively, were drawn from AlcoholEdu (EverFi, 2013), a web-based intervention completed by most first-year students at participating universities. Students reported alcohol use, approval, expectancies, and covariates prior to enrollment (Time 1). During the first semester (Time 2), abstinence, moderate drinking, or heavy drinking, and negative consequences experienced were reassessed. Campus heavy drinking reflected the percentage of other students attending the same school who engaged in heavy drinking at Time 2. In multilevel multinomial logistic regression models, campus heavy drinking was consistently among the strongest predictors of heavy drinking and consequences: It predicted an 83% and 82% increase in risk of heavy drinking and a 106% and 91% increase in risk of consequences among students who were abstainers and moderate drinkers at Time 1, respectively. There were few interactions among campus heavy drinking and psychological factors. Post hoc analyses supported that students did not self-select into heavier drinking environments. Campus heavy drinking is a key predictor of first semester alcohol use and an important intervention target. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Roles of attitudes and injunctive norms in decisional conflict and disclosure following receipt of genome sequencing results.

RATIONALE: Individuals who choose to obtain genetic information may learn that their genetic profile confers health risks to themselves or offspring. Individuals may react more negatively to this information when personal attitudes, perceived norms, and/or the decision to receive results conflict with one another. OBJECTIVE: We predicted that holding more negative attitudes (personal evaluations) or injunctive norms (perceptions of others' approval) toward obtaining genetic test results would prospectively predict greater conflict about the decision to undergo sequencing and less disclosure of sequencing results to family members. We also expected attitudes and norms to interact, such that attitudes would be negatively associated with decisional conflict and positively associated with disclosure when injunctive norms were positive, but weakly associated with outcomes when injunctive norms were negative. METHOD: Participants (N=312) were enrolled in a genomic sequencing trial focused on identifying carrier genetic variants, reflecting a variant that might affect their biological children's or grandchildren's health. Participants reported attitudes and injunctive norms, underwent sequencing, and later received results indicating carrier status for at least one variant. Decisional conflict was assessed at immediate post-test, and 1- and 6-month follow-ups. Disclosure of results to children and siblings were assessed at 1 and 6 months. RESULTS: In structural equation models with covariates, attitudes were negatively associated with post-test and 1-month decisional conflict. Injunctive norms were negatively associated with decisional conflict at 1 and 6 months and positively associated with disclosure to children and siblings at 1 month. The significant attitudes by injunctive norms interaction predicting post-test decisional conflict supported lower decisional conflict when attitudes, norms, and the decision to receive results were all aligned. Exploratory analyses supported indirect effects of attitudes and norms on 6-month sibling disclosure via 1- month decisional conflict. CONCLUSION: Results support roles of psychosocial factors in decisional conflict and disclosure after receiving sequencing results.

Are college students' perceptions of social network drinking accurate?: Examining the validity of the Important People Instrument.

A growing body of research has examined self-reported measures of social network alcohol use, such as the Important People Instrument (IPI), among college students. However, it remains unknown whether IPI judgments of friends' alcohol use are accurate. We hypothesized that judgments of friends' drinking status (e.g., heavy drinker) and maximum drinks per day would primarily reflect friends' self-report (accuracy), rather than projection of participants' self-report (assumed similarity) or a systematic tendency to under- or overestimate behavior (directional bias). We also expected that accuracy would be stronger when participants were women, had more contact with friends, or drank less each week or when friends drank less each week. In all, 654 randomly selected, 1st-year students indicated their 5 closest friends in their class, yielding 111 friendship dyads. Participants judged each friend's drinking status and maximum drinks per day and rated these items for themselves. Gender, frequency of contact, and typical drinks per week were assessed. Results indicated that judgments of drinking status and maximum drinks per day were highly accurate. Accuracy effects were consistently stronger than was assumed similarity; directional bias was nonsignificant. Accuracy did not depend on gender or participants' weekly consumption but was stronger for both outcomes when contact was more frequent and, for maximum drinks per day, when friends' weekly consumption was relatively low. Results support validity of the IPI for assessing social network alcohol use among students. Given that perceptions are accurate, research is needed on intervention strategies that facilitate management of risky peers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Social modelling of health behaviours: Testing self-affirmation as a conformity-reduction strategy.

OBJECTIVES: Social conformity negatively affects health. Exposure to peers who model unhealthy alcohol or food consumption increases personal consumption. Self-affirmation alters processes related to the motivations underlying conformity. We therefore tested whether self-affirmation reduces conformity to unhealthy behaviour and does so by reducing affiliation needs and/or increasing self-regulation. DESIGN: In two studies, participants were randomized to one of four conditions in a 2 (low vs. high peer modelling) × 2 (self-affirmed vs. not) design. METHODS: In Study 1 (N = 153), a confederate modelled low or high alcohol consumption. Participants' alcohol consumption was recorded; mimicry of confederates' sips was coded. In Study 2 (N = 122), written information indicated others' snack food intake during the study. Participants' food consumption was recorded. Affiliative interest was assessed in both studies. Inhibitory control and private self-awareness were assessed in Studies 1 and 2, respectively. RESULTS: In Study 1, participants exposed to heavy drinking consumed significantly more alcohol and mimicked the confederate more frequently than participants exposed to the light drinking model. Self-affirmation did not reduce this tendency, nor did it affect affiliative interest or inhibitory control. Exploratory analysis supported that mimicry mediated the peer modelling-consumption relationship. In Study 2, participants ate more when they believed others had eaten a lot, as opposed to little. Self-affirmation did not reduce this tendency and did not affect affiliative interest. Self-affirmed participants had higher private self-awareness than those who were not self-affirmed, but self-awareness did not affect consumption. CONCLUSION: Peer behaviour strongly influences personal consumption. Self-affirmation did not reduce behavioural conformity. Statement of contribution What is already known on this subject? Exposure to peers who engage in high consumption of alcohol and unhealthy foods is associated with increased personal consumption. Few studies have examined strategies to reduce conformity to consumption behaviours. What does this study add? Across two studies, self-affirmation did not reduce behavioural conformity, despite its' positive effects on private self-awareness. Conformity in face-to-face interactions is largely driven by mimicry.

Using e-mail boosters to maintain change after brief alcohol interventions for mandated college students: A randomized controlled trial.

OBJECTIVE: Brief motivational interventions (BMIs) reduce drinking in the short term, but these initial effects often decay. We tested the hypothesis that theory-based e-mail boosters would promote maintenance of change after a BMI. METHOD: Participants were students (N = 568; 72% male) who violated campus alcohol policy and were mandated to participate in an alcohol-risk-reduction program. Participants provided baseline data, received a BMI, and then completed a 1-month post-BMI survey. Next, they were randomized to receive 12 booster e-mails that contained either (a) alcohol norms or (b) structurally equivalent general health information (control). Alcohol consumption and alcohol-related consequences were assessed at baseline, 1, 3, 5, 8, and 12 months. RESULTS: As expected, we observed significant reductions in both consumption and consequences after the BMI (ps < .01), and groups were equivalent at baseline and at 1-month post-BMI, prior to randomization (ps > .05). Latent growth curve models revealed no condition effects on changes in the latent consumption variable from 1- to 12-month follow-ups (b = .01, SE = .01, p > .05). Unexpectedly, a main effect of the condition emerged for self-reported consequences (b = .03, SE = .01, p = .01); we observed more consequences after boosters containing alcohol norms than general health information. Outcomes were not moderated by sex, consumption at baseline or 1 month, or e-mail exposure, and there was no mediation by descriptive norms, injunctive norms, or peer communication. CONCLUSIONS: Contrary to predictions, e-mail boosters with corrective norms content did not improve outcomes after a BMI. (PsycINFO Database Record

Why is social network drinking associated with college students' alcohol use? Focus on psychological mediators.

Level of drinking in the social network is strongly associated with college students' alcohol use. However, mechanisms through which networks are associated with personal drinking have been underexplored thus far. The present study examined theoretically derived constructs-sociability outcome expectancies, attitudes toward heavy drinking, self-efficacy for use of protective strategies, and descriptive norms-as potential mediators of the association between egocentric social network drinking and personal consumption. College students (N = 274) self-reported their social network's level of alcohol consumption, all mediators, drinks per week, and consequences at both baseline (Time 1) and a 1-month follow-up (Time 2). Autoregressive mediation models focused on the longitudinal associations between Time 1 network drinking and the Time 2 mediators and between the Time 1 mediators and the Time 2 outcomes. Consistent with hypotheses, Time 1 social network drinking was significantly associated with Time 2 drinks per week and consequences. Only attitudes significantly mediated social network associations with drinks per week and consequences, though the proportion of the total effects accounted for by attitudes was small. After accounting for the stability of constructs over time, social network drinking was generally un- or weakly related to sociability expectancies, self-efficacy, and descriptive norms. Results support reducing attitudes toward heavy drinking as a potential avenue for mitigating network effects, but also highlight the need to evaluate additional potential mechanisms of network effects. Intervention efforts that aim to address the social network have the potential to substantially reduce alcohol consumption, thereby enhancing the overall efficacy of alcohol risk-reduction interventions. (PsycINFO Database Record

Associations of perceived norms with intentions to learn genomic sequencing results: Roles for attitudes and ambivalence.

OBJECTIVE: Genomic sequencing is becoming increasingly accessible, highlighting the need to understand the social and psychological factors that drive interest in receiving testing results. These decisions may depend on perceived descriptive norms (how most others behave) and injunctive norms (what is approved of by others). We predicted that descriptive norms would be directly associated with intentions to learn genomic sequencing results, whereas injunctive norms would be associated indirectly, via attitudes. These differential associations with intentions versus attitudes were hypothesized to be strongest when individuals held ambivalent attitudes toward obtaining results. METHOD: Participants enrolled in a genomic sequencing trial (n = 372) reported intentions to learn medically actionable, nonmedically actionable, and carrier sequencing results. Descriptive norms items referenced other study participants. Injunctive norms were analyzed separately for close friends and family members. Attitudes, attitudinal ambivalence, and sociodemographic covariates were also assessed. RESULTS: In structural equation models, both descriptive norms and friend injunctive norms were associated with intentions to receive all sequencing results (ps < .004). Attitudes consistently mediated all friend injunctive norms-intentions associations, but not the descriptive norms-intentions associations. Attitudinal ambivalence moderated the association between friend injunctive norms (p ≤ .001), but not descriptive norms (p = .16), and attitudes. Injunctive norms were significantly associated with attitudes when ambivalence was high, but were unrelated when ambivalence was low. Results replicated for family injunctive norms. CONCLUSIONS: Descriptive and injunctive norms play roles in genomic sequencing decisions. Considering mediators and moderators of these processes enhances ability to optimize use of normative information to support informed decision making. (PsycINFO Database Record

Intergenerational Consequences: Women's Experiences of Discrimination in Pregnancy Predict Infant Social-Emotional Development at 6 Months and 1 Year.

OBJECTIVE: Racial/ethnic and socioeconomic disparities in infant development in the United States have lifelong consequences. Discrimination predicts poorer health and academic outcomes. This study explored for the first time intergenerational consequences of women's experiences of discrimination reported during pregnancy for their infants' social-emotional development in the first year of life. METHODS: Data come from a longitudinal study with predominantly Black and Latina, socioeconomically disadvantaged, urban young women (N = 704, Mage = 18.53) across pregnancy through 1 year postpartum. Women were recruited from community hospitals and health centers in a Northeastern US city. Linear regression analyses examined whether women's experiences of everyday discrimination reported during pregnancy predicted social-emotional development outcomes among their infants at 6 months and 1 year of age, controlling for potentially confounding medical and sociodemographic factors. Path analyses tested if pregnancy distress, anxiety, or depressive symptoms mediated significant associations. RESULTS: Everyday discrimination reported during pregnancy prospectively predicted greater inhibition/separation problems and greater negative emotionality, but did not predict attention skills or positive emotionality, at 6 months and 1 year. Depressive symptoms mediated the association of discrimination with negative emotionality at 6 months, and pregnancy distress, anxiety, and depressive symptoms mediated the association of discrimination with negative emotionality at 1 year. CONCLUSION: Findings support that there are intergenerational consequences of discrimination, extending past findings to infant social-emotional development outcomes in the first year of life. It may be important to address discrimination before and during pregnancy and enhance support to mothers and infants exposed to discrimination to promote health equity across the life span.

Discrimination and excessive weight gain during pregnancy among Black and Latina young women.

RATIONALE: Excessive weight gain during pregnancy is a major determinant of later life obesity among both Black and Latina women and their offspring. However, psychosocial determinants of this risk, including everyday discrimination, and potential moderators of such effects remain unexplored. OBJECTIVE: We examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. Whether the effect was moderated by race/ethnicity, age, or depressive symptoms was also examined. METHOD: Participants were 413 Black and Latina pregnant young women, ages 14-21 years. Experience with discrimination and all moderators were assessed in the second trimester. Last weight recorded in the third trimester was abstracted from medical records and used to determine excessive weight gain. RESULTS: Ever experiencing discrimination was associated with a 71% increase in the odds of excessive weight gain. The effect of discrimination was primarily present among women who attributed this treatment to membership in a historically oppressed group (e.g., ethnic minority, female) or to membership in other stigmatized groups (e.g., overweight). The effect of ever experiencing discrimination was not moderated by race/ethnicity or age but was moderated by depressive symptoms. Supporting the perspective of the environmental affordances model, discrimination strongly predicted excessive weight gain when women were low in depressive symptoms but had no effect when women were high in depressive symptoms. The moderating role of depressive symptoms was equivalent for Black and Latina women. CONCLUSION: Results highlight the role of discrimination in perpetuating weight-related health disparities and suggest opportunities for improving health outcomes among young pregnant women.

How Mandated College Students Talk About Alcohol: Peer Communication Factors Associated with Drinking.

Relatively little research has examined how peer communication influences alcohol consumption. In a sample of mandated college students, we differentiate conversations about drinking from conversations about harm prevention and provide evidence for the validity of these communication constructs. Students who violated campus alcohol policies and were referred for alcohol sanctions (N = 345) reported on drinking patterns, use of protective behavioral strategies, perceived descriptive norms for close friends, and serving as social leader among their friends; they also reported on the frequency of conversations about drinking, about drinking safety, and about risk reduction efforts. Predicted correlations were found among types of communication and conceptually related variables. General communication was related to consumption but not protective behavioral strategies, whereas safety/risk reduction conversations correlated positively with all protective behavioral strategies. Both types of communication were associated with social leadership. Safety communication moderated the relationship between peer descriptive norms and drinks per week; more frequent talking about safety attenuated the norms-consumption relationship. Peer communication about both drinking and safety may serve as targets for change in risk reduction interventions for mandated college students.

Interventions to reduce college student drinking: State of the evidence for mechanisms of behavior change.

Interventions to reduce college student drinking, although efficacious, generally yield only small effects on behavior change. Examining mechanisms of change may help to improve the magnitude of intervention effects by identifying effective and ineffective active ingredients. Informed by guidelines for establishing mechanisms of change, we conducted a systematic review of alcohol interventions for college students to identify (a) which constructs have been examined and received support as mediators, (b) circumstances that enhance the likelihood of detecting mediation, and (c) the extent of evidence for mechanisms of change. We identified 61 trials that examined 22 potential mediators of intervention efficacy. Descriptive norms consistently mediated normative feedback interventions. Motivation to change consistently failed to mediate motivational interviewing interventions. Multiple active ingredient interventions were not substantially more likely to find evidence of mediation than single ingredient interventions. Delivering intervention content remotely reduced likelihood of finding support for mediation. With the exception of descriptive norms, there is inadequate evidence for the psychosocial constructs purported as mechanisms of change in the college drinking literature. Evidence for mechanisms will be yielded by future studies that map all active ingredients to targeted psychosocial outcomes and that assess potential mediators early, inclusively, and at appropriate intervals following interventions.

Social network influences on initiation and maintenance of reduced drinking among college students.

OBJECTIVE: To determine whether (a) social networks influence the extent to which college students initiate and/or maintain reductions in drinking following an alcohol intervention and (b) students with riskier networks respond better to a counselor-delivered, vs. a computer-delivered, intervention. METHOD: Mandated students (N = 316; 63% male) provided their perceptions of peer network members' drinking statuses (e.g., heavy drinker) and how accepting each friend would be if the participant reduced his or her drinking. Next, they were randomized to receive a brief motivational intervention (BMI) or Alcohol Edu for Sanctions (EDU). In latent growth models controlling for baseline levels on outcomes, influences of social networks on 2 phases of intervention response were examined: initiation of reductions in drinks per heaviest week, peak blood alcohol content (BAC), and consequences at 1 month (model intercepts) and maintenance of reductions between 1 and 12 months (model slopes). RESULTS: Peer drinking status predicted initiation of reductions in drinks per heaviest week and peak BAC; peer acceptability predicted initial reductions in consequences. Peer Acceptability × Condition interactions were significant or marginal for all outcomes in the maintenance phase. In networks with higher perceived acceptability of decreasing use, BMI and EDU exhibited similar growth rates. In less accepting networks, growth rates were significantly steeper among EDU than BMI participants. For consumption outcomes, lower perceived peer acceptability predicted steeper rates of growth in drinking among EDU but not BMI participants. CONCLUSIONS: Understanding how social networks influence behavior change and how interventions mitigate their influence is important for optimizing efficacy of alcohol interventions.

Changes in experiences with discrimination across pregnancy and postpartum: age differences and consequences for mental health.

OBJECTIVES: We aimed to contribute to growing research and theory suggesting the importance of examining patterns of change over time and critical life periods to fully understand the effects of discrimination on health, with a focus on the period of pregnancy and postpartum and mental health outcomes. METHODS: We used hierarchical linear modeling to examine changes across pregnancy and postpartum in everyday discrimination and the resulting consequences for mental health among predominantly Black and Latina, socioeconomically disadvantaged young women who were receiving prenatal care in New York City. RESULTS: Patterns of change in experiences with discrimination varied according to age. Among the youngest participants, discrimination increased from the second to third trimesters and then decreased to lower than the baseline level by 1 year postpartum; among the oldest participants, discrimination decreased from the second trimester to 6 months postpartum and then returned to the baseline level by 1 year postpartum. Within-subjects changes in discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points. Discrimination more strongly predicted anxiety symptoms among participants reporting food insecurity. CONCLUSIONS: Our results support a life course approach to understanding the impact of experiences with discrimination on health and when to intervene.

Gender and depression moderate response to brief motivational intervention for alcohol misuse among college students.

OBJECTIVE: Brief motivational interventions (BMIs) effectively reduce problematic drinking in college students. However, not all students benefit, and little is known about the subgroups of students for whom BMIs are most effective. In the present study, we examined 2 factors that may influence BMI efficacy: gender and depression. METHOD: We reanalyzed data from a clinical trial in which heavy drinking students (N = 330; 65% female) were randomized to a BMI (n = 165) or an assessment only control (n = 165). Depression was assessed at baseline; past-month typical drinks per week, heavy drinking frequency, and consequences were assessed at baseline and 1 month. Three- and 2-way interactions among intervention condition (BMI vs. control), gender (male vs. female), and depression (low vs. high) were tested. RESULTS: We observed 3-way interaction effects on 2 outcomes: (a) typical drinks per week and (b) frequency of heavy drinking at 1 month. Relative to controls and adjusting for baseline drinking, low-depression women reduced their drinking more after a BMI whereas high-depression women did not show differential improvement. In contrast, high-depression men showed significant reductions in weekly drinks following the BMI whereas low-depression men did not show differential improvement. In addition, higher levels of depression were associated with higher levels of consequences at follow-up across conditions. CONCLUSIONS: BMIs are indicated for heavy drinking, depressed men, consistent with recommendations for implementing screening and brief intervention in mental health settings. However, BMIs may need to be refined to enhance their efficacy for depressed women.