Overestimation of alcohol consumption norms as a driver of alcohol consumption: a whole-population network study of men across eight villages in rural, southwestern Uganda.

BACKGROUND AND AIMS: Little is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption. DESIGN: Cross-sectional, whole-population, sociocentric social network study. SETTING: Eight rural villages in Rwampara District, southwestern Uganda in 2016-18. PARTICIPANTS: A total of 719 men aged 18 years and older (representing 91% of permanent resident men). MEASUREMENTS: Self-reported frequent (≥ 4 days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self-reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior. FINDINGS: Throughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio-demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR) = 3.98; 95% confidence interval (CI) = 1.69-9.34) and heavy (aRR = 4.75; 95% CI = 2.33-9.69) alcohol consumption themselves. CONCLUSIONS: Most men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior.

Norms and Attitudes about Being an Active Bystander: Support for Telling Adults about Seeing Knives or Guns at School among Greater London Youth.

A detailed understanding of the factors associated with support among youth for reporting a knife or gun at school to an adult is essential to inform violence prevention initiatives. However, no studies have empirically assessed attitudes about support for reporting among secondary school students in Greater London nor perceived norms about such support among peers. Thus, this study explores whether students misperceive peer norms about support for telling adults about seeing weapons at school. Anonymous surveys were completed by 7401 youth (52% female; 43% White; mean age 11.8 years) in school years 4-11 in 45 school cohorts in a greater London borough between 2007 and 2012. Students reported both personal support about reporting weapons to several categories of adults and whether they perceived most other students at their school to support reporting weapons to adults in each category. Most students (64-78% on average) in most cohorts personally thought that students should report seeing a weapon at school to head teachers, police/security guard, teachers/counselors, and parent/other adult relatives. However, 34-44% of students erroneously thought that the majority of their peers did not support reporting to these adults. Perceived norms predicted personal support for reporting, adjusting for the prevalence of actual support at one's school and other factors. Pervasive norm misperceptions about reporting may contribute to a less safe environment.

Adolescent Tobacco Use and Misperceptions of Social Norms Across Schools in the United States.

OBJECTIVE: This study assesses tobacco use norm misperceptions by distinguishing between perceived and actual peer norms for both tobacco use attitudes and behavior, and examines the association between perceived norms and personal use among U.S. students in Grades 6-12. METHOD: Anonymous self-report surveys were conducted with 28,070 students across 64 schools in 11 U.S. states between 1999 and 2017. RESULTS: Although 77% of students said tobacco use is never good, 64% of students thought that most students in their grade believed that use is acceptable. Similarly, although 79% of students reported never using tobacco, 85% of students perceived that most students in their grade typically use tobacco, with 66% thinking that peers use monthly or more often. Substantial norm misperception existed regardless of student and school factors, increasing by grade. Perceiving that most peers thought tobacco use is acceptable was highly predictive of personal attitude, and perceiving tobacco use as the norm among same-grade peers strongly predicted personal tobacco use, even after we adjusted for actual peer use prevalence and other factors. Males' perception of the male peer norm was a stronger predictor of personal use than was their perception of the female peer norm. Females' perceptions of sex-specific norms were associated with personal use, each at about the same magnitude. CONCLUSIONS: Norm misperceptions are pervasive across a diversity of students and schools, whereas perceptions of peer norms about tobacco use are highly associated with personal attitude and use. Results suggest that population-wide interventions correcting these misperceptions may help reduce tobacco use broadly among youth.

Misperceived norms and personal sugar-sweetened beverage consumption and fruit and vegetable intake among students in the United States.

Perceptions of peer food and beverage consumption norms may predict personal consumption. Yet actual peer norms may be misperceived. Data were collected from adolescents in grades 6-12 (n = 5841) in 13 schools across six regionally diverse states via an anonymous online survey. The male and female averages for the number of sugar-sweetened beverages (SSBs) personally consumed per day were significantly lower than average perceptions of the typical number of SSBs consumed by peers. Inversely, the male and female averages for the number of fruit and vegetable (FV) servings personally consumed per day were significantly higher than average perceptions of typical FVs consumed by peers. Among the majority of male and female grade cohorts, the median SSB consumption was 1 drink per day and the median FV intake was 3 servings per day. Regression analyses found a strong relationship between personal consumption and perceived peer norms about male and female consumption (ß â€¯= 0.56, p < .001 for perceived male norm among male students and ß â€¯= 0.52, p < .001 for perceived female norm among female students about SSB consumption, for example), adjusting for sociodemographic characteristics and actual consumption norms. Overall, 65% and 67% of students overestimated average SSB consumption among males and females in their grade cohort, respectively, while less than 5% underestimated these norms. In addition, 49% and 52% of students underestimated average FV intake among males and females in their grade cohort, respectively, while only about 25-30% overestimated the norm. There was little difference in male and female students' estimations of peer norms. Unhealthy misperceptions of SSB norms and FV norms existed across all student categories and grade cohorts, which may contribute to unhealthy personal dietary patterns.

Accuracy of Estimated Blood Alcohol Concentration Norms From College Student Drinking Survey Data: Verification Using Matched Late-Night Breath Measurements.

OBJECTIVE: This study assesses the accuracy of estimated blood alcohol concentration (eBAC) from survey data in a college student sample using six computational methods from the literature. Corrections for heavy-drinker metabolic rate and preabsorptive error are added to the estimating formula. METHOD: Late-night interception of 2,282 students returning to residence halls every night of the week was used in a double-blind breath test and survey about typical and current-evening alcohol use and body characteristics. RESULTS: Measured breath alcohol concentration (BrAC) was used to assess the accuracy of the computational models. The Seidl method yielded the best performance, with further reduction in error observed when a heavy-drinker metabolic rate correction was applied. In situations when an intercept occurred shortly after alcohol consumption, a correction for alcohol absorption kinetics further reduced error. Despite significant remaining error of estimates for a substantial minority of individuals, using the refined calculation of an eBAC permitted computation of low risk/low impairment (<.05 g/dl) and high risk/high impairment (≥.08 g/dl) prevalences that were virtually identical to the corresponding prevalences revealed using the data from the BrAC measurements. CONCLUSIONS: In late-night intercepts of college students, an eBAC can be calculated from survey data with only modest accuracy for individuals. This measure can quite accurately measure norms, however, with regard to actual BAC levels in circumstances in which students are returning from activities that might include heavy or high-risk drinking.

Actual Versus Perceived HIV Testing Norms, and Personal HIV Testing Uptake: A Cross-Sectional, Population-Based Study in Rural Uganda.

HIV testing is an essential part of treatment and prevention. Using population-based data from 1664 adults across eight villages in rural Uganda, we assessed individuals' perception of the norm for HIV testing uptake in their village and compared it to the actual uptake norm. In addition, we examined how perception of the norm was associated with personal testing while adjusting for other factors. Although the majority of people had been tested for HIV across all villages, slightly more than half of men and women erroneously thought that the majority in their village had never been tested. They underestimated the prevalence of HIV testing uptake by 42 percentage points (s.d. = 17 percentage points), on average. Among men, perceiving that HIV testing was not normative was associated with never testing for HIV (AOR = 2.6; 95% CI 1.7-4.0, p < 0.001). Results suggest an opportunity for interventions to emphasize the commonness of HIV testing uptake.

Misperception of peer weight norms and its association with overweight and underweight status among adolescents.

Previous research has revealed pervasive misperceptions of peer norms for a variety of behaviors among adolescents such as alcohol use, smoking, and bullying and that these misperceptions are predictors of personal behavior. Similarly, misperception of peer weight norms may be a pervasive and important risk factor for adolescent weight status. Thus, the comparative association of actual and perceived peer weight norms is examined in relation to personal weight status. Secondary school students in 40 middle and high schools (n = 40,328) were surveyed about their perceptions of the peer weight norm for same gender and grade within their school. Perceived norms were compared to aggregate self-reports of weight for these same groups. Overestimation of peer weight norms by more than 5 % occurred among 26 % of males and 20 % of females (by 22 and 16 lb on average, respectively). Underestimation occurred among 38 % of males as well as females (by 16 and 13 lb on average, respectively). Personal overweight status based on body mass index (BMI) was much more prevalent among respondents who overestimated peer weight norms as was personal underweight status among respondents who underestimated norms. Perception of the peer norm was the strongest predictor of personal BMI among all personal and school variables examined for both male and female students. Thus, reducing misperceived weight norms should be given more attention as a potential avenue for preventing obesity and eating disorders.

No safe haven: locations of harassment and bullying victimization in middle schools.

BACKGROUND: Given that adolescent bullying victimization is a significant concern for secondary education and adolescent development, identifying school contexts in which victimization is most likely to occur is salient. METHODS: An anonymous online survey assessed the prevalence of being harassed or bullied in various locations within 20 middle schools (grades 5-9) in New Jersey and New York (N = 10,668). Seven types of bullying-related victimization (teased in an unfriendly way, called hurtful names, physically abused, excluded from a group to hurt feelings, belongings taken/damaged, threatened to be hurt, and negative rumors spread) were examined in 7 locations where each type of victimization could occur (classroom, lunchroom, hallways, gym, playground, bus, or bathroom). RESULTS: Prevalence of victimization types ranged from 4% to 38% depending on location. Prevalence of overall victimization was equal or greater in classrooms compared with other school locations (highest prevalence rates in hallways, classrooms, and lunchrooms), regardless of school demographic characteristics. Victimization in classrooms compared with other school settings was most highly associated with feelings of being unsafe. CONCLUSIONS: Vigilant attention to bullying is needed across all school environments and especially in the classroom context, which may mistakenly be perceived as a more protected area. Indeed, middle school classrooms are not safe havens.

Evaluation of a universal point-of-issue assay for bacterial detection in buffy coat platelet components.

Bacterial contamination of platelet concentrates poses a major post-transfusion infectious risk. This study was aimed at evaluating the efficacy of the BacTx(®) assay (Immunetics Inc.) for bacterial detection in leucocyte-reduced buffy coat platelet pools and for its sensitivity in detecting clinical isolates, including bacteria that form surface-attached aggregates (biofilm positives). Platelet pools were inoculated at bacterial concentrations of 0·8-13 CFU/ml. The BacTx(®) assay detected all species at concentrations ≥10(3)  CFU/ml within 20-69 h of platelet incubation. Detection of slow-growing and biofilm-forming strains was delayed in comparison with the other strains. This assay could be used as a point-of-issue method to increase the safety of the platelet supply.

Bacterial growth in red blood cell units exposed to uncontrolled temperatures: challenging the 30-minute rule.

BACKGROUND AND OBJECTIVES: The '30-min rule' requires discarding red blood cells (RBCs) exposed to uncontrolled temperatures for >30 min to ensure safe RBC transfusion. This study was aimed at determining whether multiple room temperature (RT) exposures promote bacterial growth. MATERIALS AND METHODS: Pooled and split RBC units were inoculated with ~1 CFU/ml of Serratia marcescens, Yersinia enterocolitica, Escherichia coli or Staphylococcus epidermidis. Control units remained in storage, while test units were exposed to RT for six 30-min or three 60-min intervals. Bacterial concentrations and endotoxin levels were determined after each exposure and at 42 days of storage. RBC core temperature and RT were monitored in mock units with Escort iLog temperature loggers. A mixed model was used for statistical analyses. RESULTS: Red blood cell core temperature reached 10.7 ± 0.4°C and 14.2 ± 0.2°C during 30- and 60-min exposures, respectively. Staphylococcus epidermidis and E. coli did not grow in either control or exposed RBCs. Yersinia enterocolitica concentration and endotoxin levels were similar in both control and test units. Serratia marcescens concentration and endotoxin levels were higher in exposed units; however, differences between units exposed for 30 min or 60 min were not observed. CONCLUSION: There is no added risk to RBC safety by increasing RT exposures to 60 min with each removal from storage for up to a total of 3 h during RBC shelf life. Therefore, extending the 30-min limitation in RBCs exposed to uncontrolled temperatures to 60 min should be considered by regulatory agencies.

Misperceptions of peer norms as a risk factor for sugar-sweetened beverage consumption among secondary school students.

Research has shown that excess calories from sugar-sweetened beverages are associated with weight gain among youth. There is limited knowledge, however, regarding perception of sugar-sweetened beverage consumption norms. This study examined the extent of misperception about peer sugar-sweetened beverage consumption norms and the association of perceived peer norms with personal self-reported consumption. Among 3,831 6th- to 12th-grade students in eight schools who completed anonymous cross-sectional surveys between November 2008 and May 2009, students' personal perception of the daily sugar-sweetened beverage consumption norm in their school within their grade (School Grade group) was compared with aggregate self-reports of daily sugar-sweetened beverage consumption for each School Grade group. The median daily sugar-sweetened beverage consumption from personal reports was one beverage in 24 of 29 School Grade groups, two beverages in four School Grade groups, and three beverages in one School Grade group. Seventy-six percent of students overestimated the daily norm in their School Grade group, with 24% perceiving the norm to be at least three beverages or more per day. Fixed-effects multiple regression analysis showed that the perceived peer sugar-sweetened beverage consumption norm was much more positively associated with personal consumption than was the estimated actual sugar-sweetened beverage consumption norm per School Grade group. Misperceptions of peer sugar-sweetened beverage consumption norms were pervasive and associated with unhealthy sugar-sweetened beverage consumption behavior. These misperceptions may contribute to intake of excess calories, potentially contributing to adolescent obesity. Future research should assess the pervasiveness of sugar-sweetened beverage consumption misperceptions in other school populations as well as causes and consequences of these misperceptions. Health professionals may wish to consider how normative feedback interventions could potentially reduce consumption.

Peer weight norm misperception as a risk factor for being over and underweight among UK secondary school students.

BACKGROUND: Erroneous perceptions of peer weight norms may be important risk factors for being underweight and overweight. This study assessed misperceptions of peer weight norms and their association with being overweight or underweight among UK youth. METHODS: Anonymous surveys were conducted among students (n=2104) attending schools in a Greater London borough in Fall 2007. Students' perceptions of the weight norm for same sex peers in their year in their school (years 5 through 11) are compared with the aggregate self-reports of weight for these same sex and year cohorts in each school. Variation in perceptions is compared with personal body mass index (BMI) on the basis of self-reported height and weight. RESULTS: A total of 34% of males and 32% of females overestimated peer weight norms by more than 5% (10 kg on average). Similarly, 37% of males and 43% of females underestimated peer weight norms by more than 5% (7 kg on average). For both males and females, overestimating peer weight norms was associated with a greater risk for being overweight and underestimating peer weight norms was associated with a greater risk for being underweight. Perceived peer weight norm was the strongest predictor of BMI among females compared with estimated actual weight norms of peers (based on the mean of self-reported weight) and demographic factors, and one of the two strongest predictors among males in linear regression analyses, including schools as fixed effects. CONCLUSIONS: Pervasive misperceptions of peer weight norms may contribute to unhealthy weight-related behaviors and help perpetuate students' overweight or underweight status. Future research should examine perceptions of other weight-related peer norms and explore what may create misperceptions. Addressing pervasive misperceptions of weight could perhaps be included as a part of interventions aimed at reducing unhealthy weight and related behaviors.

Effectiveness of social norms media marketing in reducing drinking and driving: A statewide campaign.

This research evaluated the efficacy of a high-intensity social norms media marketing campaign aimed at correcting normative misperceptions and reducing the prevalence of drinking and driving among 21-to-34-year-olds in Montana. A quasi-experimental design was used, such that regions of Montana were assigned to one of three experimental groups: social norms media marketing campaign, buffer, and control. Four random samples of Montanans between the ages of 21 and 34 were assessed at four time points over 18 months via phone surveys. Findings suggest that the social norms media campaign was successful at exposing the targeted population to social norms messages in the counties within the intervention region. Moreover, results demonstrate the campaign reduced normative misperceptions, increased use of designated drivers, and decreased drinking and driving among those young adults in counties within the intervention region. Social norms media marketing can be effective at changing drinking-related behaviors at the population level. This research provides a model for utilizing social norms media marketing to address other behaviors related to public health.

Declining negative consequences related to alcohol misuse among students exposed to a social norms marketing intervention on a college campus.

OBJECTIVE: The authors examined whether alcohol-related negative consequences decreased among students exposed to an intervention. PARTICIPANTS: Beginning in 1999, approximately 2,500 randomly selected undergraduates from a 4-year US university annually participated in a Web-based survey over 6 years. METHODS: The educational intervention used social norms initiatives. Main outcome measures included recall of intervention, estimated blood alcohol content (eBAC) when drinking, and 10 negative consequences from alcohol within the past year. RESULTS: First-year students recalling exposure had lower odds of negative consequences (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.64-0.95) and of having an eBAC higher than .08 (OR = 0.76, 95% CI = 0.62-0.92). Over the 6 study years, the odds among all participants of experiencing (a) none of 10 alcohol consequences nearly doubled (OR = 2.13, 95% CI = 1.82-2.49) and (b) multiple consequences decreased by more than half (OR = 0.43, 95% CI = 0.36-0.50). CONCLUSIONS: These findings have important implications for US colleges and universities engaged in the reduction of harm associated with alcohol misuse.

Self-efficacy and participation in physical and social activity among older adults in Spain and the United States.

PURPOSE: We explored Bandura's self-efficacy theory as applied to older adult (aged 63-92) participation in physical and social activity in a cross-cultural study. DESIGN AND METHODS: Older adults in Spain (n = 53) and the United States (n = 55) completed questions regarding self-efficacy, outcome expectancy, and participation in physical and social activities. RESULTS: Self-efficacy significantly predicted both physical and social activity in both Spain and the United States. Outcome expectancy did not significantly predict either activity, nor did education, gender, or overall health. Modified and new self-efficacy measures proved reliable in both samples. IMPLICATIONS: This study enhances understanding of how self-efficacy motivates participation in physical activity, as noted in previous studies, as well as provides a new understanding of what motivates participation in social activities. The high reliability of the new measures used in this study provides evidence for further use of these measures in other contexts. It is important to note that this study further supports the use of Bandura's theory of self-efficacy for cross-cultural applications.

Misperceptions of peer drinking norms in Canada: another look at the "reign of error" and its consequences among college students.

OBJECTIVE: Much research has documented extensive misperceptions of drinking norms and their negative effects in U.S. student populations. This study provides extensive research evidence documenting this phenomenon in Canadian higher education. METHODS: Data were collected in a 2003-2004 survey of students (N=5280) attending 11 institutions across Canada. Surveys were administered either to a random sample of students through the mail or to students attending a diverse selection of classes. RESULTS: Regardless of the actual drinking norm on each campus, students most commonly overestimated the alcohol consumption norms (both quantity and frequency levels) in every instance. Students' perception of their campus drinking norm was the strongest predictor of the amount of alcohol personally consumed in comparison with the influence of all demographic variables. Perception of the norm was also a much stronger predictor of personal use than the actual campus norm for consumption on each campus or the actual norm for compliance with campus regulations. Among students who personally abstain or consume lightly, misperceptions of the student drinking norms contribute to alienation from campus life. CONCLUSION: The data presented here on Canadian students extends the evidence that peer drinking norms are grossly misperceived and that these misperceptions produce a highly detrimental "reign of error" in the lives of college students. The data suggest that a broad range of students--abstainers and light drinkers as well as moderate and heavy drinkers--may benefit from implementing intervention strategies that can correct or reduce these misperceptions.

A successful social norms campaign to reduce alcohol misuse among college student-athletes.

OBJECTIVE: This study examines the impact of a social norms intervention to reduce alcohol misuse among student-athletes. The intervention was designed to reduce harmful misperceptions of peer norms and, in turn, reduce personal risk. METHOD: A comprehensive set of interventions communicating accurate local norms regarding alcohol use targeted student-athletes at an undergraduate college. An anonymous survey of all student-athletes was conducted annually for 3 years (2001: n = 414, 86% response; 2002: n = 373, 85% response; and 2003: n = 353, 79% response). A pre/post comparison of student-athletes was conducted separately for new and ongoing athletes at each time point to isolate any general time period effects from intervention effects. A cross-sectional analysis of student-athletes with varying degrees of program exposure was also performed. RESULTS: The intervention substantially reduced misperceptions of frequent alcohol consumption and high-quantity social drinking as the norm among student-athlete peers. During this same time period, frequent personal consumption, high-quantity consumption, high estimated peak blood alcohol concentrations during social drinking, and negative consequences all declined by 30% or more among ongoing student-athletes after program exposure. In contrast, no significant differences across time were seen for new student-athletes each year with low program exposure. Among student-athletes with the highest level of program exposure, indications of personal misuse were at least 50% less likely on each measure when compared with student-athletes with the lowest level of program exposure. CONCLUSIONS: This social norms intervention was highly effective in reducing alcohol misuse in this high-risk collegiate subpopulation by intensively delivering data-based messages about actual peer norms through multiple communication venues.

Immunocontraceptive effects on female rabbits infected with recombinant myxoma virus expressing rabbit ZP2 or ZP3.

Recombinant myxoma viruses expressing rabbit zona pellucida 2 (rZP2) or rabbit zona pellucida 3 (rZP3) glycoproteins were constructed and tested in domestic rabbits to assess their potential to induce autoimmune infertility. The recombinant virus expressing rZP2 had no effect on fertility or ovarian histology, despite all animals developing antibodies against the rZP2 antigen. However, recombinant viruses expressing rZP3 induced infertility in 70% of animals at the first breeding. Serum antibodies were relatively short-lived, but antibody was bound to zona pellucida of all rabbits from Day 10 onward. There was no obvious correlation between infertility and rZP3 antibody titer. There was a transient inflammatory response in the ovaries of rZP3-immunized rabbits at Day 15 but no T-cell response to rZP3 could be detected at any time. Dysfunctional follicular formation was present in ovaries from rabbits infected with rZP3-expressing viruses 15-40 days postinfection but this had disappeared at later time points. A recombinant myxoma virus expressing a modified rZP3 antigen with the C-terminal hydrophobic putative anchor sequence deleted was also tested. This virus did not induce either infertility or an antibody response against the zona pellucida. Thus, the context of antigen presentation was crucial for an autoimmune response.

Misperceiving the college drinking norm and related problems: a nationwide study of exposure to prevention information, perceived norms and student alcohol misuse.

OBJECTIVE: This study examined (1) the prevalence of misperceptions of college student drinking norms across campuses nationwide, (2) the importance of perceived norms in predicting high-risk drinking, (3) the association of exposure to alcohol education information with students' perceptions of campus drinking norms and (4) the differences in high-risk drinking rates between schools where exposure to alcohol information is associated with more accurately perceived norms and schools where exposure to information is unrelated to perceptions or is associated with greater misperceptions. METHOD: Multivariate analyses were used to analyze an aggregate database of the National College Health Assessment survey administered to 76,145 students from 130 colleges and universities nationwide from spring 2000 through spring 2003. RESULTS: Regardless of the actual campus drinking norm, a consistently large percentage of students nationwide overestimated the quantity of alcohol consumed by their peers. Students' perception of their campus drinking norm was the strongest predictor of the amount of alcohol personally consumed in comparison with the influence of all demographic variables. Perception of the norm was also a much stronger predictor when compared with the actual campus norm. Reduced levels of high-risk drinking and negative consequences were found among students attending the relatively few schools where exposure to prevention information was associated with less exaggerated perceptions of the drinking norm compared with students attending other schools. CONCLUSIONS: Misperceived drinking norms are a pervasive problem. Schools that do not seek to reduce these misperceptions with their prevention information are neglecting a potentially powerful component of prevention.