Transdermal alcohol concentration features predict alcohol-induced blackouts in college students.

BACKGROUND: Alcohol-induced blackouts (AIBs) are common in college students. Individuals with AIBs also experience acute and chronic alcohol-related consequences. Research suggests that how students drink is an important predictor of AIBs. We used transdermal alcohol concentration (TAC) sensors to measure biomarkers of increasing alcohol intoxication (rise rate, peak, and rise duration) in a sample of college students. We hypothesized that the TAC biomarkers would be positively associated with AIBs. METHODS: Students were eligible to participate if they were aged 18-22 years, in their second or third year of college, reported drinking 4+ drinks on a typical Friday or Saturday, experienced ≥1 AIB in the past semester, owned an iPhone, and were willing to wear a sensor for 3 days each weekend. Students (N = 79, 55.7% female, 86.1% White, Mage = 20.1) wore TAC sensors and completed daily diaries over four consecutive weekends (89.9% completion rate). AIBs were assessed using the Alcohol-Induced Blackout Measure-2. Logistic multilevel models were conducted to test for main effects. RESULTS: Days with faster TAC rise rates (OR = 2.69, 95% CI: 1.56, 5.90), higher peak TACs (OR = 2.93, 95% CI: 1.64, 7.11), and longer rise TAC durations (OR = 4.16, 95% CI: 2.08, 10.62) were associated with greater odds of experiencing an AIB. CONCLUSIONS: In a sample of "risky" drinking college students, three TAC drinking features identified as being related to rising intoxication independently predicted the risk for daily AIBs. Our findings suggest that considering how an individual drinks (assessed using TAC biomarkers), rather than quantity alone, is important for assessing risk and has implications for efforts to reduce risk. Not only is speed of intoxication important for predicting AIBs, but the height of the peak intoxication and the time spent reaching the peak are important predictors, each with different implications for prevention.

Cardiovascular risk, social vigilance, and stress profiles of male law enforcement officers versus civilians.

This study examined the cardiovascular disease (CVD) risk profiles of male law enforcement officers (LEOs) and civilians. CVD risk profiles were based on data collected using traditional objective (e.g., resting BP, cholesterol), novel objective (e.g., ambulatory BP) and self-report measures (e.g., EMA social vigilance). A subset of male LEOs (n = 30, M age = 41.47, SD = 8.03) and male civilians (n = 120, M age = 40.73, SD = 13.52) from a larger study were included in analyses. Results indicated LEOs had significantly higher body mass index [BMI], 31.17 kg/m2 versus 28.87 kg/m2, and exhibited significantly higher trait and state social vigilance across multiple measures, whereas perceived stress was higher among civilians. Findings highlight the need for future research examining CVD risk associated with occupational health disparities, including attributes of individuals entering certain professions as well as experiential and environmental demands of the work.

Subjective intoxication predicts alcohol-related consequences at equivalent alcohol concentrations in young adults using ecological momentary assessment and alcohol sensors.

OBJECTIVE: Subjective intoxication (SI) when drinking may serve as an internal barometer of whether to continue drinking or engage in potentially unsafe behavior. Mobile assessments offer the potential to use SI as a prospective risk indicator during drinking episodes; little evidence exists for the validity of real-time SI measures. We test the correspondence of SI with estimated blood alcohol concentration and transdermal alcohol concentration (TAC) in young adults' natural settings. We provide a novel test of whether SI features (peak and mean SI) uniquely predict consequences adjusting for alcohol concentration. METHOD: Two hundred twenty-two heavy-drinking young adults (Mage = 22.3, 64% female, 79% non-Hispanic White, 84% undergraduates) participated in a 6-day study that used ecological momentary assessment of drinking and TAC sensors. SI was assessed every 30 min during drinking episodes. Multilevel modeling was used to test hypotheses. RESULTS: Momentary SI and estimated blood alcohol concentration had moderate associations at the moment and day levels (standardized ßs = 0.5-0.6); SI was moderately associated with TAC at the day level (ßs = 0.5). Associations between SI and alcohol concentration varied widely between persons and across days. Day-level SI features predicted consequences when adjusting for alcohol concentration (incidence rate ratios, IRRs = 1.29-1.70). CONCLUSIONS: Our two-item SI measure shows evidence of validity in real-world settings with heavy-drinking young adults. SI was significantly correlated with alcohol concentration and was a unique predictor of consequences. The strength of these associations varied greatly across persons and days. Real-time SI measurement may be useful in preventive interventions, but continued research is needed into when and for whom momentary SI is most predictive of risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

College Students' Day-to-Day Maladaptive Drinking Responses to Stress Severity and Stressor-Related Guilt and Anger.

BACKGROUND: Stress is a common part of college students' daily lives that may influence their physical activity (PA) and alcohol use. Understanding features of daily stress processes that predict health behaviors could help identify targets for just-in-time interventions. PURPOSE: This study used intensive longitudinal data to examine whether prior day stress processes predict current day PA or alcohol use. METHODS: Participants (N=58, Mage=20.5, 59% women, 70% White) were 18-to-25-year-old students who engaged in binge drinking at least twice monthly and used cannabis or tobacco in the past year. They wore activity (activPAL4) and alcohol (Secure Continuous Remote Alcohol Monitor) monitors for 11 days to assess daily PA (e.g., step counts) and alcohol use (e.g., drinking day), and completed daily surveys about yesterday's stress, including number of stressors (i.e., frequency), stressor intensity (i.e., severity), and frequency of affective states (e.g., guilt). Multilevel models examined prior day stress predicting current day PA or alcohol use. RESULTS: Participants had higher odds of current day drinking (odds ratio=1.21) and greater area under the curve (B=0.08) when they experienced greater than usual stress severity the prior day. Participants had higher current day peak transdermal alcohol concentration (B=0.12) and area under the curve (B=0.11) when they more frequently experienced guilt due to stressors the prior day. CONCLUSIONS: College students' unhealthy response of increasing alcohol use due to stress could adversely impact health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

College students experience stress regularly, which may influence their physical activity (PA) and drinking behaviors. Understanding how daily stress predicts health behaviors could be useful for stress-reduction interventions. This study examined whether prior day stress predicted current day PA or alcohol use. Participants (N = 58) were 18- to 25-year-old college students who binge drank at least twice per month and used cannabis or tobacco in the past year. They wore PA and alcohol sensors for 11 days to assess daily PA and alcohol use, and completed daily surveys about yesterday's stress, including the number of stressors experienced (i.e., frequency), stressor intensity (i.e., severity), and mood responses related to stress (anger, anxiety, guilt, sadness). Participants were 21% more likely to drink and drank at higher intensity when they experienced greater than usual stress severity the prior day. Participants had higher current day alcohol use intensity when they more frequently experienced guilt due to stressors the prior day. College students' unhealthy response of increasing alcohol use due to stress could negatively impact short- and long-term health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

A Dual-Process Decision-Making Model Examining the Longitudinal Associations Between Alcohol-Induced Blackouts and Alcohol Use Disorder Risk Among College Student Drinkers.

OBJECTIVE: The purpose of this study was to use a dual-process decision-making model to examine the longitudinal associations between alcohol-induced blackouts (blackouts) and alcohol use disorder (AUD) risk symptoms among college student drinkers. METHOD: Undergraduate drinkers (N = 2,024; 56% female; 87% White; 5% Hispanic) at a large northeastern university completed online surveys each semester during their first (Time [T] 1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). Path analyses were examined testing the longitudinal associations between T1 willingness to experience a blackout, T1 intentions to avoid a blackout, T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms. Hypotheses 1 and 2 tested the associations between T1 willingness, T1 intentions, T2-T8 drinking, and T2-T8 blackouts. Hypothesis 3 tested the associations between T2-T8 drinking, T2-T8 blackouts, and T8 AUD risk symptoms. RESULTS: Students experienced an average of 8 (SD = 8) blackouts during college. Approximately 1,514 (88.8%) participants reported experiencing 1 of 8 AUD risk symptoms. T1 willingness was positively associated with T2-T8 blackouts. T2-T8 drinking and T2-T8 blackouts were positively associated with T8 AUD risk symptoms. T1 willingness significantly indirectly affected T8 AUD risk symptoms through its association with T2-T8 blackouts. CONCLUSIONS: Results estimated that, on average, college student drinkers experienced eight blackouts across 4 years of college, and 88% of participants reported experiencing at least one symptom of AUD in the last semester of college. Willingness to experience a blackout influenced students' AUD risk symptoms through the number of blackouts they experienced throughout college.

Does it really matter that I do not remember my night? Consequences related to blacking out among college student drinkers.

BACKGROUND: Alcohol-induced blackouts (AIBs) are experienced frequently by college student drinkers and are more likely to occur on days with high-intensity drinking (HID; 8+ for females/10+ for males) than non-HID days. Research suggests that AIBs are associated with experiencing other alcohol-related consequences (ARCs), including more serious ARCs (SARCs; e.g., legal and sexual consequences), but we do not know whether individuals experience more ARCs and more SARCs on occasions when they black out than when they do not black out. This study examines the associations between AIBs and the total number of both ARCs and SARCs. METHODS: Students (N = 462, 51.7% female, 87.7% White, Mage = 20.1) were assessed across 6 weekends via e-surveys (80%-97% response rate). Multilevel models were used to test for main effects, controlling for drinking (HID or estimated blood alcohol concentration; eBAC) and sex. RESULTS: Drinking days when an AIB was experienced were associated with more total ARCs (b = 3.54, 95% CI: 3.10, 3.99) and more SARCs (b = 0.77, 95% CI: 0.60, 0.95) per day than non-AIB days. The more frequently a person experienced an AIB, the more total ARCs (b = 5.33, 95% CI: 4.40, 6.25) and SARCs (1.05, 95% CI: 0.80, 1.30) they reported on average. CONCLUSION: Alcohol-induced blackout days were associated with higher levels of harm than non-AIB days, even at the same levels of drinking. Interventions that focus on reducing the occurrence of AIBs and factors that contribute to them, in addition to reducing alcohol consumption, may help reduce total harm associated with drinking among college students.

Baseline protective behavioral strategy use predicts more moderate transdermal alcohol concentration dynamics and fewer negative consequences of drinking in young adults' natural settings.

OBJECTIVE: Test whether frequent protective behavioral strategies (PBS) users report (a) fewer alcohol-related consequences and (b) less risky alcohol intoxication dynamics (measured via transdermal alcohol concentration [TAC] sensor "features") in daily life. METHOD: Two hundred twenty-two frequently heavy-drinking young adults (Mage = 22.3 years) wore TAC sensors for 6 consecutive days. TAC features peak (maximum TAC), rise rate (speed of TAC increase), and area under the curve (AUC) were derived for each day. Negative alcohol-related consequences were measured in the morning after each self-reported drinking day. Past-year PBS use was measured at baseline. RESULTS: Young adults reporting more frequent baseline PBS use showed (a) fewer alcohol-related consequences and (b) lower intoxication dynamics on average (less AUC, lower peaks, and slower rise rates). Limiting/stopping and manner of drinking PBS showed the same pattern of findings as the total score. Serious harm reduction PBS predicted fewer negative alcohol-related consequences, but not TAC features. Multilevel path models showed that TAC features peak and rise rate partially explained associations between PBS (total, limiting/stopping, and manner of drinking) and consequences. Independent contributions of PBS subscales were small and nonsignificant, suggesting that total PBS use was a more important predictor of risk/protection than the specific types of PBS used. CONCLUSIONS: Young adults using more total PBS may experience fewer alcohol-related consequences during real-world drinking episodes in part through less risky intoxication dynamics (TAC features). Future research measuring PBS at the daily level is needed to formally test TAC features as day-level mechanisms of protection from acute alcohol-related consequences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Acceptability and anklet user experience with the SCRAM-CAM transdermal alcohol concentration sensor in regularly drinking young adults' natural environments.

Recent developments in wearable technologies have allowed for device-based capture of alcohol concentration among participants in their natural environments. Currently, the Continuous Alcohol Monitor from SCRAM systems (SCRAM-CAM) is the most extensively studied and validated transdermal alcohol concentration (TAC) sensor. However, there has been relatively little work focusing on its acceptability from the participants' perspective. In the current study, we assess the user experience of the SCRAM-CAM anklet in a sample of 222 regularly heavy drinking young adults (mean age = 22.3) who wore the anklet in their natural environments for five 24-h periods spanning 6 consecutive days. Differences in the anklet user experience were measured along a number of dimensions, and differences were tested by sex at birth, white/non-white racial/ethnic group membership, and alcohol use disorder (AUD) risk (measured through Alcohol Use Disorder Identification Test [AUDIT] scores). Males and females differed significantly on six of the eight acceptability items, with males showing more positive responses toward the anklet than females. No differences were found by white/non-white racial/ethnic groups nor AUD risk. Results suggest positive levels of acceptability toward the device overall while in natural environments, further validating the usage of the device in studies that measure alcohol consumption among different groups, including those with high levels of alcohol consumption. Researchers should take into consideration the different levels of burden or discomfort in male versus female participants when using the device.

Alcohol-induced blackouts among college student drinkers: A multilevel analysis.

OBJECTIVE: To identify factors (manner of drinking, combined alcohol and other substance use, physiology) that are associated with alcohol-induced blackouts (AIBs) over and above estimated blood alcohol concentration (eBAC). METHODS: Students (N = 462, 51.7 % female, 87.7 % White, Mage = 20.1) were assessed across 6 weekends via e-surveys (80-97 % response rate). eBAC was calculated using standard number of drinks, drinking duration, sex, and weight. Three-level multilevel models (days, weeks, persons) were conducted to test for main effects, controlling for eBAC. RESULTS: Protective behavioral strategies (PBS) were associated with decreased odds of AIBs on the daily (OR = 0.64, 95 % CI: 0.53, 0.77), weekly (OR = 0.84, 95 % CI: 0.72, 0.98), and person-levels (OR = 0.62, 95 % CI: 0.51, 0.74). Combined cannabis with alcohol was associated with increased odds of AIBs on the weekly (OR = 2.13, 95 % CI 1.13, 4.07) and person-levels (OR = 3.56, 95 % CI 1.60, 7.93). People who more frequently played drinking games (OR = 1.41, 95 % CI: 1.12, 1.77), pregamed (OR = 1.55, 95 % CI: 1.19, 2.03), and showed higher tolerance (OR = 1.22, 95 % CI: 1.08, 1.37) showed increased risk of AIBs, over and above eBAC levels. CONCLUSION: We identified a number of daily-, weekly-, and person-level factors that uniquely contribute to the prediction of AIBs even at equivalent eBACs. Many of these factors were behavioral, suggesting that they may serve as malleable prevention targets for AIBs in college student drinkers.

Examining engagement with and acceptability and usability of REAL Parenting: A brief online parent-based intervention to reduce alcohol use and consequences among high school students.

This study is a formative assessment of REAL Parenting (RP): a brief, digital intervention for parents of high school students that encourages parent-teen communication about alcohol and, in turn, aims to prevent teen alcohol use. The aims of this study were to describe engagement with, and acceptability and usability of RP; and to explore the relationship of these measures with each other and with short-term outcomes. Participants were 160 parents randomly assigned to the treatment group who received RP as part of a randomized pilot trial (Mage = 45.43[SD = 7.26], 59.3% female, 56% White, 19% Hispanic). App-based program analytics captured real-time engagement with RP. Parents completed self-report measures of acceptability, usability, perceived communication effectiveness, perceived self-efficacy to communicate, and frequency of communication post-intervention. Descriptive statistics were calculated to describe engagement, acceptability and usability, and zero-order correlations were calculated to examine associations between these and self-report variables. About 75% (n = 118) of parents accessed the intervention and two-thirds (n = 110) accessed at least one module. Self-report ratings of acceptability and usability were neutral to positive, and mothers liked RP more than fathers. Self-report, but not program analytic indicators were associated with short-term outcomes. Findings suggest that, with little incentive, most parents will access an app focused on parent-teen communication about alcohol. While parent feedback was positive, it also highlighted areas for improvement with app content and design. Correlations suggest that analytic metrics of engagement are useful to discern who is and is not using interventions, and self-report measures are important for understanding pathways by which interventions are associated with short-term outcomes.

Mean affect and affect variability may interact to predict inflammation.

INTRODUCTION: Individuals with greater affect variability (i.e., moment-to-moment fluctuations possibly reflecting emotional dysregulation) are at risk for greater systemic inflammation, which is associated with cardiovascular disease. Some evidence suggests that affect variability is linked with poorer health indicators only among those with higher average levels of affect, particularly for positive affect (PA), and that associations may be non-linear. The present study sought to examine whether links between both PA and negative affect (NA) variability and inflammation are moderated by average level of affect. METHODS: Participants (N = 300, 50 % female, ages 21-70, 60 % non-Hispanic White, 19 % Hispanic, 15 % non-Hispanic Black) completed a lab assessment and provided a blood sample to measure systemic inflammation (i.e., TNF-α, IL-6, CRP). Affect was collected via a two-day ecological momentary assessment protocol where reports were collected about every 45-min during waking hours. Momentary affect ratings were averaged across both days (i.e., iM), separately for PA and NA, for each participant. Affect variability was calculated as the person-specific SD (i.e., iSD) of affect reports, separately for PA and NA. Linear and quadratic interactions were tested. Models included covariates for sex, race, and body mass index. RESULTS: There were significant interactions between NA iM and NA iSD predicting TNF-α (b = 6.54; p < 0.05) and between PA iM and PA iSD predicting IL-6 (b = 0.45; p < 0.05). Specifically, the association between these affect variability indicators and inflammatory markers were suggestive of a positive association among those with higher average affect but a negative association among those with lower average affect. There was no evidence of non-linear associations between affect and inflammation. DISCUSSION: Incorporating interactive effects between affect variability and average affect may be an important consideration in understanding affective-inflammatory associations.

Within-person associations of optimistic and pessimistic expectations with momentary stress, affect, and ambulatory blood pressure.

BACKGROUND AND OBJECTIVES: Although dispositional optimism and pessimism have been prospectively associated with health outcomes, little is known about how these associations manifest in everyday life. This study examined how short-term optimistic and pessimistic expectations were associated with psychological and physiological stress processes. METHODS: A diverse sample of adults (N = 300) completed a 2-day/1-night ecological momentary assessment and ambulatory blood pressure (ABP) protocol at ∼45-minute intervals. RESULTS: Moments that were more optimistic than typical for a person were followed by moments with lower likelihood of reporting a stressor, higher positive affect (PA), lower negative affect (NA), and less subjective stress (SS). Moments that were more pessimistic than typical were not associated with any affective stress outcome at the following moment. Neither optimism nor pessimism were associated with ABP, and did not moderate associations between reporting a stressor and outcomes. DISCUSSION: These findings suggest that intraindividual fluctuations in optimistic and pessimistic expectations are associated with stressor appraisals.

Peer Network Counseling Effects on Substance Use: an Individual Participant Data Meta-Analysis Integrating Three Randomized Controlled Trials.

The current study describes an individual participant data meta-analysis (IPDMA) testing the efficacy of a peer-network counseling (PNC) intervention for preventing substance use escalation in adolescents and young adults. PNC has shown efficacy in reducing substance use among adolescents and young adults across small-scale randomized controlled trials (RCTs). Identifying expected large-scale effects and moderators is an important next step in guiding use of PNC in practice. To this end, we combine three small-scale RCTs to test PNC intervention effects on substance use change in a combined sample of 421 adolescents and young adults (50% intervention, 55% female, 69% Black/African-American, M age [SD] = 17.3 [2.2] years). Our approach combines latent change score modeling in a structural equation modeling (SEM) framework with study-level fixed effects to obtain (a) a more generalizable PNC effect than we could obtain with each constituent sample and (b) greater power and precision for individual-level moderation of treatment effects. We found that although PNC main effects on substance use outcomes (past 30-day cannabis, alcohol, tobacco, and drug use) were not significant, PNC effects were moderated by individual-level pre-intervention substance use frequency. PNC more strongly reduced drug use at the 1-month follow-up and cannabis use at the 3-month follow-up among participants who showed higher baseline use of these substances. Implications of our approach and findings for prevention researchers are discussed.

Acceptability and validity of using the BACtrack skyn wrist-worn transdermal alcohol concentration sensor to capture alcohol use across 28 days under naturalistic conditions - A pilot study.

Wrist-worn transdermal alcohol concentration (TAC) sensors have the potential to provide detailed information about day-level features of alcohol use but have rarely been used in field-based research or in early adulthood (i.e., 26-40 years) alcohol users. This pilot study assessed the acceptability, user burden, and validity of using the BACtrack Skyn across 28 days in individuals' natural settings. Adults aged 26-37 (N = 11, Mage = 31.2, 55% female, 73% non-Hispanic white) participated in a study including retrospective surveys, a 28-day field protocol wearing Skyn and SCRAM sensors and completing ecological momentary assessments (EMA) of alcohol use and duration (daily morning reports and participant-initiated start/stop drinking EMAs), and follow-up interviews. Day-level features of alcohol use extracted from self-reports and/or sensors included drinks consumed, estimated Blood Alcohol Concentration (eBAC), drinking duration, peak TAC, area under the curve (AUC), rise rate, and fall rate. Repeated-measures correlations (rrm) tested within-person associations between day-level features of alcohol use from the Skyn versus self-report or the SCRAM. Participants preferred wearing the Skyn over the SCRAM [t (10) = -6.79, p < .001, d = 2.74]. Skyn data were available for 5614 (74.2%) out of 7566 h, with 20.7% of data lost due to syncing/charging issues and 5.1% lost due to device removal. Skyn agreement for detecting drinking days was 55.5% and 70.3% when compared to self-report and the SCRAM, respectively. Correlations for drinking intensity between self-report and the Skyn were 0.35 for peak TAC, 0.52 for AUC, and 0.30 for eBAC, which were smaller than correlations between self-report and SCRAM, at 0.78 for peak TAC, 0.79 for AUC, and 0.61 for eBAC. Correlations for drinking duration were larger when comparing self-report to the Skyn (rrm = 0.36) versus comparing self-report to the SCRAM (rrm = 0.31). The Skyn showed moderate-to-large, significant correlations with the SCRAM for peak TAC (rrm = 0.54), AUC (rrm = 0.80), and drinking duration (rrm = 0.63). Our findings support the acceptability and validity of using the Skyn for assessing alcohol use across an extended time frame (i.e., 28 days) in individuals' natural settings, and for providing useful information about day-level features of alcohol use.

Pubertal timing moderates the same-day coupling between family hassles and negative affect in girls and boys.

This study examined the association between pubertal timing, daily affect, conduct problems, and the exposure to hassles across family, peer, and school contexts. Adolescents (M age = 12.27; 49.7% female; 62.6% White) completed ecological momentary assessments across 14 consecutive days (N = 388). Earlier maturing girls reported lower daily averages of positive affect compared to their same-sex, same-age peers. We did not find evidence for a relationship between pubertal timing and daily negative affect or conduct problems in girls, nor for daily negative and positive affect or conduct problems in boys. However, pubertal timing did moderate the day-level association between average negative affect and family hassles for both girls and boys. When experiencing more family hassles, earlier maturing girls reported greater negative affect relative to later maturing girls who experienced family hassles. In contrast, later maturing boys, relative to earlier maturing boys, reported higher levels of negative affect in the context of family hassles.

To Drink or Not to Drink: Is That the Question? Examining Correspondence and Predictive Validity of Morning Drinking Intentions for Young Adults' Drinking Behaviors and Consequences.

The Theory of Planned Behavior suggests that intentions are significant and proximal determinants of behavior. The purpose of this study was to test the predictive validity of drinking intentions for subsequent same-day drinking behaviors and negative consequences. Regularly drinking young adults (N = 222, 21-29 years, 84% undergraduates) completed an ecological momentary assessment (EMA) protocol and wore an alcohol monitor for five consecutive 24-h periods spanning 6 days (Wednesday-Monday). Each morning, participants reported their drinking intentions for the day and their previous day's alcohol consumption and the number of negative drinking consequences. Multilevel models showed that, at the within-person level, on days when people reported intending to drink, to get drunk, or to drink more than usual, they had higher odds of drinking, consumed more drinks, and had higher peak transdermal alcohol concentrations later that day. However, drinking occurred on 28% of days without drinking intentions, suggesting intentions were an imperfect signal for future drinking behavior. Morning drinking intentions also predicted experiencing more negative consequences, even after controlling for alcohol consumption. On average, young adults' morning-reported drinking-related intentions predicted increased odds of same-day drinking behavior and alcohol-related consequences. However, drinking frequently occurred on days participants did not intend to drink, suggesting that focusing only on drinking intention days will result in many missed prevention opportunities. Together, these results suggest the need for additional research to increase the predictive value of drinking intention assessments and for prevention interventions aimed at helping individuals follow through on their intentions not to drink.

Examining the impact of early college experiences on the cumulative number of alcohol-related consequences.

OBJECTIVE: To estimate the total number of alcohol-related consequences students experience during 4 years of college and examine early college indicators that result in higher rates of consequences. METHOD: Undergraduate drinkers (N = 1,744; 58% female; 87% White; 5% Hispanic) at a large northeastern university completed an online survey at the end of the fall and spring semesters during their first (T1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). First, descriptive statistics were calculated to estimate the total number of alcohol-related consequences students experienced across all 4 years of college. Second, a structural equation model was examined to identify early college indicators that influence individuals experiencing more cumulative consequences. RESULTS: Students experienced an average of 102 (SD = 89.91) alcohol-related consequences during 4 years of college. Next, early parental approval of consequences, but not peer drinking norms, were positively associated with students' willingness to experience consequences, which in turn, were positively associated with higher alcohol consumption and greater total consequences. CONCLUSIONS: Results estimated that, on average, students experienced 102 alcohol-related consequences across all 4 years of college. Parental approval of consequences influenced students' total consequences through their willingness to experience consequences and drinking behaviors. Findings from the current study have several important implications for interventions.

Predicting Self-Medication with Cannabis in Young Adults with Hazardous Cannabis Use.

Using cannabis to reduce psychological and physical distress, referred to as self-medication, is a significant risk factor for cannabis use disorder. To better understand this high-risk behavior, a sample of 290 young adults (ages 18-25; 45.6% female) were recruited from two U.S. universities in January and February of 2020 to complete a survey about their cannabis use and self-medication. Results: seventy-six percent endorsed using cannabis to reduce problems such as anxiety, sleep, depression, pain, loneliness, social discomfort, and concentration. When predicting reasons for self-medication with cannabis, logistic regression models showed that lower CUDIT-R scores, experiencing withdrawal, living in a state where cannabis was illegal, and being female were all associated with higher rates of self-medication. Withdrawal symptoms were tested to predict self-medication with cannabis, and only insomnia and loss of appetite were significant predictors. To further explore why young adults self-medicate, each of the original predictors were regressed on seven specified reasons for self-medication. Young adults experiencing withdrawal were more likely to self-medicate for pain. Participants living where cannabis is legal were less likely to self-medicate for anxiety and depression. Living where cannabis is illegal also significantly predicted self-medicating for social discomfort-though the overall model predicting social discomfort was statistically non-significant. Finally, female participants were more likely to self-medicate for anxiety. These results suggest widespread self-medication among young adults with likely CUD and underscore the complexity of their cannabis use. The findings have implications for understanding why young adults use cannabis in relation to psychological and physical distress and for accurately treating young adults with cannabis use disorder.

The microrandomized trial for developing digital interventions: Experimental design and data analysis considerations.

Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted-weekly, daily, or even many times a day. The microrandomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether and under what circumstances JITAI components are effective, with the ultimate objective of developing effective and efficient JITAI. The purpose of this article is to clarify why, when, and how to use MRTs; to highlight elements that must be considered when designing and implementing an MRT; and to review primary and secondary analyses methods for MRTs. We briefly review key elements of JITAIs and discuss a variety of considerations that go into planning and designing an MRT. We provide a definition of causal excursion effects suitable for use in primary and secondary analyses of MRT data to inform JITAI development. We review the weighted and centered least-squares (WCLS) estimator which provides consistent causal excursion effect estimators from MRT data. We describe how the WCLS estimator along with associated test statistics can be obtained using standard statistical software such as R (R Core Team, 2019). Throughout we illustrate the MRT design and analyses using the HeartSteps MRT, for developing a JITAI to increase physical activity among sedentary individuals. We supplement the HeartSteps MRT with two other MRTs, SARA and BariFit, each of which highlights different research questions that can be addressed using the MRT and experimental design considerations that might arise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Transdermal sensor features correlate with ecological momentary assessment drinking reports and predict alcohol-related consequences in young adults' natural settings.

BACKGROUND: Wearable transdermal alcohol concentration (TAC) sensors allow passive monitoring of alcohol concentration in natural settings and measurement of multiple features from drinking episodes, including peak intoxication level, speed of intoxication (absorption rate) and elimination, and duration. These passively collected features extend commonly used self-reported drink counts and may facilitate the prediction of alcohol-related consequences in natural settings, aiding risk stratification and prevention efforts. METHOD: A total of 222 young adults aged 21-29 (M age = 22.3, 64% female, 79% non-Hispanic white, 84% undergraduates) who regularly drink heavily participated in a 5-day study that included the ecological momentary assessment (EMA) of alcohol consumption (daily morning reports and participant-initiated episodic EMA sequences) and the wearing of TAC sensors (SCRAM-CAM anklets). The analytic sample contained 218 participants and 1274 days (including 554 self-reported drinking days). Five features-area under the curve (AUC), peak TAC, rise rate (rate of absorption), fall rate (rate of elimination), and duration-were extracted from TAC-positive trajectories for each drinking day. Day- and person-level associations of TAC features with drink counts (morning and episodic EMA) and alcohol-related consequences were tested using multilevel modeling. RESULTS: TAC features were strongly associated with morning drink reports (r = 0.6-0.7) but only moderately associated with episodic EMA drink counts (r = 0.3-0.5) at both day and person levels. Higher peaks, larger AUCs, faster rise rates, and faster fall rates were significantly predictive of day-level alcohol-related consequences after adjusting for both morning and episodic EMA drink counts in separate models. Person means of TAC features added little above daily scores to the prediction of alcohol-related consequences. CONCLUSIONS: These results support the utility of TAC sensors in studies of alcohol misuse among young adults in natural settings and outline the specific TAC features that contribute to the day-level prediction of alcohol-related consequences. TAC sensors provide a passive option for obtaining valid and unique information predictive of drinking risk in natural settings.