College students' virtual and in-person drinking contexts during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in pronounced changes for college students, including shifts in living situations and engagement in virtual environments. Although college drinking decreased at the onset of the pandemic, a nuanced understanding of pandemic-related changes in drinking contexts and the risks conferred by each context on alcohol use and related consequences have yet to be assessed. METHODS: Secondary data analyses were conducted on screening data from a large parent clinical trial assessing a college student drinking intervention (N = 1669). Participants across six cohorts (from Spring 2020 to Summer 2021) reported on the frequency of drinking in each context (i.e., outside the home, home alone, home with others in-person, and home with others virtually), typical amount of drinking, and seven alcohol-related consequence subscales. RESULTS: Descriptive statistics and negative binomial regressions indicated that the proportion and frequency of drinking at home virtually with others decreased, while drinking outside the home increased from Spring 2020 to Summer 2021. Limited differences were observed in the proportion or frequency of individuals drinking at home alone or at home with others in-person. Negative binomial and logistic regressions indicated that the frequency of drinking outside the home was most consistently associated with more alcohol-related consequences (i.e., six of the seven subscales). However, drinking at home was not without risks; drinking home alone was associated with abuse/dependence, personal, social, hangover, and social media consequences; drinking home with others virtually was associated with abuse/dependence and social consequences; drinking home with others in-person was associated with drunk texting/dialing. CONCLUSION: The proportion and frequency of drinking in certain contexts changed during the COVID-19 pandemic, although drinking outside the home represented the highest risk drinking context across the pandemic. Future prevention and intervention efforts may benefit from considering approaches specific to different drinking contexts.

"On a night like this": A mixed-methods approach to understanding high-risk drinking events in college students.

BACKGROUND: Previous research indicates college students report heavier drinking on certain events (e.g., 21st birthday). While past research has identified heavier drinking events, students' own reports of which events are associated with elevated drinking remains understudied. The current study utilized mixed methods to explore potential high-risk drinking events (HRDE) for college student drinkers and how these events differed from typical drinking and each other. METHODS: College student drinkers (N = 204) reported the number of drinks they consume on nine predetermined events (e.g., Halloween). Students also responded to open-ended questions listing five events during which they had elevated drinking and indicating the amount consumed on each event. Open-ended responses were coded into similar event categories. Descriptive statistics for drinks consumed were calculated for predetermined and coded open-ended events. Chi-square analyses assessed differences in endorsement of open-ended events by birth sex, age group, and Greek membership. Two multilevel count regressions assessed within-person differences in number of drinks consumed between participants' typical drinking occasions and (1) highly endorsed open-ended events and (2) predetermined events. RESULTS: For all open-ended event categories, average number of drinks consumed exceeded heavy episodic drinking thresholds; however, there was substantial variability. Comparing predetermined events to participants' typical drinking indicated elevated drinking on participants' birthdays, New Year's Eve, Halloween, Finals, and Spring Break; significant differences between events also emerged. Comparison of open-ended categories to participants' typical drinking indicated elevated drinking on birthdays, celebrations, parties, and holidays; however, there were no significant differences between open-ended events. CONCLUSIONS: Students who drink alcohol report heavier drinking on specific calendar-based events (e.g., Spring Break). However, students also report non-calendar-related events (e.g., non-specific parties) as some of their highest drinking events. More research is needed to understand how intervention and prevention programs can be adapted to target both known calendar-based HRDE, and unknown, idiosyncratic HRDE.

Meaning in life and stress-related drinking: A multicohort study of college students during the COVID-19 pandemic.

During the COVID-19 pandemic, college students have experienced heightened stressors and reported stress-related drinking. To identify potential protective factors among college students, we investigate the possibility that finding meaning and purpose in one's life may lessen the strength of the association between stress and alcohol consumption in a multicohort sample of college students (N = 694; 64.8% women) recruited between November 2019 and September 2021. Consistent with expectations, negative binomial regressions revealed significant interactions, such that higher stress was only associated with more past-month alcohol use among individuals who reported low levels of meaning in life. The buffering role of meaning in life appeared to be robust; interaction results held when investigating both general perceived stress and COVID-specific stress, and did not vary by cohort. Although longitudinal and experimental research are needed, findings indicate that finding meaning and purpose in one's life may help college students to navigate heightened periods of stress with more adaptive coping strategies that do not result in drinking to cope. Findings highlight the potential utility of meaning-promoting strategies in college alcohol interventions.

Facilitating Change in Drinking Cognitions and Behaviors Among Three Immigrant Generations of Latinx Youth Through a School-Based Intervention: Findings From a Multi-Site Clinical Trial.

Latinx youth experience disparities in the availability of and participation in evidence-based interventions to reduce hazardous alcohol use. The aim of this secondary data analysis was to examine whether Project Options, a brief, evidence-based alcohol use intervention was beneficial for Latinx participants. A total of 331 first-, second-, and third-generation immigrant Latina and Latino youth who participated in a multi-site, hybrid effectiveness/efficacy clinical trial of the intervention were selected for analyses. Mixed-effects growth models tested changes in drinking cognitions (i.e., perception of peer drinking, intention to drink next month, alcohol use and cessation expectancies) and behaviors (i.e., number of past-month drinking days, average number of drinks per occasion, and maximum number of drinks per occasion) across three time points (i.e., baseline, 4-weeks, and 12-weeks). Consistent with prior Project Options studies, participants with more drinking experience reported greater decreases in perception of peer drinking, intentions to drink next month, and all drinking behaviors than those with less experience. While no changes were observed in expectancies, first-generation participants endorsed lower positive use expectancies than second- and third-generation youth as well as more favorable cessation expectancies than third-generation teens. In concert with prior studies demonstrating the intervention's success in recruitment and retention of Latinx participants, results suggest that Project Options might be a promising school-based intervention for Latinx youth. This intervention has the potential to reach adolescents who might otherwise not participate in traditional programming and help decrease disparities in availability of evidence-based practices for Latinx youth.

Examining the associations between alcohol-related parental communication, alcohol use, and protective behavioral strategy use among young adults.

Underage alcohol use is a public health concern as it remains prevalent and problematic. Protective behavioral strategies (PBS) may prevent or reduce alcohol-related consequences, yet daily-level findings show they instead might be associated with increased drinking and consequences. While parents are a possible source of influence to their child's decision making, it is unclear whether parental communication about alcohol affects drinking outcomes, with mixed findings noted in the literature. Furthermore, little research focuses on understanding how parental communication may impact the use of PBS. This study assessed whether alcohol specific parental communication would be associated with reduced drinking and increased use of PBS. Data from baseline and 3-month follow up were evaluated from a control group of a larger randomized controlled trial on 18- to 20-year-olds in the U.S. (N = 269). Outcomes included drinks per week, peak drinks per occasion, negative consequences and use of PBS. Using negative binomial regression modeling, controlling for age, sex, and whether participants lived with parents, findings revealed that parental communication was not associated with drinks per week, peak drinks per occasion, or negative consequences reported 3 months later. However, it was positively associated with limiting/stopping drinking PBS, manner of drinking PBS, and serious harm reduction PBS reported 3 months later. Results suggest that parental communication about alcohol may be more effective in increasing the use of protective behavioral strategies rather than reduction of drinking. Research is needed to determine why parental communication may influence the use of PBS and how we can strengthen the quality or focus of communication to ultimately increase the impact on risk behaviors.

Examining the ecological validity of the prototype willingness model for adolescent and young adult alcohol use.

The present study is the first ecologically valid, daily level test of the prototype willingness model (PWM), a model previously tested with hypothetical scenarios to investigate the social reaction and reasoned pathways toward engaging in health-risk behavior. The purpose of the present study is to examine whether days with elevated alcohol-favorable PWM cognitions are also associated with greater intentions and willingness to drink and increased drinking behavior on that day. Participants included 15-25-year-olds (N = 124; 57.3% female; Mage =18.7; SD = 2.87) who were part of an ecological momentary assessment study on drinking cognitions (including willingness, intentions, perceived vulnerability, social norms, prototype favorability) and alcohol use, reported across 3 weeks. Analyses accounted for the multilevel structure of the data and the various outcome distributions. Findings supported and advanced the PWM by using real-time, real-world daily data that captured within-person variation of PWM cognitions across days and showed daily level associations between PWM cognitions and alcohol use and negative consequences among adolescents and young adults, thus supporting the social reaction and reasoned pathways at the daily level. Current results may improve interventions by precisely informing the use of technology to bring interventions to adolescents and young adults in moments when they are at highest risk (i.e., days with higher than usual PMW alcohol cognitions). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Growing Up, Hooking Up, and Drinking: A Review of Uncommitted Sexual Behavior and Its Association With Alcohol Use and Related Consequences Among Adolescents and Young Adults in the United States.

Hookups are uncommitted sexual encounters that range from kissing to intercourse and occur between individuals in whom there is no current dating relationship and no expressed or acknowledged expectations of a relationship following the hookup. Research over the last decade has begun to focus on hooking up among adolescents and young adults with significant research demonstrating how alcohol is often involved in hooking up. Given alcohol's involvement with hooking up behavior, the array of health consequences associated with this relationship, as well as its increasing prevalence from adolescence to young adulthood, it is important to determine the predictors and consequences associated with alcohol-related hooking up. The current review extends prior reviews by adding more recent research, including both qualitative and experimental studies (i.e., expanding to review more diverse methods), research that focuses on the use of technology in alcohol-related hookups (i.e., emerging issues), further develops prevention and intervention potentials and directions, and also offers a broader discussion of hooking up outside of college student populations (i.e., expanding generalization). This article will review the operationalization and ambiguity of the phrase hooking up, the relationship between hooking up and alcohol use at both the global and event levels, predictors of alcohol-related hooking up, and both positive and negative consequences, including sexual victimization, associated with alcohol-related hookups. Throughout, commentary is provided on the methodological issues present in the field, as well as limitations of the existing research. Future directions for research that could significantly advance our understanding of hookups and alcohol use are provided.

Consideration of future consequences as a moderator of the willingness-behavior relationship for young adult marijuana use and consequences.

The Prototype Willingness Model is a dual-processing (i.e., intentional and socially reactive) health-risk behavior model. The socially reactive path includes behavioral willingness, descriptive normative perceptions, and favorable images of individuals who engage in health-risk behavior (prototype favorability) as important predictors of health behaviors. Individual differences (such as consideration of future consequences) may potentiate the effects of behavioral willingness on health-risk outcomes, such as marijuana use. Given limited research investigating marijuana use and the Prototype Willingness Model, the goals of the current study were: 1) examine consideration of future consequences and Prototype Willingness Model social reaction pathway variables in relation to behavioral willingness to use marijuana longitudinally; and 2) determine if consideration of future consequences moderated the behavioral willingness-marijuana use relation prospectively. Young adults (N = 769) from a larger longitudinal study completed baseline and 3 follow-up assessments (Months 3, 4, 5). Behavioral willingness was positively related to a higher likelihood of use, more days having used marijuana, and more consequences prospectively, over and above baseline use. Consideration of future consequences moderated the association between behavioral willingness and hours high in a typical week. These findings support the willingness-behavior association of the Prototype Willingness Model and preliminarily demonstrate consideration of future consequences' differential impact on behavioral willingness-future marijuana use relation. Intervention and prevention implications are discussed.

Alcohol use and alcohol/marijuana use during the most recent sexual experience differentially predict characteristics of the sexual experience among sexually active young adult drinkers.

INTRODUCTION: Few studies have examined associations between using alcohol only and using both alcohol and marijuana with sexual behavior on specific occasions. The current study examined alcohol and marijuana use during the most recent sexual experience in association with relationship characteristics, psychological issues, and condom use. METHODS: Young adult drinkers aged 18-25 who reported not using a condom during sex in the past month were recruited nationally. An analytic subsample (N = 378) was identified based on substance use during the most recent sexual experience [53% female, 70% Caucasian; mean age = 22.42 years (SD = 1.90)]. Using logistic regression, two dummy codes compared the alcohol use only group (n = 197) and the both alcohol and marijuana group (n = 95) to the group who used neither substance (n = 86). Participant sex, drinking frequency, and number of sexual partners were included as covariates. RESULTS: The alcohol only group and the both alcohol and marijuana group had greater odds of being with a casual acquaintance and loss of respect compared to the group who used neither substance. The alcohol only group had greater odds of being with someone they just met and embarrassment compared to the group who used neither substance. No associations were found for condom use or emotional difficulties. CONCLUSIONS: Preventative interventions may need to address both alcohol and marijuana to more effectively reduce risky behaviors.

Towards an understanding of self-directed language as a mechanism of behavior change: A novel strategy for eliciting client language under laboratory conditions.

INTRODUCTION: Change talk (CT) and sustain talk (ST) are thought to reflect underlying motivation and be important mechanisms of behavior change (MOBCs). However, greater specificity and experimental rigor is needed to establish CT and ST as MOBCs. Testing the effects of self-directed language under laboratory conditions is one promising avenue. The current study presents a replication and extension of research examining the feasibility for using simulation tasks to elicit self-directed language. METHODS: First-year college students (N = 92) responded to the Collegiate Simulated Intoxication Digital Elicitation, a validated task for assessing decision-making in college drinking. Verbal responses elicited via free-response and structured interview formats were coded based on established definitions of CT and ST, with minor modifications to reflect the non-treatment context. Associations between self-directed language and alcohol use at baseline and eight months were examined. Additionally, this study examined whether a contextually-based measure of decision-making, behavioral willingness, mediated relationships between self-directed language and alcohol outcome. RESULTS: Healthy talk and unhealthy talk independently were associated with baseline alcohol use across both elicitation formats. Only healthy talk during the free-response elicitation was associated with alcohol use at follow up; both healthy talk and unhealthy talk during the interview elicitation were associated with 8-month alcohol use. Behavioral willingness significantly mediated the relationship between percent healthy talk and alcohol outcome. CONCLUSIONS: Findings support the utility of studying self-directed language under laboratory conditions and suggest that such methods may provide a fruitful strategy to further understand the role of self-directed language as a MOBC.

Perceived vulnerability moderates the relations between the use of protective behavioral strategies and alcohol use and consequences among high-risk young adults.

Drinking protective behavioral strategies (PBS) have been associated with reductions in alcohol use and alcohol-related consequences in young adults. PBS subscales, Limiting/Stopping (LS), Manner of Drinking (MOD), and Serious Harm Reduction (SHR), have been examined in the literature; LS, MOD, and SHR have mixed support as protective factors. Understanding moderators between PBS and alcohol use and related consequences is an important development in PBS research in order to delineate when and for whom PBS use is effective in reducing harm from alcohol use. Perceptions of vulnerability to negative consequences, included in health-risk models, may be one such moderator. The current study examined whether two types of perceived vulnerability (perceived vulnerability when drinking; perceived vulnerability in uncomfortable/unfamiliar situations) moderated the relations between LS, MOD, SHR strategies and alcohol use and related negative consequences. High-risk young adults (N = 400; 53.75% female) recruited nationally completed measures of PBS, alcohol use and related consequences, and measures of perceived vulnerability. Findings demonstrated that perceived vulnerability when drinking moderated the relations between MOD strategies and alcohol use. The interactions between perceived vulnerability when drinking and PBS did not predict alcohol-related consequences. Perceived vulnerability in unfamiliar/uncomfortable social situations moderated relations between MOD strategies and both alcohol use and related negative consequences; no other significant interactions emerged. Across both perceived vulnerability types and MOD strategies, those with the highest levels of perceived vulnerability and who used MOD strategies the most had the greatest decrements in alcohol use and related negative consequences. Prevention and intervention implications are discussed.

Impact of Ethnic Composition on Mechanisms of Change in School-Based Substance Use Intervention Groups.

Delivering alcohol use intervention services in the school setting represents a key approach to engaging youth of all backgrounds, particularly underserved populations, in such programming. Relative progress has been made toward implementing culturally responsive services for youth; however, little is known about the role of ethnic composition on group processes purported to underlie mechanisms of change. We examined associations between ethnic group composition and therapeutic processes within a voluntary, school-based alcohol use intervention at seven schools across three cities (N groups = 353). Ethnic composition was characterized as: group ethnic diversity on a continuum, group ethnic homogeneity (i.e., where at least 66% of participants shared the same ethnicity), and comparing groups where one of the three largest ethnicities in the sample reached the majority (i.e., African-American vs. Hispanic vs. non-Hispanic white). Ratings on group processes were obtained from participants (satisfaction; belonging), facilitators (empathy; rapport), and coders (engagement; responsiveness). Mixed-effects models revealed that students in groups with African-American and Hispanic majorities reported a higher sense of satisfaction compared to groups with non-Hispanic white majorities. Facilitators endorsed expressing empathy more frequently with majority African-American and Hispanic groups than with non-Hispanic white groups. Study findings highlight the importance of considering different dimensions of ethnic composition when examining mechanisms of change in group intervention research.

Drinking Motives and Willingness to Drink Alcohol in Peer Drinking Contexts.

Drinking motives are important proximal predictors of alcohol consumption in adolescents and emerging adults (EAs). Despite the importance of peer context on alcohol use decision-making, research on drinking motives is commonly divorced from the contexts where such decisions are made. Behavioral willingness (BW), or openness to engaging in a given behavior, is a contextually dependent aspect of nondeliberative decision-making for youth. As BW and drinking motives are proximal predictors of alcohol use, it was hypothesized that they would interact in the prediction of later drinking. Eighty-seven EAs reported their BW in simulated drinking contexts, drinking motives, and alcohol consumption upon entering college as well as drinking patterns 8 months later. Context-specific BW potentiated coping motives' impact on increased alcohol consumption and potentially hazardous drinking at the end of participants' first year. These findings support the importance of BW and context in understanding motivation's role in drinking behavior for EAs.

A novel application in the study of client language: Alcohol and marijuana-related statements in substance-using adolescents during a simulation task.

The current study explored whether laboratory-based techniques can provide a strategy for studying client language as a mechanism of behavior change. Specifically, this study examined the potential of a simulation task to elicit healthy talk, or self-motivational statements in favor of healthy behavior, related to marijuana and alcohol use. Participants (N = 84) were adolescents reporting at least 10 lifetime substance use episodes recruited from various community settings in an urban Pacific Northwest setting. Participants completed the Adolescent Simulated Intoxication Digital Elicitation (A-SIDE), a validated paradigm for assessing substance use decision making in peer contexts. Participants responded to 4 types of offers in the A-SIDE: (a) marijuana, (b) food (marijuana control), (c) alcohol, and (d) soda (alcohol control). Using a validated coding scheme adapted for the current study, client language during a structured interview assessing participants' response to the simulated offers was evaluated. Associations between percent healthy talk (PHT, calculated by dividing the number of healthy statements by the sum of all substance-related statements) and cross-sectional outcomes of interest (previous substance use, substance use expectancies, and behavioral willingness) were explored. The frequency of substance-related statements differed in response to offer type; rate of PHT did not. PHT was associated with behavioral willingness to accept the offer. However, PHT was not associated with decontextualized measures of substance use. Associations between PHT and global expectancies were limited. Simulation methods may be useful in investigating the impact of context on self-talk and to systematically explore client language as a mechanism of change. (PsycINFO Database Record

Effects of sex composition on group processes in alcohol prevention groups for teens.

Although most alcohol and other drug prevention programs for adolescents are offered in group settings, little is known about the possible effects of sex composition on group processes and mechanisms of change. Using the Group Actor-Partner Interdependence Model framework, we examined how the sex constellation of adolescent prevention group members influenced youth satisfaction, engagement, and endorsement of healthy behavior during group. Participants in Project Options (N = 379; 61.8% girls; Mage = 16.1; SD = 1.4), a voluntary school-based alcohol prevention program, completed measures of satisfaction at each prevention session and observers rated engagement and change talk for each group. When analyses were oriented toward girls, their personal satisfaction, group-rated satisfaction, and group-level engagement were positively related to having more girls in the group. Similarly, in boys, personal satisfaction, satisfaction of the group as a whole, and engagement in groups improved when groups were composed of more girls. Statements supportive of healthy alcohol/drug-related decision making were unrelated to group composition. The findings suggest that the composition of girls and boys in groups has differential effects on some group processes. This avenue of research has merit for understanding the mechanisms associated with satisfaction and engagement in adolescent substance use prevention programs.

Drinking motives as mediators of social anxiety and hazardous drinking among college students.

Although social anxiety (SA) and alcohol use disorders commonly co-occur, the relationship between these variables in college populations has been inconsistent. The present study tested the hypothesized model that negatively reinforcing, but not positively reinforcing, drinking motives (or reasons for drinking) would mediate the association between SA and three aspects of hazardous drinking (quantity/frequency, consequences, and dependence symptoms) in an ethnically diverse sample of college drinkers (N = 817; mean age = 19.9 years, range = 18-29). Structural equation modeling (SEM) results using the asymmetrical distribution of products test indicated that coping motives partially mediated the relationship between SA and negative consequences and dependence symptoms but not the quantity/frequency outcome. Contrary to the hypothesized model, conformity motives did not mediate the association between SA and hazardous drinking. As expected, positive reinforcement motives did not mediate the SA-hazardous drinking association. Multigroup SEM analyses revealed that the mediation models did not differ for men (n = 215) and women (n = 602). Overall, the present findings support extant research and theoretical models regarding the mediating role of coping motives in the relationship between SA and problem drinking, suggesting a potential pathway for the development and maintenance of SA and alcohol use disorder comorbidity. Such findings could contribute to improved intervention programs by targeting coping drinking motives and building coping skills.

Ocular injuries in children after major trauma.

OBJECTIVE: To determine the variety of ocular injuries sustained by children during major trauma. SUBJECTS AND METHODS: The pediatric trauma registry of The Children's Hospital in Denver, Colorado, was surveyed for children with ocular injuries and an Injury Severity Score higher than 15. The injuries were tabulated and correlated with mechanisms of injury to determine identifiable injury patterns. RESULTS: In a pediatric trauma center, ocular injuries were nearly twice as frequent among children with major trauma (Injury Severity Score > 15). Two-thirds of the children with an Injury Severity Score higher than 15 had been involved in a mishap with a motorized or a nonmotorized vehicle. Ocular injuries in children with an Injury Severity Score higher than 15 were characterized by fracture of the surrounding bony structures and contusions. Children with an Injury Severity Score higher than 15 had 50% to 80% fewer open wounds of the ocular adnexa and eyeball than did children with an Injury Severity Score of 15 or lower. The one optic nerve injury and two-thirds of the other ocular cranial nerve injuries occurred in children with an Injury Severity Score higher than 15. CONCLUSIONS: Serious ocular injury should be suspected in children involved in a motor vehicle accident who have an Injury Severity Score higher than 15 and fractures of the surrounding bony structures, contusions, or both. Absence of an open wound of the ocular adnexa or eyeball does not eliminate the possibility of serious ocular injury.

Spectrum of ocular injuries in children with major trauma.

BACKGROUND: Few studies document the variety of ocular injuries encountered in children after major trauma. This study was performed to determine the type and frequency of ocular injuries in a large population of children with major trauma. METHODS: All children with ocular and adnexal injuries (n = 7497) among 96,879 children registered in the National Pediatric Trauma Registry (NPTR) were analyzed. Children were stratified for Injury Severity Score (ISS is a method for categorizing patients with multiple injuries in which an ISS > 15 is considered major trauma), age, sex, injury, protective restraint, vision threatening injury, and basilar skull fracture. RESULTS: Nearly 8% of the children in the NPTR sustained an ocular injury. These children had one or more injuries to one or both eyes and/or the ocular adnexa for an average of 1.3 ocular injuries per child. Three-fourths (75%) of the children with an ocular injury had an ISS < or = 15 and one-fourth (25%) had an ISS > 15. Among children with an ISS > 15 the most common injuries were orbital wall fracture (59%) and contusion of the eye and ocular adnexa (18%). Among these same children with an ISS > 15, the percent of orbital wall fractures, injuries to the optic nerve, and injuries to the other ocular cranial nerves doubled while the percent of basilar skull fractures tripled when compared with children with an ISS < or = 15. Penetrating injuries of the globe were significantly lower in children with an ISS > 15 than in children with an ISS < or = 15. Over 70% of the children with an eye injury and an ISS > 15 sustained injury in an accident involving a motorized or non motorized vehicle, and over 75% of those who could have been restrained, were not restrained. CONCLUSIONS: Children with an ocular injury sustained during major trauma (ISS > 15) are more likely to have a basilar skull fracture, orbital wall fracture, and a contusion of the eye and/or the ocular adnexa as compared with children with ISS < or = 15. Children with any of these injuries sustained during major trauma should be afforded prompt ophthalmologic evaluation to uncover injury to components of the visual system.