Mark A. Prince

Protective behavioral strategies for reducing alcohol involvement: A review of the methodological issues

Alcohol use among college students remains a major public health concern with many students experiencing negative alcohol-related consequences as a result of their drinking. Protective behavioral strategies (PBS) have been conceptualized as skills used by drinkers to moderate their drinking and/or resulting consequences. The correlational evidence for the relationships among PBS, alcohol use, and related problems has been mixed. Experimental research reveals inconsistent relationships among intervention condition, PBS use, and alcohol outcomes. There is currently insufficient evidence to support the claim that PBS function as a mechanism of behavior change for college drinkers. We propose that the inconsistencies found in the correlational and experimental research are explained in part by psychometric and methodological issues. This review summarizes measurement and methodological issues in studies that have directly assessed the relationship between PBS and alcohol use and/or alcohol-related consequences in college drinking samples. Additionally, we provide some suggestions and future directions to overcome methodological and conceptual limitations and to advance understanding of the role of protective behavioral strategy use in reducing alcohol involvement among college drinkers.

The Malleability of Injunctive Norms Among College Students

Alcohol use among college students has been associated with injunctive norms, which refer to the perceived acceptability of excessive drinking, and descriptive norms, which refer to perceptions of actual drinking. The purpose of this study was to examine the effect of a brief injunctive norms manipulation on both injunctive and descriptive norms about drinking alcohol and to explore differences in the malleability of norms across referent groups, sex, and gender role. Participants were 265 undergraduates (43% male, 70% freshmen) who completed a web-based survey for course credit. A randomly selected half was exposed to a page of information-based feedback about typical student injunctive norms. Relative to the control condition, the manipulation produced lower injunctive and descriptive norms related to typical students drinking but no change in either type of norm related to close friends. Femininity was associated with less permissive normative beliefs about the acceptability of excessive drinking whereas masculinity was associated with elevated perceptions of peer drinking, but neither sex nor gender role moderated the manipulation effect. We conclude that perceptions of peer approval of drinking are malleable with a very brief information-based manipulation.

Variation in substance use relapse episodes among adolescents: A longitudinal investigation

Substance use disorders are chronically relapsing conditions, and there is a need to evaluate whether relapse precursors are consistent across multiple relapses. We identified latent groups of relapse characteristics over time in adolescents with alcohol and substance use disorders following an inpatient treatment episode. Youth (N = 124, mean age = 16 years, 56% male, 60% Caucasian) were interviewed while in treatment and biannually during the first year after treatment to gather contextual information about first and second relapse episodes. We identified two latent classes of relapse precursors labeled aversive-social (41% at initial relapse, 57% at subsequent relapse) and positive-social (59% at initial relapse, 43% at subsequent relapse). Classes were stable in structure over time; however, only 61% of those assigned to aversive-social and 39% assigned to positive-social classes at initial relapse remained there for the subsequent relapse. Findings highlight the dynamic nature of relapse for youth and have important clinical implications.

Effects of Normative Feedback for Drinkers Who Consume Less than the Norm: Dodging the Boomerang

Several alcohol interventions designed for college students attempt to correct exaggerated perceptions of alcohol use on college campuses through the use of personalized normative feedback. Personalized normative feedback has been shown to be effective in reducing drinking as a stand-alone intervention and as a part of a multicomponent intervention. This feedback is typically targeted to heavier drinkers to create a discrepancy between their personal beliefs and behavior and the actual lower levels of use on campus. However, little is known about how this form of normative feedback might affect lighter drinkers who learn that they are drinking less than the typical student at their school. The risk is a potential boomerang effect, or an increase in drinking among lighter drinkers receiving personalized feedback. The current study examined four samples from three geographic locations: two using computer-delivered personalized normative feedback alone and two delivering personalized feedback in the context of a brief motivational intervention. We found no evidence for a boomerang effect among lighter drinkers receiving personalized normative feedback in any of the four samples. These findings help to assuage fears of increasing drinking among lighter drinkers through widespread implementation of normative interventions for college students in the absence of screening for current drinking status.

Effects of choice on intervention outcomes for college students sanctioned for campus alcohol policy violations

This study tested the hypothesis that client choice influences intervention outcomes. We recruited 288 student drinkers (60% men, 67% freshmen) required to participate in an intervention due to a violation of campus alcohol policy. Participants were randomized either to self-chosen or researcher-assigned interventions. In the choice condition they selected either a brief motivational intervention (BMI) or a computer-delivered educational program. In the assigned condition they received 1 of the 2 interventions, assigned randomly. Follow-up assessments at 1 and 2 months revealed that choice was associated with higher intervention satisfaction. However, the assigned and choice conditions did not differentially change on consumption or consequences across intervention type. Overall, change scores favored the BMI over the computer-delivered intervention on consumption and consequences. Exploratory analyses revealed that given the choice of intervention, heavier-drinking students self-selected into the face-to-face BMI. Furthermore, among the students who received a BMI, the students who chose it (despite their heavier drinking) reduced drinks per drinking day more than did the assigned students. In summary, offering a choice of intervention to students mandated for campus alcohol violations increased the chance that at-risk students will select a more intensive and effective intervention.

Identification of trajectories of social network composition change and the relationship to alcohol consumption and norms

BACKGROUNDnCollege drinking is embedded in a social context, drawing attention to the effects of social network composition on consumption. The presence of heavy drinking friends in social networks predicts later alcohol misuse, but little is known about how the composition of ones social network composition changes over time. This study identified changes in social network composition in a sample of at-risk students and examined the relationship among network trajectories, alcohol consumption, and descriptive norms.nnnMETHODSnParticipants were 503 students (64% male) mandated to participate in an alcohol prevention intervention for residence hall alcohol policy violations. At baseline, students provided self-report data about alcohol consumption, perceived peer drinking norms, and peer alcohol involvement. Parallel assessments were completed at 6- and 12-months post-baseline.nnnRESULTSnGrowth-mixture models identified four groups of individuals with similar levels of heavy drinkers in their social networks. The majority of students had stable or decreasing numbers of heavy drinkers in their networks across the study, whereas two groups reported relatively stable densities of heavy drinkers from baseline to 6-months and increasing densities from 6- to 12-months. At baseline, the four groups were generally equivalent on consumption and normative perceptions. At 6- and 12-months, however, the groups differed significantly on consumption and norms.nnnCONCLUSIONSnThese results suggest that changes in the number of heavy drinkers in college students social networks may have significant implications for at-risk drinking.

The clinical course of alcohol use disorders: Using joinpoint analysis to aid in interpretation of growth mixture models

BACKGROUNDnThe clinical course of alcohol use disorders (AUD) is marked by great heterogeneity both within and between individuals. One approach to modeling this heterogeneity is latent growth mixture modeling (LGMM), which identifies a number of latent subgroups of drinkers with drinking trajectories that are similar within a latent subgroup but different between subgroups. LGMM is data-driven and uses an iterative process of testing a sequential number researcher-selected of latent subgroups then selecting the best fitting model. Despite the advantages of LGMM (e.g., identifying subgroups among heterogeneous longitudinal data), one limitation is the lack of precision of LGMM to model abrupt changes in drinking during treatment that are often observed by clinicians. Joinpoint analysis (JPA) is a data analysis procedure that is used to identify discrete change points in longitudinal data (e.g., changes from increasing to decreasing or decreasing to increasing).nnnMETHODnThis study presents a demonstration of using JPA as a post hoc procedure for LGMM to improve accuracy in modeling abrupt changes in clinical course of AUD.nnnRESULTSnResults from this secondary data analysis of 549 AUD participants participating in the NIAAA sponsored relapse replication and extension project uncovered four latent classes of drinking trajectories.nnnDISCUSSIONnWithin these trajectories the addition of JPA improved precision in modeling the clinical course of AUDs.

Alcohol Policy Support Among Mandated College Students

BACKGROUNDnAlcohol consumption on college campuses is high, and often dangerous. College administrators have created policies to control alcohol consumption, but student body support or opposition of specific policies has been relatively unexplored.nnnMETHODnThe current study examined the relations of alcohol policy support with gender and alcohol consumption. Mandated students (N=229; 44% women) completed self-report assessments of alcohol policy support and alcohol consumption.nnnRESULTSnWomen supported policies to a greater extent than did men, as did lighter drinkers relative to heavier drinkers. Drinks per drinking day fully mediated the relation between gender and alcohol policy support.nnnCONCLUSIONnWhile alcohol policy support differs by gender, this covariation is explained by differences in alcohol consumption. Findings have implications for addressing alcohol policy support among mandated college students.

The Protective Behavioral Strategies for Marijuana Scale: Further examination using item response theory.

Given recent state legislation legalizing marijuana for recreational purposes and majority popular opinion favoring these laws, we developed the Protective Behavioral Strategies for Marijuana scale (PBSM) to identify strategies that may mitigate the harms related to marijuana use among those young people who choose to use the drug. In the current study, we expand on the initial exploratory study of the PBSM to further validate the measure with a large and geographically diverse sample (N = 2,117; 60% women, 30% non-White) of college students from 11 different universities across the United States. We sought to develop a psychometrically sound item bank for the PBSM and to create a short assessment form that minimizes respondent burden and time. Quantitative item analyses, including exploratory and confirmatory factor analyses with item response theory (IRT) and evaluation of differential item functioning (DIF), revealed an item bank of 36 items that was examined for unidimensionality and good content coverage, as well as a short form of 17 items that is free of bias in terms of gender (men vs. women), race (White vs. non-White), ethnicity (Hispanic vs. non-Hispanic), and recreational marijuana use legal status (state recreational marijuana was legal for 25.5% of participants). We also provide a scoring table for easy transformation from sum scores to IRT scale scores. The PBSM item bank and short form associated strongly and negatively with past month marijuana use and consequences. The measure may be useful to researchers and clinicians conducting intervention and prevention programs with young adults.