Depressive Symptoms and Drinking Outcomes: The Mediating Role of Drinking Motives and Protective Behavioral Strategies Among College Students

Background: College students with depressive symptoms tend to engage in more hazardous drinking and experience more alcohol-related consequences to cope with their symptoms. Given the perceived tension reducing effects of alcohol among these students, it is important to explore how protective factors, such as protective behavioral strategies, account for the relationships among depressive symptoms, drinking motives, and alcohol-related outcomes. Objective: To examine the mediating role of drinking motives and protective behavioral strategies on the associations that depressive symptoms have with typical weekly alcohol consumption, hazardous drinking, and alcohol-related negative consequences in a sample of college student drinkers. Methods: Traditional age college students (n = 566, 73% women; 58% White, non-Hispanic) completed measures of depression, drinking motives, protective behavioral strategies, weekly alcohol use, hazardous drinking, and alcohol-related negative consequences. Results: Coping with depression motives and controlled consumption PBS explained the association between depression and weekly alcohol consumption and hazardous drinking whereas coping with depression motives and serious harm reduction PBS explained the depression-negative consequences relationship. Conformity motives and serious harm reduction PBS explained the association between depression and hazardous drinking and alcohol-related negative consequences. Conclusions: Findings suggest that students with more depressive symptoms would benefit from clinical interventions tailored to address negative reinforcement drinking motives and, by extension, increase student utilization of PBS related to minimizing harm. Clinical and research implications are provided.     

The Role of Alcohol Expectancies in the Associations Between Close Friend,Typical College Student,and Personal Alcohol Use

Background Perceptions of peer drinking and alcohol expectancies have been consistently associated with alcohol use among college students. There is evidence that perceived peer drinking also shapes alcohol expectancies. Research has yet to address the potential differential impact of perceived drinking by close friends versus by typical college students on alcohol use among first-semester college students. Relatedly, mediation of these associations by specific domains of alcohol expectancies has yet to be examined. Objectives: The first aim of the present study was to investigate whether perceptions of close friend drinking were more strongly associated with alcohol expectancies, alcohol use, and consequences of alcohol use than perceptions of typical college student drinking. The second aim focused on which alcohol expectancy domains partially accounted for the association between close friend drinking, typical college student drinking, and alcohol use and consequences. Method: Participants (n = 400 first-semester college students) completed survey questionnaires, which included measures of perceived close friend/typical student alcohol use, alcohol expectancies, and drinking behaviors. Results: Results showed that close friend alcohol use was more strongly associated with alcohol use and consequences compared to typical college student use both directly and indirectly through expectancies about alcohol enhancing social behaviors. Conclusions/Importance: These findings suggest that first-semester college student drinking is more influenced by perceived alcohol use among close friends than typical college students. Future intervention efforts for alcohol use on college campuses may benefit from including close friend network components along with targeting alcohol expectancies regarding social behaviors.     

Determinants of positive and negative consequences of alcohol consumption in college students: alcohol use, gender, and psychological characteristics

To examine the influence of alcohol consumption, gender, and psychological risk and protective factors on college students' experiences of negative and positive consequences, the present study of 181 students assessed frequency and quantity of alcohol consumption, negative and positive consequences of alcohol use, positive alcohol expectancies, constructive thinking, and positive and negative affect. Results indicated that men and women differed in their experience of some consequences and that while alcohol consumption was generally more strongly related to consequences for women than for men, it was unrelated to most consequences. Further, when controlling for alcohol consumption, positive alcohol expectancies and negative affect were positively related to experiencing positive and negative consequences while constructive thinking was related to fewer positive and fewer negative consequences. Results indicate that consequences are much more strongly related to psychological risk and protective factors than to alcohol consumption. The article concludes with a discussion of implications for intervention efforts.     

College-Related Alcohol Beliefs and Problematic Alcohol Consumption: Alcohol Protective Behavioral Strategies as a Mediator

Background: College-related alcohol beliefs, or beliefs that drinking alcohol is central to the college experience, have been shown to robustly predict alcohol-related outcomes among college students. Given the strength of these associations, it is imperative to understand more proximal factors (i.e., closer in a causal chain leading to alcohol-related outcomes) that can explain these associations. Objectives: The current research examined alcohol protective behavioral strategies (PBS) as a potential mediator of the association between college-related alcohol beliefs and alcohol outcomes among college student drinkers. Method: Participants were undergraduate students from a large southeastern university (Sample 1; n = 561) and a large southwestern university (Sample 2; n = 563) in the United States that consumed alcohol at least once in the previous month. Results: Path analysis was conducted examining the concurrent associations between college-related alcohol beliefs, PBS use (both as a single facet and multidimensionally), alcohol consumption, and alcohol-related consequences (i.e., double mediation). In both samples, there was a significant double-mediated association that suggested that higher college-related alcohol beliefs is associated with lower PBS use (single facet), which is associated with higher alcohol consumption and alcohol-related consequences. Multidimensionally, only one double-mediation effect (in Sample 2 only) was significant (i.e., college-related alcohol beliefs → manner of drinking PBS → alcohol consumption → alcohol-related consequences). Conclusions/Importance: These results suggest that targeting these college-related alcohol beliefs as well as PBS use are promising targets for college alcohol interventions. Limitations and future directions are discussed.     

The Roles of Alcohol-Related Self Statements in Social Drinking

Recent literature showed that expectancies or cognitions have been proposed as a major factor in influencing the amount of alcohol an individual consumes and the behavioral consequences following consumption.

However, how alcohol expectancies influence alcohol consumption is unclear; this paper reports two studies of the relationship. Study I examined the relationship between alcohol consumption and alcohol-related positive and negative self-statements in 110 social drinkers. The results showed that, in a nondrinking situation, the alcohol expectancies and variables measuring consumption and alcoholrelated problems were correlated. Also, subjects who perceived their “alcoholic sets” as negative consumed more than those who perceived theirs as positive. Study II investigated changes in self-statement responding in 8 light and 8 heavy drinkers in a “normal” pub drinking situation.

The results showed that alcohol-dependent self-statements in the light drinkers were relatively stable across time and between drinking and nondrinking environments. However, the alcohol-dependent self-statements of heavy drinkers became more negative during the drinking session.

Furthermore, the degree and nature of such changes appeared to be related to alcohol-associated problems and consumption.     

Family history of alcohol abuse associated with problematic drinking among college students

Studies examining family history of alcohol abuse among college students are not only conflicting, but have suffered various limitations. The current report investigates family history of alcohol abuse (FH+) and its relationship with alcohol expectancies, consumption, and consequences. In the current study, 3753 student participants (35% FH+), completed online assessments. Compared to FH− same-sex peers, FH+ males and FH+ females endorsed greater overall positive expectancies, consumed more drinks per week, and experienced more alcohol-related negative consequences. Further, FH+ females evaluated the negative effects of alcohol to be substantially worse than FH− females. An ANCOVA, controlling for age, GPA, race, and alcohol expectancies, resulted in family history main effects on both drinking and consequences. An interaction also emerged between gender and family history, such that FH+ males were especially vulnerable to high levels of alcohol consumption. Results reveal the scope of FH+ individuals in the college environment and the increased risk for these students, particularly male FH+ students, suggesting a need for researchers and college health personnel to focus attention and resources on this issue.     

Impulsivity and Problem Drinking in College: Examining the Mediating Role of Sex-Related Alcohol Expectancies and Alcohol Use at Sex

Background: Dispositional impulsivity has been consistently implicated as a risk factor for problem drinking among college students and research suggests that this relationship may be explained in part by alcohol expectancies. A subset of alcohol expectancies, sex-related alcohol expectancies, is particularly linked to problem drinking among college students. The acquired preparedness model of risk postulates that people with dispositional impulsivity develop stronger sex-related alcohol expectancies, are subsequently more likely to drink at problematic levels in sexual situations, and thus, engage in more problem drinking. Objectives: Using this model, the current study examined whether sex-related alcohol expectancies and alcohol use at sex mediated the relationship between impulsivity and problem drinking among college students. Methods: College students (N = 101) completed self-report measures of alcohol use, sex-related alcohol expectancies, and five dimensions of impulsivity: negative urgency, positive urgency, sensation seeking, lack of premeditation, and lack of perseverance. Results: Two facets of impulsivity—sensation seeking and lack of premeditation—provided unique contributions to problem drinking. Sex-related alcohol expectancies significantly mediated the effects of lack of premeditation and sensation seeking on problem drinking. In support of the acquired preparedness model, the relationship between the impulsivity traits and problem drinking was serially mediated by sex-related alcohol expectancies and alcohol use at sex. Conclusions: Results suggest that sensation seeking and lack of premeditation continue to be areas of intervention for problem drinking among college students, and implicate sex-related alcohol expectancies as an area of intervention for alcohol use at sex and problem drinking.     

Development of the Protective Behavioral Strategies Survey

OBJECTIVE: Heavy alcohol use among college students represents a public health problem on American college campuses. A promising area for combating this problem is identifying protective behavioral strategies that may reduce consumption and its resulting negative consequences among students who do choose to use alcohol. The purpose of this study was to develop and conduct initial psychometric analyses on a new scale, which we named the Protective Behavioral Strategies Survey. METHOD: Data were collected on 437 undergraduate students, who volunteered to participate in the study, at a large, public university in the northeast region of the United States. RESULTS: Results from an exploratory factor analysis yielded three theoretically meaningful factors that we labeled Limiting/Stopping Drinking, Manner of Drinking and Serious Harm Reduction. The three factors were, as a group, significantly associated with both alcohol consumption and alcohol-related problems, but the strongest unique relationship existed between Manner of Drinking and the outcome variables. CONCLUSIONS: Protective behavioral strategies seem to be a measurable construct that are related to alcohol consumption and alcohol-related problems, and thus may be a useful component of intervention and prevention programs with college students.     

A test of expectancy-value theory in predicting alcohol consumption*

Background: Research on alcohol-related outcome expectancies has primarily focused on the likelihood of the anticipated effects, while comparatively little attention has been paid to their subjective evaluation. However, according to expectancy-value theory, the expectation that alcohol use will produce certain consequences and the evaluation of those consequences jointly and interactively determine an individual's decision to consume alcohol. Previous research on this issue was hampered by multiple regression strategies that are plagued by measurement error and low statistical power.

Method: To overcome this limitation, we investigated expectancy-value interactions in predicting drinking variables by drawing on latent variable methodology using the five expectancy-value dimensions from the Comprehensive Alcohol Expectancy Questionnaire. Expectancy-value models were tested in a sample of college students (N?=?1053) and a sample of alcohol-dependent inpatients (N?=?699).

Results: Significant expectancy-value interactions emerged concerning social assertiveness among students as well as for aggression and tension reduction among alcohol-dependent inpatients. The relationship between expectancy and drinking was strongest for pronounced (either positive or negative) valuations of the effect. Effect sizes were small, however.

Conclusions: The results are in partial agreement with basic premises of expectancy-value theory. However, this study also identifies limits to the universal validity of expectancy-value theory, given that prediction of alcohol use depends on the effect domains, alcohol outcome measures, and study populations.     

Alcohol Expectancies Mediate the Relationship Between Age of First Intoxication and Drinking Outcomes in College Binge Drinkers

Background: While prior research has shown that age of first intoxication (AI) is associated with negative alcohol outcomes, limited research has examined factors accounting for this relationship. Alcohol expectancies, or beliefs about the effects of alcohol, may explain such associations as both positive and negative expectancies have been shown to be key predictors of drinking outcomes. Objective: The present study examined expectancies as mediators between early AI and alcohol-related outcomes. Method: Data collection occurred in 2012 and 2013. Participants were college students (N = 562, 65.8% women) who completed an online survey including measures of alcohol use history, alcohol expectancies, typical alcohol consumption, and alcohol-related problems. Structural equation modeling was used to test the hypothesized model. Results: Our findings support a model whereby AI is associated with drinking through its influence on both positive and negative expectancies. Specifically, an earlier AI was associated with stronger alcohol expectancies, which in turn, was associated with heavier alcohol use and alcohol-related problems. Conclusions/Importance: These findings are consistent with expectancy theory and previous research suggesting that more experienced drinkers hold stronger drinking-related beliefs, be it positive or negative, and these expectancies ultimately explain variability in alcohol use and problems. Our findings further support that expectancies play an important role in the initiation of drinking behavior.     

Thinking while drinking: Fear of negative evaluation predicts drinking behaviors of students with social anxiety

College students with social anxiety disorder experience more alcohol-related negative consequences, regardless of the amount of alcohol they consume. Social anxiety refers to psychological distress and physiological arousal in social situations due to an excessive fear of negative evaluation by others. The current study examined within-group differences in alcohol-related negative consequences of students who met or exceeded clinically-indicated social anxiety symptoms. In particular, we tested a sequential mediation model of the cognitive (i.e., fear of negative evaluation) and behavioral (protective behavioral strategies) mechanisms for the link between social anxiety disorder subtypes (i.e., interaction and performance-type) and alcohol-related negative consequences. Participants were 412 traditional-age college student drinkers who met or exceeded the clinically-indicated threshold for social anxiety disorder and completed measures of fear of negative evaluation, protective behavioral strategies (controlled consumption and serious harm reduction), and alcohol-related negative consequences. Fear of negative evaluation and serious harm reduction strategies sequentially accounted for the relationship between interaction social anxiety disorder and alcohol-related negative consequences, such that students with more severe interaction social anxiety symptoms reported more fear of negative evaluation, which was related to more serious harm reduction strategies, which predicted fewer alcohol-related negative consequences. Future directions and implications are discussed.     

Injunctive norms for alcohol-related consequences and protective behavioral strategies: effects of gender and year in school

Perceived drinking norms have received increased attention as one determinant of high levels of college alcohol consumption and alcohol-related problems. Excessive drinking is widely visible on college campuses, and students may therefore assume that it is peer-supported (Kitts, 2003). Research into peer relations indicates that the perceived approval of important others predicts drinking behavior (Neighbors, Lee, Lewis, Fossos, & Larimer, 2007). Neither the use of alcohol-related protective behavioral strategies nor alcohol-related negative consequences have been investigated in terms of their perceived approval. The purpose of this study was to extend previous research on injunctive norms and assess self-other discrepancies in levels of approval for campus drinking patterns, negative alcohol-related consequences, and protective behavioral strategies. Undergraduate volunteers (n=324, 61% female, 67% Caucasian) completed an online survey of drinking patterns; they rated comfort with overall campus drinking, and the acceptability of alcohol-related consequences and protective strategies for themselves and their close friends. As predicted, students expressed lower acceptance of consequences than their friends, and higher acceptance of alcohol-related protective strategies. We observed main effects of gender and year in school. Males and upperclassmen expressed higher acceptance of negative consequences for both self and others, and lower acceptance of protective strategies for both self and others. Implications for prevention programs are discussed.     

Use of Alcohol Protective Behavioral Strategies as a Moderator of the Alcohol Use–Consequences Relationship: Evidence from Multiple Replications

Background: The use of protective behavioral strategies (PBS) has been found to attenuate the relationship between alcohol use and related consequences. Objectives: The current study examined PBS use as a moderator of the association between alcohol use and consequences in multiple samples (N?= 9) of college students with different sample sizes (e.g., ns 125–736). We also examined sex as a moderator of the PBS moderation analyses. Across all samples, we predicted that the use of more PBS would attenuate the use–consequences relation. Methods: In total, 3,524 college students completed online measures of alcohol use, consequences, and PBS use (i.e., PBSS) across two sites. Conclusions/importance: In the analyses, 3 two-way interactions were consistent with the literature (i.e., use–consequences relation weakest among those with high PBS use), 6 were opposite of what was reported in the literature (i.e., use–consequences relation strongest among those with high PBS use), and 39 were not statistically significant. These results corroborate, contradict, and extend the current body of knowledge in the extant alcohol PBS literature. In the examination of three-way interactions in the combined sample, serious harm reduction (SHR) PBS was found to moderate the use–consequences relation among female, but not among male students. Specifically, the use–consequences relation was weakest among female students who used more SHR PBS indicating that SHR PBS may be an important intervention target for female college students. Additional experimental and longitudinal studies are needed to examine the effects of PBS use on the use–consequences relation.     

Protective behavioral strategies mediate problem-focused coping and alcohol use in college students

Objective

Protective behavioral strategies have emerged as a construct protective against alcohol use. The current study examines the theoretical associations among general coping styles, protective behavioral strategies, drinking to cope motives, and alcohol use in college students.

Method

Analyses of fully latent variables were conducted using structural equation modeling in a sample of 327 college students.

Results

Protective behavioral strategies partially mediated the association between problem-focused coping and alcohol use. Behaviorally oriented problem-focused coping strategies accounted for the positive relationship between problem-focused coping and protective behavioral strategies whereas cognitively oriented problem-focused coping strategies were associated with less use of protective behavioral strategies and increased alcohol use.

Conclusions

This is the first study to find that protective behavioral strategies are more likely to be used by college students who endorse using a problem-focused coping style, especially if they tend to use behaviorally oriented problem-focused coping strategies. These findings extend the literature on protective behavioral strategies and indicate that students less likely to use problem-focused coping skills to deal with stress in general may need additional interventions to increase their use of protective behavioral strategies.     

College student drinking, attitudes toward risks, and drinking consequences

OBJECTIVE: This study examined whether college students' attitudes toward risks explain significant variance in drinking consequences beyond gender, alcohol use, and self-protective strategies. METHOD: A derivation sample (N=276; 52% women) and a replication sample (N=216; 52% women) of undergraduate students completed the Campus Alcohol Survey (CAS) and the Attitudes Toward Risks Scale (ATRS). RESULTS: Scores on the ATRS correlated positively with students' self-reported typical number of drinks and negative drinking consequences (p<.001). Hierarchical regression analyses indicated that ATRS scores explained significant variance in negative drinking consequences beyond college students' gender, typical number of drinks, and use of protective strategies (p<.001). Furthermore, a significant Drinks x ATRS interaction revealed that heavy-drinking students who scored high on the ATRS experienced the most harm from drinking (p<.01). Students with high-risk attitudes showed a stronger link between typical number of drinks and negative drinking consequences. CONCLUSIONS: Even when controlling for students' gender, alcohol use, and protective strategies, college students' attitudes toward risks explain significant variance in drinking consequences.     

Legal Ages for Purchase and Consumption of Alcohol and Heavy Drinking Among College Students in Canada,Europe, and the United States

ABSTRACT

Heavy drinking and associated negative consequences remain a serious problem among college students. In a secondary analysis of data from two published study, the authors examine the correlation between minimum legal age to purchase and/or consume alcohol and rates of heavy drinking among college students in 22 countries. The published studies use identical definitions of heavy drinking and similar methodologies. In the study of 20 European countries and the United States, there is a positive correlation between prevalence of heavy drinking and both minimum legal purchase age (r =.34) and minimum legal drinking age (r =.19); in the study of Canada and the United States, there is a perfect positive correlation (r = 1.0). Examination of this evidence does not support the conclusion that a lower minimum legal age for purchase and/or consumption of alcoholic beverages is a protective factor for decreasing heavy drinking among college students.     

Alcohol Expectancies,Values, and Drinking of Irish and U.S. Collegians

Positive and negative alcohol expectancies, values, and their relationship to amount and severity of drinking were examined for Irish and American college students. All Irish seemed to have softer, more aesthetic values than Americans, especially males. Irish college women appeared especially dissatisfied with the conventional roles thrust upon them, and they used alcohol to relieve inhibitions, especially sexual ones. American women also used alcohol as a tranquilizer and for release of inhibitions. While Irish males also seemed to drink for rebellious reasons, all males had less concern about social censure and rejection because of drinking than did females.

Cross-cultural studies have provided an interesting approach to the question of what needs are satisfied by alcohol, especially by studying those cultures where the consumption of alcohol is particularly high or low. In this respect, Ireland has often been singled out for study because, in spite of the fact that Irish overall consumption is not greater than many other European countries, at the same time this country appears to contain a higher rate of both abstainers and alcoholics (O'Connor, 1978). Recent approaches to the study of alcohol have focused on the issue of needs by inquiring about the positive and negative expectations that drinkers entertain regarding the consequences of their alcohol sumption (Goldman, Brown, and Christiansen, 1986). Christiansen and Teahan (1986) have recently applied this approach to a study of Irish and U.S. high school students, and Teahan (1986) has used a similar method with Irish and North American alcoholics. In the present study, the positive and negative expectations from alcohol consumption by Irish and American college students were examined, and an attempt was made to relate these, as well as the value structure of these collegians, to their reported drinking behavior.     

Alcohol consequences,not quantity,predict major depression onset among first-year female college students

Alcohol use and its consequences have often been associated with depression, particularly among female college students. Interpretation of this association has been challenging due to potential reverse causation. The current study sought to clarify the temporality of these relationships. We examined: (1) the association between alcohol consumption and onset depression among female college students, and (2) the association between drinking consequences and onset depression among drinkers only. We used a prospective longitudinal design. Participants were first-year female college students who completed a baseline survey at study entry, and monthly assessments of alcohol consumption, drinking consequences, and depression symptoms. Cox proportional hazards regression with time-varying covariates were constructed among the full sample (N = 412) and the drinkers only sample (N = 335). Adjusted hazard ratios accounted for known risk factors for depression such as race/ethnicity, academic challenge, not getting along with one's roommate, sexual victimization prior to college, marijuana use, and socioeconomic status. For each additional average drink per week, adjusting for all covariates, there was no (95% CI: -4%, +4%) increased risk of onset depression. For each additional alcohol consequence, adjusting for all covariates, there was a 19% (95% CI: 5%, 34%) increased risk of onset depression. This significant relationship remained after adjusting for quantity of alcohol consumption. Quantity of alcohol consumed did not predict incident depression. However, experiencing alcohol consequences, regardless of consumption, did increase the risk of incident depression. College substance use and mental health interventions should aim to reduce not only alcohol consumption, but also alcohol-related consequences.     

Second-hand effects of college drinking and educational experiences: Findings from an analysis of pooled cross-sections

Abstract

Aims: Research from several countries has demonstrated the prevalence of exposure to alcohol’s second-hand effects. This study adds to this literature with an examination of the relationships between exposure and grades and school satisfaction among the US college and university students. Methods: The study used pooled cross-sectional data from the four rounds (1993, 1997, 1999 and 2001) of the Harvard School of Public Health College Alcohol Study (N?=?53,061). Random samples of students at four-year colleges and universities completed self-report mailed surveys and provided information on the frequency of their exposure to alcohol’s second-hand effects, their own drinking behaviour, college grades, school satisfaction and backgrounds. Findings: Multilevel, multivariate logit analyses showed significant, negative associations between exposure to second-hand effects and both grades and school satisfaction (p?<?0.05). These effects were pronounced among abstainers and light drinkers compared to students who consumed alcohol more frequently. Drinking level also moderated the relationship between exposure and satisfaction with college: this association was significantly larger for abstainers and infrequent drinkers (p?<?0.05). Conclusions: The majority of students reported exposure to alcohol’s second-hand effects; this exposure was negatively associated with grades and satisfaction with school. Colleges and universities could help reduce the negative consequences of second-hand exposure by providing all students – abstainers and drinkers alike – with information on its negative consequences. They could also create more opportunities for students to live and socialize in alcohol-free settings.