Learning From Experience? The Influence of Positive and Negative Alcohol-Related Consequences on Next-Day Alcohol Expectancies and Use Among College Drinkers.

OBJECTIVE: The purpose of the present study was to examine daily-level associations between alcohol-related consequences and next-day expectancies and alcohol use among frequently drinking college students using a measurement-burst daily diary study. METHOD: College students (N = 327; mean age = 19.7 years, SD = 1.26; 53.4% female) participated in a yearlong study in which they completed computerized interviews daily via mobile phones for 2 weeks in each academic quarter. Multilevel modeling was used to examine whether positive and negative consequences were associated with next-day alcohol expectancies and alcohol consumption. RESULTS: Experiencing positive consequences from drinking was significantly associated with higher positive expectancies and a greater number of drinks consumed on the following day. The within-person association between daily consequences and next-day positive expectancies was stronger for those who were in fraternities/sororities compared with those who were not. Negative consequences were significantly associated with higher negative expectancies the next day but were not associated with number of drinks consumed the next day. CONCLUSIONS: Results of this study highlight the role of direct drinking experiences in influencing future expectations and drinking behavior using a method that enables analysis of both between- and within-person associations.

Psychometric analysis and validity of the daily alcohol-related consequences and evaluations measure for young adults.

College students experience a variety of effects resulting from alcohol use and evaluate their experiences on a continuum from negative to positive. Using daily reports collected via cell phone, we examined the psychometric properties of alcohol use consequences and evaluations of those consequences. Participants were 349 undergraduate students (mean age 19.7 [SD = 1.26], 53.4% female). Data were analyzed using a multilevel factor analysis framework, incorporating binary items (consequences) and normally distributed items (evaluations). Our model converged on 2 factors-positive and negative-with similar loadings between- and within-persons. Intraclass correlation coefficients for positive consequences and their evaluations ranged from .30 to .40, whereas values for negative consequences were more variable. Intraclass correlation coefficients for negative evaluations were higher, suggesting evaluations were more trait-like compared to experience of consequences which may be context dependent. Generalizability coefficients on the whole were good to excellent, suggesting highly reliable scales at both person-mean and daily-mean levels. However, likely due to binary scale and infrequency, the generalizability coefficients for negative consequences at the daily level was somewhat low. Convergent validity was demonstrated by (a) positive associations between baseline Rutgers Alcohol Problem Index and Alcohol Use Disorders Identification Test scores with latent factors for daily positive and negative consequences, and (b) positive associations between daily drinking and daily consequences and evaluations of consequences. Overall, this measure demonstrated good psychometric properties for use in studies examining daily and lagged relationships between alcohol use and related consequences. (PsycINFO Database Record

A daily measure of positive and negative alcohol expectancies and evaluations: documenting a two-factor structure and within- and between-person variability.

OBJECTIVE: Despite the documented importance of alcohol outcome expectancies in predicting alcohol use and related consequences, little research has explored within-person variability in expectancies. This article details the construction and psychometric analysis of a measure of alcohol expectancies specifically designed for daily assessment. METHOD: We developed a 15-item instrument to measure the likelihood of experiencing various outcomes from drinking, as well as the subjective evaluation of these outcomes. College students (N = 352; mean age = 19.7 years, SD = 1.26; 53.4% female) participated in a yearlong study wherein they completed three computerized interviews daily via mobile phones for 2 weeks in each academic quarter. Multilevel exploratory factor analysis was used to examine dimensionality at between-person and within-person levels, and generalizability coefficients were calculated to establish reliability. RESULTS: Intraclass correlation coefficients were generally between .30 and .40, demonstrating both between-person and within-person variability. Exploratory factor analysis resulted in a two-factor solution of positive and negative effects of alcohol, and two items with equivocal loadings were dropped from the final scale. The two subscales showed excellent reliabilities at within- and between- person levels, and the measure demonstrated good convergent and discriminant validity with a commonly used expectancy measure. CONCLUSIONS: Drinkers hold many expectations about the effects of alcohol, and measures are needed that are designed to capture both stable and context-dependent aspects of these beliefs. Results demonstrated significant day-to-day variation in the strength and valuation of alcohol expectancies, and the scale demonstrated good psychometric properties that establish its appropriateness for use in daily process studies of alcohol use.

Development and evaluation of a mobile intervention for heavy drinking and smoking among college students.

Nearly all college student smokers also drink alcohol, and smoking and heavy episodic drinking (HED) commonly co-occur. However, few studies have examined the factors that concurrently influence smoking and HED among college students and, to date, no interventions have been developed that target both HED and smoking in this population. The objective of the current study was to develop and evaluate a mobile feedback intervention that targets HED and smoking. Participants (N = 94) were non-treatment-seeking college students (M(age) = 20.5 years, SD = 1.7) who engaged in at least a single HED episode in the past 2 weeks and reported concurrent smoking and drinking at least once a week. Participants were randomized to receive either the mobile intervention for 14 days, complete mobile assessments (without intervention) for 14 days, or complete minimal assessments (without intervention or mobile assessments). At a 1-month follow-up, compared with the minimal assessment condition, we observed significant reductions in the number of cigarettes per smoking day in both the mobile intervention (d = 0.55) and mobile assessment (d = 0.45) conditions. Among those randomized to the mobile intervention, receiving more modules of the intervention was significantly associated with a lower likelihood of any drinking during the 14-day assessment period and significant reductions in smoking at 1-month follow-up. The mobile intervention did not result in significant reductions in HED or concurrent smoking and drinking. Future research should continue to examine ways of using technology and the real-time environment to improve interventions for HED and smoking.

Return to work rates and activity profiles: are there differences between those receiving C-ADR and ACDF?

STUDY DESIGN: Comparative effectiveness review. STUDY RATIONALE: The ability of a patient to return to work and the speed with which this occurs are important outcome metrics for the assessment of patients undergoing spinal surgery.Clinical questions: In patients with degenerative disease of the cervical spine, does cervical artificial disc replacement (C-ADR) lead to better work-related outcomes than fusion? Does return to work after surgery differ based on gender, age, smoking, litigation status, workers' compensation status, or other sociodemographic factors? METHODS: A systematic search and review of the English-language literature was undertaken to identify studies published through October 2, 2011. PubMed, Cochrane, National Guideline Clearinghouse Databases, and bibliographies of key articles were searched. Two individuals independently reviewed articles based on inclusion and exclusion criteria, which were set a priori. Each article was evaluated using a predefined quality-rating scheme. RESULTS: For follow-up periods of more than 6 months, there was no significant difference in work status between disc replacement and fusion patients; however, C-ADR patients began working sooner after surgery. Statistical significance for earlier return was not reached in all studies. CONCLUSIONS: Most patients undergoing cervical decompression and fusion or C-ADR return to work. The rates are equivalent at 6 months but patients treated with C-ADR resumed work sooner.

Quality of life in persons with spinal cord injury: comparisons with other populations.

OBJECT: The aim of this study was to identify the quality of life (QOL) measures commonly used to assess patients with spinal cord injury (SCI) and to summarize studies using common QOL measures that have been validated in SCI populations to compare scores in persons with SCI with those in a control population. METHODS: A systematic search of PubMed was conducted to identify studies using common QOL measures in persons with SCI and those comparing scores for QOL measures in an SCI population with scores in other populations. The authors sought comparative studies utilizing QOL measures for which validity and reliability analyses had been done. RESULTS: Of 28 QOL measures found, validity and reliability studies had been conducted in patients with SCI for 5 measures. Twelve comparative studies compared QOL in SCI patients with QOL in healthy controls or in patients with other disabilities, or with normative data. The 36-Item Short Form Health Survey (SF-36) and the short version of the WHOQOL (WHOQOL-BREF) were the most widely used QOL instruments. Patients with SCI had a decreased QOL as compared with that in healthy controls or normative data, with the most pronounced deficits in the domains of physical functioning and physical role limitations. In 3 studies, patients with tetraplegia had a lower physical domain QOL than did those with paraplegia. Overall, however, the impact of injury level and injury completeness on QOL after SCI remains unclear due to a lack of longitudinal studies. CONCLUSIONS: The SF-36 and WHOQOL-BREF are validated instruments that should be considered for use in SCI QOL studies. Future analysis of deficits in QOL among patients with SCI would benefit from the development of a QOL instrument specifically targeted to SCI. Longitudinal studies to assess the impact of injury level and injury completeness on SCI QOL are also needed.

Concurrent drinking and smoking among college students: An event-level analysis.

Cigarette smoking and drinking commonly co-occur among college students, a population that is at high risk for developing alcohol and nicotine use disorders. Several studies have been conducted that have examined predictors of drinking or smoking to gain a better understanding of the antecedents of engaging in these behaviors. Yet, few studies have examined specific factors that influence concurrent smoking and drinking in this population. The current study used data from a 21-day electronic diary-based study of college students (n=86) who engaged in concurrent drinking and smoking to examine event-level associations between alcohol use and cigarette smoking in the student's natural environment. We specifically focused on within-person analyses of contexts in which students reported smoking and drinking simultaneously in comparison to contexts in which students reporting drinking without smoking. Situational contexts included environmental setting, whether s/he was alone or with others, and changes in stress and urges to smoke before initiating drinking. Results indicated that students drank more while smoking and smoked three times as many cigarettes, on average, during drinking episodes. Being with others at a party or a bar was associated with increased odds of smoking while drinking. Likewise, increased stress since the prior assessment predicted a greater likelihood of smoking while drinking. Based on the findings from the present study, it is important for future prevention and intervention efforts to consider social settings and heightened stress among students as potential risk factors for engaging in concurrent drinking and smoking.

A spatial analysis of the physical and social environmental correlates of discarded needles.

The role that the urban environment plays in influencing drug users' injection and needle disposal decisions is poorly understood. We identified potential attractors and deterrents of needle discarding, and then used a geographic information system (GIS) to quantify these factors for a neighborhood in Montréal, Canada. In multivariate logistic regression, discarded needles were found to have more associations with physical factors than with social factors. Visual exposure and proximity to a single-room occupancy hotel, a pay phone, an adult service or a pawnshop were important physical environmental predictors. These findings are discussed in relation to developing public health and urban design-based harm reduction approaches to needle discarding in public space.

Comparison of daily and retrospective reports of vaginal sex in heterosexual men and women.

This study examined the agreement between daily and retrospective reports of vaginal sex over a two-month period in a sample of 376 heterosexually active men and women. We also examined whether gender, age, or method of daily data collection (self-administered vs. interviewer administered) were related to agreement between daily and retrospective reports. Both counts and categorical measures of frequency of the behaviors were examined. There were no gender, age, or data collection method effects. When measured as a count, participants reported more instances of vaginal intercourse in the retrospective reports than on the daily reports. In contrast, comparison of retrospective categorical measures of frequency to daily reports showed considerable variability. Possible reasons for the over-reporting of counts of vaginal sex in retrospective reports are explored.

Retrospective assessment of the association between drinking and condom use.

OBJECTIVE: Retrospective reports of the association between drinking and high-risk sexual behavior can be biased by implicit theories of the effects of drinking or may represent post hoc justifications instead of accurate reports of behavior. Using data from a daily diary study, we compared daily reports of condom use when drinking and not drinking with the same participants' reports of these behaviors from a retrospective questionnaire administered after diary collection was complete. METHOD: Participants included adolescents (n=145), adult sexually transmitted disease clinic clients (n=167), college students (n=145), and men who have sex with men (n=147). All participants reported their alcohol consumption and sexual activity daily for 8 weeks and then completed a retrospective questionnaire about their behavior over the diary period. RESULTS: Participants' retrospective judgments about whether they used condoms more or less when drinking were not significantly related to their behavior as reported in the diary. Fewer than two thirds of the participants were accurate in their recollection of the association of condom use and drinking. Teenagers and men who have sex with men were more likely to retrospectively overestimate the negative effect of alcohol on condom use. CONCLUSIONS: Retrospective questions about the association between drinking and condom use were consistent with actual behavior only among people who consistently either never or always used condoms. These individuals correctly reported that drinking had no effect on their condom use. For people whose condom use varies, questions about associations between drinking and sex may be difficult to answer, owing to their conditional nature, and may lead to error.

Alcohol, drugs, and condom use among drug offenders: an event-based analysis.

BACKGROUND: Studies of the association between substance use and condom use in specific sexual encounters often do not separate the effects of alcohol and different types of drugs. Because the pharmacological effects and social settings of various substances differ, their effects on unprotected intercourse may vary as well. GOAL: This study examined the relationship between alcohol and drug use and the use of condoms in sexual encounters with casual partners in a high-risk population of drug offenders. DESIGN: Participants in court-ordered drug diversion programs (n=536; 26% female) completed a questionnaire in which they reported on the circumstances of their most recent sexual encounter with a casual partner. RESULTS: In multivariate logistic models, alcohol use in conjunction with sex was not related to decreased condom use in either men or women. Amphetamines (smoked or injected) were associated with decreased condom use, while cocaine, marijuana, and orally-administered amphetamines were not significantly associated with condom use. CONCLUSIONS: In this high-risk sample, links between substance use and unprotected sex differ with type of drug used.

Drinking and condom use: results from an event-based daily diary.

Although it is often assumed that drinking alcohol interferes with condom use, most studies on this topic do not meet the conditions required for causal interpretation. We examined the association of drinking to condom use using data from diaries of alcohol use and sexual encounters, collected over 8 weeks from college students and clients of a sexually transmitted disease clinic. This method establishes the temporal relationships between drinking and condom use and controls for individual differences by using a within-subjects analysis. Multilevel models that predicted condom use from alcohol use before the sexual encounter, partner type, and the use of other contraception showed that drinking before sex was unrelated to condom use. These results do not support the persistent notion that alcohol causes people to engage in sexual risk that they would avoid when sober; instead, people tend to follow their usual pattern of condom use, regardless of alcohol use.

Agreement of daily diary and retrospective measures of condom use.

This study compares condom use reported two ways. 251 heterosexual participants (63% female) reported condom use on a prospective daily diary and on a retrospective questionnaire. Proportion of condom use with vaginal sex was calculated from the diary data and contrasted with retrospective categories. Responses were consistent for some participants, especially those who used condoms never or always, but responses from others showed considerable variability. Participants with few sexual encounters were more likely than those with more encounters to use "never" and "every time" endpoints. The results call into question the way participants interpret the meaning of retrospective categories.

Spontaneous cognition and HIV risk behavior.

Theories of cognitive processes and risk behavior have not usually addressed spontaneous forms of cognition that may co-occur with, or possibly influence, behavior. This study evaluated whether measures of spontaneous cognition independently predict HIV risk behavior tendencies. Whereas a trait-centered theory suggests that spontaneous cognitions are a by-product of personality, a cognitive view hypothesizes that spontaneous cognitions should predict behavior independently of personality. The results revealed that spontaneous cognition was an independent predictor of behavior tendencies in cross-sectional analyses. Its predictive effect was stronger than drug use, a frequently emphasized correlate of HIV risk behavior in the literature, and comparable with sensation seeking in magnitude. The results suggested that a relatively spontaneous form of cognition may affect HIV risk behavior.

Content analysis of drug offenders' sketches on the draw-an-event test for risky sexual situations.

OBJECTIVES: To evaluate the utility of the Draw-an-Event Test for risky sexual situations (DET-RS), a nonverbal memory-based assessment tool used for productions of spontaneous content associated with risky sex. METHODS: Traditional holistic coding analysis of 298 drug offenders' content productions. RESULTS: Content analyses of DET-RS sketches provided increased understanding of substance use and other context preceding risky sexual situations with different types of sex partners. None of the sketches including drugs depicted condoms, only one of the sketches with alcohol included a condom, and only 2 sketches mentioned sexually transmitted diseases. CONCLUSIONS: The DET-RS is a useful research tool for generating nonverbal context-specific stimuli associated with risky sexual situations.

Alcohol expectancies and drinking in different age groups.

AIMS: Because expectancies about the effects of alcohol change as drinking experience is accumulated, it is likely that the relationship of expectancy to drinking will differ with age. In this study, we examine the prediction of drinking behavior from positive and negative outcome expectancy at different ages. DESIGN: Data were collected as part of the National Alcohol Survey, using a multi-stage area probability sample of the household population of the 48 contiguous United States. PARTICIPANTS: US residents aged 12 and older (n = 2875). MEASUREMENTS: Survey questions included drinking habits (frequency, quantity, frequency of drunkenness, maximum quantity) and beliefs about the effects of alcohol (alcohol expectancies). FINDINGS: Structural equation models tested the relationship of positive and negative expectancy to drinking behavior in six age groups. Outcome expectancy accounted for a larger portion of the variance in drinking among younger respondents than among older respondents. However, suppression effects were common. When suppression effects were considered, positive expectancy predicted drinking better than negative expectancy only among respondents under 35, while negative expectancy was a better predictor of drinking status in most respondents over 35 years. Among drinkers, positive expectancy predominated over negative expectancy when suppression effects were considered. CONCLUSIONS: These results suggest that negative expectancy predicts abstention, while positive expectancy predicts level of drinking among drinkers. In expectancy research, differences between drinkers and abstainers, age of participants and the presence of suppression effects should be taken into account.

Adolescent drinking and sex: findings from a daily diary study.

CONTEXT: Alcohol consumption often has been cited as increasing adolescents' risk of HIV, and several studies have shown positive relationships between drinking and risky sexual behavior among adolescents. Because most of these studies used global measures of drinking and risky sex, and conducted comparisons across persons, they could not determine whether alcohol use was a cause of risky sex or simply a correlate. METHODS: A sample of 112 U.S. adolescents completed daily diaries about their health behaviors, including drinking and intercourse, for eight weeks. In analyses using t-tests and hierarchical linear modeling, each respondent's rate of condom use after drinking was compared with his or her rate of use when not drinking, and predictors of condom use were examined RESULTS: Rates of condom use did not differ significantly between sexual events preceded by drinking (use in 54% of events) and those not preceded by drinking (use in 52% of events). Condoms were more likely to be used during sexual events with casual partners than in those with steady partners, less likely to be used on occasions when other birth control was used and more likely to be used when the sexual encounter was expected. In the multivariate analyses, the odds of condom use were not associated either with whether a teenager had been drinking before sex or with the quantity of alcohol consumed. CONCLUSIONS: These findings challenge the widely accepted hypothesis that drinking is a cause of sexual risk-taking. Rather, they underscore the need for interventions to increase teenagers'access to and ability to use condoms.

Alcohol and condom use: a meta-analysis of event-level studies.

BACKGROUND: Although it is often assumed that drinking alcohol interferes with condom use, studies on this topic have used several different methods and have yielded inconsistent findings. By examining drinking and condom use in specific sexual encounters, the role of alcohol in influencing unprotected intercourse is targeted. GOAL: The goal of the study was to assess the relationship of alcohol use and condom use in discrete sexual encounters using meta-analysis. STUDY DESIGN: Studies in the literature were identified by computerized searches of MEDLINE and PsycINFO and hand searches of reference lists. Summary odds ratios were calculated for all analyses and for subgroups formed according to type of sexual encounter (first, most recent, most recent with a new sexual partner). RESULTS: The association of alcohol use and condom use varied by type of sexual encounter: drinking at first intercourse was associated with decreased condom use (odds ratio [OR], 0.54; 95% CI, 0.44-0.66), but drinking was unrelated to condom use in recent sexual encounters (OR, 1.04; 95% CI, 0.89-1.21) and in recent encounters with new partners (OR, 1.1; 95% CI, 0.92-1.32). CONCLUSION: Drinking is not necessarily linked to unprotected intercourse; the relationship between alcohol use and unprotected sex depends on context and sexual experience of the partners.