Exploring how military culture shapes veterans' perception of aortic aneurysm repair: A qualitative study.

BACKGROUND: Veterans represent a distinct cultural group whose perceptions of illness and treatment are influenced by military culture. The study explores how prior military service shapes Veterans' assumptions and behaviors in the setting of aneurysm repair surgery. STUDY DESIGN: We conducted content and thematic analysis of a case series of 10 transcripts from telephone interviews with older (76.7 ± 4.3 years) African American and White male Veterans now residing in the Southern U.S. who underwent open or endovascular aneurysm surgery at Veterans Affairs Medical Centers or university affiliates between 2004 and2019. RESULTS: Throughout the continuum of care, Veterans described deferring to authority and not questioning provider's decisions ["I just can't make a judgment on that, because I'm not a doctor"]. Veterans valued commitment and articulated pride in keeping logistically challenging surveillance appointments [I always took them very seriously. . . If I'm scheduled for something by the doctor, I always make it."]. The routine structure of VA care aligned with Veterans military experiences, facilitating compliance with doctor's orders. However, procedural deviations in VA care were disconcerting for patients ["They haven't reached out to me in at least three years, since my surgery; I was being seen once a year and then all of a sudden, they just quit."]. While Veterans praised VA care, they exhibited sensitivity to signs of untoward treatment from clinical and support staff "…my surgeon, he never talked to me before, nor after, no anytime…I thought that maybe that wasn't right". CONCLUSIONS: Military culture embodies rank, order, and respect, and remains a source of strength and stability for Veterans in their medical care late in life. Cultural competency about how military service has shaped Veterans' expectations can enhance providers' awareness of patients' military mindsets and inform surgeons' efforts to engage Veterans in shared decision making.

Tension reduction and affect regulation: An examination of mood indices on drinking and non-drinking days among university student drinkers.

Several theories posit problematic alcohol use develops through mechanisms of positive and negative reinforcement. However, the literature on these mechanisms remains inconsistent. This may be due to a number of issues including a failure to disaggregate negative mood or a failure to account for mood functioning (i.e., stability in mood). Alternatively, there may be differences in typical postdrinking/evening mood on drinking and nondrinking days, however, this has yet to be fully explored. We examined multiple indices of distinct mood states prior to and after typical drinking onset times on drinking and nondrinking days using ecological momentary assessment. College student drinkers (n = 102) carried personal data devices for 15 days. They reported on mood and alcohol use several times per day. Tonic positive mood was higher on drinking days than nondrinking days prior to typical drinking initiation. After typical drinking times, positive mood was higher on drinking days than nondrinking days. Similarly, negative moods (anxiety, stress, anger, and stress instability) indicated a pattern of lower levels relative to both predrinking mood on drinking days, and matched mood time-points on nondrinking days; though, not all of these differences were statistically different. Results suggest positive and negative reinforcing mechanisms may be at play-though the negative reinforcement effects may manifest through subjectively "better" mood on drinking versus nondrinking days. (PsycINFO Database Record

Deviance regulation theory and drinking outcomes among Greek-life students during spring break.

Alcohol use among college students increases during spring break, which often results in more alcohol-related consequences. Given the rates of heavy alcohol use among Greek-life college students, this population may be particularly at risk for experiencing negative outcomes during this time. Thus, the current study utilized a Deviance Regulation Theory (DRT)-based approach to increase the use of protective behavioral strategies (PBS) among Greek-life college students during spring break. Greek-life college students going on spring break (n = 89) completed a screening before being randomly assigned to a pre-spring break condition (i.e., either a positively or negatively framed message about peers who do or do not use PBS during spring break). Participants then completed a post-spring break assessment of alcohol and PBS use over spring break (n = 70). There were no observed DRT effects on manner of drinking or stopping/limiting PBS use during spring break. However, there were effects on Harm Reduction PBS (HR PBS). In the positive frame, HR PBS use was positively associated with PBS norm discrepancy (the difference between spring break specific PBS norms and typical PBS norms). While these associations did not result in lower alcohol consumption, HR PBS was inversely associated with risk-related alcohol problems, but not other types of alcohol problems. A brief DRT-based approach may increase specific PBS types during spring break and may reduce risk-related alcohol-related problems among Greek-life students during spring break. (PsycINFO Database Record

Using deviance regulation theory to target marijuana use intentions among college students.

Several large epidemiological studies have shown increasing trends on a number of indices of marijuana use among college age samples. This may be due to changing attitudes about marijuana use linked to legalization efforts. Interventions that can target problematic use on a broad scale are lacking. Recent research has shown that deviance regulation theory (DRT) can be used to design effective web-based substance use interventions. DRT relies on the interplay between perceived norms and an appropriately framed message about the given behavior. The current study examines the use of DRT to change marijuana use intentions. Participants (n = 694 college students) completed measures of marijuana use and marijuana use norms. They were then assigned to receive a positively framed message about marijuana abstainers or a negatively framed message about marijuana users. Following the manipulation, participants rated intentions to use marijuana over the next three months. Consistent with DRT, there was an interaction between message frame and marijuana use norms. The positive frame attenuated the association between marijuana use norms and use intentions. A negative frame resulted in the lowest levels of use intentions among those with low use norms. Results suggest that DRT may be used to modify use intentions in college students, a population that has shown increasing rates of use. (PsycINFO Database Record

An application of deviance regulation theory to reduce alcohol-related problems among college women during spring break.

Spring break (SB) can lead to heavy episodic drinking and increased alcohol-related risks. This may be especially relevant for women. The current study utilized deviance regulation theory to increase the use of protective behavioral strategies (PBSs) among female college students on SB. Female college students going on SB (n = 62) completed a screening, a pre-SB intervention (where they were randomly assigned to receive either a positively or negatively framed message about individuals who do or do not use PBS), and a post-SB assessment that provided alcohol and PBS use data for each day of SB (n = 620 person-days). Data were analyzed using a multilevel structural equation model. In the negative frame, SB PBS use was higher among those who perceived SB PBS norms to be more common on SB relative to non-SB. In the positive frame, SB PBS use was higher among those who perceived SB PBS norms to be less common on SB relative to non-SB. These associations did not result in lower alcohol consumption, but did result in a lower likelihood of experiencing alcohol-related problems during SB. These results suggest that a brief online intervention, that utilizes targeted messages based on normative perceptions of SB PBS use, could be an effective strategy for reducing alcohol-related consequences among college student women during SB. (PsycINFO Database Record

Daily associations between emotional functioning and alcohol involvement: Moderating effects of response inhibition and gender.

BACKGROUND: Research has linked tonic and variable mood to problematic alcohol use, both between- and within-subjects. Indices of behavioral control have moderated these links, at least at the between-subjects level. The current study examines daily associations between indices of emotional functioning and alcohol involvement as a function of response inhibition. METHODS: College student drinkers (n=74; 58.11% female) were enrolled in a study on emotion and alcohol use. Participants completed a stop-signal task as an index of response inhibition. They then carried a personal data device for 21 days, reporting daily on mood, alcohol use, and acute alcohol use disorder symptoms. Mood instability was the mean square of successive differences from daily mood assessments. RESULTS: There were 1309 person days (622 drinking days) available for analysis. Pre-drinking mood instability was positively associated the likelihood of drinking and drinks consumed on drinking days. The former association was diminished among women with high response inhibition. Pre-drinking positive mood was positively associated the likelihood of drinking and drinks consumed on drinking days. The latter association was diminished among women with high response inhibition. Pre-drinking negative mood was positively associated with drinks consumed on drinking days among women with low response inhibition. Finally, pre-drinking positive mood was associated with acute alcohol use disorder symptoms among those with low response inhibition. CONCLUSIONS: These results suggest that interventions targeting positive mood may be particularly important. Further, developing ways to improve response inhibition control may broadly influence negative drinking outcomes by affecting multiple mood-drinking associations.

Are drinking motives associated with sexual "hookups" among college student drinkers?

OBJECTIVE: This study examined associations between drinking motivation, alcohol use, and sexual hookups among college students. PARTICIPANTS: Participants (n = 755 Midwest college student drinkers; 61% female) ranged in age from 18 to 24. METHODS: Participants completed online measures of alcohol involvement (use and motives) and sexual activity. RESULTS: Alcohol use was positively linked to sexual hookups. Social and enhancement motives were positively and indirectly associated with sexual hookups via alcohol use. Drinking to cope had a direct association with sexual hookups. Social drinking was more strongly associated with hookups in men than in women, but both groups exhibited a positive association. CONCLUSIONS: This study is the first to highlight the relationships between distinct drinking motives and sexual risk behavior. The results indicate that specific motives may increase risk of sexual hookups both indirectly via alcohol use, as well as directly, at least among those that drink to cope with negative mood.

Alcohol use and alcohol-related consequences: associations with emotion regulation difficulties.

BACKGROUND: Understanding factors associated with alcohol-related consequences is an important area of research. Emotional functioning has been associated with alcohol-related consequences but there is less research examining a comprehensive underlying model of emotional regulation. The Difficulties in Emotion Regulation Scale (DERS) is a recent measure developed to assess six facets of emotion regulation difficulties that contribute to overall emotional functioning. OBJECTIVES: The current study examines associations between these six facets of emotion regulation difficulties and problematic alcohol use. METHODS: Participants (n = 1758 college students) were recruited as part of a larger study and were asked to complete online questionnaires assessing demographics, alcohol use and problems, and emotion regulation difficulties. RESULTS: Negative binomial hurdle models for alcohol use and alcohol-related consequences were estimated. Impulse control difficulties were positively related to the number of drinks consumed during the week among active drinkers. Non-acceptance of emotional responses, impulse control difficulties, lack of emotional clarity, and difficulties engaging in goal-directed behavior were all positively associated with number of consequences endorsed. Difficulty engaging in goal-directed behavior was also positively associated with the likelihood of experiencing any alcohol-related consequences. CONCLUSIONS: The findings support previous research indicating that emotion-regulation difficulties are broadly associated with alcohol-related consequences. Results suggest exposure and/or mindfulness based prevention/interventions with emotion focused psychoeducation may offer one path to reducing alcohol-related consequences among college students.

Self-regulation and alcohol use involvement: a latent class analysis.

Although alcohol use can be problematic, research suggests considerable heterogeneity in problems across various drinking classes; particularly among the heaviest drinking groups. Differences in self-regulation may differentiate drinking classes. The current study evaluated differences in emotional and behavioral self-regulation across four empirically derived drinking classes. Participants (n=1895 college students) completed online measures of demographics, alcohol involvement, and self-regulation. Using latent class analysis (LCA), four drinking classes were empirically derived. Moderate drinkers were the largest class (38.1%) followed by light drinkers (37.4%), heavy drinkers (17.8%), and problem drinkers (6.8%). Each class was predicted by self-regulation indicators in the LCA. With the exception of urgency, behavioral self-regulation distinguished primarily between light drinkers and the other three classes. Emotional self-regulation and urgency were not associated with use, but did distinguish among the most problematic class. Specifically, emotional instability and urgency were higher in the problem use class than all other classes. Overall, the findings suggest important differences in behavioral and emotional self-regulation across drinking classes that differentially contribute to use and consequences. Further, the results highlight the importance of examining homogenous subpopulations of drinkers that may differ on indices other than consumption.