Lung cancer screening decisional needs among African American smokers of lower socioeconomic status.

OBJECTIVES: Adherence to most evidence-based cancer screenings is lower among African Americans due to system- and individual-level factors that contribute to persistent disparities. Given the recommendation for low-dose computed tomography (LDCT) screening among individuals at high risk for lung cancer, we sought to describe aspects of decision-making for LDCT among African Americans and to examine associations between select components of decision-making and screening-related intentions. DESIGN: African Americans (N = 119) with a long-term smoking history, aged 55-80 years, and without lung cancer were recruited to participate in a cross-sectional survey. We measured knowledge, awareness, decisional conflict, preferences, and values related to lung cancer screening. RESULTS: The majority of the study population was of lower socioeconomic status (67.2% had an annual income of ≤$20,000) and long-term current (79%) smokers. Participants had a median 20 pack-years smoking history. Most participants (65.8%) had not heard of LDCT and the total lung cancer screening knowledge score was M = 7.1/15.0 (SD = 1.8). Participants with higher scores on the importance of the pros and cons of screening expressed greater likelihood of talking with a doctor, family, and friends about screening (p's < .10). CONCLUSIONS: Findings have implications for addressing the decisional needs of lower socioeconomic African American current and former smokers to promote informed decision-making for LDCT.

Driver experiences with the alcohol ignition interlock: Comparing successful and poor performers.

OBJECTIVES: The purpose of this investigation was to compare the drinking patterns and experiences (both positive and negative) among DUI offenders who had installed an ignition interlock. The association between those experiences and interlock performance as measured by the number of times they had a lockout, was also assessed. METHODS: Over 300 DUI offenders who installed an interlock in the State of Florida were recruited and completed an on-line survey at the beginning and end of their interlock restriction. A record of the interlock performance data from each was downloaded and used to determine how many lockouts they experienced during their interlock restriction period. Offenders were defined into two groups; successful cases (having 0 or 1 lockout) or poor performers (have 2 or more lockouts). Chi-square and binary regressions were used to assess differences between groups. RESULTS: Poor performers reported significantly more drinking and were more likely to drink in a context of emotional comfort, yet they were more likely to report positive experiences with the interlock, especially as to its ability to remind them to avoid another DUI by reducing their drinking and driving. No difference was found between these two groups for the interlock's ability to reduce drinking. CONCLUSIONS: People with a more serious drinking pattern and who may be most at risk for recidivating may be more inclined to recognize the potential benefits of the interlock as a DUI preventive countermeasure. More research is needed to identify and influence high risk DUI offenders while on the interlock to increase its effectiveness once the interlock is removed.

Correction to: Development of Decisional Values Statements for Lung Cancer Screening among African American Smokers.

The original version of this article unfortunately contained mistakes in Tables 1 and 3.

Development of Decisional Values Statements for Lung Cancer Screening Among African American Smokers.

Lung cancer screening via low-dose computed tomography (LDCT) has been underutilized by high-risk current and former smokers since its approval in 2013. Further, lower use of other evidence-based cancer screening tests (e.g., colorectal cancer, breast cancer) has been noted among African Americans when compared with other racial and ethnic groups. Reasons for low uptake are multilayered but include the need for consideration of patients' personal values about the screening decision. The goal of the present study was to (1) identify positive and negative factors specific to lung cancer screening via LDCT and (2) develop statements to capture values about the screening test for use in a new measure of decisional values. Key informant interviews (n = 9) identified several benefits and risks of lung cancer screening that may be important to African American smokers. Based on these interviews, a pool of items with the values statements was administered to a convenience sample of 119 African Americans [aged 55-80 years, current or former smokers (who quit < 15 years), and without lung cancer]. An exploratory factor analysis revealed two components explaining 64% of the variance: cons of screening (e.g., "make you feel badly about your smoking history") and pros of screening (e.g., "lowering your risk of dying from lung cancer"). The final 12-item measure had very good internal consistency (α = 0.89 overall; α = 0.86 and 0.88 for subscales, respectively). This tool provides a promising values measure for lung cancer screening among African Americans and could inform future values clarification tools promoting informed and shared decision-making.

Situational context and motives of alcohol use among graduate student drinkers.

Extensive research has examined alcohol use context and motives among undergraduates, but less is known about where, when, and why graduate students drink. The current study aimed to describe the motives and situational context of graduate student alcohol use, identify demographic and program characteristics associated with alcohol use motives and context, and assess how alcohol use motives and context are associated with alcohol use behavior. A sample of master's and doctoral-level students who drank during the past month (n = 2091; 63% female) completed an online survey. An exploratory factor analysis yielded two situational context factors: drinking in social situations (e.g., with friends, at a bar) and non-social situations (e.g., alone, at home). Graduate students most frequently endorsed social and enhancement drinking motives. Results of multivariate linear regression models showed that age, sex, race/ethnicity, and international student, marital, parental, and employment status were all associated with motives and context. Drinking for enhancement and drinking to cope were the motives most strongly associated with increased alcohol quantity and frequency, respectively. Drinking in social contexts was positively associated with alcohol quantity and frequency, and drinking in non-social contexts was positively associated with alcohol use frequency but inversely related to alcohol quantity. Graduate students who drink for enhancement reasons and in social situations might be at increased risk for higher quantity alcohol use, or graduate students who drink for coping reasons and in non-social situations might be at increased risk for more frequent alcohol use. Future longitudinal research is needed to explore whether drinking in certain contexts and with certain motivations is predictive of alcohol problems during and after graduate school.

Driving concerns among older adults: Associations with driving skill, behaviors, and experiences.

OBJECTIVES: The purpose of this investigation was to determine what older adults find most concerning about driving as they age and how these concerns are related to driving skill, behaviors, and experiences. METHODS: In partnership with the Maryland Motor Vehicle Administration, a sample of 751 older adults ages 65 and older completed an online survey between October 2017 and May 2018. A content analysis was used to code open-ended responses about driver concerns, and multivariate logistic regression models were used to analyze the associations between driving concerns and driving skill, behavior, and experiences. RESULTS: Eighty-four percent of participants reported at least one driving concern, with 44% concerned about others' driving, 34% concerned about their own driving, and 24% concerned about driving conditions. The most frequently mentioned driving concerns were other drivers in general, driving at night, visual ability and awareness, and other drivers being aggressive or reckless. Being concerned with their own driving was significantly associated with decreased perceived driving skill and increased odds of experiencing negative driving experiences in the past year. Being concerned about others' driving was associated with increased odds of wearing a seat belt (adjusted odds ratio [AOR] = 2.67; 95% confidence interval [CI], 1.02, 7.00), having high perceived driving skills in emergency situations (AOR = 1.56; 95% CI, 1.14, 2.12), and getting in a near crash or collision in the past year (AOR = 1.50; 95% CI, 1.04, 2.18). CONCLUSIONS: Older adult drivers are frequently concerned about their own driving as well as the driving of others. Implications for future research and health practice are discussed.

Graduate degree completion: Associations with alcohol and marijuana use before and after enrollment.

Research has shown that alcohol and marijuana use are associated with academic performance difficulties, but the relationship to completion of a graduate degree has not been explored. Undergraduate students (n = 1253) were assessed during their first year of college and annually thereafter until age 29. Among the subset of the original sample who enrolled in graduate school (n = 520), measures of alcohol and marijuana use were averaged separately for the time periods before and after graduate school enrollment. Logistic regression models were developed to examine the associations between these variables and graduate degree completion, adjusting for other factors. In general, a minority of the sample were excessive drinkers or frequent marijuana users. The majority of drinkers (70%) drank an average of twice a week or less each year, and 62% of marijuana users used marijuana once a month or less each year. After adjusting for demographic and program characteristics, marijuana use frequency after graduate school enrollment was negatively associated with odds of graduate degree completion. Alcohol use frequency before graduate school enrollment was positively associated with odds of graduate degree completion. Results add to the growing body of literature on marijuana use and decreased academic achievement, but results should be interpreted with caution given the small, but significant, effect sizes found. The positive association between alcohol use frequency and degree completion might be attributed to engagement in the academic environment. Future studies should examine the potential mechanisms through which alcohol and marijuana use are related to the academic achievement of graduate students.

Substance Use, Academic Performance, and Academic Engagement Among High School Seniors.

BACKGROUND: Substance use is prevalent and is associated with academic performance among adolescents. Few studies have examined the association between abstinence from all substances and academic achievement. METHODS: Data from a nationally representative sample of 9578 12th graders from the 2015 Monitoring the Future survey were analyzed to examine relationships between abstinence from substance use and 4 academic variables: skipping school, grades, academic self-efficacy, and emotional academic engagement. Participants were categorized as lifetime non-users, former users, and past-year users based on the use of 14 substances. RESULTS: Approximately one-fourth of participants had never used cigarettes, alcohol, or other drugs during their lifetime, and 8%wt used at least one substance during their lifetime but not during the past year. Adjusting for demographic variables, past-year substance users had 2.71 greater odds of skipping school during the past month than lifetime non-users and 1.74 greater odds of having low grades. Lifetime non-users reported greater academic self-efficacy and emotional academic engagement than past-year users. CONCLUSIONS: Many 12th graders have abstained from all substance use during their lifetime, and these adolescents experience better academic outcomes than their substance-using peers. Substance use prevention programs should be evaluated as a way to promote academic achievement.

Alcohol, Driving, and Health among Community-dwelling Older Adults.

OBJECTIVE: The purpose of this investigation was to examine the relationships among alcohol use, driving behavior, and indicators of health among older adults. METHODS: A sample of 818 adults ages 65 and older were recruited through the state motor vehicle administration and completed an online survey. Regression models were used to assess the associations between alcohol use, driving behaviors, and 6 health indicators. RESULTS: Whereas more frequent alcohol use was associated with fewer health conditions, higher quantity alcohol use was associated with increased likelihood of having at least one health condition. Participants who drove several days a week and those who drove every day had higher perceived health status, a lower number of past-year health conditions, and a lower number of past-year health events when compared to less frequent drivers. Persons who had at least one past-year negative driving behavior or event were significantly less likely to have positive health status, had lower perceived health status, and had a higher number of past-year health conditions and events. CONCLUSIONS: High quantity alcohol use and risky driving behavior among older adults are indicative of poorer health. Continued efforts are needed to educate older adults on the relationships among alcohol use, driving behavior, and health.

A Mixed Methods Examination of Sleep Throughout the Alcohol Recovery Process Grounded in the Social Cognitive Theory: The Role of Self-Efficacy and Craving.

Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points. Individuals with fewer dysfunctional beliefs about sleep had poorer sleep quality at both time points. Individuals with higher unhealthy sleep-related safety behaviors had poorer sleep quality at both time points. In a linear regression model, only the difference in SE-S scores from pre- to postdischarge (ß = -.396, p = .01) and the postdischarge Penn Alcohol Craving Score (ß = .283, p = .019) significantly predicted the change in sleep quality. Thus, those whose SE-S scores increased and those with lower postdischarge craving scores were more likely to experience a decrease on Pittsburgh Sleep Quality Index scores from pre- to postdischarge even after controlling for covariates. References to behavior or personal factors were often discussed during the qualitative interviews in tandem with the environment. Participants reported both (1) self-medicating anxiety with alcohol and (2) self-medicating the inability to fall asleep with alcohol. Given the success of behavioral sleep interventions in various populations and the unique potential contributions of mixed methods approaches to examine sleep and alcohol use, assessing sleep-related cognitions and behaviors of individuals with severe alcohol use disorders may be important in understanding sleep quality and subsequent relapse.

Social context of drinking among older adults: Relationship to alcohol and traffic risk behaviors.

OBJECTIVE: Alcohol use among older adults is a major public health concern given potentially negative effects to health and functioning in this population. Little is known about context in which alcohol use among older adults occurs, or how context of use is associated with risk behaviors. METHOD: Invitation letters were mailed to licensed drivers 65 years and older in Maryland. A total of 825 participants completed an online survey that assessed demographic characteristics, alcohol use, social context of drinking, and driving behaviors. RESULTS: The analytic sample consisted of 604 older adult current drinkers (55% male). A factor analysis revealed three separate contexts of drinking: social facilitation, emotional comfort, and relaxation. Drinking in the context of social facilitation was associated with driving after drinking. Drinking in the context of emotional comfort was associated with getting drunk, driving after drinking, and running a stop sign or red light. Drinking in the context of relaxation was associated with traffic risk behaviors, including running a stop sign or red light and getting in a near crash or collision. CONCLUSIONS: Understanding the social context of alcohol use among older adults may be useful for targeting and attempting to modify risky alcohol use and driving behaviors.

Motivational factors associated with drowsy driving behavior: a qualitative investigation of college students.

OBJECTIVES: This qualitative investigation sought to identify the motivational factors that contribute to drowsy driving in college students and to discover important messaging strategies that may help prevent or reduce this behavior in this population. DESIGN: Four focus groups of college students. SETTING: A large university in the Washington, DC, metropolitan area during the Fall 2016 term. PARTICIPANTS: Twenty-six undergraduate students between the ages of 18 and 25 years. MEASUREMENTS: Notes and transcripts from the focus group sessions were analyzed to identify recurring themes regarding attitudes, motivations, experiences, influences, and potential preventive messaging strategies related to drowsy driving. RESULTS: Although most participants had heard of drowsy driving and were concerned about it, they did not associate it with legal risks and were more concerned about alcohol-impaired and distracted driving as crash risks. Participants viewed drowsy driving as a normal and unavoidable part of their lives over which they had little control. For potential anti-drowsy driving messaging strategies, participants preferred messages delivered via audiovisual or social media that featured graphic and emotional portrayals of crashes and their consequences. Participants also voiced strong support for preventive messaging strategies equating various degrees of sleep deprivation to known impairing levels of alcohol, as well as messages providing cues to action to actual drowsy drivers on roadways. CONCLUSIONS: Increased enforcement, education, and public messaging campaigns are needed to increase knowledge and influence attitudes and opinions among young drivers about the dangers and social unacceptability of drowsy driving.

Evaluation of Maryland's state police impaired driving reduction effort (SPIDRE).

OBJECTIVE: Alcohol-impaired driving is a significant factor in fatal and serious injury-producing crashes in the United States and many other countries. In 2013, the State of Maryland implemented an anti-driving under the influence (DUI) enforcement program, called the State Police Impaired Driving Reduction Effort (SPIDRE). This enforcement effort consisted of a select team of 7 police officers from the Maryland State Police who engaged in high-intensity driving under the influence (DUI) enforcement. The purpose of this evaluation was to determine the impact of the SPIDRE program on impaired-driving crashes, DUI arrests, DUI adjudicative outcomes, and public perceptions of DUI enforcement. METHODS: Data from alcohol-related crashes, arrests, and adjudicative outcomes of those arrests were used, along with data obtained from public opinion and bar patron surveys, to compare counties where the SPIDRE program operated and non-SPIDRE counties where it did not. The evaluation period extended from 2010 to 2016 in monthly intervals. Autoregressive integrated moving average (ARIMA) methods were used for the data analyses of crashes and arrests. RESULTS: There was no significant reduction in alcohol-related crashes as reported by the police associated with the SPIDRE program. However, there was a statistically significant decrease in the ratio of single-vehicle nighttime to multiple-vehicle daytime crashes in the SPIDRE counties but not in any other counties, suggesting a positive effect using this surrogate measure of impaired-driving crashes. The specific comparison counties as well as the other non-SPIDRE counties in Maryland experienced a statistically significant decrease in DUI arrests during the evaluation period, whereas the SPIDRE counties did not show such a decrease. Further, the arrests made by the SPIDRE team resulted in a significantly higher rate of positive adjudicative outcomes than arrests made by non-SPIDRE officers in those counties where the SPIDRE team operated. There was no evidence that the public was more aware of DUI enforcement efforts in the SPIDRE counties than in the non-SPIDRE counties. CONCLUSIONS: The SPIDRE program appeared able to prevent a downward trend in DUI arrests, experienced by the rest of the state, and achieved higher quality arrests resulting in more positive adjudicative outcomes. The way in which the SPIDRE team was deployed may have lacked sufficient duration and intensity (e.g., only 2-3 months of activity in any given county) to achieve a reduction in alcohol-impaired-driving crashes as reported by the police. It is recommended that the SPIDRE team increase its enforcement activities for at least 9-12 consecutive months in the county where they are employed.

Examining Associations Between Relocation, Continuity of Care, and Patient Satisfaction in Military Spouses.

INTRODUCTION: The purpose of this study was to determine how frequent permanent change of station moves and turnover in primary care providers are associated with continuity of care and patient satisfaction in military spouses. These domains have been studied extensively in civilian populations, but this study seeks to begin filling a gap in the literature surrounding military spouses and their experiences with the military health system. MATERIALS AND METHODS: Spouses were recruited via social media to complete a brief online questionnaire to examine factors related to continuity of care and satisfaction with military health care. Results were analyzed using analysis of variance and χ2 tests, and through logistic regression. RESULTS: Continuity of care scores were significantly lower as the number of moves and providers increased. Patient satisfaction was also significantly associated with continuity. In logistic regression analyses, patient-provider relationship and health status were the only significant predictors across two measures of patient satisfaction. Respondents with higher relationship scores were nearly two times more likely to report being satisfied than those with lower scores. Qualitative results indicated that the majority of dissatisfied spouses were unhappy with their military providers, which supported quantitative findings related to patient-provider relationship. CONCLUSION: No studies have previously been conducted to determine why military health system beneficiaries are less satisfied with care than their civilian counterparts. Discontinuous care is an ongoing issue for military families, which can impact satisfaction and potentially lead to poorer health outcomes. Although the military culture may not allow for fewer relocations, these results indicate that taking steps to promote enduring, trusting relationships with primary care providers may improve patient satisfaction.

Critical Transitions: A Mixed Methods Examination of Sleep from Inpatient Alcohol Rehabilitation Treatment to the Community.

AIMS: This prospective, repeated measures study utilized a convergent parallel mixed methods approach to assess sleep experiences among individuals who were alcohol-dependent undergoing inpatient detoxification and treatment at a clinical research facility across the transition periods associated with the rehabilitation process: the initial adjustment to becoming an inpatient and the transition from inpatient to outpatient status. METHODS: This study included individual semi-structured interviews and quantitative measures relating to psychological distress, sleep quality, daytime sleepiness, and sleep-related beliefs and behavior (n = 33; 66.7% male). Interviews were conducted and questionnaires were administered within one week of participants' scheduled discharge date and again four to six weeks post-discharge when they returned for a follow-up visit (or via phone). RESULTS: Participants self-reported significant sleep disturbances at both study time points. Of those participants with valid data at both time points (n = 28), there were no significant changes in mean scores from pre- to post-discharge with the exception of self-efficacy for sleep (SE-S) being significantly higher post-discharge. Preliminary qualitative findings suggested differences between those with ongoing sleep disturbances, those whose sleep disturbances had resolved, and those with no sleep disturbances at either time point. CONCLUSIONS: This analysis highlights individual variation in sleep throughout the process of inpatient treatment and transition to outpatient aftercare in individuals with alcohol dependence. Collecting quantitative and qualitative data concurrently and combining emerging themes from qualitative data with quantitative analyses allowed for a more thorough examination of this relatively novel area of research and provided information that can be utilized to inform future behavioral sleep interventions.

Intentions and willingness to drive while drowsy among university students: An application of an extended theory of planned behavior model.

A web-based questionnaire was used to assess the utility of constructs from the Theory of Planned Behavior (TPB) and the Prototype Willingness Model (PWM) to predict intentions and willingness to engage in drowsy driving in a sample of 450 university students. Those students who reported more favorable attitudes and subjective norm and greater perceived control and willingness in relation to drowsy driving behavior were more likely to report stronger intentions to engage in drowsy driving behavior. Augmenting the TPB constructs with the PWM construct of willingness significantly explained up to an additional 8 percent of the variance in drowsy driving intention. Perceived behavioral control and willingness were consistently the strongest predictors of drowsy driving intention in the augmented model, which together with the control (personal) variables explained up to 70 percent of the variance in intention. Thus, the Theory of Planned Behavior and the Prototype Willingness Model may be useful for understanding motivational influences on drowsy driving behavior in young people and present promising theoretical frameworks for designing more effective interventions against drowsy driving in this population.

A qualitative study of college students' perceptions of risky driving and social influences.

OBJECTIVES: Young adults and teens are documented as the riskiest drivers on the road, and newer issues such as texting and driving are a growing concern. This study sought to determine the risk perceptions of young adults regarding various driving behaviors, their past experiences, how their social circles are structured, and how this might affect their driving. METHODS: This study conducted qualitative research with 25 college undergraduate students to determine their peer and social influences regarding distracted driving. Data were analyzed and related to the health belief model and past research on social influence. RESULTS: Though most participants felt that their behaviors were set after learning to drive, they were, in fact, quite susceptible to the influence of those in their social circles (e.g., fear of judgment and accountability) and, more broadly, to social norms. Texting and driving was the largest and most topical distracted driving issue and was also identified as very difficult to stop due to perceived barriers and the idea that intervening is rude. Participants identified low perceived susceptibility and severity (perceived threat) for a number of risky driving behaviors, including texting and driving. CONCLUSIONS: Training is needed to encourage people to intervene and speak up regarding behaviors other than drinking and driving, and cues to action and campaigns should target intervention to increase self-efficacy, as well as norms, susceptibility, and common rationalizations for risky behavior.

Medical Students' Beliefs About Screening for Intimate Partner Violence: A Qualitative Study.

Researchers have found that medical students who have received training on intimate partner violence (IPV) report greater comfort with screening for IPV and improved IPV interviewing skills than their counterparts. However, less is known about medical students' beliefs toward screening female patients for IPV and behavioral intention to screen. Semistructured, qualitative interviews were conducted with medical students to assess their beliefs, using the theory of planned behavior and social cognitive theory as theoretical frameworks for the interview questions. Most students felt that screening for IPV could help identify victims but could also potentially offend patients. Perceived barriers to screening included time and negative patient reactions, while perceived facilitators to screening included receiving IPV training and provision of IPV screening questionnaires while interviewing patients. Interviewees identified physicians as both supporters and nonsupporters of IPV screening. Behavioral intention scores ranged from 17 to 50 out of a possible 11 to 55. Findings from the study can help inform the IPV training needs of medical students.

Association of school social networks' influence and mass media factors with cigarette smoking among asthmatic students.

BACKGROUND: Around 10% of adolescent students under 18 years have current asthma. Asthmatic adolescents smoke as much or more than non-asthmatic adolescents. We explored the association between exposure to mass media and social networks' influence with asthmatic student smoking, and variations of these exposures by sex. METHODS: This study included 9755 asthmatic and 38,487 non-asthmatic middle and high school students. Secondary data analysis incorporated the complex sample design; and univariate, bivariate, and logistic regression statistics. RESULTS: Asthmatic students had greater odds of smoking than non-asthmatic students. Asthmatic female students were more likely than asthmatic male students to have been exposed to secondhand smoke in rooms or cars and to smoking actors, but less likely to associate smoking with intent to wear tobacco-marketing products, or with looking cool/fitting in. Asthmatic male and female students, who have smoking friends, were exposed to secondhand smoke in rooms (only girls) or cars, intended to smoke if best friends offered cigarettes, or received/bought tobacco marketing products had greater odds of smoking than other asthmatic students. CONCLUSIONS: The observed associations suggest the need for general interventions to reduce middle and high school students' cigarette smoking as well as targeted interventions for asthmatic adolescent students.

DUI offenders' experience with an ignition interlock program: comparing those who have and have not adapted from their primary drinking location.

OBJECTIVE: The purpose of this study was to compare driving under the influence (DUI) offenders on an alcohol ignition interlock program who had or had not changed their primary drinking context from a bar/restaurant where they might be required to drive after drinking before the interlock was installed to drinking at home where driving would not be likely to be required following interlock installation. METHODS: A total of 171 DUI offenders who were on an ignition interlock program completed a web-based survey. All of these offenders reported that they drank primarily in a bar/restaurant before the interlock was installed. These offenders were classified into 2 groups: adapters who said they currently drink at home and nonadapters who said they still drink in a bar/restaurant. Measures were made of their reported drinking, driving patterns, perceptions of the likely outcomes of being on the interlock, perceived effectiveness of various prevention strategies, and demographic characteristics. Chi-square and t-test analyses were used to compare these 2 groups. RESULTS: Adapters and nonadapters did not differ with regard to any of the demographic characteristics, whether they were a first-time DUI offender, the length of time in the interlock program, number of lockouts (being blocked from starting their cars) they had experienced, miles driven per week, or current driving patterns since being on the interlock program. Adapters were more likely to report changing their drinking plans and habits. Currently they reported fewer drinks per occasion than nonadapters. They were more likely to report reducing the amount they drink, solo drinking or only drinking with a spouse/significant other, and changing their drinking plans and habits. They were also more likely to say that the interlock reminded them to limit their drinking after it is removed and that it might have longer term benefits in preventing future DUIs. They were also more receptive to interventions that might help them separate their drinking from their driving. CONCLUSIONS: Interlock clients who report that they have altered their drinking context and a willingness to receive programs that help them separate their drinking from their driving may be more receptive to and benefit from ignition interlock programs.