Introduction: The excessive consumption of alcohol by college students is a major public health problem in the U.S. Heavy alcohol use has been linked to numerous consequences ranging from less serious effects (i.e.., hangovers) to death. Decades of research have linked certain beliefs, attitudes or motivations to drinking behavior but intensive prevention efforts based on these ideas have done little to mitigate this issue. Much of the past research has focused on the interplay of cognitive factors (i.e., expectancies, motivations) and typical drinking patterns (i.e., quantity or frequency of drinking during the past year). Unfortunately, examining the relationship between “general” motives, expectancies, or use of protective strategies and “typical” drinking is not adequate to understand behavior as it occurs. Therefore, the need to understand drinking at the event-level is critical. To this end, this study examined a conceptual model of college students’ drinking events in order to determine the potential mediating effect of drinking motives and protective behavioral strategies in the relationship between alcohol expectancies and event-level alcohol use and consequences. Methods: An existing dataset containing information about 2,279 college student drinking events was analyzed for this study. Students completed surveys during the administration of a commercial online alcohol course during 2010 and 2011. These surveys contained measures of typical alcohol expectancies, drinking motives, and use of protective behavioral strategies. Students also provided detailed information about their last drinking event that occurred within seven days prior to the course. A theoretical model that examined the mediating influence of these cognitive factors and typical use of protective strategies on event-level alcohol use was analyzed with structural equation modeling. Results: The hypothesized causal ordering was supported by the findings. Both typical use of protective strategies and drinking motives mediated the relationship between expectancies and event-level alcohol use and problems. Positive expectancies was associated with greater positive motives, greater motives were associated with less use of PBS, and less PBS use was then, in turn, associated with higher event-level intoxication. Lastly, higher intoxication was associated with more serious consequences during the event. Discussion: In order to develop effective prevention that can be implemented during an event, the role of expectancies, drinking motives, and protective strategies needs to be considered in tandem. This is the first study to simultaneously explore the relationship between these factors and event-level drinking. There is a great need to continue to further explore the dynamic nature of drinking at the event-level to illuminate potential leverage points amendable to change.

The Center for Disease Control and Prevention indicates that alcohol use is the third leading preventable cause of death in the United States and results in approximately 79,000 deaths annually. College students are at particular risk of alcohol-related consequences due to their heavy drinking tendencies, with multiple studies indicating over 40% of students engage in the practice of binge drinking. Although there have been some promising findings with respect to programs that serve to reduce alcohol use and limit associated harm, researchers note the pressing need for the continued examination of etiological variables that can improve prevention efforts. Two important predictors of drinking outcomes identified in both the etiological and prevention literature are protective and risk behaviors students engage in while drinking. Although associations between drinking-related protective and risk behaviors and drinking outcomes have been well studied on their own, there is a lack of research examining how both types of behaviors operate collectively. Further, these variables are often assessed globally, such that students are asked to report their typical, or average use of these behaviors. Thus, it is unclear as to what types of protective and risk behaviors are most influential of drinking outcomes, whether these associations are consistent across multiple drinking events, and whether the use of these variables is consistent from one drinking event to the next. Accordingly, there were three aims of the dissertation: (1) to examine the collective influence of individual drinking-related protective and risk behaviors on alcohol use and related consequences using a global assessment, (2) to examine the stability of drinking-related protective and risk behaviors over time, as well as relationships between these variables, alcohol use, and related consequences using an event-level assessment, and (3) to examine whether gender differences exist in the use of protective and risk behaviors over time. Several findings emerged from the current study. Results of the global analysis revealed pacing protective behaviors, and drinking to get drunk, mixing, and mass consumption risk behaviors accounted for significant, unique variance in drinking outcomes. Results of the event-level analysis revealed that use of individual protective and risk behavior constructs were stable over time, however the associations between individual protective and risk behavior constructs, alcohol use, and consequences varied. Finally, results of the test for gender differences indicated that use of protective and risk behaviors over time was equivalent between males and females, with the exception of social protective behaviors and drinking to get drunk risk behaviors. Findings reinforce the importance of including components in prevention programs that aim to increase the use protective behaviors and decrease the use of risk behaviors, and also highlight the need for additional research that examines context-specific predictors of these constructs. [The dissertation citations contained here are published with the permission of ProQuest llc. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.].

The Brief Alcohol Screening and Intervention for College Students (BASICS: Dimeff et al., 1999) is a program used in higher education institutions to reduce drinking outcomes. Level of dependence on alcohol is a global and multidisciplinary concern. The connections between mental health (anxiety and depression) have been well established in the literature. Other connections such as family history and personality dimensions are being further explored. This study reviewed the prevalence and consequences of alcohol use as well as the connections to the specific population of college students. Theoretical frameworks from Chickering and Baxter Magolda are discussed. Quantitative analysis including regression was used to examine the connections between level of dependence on alcohol with the mental health, familial history, and personality dimensions of college students. Results indicated that participants were predominately, male, white, 18-19 years-old, freshman or sophomore, domestic students, and resided in campus residence halls. Research question one results showed that gender is a moderator and that participants anxiety, other drug use, and number of consequences significantly predicted their level of dependence. In research question two, gender was again a moderator and self-efficacy was statistically significant and negative. Research question three showed that gender is a moderator and that anxiety, impulsivity, hopelessness, and self-efficacy were statistically significant. For this third model self-efficacy and hopelessness had negative beta scores.

Alcohol use commonly begins during high school, increases and peaks in the early twenties, and then decreases during young adulthood as individuals transition into adult work and social roles. The peak in alcohol use trajectories during the early twenties is particularly pronounced for college students. Although many heavy drinking college students mature out of this behavior, some develop patterns of heavy drinking that continue into adulthood and which may lead to serious health and/or developmental problems, such as alcohol use disorder. Heavy episodic drinking (HED), or women/men consuming four/five or more drinks in a row, is the most widely used indicator of heavy college drinking, and has been shown to predict an array of negative consequences across multiple domains. However, research is increasingly showing that some students drink at levels far beyond this threshold on many occasions. Recent findings have also demonstrated that drinking in specific contexts, such as when pregaming, is associated with HED and can be particularly risky. This dissertation sought to advance research on heavy college drinking by demonstrating the need for researchers to better differentiate among levels of drinking and to more fully consider the effects of HED in certain situations, such as before going out (Pregame HED) and during the daytime (Day Drinking). Data came from the University Life Study which followed first-year, first-time, full-time college students under the age of 21 at a large, land grant university (N = 736, M = 18.44 years old, SD = .43 years). Students were selected using a stratified random sampling technique that resulted in a balanced sample in regard to gender (50.8% female) and four major race/ethnicity groups (25.1% Hispanic/Latinx, 15.7% African American non-Hispanic [NH], 23.3% Asian American/Pacific Islander NH, 27.4% European American NH, and 8.5% multiracial NH). A longitudinal measurement-burst design was used in which students completed a longer web-based survey and up to 14 consecutive web-based daily surveys in each of their first seven semesters (3 years) of college.Paper 1 introduces the concept of Pregame HED, or getting drunk before going out, and tested whether students were more likely to engage in high-intensity drinking (HID; i.e., double the HED threshold) and risky behaviors and whether they experienced more negative consequences on Pregame HED days than on days they consumed a more moderate amount of drinks while pregaming (N = 4,454 drinking days nested within N = 521 students who reported drinking on at least one occasion in Semesters 4-7 when data on pregaming were available). Multilevel models nesting days within semesters within persons contrasted Pregame HED days, that is, days students got drunk before going out, with drinking days on which they consumed a more moderate amount of alcohol while pregaming. Pregame HED was reported by 41% of drinkers and on 15% of drinking days and 38% of pregaming days. Students were more likely to engage in HID and to use illegal drugs and experienced more negative consequences on Pregame HED days than on Moderate Pregaming days. Similar to past research, students were more likely to engage in HID, experience negative consequences, play drinking games, and mix alcohol with energy drinks on Moderate Pregaming days than on Non-Pregaming drinking days.Paper 2 introduces the concept of Day Drinking, or drinking that begins during the daytime (i.e., between 6:00 AM and 3:45 PM), and tested whether students were more likely to engage in HED, HID, and risky behaviors and whether they experienced more negative consequences on Day Drinking days than on days drinking began during the evening or nighttime (N = 7,549 drinking days nested within 618 student drinkers). Day Drinking was reported by 50% of drinkers and on 9% of drinking days across the study. Results of multilevel models nesting days within semesters within persons showed that students were more likely to engage in HED and HID, play drinking games, and use illegal drugs on Day Drinking days than on Nighttime-Only drinking days. Students who reported Day Drinking more frequently were more likely to report HED, HID, mixing alcohol with energy drinks, and negative consequences of alcohol use on drinking days across the study.Paper 3 tested whether three novel risky drinking indicators (HID, Day Drinking, and Pregame HED) predicted medium-term health, legal, and academic consequences, beyond associations with HED (N = 473 student drinkers). Logistic and negative binomial regressions tested whether risky drinking behaviors earlier in college predicted consequences several years later by fourth year of college. Results showed that Pregame HED in the middle of college predicted greater alcohol-related problems and a hazardous and harmful pattern of drinking, independent of HED, in fourth year. First-year HID independently predicted a hazardous and harmful pattern of drinking in fourth year, whereas first-year Day Drinking was not independently associated with any of the four outcomes. Supplemental analyses demonstrated that Pregame HED and HID provided greater specificity in predicting medium-term consequences than HED, and HED provided greater sensitivity.Taken together, this dissertation highlights how common these three extreme, yet understudied, risky drinking behaviors were among the traditionally-aged, full-time students in this multi-ethnic sample from a large, land grant university. This work demonstrates the importance of better differentiating among levels of alcohol consumption and of considering the context in which heavy drinking occurs. By only using single, dichotomous indicators of risky drinking (i.e., HED or any pregaming), researchers fail to capture much of the unique variance that predicts both acute and distal outcomes. It is argued that by using the three novel indicators of risky drinking assessed here (i.e., Pregame HED, Day Drinking, and HID) in conjunction with the broader and more widely used HED and any pregaming indicators, researchers will be able to better identify nuances in the associations between risky college drinking and its correlates and consequences, such as whether particular correlates and consequences are more a result of the amount of alcohol consumed or whether it is the situation in which it is consumed that is particularly conducive to that behavior or consequence. This dissertation illustrated this type of nuanced association by showing that the amount of alcohol consumed while pregaming predicted the number of negative consequences students experienced, whereas students likelihood of playing drinking games was predicted by pregame drinking more generally, regardless of amount. Future work could use a similar analytic technique to assess nuances in other correlates and consequences of risky college drinking.

Self-medication theory (SMT) posits that individuals exposed to trauma and resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and associated negative consequences. Estimates of PTSD among college students are comparable to rates in the general adult population, and recent research has linked PTSD and negative alcohol-related consequences in college individuals. The social environment (e. g., perceived peer norms, active peer influences) is a critical predictor of alcohol involvement in college. Research also shows that emotionally supportive peers are critical to the diminution and resolution of PTSD symptoms. As such, drinking behaviors of supportive peers may have an effect on drinking outcomes for students struggling with posttraumatic distress. The present project aimed to assess the dynamic relationship between PTSD, alcohol behavior, and the influence of emotionally supportive peers at the daily level. Specifically, the study investigated: (1) whether higher daily levels of PTSD symptoms were associated with increased within-subject levels of daily alcohol use and consequences; (2) whether daily PTSD symptom expression and alcohol behavior was moderated by the typical drinking patterns in one0́9s emotional support group; and (3) whether the relationship between daily PTSD symptoms and daily alcohol behavior was moderated by the daily drinking behavior of emotionally support peers. In addition, multilevel modeling (MLM) analyses were used to test the relationship between weekly PTSD symptom severity and weekend alcohol behavior to delineate temporal associations posited by SMT. Exploratory MLM analyses also assessed how participants0́9 other friends/acquaintances moderated the daily and week to weekend PTSD-alcohol relationship. Trauma-exposed heavy drinking college students (N=128) completed a baseline assessment and subsequent 30 days of daily web-based surveys assessing alcohol use and related consequences, PTSD symptoms, emotionally supportive and other friend/acquaintance alcohol behavior. Results directly testing SMT were not supported. However, both supportive peer and other friend/acquaintance alcohol behavior moderated the relationship between daily PTSD and daily alcohol behavior, as well as weekday PTSD and weekend alcohol behavior. Overall, supportive peer drinking behaviors were not as harmful to those experiencing more daily/weekly PTSD symptoms relative to other friends/acquaintances' alcohol behaviors. These findings highlight the importance of social support as a buffer against problematic drinking and provide useful information for interventions aimed at high-risk drinkers.

Objective: Problematic drinking in college students is a national problem and is associated with severe alcohol-related consequences such as overdose. However, little is known about the discrete episodes of problematic drinking that lead to alcohol overdoses.