Jennifer E. Merrill, Ph.D. - US grants

DESCRIPTION (provided by applicant): Project Summary/Abstract: Heavy alcohol use and its associated consequences are common during the college years, and are associated with deleterious short- and long-term outcomes for both the individuals and the college community. Though some college students make self-initiated changes to their drinking, little is known about how such adjustments occur or why and when students decide to make them. Such knowledge could inform intervention, by elucidating factors that might maximize the likelihood of behavior change. Data show that the experience of negative consequences from drinking is one important catalyst for change. Yet, there is significant individual variability in subjective responses to consequences and thus, variability in how such consequences may elicit behavioral change. Social Learning Theory (SLT) provides a guiding theory in this proposal with primary aims to investigate (1) whether subjective cognitive evaluations regarding the aversiveness, negativity, and severity of experienced alcohol consequences influence within-person changes in drinking behavior, and (2) whether individual-level variables (past experience with and normative perceptions of alcohol consequences) influence week-to-week alterations in drinking behavior by way of such cognitions. A secondary aim involves examining the association between empirically established severity of experienced consequences and within-person behavioral change. Following a baseline assessment of individual difference variables, participants (N=66 regularly drinking college students) will complete weekly web-based surveys to report on previous week alcohol use and experience of 24 alcohol-related consequences, as well as their cognitive evaluations of those consequences. Data will be collected for 10 weeks, to provide both within- and between-person variation. Using such methodology in combination with hierarchical linear modeling techniques will allow a fine-grained (week-to-week), prospective examination of the hypothesized effects as they unfold over time. PUBLIC HEALTH RELEVANCE: Project Narrative: Aims of the present study represent keys to providing insight into the processes by which students self- initiate change in alcohol use behaviors and to refining interventions for college drinking, particularly those that target how individuals think about their behavior and its consequences. Findings also have potential to inform efforts to prioritize for intervention those students most at risk for continued problematic drinking.

DESCRIPTION (provided by applicant): This K01 research and training award will enable the PI to develop skills as an independent researcher using advanced methodological and statistical techniques to ultimately (a) uncover etiological factors of alcohol misuse among young adults, and (b) use that knowledge to refine brief interventions for young adult drinkers. The aim of the proposed research is to identify the impact that event-level alcohol-related consequences have on subsequent drinking decisions among heavy drinking college students. Social learning theory (SLT) highlights the importance of both cognitive factors and contextual factors underlying alcohol misuse. Both SLT and recent research suggest that the way students subjectively evaluate their consequences (i.e., the degree to which consequences are personally perceived as positive versus negative) may be more important than the consequences themselves. This project will be the first to examine how the real-time subjective evaluations of positive and negative alcohol-related consequences influence latency to and amount of drinking at the next drinking event. Qualitative methods (focus groups with 30-48 heavy drinking college students; individual interviews with 10 pilot participants) will be used (a) to better understand how students personally evaluate the consequences of their drinking and (b) to modify measures for and learn how to maximize compliance with an ecological momentary assessment (EMA) protocol during discrete drinking events. Subsequently, EMA will be used to gather data from 72 students on consequences, consequence evaluations, and contextual factors (mood, event-level normative perceptions of consequences). Heterogeneous mixed effects and frailty modeling will be used to examine (a) contextual predictors of consequence evaluations, and (b) both real-time and next day evaluations as predictors of both latency to and amount of drinking at the next drinking event. An exploratory aim is to examine whether real-time and next-day evaluations of the same consequence differ systematically. Results will inform our understanding of college students' decisions to drink and will help identify potential targets of intervention. This research will lead to subsequent grant applications involving (a) a larger scale EMA examination of mediators and moderators of the impact of consequences on drinking over time, and (b) tests of whether evaluations and consequence norms can be modified within the context of intervention to result in decreased drinking. The PI will work with a highly skilled mentorship team (Drs. Kate Carey, Rochelle Rosen, Robert Miranda, Kristina Jackson, and Thomas Piasecki) to build four areas of expertise relevant to this research agenda: (1) qualitative research methods to inform measures and methods development; (2) methodology of EMA; (3) analysis of EMA data; and (4) intervention development. This K01 proposal to understand mechanisms of the influence of the real-time experience of alcohol consequences on later drinking addresses a key priority in the science of alcohol misuse, and will fully prepare the PI for an independent research career in this specific field.

PROJECT SUMMARY One in three young adults engage in high intensity drinking (HID; 8+ drinks for women/10+ for men) in the past year, placing them at risk for serious acute consequences of alcohol use (e.g., severe injury, overdose). Further, one third to one half of young adult drinkers report alcohol-induced blackouts (AIB), an outcome distinct from HID episodes. Most research to date on HID and AIB has been cross-sectional, retrospective, and conducted exclusively in college students, revealing little about specific drinking events leading to HID or AIB. Needed also are objective indicators of the topography of drinking during these events, which is feasible with biosensor technology. Understanding more about drinking patterns, proximal antecedents and consequences of HID and AIB is imperative to the continued development and refinement of effective interventions for the most at-risk drinkers. The specific aims of this study are to: (1) elucidate the topography of drinking at the event-level during naturally occurring drinking events characterized by HID and/or AIB, using both self-reported drinking captured via ecological momentary assessment (EMA) and objective biosensor data; (2) determine event-level behavioral antecedents (pregaming, drinking games, protective behavioral strategies) and psychosocial antecedents (drinking motives, willingness, intentions, affect, social context), as well as positive and negative consequences of HID events; (3) isolate event-level factors that increase AIB risk beyond level of intoxication (co-use of other drugs, inadequate sleep, willingness, intentions); and (4) examine changes in frequency of and associations among HID, AIB, and related negative consequences across three annual assessments. First, key informant interviews (n=20-28) will be used to gather data on the relevance of theoretically-based cognitive and behavioral factors, social context, affect and other factors in the prediction of HID, as well as to identify consequences of HID for young adults. Next, in a measurement burst design, 200 young adults will complete in-person assessments and three 30-day bursts of daily EMA assessments at 12-month intervals, in combination with objective measurement of alcohol consumption using biosensor technology. We seek to differentiate the event-level predictors and outcomes of HID and AIB relative to all other drinking events, and relative to heavy episodic drinking (4+/5+ drinks), in order to isolate what places an individual at unique risk for these particularly concerning outcomes. Multilevel models will be used to determine predictors and outcomes as a function of whether each drinking event is characterized by HID or AIB. The results of the proposed research will provide novel information on proximal predictors of these two public health concerns among young adults. This innovative study will help to determine motivational targets for interventions, and in doing so, provide theoretical and empirical bases for designing preventive interventions to reduce HID, AIB and other severe alcohol-related consequences.