Use Of Protective Behavioral Strategies Research Articles

The role of sociocultural factors on alcohol self-efficacy and protective drinking behaviors among Hispanic/Latinx young adults

ABSTRACT Objectives Hispanic/Latinx drinkers have been found to experience more adverse alcohol-related consequences than any other racial/ethnic group. Due to this, researchers have looked at the connection between drinking and cultural factors, alongside discrimination, to further analyze what sociocultural factors lead to negative outcomes when drinking. Design Researchers used a sample of Hispanic/Latinx young adult drinkers (n = 710) with an average age of 22.43 (SD = 6.69), recruited through social media and assessed on several factors, including protective behavioral strategies (PBS), alcohol use severity, bicultural self-efficacy, discrimination, acculturation, and enculturation. Results Utilizing an observed variable path analysis, results showed perceived discrimination to have a significant effect on all variables in the model (bicultural self-efficacy, acculturation, enculturation, PBS self-efficacy, PBS use, and alcohol use severity). Acculturation was positively associated with PBS self-efficacy, while enculturation was positively associated with PBS use. PBS self-efficacy was positively correlated with PBS use and negatively associated with alcohol use severity. There was a significant total indirect effect from perceived discrimination to alcohol use severity through various paths (i.e. PBS self-efficacy, acculturation, and bicultural self-efficacy), with the strongest path to occur through PBS self-efficacy. Conclusions Findings showcase the risk and protective effects of various sociocultural factors on drinking behaviors among young adults. PBS self-efficacy was found to have robust protective effects against alcohol use severity. Future research should continue to investigate these sociocultural and behavioral factors in order to develop efforts to mitigate hazardous alcohol use among Hispanic/Latinx young adult drinkers.

A systematic review of the associations between protective behavioral strategies and heavy alcohol consumption and consequences among young adults.

We systematically reviewed the literature to assess the association between use of alcohol protective behavioral strategies (PBS) and young adult heavy drinking and alcohol-related consequences. We followed the preferred reporting items for systematic review and meta-analysis guidelines to select and review research studies that were comprised of a sample of young adults ages 18-26, included PBS derived from one of 10 validated scales as an independent variable, measured heavy alcohol use or alcohol consequences as the dependent variable, and tested the direct association between the two. Studies were gathered via PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, and Global Health. All identified study records underwent a two-step screening process and risk of bias assessment. Data were extracted from 94 studies that met inclusion criteria; 16 studies (17%) examined associations with heavy alcohol use and 91 studies (97%) tested effects of PBS on alcohol consequences. All studies that measured a total effect of PBS use (summations across all strategies) found significant negative associations with heavy alcohol use and 91% were negatively associated with alcohol consequences. Most studies that examined subscales of PBS found at least one significant, negative relation with heavy alcohol use (73%) and alcohol-related consequences (78%), though effects varied across type of subscale (e.g., manner of drinking). Our results support the use of PBS to address heavy alcohol consumption and related harms among young adults. Opportunities for refinement of current PBS in preventive interventions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Discrimination, drinking to cope, protective behavioral strategies, and alcohol-related consequences among university students.

University students who experience more discrimination typically report more negative consequences from alcohol use. The study aimed to assess whether drinking to cope and protective behavioral strategies for alcohol use would help explain the relationship between everyday discrimination and alcohol-related consequences among university student drinkers. Data were collected in Fall 2020 and the sample included 707 undergraduate and graduate students from a large public institution in the northeast who reported consuming alcohol in the past month. Participants identified predominantly as women (71.7%; 24.6% men) and White (65.1%; 7.9% Black/African American; 7.2% Asian/Asian American; 7.1% Hispanic/Latinx). A cross-sectional serial mediation analysis using structural equation modeling was conducted using Mplus. Controlling for alcohol use, results supported a serial partial mediation model. More experiences of discrimination predicted a significant increase in alcohol-related consequences, above and beyond the increase attributed to drinking to cope. More frequent use of protective behavioral strategies significantly increased the odds of reporting no alcohol-related consequences. Drinking to cope and protective behavioral strategies for alcohol use may help explain why university students who report frequent discrimination are more likely to experience alcohol-related consequences, independent of how much alcohol they consume. Findings can inform clinical and prevention practice, advocacy, and training.

A cross-sectional examination of race, gender, and intersectionality on protective behavioral strategies and alcohol outcomes among Black and White college students.

College students consistently report problematic alcohol use (e.g., excessive drinking). Protective behavioral strategies (PBS) are behaviors for reducing alcohol use and/or problems and are negatively associated with alcohol misuse among college students. Studies suggest PBS are used more often and/or more effectively by female individuals. Additionally, examinations specifically between Black and White students have yielded mixed findings and are typically underpowered. Scant studies have investigated the intersectionality between race and gender or examined perceived effectiveness of PBS use related to alcohol outcomes. The current cross-sectional study examined if (a) race, (b) gender, and (c) their interaction moderate the associations between perceived effectiveness of PBS use on PBS use (a path) and between PBS use on alcohol outcomes (i.e., alcohol quantity, peak drinks, and problems; b path). A sample size of N = 528 college drinkers ages 18-24 years old (Mage = 19.85; 52.5%, Black, 40.3% White) completed an online survey and were used for analyses. A series of moderated mediation models were conducted. Race did not moderate the a or b paths. The positive association for the a path as well as the indirect effect of PBS perceived effectiveness on lower alcohol outcomes through PBS use were stronger for female students than male students. The intersectionality examination indicated a stronger association between more PBS use and lower consumption, specifically for White male students, and lower problems for Black female students. More attention is needed toward considering intersectionality when identifying at-risk groups and tailoring alcohol intervention efforts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parental Alcohol Communication and Student Drinking: Examining Potential Differences between Underage and Legal Drinking Age Students

Background We explored associations between parental alcohol communication (PCA) and student drinking behavior and protective behavioral strategies (PBS) use. Methods College students in the United States, who had talked about alcohol with parents, (N = 251) completed an anonymous online survey in Fall 2021. Participants reported frequency of discussing 14 alcohol-related topics with parents, past 30-day drinking behaviors, and PBS use. Results We identified two forms of PCA: general alcohol information and alcohol risk information, with alcohol risk information being more common than general alcohol information. PCA was not significantly associated with drinking behavior but was associated with two types of PBS. Specifically, general alcohol information was associated with greater use of serious harm reduction and stopping or limiting drinking strategies. Additionally, legal drinking age status moderated the associations between both forms of PCA and the use of stopping or limiting drinking strategies. In general, underage students stopping or limiting drinking strategies benefited from general alcohol information but not alcohol risk information. Legal drinking age students stopping or limiting drinking strategies benefited from alcohol risk information. Conclusions Among these students, PCA appears to have a greater impact on PBS use rather than drinking behavior. This may reflect a shift in students’ beliefs about parental authority over alcohol and parents’ acceptance of alcohol use by their children.

Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial.

Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients' preferences supporting harm reduction interventions, we developed a mobile app-based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm-reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use-related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275. DERR1-10.2196/53094.

College men's use of protective behavioral strategies for sexual aggression, risky sexual behavior, and heavy episodic drinking.

Sexually aggressive behavior (SAB), risky sexual behavior (RSB), and heavy episodic drinking (HED) are serious behavioral health problems among college men. The present study substantially revises and validates protective behavioral strategies (PBS) measures in the SAB and RSB domains; evaluates the relations among PBS usage in the SAB, RSB, and HED domains; and determines whether college men with SAB, RSB, or HED histories report lower PBS usage. College students who identified as men (n = 1,121) completed measures of PBS, SAB, RSB, HED, rape-supportive attitudes, sociosexuality, and bar/party attendance. Factor analyses resulted in three PBS scales (SAB, RSB-General, and RSB-Protection) that showed good fit and cross-validated well. Average scores for all four PBS measures converged moderately to strongly. Men reporting histories of SAB, RSB, or HED reported much lower domain-specific PBS use, and domain-specific PBS predicted concurrent SAB, RSB, or HED in the presence of other established predictors. Four well-developed and validated PBS measures now provide an expanded set of potential harm-reduction strategies for college men who drink and engage in sexual activity. Given the strong concurrent associations between PBS use and problems, as well as the interrelatedness of PBS use across domains, future research should examine the impact of simultaneous personalized normative feedback on PBS use across alcohol and sexual domains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for College Men’s Use of Protective Behavioral Strategies for Sexual Aggression, Risky Sexual Behavior, and Heavy Episodic Drinking

Supplemental Material for College Men’s Use of Protective Behavioral Strategies for Sexual Aggression, Risky Sexual Behavior, and Heavy Episodic Drinking

Alcohol protective behavioral strategies for young adults: a content analysis across drinking contexts and gender

ABSTRACTBackground: Protective behavioral strategies (PBS) are specific harm reduction behaviors which mitigate alcohol-related consequences among young adults. Prior work indicates PBS utilization varies according to drinking context and gender, suggesting a need for further research assessing whether young adults employ unidentified PBS according to such factors.Objectives: This study examined alcohol PBS young adults suggest using across drinking contexts and gender to inform alcohol-related harm reduction interventions.Methods: An online survey with 514 young adult heavy drinkers (n = 269 female, Mage = 22.36 years) assessed PBS use generally, and across 12 physical and social contexts. We utilized qualitative content analysis methods to code and derive themes from open-ended responses from a prompt asking participants to state additional PBS used per context. The frequency of each theme’s appearance was calculated across the overall sample, by gender, and within each context.Results: PBS endorsement varied across context and gender within each theme. Young adults who reported PBS use most frequently endorsed utilizing strategies related to drink content (18.30%), social support (12.36%), and engaging in other activities (10.34%). Participants infrequently endorsed strategies related to awareness of time (0.23%), standards of behavior (0.78%) and avoiding environments (0.87%).Conclusions: Young adults endorse utilizing additional PBS in varying frequency according to drinking context and gender. Given PBS are often a key component of alcohol harm reduction interventions, monitoring trends in young adult PBS use is crucial to ensure continued relevance and efficacy of such interventions to minimize harms associated with young adult heavy alcohol use.

Resilience Through Harm Reduction? Protective Behavioral Strategies as a Factor of Resilience Among Polish Young Adults Using Various Psychoactive Substances

ABSTRACT Resiliency theory might provide a conceptual framework for understanding why adverse substance-related consequences vary considerably among young adults using psychoactive substances. Protective behavioral strategies (PBS) are behaviors that reduce substance use and related consequences. Despite such suggestions, to date no research has explicitly treated PBS as resilience factors. The purpose of this study was to examine compensatory and protective models of resilience among young adults using various substances. Data were obtained from an online questionnaire distributed through online social networks. Participants were Polish young adults (18–30 years old; M = 22, SD = 3.6; about 30% female and 1.3% non-binary; N = 7253), who reported using substances, other than alcohol or nicotine, in the last 12 months. After controlling for sociodemographics, hierarchical regression analyses of both substance-related harms and SUDs indicated the main effects of risk and protective factors, and the interaction between substance use and PBS. The models explained about 50% and 52% of the dependent variables variance, respectively. The results of this cross-sectional study provide support for both compensatory and protective models of resilience. This presents a rationale for recognizing PBS use as resilience factors that help young adults reduce substance-related harms. Theoretical discussion and practical implications are provided.

Using Latent Profile Analysis to Examine Cannabis Use Contexts: Associations with Use, Consequences, and Protective Behaviors

Objective College students represent a large portion of the population, and report high rates of cannabis use and related negative outcomes, including interpersonal problems, risky behaviors, or physical dependency. The contexts in which students use cannabis (e.g., at a party, when feeling down or depressed, after a fight with a loved one) likely affect their risk of experiencing consequences. We aimed to discern profiles of cannabis use contexts and compare profiles on use frequency, consequences, and the use of cannabis protective behavioral strategies (PBS). Method College students were surveyed regarding their cannabis use contexts, frequency, consequences, and PBS use (n = 265; female = 72.8%). We used Latent Profile Analysis to identify patterns of cannabis use contexts and auxiliary testing to compare profiles on use frequency, consequences, and PBS use. Results Our examination revealed three latent profiles of cannabis use. The Social Use Profile was associated with use in predominantly social/uplifting contexts. The Physical & Emotional Pain Profile was also associated with use in these contexts but was defined by additional use in response to pain. The All Contexts Profile was associated with frequent use in all contexts, including those that were least endorsed by the other profiles. Profiles differed in cannabis use frequency, PBS use, and the number of consequences experienced, such that profiles were more likely to be associated with more frequent cannabis use, higher risk of experiencing use-consequences, and using fewer PBS as the number of use contexts increased across the profiles. Conclusions The contexts in which people use cannabis are associated with cannabis risk and protection. Prevention and intervention efforts may benefit from considering contexts of cannabis use.

A Cross-Cultural Comparison of Negative Alcohol-Related Consequences in the United States and Sweden: Measurement Invariance of the Rutgers Alcohol Problem Index.

Commensurate measures of alcohol-related consequences across countries and cultures are critical for addressing the global burden of hazardous alcohol use. The Rutgers Alcohol Problem Index (RAPI), developed and validated in the United States, is a popular measure of alcohol problems. This study examined measurement invariance of the RAPI across samples of U.S. and Swedish high school seniors. Latent mean differences in alcohol problems across countries and differences in associations between alcohol problems with alcohol use and protective behavioral strategies (PBS) were also examined. The RAPI was scalar invariant. Swedish students reported fewer problems than U.S. students (latent mean difference = -0.19, p = .047). In both samples, the RAPI was positively correlated with alcohol use frequency and quantity (ps < .001), and negatively correlated with PBS use (ps < .05). Overall, the RAPI demonstrated measurement invariance, and we found evidence for its validity across samples of U.S. and Swedish high school seniors.

Descriptive Drinking Norms and Alcohol-Related Negative Consequences: A Moderated Mediation Model Involving Drinking Quantity and Protective Behavioral Strategies

We examined whether drinking quantity mediated the relationship between descriptive drinking norms and alcohol-related negative consequences, and if this was moderated by protective behavioral strategies (PBS) use. Undergraduate students ( n = 538, 78.0% female, mean age = 21.21 [ SD = 3.62]) from three Spanish universities completed a questionnaire. Simple and moderated mediation analyses were conducted. Drinking quantity fully mediated the relationship between descriptive drinking norms and alcohol consequences, and PBS moderated this relationship. Among participants with high PBS use, the impact of descriptive drinking norms on drinking quantity disappeared. The indirect effect of descriptive drinking norms on alcohol consequences through drinking quantity was significant for individuals with low/moderate PBS use levels, but not for those with high PBS use. Our findings shed light on how descriptive drinking norms influence alcohol-related negative consequences, and suggest that promoting the utilization of PBS could be an effective approach to ameliorate the impact of peer influences on drinking behavior.

Baseline protective behavioral strategy use predicts more moderate transdermal alcohol concentration dynamics and fewer negative consequences of drinking in young adults' natural settings.

Test whether frequent protective behavioral strategies (PBS) users report (a) fewer alcohol-related consequences and (b) less risky alcohol intoxication dynamics (measured via transdermal alcohol concentration [TAC] sensor "features") in daily life. Two hundred twenty-two frequently heavy-drinking young adults (Mage = 22.3 years) wore TAC sensors for 6 consecutive days. TAC features peak (maximum TAC), rise rate (speed of TAC increase), and area under the curve (AUC) were derived for each day. Negative alcohol-related consequences were measured in the morning after each self-reported drinking day. Past-year PBS use was measured at baseline. Young adults reporting more frequent baseline PBS use showed (a) fewer alcohol-related consequences and (b) lower intoxication dynamics on average (less AUC, lower peaks, and slower rise rates). Limiting/stopping and manner of drinking PBS showed the same pattern of findings as the total score. Serious harm reduction PBS predicted fewer negative alcohol-related consequences, but not TAC features. Multilevel path models showed that TAC features peak and rise rate partially explained associations between PBS (total, limiting/stopping, and manner of drinking) and consequences. Independent contributions of PBS subscales were small and nonsignificant, suggesting that total PBS use was a more important predictor of risk/protection than the specific types of PBS used. Young adults using more total PBS may experience fewer alcohol-related consequences during real-world drinking episodes in part through less risky intoxication dynamics (TAC features). Future research measuring PBS at the daily level is needed to formally test TAC features as day-level mechanisms of protection from acute alcohol-related consequences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Baseline Protective Behavioral Strategy Use Predicts More Moderate Transdermal Alcohol Concentration Dynamics and Fewer Negative Consequences of Drinking in Young Adults’ Natural Settings

Supplemental Material for Baseline Protective Behavioral Strategy Use Predicts More Moderate Transdermal Alcohol Concentration Dynamics and Fewer Negative Consequences of Drinking in Young Adults’ Natural Settings

Direct and indirect effects of cannabis risk perceptions on cannabis use frequency

Background Perceived risk of harm associated with cannabis use has decreased in recent decades, particularly among emerging adults who show the highest prevalence of use. Cannabis-related protective behavioral strategies (PBS) are associated with lower cannabis use and fewer consequences; however, individuals who perceive using cannabis as low risk may use cannabis PBS less often. Therefore, using cross-sectional data, we examined the associations between perceived risk of harm associated with cannabis use, cannabis PBS, and cannabis use frequency. Method Participants were 146 emerging adults between the ages of 18–25 (56.2% female) who reported consuming cannabis at least 3 times/week and completed measures of past-month cannabis use, past three-month use of cannabis PBS, and perceived risk of harm associated with cannabis use. Path analyses examined direct and indirect effects of perceived risk of cannabis-related harm on cannabis frequency through cannabis PBS. Results Most (66.4%) participants reported no perceived risk of harm associated with occasional cannabis use, whereas 30.1% reported no perceived risk of harm associated with regular cannabis use. Findings indicated a significant indirect effect between perceived risk of harm and cannabis use frequency through cannabis PBS, b = −10.23, SE = 3.80, 95% CI [−17.67, −2.80], p = .007. Conclusions Among emerging adults who consume cannabis regularly, findings suggest that a greater perceived risk of cannabis-related harm is associated with decreased cannabis use frequency via increased use of cannabis PBS. Although future analyses evaluating causal mechanisms are needed, these findings have clinical implications for harm reduction interventions focused on cannabis use. Trial Registration: The parent study from which these data were drawn was preregistered at Clinical Trials.Gov NCT04187989.

A comprehensive examination of motivational profiles for alcohol-related behaviors among college students.

Recent research demonstrates unique relations of types of motivation for drinking responsibly based on self-determination theory and drinking motives with alcohol-related outcomes among college students. In the present study, we sought to extend prior research by using a person-centered approach to simultaneously consider types of motivation within and across these motivational constructs as well as their synergistic relations with alcohol-related outcomes. We used cross-sectional survey data from 2,808 college students at 10 universities in eight states across the United States who reported past-month alcohol use (Mage = 20.59, SD = 4.18; 72.9% female; 58.2% non-Hispanic White). A series of latent profile analyses were conducted using types of motivation for drinking responsibly and drinking motives as indicators. A five-profile solution was selected as optimal. Mean comparisons indicated that profiles defined by high endorsement of higher quality motivations for drinking responsibly (i.e., more self-determined) and low endorsement of drinking motives in combination were related to the most frequent protective behavioral strategies use, least alcohol use, and fewest negative alcohol-related consequences. Additionally, these profiles were higher on dispositional autonomy and psychological need satisfaction and lower on psychological need frustration. These findings provide initial insight into simultaneously considering motivational profiles for the interrelated behaviors of drinking responsibly and drinking that can be leveraged in college drinking interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Latent profiles of cannabis use, protective behavioral strategies, and health beliefs in college students

College student cannabis use is prevalent and heterogeneous, with some students experiencing cannabis-related problems. Cannabis protective behavioral strategies (PBS) are cognitive-behavioral strategies associated with reduced cannabis use and problems. There is a need for theory-informed and person-centered research to better understand cannabis PBS. The current study applied the health belief model (HBM) and latent profile analysis to discern patterns of cannabis use, PBS, and health beliefs among college students. Students (n = 164; Mage = 18.8; 53% female) who endorsed past-month cannabis use completed an online survey between September and November 2017. The 3-profile model best fit the data. Profile 1 (24.3%) represents the “infrequent use/high protection” profile characterized by using cannabis about 1–9 times, high PBS use, high perceived threat and benefits, and moderate perceived barriers. Profile 2 (38.1%) represents the “occasional use/moderate protection” profile characterized by using cannabis about 20–59 times, moderate PBS use, moderate perceived threat and benefits, and low perceived barriers. Profile 3 (37.6%) represents the “frequent use/low protection” profile characterized by using cannabis about 80 or more times, low PBS use, low perceived threat and benefits, and high perceived barriers. Profiles did not differ by age, ethnicity/race, sex, or college year, though varied significantly by age at first cannabis use, cannabis availability, cannabis problems, use frequency, and use context. Results provide preliminary support for distinct patterns of cannabis use, PBS, and health beliefs that align with the HBM. Results highlight the importance of considering how students perceive cannabis PBS and problems and how those beliefs may influence their PBS and cannabis use.

Use of Both Alcohol and Cannabis Protective Behavioral Strategies is Associated with Fewer Negative Consequences: A Moderation Analysis

Background: Concurrent alcohol and cannabis (i.e. marijuana) use (CAM; use of both substances within the same specified time frame) is prevalent among college students and associated with increased risk of negative substance-related consequences. Extant research supports the use of protective behavioral strategies (PBS) for reducing negative consequences associated with both alcohol and cannabis use. However, limited research exists regarding the efficacy of PBS among CAM users, and it is unknown whether using PBS for both alcohol and cannabis augments protective effects. The present study tested four moderation models to evaluate the interactive effects of alcohol and cannabis PBS on alcohol and cannabis negative consequences and use frequency. Methods: A multisite sample of college students (N = 1705) reporting past-month CAM use completed questionnaires regarding substance use behaviors, PBS use, and substance-related negative consequences. Results: Alcohol and cannabis PBS were negatively associated with alcohol and cannabis use, respectively. However, two-way interactions between PBS on substance use were not supported, such that negative associations between PBS and same-substance use were not augmented as other-substance PBS use increased. Interactive effects of alcohol and cannabis PBS on negative alcohol and cannabis consequences were supported, such that negative associations between alcohol PBS and consequences were augmented as cannabis PBS increased and vice versa. Conclusions: Findings suggest that using both types of PBS may increase protective effects against negative consequences among CAM users. Accordingly, promoting both types of PBS may enhance extant harm reduction interventions.

An examination of the effects of ADHD symptoms and sex on the relation between cannabis protective behavioral strategies and cannabis consequences

The risk for cannabis-related problems is elevated among young adults with attention-deficit/hyperactivity disorder (ADHD) symptoms. It is unknown whether the use of cannabis protective behavioral strategies (PBS) mitigates this risk for college students with ADHD. Prior research finds that college students who use alcohol and report high levels of ADHD symptoms particularly benefit from employing alcohol PBS, and these relations are strongest for male students. Thus, this study examined the moderating effects of ADHD symptoms and sex assigned at birth on the relation between cannabis PBS use and cannabis-related problems among college students who use cannabis. Participants were 384 college students (66.9% female, 57.8% white non-Hispanic, Mage = 19.29) from 12 United States universities who reported past-month cannabis use. Participants completed measures of demographics, ADHD symptoms, past-month cannabis frequency and related problems, and cannabis PBS use via an online survey. There was a significant interaction of ADHD hyperactive/impulsive symptoms, PBS use, and sex on cannabis-related problems, controlling for cannabis use frequency. The strength of the negative association between PBS use and problems depended on level of ADHD symptoms for females, but not for males. However, there were no interactive effects for ADHD inattentive symptoms. These results supplement the literature base on relations between PBS use and ADHD symptoms in college students, extending support for their use to cannabis users. Importantly, promoting PBS use to female college students who are high in hyperactive/impulsive ADHD symptoms is recommended.