Alcohol misuse among college students is a persistent public health problem. Identifying the circumstances which influence alcohol misuse can inform the development of interventions to reduce risk for adverse outcomes in this population. Prior research suggests that people who engage in unplanned drinking report more alcohol-related consequences, and that unplanned heavy drinking is associated with consequences at the within-person level. The present study involved exploration of the within-person relationship between drinking events that were unplanned (vs. planned) in the morning and later quantity consumed, negative and positive consequences, and overall event evaluations. College student drinkers (N ϭ 96) provided data on their drinking experiences each morning during a 28-day ecological momentary assessment study. Hierarchical linear models revealed that unplanned drinking events were associated with lower alcohol quantity, fewer alcohol-related consequences, and lower ratings on how "worth it" the drinking event was, compared to planned events. In contrast to prior work highlighting the risk associated with unplanned heavy drinking, our findings indicate that drinking events that are planned (vs. unplanned) are related to increased consumption and the experience of negative consequences. Additional research is needed to more definitively assess the differences between planned and unplanned drinking events and their relationship to adverse alcohol-related outcomes among college students.

Background: Prior research identifies a range of potential predictors of blackouts and suggests that blackouts increase risk for additional negative consequences. However, these studies are based on epidemiological work that allows us to draw conclusions about groups of people but not within-person processes. The present study examined within-person, event-level correlates of blackouts.Methods: Ninety-six heavy drinking college students (52% female) completed 28 days of daily reports of alcohol use and consequences, including blackouts. Thirty-three participants reported 56 blackouts. Hierarchical linear modeling compared morning reports of drinking events on which participants did versus did not report a blackout, controlling for total drinks at the event.Results: Blackout likelihood increased as a function of total drinks consumed and of crossing thresholds for heavy episodic drinking (4+/5+ drinks for women/men) and high-intensity drinking (8+/ 10+). Participants reported a higher total number of additional negative consequences on blackout events. Specific consequences that were more likely included embarrassing oneself and hangover. Blackouts were associated with morning ratings of less positive mood and a less favorable drinking event.Motives for drinking and simultaneous use of marijuana were not associated with blackouts.Conclusions: Event-level findings of this study document that events leading to alcohol-induced memory loss are associated with other adverse experiences relative to drinking events that do not result in blackout, and offer potentially motivational levers for preventive interventions.

Planning and preparation for a large-scale nuclear event would be advanced by assessing the applicability of potentially available bio-dosimetry methods. Using an updated comparative framework the performance of six bio-dosimetry methods was compared for five different population sizes (100-1 000 000) and two rates for initiating processing of the marker (15 or 15 000 people per hour) with four additional time windows. These updated factors are extrinsic to the bio-dosimetry methods themselves but have direct effects on each method's ability to begin processing individuals and the size of the population that can be accommodated. The results indicate that increased population size, along with severely compromised infrastructure, increases the time needed to triage, which decreases the usefulness of many time intensive dosimetry methods. This framework and model for evaluating biodosimetry provides important information for policy-makers and response planners to facilitate evaluation of each method and should advance coordination of these methods into effective triage plans.

Objective: To pilot test two low-cost and thus financially sustainable incentive programs to promote physical activity (PA) among low-active adults in a community setting. Method: In a three-arm randomized controlled trial the effects of small monetary incentives (cash incentives $1/day; n ϭ 25) were compared to charitable donations (donation $1/day; n ϭ 25) and a control group (n ϭ 25) on PA behavior over the course of 12 months in insufficiently active, otherwise healthy adults. Incentives were based on attendance at a local YMCA. Electronic swipe card data from the YMCA was the primary outcome, with self-reported minutes of PA as a secondary outcome. Results: Quantile regression models showed promising effects of treatment allocation on the primary outcome (attendance) adjusted for age and employment. There was a difference between cash incentives and control conditions such that median attendance in the cash incentives condition was 19.24 visits more over 12 months (b ϭ 19.24; SE ϭ 8.26, 95% CI [2.75, 35.72]). There was a similar though only marginally significant trend for the donation condition showing that participants in the donation condition made 11.88 additional visits to the YMCA over 12 months relative to the control condition (b ϭ 11.88, SE ϭ 8.41,95% CI [Ϫ0.91, 28.67]). There was a significant correlation between objectively verified YMCA attendance and self-reported moderate-to-vigorous PA at the YMCA ( ϭ 0.587) over 12 months. Conclusions: These promising findings provide early support for small monetary incentives and charitable donations for promoting PA in community settings. Further research on the efficacy of using financially sustainable incentive programs, including charitable donations, for PA through community organizations (e.g., YMCAs) seems warranted.

Correcting misperceptions in drinking norms is an established method of reducing college student drinking; however, delivery of accurate norms has typically been limited to a single dose within the confines of an alcohol intervention. The present study tests the feasibility, acceptability, and preliminary efficacy of using text messages to promote pro-moderation descriptive and injunctive norms. Following a baseline survey, 68 heavy drinking college students were randomly assigned to receive 28 daily messages with either accurate norms information (experimental group, n=34) or fun facts (control group, n=34). Participants rated each message on a 5-point scale of interest, and at the end of the 28days completed a follow-up assessment of normative perceptions and drinking behavior. The study protocol was feasible: 87% of invited students completed the screener, 64% of eligible students completed the consent form, and 93% agreed to participate. All messages were delivered and 98% were rated. Regarding acceptability, the mean interest rating for the alcohol-related text messages was 2.84 (SD=1.30), and no participants withdrew from the study. Although between-group differences were not observed at follow-up, participants in the experimental group showed significant reductions between baseline and follow-up on peak drinks, frequency of heavy episodic drinking (HED), negative consequences, and injunctive norms (ps<0.01). Results lay the groundwork for development of a text-based prevention strategy for use in college settings.

College students may subjectively evaluate the consequences of drinking in unexpected ways, rating "negative" consequences as neutral or even positive experiences. We previously gathered qualitative evidence for several contextual factors that may influence one's subjective evaluations (e.g., social influences, intoxication level, concurrent positive consequences). The purpose of the present study was to quantitatively investigate whether student evaluations of consequences differ by various contextual factors. We administered an anonymous online survey to 214 college students (76% female, 69% drinkers, 48% heavy drinkers) in return for academic credit, on which they reported how positively or negatively they would evaluate 6 alcohol-related consequences (e.g., vomiting, being rude, blacking out) under different conditions. Paired samples tests were used to compare evaluation ratings, averaged across consequences, under different hypothetical contextual conditions (e.g., among friends vs. strangers). Out of 16 contextual comparisons, all but one (first-time vs. repeated consequence) revealed significant differences in subjective evaluations; the pattern held in reduced samples of just drinkers or just heavy drinkers. Examples include that consequences were viewed more negatively (a) if occurring at either a party or bar versus alone in one's home/dorm, (b) if friends express concern versus find it funny, (c) if the consequence was expected versus unexpected, and (d) if there are lasting consequences versus none. When using recent consequences in feedback-based interventions to build motivation to change, it may be useful to discuss the context of a consequence and how this influences the perceived aversiveness of that consequence. (PsycINFO Database Record

Use of alcohol and cannabis together so their effects overlap (simultaneous use) is common among college students and associated with numerous negative consequences. The aim of this study was to gain insight into college students' recent simultaneous use events in order to inform future studies (i.e., generate hypotheses, inform measures/assessments of simultaneous use, and identify factors influencing simultaneous use). Qualitative interviews of simultaneous use experiences among heavy drinking college students (n = 38) were conducted to better understand reasons for simultaneous use, evaluations of simultaneous use events, and patterns of substance use during simultaneous use events. Findings indicated that students' reasons for simultaneous use included traditional four-factor motive types (i.e., social, conformity, enhancement, and coping), cross-fading motives, harm reduction motives (e.g., to drink less), and reactive/situational reasons (e.g., because it was offered/available). There was variability in participants' subjective evaluations of how positive versus negative simultaneous use events were and how this compared to single-substance events. Evaluation of simultaneous use events depended on patterns of use, external and internal context, and consequences experienced. Additionally, patterns of simultaneous use including order of substances, timing of using each substance, and quantities of substances used were highly variable across participants. Notably, participants endorsed patterns of use they perceived to reduce negative consequences during simultaneous use events. Further research on reasons for simultaneous use and patterns of use may help identify simultaneous use occasions that result in greater risk; identification of high-risk simultaneous use occasions and evaluation of these occasions can then help inform targeted interventions. Public Health Significance StatementThis study highlights variations in reasons for simultaneous alcohol and cannabis use, evaluations for simultaneous use, and patterns of use. Understanding reasons and corresponding patterns of simultaneous use may help to identify risky simultaneous use occasions. Understanding evaluations of these occasions may help to predict future substance use behavior and inform prevention and intervention efforts aimed at reducing simultaneous use and associated harms.

Objective: Simultaneous alcohol and cannabis use is common among college students and associated with more consumption and consequences compared to single-substance use. This study examined occasions of simultaneous use and compared planned occasions to unplanned occasions with respect to motives, contexts, consumption, and consequences. Method: College student simultaneous users (N = 341; 53% women; 74% White) completed five daily surveys for 54 days. Mixed-effects models examined motives and contexts of simultaneous use occasions as a function of whether alcohol and cannabis use were (a) both planned versus (b) unplanned, no use planned, or (c) unplanned, single-substance use planned and whether alcohol and cannabis consumption and negative simultaneous use-related consequences varied across planned versus unplanned occasions. Results: Social and enhancement motives were related to planned simultaneous use; offered and coping motives were associated with planned single-substance use that became simultaneous use (vs. planned simultaneous use). Compared to unplanned use, planned simultaneous use was negatively associated with using at home or alone, and positively associated with using with others, more intoxicated people, and more people using cannabis. Planned simultaneous use was associated with more alcohol and cannabis consumption. No significant differences were found for negative consequences. Conclusions: Planned simultaneous use was motivated by social and enhancement reasons, whereas planned single-substance use that became simultaneous use was more likely motivated by offers or for coping. Planned simultaneous use resulted in greater consumption, but not negative consequences. Results provide specific motives and contexts associated with unplanned and planned simultaneous use to be incorporated into real-time interventions. Public Health Significance StatementThis study highlights the importance of understanding predictors and outcomes of planned simultaneous alcohol and cannabis use compared to simultaneous use that was not planned (either no plans for any use or plans for either alcohol or cannabis but not both). Positive-reinforcement motives and socialorientated context may be important targets for risky planned simultaneous use occasions.