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Alcohol Protective Behavioral Strategy Use and Negative Consequences across Heavy Alcohol Users and Risky Drinkers

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Title: Alcohol Protective Behavioral Strategy Use and Negative Consequences across Heavy Alcohol Users and Risky Drinkers
Language: English
Authors: Skyler M. Hoover, Molly J. Swinney, Lauren A. Greenspoon, Michael B. Madson (ORCID 0000-0002-2025-8856), Byron L. Zamboanga, Morgan Haga
Source: Journal of Drug Education. 2025 54(1):3-16.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 14
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Alcohol Abuse, Drinking, College Students, Student Behavior, Risk, Gender Differences, Health Behavior, Negative Reinforcement, Behavior Modification
Geographic Terms: Arkansas, California, Colorado, Florida, Mississippi, Montana, New Mexico, Oklahoma, Pennsylvania, Texas, Wisconsin, Wyoming
DOI: 10.1177/00472379241278325
ISSN: 0047-2379
1541-4159
Abstract: This study investigated differences in alcohol protective behavioral strategy (PBSA) use and negative consequences (ARNC) experienced among heavy alcohol users and non-heavy alcohol users, and risky and non-risky drinkers. Participants were from 12 universities in the United States (n = 2,163 college students, M[subscript age] = 19.47), predominantly identified as White (74%), and female (68.7%), who completed measures of typical weekly drinking, risky drinking, ARNC, and PBSA use. ANOVAs revealed that the heavy alcohol users and risky drinkers reported significantly fewer total PBSA, subtype strategy use, and greater negative consequences than their counterparts. Harm reduction interventions may benefit from identifying and targeting college students who are engaging in heavy alcohol use and risky drinking regardless of sex.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1465705
Database: ERIC
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  Value: <anid>AN0183198832;jdr01mar.25;2025Feb25.03:44;v2.2.500</anid> <title id="AN0183198832-1">Alcohol Protective Behavioral Strategy use and Negative Consequences Across Heavy Alcohol Users and Risky Drinkers </title> <p>This study investigated differences in alcohol protective behavioral strategy (PBSA) use and negative consequences (ARNC) experienced among heavy alcohol users and non-heavy alcohol users, and risky and non-risky drinkers. Participants were from 12 universities in the United States (n = 2,163 college students, M <sub>age </sub>= 19.47), predominantly identified as White (74%), and female (68.7%), who completed measures of typical weekly drinking, risky drinking, ARNC, and PBSA use. ANOVAs revealed that the heavy alcohol users and risky drinkers reported significantly fewer total PBSA, subtype strategy use, and greater negative consequences than their counterparts. Harm reduction interventions may benefit from identifying and targeting college students who are engaging in heavy alcohol use and risky drinking regardless of sex.</p> <p>Keywords: risky drinkers; heavy alcohol use; protective behavioral strategies; negative consequences; group differences</p> <p>Alcohol use by college students remains a public health concern as they report drinking at greater levels that might meet criteria for an Alcohol Use Disorder (i.e., difficulties controlling alcohol use despite impairment on life [AUD]) than their non-college peers (Alcohol use- 48.2% vs. 41.6%; AUD- 16.2% vs 12.4%; [<reflink idref="bib22" id="ref1">22</reflink>]). Studying drinking behaviors that put college students at risk for negative physical, academic, social, and emotional consequences remains important to better inform harm reduction efforts ([<reflink idref="bib15" id="ref2">15</reflink>]). Deconstructing such drinking behaviors, for example, heavy alcohol use and risky drinking, enables more targeted intervention efforts.</p> <p>Identifying students who engage in alcohol use behaviors associated with greater negative drinking consequences remains an important endeavor in research. Heavy alcohol use, as defined by the National Institute of Alcohol Abuse and Alcoholism (NIAAA), involves exceeding the safe drinking limits set for daily and weekly alcohol use (i.e., 4 drinks daily and 8 drinks per week for women, 5 drinks daily and 15 drinks per week for men; [<reflink idref="bib14" id="ref3">14</reflink>]). College students who drink within these limits are less likely to develop an AUD than those who exceed these limits ([<reflink idref="bib27" id="ref4">27</reflink>]). In 2020, 7.8% of college students endorsed engaging in heavy alcohol use in the past 30 days ([<reflink idref="bib22" id="ref5">22</reflink>]). In contrast, college students who engage in heavy alcohol use experience higher rates of negative consequences and are at greater risk of developing an AUD than those who do not drink heavily (HHS, n.d.). The guidelines outlined by the [<reflink idref="bib14" id="ref6">14</reflink>] are only one means of identifying college students at risk for greater consequences. Broader conceptualizations of dangerous alcohol use, such as "risky drinking" (e.g., exceeding safe drinking guidelines; [<reflink idref="bib14" id="ref7">14</reflink>]), is similarly important to continue to investigate.</p> <p>Risky drinking as identified by the US-AUDIT consumption subscale ([<reflink idref="bib3" id="ref8">3</reflink>]) provides a broader look into harmful alcohol use. Where the [<reflink idref="bib14" id="ref9">14</reflink>] guidelines for heavy alcohol use focuses on weekly/daily quantity, risky drinking measured by the US-AUDIT consumption subscale importantly includes binge drinking behaviors (i.e., in a two hour period consuming 4 or more drinks for females or 5 or more drinks for males; [<reflink idref="bib14" id="ref10">14</reflink>]). This distinction and use of rigorous measurement is important for identifying college students who are at risk for not only negative drinking consequences, but also an AUD. Indeed, [<reflink idref="bib11" id="ref11">11</reflink>] established a cutoff score of 4 for males and females on the US-AUDIT consumption subscale which indicates the presence of risky drinking. In 2020, 24.2% to 28.5% of full-time college students reported risky drinking ([<reflink idref="bib22" id="ref12">22</reflink>]; [<reflink idref="bib19" id="ref13">19</reflink>]). Given the prevalence of heavy alcohol use and risky drinking among college students, examining differences in alcohol use, negative consequences, and harm reduction use allows for identification of potentially clinically relevant patterns of alcohol use for intervention.</p> <p>A need remains to better understand the differences in utilization of harm reduction strategies within the context of heavy alcohol use and risky drinking to better inform intervention and prevention targets ([<reflink idref="bib18" id="ref14">18</reflink>]), as most research explores the associations between alcohol consumption and harm reduction. However, examining differences in college students who engage in heavy alcohol use or risky drinking to those who do not presents a novel route to assisting prevention and intervention efforts.</p> <hd id="AN0183198832-2">Alcohol protective behavioral strategies</hd> <p>Alcohol protective behavioral strategy (PBSA) use tends to be negatively associated with alcohol consumption and consequences ([<reflink idref="bib16" id="ref15">16</reflink>]). However, when examining the types of PBSA, differential effects emerge. Strategies focused on alcohol consumption [i.e., manner of drinking (e.g., avoiding drinking games) and stopping/limiting drinking (e.g., leave the bar/party at a predetermined time) ] tend to be associated with less alcohol consumption ([<reflink idref="bib10" id="ref16">10</reflink>]), though these results have been less supportive of stopping/limiting drinking ([<reflink idref="bib13" id="ref17">13</reflink>]). Serious harm reduction strategies (e.g., using a designated driver) are typically associated with less negative consequences ([<reflink idref="bib9" id="ref18">9</reflink>]). An inverse association tends to exist between PBSA, and its subtypes, with heavy alcohol use ([<reflink idref="bib7" id="ref19">7</reflink>]), risky drinking ([<reflink idref="bib26" id="ref20">26</reflink>]), and negative consequences in college student populations ([<reflink idref="bib12" id="ref21">12</reflink>]). However, there are limited studies comparing differences in PBSA use among college students who do or do not engage in heavy alcohol use or risky drinking, as categories of drinking behavior. Categorizing students based on their alcohol use behaviors may provide important implications for developing individualized harm reduction-based interventions that better match students' alcohol use.</p> <hd id="AN0183198832-3">Differences by sex</hd> <p>Research related to sex differences in heavy alcohol use contain notable findings. Male college students endorsed rates of heavy alcohol use in the past 30 days at 9.3% compared to 6.2% of females ([<reflink idref="bib23" id="ref22">23</reflink>]). Interestingly, recent estimates suggested males and females engage in risky drinking at similar rates (26.8% vs 29.3% respectively; [<reflink idref="bib23" id="ref23">23</reflink>]). Females appear to report fewer negative consequences ([<reflink idref="bib20" id="ref24">20</reflink>]) although some findings suggest females experience more emotional and physical negative consequences ([<reflink idref="bib15" id="ref25">15</reflink>]). Sex differences in PBSA use consistently support that females use more PBSA and subtypes when compared to males ([<reflink idref="bib21" id="ref26">21</reflink>]). However, with the recent prevalence rate of risky drinking and differences in negative consequences experienced, it is important to continue to explore sex differences.</p> <hd id="AN0183198832-4">The present study</hd> <p>The associations between heavy alcohol use to negative consequences and PBSA is well established when drinking is explored as a continuous variable (HHS, n.d.; [<reflink idref="bib7" id="ref27">7</reflink>]); the same is true for risky drinking ([<reflink idref="bib26" id="ref28">26</reflink>]). However, less is known about how these relationships function when categorizing heavy alcohol use or risky drinking behaviors. Further, mixed findings remain for heavy alcohol use, risky drinking, negative consequences, and PBSA use in the context of sex, warranting continued investigation.</p> <p>The present study examined differences in negative consequences and PBSA use among those who do and do not engage in heavy alcohol use (according to [<reflink idref="bib14" id="ref29">14</reflink>] guidelines) and risky drinking (defined by [<reflink idref="bib11" id="ref30">11</reflink>]), while also testing for potential sex (biological sex assigned at birth) interaction effects. We hypothesized that college students who engage in heavy alcohol use would report greater negative consequences and less use of total PBSA and subtypes when compared to those who do not engage in heavy alcohol use. Those who engage in risky drinking would experience more negative consequences and use less PBSA, and its subtypes, when compared to non-risky drinkers. Finally, we hypothesized interaction effects by sex would emerge.</p> <hd id="AN0183198832-5">Method</hd> <p></p> <hd id="AN0183198832-6">Participants and procedures</hd> <p>Participants for this study were recruited using the psychology subject pool at 12 universities from different states throughout the country (Arkansas, California, Colorado, Florida, Mississippi, Montana, New Mexico, Oklahoma, Pennsylvania, Texas, Wisconsin, Wyoming). Universities were selected specifically to represent the five major regions of the United States. In total, there were 3,707 participants who completed the larger study on substance use and health. To be eligible, participants had to have used any substance within the past month, be between the ages of 18–25, identified their sex assigned at birth, completed the study measures and provided consent to participate. However, the sample for this project was limited to participants who reported alcohol use within the past month and completed specific study measures. As a result, 1,287 participants were removed for failing validity checks, and 255 were removed for missing data and/or for reporting zero drinks on average per week in the past month while also obtaining a score of zero on the US-AUDIT-C. Thus, the analytic sample used in this study consisted of 2,163 total participants with a mean age of 19.47 (<emph>Median </emph>= 19.00, <emph>SD </emph>= 1.45). The majority of participants reported being assigned female at birth (68.7%) and White (74%). See Table 1 for additional demographic details about the sample.</p> <p>Table 1. Demographic characteristics of the analytic sample</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="center" /><col align="char" char="." /><col align="left" /><col align="center" /><col align="center" /></colgroup><thead><tr><th align="left">Demographic</th><th align="center">N</th><th align="center">%</th><th align="left">Demographic</th><th align="center">N</th><th align="center">%</th></tr></thead><tbody><tr><td>Sex</td><td /><td /><td>Type of University</td><td /><td /></tr><tr><td>Female</td><td>1662</td><td>69</td><td>Public/state</td><td>2003</td><td>82.8</td></tr><tr><td>Male</td><td>748</td><td>30.9</td><td>Private</td><td>387</td><td>16</td></tr><tr><td>Intersex</td><td>2</td><td><1</td><td>Liberal Arts College</td><td>18</td><td><1</td></tr><tr><td /><td /><td /><td>Religiously Affiliated</td><td>4</td><td><1</td></tr><tr><td>Race</td><td /><td /><td /><td /><td /></tr><tr><td>White</td><td>1790</td><td>74</td><td>Class Standing</td><td /><td /></tr><tr><td>Multiracial</td><td>233</td><td>9.6</td><td>Freshmen</td><td>1114</td><td>46</td></tr><tr><td>Hispanic</td><td>204</td><td>8.4</td><td>Sophomore</td><td>612</td><td>25.3</td></tr><tr><td>African American</td><td>101</td><td>4.2</td><td>Junior</td><td>388</td><td>16</td></tr><tr><td>Asian American</td><td>69</td><td>2.9</td><td>Senior</td><td>298</td><td>12.3</td></tr><tr><td>Native American</td><td>11</td><td><1</td><td /><td /><td /></tr><tr><td>Native Hawaiian</td><td>2</td><td><1</td><td>Taking Classes</td><td /><td /></tr><tr><td>Other not listed</td><td>8</td><td><1</td><td>Fully in person</td><td>34</td><td>1.4</td></tr><tr><td /><td /><td /><td>Fully online</td><td>1169</td><td>48.3</td></tr><tr><td>Region of the U. S.</td><td /><td /><td>Both face to face and online</td><td>1209</td><td>50</td></tr><tr><td>Northeast</td><td>100</td><td>4.1</td><td /><td /><td /></tr><tr><td>Southeast</td><td>612</td><td>25.3</td><td /><td /><td /></tr><tr><td>Midwest</td><td>94</td><td>3.9</td><td /><td /><td /></tr><tr><td>West/Northwest</td><td>1112</td><td>46</td><td /><td /><td /></tr><tr><td>Southwest</td><td>494</td><td>20.4</td><td /><td /><td /></tr></tbody></table> </ephtml> </p> <p>A single-site institutional review board approval was used, and all study procedures were approved by the board at the University of Southern Mississippi. The procedures were consistent across all sites with participants reading and electronically consenting to participate. After consenting, all participants completed a demographic form followed by all measures of substance use behaviors. After completing the substance use behavior measures, all participants completed a random sample of 10 measures that assessed social-cognitive constructs (e.g., drinking motives), health (e.g., sleep), and mental health. All data were collected from September 2020 to May 2021 during an academic pandemic year. Other than the demographic form, all measures were presented in random order to prevent testing effects. A matrix sampling design was used to reduce fatigue. More information about the larger study is presented in [<reflink idref="bib4" id="ref31">4</reflink>].</p> <hd id="AN0183198832-7">Measures</hd> <p> <emph>Heavy Alcohol Use</emph>. The Daily Drinking Questionnaire (DDQ; [<reflink idref="bib1" id="ref32">1</reflink>]) was used to assess heavy alcohol use. Participants were presented with descriptions of what constitutes a standard drink and indicated the number of standard drinks they typically drink each day during a week. The number of typical drinks consumed weekly is calculated by summing drinks consumed each day. [<reflink idref="bib14" id="ref33">14</reflink>] guidelines for heavy alcohol use were used (i.e., 4 drinks daily and 8 drinks per week for women, 5 drinks daily and 15 drinks per week for men).</p> <p> <emph>Risky Drinking.</emph> The three-item Alcohol Use Disorders Identification Test-United States-Consumption (AUDIT-US-C) subscale was used to identify risky drinking ([<reflink idref="bib3" id="ref34">3</reflink>]). Compared to the original AUDIT where all three items are scored on a five-point scale, two items are scored on a seven-point scale ranging from "0" (never) to "6" (daily) and one item is scored on a seven-point scale ranging from "0" (1 drink) to "6" (10 or more drinks). Further, one item is revised to read, "In the past year, how often do you have 5 drinks (male) or 4 drinks (female) or more on one occasion" to account for sex differences in binge drinking. Total scores are the sum of all three items and range from "0" to "18", with greater hazardous drinking reflected by higher scores. [<reflink idref="bib11" id="ref35">11</reflink>] found a single score of 4 on AUDIT-US-C suggests risky drinking for men and women college students. Internal consistency was acceptable in this study (α =.79).</p> <p> <emph>Protective Behavioral Strategy Use.</emph> Participants use of PBSA was assessed using the 20-item Protective Behavioral Strategy Scale-20 (PBSS-20; [<reflink idref="bib25" id="ref36">25</reflink>]). The PBSS includes a total score (20 items ranging 20–140, α =.91) and three subscales; serious harm reduction (SHR, 8 items ranging from 8–48, α =.80), stopping/limiting drinking (SLD, 7 items ranging from 7–42, α =.67), and manner of drinking (MOD; 5 items ranging from 5–30, α =.84). Participants reported the degree to which they use each strategy, such as "keep an eye on your drink", "avoid combining alcohol with marijuana", and "leave the bar/party at a predetermined time" using a Likert-type scale ranging from "1" (never) to "6" (always) so that higher scores on each subscale indicated greater use of that strategy.</p> <p> <emph>Negative consequences.</emph> Participants' experience of negative consequence was assessed using the 24-item Brief Young Adult Alcohol Consequences Questionnaire (BYAACQ; [<reflink idref="bib5" id="ref37">5</reflink>]). Participants were presented with negative consequences such as "I have taken foolish risks when I have been drinking" and "I have spent too much time drinking" and indicated whether they experienced each consequence by responding "no" (0) or "yes" (<reflink idref="bib1" id="ref38">1</reflink>). Scores range from "0" to "24" based on the number of items endorsed as "yes". The internal consistency was good in this sample (α =.89).</p> <hd id="AN0183198832-8">Data analytic plan</hd> <p>To test for group differences, Analysis of Variances (ANOVA) were performed with participants divided into two groups, heavy alcohol users and non-heavy alcohol users, based on reported average weekly alcohol consumption ([<reflink idref="bib14" id="ref39">14</reflink>]). In addition, participants were also divided into groups of risky or non-risky drinkers ([<reflink idref="bib11" id="ref40">11</reflink>]).</p> <p>One-way ANOVAs were used when examining group differences in number of negative consequences experienced, PBSA use, and strategy subtype use among heavy alcohol users and non-heavy alcohol users, and among risky and non-risky drinkers. In instances where Levene's test of equality of variances was non-significant, the classical F-test is reported. Where Levene's test is significant, Welch's F-test is reported. Statistically significant interactions are reported with their simple main effects.</p> <hd id="AN0183198832-9">Results</hd> <p>As seen in Table 2, heavy alcohol use and risky drinking were positively correlated with negative consequences and negatively correlated with PBSA and subtype use, while negative consequences were negatively correlated with PBSA and its subtypes. Table 3 provides bivariate correlations for males and females.</p> <p>Table 2. Correlations, means, and standard deviations for selected measures for total sample</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="center" /></colgroup><thead><tr><th align="left">Scale</th><th align="center">1</th><th align="center">2</th><th align="center">3</th><th align="center">4</th><th align="center">5</th><th align="center">6</th><th align="center">7</th></tr></thead><tbody><tr><td>1. DDQ</td><td>-</td><td /><td /><td /><td /><td /><td /></tr><tr><td>2. US-AUDIT-C</td><td>0.74*</td><td>-</td><td /><td /><td /><td /><td /></tr><tr><td>3. PBSA Total</td><td>−0.35*</td><td>−0.39*</td><td>-</td><td /><td /><td /><td /></tr><tr><td>4. PBSA- MOD</td><td>−0.41*</td><td>−0.50*</td><td>0.82*</td><td>-</td><td /><td /><td /></tr><tr><td>5. PBSA- SLD</td><td>−0.26*</td><td>−0.32*</td><td>0.88*</td><td>0.63*</td><td>-</td><td /><td /></tr><tr><td>6. PBSA- SHR</td><td>−0.23*</td><td>−0.20*</td><td>0.78*</td><td>0.47*</td><td>0.51*</td><td>-</td><td /></tr><tr><td>7. BYAACQ</td><td>0.49*</td><td>0.53*</td><td>−0.31*</td><td>−0.38*</td><td>−0.22*</td><td>−0.21*</td><td>-</td></tr><tr><td>Mean</td><td>9.28</td><td>7.29</td><td>85.85</td><td>18.22</td><td>25.72</td><td>42.04</td><td>5.76</td></tr><tr><td>SD</td><td>9.08</td><td>3.19</td><td>18.05</td><td>6.22</td><td>8.50</td><td>6.57</td><td>4.82</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note: DDQ </emph>= Daily Drinking Questionnaire, <emph>US-AUDIT-C </emph>= US Alcohol Use Identification Test Consumption subscale, <emph>PBSA Total </emph>= Protective Behavioral Strategies Survey 20 total score, <emph>PBSA-MOD </emph>= Manner of Drinking strategies, <emph>PBSA-SLD </emph>= Stopping/Limiting Drinking strategies, <emph>PBSA-SHR </emph>= Serious Harm Reduction strategies, <emph>BYAACQ </emph>= Brief Young Adult Alcohol Consequences Questionnaire, <emph>SD </emph>= Standard Deviation.</p> <p>2 * <emph>p </emph>≤.01.</p> <p>Table 3. Correlations, means, and standard deviations for selected measures for males and females</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Scale</th><th align="center">1</th><th align="center">2</th><th align="center">3</th><th align="center">4</th><th align="center">5</th><th align="center">6</th><th align="center">7</th><th align="center">Mean</th><th align="center">SD</th></tr></thead><tbody><tr><td>1. DDQ</td><td>-</td><td>0.72*</td><td>−0.34*</td><td>−0.40*</td><td>−0.26*</td><td>−0.17*</td><td>0.51*</td><td>8.18</td><td>7.72</td></tr><tr><td>2. US-AUDIT-C</td><td>0.77*</td><td>-</td><td>−0.38*</td><td>−0.48*</td><td>−0.31*</td><td>−0.14*</td><td>0.53*</td><td>6.94</td><td>3.04</td></tr><tr><td>3. PBSA Total</td><td>−0.30*</td><td>−0.36*</td><td>-</td><td>0.82*</td><td>0.88*</td><td>0.73*</td><td>−0.35*</td><td>88.61</td><td>16.82</td></tr><tr><td>4. PBSA- MOD</td><td>−0.39*</td><td>−0.50*</td><td>0.82*</td><td>-</td><td>0.61*</td><td>0.42*</td><td>−0.40*</td><td>18.81</td><td>6.01</td></tr><tr><td>5. PBSA- SLD</td><td>−0.21*</td><td>−0.27*</td><td>0.87*</td><td>0.62*</td><td>-</td><td>0.45*</td><td>−0.25*</td><td>26.72</td><td>8.34</td></tr><tr><td>6. PBSA- SHR</td><td>−0.21*</td><td>−0.19*</td><td>0.82*</td><td>0.51*</td><td>0.56*</td><td>-</td><td>−0.30*</td><td>43.25</td><td>5.63</td></tr><tr><td>7. BYAACQ</td><td>0.52*</td><td>0.55*</td><td>−0.26*</td><td>−0.35*</td><td>−0.16*</td><td>−0.20*</td><td>-</td><td>5.77</td><td>4.80</td></tr><tr><td>Mean</td><td>11.75</td><td>8.08</td><td>79.70</td><td>16.90</td><td>23.52</td><td>39.36</td><td>5.73</td><td /><td /></tr><tr><td>SD</td><td>11.17</td><td>3.37</td><td>19.18</td><td>6.49</td><td>8.42</td><td>7.64</td><td>4.87</td><td /><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>3 <emph>Note:</emph> Values for females are below the diagonal, whereas values for males are above the diagonal. <emph>DDQ </emph>= Daily Drinking Questionnaire, <emph>US-AUDIT-C </emph>= US Alcohol Use Identification Test Consumption subscale, <emph>PBSA Total </emph>= Protective Behavioral Strategies Survey 20 total score, <emph>PBSA-MOD </emph>= Manner of Drinking strategies, <emph>PBSA-SLD </emph>= Stopping/Limiting Drinking strategies, <emph>PBSA-SHR </emph>= Serious Harm Reduction strategies, <emph>BYAACQ </emph>= Brief Young Adult Alcohol Consequences Questionnaire, <emph>SD </emph>= Standard Deviation</item> <item>4 * <emph>p </emph>≤.01.</item> </ulist> <hd id="AN0183198832-10">Heavy alcohol use versus non-heavy alcohol use</hd> <p>Significant differences between heavy alcohol users and non-heavy alcohol users were found in all outcome variables (see Table 4). Significantly fewer total PBSA and subtypes (i.e., manner of drinking, stopping/limiting drinking, serious harm reduction) were used by heavy alcohol users compared to non-heavy alcohol users. Additionally, heavy alcohol users endorsed significantly greater amounts of alcohol related negative consequences.</p> <p>Table 4. Means, standard deviations, and one-way analyses of variance for heavy alcohol users and non-heavy alcohol users</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="center" /><col align="center" /></colgroup><thead><tr><th align="left">Measure</th><th align="center" colspan="2">Non-Heavy Alcohol Users</th><th align="center" colspan="2">Heavy Alcohol Users</th><th align="center" /><th align="center" /></tr><tr><th align="center" /><th align="center">M</th><th align="center">SD</th><th align="center">M</th><th align="center">SD</th><th align="center"><italic>F<sub>Welch</sub></italic>(1, 1716.25)</th><th align="center">η<sup>2</sup> (95% CI)</th></tr></thead><tbody><tr><td>PBSA Total</td><td>88.96</td><td>18.36</td><td>80.61</td><td>16.28</td><td>111.34</td><td>.05 (.03,.07)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F<sub>Welch</sub></italic> (1, 1712.01)</td><td>η2 (95% CI)</td></tr><tr><td>PBSA- MOD</td><td>19.80</td><td>6.13</td><td>15.55</td><td>5.43</td><td>258.56</td><td>.10 (.08,.13)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F<sub>Welch</sub></italic>(1, 1717.57)</td><td>η2 (95% CI)</td></tr><tr><td>PBSA- SLD</td><td>26.83</td><td>8.74</td><td>23.86</td><td>7.74</td><td>61.89</td><td>.02 (.01,.04)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F</italic>(1, 1982.00)</td><td>η2 (95% CI)</td></tr><tr><td>PBSA- SHR</td><td>42.46</td><td>6.72</td><td>41.34</td><td>6.26</td><td>13.46</td><td>.007 (.001,.01)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F<sub>Wlech</sub></italic>(1, 1333.51)</td><td>η2 (95% CI)</td></tr><tr><td>BYAACQ Total</td><td>4.08</td><td>3.86</td><td>8.48</td><td>4.99</td><td>436.52</td><td>.19 (.16,.22)</td></tr></tbody></table> </ephtml> </p> <p>5 <emph>Note: All</emph> were significant at <emph>p </emph><.001. <emph>PBSA Total </emph>= Protective Behavioral Strategies Survey 20 total score, <emph>PBSA-MOD </emph>= Manner of Drinking strategies, <emph>PBSA-SLD </emph>= Stopping/Limiting Drinking strategies, <emph>PBSA-SHR </emph>= Serious Harm Reduction strategies, <emph>BYAACQ </emph>= Brief Young Adult Alcohol Consequences Questionnaire, <emph>M </emph>= Mean, <emph>SD </emph>= Standard Deviation.</p> <hd id="AN0183198832-11">Risky versus non-risky drinkers</hd> <p>As seen in Table 5, risky drinkers reported using fewer total PBSA use compared to non-risky drinkers. Examination of differences in subtype use revealed non-risky drinkers used more stopping/limiting drinking, manner of drinking, and serious harm reduction strategies compared to risky drinkers. Further, non-risky drinkers reported fewer negative consequences than risky drinkers.</p> <p>Table 5. Means, standard deviations, and one-way analyses of variance for non-risky and risky drinkers</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="center" /><col align="center" /></colgroup><thead><tr><th align="left">Measure</th><th align="center" colspan="2">Non-Risky</th><th align="center" colspan="2">Risky</th><th /><th /></tr><tr><th align="center" /><th align="center">M</th><th align="center">SD</th><th align="center">M</th><th align="center">SD</th><th align="center"><italic>F</italic>(1, 1924)</th><th align="center">η<sup>2</sup> (95% CI)</th></tr></thead><tbody><tr><td>PBSA Total</td><td>96.60</td><td>20.76</td><td>84.59</td><td>16.91</td><td>93.55</td><td>.04 (.03,.06)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F</italic>(1, 1923)</td><td>η2 (95% CI)</td></tr><tr><td>PBSA- MOD</td><td>23.78</td><td>6.11</td><td>17.52</td><td>5.86</td><td>220.42</td><td>.10 (.07,.12)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F<sub>Welch</sub></italic>(1, 266.39)</td><td>η2 (95% CI)</td></tr><tr><td>PBSA- SLD</td><td>29.91</td><td>9.41</td><td>25.18</td><td>8.18</td><td>51.13</td><td>.03 (.01,.04)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F</italic>(1, 1922)</td><td>η2 (95% CI)</td></tr><tr><td>PBSA- SHR</td><td>43.19</td><td>7.97</td><td>41.90</td><td>6.35</td><td>7.64</td><td>.004 (0,.01)</td></tr><tr><td /><td /><td /><td /><td /><td><italic>F<sub>Wlech</sub></italic>(1, 398.22)</td><td>η2 (95% CI)</td></tr><tr><td>BYAACQ Total</td><td>1.94</td><td>2.78</td><td>6.27</td><td>4.80</td><td>434.44</td><td>.08 (.06,.10)</td></tr></tbody></table> </ephtml> </p> <p>6 <emph>Note:</emph> PBSA-SHR was significant at <emph>p </emph>=.006, the remaining were significant at <emph>p </emph><.001. <emph>PBSA Total </emph>= Protective Behavioral Strategies Survey 20 total score, <emph>PBSA-MOD </emph>= Manner of Drinking strategies, <emph>PBSA-SLD </emph>= Stopping/Limiting Drinking strategies, <emph>PBSA-SHR </emph>= Serious Harm Reduction strategies, <emph>BYAACQ </emph>= Brief Young Adult Alcohol Consequences Questionnaire, <emph>M </emph>= Mean, <emph>SD </emph>= Standard Deviation.</p> <hd id="AN0183198832-12">Interactions by sex</hd> <p>Interaction effects by sex were not significant for total PBSA use and subtype use. The main effects of heavy alcohol use and sex were significant for total PBSA use (heavy alcohol use: <emph>p </emph><.001, η<sups>2 </sups>=.05; sex: <emph>p </emph><.001, η<sups>2 </sups>=.06), manner of drinking (heavy alcohol use: <emph>p </emph><.001, η<sups>2 </sups>=.10; sex: <emph>p </emph><.001, η<sups>2 </sups>=.03), stopping/limiting drinking (heavy alcohol use: <emph>p </emph><.001, η<sups>2 </sups>=.02; sex: <emph>p </emph><.001, η<sups>2 </sups>=.03), and serious harm reduction (heavy alcohol use: <emph>p </emph><.001, η<sups>2 </sups>=.01; sex: <emph>p </emph><.001, η<sups>2 </sups>=.07). These results indicated that males used less total PBSA and subtypes than females, without accounting for if they engage in heavy alcohol use. The effects of sex and heavy alcohol use on negative consequences was not significant. The main effects of heavy alcohol use and sex were significant for negative consequences (heavy alcohol use: <emph>p </emph><.001, η<sups>2 </sups>=.15; sex: <emph>p </emph>=.05, η<sups>2 </sups>=.002).</p> <p>There were no statistically significant interactions between risky drinking and sex on total PBSA, subtype use, or negative consequences. Main effects of risky drinking and sex were significant on total PBSA use (risky: <emph>p </emph><.001, η<sups>2 </sups>=.03; sex: <emph>p </emph><.001, η<sups>2 </sups>=.01) and stopping/limiting drinking use (risky: <emph>p </emph><.001, η<sups>2 </sups>=.01; sex: <emph>p </emph><.001, η<sups>2 </sups>=.01). Compared to females, males reported less total PBSA and stopping/limiting drinking use. Although the main effects of risky drinking were significant, the main effects of sex were not significant for manner of drinking use (risky: <emph>p </emph><.001, η<sups>2 </sups>=.08; sex: <emph>p </emph>=.09, η<sups>2 </sups>=.001) and negative consequences (risky: <emph>p </emph><.001, η<sups>2 </sups>=.06; sex: <emph>p </emph>=.15, η<sups>2 </sups>=.001). Sex was not found to have a significant effect on these variables; however, non-risky drinkers endorsed greater use of manner of drinking strategies wherein risky drinkers reported more negative consequences. Alternatively, main effects were significant for sex but not risky drinking on serious harm reduction use (risky: <emph>p </emph>=.09, η<sups>2 </sups>=.001; sex: <emph>p </emph><.001, η<sups>2 </sups>=.02).</p> <hd id="AN0183198832-13">Discussion</hd> <p>Consistent with previous findings, college students who engaged in heavy alcohol use endorsed less PBSA and subtype use than their non-heavy alcohol use peers, and experienced greater negative consequences (HHS, n.d.). Our findings support past research suggesting that risky drinkers use less PBSA, subtypes, and report greater negative consequences ([<reflink idref="bib15" id="ref41">15</reflink>]; [<reflink idref="bib26" id="ref42">26</reflink>]). Given that college students who engage in risky drinking behaviors are placed at a higher risk for negative outcomes (e.g., AUD), these results further support the apparent need and utility of harm reduction strategies for individuals drinking at potentially harmful rates.</p> <p>However, we did not find an interaction effect by sex assigned at birth for risky/non-risky drinking on outcome variables, or for heavy alcohol use/non-heavy alcohol use on PBSA and subtype use. This is unexpected given the large amount of research indicating females use more protective behavioral strategies than males ([<reflink idref="bib21" id="ref43">21</reflink>]). This finding could be due to the increasing convergence of females and males engaging in risky drinking ([<reflink idref="bib23" id="ref44">23</reflink>]); as the drinking behaviors of males and females continue to change, continued examination of this in research is needed. Taken together, although research shows that females are using greater numbers of PBSA, those strategies may not always be effective in reducing negative consequences (e.g., someone limits their drinking to four drinks [stopping/limiting drinking] but consumes all four drinks in a short period of time). Further, confounding factors not accounted for in this study (e.g., simultaneous cannabis and alcohol use) may be suppressing the protective effects of PBSA.</p> <p>A key strength of the present study was the large multisite sample collected from different regions of the United States, promoting the generalizability of the results. Another notable strength of this study is that it is the first to consider heavy alcohol use and risky drinking as groups and examine how they relate to PBSA and negative consequences. However, there are limitations that need to be considered when interpreting these findings. The exclusion of some groups due to low participation limits generalizability. The majority of participants were White females, which may influence the reported differences among sex. Our results may have been influenced by other variables (e.g., social cognition, drinking motives, mental health) that have been shown to impact alcohol use, PBSA use, and consequences ([<reflink idref="bib2" id="ref45">2</reflink>]) that were not accounted for in this study. Given the mixed findings on the performance of the PBSS-20 among men and women ([<reflink idref="bib24" id="ref46">24</reflink>]; [<reflink idref="bib9" id="ref47">9</reflink>]), consideration of possible sex-based differences that may also exist for this measure is warranted. Finally, despite the benefits of using discretization (i.e., turning continuous variables into categorical variables) to examine relationships using natural categorical variables (e.g., sex, [<reflink idref="bib6" id="ref48">6</reflink>]), attention should be given to the known statistical drawbacks such as loss of statistical power ([<reflink idref="bib8" id="ref49">8</reflink>]).</p> <p>Research areas warranting further investigation include examining PBSA use at a more granular level. It would be beneficial to examine PBSA by the strategy itself (i.e., on an item level) in order to best determine how each strategy is related to alcohol use negative consequences. Current research measures PBSA as a univariate variable or via subtype use, thus preventing a deeper understanding of these strategies' utility and relationship to other variables. Further, it would be valuable to employ diverse methodologies to investigate PBSA use in greater detail. For example, using qualitative methods could help address limitations of forced choice response approaches. Finally, it would be beneficial to replicate these results with a more diverse sample, with the inclusion of those who identify with multiple genders and/or are intersex, as well as broadening investigation with more racial and ethnic identities.</p> <p>Using information from this study can help to enhance individualization and matching of interventions to the unique needs of college student drinkers. Specifically, these results support the notion of identifying college students by their drinking behaviors as potential risk or protective factors. Findings from this study may enable clinicians to target at-risk college students for psychoeducational interventions (e.g., education on the risks of heavy alcohol use) and/or behavioral interventions (e.g., promoting harm reduction use among risky drinkers). To this point, findings from this study may be beneficial to use alongside commonly used interventions, such as brief motivational interviewing or personalized normative feedback ([<reflink idref="bib17" id="ref50">17</reflink>]). Additionally, these results support the notion that heavy alcohol use and risky drinking's relationship to harm reduction behaviors and consequences is similar between males and females, such that equal attention is warranted between these sexes. Clinicians may find it beneficial to screen college student drinkers for heavy alcohol use and risky drinking, given they are at higher risk for consequences. Efforts to increase the use of PBSA and strategy subtypes in interventions among heavy alcohol users and/or risky drinkers may be beneficial, and potentially reduce negative consequences.</p> <ref id="AN0183198832-14"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref32" type="bt">1</bibl> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref45" type="bt">2</bibl> <bibtext> The authors received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref8" type="bt">3</bibl> <bibtext> Michael B. Madson https://orcid.org/0000-0002-2025-8856</bibtext> </blist> <blist> <bibl id="bib4" idref="ref31" type="bt">4</bibl> <bibtext> ** This project was completed by the Harm Reduction Research Team (HRRT), which includes the following investigators (in alphabetical order): Robert D. Dvorak, University of Central Florida; Lindsay S. Ham, University of Arkansas; Margo C. Hurlocker (Co-PI), University of New Mexico; Thad Leffingwell, Oklahoma State University; Alison Looby, University of Wyoming; P. Priscilla Lui, Southern Methodist University; Michael B. Madson (Co-PI), University of Southern Mississippi; Ellen Meier, University of Wisconsin-Stevens Point; Kevin Montes, California State University, Dominguez Hills; Lucy Napper, Lehigh University; Mark A. Prince, Colorado State University; Monica Skewes, Montana State University; Byron L. Zamboanga, University of Arkansas.</bibtext> </blist> </ref> <ref id="AN0183198832-15"> <title> References </title> <blist> <bibtext> Collins R. 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Zamboanga and Morgan Haga</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib22" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib15" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib14" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib27" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib11" firstref="ref11"></nolink> <nolink nlid="nl6" bibid="bib19" firstref="ref13"></nolink> <nolink nlid="nl7" bibid="bib18" firstref="ref14"></nolink> <nolink nlid="nl8" bibid="bib16" firstref="ref15"></nolink> <nolink nlid="nl9" bibid="bib10" firstref="ref16"></nolink> <nolink nlid="nl10" bibid="bib13" firstref="ref17"></nolink> <nolink nlid="nl11" bibid="bib26" firstref="ref20"></nolink> <nolink nlid="nl12" bibid="bib12" firstref="ref21"></nolink> <nolink nlid="nl13" bibid="bib23" firstref="ref22"></nolink> <nolink nlid="nl14" bibid="bib20" firstref="ref24"></nolink> <nolink nlid="nl15" bibid="bib21" firstref="ref26"></nolink> <nolink nlid="nl16" bibid="bib25" firstref="ref36"></nolink> <nolink nlid="nl17" bibid="bib24" firstref="ref46"></nolink> <nolink nlid="nl18" bibid="bib17" firstref="ref50"></nolink>
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PubType: Academic Journal
PubTypeId: academicJournal
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Alcohol Protective Behavioral Strategy Use and Negative Consequences across Heavy Alcohol Users and Risky Drinkers
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Skyler+M%2E+Hoover%22">Skyler M. Hoover</searchLink><br /><searchLink fieldCode="AR" term="%22Molly+J%2E+Swinney%22">Molly J. Swinney</searchLink><br /><searchLink fieldCode="AR" term="%22Lauren+A%2E+Greenspoon%22">Lauren A. Greenspoon</searchLink><br /><searchLink fieldCode="AR" term="%22Michael+B%2E+Madson%22">Michael B. Madson</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2025-8856">0000-0002-2025-8856</externalLink>)<br /><searchLink fieldCode="AR" term="%22Byron+L%2E+Zamboanga%22">Byron L. Zamboanga</searchLink><br /><searchLink fieldCode="AR" term="%22Morgan+Haga%22">Morgan Haga</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Drug+Education%22"><i>Journal of Drug Education</i></searchLink>. 2025 54(1):3-16.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 14
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Alcohol+Abuse%22">Alcohol Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Drinking%22">Drinking</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Behavior%22">Student Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Risk%22">Risk</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Negative+Reinforcement%22">Negative Reinforcement</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Arkansas%22">Arkansas</searchLink><br /><searchLink fieldCode="DE" term="%22California%22">California</searchLink><br /><searchLink fieldCode="DE" term="%22Colorado%22">Colorado</searchLink><br /><searchLink fieldCode="DE" term="%22Florida%22">Florida</searchLink><br /><searchLink fieldCode="DE" term="%22Mississippi%22">Mississippi</searchLink><br /><searchLink fieldCode="DE" term="%22Montana%22">Montana</searchLink><br /><searchLink fieldCode="DE" term="%22New+Mexico%22">New Mexico</searchLink><br /><searchLink fieldCode="DE" term="%22Oklahoma%22">Oklahoma</searchLink><br /><searchLink fieldCode="DE" term="%22Pennsylvania%22">Pennsylvania</searchLink><br /><searchLink fieldCode="DE" term="%22Texas%22">Texas</searchLink><br /><searchLink fieldCode="DE" term="%22Wisconsin%22">Wisconsin</searchLink><br /><searchLink fieldCode="DE" term="%22Wyoming%22">Wyoming</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/00472379241278325
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0047-2379<br />1541-4159
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study investigated differences in alcohol protective behavioral strategy (PBSA) use and negative consequences (ARNC) experienced among heavy alcohol users and non-heavy alcohol users, and risky and non-risky drinkers. Participants were from 12 universities in the United States (n = 2,163 college students, M[subscript age] = 19.47), predominantly identified as White (74%), and female (68.7%), who completed measures of typical weekly drinking, risky drinking, ARNC, and PBSA use. ANOVAs revealed that the heavy alcohol users and risky drinkers reported significantly fewer total PBSA, subtype strategy use, and greater negative consequences than their counterparts. Harm reduction interventions may benefit from identifying and targeting college students who are engaging in heavy alcohol use and risky drinking regardless of sex.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1465705
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1465705
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/00472379241278325
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 3
    Subjects:
      – SubjectFull: Alcohol Abuse
        Type: general
      – SubjectFull: Drinking
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Student Behavior
        Type: general
      – SubjectFull: Risk
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Negative Reinforcement
        Type: general
      – SubjectFull: Behavior Modification
        Type: general
      – SubjectFull: Arkansas
        Type: general
      – SubjectFull: California
        Type: general
      – SubjectFull: Colorado
        Type: general
      – SubjectFull: Florida
        Type: general
      – SubjectFull: Mississippi
        Type: general
      – SubjectFull: Montana
        Type: general
      – SubjectFull: New Mexico
        Type: general
      – SubjectFull: Oklahoma
        Type: general
      – SubjectFull: Pennsylvania
        Type: general
      – SubjectFull: Texas
        Type: general
      – SubjectFull: Wisconsin
        Type: general
      – SubjectFull: Wyoming
        Type: general
    Titles:
      – TitleFull: Alcohol Protective Behavioral Strategy Use and Negative Consequences across Heavy Alcohol Users and Risky Drinkers
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Skyler M. Hoover
      – PersonEntity:
          Name:
            NameFull: Molly J. Swinney
      – PersonEntity:
          Name:
            NameFull: Lauren A. Greenspoon
      – PersonEntity:
          Name:
            NameFull: Michael B. Madson
      – PersonEntity:
          Name:
            NameFull: Byron L. Zamboanga
      – PersonEntity:
          Name:
            NameFull: Morgan Haga
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0047-2379
            – Type: issn-electronic
              Value: 1541-4159
          Numbering:
            – Type: volume
              Value: 54
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of Drug Education
              Type: main
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