Articles of Public Interest

Abstract

College students reporting increased mental distress during the pandemic also reported greater quantity and frequency of alcohol use, and distress was linked to certain pandemic-related factors which differed by race. A study published in Alcohol: Clinical and Experimental Research identified social distancing as a stressor linked with mental distress for both Black and White college students, whereas financial issues were associated with mental distress in White students, and contracting COVID-19 was linked to mental distress in Black students.

The study examined whether mental distress may be a link between pandemic-specific stressors and student drinking behaviors and whether that link differs by race. Researchers surveyed four hundred college students from October to December 2020 about whether they experienced any of nine pandemic-related stressors. They were also asked about changes in drinking quantity and frequency and assessed for symptoms of stress, anxiety, depression, and alcohol use over the past month.

Half of the participants experienced financial stressors. Twenty to 30 percent reported each of five other factors due to the pandemic: job loss, taking care of someone, change to telework, being an essential worker, or a changed living situation. Overall, taking care of someone, financial stressors, and social distancing were associated with increased mental distress. In turn, mental distress was linked to increased quantity and frequency of drinking. Regardless of mental distress levels, students experiencing financial stressors were more likely to drink more and more often than they did pre-pandemic. Participants who started teleworking were more likely to report an increased quantity of drinking; participants taking care of someone drank more often.

When examining differences across race, Black participants reported greater mental distress than White participants. Financial stressors were linked to greater mental distress among White students but not for Black students. For Black participants, being an essential worker was associated with lower levels of mental distress, while contracting COVID-19 was associated with greater mental distress; neither factor was significantly associated with mental distress for White participants. Social distancing was linked to greater mental distress for all students. Researchers found no significant differences between Black and White students in perceived changes in the quantity and frequency of drinking.

Compared to their drinking patterns before the pandemic, about half of the participants reported no changes in the quantity or frequency of their drinking; twenty-seven percent reported drinking greater quantity, and 34 percent reported drinking more often. Black students reported drinking alcohol less frequently and in significantly lower quantities than White students.

Researchers recommend university efforts to connect students with campus mental health services, which tend to be used by 10 percent of students, with Asian, Black, and Latinx students utilizing care at lower rates than White students.

This cross-sectional mediation analysis does not imply causality and did not examine other factors that may have contributed to mental distress. Forty-three percent of participants were White, and 28 percent were Black; three-quarters were cisgender women.

The impact of COVID-19 pandemic experiences on college drinking via mental distress: Cross-sectional moderated mediation by race. Abby L. Braitman, R. Ayala Guzman, M. Strowger, J. Shipley, D. Glenn, E. Junkin, A. Whiteside, C. Lau-Barraco. (pp. 2313–2330)

Learning that their peers’ alcohol use is declining over time may help reduce young adults’ drinking, according to the first study that tested this approach among community-based participants (versus college students). During young adulthood, drinking habits tend to become established. Young adults are known to be influenced by social norms, particularly their peers’ drinking behaviors. They tend to misperceive those behaviors, however, conforming to a false “norm” that often exceeds their peers’ actual alcohol consumption. Interventions that highlight discrepancies between perceived and actual drinking norms—called personalized normative feedback—can lead to reduced use. In studies, the reduction is consistent but small. This may be because most interventions are based on static norms, highlighting current alcohol use data. Dynamic norms, in contrast, emphasize collective changes over time, potentially signaling that reduced drinking represents a trend. For the study in Alcohol: Clinical & Experimental Research, investigators tested the effects of a dynamic norms intervention on young adults’ perceptions of peers’ drinking and their own alcohol use. They compared those participants with a group who experienced a similar intervention addressing COVID-19 vaccination.

Researchers worked with 546 adults aged 18–24, unvaccinated against COVID-19, recruited from the community in states across the US. The participants filled out a baseline survey on their alcohol use and perceptions of their peers’ drinking behaviors. They were randomly divided into two groups and experienced a dynamic norms intervention on drinking or COVID-19 vaccination. For the alcohol feedback intervention, researchers calculated dynamic norms using CDC data on alcohol use, drinking frequency, amounts consumed, heavy episodic (binge) drinking, and driving under the influence of alcohol. In a survey, participants in the alcohol group guessed the amount and frequency of peers’ drinking; their individual answers were contrasted first with 2021 data and then with trend-level information for 2016–21 and its implications for declining alcohol use. The vaccine feedback group similarly guessed vaccine rates and beliefs and then was exposed to accurate vaccine data and trends. The participants rated the interventions for satisfaction and engagement. After one month, 253 participants responded to a follow-up survey, again assessing their perceptions of peers’ drinking behaviors and their alcohol use.

Participants in the alcohol feedback group reported substantially changed perceptions of their peers’ drinking, including a 26% reduction in perceived drinks per week. Their own reported alcohol use also declined: a 38% relative reduction in drinks per week, a 39% relative drop in drinking frequency, and a 63% reduction in driving after drinking. Heavy episodic drinking did not significantly change, perhaps reflecting low rates at baseline. The effects of the intervention did not seem to be influenced by baseline drinking level, and lighter-drinking participants did not show increased alcohol use a month later. Overall, the participants liked the alcohol intervention and considered it helpful and engaging; 90% said they would recommend it to a friend. The participants of the vaccination group, in contrast, did not report changing perceptions of alcohol use or shifts in their drinking.

The findings support the potential effectiveness of personalized feedback leveraging dynamic norms—when behavioral norms are trending in a favorable direction—in reducing alcohol consumption among community-based young adults. Further research is needed to compare this novel dynamic norms intervention approach to the current ‘status quo’ personalized normative feedback approach that only provides static norms information without the recent trends. It is not known whether the current findings generalize to vaccinated young adults, though the researchers do not anticipate major differences.

A brief dynamic norms intervention for young adult alcohol use: Pilot testing acceptability, efficacy, and iatrogenic effects. S. Graupensperger, A. Jaffe, J. Blayney, J. Duckworth, C. Stappenbeck. (pp. 2331–2342)

Alcohol use on certain special occasions may contribute to harsher parenting by mothers, according to an innovative study. The findings compare drinking and parenting behaviors on Super Bowl Sunday and Valentine's Day and may help create environments conducive to positive parenting. It is known that special occasions—sporting events, holidays, bachelor parties, and so on—involve atypical drinking behaviors. Major sporting events, in addition, are linked to increased levels of domestic violence and assault. Potentially, atypical drinking on such occasions may similarly be a risk factor for harsh parenting behaviors. Although alcohol raises the likelihood of physical abuse and corporal punishment by both mothers and fathers, little is known about whether special occasions influence harsh parenting behaviors—including hitting, spanking, name calling, and yelling—associated with negative outcomes for children. For the study in Alcohol: Clinical & Experimental Research, investigators used real-time self-reports from mothers. They assessed the relationship between concurrent drinking and parenting behaviors during two markedly different occasions over consecutive Sundays in 2021.

Researchers worked with parents, primarily mothers, in Ohio who had at least one child aged 2–12. The participants were predominantly White, well-educated, and married or cohabiting. They filled out a baseline survey and, over 14 days, responded to brief surveys sent via an app every morning, afternoon, and evening. On days 7 and 14, the survey included questions about alcohol use and parenting behaviors (positive, punitive, non-punitive, and aggressive) toward one child during the past week. Researchers analyzed 637 self-reports from 254 women for the Super Bowl, and for Valentine's Day, 420 self-reports from 179 women.

The sample of mostly mothers reported drinking when children were present in 6% of self-reports on Super Bowl Sunday and 9% on Valentine's Day. During the Super Bowl, they were 2 ½ times likelier to use aggressive discipline and punitive parenting measures compared to mothers who weren't drinking. Alcohol use that day did not seem to affect their positive or non-punitive parenting. Having more adults in the family was linked to higher odds of aggressive and punitive parenting; boys and younger children were more likely to face punitive parenting than girls and older children. On Valentine's Day, mothers who reported drinking were less likely than others to use aggressive discipline. Alcohol use was not linked to punitive, non-punitive, or positive parenting. Over the 14 days, alcohol use was not generally related to aggressive discipline; those findings were specific to the Super Bowl.

The study offers the first evidence of a link between alcohol use and aggressive parenting among parents during a major sporting event. The odds of harsh discipline on special occasions may be related to a combination of alcohol use and varying event norms around socializing, venues, drinking patterns, and the amount of time spent with children, contributing to the differing outcomes. Harm reduction strategies for sporting events could include hiring babysitters and planning children's activities. Research involving larger, more diverse samples is needed.

Using ecological momentary assessments to understand how drinking during special occasions relates to parenting behaviors. B. Freisthler, J. Sarabia, J. Price Wolf. (pp. 2343–2353)

An online treatment for insomnia may improve both sleep and problem drinking patterns in people who drink heavily, according to a study in Alcohol: Clinical and Experimental Research. Researchers found that heavy drinkers who received web-based cognitive behavioral therapy designed to treat their insomnia had greater improvement in sleep and drinking behaviors compared to people who were given access to online education to improve their sleep. This is the first study to show that cognitive behavioral therapy for insomnia can lead to significant reductions in alcohol consumption among heavy drinkers. The findings support the use of self-administered online health interventions, which may help overcome barriers to treatment for people at high risk.

The study compared the sleep and drinking outcomes of two groups of heavy drinkers with insomnia. One group was given a validated, interactive, online cognitive behavioral therapy program, while a control group received unlimited access to online educational resources to address insomnia.

Both groups experienced improvements in sleep and drinking, but the group using the digital cognitive behavioral intervention, called SHUTi, saw greater improvement. Following the nine-week intervention, the digital cognitive behavioral program participants showed a more pronounced decrease in alcohol consumption measures over time compared to the control group. SHUTi users reported significantly lower insomnia severity and significantly improved sleep quality compared to participants in the control group and maintained lower insomnia severity scores at six months. At six months, the sleep quality scores were the same for both groups due to improvements in sleep quality in the control group.

Researchers note that SHUTi is the first digital cognitive behavioral therapy intervention for insomnia to result in reductions in alcohol consumption among people with hazardous drinking behaviors and insomnia. Digital cognitive behavioral therapy has the potential to improve access to treatment for people with alcohol use disorder who may not otherwise seek treatment due to barriers such as stigma or lack of transportation. Women, in particular, are more likely to receive treatment for alcohol problems in alternative settings and show a stronger association between poor sleep quality and alcohol-related problems.

The SHUTi program used for the study is entirely online and automated and provides individualized feedback based on participants’ sleep data and other self-reported information. Participants complete a series of interactive modules based on principles of cognitive behavioral therapy for insomnia. The study, conducted from September 2020 to September 2021, included 71 men and women ages 21 to 50. Participants were considered to be hazardous drinkers who experienced insomnia for three or more nights per week for the past three months.

The researchers recommend further studies with a greater number of and more diverse participants to identify whether outcomes are influenced by other factors, such as marriage, caregiving, education status, sleep aid use, age, sex, and circadian preferences.

Effects of a digital cognitive behavioral therapy for insomnia on sleep and alcohol consumption in heavy drinkers: A randomized pilot study. J. Verlinden, M. Moloney, O. Vsevolozhskaya, L. Ritterband, F. Winkel, J. Weafer. (pp. 2354–2365)