Day‐level associations between protective behavioral strategies and alcohol consequences among young adults enrolled vs. not enrolled in college

Abstract Background and aims Protective behavioral strategies (PBS) are designed to minimize negative alcohol‐related consequences. They include limiting/stopping, manner‐of‐drinking (e.g. avoiding shots or drinking games) and serious harm reduction strategies. This secondary analysis measured day‐level, within‐person associations between PBS and alcohol‐related consequences (including alcohol‐induced blackout) among young adults enrolled and not enrolled in college. Design Observational study using ambulatory assessments each morning for 30 days. Setting United States. Participants Young adults ( n = 153, 35% male, 58% White, mean age = 22 y) with a history of alcohol‐induced blackout. Fifty‐nine participants (39%) were enrolled in college. Measurements Participants completed an orientation interview, baseline self‐report measures and 30 days of prospective morning reports. Multilevel logistic regression was used to analyze data. Findings Within persons, participants had lower odds of experiencing any same‐day alcohol‐related consequence odds ratio (OR) = 0.36; 95% confidence interval (CI) = 0.25–0.53, including blackout (OR = 0.24; 95% CI = 0.14–0.42) on days they used manner‐of‐drinking strategies compared with days they did not. Conversely, experiencing an alcohol‐related consequence was not associated with use of manner‐of‐drinking (OR = 1.06; 95% CI = 0.76–1.48) or limiting/stopping (OR = 1.06; 95% CI = 0.76–1.49) strategies on the next drinking day. College enrollment did not moderate any of the associations. Conclusions Manner‐of‐drinking strategies appear to reduce the odds of alcohol‐related harm at the event level among young adults in the United States, whether or not they are enrolled in college. We speculate that limiting strategies (e.g. counting drinks) appear less effective because they are more difficult to implement in real‐life drinking contexts.