Burgeoning evidence of sports betting harms among young adults highlights the need to refine our understanding of psychosocial processes driving sports betting behavior. This study longitudinally examined sports betting patterns over time within the Prototype Willingness Model (PWM), a dual-process behavioral model comprised of both a reasoned and socially reactive component. Participants included 210 18–29 year olds (77.1

The Prototype Willingness Model (PWM) emphasizes the importance of risk-conducive contexts in shaping behavior, yet these contextual processes have not been examined at the daily level. This study, in line with the PWM, examined the extent to which risk-conducive contexts (e.g., personal cannabis use, others' cannabis use, others' drinking, others' drinking game engagement, being in new environments or with new people) increase alcohol use on days when individuals are more willing to engage in alcohol-related behaviors. Participants (N = 996, 57% female, 44.4% White, Mage = 20.00, SD = 3.22) were recruited in Texas (United States) for a longitudinal ecological momentary assessment (EMA) study examining cognitions and alcohol use. Results of a hurdle negative binomial model indicated on days participants reported elevated (i.e., higher than their own average level) willingness to engage in alcohol use, they had greater odds of drinking and consumed more drinks. Drinking odds increased on days they were around others who drank and decreased when around new people. Two significant interactions showed willingness was positively associated with the predicted probability of consuming any alcohol and the number of drinks consumed, and the strength of the association became stronger when the participant was around others who were drinking. Findings extend the PWM by demonstrating how theoretically-based contextual processes operate at the daily level, informing intervention targets to reduce risky alcohol use.

OBJECTIVE:Personalized normative feedback interventions targeting perceived descriptive norms (perceptions of how much or how often other people drink) have repeatedly been shown to reduce problem drinking among young adults. Less work has targeted perceived injunctive norms (perceptions of others' approval of drinking), possibly due to the potential for reactance to feedback, which communicates that others disapprove of intervention recipients' drinking. Motivational interviewing (MI) is a nonjudgmental clinical approach that diffuses reactance by emphasizing empathy and autonomy. This study evaluated the efficacy of in-person computer-delivered injunctive personalized normative feedback (IPNF) and facilitator-delivered IPNF with MI (IPNF + MI) in reducing alcohol consumption (past month drinking, typical weekly drinking, and maximum drinks consumed on one occasion) and two indices of alcohol-related consequences. METHOD:Participants included 605 heavy-drinking college students from two large universities who were randomized to receive either IPNF, IPNF + MI, or attention control feedback. Participants completed 3- and 6-month follow-up surveys. RESULTS:Findings revealed no significant reductions in alcohol outcomes for IPNF relative to control. Results showed significant reductions for IPNF + MI relative to control in drinks per week and both indices of alcohol-related consequences. The effect of IPNF + MI was significantly stronger than IPNF for one index of consequences. There were no between-condition effects for peak drinks consumed or past month drinking after correcting for multiple comparisons. Mediation results revealed indirect effects of both IPNF conditions versus control through reductions in injunctive norms on all outcomes. CONCLUSIONS:Results provide modest evidence for injunctive norms-based feedback as an intervention strategy for heavy-drinking students only when MI-delivered. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background: Exposure to racial and ethnic discrimination (RED) is positively associated with alcohol-related outcomes among Hispanics; however, links between RED and alcohol use are poorly understood, particularly when considering RED in social media.Objectives: Study aimed to (1) examine the direct and indirect associations between RED on social media and alcohol use severity (i.e., AUDIT total score) via coping drinking motives (a form of negative reinforcement in which an individual uses alcohol to alleviate/regulate negative emotions) among Hispanic emerging adult college students, and (2) examine if psychological resilience moderates the direct and indirect associations of social media discrimination on alcohol use severity.Methods: A convenience sample of 423 (women = 300, men = 123) Hispanic college students from Texas and Florida completed a cross-sectional online survey. Data were analyzed by conducting a conditional process analysis.Results: Social media discrimination did not have a direct association with alcohol use severity (β = .05, 95% CI=[-.03, .13], p > .05), but it did have a statistically significant indirect association with alcohol use severity via coping drinking motives (β = .08, 95% CI = [.03, .13], p < .05). Further, psychological resilience functioned as a moderator that weakened the indirect association between social media discrimination and alcohol use severity (β = -.14, 95% CI=[-.23, -.05], p < .001).Conclusions: Our conditional process analysis may help guide etiological studies on RED and alcohol use. The data suggest that psychological resilience and coping drinking motives may be relevant constructs for interventions that aim to mitigate the association between RED and alcohol use.

OBJECTIVE:Motivational theories hypothesizing that people drink to relieve negative affect have not been supported using data from people's daily lives. People may experience negative affect when alcohol is unavailable or when use would conflict with people's current goals, but people's thoughts about alcohol use, such as intentions to drink later in the day, are less contextually constrained. Alcohol intentions may serve as affect regulation and lead to decreases in negative or increases in positive affect prior to drinking itself. METHOD:This registered report provides an initial test of this hypothesis across two large ecological momentary assessment samples of adolescents and young adults (total n = 1,511). We tested whether daily drinking intentions were associated with levels and within-day changes in negative and positive affect in two large samples of adolescents and young adults and whether drinking history and motives moderated these associations. RESULTS:We found evidence, replicated across studies, that positive affect was higher and increased more on days when people reported intending to drink more than usual, but negative affect was only very weakly associated with daily drinking intentions. We found no evidence of moderation that replicated across samples. CONCLUSIONS:Results suggest that prior research linking positive affect and alcohol use is at least in part capturing the anticipation of drinking rather than a causal association between affect and drinking behaviors among adolescents and young adults. Theories should consider how anticipation, as well as the contexts in which drinking occurs, shapes people's motives for drinking and their drinking behaviors themselves. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: There is considerable variability in how young adults (YAs) perceive drinking-related consequences, and some researcher-identified "negative" consequences are viewed by YAs as neutral or even somewhat positive. Little is known about individual difference factors that may influence subjective evaluations of alcohol consequences. Method: We tested whether endorsement and subjective evaluation ("extremely negative" to "extremely positive") of 24 alcohol-related negative consequences differed by age (18-20, 21-27), past-3-month drinking frequency (three times/month or less, weekly or more), and current undergraduate status (4-year undergraduate, nonstudent). YAs were recruited for a longitudinal ecological momentary assessment study on cognitions and alcohol use. Participants in the analytic sample (N = 640; 48.1% White non-Hispanic/Latinx, 50.0% female, M age = 22.2 years, SD = 2.3) reported past-3-month drinking. Past-3-month drinking frequency, negative consequences (total and item-level), and subjective evaluations of consequences were assessed cross-sectionally. Results: Compared with YAs age 18-20, YAs 21 and older experienced fewer total consequences, were significantly less likely to endorse experiencing physical/behavioral consequences, and rated these consequences more negatively if they were endorsed. YAs who drank weekly or more reported experiencing more consequences and were significantly more likely to experience all 24 consequences in comparison with YAs who drank three times/month or less. Subjective evaluation ratings did not significantly differ by drinking frequency. There were few differences between 4-year undergraduates and non-undergraduates; non-undergraduates rated several health/responsibility-related consequences more negatively. Conclusions: Findings highlight the importance of identifying individual difference factors that contribute to subjective evaluation ratings and may be useful for tailoring brief, personalized alcohol interventions for YAs. (J. Stud. Alcohol Drugs, 86, 124-135, 2025)

OBJECTIVE:This article describes the development of an online and text-messaging intervention aimed at augmenting protective behavioral strategies (PBS) utilization at the daily level among young adults engaged in alcohol and cannabis use. PBS, encompassing tips and strategies to moderate alcohol and cannabis use and reduce associated risks, have been integral components of personalized feedback interventions. The quality and consistency of PBS use have been underexplored in intervention frameworks. METHOD:We describe six initial focus groups and 13 cognitive interviews that were conducted with young adults who use alcohol and cannabis to learn the motivations underpinning alcohol and cannabis PBS utilization, barriers impeding PBS use, and PBS use with high quality and consistency. This step served as the cornerstone for crafting targeted intervention strategies. Drawing from the insights from the focus groups and cognitive interviews, we developed an interactive online intervention and text message platform. We then conducted three additional focus groups and nine cognitive interviews with young adults who use alcohol and cannabis to gain insight into intervention content, and we implemented any needed changes. RESULTS:We present the final iteration of the intervention, which consisted of a brief, web-based intervention followed by text messages 3 days a week for 8 consecutive weeks, as well as two monthly daily-level summaries of behaviors reported across 8 weeks. CONCLUSIONS:This article shares our process for designing an intervention using daily-level data, aimed at reducing alcohol and cannabis use among young adults and fostering quality and consistent use of PBS.

Examining why adolescents and young adults post or delete alcohol-related content on social media has important implications for understanding and mitigating the influence of alcohol-related social media content on alcohol cognitions and use. This longitudinal study explored motives for posting and deleting alcohol content and their association with actual posting and deleting one month later. Survey data were collected from 306 adolescents and young adults recruited as part of a longitudinal experimental study examining alcohol-related content on social media and alcohol norms and use. Participants aged 15-20 (M = 18.39; SD = 1.32) indicated the top three motives for posting alcohol content: prove they were having fun, show they have an active social life, and make themselves look cool. The most endorsed motives for deleting alcohol-related social media content included: it being unflattering, feeling embarrassed, or fear of others sharing it. After controlling for relevant covariates, a negative binomial regression indicated that at baseline, alcohol-related posting motives related to making others jealous, posting about most things, and doing what friends do were significantly and positively associated with frequency of posting alcohol-related content one month later. Further, results of a linear regression indicated that the only baseline motive significantly associated with frequency of deleting alcohol-related content at 1-month follow-up was finding the content unflattering. Overall, results suggest that there are unique motives associated with both posting and deleting alcohol-related content on social media, which has implications for preventative interventions aiming to reduce alcohol-related social media behavior.

Objective: Despite protective behavioral strategies (PBS) being an important part of alcohol-prevention programs, use of PBS is suboptimal, and research is needed to determine factors associated with the use and non-use of PBS. The present study examined daily-level associations between situational familiarity (i.e., familiarity with locations and people) and the use of alcohol-related PBS among adolescents and young adults. Method: Participants (analysis n = 564, 55.1% female, 45.2% White, non-Hispanic, ages 15 to 25 years, M = 21.07 years [SD = 2.79]) were part of a longitudinal ecological momentary assessment burst study on cognitions and alcohol use. Mixed-effects Poisson models were used to analyze data for engagement in PBS (i.e., serious harm- reduction, stopping/limiting, and manner-of-drinking PBS). Results: Within-person results indicated that when participants had elevated (i.e., higher than their own average) familiarity with their location, they were less likely to use serious harm-reduction PBS (rate ratio [RR] = 0.94, p <.001) and stopping/limiting PBS (RR = 0.95, p < .001). Results showed that on drinking days with elevated familiarity with people, individuals were more likely to use serious harm-reduction PBS (RR = 1.03, p = .01). There were no significant daily-level associations between familiarity with people or location and manner-of-drinking PBS. Conclusions: The study suggests that PBS use, particularly for serious harm-reduction and stopping/limiting strategies, varies among adolescents and young adults based on familiarity with location and people. Alcohol-prevention interventions, including just-in-time interventions, should consider how to promote PBS use, particularly in familiar locations and with less familiar people. (J. Stud. Alcohol Drugs, 86, 115-123, 2025)

OBJECTIVE:This study examined daily associations between alcohol use, cannabis use, and simultaneous alcohol and cannabis/marijuana (SAM) use with the likelihood of hooking up (uncommitted sexual encounter that may or may not include intercourse). METHOD:We used a longitudinal measurement burst ecological momentary assessment (EMA) design with 3-week EMA bursts with daily measurements repeated quarterly across 12 months. 1,009 (57 % female, Mean age = 20.00 [SD = 3.21]) Texan adolescents and young adults ages 15-25 participated in the study. Mixed effects logistic regression models were estimated using maximum likelihood estimation to evaluate the associations between substance use and hooking up. RESULTS:Within-person results indicated that participants were more likely to hook up on days with alcohol use and on days with cannabis use, but not on days with SAM use. Participants were also more likely to hook up on drinking days with higher-than-usual alcohol use. Between-person results indicated that participants who used alcohol more often or cannabis more often on average were more likely to hook up, and participants who tended to drink more on drinking days were more likely to hook up. CONCLUSIONS:Given the significant daily-level associations between alcohol and cannabis use and hooking up behavior, public health initiatives should focus on developing interventions to reduce alcohol and cannabis use and promote safer hooking up behavior among adolescents and young adults.

IntroductionWomen experiencing homelessness are at higher risk of unintended pregnancy than women who are stably housed and may have unique reasons for not engaging in postpartum pregnancy prevention. This sequential explanatory mixed‐methods study aimed to examine reasons women experiencing homelessness may not engage in pregnancy prevention during the postpartum period.MethodsQuantitative 2016‐2019 Pregnancy Risk Assessment Monitoring System data regarding postpartum pregnancy prevention among recently pregnant women experiencing homelessness and women stably housed (n = 99,138) were analyzed with complex survey‐weighted bivariate analysis. Primary outcomes included whether women engaged in postpartum contraception and key reasons for not engaging in postpartum contraception. Qualitative data from semistructured interviews with north Texas women (n = 12) recently pregnant and homeless were coded and thematically analyzed. Findings were triangulated using a woman‐centered conceptual framework that facilitates meeting reproductive goals.ResultsWomen experiencing homelessness reported several statistically significant (P < .05) reasons for not using postpartum pregnancy prevention: currently pregnant, currently abstinent, cannot afford contraception, and partner not liking contraception. Key themes from interviews were related to internal factors (eg, perceived risk of pregnancy is high, current situation not good for having children); external factors (eg, my partner wants to have another child); perceptions of pregnancy (eg, children would be joyful, I want to get pregnant soon after I get housing), and salience of planning (eg, doesn't matter if we plan).DiscussionFindings highlight several key reasons for not engaging in postpartum pregnancy prevention among women experiencing homelessness. Findings lay the groundwork for interventions seeking to support individualized and evolving sexual and reproductive health goals within the context of needed housing and family resources.

This study investigated consequences of posting about alcohol on social networking sites and explore their associations with drinking behavior and social networking site-related cognitions. A sample of 306 participants aged 15-20 completed surveys from which the data is drawn. Results revealed that individuals who posted about alcohol on social networking sites experienced various consequences, including interpersonal conflicts, guilt, shame, and embarrassment. While legal and job repercussions were rare, unwanted attention and negative comments on posts were reported. Correlations demonstrated positive associations between social networking site consequences and drinking consequences, as well as with social norms and perceived vulnerability. Notably, the frequency of alcohol-related posts and willingness to engage in such behavior was not associated with consequences. Additional item-level correlations primarily supported the overall correlational findings. Findings highlight that further research is warranted to unravel the complex interplay between social networking site use, alcohol consumption, and related consequences.

OBJECTIVE The present study examined young adults' completion of the Web-based intervention content in a randomized trial that tested two Personalized Feedback Interventions (PFIs) for alcohol use and risky sex behavior (RSB). METHOD Data are from a study that evaluated efficacy of two Web-delivered PFIs (combined PFI and integrated PFI) among 269 sexually active young adults between the ages of 18 and 25. We described the view patterns of the Web-based intervention and examined if baseline sociodemographic and alcohol- and sex-related behavioral factors were associated with the completion of PFI. RESULTS Many participants viewed the intervention more than one time, and the majority finished all intervention pages in at least one session. Older participants and participants who drink more frequently prior to or during sex were more likely to complete. CONCLUSIONS Most participants, especially the young adults who were at higher risk, utilized the intervention contents as intended.

Compared to other age groups, 18- to 25-year olds (young adults) are more likely to engage in heavy alcohol use and inconsistent contraceptive use, increasing their susceptibility to sexually transmitted infections (STIs) and unintended pregnancy. The Studying Alcohol and Related Risks (STARR) intervention was efficacious in reducing young adult alcohol-related risky sexual behavior, including reducing the number of casual sexual partners and alcohol use prior to sex. We conducted a qualitative study to guide the adaptation of the STARR intervention to include additional content on contraceptive use and prepare for dissemination of the intervention to a community audience. We conducted 10 focus groups with young adults (n = 16) and semistructured interviews with local community stakeholders (n = 12) to examine: (a) intervention characteristics, such as compatibility, adaptability, and design and packaging and (b) dissemination and communication channels. Focus groups and interviews were audio-recorded, transcribed, and thematically analyzed. Participants found the proposed intervention acceptable and highlighted the need to promote STI prevention among young adults. Participants viewed text-based interventions as accessible and effective. Key considerations included developing personalized messages from credible sources, using gender-inclusive language, and sending messages at strategic timepoints. Social media (Instagram, Twitter, Snapchat, TikTok), events, and campus resources were described as avenues to create awareness and disseminate information about the proposed intervention. Findings demonstrate the need for innovative and tailored young adult health programs that incorporate multilevel dissemination strategies. This study highlights the need for implementation activities that will improve the adoption and dissemination of evidence-based programs, particularly among young adults.

Indigenous patients frequently experience bias and racism in society and within medical encounters. Biased health care relates to delayed and worsened health care, as well as worse health outcomes. Evidence exists that training can reduce bias and improve care. However, no recommendations or requirements around Indigenous health education exist. Therefore, a team of 7 experts was formed to create a training guide called the Indigenous Health Toolkit to train healthcare providers to provide more effective care to Indigenous patients. Indigenous methodologies were applied to this endeavor to create recommendations and training which included engagement with Indigenous elders, community, youth, and businesses. A 7-module toolkit was created over one year to train healthcare providers to provide culturally congruent and bias-free care to Indigenous patients in hopes of reducing the gap in health disparities that exists between Indigenous and non-Indigenous communities.

OBJECTIVES:Women experiencing homelessness have higher rates of unintended pregnancy than stably housed women and may benefit from reproductive interconception care. How reproductive interconception care differs between women who did and did not experience perinatal homelessness is not known. We estimated prevalence ratios of reproductive interconception behaviors among US women experiencing homelessness during the perinatal period. METHODS:We used data from the 2016-2019 Pregnancy Risk Assessment Monitoring System to calculate the prevalence of 5 reproductive interconception care outcomes: attending a maternal postpartum checkup, participating in a conversation with a health care provider about birth intervals, receiving family planning counseling, obtaining a prescription for short-acting contraception, and having a long-acting reversible contraceptive inserted. We used complex survey weights, stratified by perinatal homelessness, and converted adjusted logistic regression odds ratios between housing status and outcome variables to adjusted prevalence ratios (aPRs) and 95% CIs. RESULTS:Among participants, approximately 2.4% (weighted percentage; unweighted 2953 of 100 706) experienced homelessness sometime in the 12 months before their children were born; the majority were non-Hispanic (83.2%) and White (69.4%), were not married (82.2%), and had public health insurance (56.8%). Perinatal homelessness was significantly associated with a lower prevalence of attending a postpartum maternal visit (aPR = 0.90; 95% CI, 0.87-0.94) and a higher prevalence of having a conversation about birth intervals with their health care providers (aPR = 1.13; 95% CI, 1.03-1.21). CONCLUSIONS:Findings suggest that improving attendance at postpartum visits and evaluating birth interval conversations may strengthen interconception care practices while contextualizing social determinants such as housing stability. Improving uptake of postpartum visits may reduce unintended pregnancy, short birth intervals, and adverse birth outcomes in future pregnancies among women experiencing homelessness.

Background and Objectives: Strategic recruitment is necessary to reach recruiting goals when conducting research with vulnerable and transient populations, such as postpartum women experiencing homelessness. The current study evaluated the recruitment process for a qualitative study using the Plan-Do-Study-Act (PDSA) method. Methods: In a study conducting semistructured interviews about reproductive interconception care barriers and facilitators for local women who were recently pregnant and homeless in 2022, PDSA cycles were used to improve community organizations' assistance with identifying participants, facilitate screening and interviewing processes, and ensure participants were safeguarded. Results: Iterative PDSA cycles were conducted across a 20-week period. Ultimately, 12 women were interviewed, with increasing participant location and organizational assistance over time. Following 4 key lessons were identified: provide in-person and remote options for conducting data collection; include fair compensation that balances time versus study coercion; weigh feasibility versus importance of sample size with eligibility criteria; and support partnerships with organization connections. Conclusions: The PDSA method served as a parsimonious framework for evaluation. The lessons learned will help facilitate future recruitment efforts for this difficult-to-recruit and vulnerable population.

Indigenous patients around the globe experience bias and racism within medical encounters that originate from colonial systems of education, media, and other societal venues. Biased health care translates to delayed and worsened health care, as well as worse health outcomes. Evidence exists that health care provider training can reduce bias and improve care. However, in the United States, no recommendations or requirements around Indigenous health education exist. Therefore, a team of seven experts from multiple health disciplines was formed to create a training guide called the Indigenous Health Toolkit to train medical and behavioral health care providers to provide more effective care to Indigenous patients. Indigenous research methods were applied to this endeavor to create recommendations and training which included engagement with Indigenous Elders, community, youth, and businesses. A 7 -module toolkit, with instructions for localization, was created over one year to train health care providers to provide culturally congruent and bias -free care to local Indigenous patients in the hope of contributing to the reduction of the gap in health disparities that exists between Indigenous and nonIndigenous communities.