Protective behavioral strategies for alcohol use (PBSA) are generally associated with reduced drinking and fewer negative consequences. Consumption-focused strategies correlate with lower alcohol intake, while harm reduction strategies relate to fewer adverse outcomes. Research consistently shows inverse relationships between PBSA use and heavy or risky drinking behaviors. However, despite well-established links between PBSA, heavy drinking, and negative consequences, few studies have directly compared PBSA use between college students who engage in heavy/risky drinking versus those who do not. This study addresses this gap by examining differences in negative consequences and PBSA use across these drinking behavior categories, while also exploring potential sex differences.
The study included 2,163 participants aged 18-25 from 12 universities who had used any substance within the past month, identified their sex assigned at birth, and provided informed consent. Participants completed a demographic form and substance use behavior measures, followed by a random sample of 10 measures assessing social-cognitive constructs (e.g., drinking motives), health, and mental health. Key measures included the Daily Drinking Questionnaire for heavy alcohol use, the Alcohol Use Disorders Identification Test-United States-Consumption (AUDIT-US-C) for risky drinking, the Protective Behavioral Strategy Scale-20 (PBSA-20) for protective behavioral strategies, and the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) for negative consequences. Analyses of Variance (ANOVA) were conducted to examine group differences in negative consequences and PBSA use between heavy vs. non-heavy alcohol users and risky vs. non-risky drinkers.
Heavy alcohol use and risky drinking were positively correlated with negative consequences and negatively correlated with PBSA use and its subtypes. Heavy alcohol users reported significantly fewer total PBSA and all subtypes (manner of drinking, stopping/limiting drinking, serious harm reduction) compared to non-heavy users, along with more alcohol-related negative consequences. Similarly, risky drinkers used fewer total PBSA and all subtypes and experienced more negative consequences than non-risky drinkers. No significant sex interactions were found for PBSA use or subtypes in either drinking group. However, main effects revealed that males used less total PBSA and subtypes than females across both heavy and risky drinking analyses. For negative consequences, main effects of drinking behavior (heavy use and risky drinking) were significant, but sex effects were not significant for manner of drinking use or negative consequences.
Takeaway: College students engaging in heavy or risky drinking use fewer PBSA and experience more negative consequences, highlighting the need for targeted harm reduction interventions regardless of sex.