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Journal of LGBT Issues in Counseling

ISSN: 1553-8605 (Print) 1553-8338 (Online) Journal homepage: http://www.tandfonline.com/loi/wlco20

Drinking Motives, Negative Consequences, and


Protective Behavioral Strategies in Lesbian, Gay,
Bisexual, and Transgender College Students
Ryan C. Ebersole , Jeremy J. Noble & Michael B. Madson
To cite this article: Ryan C. Ebersole , Jeremy J. Noble & Michael B. Madson (2012) Drinking
Motives, Negative Consequences, and Protective Behavioral Strategies in Lesbian, Gay,
Bisexual, and Transgender College Students, Journal of LGBT Issues in Counseling, 6:4, 337-352,
DOI: 10.1080/15538605.2012.725650
To link to this article: http://dx.doi.org/10.1080/15538605.2012.725650

Published online: 29 Nov 2012.

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Date: 18 October 2016, At: 10:01

Journal of LGBT Issues in Counseling, 6:337352, 2012


Copyright Taylor & Francis Group, LLC
ISSN: 1553-8605 print / 1553-8338 online
DOI: 10.1080/15538605.2012.725650

Drinking Motives, Negative Consequences, and


Protective Behavioral Strategies in Lesbian,
Gay, Bisexual, and Transgender College
Students
RYAN C. EBERSOLE, JEREMY J. NOBLE, and MICHAEL B. MADSON
Department of Psychology, The University of Southern Mississippi, Hattiesburg,
Mississippi, USA

Lesbian, gay, bisexual, and transgender (LGBT) students engage


in heavy episodic drinking more frequently than their heterosexual
peers. However, there is currently no research on protective behavioral strategies (PBS) or alcohol motives with this population. This
study explored the degree to which PBS mediated the relationship
between five drinking motives and negative consequences among
143 LGBT college student drinkers. PBS partially mediated the relationship enhancement motives and coping with depression motives
had with negative consequences. Clinical and research implications are discussed.
KEYWORDS alcohol, LGBT students, protective behavior strategies

INTRODUCTION
Lesbian, gay, bisexual and transgender (LGBT) youth are more likely than
their heterosexual peers to engage in alcohol use (Almeida et al., 2009). In
fact, Reed, Prado, Matsumoto, and Amaro (2010) found that approximately
85% of self-identifying lesbian, gay, and bisexual (LGB) students reported
alcohol use within the past month and that 81% of LGB students have had
at least one incident of heavy episodic drinking (HED) per week in the past
month. Given that 37% to 50% of college students in national surveys report
participating in HED within the past 2 weeks (Johnston, OMalley, Bachman,
& Schulenberg, 2011; National Institute on Alcohol Abuse and Alcoholism
Address correspondence to Michael B. Madson, The University of Southern Mississippi,
Department of Psychology, 118 College Drive #5025, Hattiesburg, MS 39406-5025, USA. E-mail:
michael.madson@usm.edu
337

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R. C. Ebersole et al.

[NIAAA], 2012), these findings would put the LGB student populations consumption of alcohol at a higher rate than the general college population.
These findings are consistent with other studies of drinking for LGB students
(Spinardi-Pirozzi, 2008). Ridner, Frost, and LaJoie (2006) found that significantly more LGB students reported being drinkers than their heterosexual
peers (81% vs. 64%). Interesting differences have also been found among
lesbian and gay students. Gay male students, for example, tend to be more
likely than lesbians to engage in HED (Eisenberg & Wechsler, 2003). This
finding is consistent with gay males and lesbians in the general population
(Amadio, Adam, & Buletza, 2008) and is consistent with the gender differences found in national surveys of college students (Johnston et al., 2011).
However, many of these studies are limited in their availability of comparisons between LGBT and heterosexual students (Eisenberg & Wechsler,
2003). Considering that college students tend to use alcohol more than their
noncollege peers (Johnston et al., 2011) and that more LGB students report
drinking alcohol (Reed et al., 2010; Ridner et al., 2006), it is a logical conclusion that sexual minority college students are an at-risk group for alcohol
problems within an at-risk group (college students). Unfortunately, there is
a paucity of research that has thoroughly examined the factors related to alcohol use among LGBT college students. More information is needed about
factors related to HED among LGBT college students, such as drinking motives and how students reduce the harm associated with drinking. In fact,
Reed and colleagues (2010) called for more research exploring mechanisms
that increase alcohol use and consequences among LGB students. Thus,
the purpose of this study is to investigate the relationships among drinking
motives, negative alcohol-related consequences, and use of protective behavioral strategiesaimed at reducing harm among college drinkersin a
national sample of LGBT college students.

Negative Consequences of HED


Alcohol consumption is a behavior that is ubiquitous on American college
campuses, as college students consistently report amounts and frequencies
of alcohol consumption that exceed those of any other subset or age group
(Johnston et al., 2011). According to data from annual national surveys,
four of five college students consume alcohol (NIAAA, 2012), and two of
every five (44.4%) regularly engage in HED (Johnston, OMalley, Bachman,
& Schulenberg, 2009). This type of drinking is typically performed with
the intention of becoming intoxicated and is of greatest concern due to the
myriad of negative consequences that often accompany this level of drinking
(Borden et al., 2011).
Not surprisingly, there are several negative consequences that occur frequently with HED among students (Borden et al., 2011). Specifically, HED has been observed to have a direct relationship with negative

Protective Behavioral Strategies and LGBT Students

339

consequences (Hingson, Zha, & Weitzman, 2009); that is, the more students
engage in HED, the more likely they are to experience alcohol-related negative consequences. These negative consequences may range from minor
inconveniences, such as having a hangover, missing class, or getting behind in coursework (Park & Grant, 2005) to more serious consequences,
such as legal troubles, physical injuries, unwanted sexual experiences, and
death (Hingson et al., 2009; NIAAA, 2012). Boyd, McCabe, and dArcy (2004)
showed that LGB students reported more alcohol-related consequences than
heterosexual students. Furthermore, alcohol consumption on college campuses has secondhand consequences, such as disrupted sleep, assaults, and
damaged property, which negatively affect students who abstain from drinking (Wechsler et al., 2002). The severity and pervasiveness of these problems
make it important for researchers to find viable methods that can be used by
students to minimize negative consequences when consuming alcohol.

Drinking Motives
Drinking motives are an important factor in understanding what may drive
people to consume alcohol (Maclean & Lecci, 2000). It is postulated that
certain motives drive the consumption of alcohol by individuals to achieve
a certain goal or state (Ham, Zamboanga, Bacon, & Garcia, 2009). Motives
are a catalyst for alcohol consumption and may act as a pathway for more
global factors (e.g., depression, anxiety, stress; Cooper, 1994). Within the
realm of alcohol motives, there are four types including enhancement (to
make me feel better), social (to make social gatherings more fun), coping
(to ease distress), and conformity (to fit in; Cooper, 1994). Enhancement and
social motives act via positive reinforcement, using alcohol to increase enjoyment or improve affect, whereas coping and conformity serve as negative
reinforcement, using alcohol to avoid negative effects or social chastisement
(Ham et al., 2009). Reed and colleagues (2010) hypothesized that alcohol
use might be higher among LGBT students as a result of the harassment,
fear for safety, and to reduce stress. In other words, LGBT students may use
alcohol to cope with these negative situations in their environment.
Grant, Stewart, and Mohr (2009) suggested that coping motives could be
more accurately divided into two separate variables: coping with depression
and coping with anxiety. Coping with depression and coping with anxiety
are associated with different alcohol use patterns (Grant et al., 2009). To
accommodate these differences, coping motives that are divided into two
separate variables more accurately capture idiosyncrasies of alcohol motives.
Taken together, alcohol motives are important because they affect alcohol
consumption and related behaviors, such as strategies to reduce harm when
drinking. Although alcohol motives are predictors of alcohol consumption,
we found no studies have looked at these five drinking motives within the
LGBT student population. Given that understanding what motivates LGBT

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R. C. Ebersole et al.

students to drink alcohol has potential applications to understanding how


this population copes with certain stressors (e.g., negative affects) or peer
pressure, this is an important hole in the literature to address.

Protective Behavioral Strategies


Protective behavioral strategies (PBS) are specific behaviors that students
may engage in to reduce overall alcohol consumption as well as reduce the
risk of alcohol-related consequences (Martens et al., 2007). In essence, PBS
serve a harm reduction role in the context of alcohol use as greater use of
PBS is associated with fewer negative consequences and reduced alcohol
consumption (Araas & Adams, 2008; Benton et al., 2004; Borden et al.,
2011; Ray, Turrisi, Abar, & Peters, 2009). Strategies such as avoiding shots
of liquor, using a designated driver, and avoiding mixing different types of
alcohol can be learned and are included in some intervention programs with
college students for this reason (Martens, Martin et al., 2008). Additionally,
the use of PBS has been shown to partially mediate the association that
positively reinforcing drinking motives (social, enhancement motives) have
with alcohol consumption and negative consequences, but not for negatively
reinforcing drinking motives (coping, conformity) (Martens, 2007). Clearly,
the value of PBS has been demonstrated in recent research. However, we
know nothing about the value of PBS among LGBT college drinkers, an
at-risk group of drinkers.
Given that LGBT college students may be an at-risk group for heavy
drinking within an already identified group of heavy drinkers (i.e., college students), more research is needed to evaluate factors that relate to
alcohol consumption. Further, drinking motives appear to have a strong
link with drinking behavior, and PBS have been shown to reduce negative
consequences often associated with heavy drinking (Araas & Adams, 2008;
Benton et al., 2004; Borden et al., 2011; Martens et al., 2005; Ray et al., 2009).
However, we know little about the relationship among these variables for
LGBT college students. Thus, the purpose of this study is to examine the relationships that exist among drinking motives, negative alcohol-related consequences, and PBS use among a national sample of LGBT college students.
Specifically, we sought to understand the degree to which PBS use mediates the association between drinking motives and negative alcohol-related
consequences. Once these relationships are better understood, targeted prevention and interventions efforts might be established for this population.
Overall, due to their largely social nature (Martens, Martin et al., 2008), it
is likely that PBS will mediate the relationship between the positively reinforcing motives, but not negatively reinforcing motives and negative consequences of drinking. To that end, we hypothesize that, similar to the general
college student drinking population, PBS will significantly mediate the relationship between the positively reinforcing drinking motives and negative

Protective Behavioral Strategies and LGBT Students

341

consequences of alcohol use but not negatively reinforcing drinking motives


and negative consequences among LGBT college drinkers.

METHOD
Participants and Procedure
Participants were 143 traditional age (1825) self-identified LGBT college
students at 4-year universities in the United States. This sample provides
adequate power given that smallmedium indirect effects (.06) of PBS as
a mediator were found in previous research (Martens, Martin et al., 2008).
Thus, a sample of 132 would be needed to detect a smallmedium effect
size, .12, with a desired power of .95. Participants were recruited via a
nation-wide online LGBT-related message board that directed them to the
questionnaire via the website Survey Monkey. As recruitment was through
a message board we are unable to estimate a response rate, however, 433
individuals began the survey, and 184 completed the survey. Of the 184
participants who completed the survey 41 were dropped for not meeting
eligibility requirements (1825, drank in the past 30 days). After reading
and electronically signing an informed consent, participants completed the
online questionnaires. Participation was contingent on the participant being
traditional college age (between age 1825) and having reported drinking
alcohol within the past month. The mean age of participants was 21.08 (SD
= 1.72), and there were 11 (7.7%) freshman, 20 (13.9%) sophomores, 34
(23.8%) juniors, and 78 (54.6%) seniors. The majority of participants were
male (n = 112, 78.0%) with 27 (18.9%) females, 3 (2.1%) transgender femaleto-males, and one transgender male-to-female. There were 92 (64.3%) participants who reported being gay, 17 (11.9%) lesbian, 31 (21.7%) bisexual
and 2 (1.3%) indicating other as their sexual orientation. The majority of
participants were White non-Hispanic (n = 125, 87.4%), with 5 (3.4%) participants self-identifying as Hispanic, 3 (2.1%) as African American, 4 (2.7%)
as Asian, 2 (1.3%) as Native American, and 6 (4.1%) as Other. Among the
participants, 80 (55.9%) reported being open to everyone about their sexual
orientation, 14 (9.9%) reported not being open to anyone about their sexual
orientation, 44 (30.9%) reported being open about their sexual orientation
only to members of their family, and 4 (2.9%) reported being open about
their sexual orientation only to their friends.

Measures
Daily Drinking Questionnaire. The Daily Drinking Questionnaire
(DDQ) was used to measure alcohol consumption as it asks participants
to estimate the typical number of alcoholic drinks they consumed each day
of the week (Collins, Parks, & Marlatt, 1985). These drinks were summed
to produce a total number of drinks during a typical week (Lewis, Rees,

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R. C. Ebersole et al.

& Lee 2009). Participants were classified as infrequent drinkers (fewer than
3 drinks per week), moderate drinkers (411 drinks per week), and highvolume drinkers (12 or more drinks per week) using the guidelines outlined
by Collins and colleagues (1985). Collins and colleagues established the
validity of the DDQ by finding a moderate correlation with the Drinking
Practices Questionnaire. Internal consistency in this study was .64.
Protection Behavioral Strategies Scale. Use of PBS was measured by the
15-item Protection Behavioral Strategies Scale (PBSS; Martens et al., 2005).
Participants indicate the extent to which they use a particular strategy such
as use a designated driver, avoid shots of liquor, and avoid drinking
games when drinking using a Likert-type scale ranging from 1 (never) to
6 (always). A total score ranges from 15 to 90 with higher scores indicating
more use of PBS. Internal consistency estimates for the PBSS have range from
.67 to .81 (Martens et al., 2005), and the PBSS has an inverse relationship
with alcohol consumption and negative consequences supporting its validity
with college students (Martens et al., 2005; Martens et al., 2007). The internal
consistency estimate for this sample was .86.
Rutgers Alcohol Problem Index). The Rutgers Alcohol Problem Index
(RAPI) is a 23-item measure designed to assess negative alcohol-related consequences. Participants rate how often they have experienced a specific
negative consequence such as neglected your responsibilities, and missed
a day, or part of a day, of school or work within the past year using a
5-point Likert-type scale ranging from 0 (never) to 4 (more than 10 times)
(Martens et al., 2007). A total score ranges from 0 to 92 with higher scores
indicating more negative consequences. The RAPI has been shown to be
reliable (1 week testretest, r = .89) (Neal, Corbin, & Fromme, 2006) and
with LGB students ( = .93; Reed et al., 2010). The RAPI has been shown
to be a valid measure with college students through expected correlations
with alcohol the Young Adult Alcohol Consequences Questionnaire (r =
.78) (Neal et al., 2006).The internal consistency estimate for this sample was
.90.
Modified Drinking Motives Questionnaire. Drinking motives were assessed using the 28-item Modified Drinking Motives Questionnaire (MDMQ;
Grant et al., 2007). Participants indicate how often they consume alcohol for
a particular reason (e.g., makes me feel good, to fit in, to forget your worries)
using a 5-point Likert-type scale ranging from 1 (almost/never or never) to
5 (almost always/always). The measure involves five motive subscales: social (makes me/gatherings more fun), enhancement (makes me feel good),
conformity (to fit in), coping for depression, and coping for anxiety. The
MDMQ has been shown to be a reliable ( = .66, social to .91, coping with
depression). Validity of the MDMQ for use with college students has been
established through expected correlations with alcohol consumption (r =
.23, coping-depression to. 32, conformity) and negative consequences (r =
.18, social to .34, coping-depression) (Grant et al., 2007). The alpha for this

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Protective Behavioral Strategies and LGBT Students

sample was .92. The internal consistency for the subscales were .67 (social
motives), .93 (coping with depression motives), .78 (coping with anxiety
motives), .82 (enhancement motives), and .77 (conformity motives).

RESULTS
Participants reported an average of 12.42 drinks per week (SD = 10.0). According to DDQ classification (Collins et al., 1985), 23 (16%) participants were
classified as light drinkers, 58 (40.5%) participants were moderate drinkers,
and 62 (43.3%) were considered heavy drinkers. The least endorsed PBS
were avoid taking shots of liquor, stop drinking at a predetermined time,
avoid mixing different types of liquor, and put extra ice in your drink,
with 40 (27.9%), 41 (28.7%), 41 (28.7%), and 43 (30.1%) respondents answering never, respectively. The most endorsed PBS were avoid getting in
a car with someone who has been drinking, always know what youve
been drinking, and avoid mixing alcohol with prescription drugs, with
94 (65.7%), 95 (66.4%), and 95 (66.4%) participants, respectively, indicating
that they always utilize these PBS. The most commonly reported negative
consequences were caused shame or embarrassment to someone and neglected your responsibilities, with 52 (36.3%) participants reporting experiencing these problems or consequences at least once. Additionally, at least
47 (32.8%) participants indicated that they went to work or school drunk or
high at least once or more.
Means, standard deviations, and intercorrelations (Pearsons r) are presented in Table 1. A mediation analysis, as suggested by Preacher and Hayes
(2004), was performed to investigate the extent to which PBS mediated the
relationship between specific alcohol motives and drinking related negative consequences among LGBT college students. In sum, a total of five
TABLE 1 Intercorrelations of Measures
M
1.
2.
3.
4.
5.

SD

PBSS
69.47 15.28
DDQ
12.42 10.01 .25
RAPI
8.10 10.17 .41 .50
MDMQ-Social
10.22 3.95 .04
.18
.10
MDMQ-Coping
4.96 3.78 .18
Anxiety
.17
6. MDMQ-Coping
4.20 6.44 .20
Depression
7. MDMQ-Enhancement 8.88 4.78 .24 .32
8. MDMQ-Conformity
1.52 2.41 .01 .02

.12
.27

.46

.41

.23

.56

.42
.18

.47
.47

.50 .47
.53 .28 .31

PBSS = Protection Behavioral Strategies Scale; DDQ = Daily Drinking Questionnaire; RAPI = Rutgers
Alcohol Problem Index; MDMQ = Modified Drinking Motives Questionnaire.
p < .05, p < .01.

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R. C. Ebersole et al.

mediation analyses were conductedone for each of the subscales of the


MDMQ. Given that a number of the variables used had issues with skewness
and kurtosis, a resampling technique known as bootstrapping was utilized to
generate 5,000 resamples of the data. Bootstrapping is defined as a nonparametric, effect size estimation that does not operate out of large sample theory,
makes no assumptions about the distribution shape of the sample, and can
be confidently applied to smaller sample sizes (Preacher & Hayes). Due to
Martens, Martin et al.s (2008) demonstration of PBS as a partial mediator
between depressive symptoms and negative alcohol-related consequences,
bootstrapping was also chosen due to its ability to better detect partial mediations as compared to the Baron and Kenny (1986) method (Preacher &
Hayes).
As can be seen in Figure 1, PBS significantly partially mediated the
relationship between coping with depression motives and negative consequences, p < .05. The true indirect effect is between .001 and .208 with 95%
confidence, and PBS mediated 16% of the relationship. As seen in Figure 2,
PBS also significantly partially mediated the relationship between enhancement motives and negative consequences, p = .02. The true indirect effect
is between .026 and .315 with 95% confidence, and PBS mediated 22% of
the relationship. Consistent with our hypotheses, PBS was not a statistically

.65***

Negative
Consequences

Coping with depression

PBS
-.45*

Coping with depression

-.23***

.55***

Negative
Consequences

*p < .05; ***p < .001

FIGURE 1 Mediation analysis of protective behavioral strategies (PBS), coping with depression, and negative consequences.

Protective Behavioral Strategies and LGBT Students

Enhancement

.91***

345

Negave
Consequences

PBS
-.75**

-.22***

Enhancement

Enhancement

.74***

Negative
Consequences

**p < .01; ***p < .001

FIGURE 2 Mediation analysis of protective behavioral strategies (PBS), enhancement, and


negative consequences.

significant mediator in the relationship between coping with anxiety motives


and negative consequences or between conformity motives and negative
consequences. Contrary to our hypothesis, PBS was not a statistically significant mediator in the association between social motives and negative
consequences.

DISCUSSION
We sought to examine the role PBS play in reducing negative consequences
associated with alcohol motives among LGBT college students. We found
that PBS partially mediated the relationship between coping with depression
motives and negative consequences. This finding is divergent from previous
research among the general college student population in which PBS partially
mediated the relationship between positively reinforcing drinking motives
and negative consequences but not negatively reinforcing drinking motives
and negative consequences (Martens et al., 2007). This result is surprising
because many PBS items (e.g., leaving a party at a specified time, using
a designated driver) are oriented toward drinking in a social atmosphere
(Martens, Martin et al., 2008). One explanation for this finding is that many

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R. C. Ebersole et al.

LGBT students may be drinking to cope with depressive symptoms in social


manners (e.g., at parties or at bars), contrasting with those usually drinking
to cope with depression, which often occurs in solitary environments (Grant
et al., 2009).
However, this result may be due to possible differences in coping styles
between sexual minority students and the general population. Although there
exists relatively little research on affective disorders among LGBT college students, literature exists on LGBT adolescents of comparable age. When compared to the general population, LGBT adolescents are much more likely to
experience symptoms of depression (Mustanski, Garofalo, & Emerson, 2010).
This higher prevalence of affective disorders has been observed to have a
direct relationship with the intense levels of stigmatization experienced by
this population (Kosciw, Greytak, Diaz, & Bartkiewicz, 2010; Toomey et al.,
2010; Williams, Connolly, Pepler, & Craig, 2005). This sexuality-based prejudice results in internalization and externalization may relate to higher rates of
depression observed in this population (Williams et al., 2005) and increased
rates of substance use and HED (Almeida et al., 2009; Mustanski et al., 2010).
Thus, it is possible that LGBT college students may not be able to cope with
sexuality-related depression in a manner similar to their heterosexual peers
who experience non-sexuality-related depression. For example, many situations that may lead to depression (relationship difficulties, stress, etc.) can
be an experience that is noticeable and common to ones peers. As a result,
students can turn to their peers for support. Support for sexuality-based stressors is less available to LGBT students (Doty, Willoughby, Lindahl, & Malik,
2010). To that end, it is possible that students may turn to less conventional
means of coping, including drinking when in social situations; situations in
which PBS have been shown to reduce alcohol related consequences, as a
way to deal with negative affect.
We also found that PBS partially mediated the relationship between
enhancement motives and negative consequences. This finding is not surprising, as this finding is consistent with previous research (Martens et al.,
2007). Although there are many unique experiences among the LGBT student population, these individuals are still members of the college student
population and such overlap can be expected. A common perception in
the college environment is that everybody drinks alcohol to feel good and
have a good time (NIAAA, 2012). Feeling good is a positively reinforcing
motive. Given that PBS are valuable for positively reinforcing motives this
finding was expected. Our finding that PBS were valuable for enhancement motives and coping with depression motives may have uncovered a
similarity between these two motives among LGBT students. For LGBT students, there may be perceived similarities between enhancement motives
(e.g., drinking makes me feel good) and coping with depression motives
(e.g., drinking helps me feel less bad). Thus, a link may exist between these
two drinking motives for LGBT students and should be explored further.

Protective Behavioral Strategies and LGBT Students

347

Our finding that PBS was not a statistically significant mediator with
the other positively reinforcing motive (social) is inconsistent with previous
findings. Unlike many college students who link alcohol consumption and
increased sociability, LGBT students may experience increased stress and depression in social drinking environments on campus, especially for students
who are not open about their sexual orientation or in campus environments
that are not supportive of LGBT students (Reed et al., 2010). Thus, these students may withdraw from social situations and prefer to drink in isolation.
Labrie, Kenny, and Lac (2010) found that students with stronger social health
were more likely to implement PBS. Thus, PBS might not be as effective for
individuals with weaker social motives. Our finding that PBS did not mediate
the coping with anxiety drinking motive and negative consequences is consistent with previous research. Anxiety has been shown to be a protective
factor related to lower amounts of alcohol consumption. For LGBT students,
especially those on unwelcoming campuses, there are safety concerns that
may influence their drinking patterns. Reed and colleagues (2010) found that
LGB students felt less safe on campus and experienced more threats and victimization, thus, they may avoid situations (e.g., parties) where HED is more
likely to occur. Similarly, LGB students may not have a strong motivation to
conform to the majority culture of an unwelcoming campus and thus feel no
need to drink to conform.

Clinical Implications
Based on our results, it appears that PBS can be effective for reducing negative drinking consequences in the LGBT population. This is particularly useful in light of this populations increased risk for substance abuse (Almeida
et al., 2009; Reed et al., 2010). Perhaps more importantly, it highlights the
significance of educating LGBT students on constructive coping mechanisms
for affective disorders as well as their motives and expectations for drinking alcohol. To that end, this study also provides support for a possible
solution: PBS. Thus, PBS use and motives should be integrated into traditional prevention and intervention efforts for LGBT students. Clinicians may
reach out to campus LGBT communities to provide targeted prevention efforts highlighting the importance of drinking motives and PBS use. These
efforts can also advocate students supporting PBS use with their peers. With
targeted prevention efforts for LGBT students clinicians may better account
for contextual issues (e.g., victimization, unwelcoming environment) related
to alcohol use that may not be addressed in general university prevention
efforts.
Clinicians might benefit from recognizing that LGBT students may not
cope with stressors in ways similar to other students, especially stressors related to their sexual orientation. For instance, LGBT students may not receive
social support to help them cope more effectively with discrimination and

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microaggressions. Thus, clinicians need to attune to the potential for these


students to use alcohol whether to cope with depression or to feel good. Attention to the motivations behind the students alcohol use and discussion of
how sexuality-based stressors may affect alcohol use may be important when
working with LGBT students. Implementing evidence-based screening and
intervention programs, such as the Brief Alcohol Screening and Intervention
Program (BASICS) (Dimeff, Baer, Kivlahan, & Marlatt, 1999), provide a great
opportunity to individualize harm reduction efforts that can also address the
contextual issues LGBT students encounter related to their drinking. As such
the BASICS approach would allow clinicians the opportunity to address the
factors (motives, mental health, etc.) that related to ones use of alcohol.
Finally, and perhaps most importantly, clinicians, student support personnel,
and university administrators need to make efforts to create a campus environment that is welcoming and supportive for LGBT students. Unwelcoming
campus environments and the associated consequences (e.g., threats, violence) for LGBT students have been shown to be a predictive factor for
heavy alcohol consumption and negative consequences (Reed et al., 2010).
Facilitating programming such as dialogues and speaker panels have been
shown to positively influence the attitudes on heterosexual students toward
LGBT students (Kwon & Hugelshofer, 2012). Thus, social justice advocacy
efforts must be implemented on campuses to create a better environment for
LGBT students.

Limitations and Future Research


Although our results highlight the value of PBS use among LGBT college
students, they need to be interpreted within study limitations. One limitation
is the sample size and homogeneity among the participants. Although a sufficient number of participants were recruited to achieve statistical power for
analyses, the sample size was insufficient to observe any group differences
by gender or between sexual orientations. Additionally, the small (n = 4)
size of transgender participants made it impossible to observe any unique
behaviors or motivations within that group. The sample in this study is overwhelmingly male, which may limit the generalizability of these results to
LGBT students in general, as gender differences have been observed in alcohol patterns between sexual minority men and women (Ridner et al., 2006).
As with the general population (OMalley & Johnston, 2002), sexual minority
male students have been observed to engage in HED more frequently than
their female counterparts (Eisenberg & Wechsler, 2003). Finally, this study
has a sample that is overwhelmingly White. This is a limitation in that it fails
to incorporate unique experiences and psychological components of racial
minority LGBT students, population that is stigmatized by heterosexism and
racism (Baslam et al., 2011).
Future research should focus on incorporating the diverse nature of sexual orientation and gender nonconformity when exploring college alcohol

Protective Behavioral Strategies and LGBT Students

349

use. Specifically, to incorporate the extent to which students sexual orientation or gender identity may influence their drinking behaviors. Future studies
should address where students are in their identity development as well as
their acculturation into the general college student population. That is, perhaps students developmental position with their sexual or gender identity
(i.e., how comfortable or settled they are with their identity) might affect their
drinking motives. Furthermore, how well are students acculturated with their
general student population (using factors such as how well LGBT students
are accepted or welcomed) likely would also affect their drinking behaviors.
Future research also should attempt to recruit larger transgender samples to
provide baseline data on this group. Researchers should be diligent to oversample transgender individuals to gather sufficient transgender sample sizes.
For example, though this study utilized an LGBT message board, it may be
prudent to also utilize a transgender-specific message board to reach a significant sample size. As sexual orientation and gender identity are discrete
constructs, it might be that there may be differences in alcohol motivations or
behaviors between these two groups. However, to our knowledge, no such
study has investigated these possible differences. Exploring possible reasons
PBS partially mediated the relationship between coping with depression
but not anxiety and negative consequences is also needed. In particular, the
construct anxiety consists of several manifestations (e.g., generalized anxiety,
social anxiety, anxiety sensitivity) that have some similarities and differences
which may affect how one copes. For instance, social anxiety has been suggested to initially serve to as a protective factor in relation to alcohol use
for some but not for others (Labrie, Pedersen, Neighbors, & Hummer, 2008).
Thus, exploring coping with anxiety motives may be too broad to understand
the nuances this drinking motive.

CONCLUSION
The use of protective behavioral strategies among college students is important for reducing the harm associated with increased alcohol consumption
during this period of life. This study contributes further support for the
value of PBS in particular, as they mediate the associations that coping with
depression and enhancement motives have with negative alcohol consequences among LGBT college drinkers. Our results also add support for the
importance of harm reduction approaches that incorporate discussions about
drinking motives and PBS use as they specifically relate to LGBT students.

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