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Journal of Gay & Lesbian Mental Health

ISSN: 1935-9705 (Print) 1935-9713 (Online) Journal homepage: http://www.tandfonline.com/loi/wglm20

Protective Behavioral Strategies, Alcohol


Consumption, and Alcohol-Related Negative
Consequences Among Lesbian, Gay, and Bisexual
College Students
Ryan C. Ebersole MS, Kayla D. Moorer MA, Jeremy J. Noble PhD & Michael B.
Madson PhD
To cite this article: Ryan C. Ebersole MS, Kayla D. Moorer MA, Jeremy J. Noble PhD & Michael
B. Madson PhD (2015) Protective Behavioral Strategies, Alcohol Consumption, and AlcoholRelated Negative Consequences Among Lesbian, Gay, and Bisexual College Students, Journal
of Gay & Lesbian Mental Health, 19:2, 184-200, DOI: 10.1080/19359705.2014.991957
To link to this article: http://dx.doi.org/10.1080/19359705.2014.991957

Accepted author version posted online: 25


Mar 2015.
Published online: 25 Mar 2015.
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Date: 18 October 2016, At: 09:58

Journal of Gay & Lesbian Mental Health, 19:184200, 2015


Copyright Taylor & Francis Group, LLC
ISSN: 1935-9705 print / 1935-9713 online
DOI: 10.1080/19359705.2014.991957

Protective Behavioral Strategies, Alcohol


Consumption, and Alcohol-Related Negative
Consequences Among Lesbian, Gay,
and Bisexual College Students
RYAN C. EBERSOLE, MS, KAYLA D. MOORER, MA,
JEREMY J. NOBLE, PhD, and MICHAEL B. MADSON, PhD
Department of Psychology, The University of Southern Mississippi, Hattiesburg,
Mississippi, USA

INTRODUCTION: Limited research exists exploring the safe drinking behaviors of lesbian, gay, and bisexual (LGB) college students
despite evidence that they seem to engage in higher frequencies
of heavy episodic drinking than the general student population.
METHODS: This study examined protective behavioral strategies
(PBS) as a moderating variable in the relationship between alcohol consumption and alcohol-related negative consequences in an
online sample of 139 LGB college students. RESULTS: PBS qualified
this relationship for heavy drinkers and not for light drinkers. DISCUSSION: Clinical and future research implications are explored,
including for college counseling center clinicians with LGB clients.
KEYWORDS
apy

substance abuse, mental health services, psychother-

Alcohol consumption is a pervasive and seemingly normative behavior on


college campuses. American college students consume alcohol in greater
amounts and frequencies than any other age group, including their same
age noncollege peers (Hingson, Zha, & Weitzman, 2009; Johnston, OMalley,
Bachman, & Schulenberg, 2013). Four out of five college students report
having ever consumed alcohol (National Institute on Alcohol Abuse and
Alcoholism [NIAAA], 2013), and between 37% and 50% of students report

Address correspondence to Michael B. Madson, PhD, Department of Psychology, The


University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS 39406-5025.
E-mail: Michael.madson@usm.edu
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PBS Among LGB Students

185

engaging in heavy episodic drinking (HED; 4/5 or more standard drinks for
females/males in a two-hour period) in the past two weeks (Johnston et al.;
NIAAA, 2013). Furthermore, 19% of American college students in a national
survey met criteria for alcohol abuse or dependence based on the Diagnostic
and Statistical Manual of Mental Disorders, 4th edition, text revision (DSMIV-TR) (NIAAA, 2013). Approximately 6085% of LGB college students report
past-month alcohol use in three studies (Kerr, Ding, & Chaya, 2014; Reed,
Prado, Matsumoto, & Amaro, 2010; Woodford, Krentzman, & Gattis, 2012),
and when studied in explicit comparison to heterosexual peers LGB students
are more likely to report alcohol consumption (Kerr et al., 2014; Woodford
et al., 2012), HED (Reed et al., 2010), and problematic drinking as measured
by the CAGE questionnaire (Woodford et al., 2012). With more frequent
reports of alcohol consumption and HED than the general college population, LGB college students appear to be an at-risk group for experiencing
alcohol-related negative consequences, as increased alcohol consumption is
related to more frequentand more severe alcohol-related negative consequences (Hingson et al., 2009).
A wide array of alcohol-related negative consequences has been observed as a result of ubiquitous alcohol consumption among the college population (Borden et al., 2011). Hingson and colleagues (2009) demonstrated
that HED is linked with the experience of alcohol-related negative consequences ranging from academic difficulties to injuries (physical assaults,
sexual assaults and death; Ham & Hope, 2003; Hingson et al., 2009; Park &
Grant, 2005). Exploring alcohol-related negative consequences is important
because college students alcohol consumption has consequences that extend beyond the drinker to the campus and community in general (Wechsler
et al., 2002), such as being physically or sexually assaulted by intoxicated
students (Hingson et al., 2009). While the prevalence of alcohol-related negative consequences has been increasing among the general college population (Hingson et al., 2009; NIAAA, 2013), less is known about these trends
among LGB students. In order to promote effective alcohol prevention and
interventions for LGB college students, further exploration of their drinking
behaviors, both risky and protective, as well as the alcohol-related negative
consequences associated with these drinking behaviors within this population is needed.
Protective behavioral strategies (PBS) are safe drinking behaviors that
have recently been referred to as self-regulatory behaviors (DLima, Pearson, & Kelley, 2012). Specifically, PBS are active strategies that students
can choose to implement when drinking and are linked with decreases in
alcohol-related negative consequences (Martens, Pedersen, LaBrie, Ferrier,
& Cimini, 2007; Noble, Madson, Mohn, & Mandracchia, 2013; Zeigler-Hill,
Madson, & Ricedorf, 2012). PBS include strategies that are directly related to
controlling alcohol consumption and strategies related to reducing serious
harm but that are not directly related to controlling consumption (DeMartini

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et al., 2013; Madson, Arnau, & Lambert, 2013). Examples of these strategies
include avoiding drinking games, alternating between alcoholic and nonalcoholic drinks, and using a designated driver (Martens et al., 2007). Researchers
have found PBS to moderate relationships between alcohol consumption
and negative consequences in the general college student population (Borden et al., 2011; DLima et al., 2012). Overall, examining PBS can be useful
when exploring harm reduction strategies among college drinkers.
While PBS have been well researched in relation to reducing alcohol
consumption and alcohol-related negative consequences among college students, less is known about these links among specific groups of college
students such as LGB students. Thus, the purpose of this study was to evaluate the degree to which a sample of LGB college students engages in HED,
to identify commonly experienced alcohol-related negative consequences
among LGB students, and to examine the degree to which PBS use moderates the relationship between alcohol consumption and alcohol-related
negative consequences among LGB college students. LGB students have
been observed to engage in HED at higher frequencies than those found
among samples from the general college population (Kerr et al., 2014; Reed
et al., 2010; Woodford et al., 2012); thus, we hypothesized that LGB students
would engage in HED at a higher percentage than previously observed samples of college students. PBS usage has been observed to have an inverse
relationship with consumption and alcohol-related negative consequences
(Araas & Adams, 2008; Martens et al., 2004; Martens et al., 2007), and there is
an absence of literature to indicate that LGB students will utilize PBS differently than their heterosexual peers. To that end, we hypothesized that PBS
would qualify the association between alcohol consumption and alcoholrelated negative consequences among LGB college students such that higher
use PBS would be related to fewer alcohol-related negative consequences
among students who consume more alcohol.

METHOD
Procedure
Participants were recruited using an online LGB-related message board on
the website www.reddit.com. The posting contained a web link that directed them to an informed consent page. This page detailed that this study
had received approval from an institutional review board and that their
information would remain anonymous. Upon indicating their consent for
participation, they were directed to an online questionnaire via the website
www.SurveyMonkey.com which included a demographics questionnaire and
the measures described below. Inclusion criteria in the study included: being
aged 1825, self-identification as lesbian, gay, or bisexual, current enrollment

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187

in an American four-year university, and reported alcohol use within the past
30 days.

Participants
There were 139 participants included in the study. The mean age of the
participants was 21.08 (SD = 1.74). The initial sample size was 143; however, due to the low number of transgender students who completed the
survey (n = 4), these participants were removed from analyses. We had
originally sought to include transgender college students in our sample and
analyses, but this was precluded by the low number of transgender students
who completed our survey. Thus, the final sample consisted of 139 cisgender (those whose gender is congruent with their biological sex; Schoellkopf,
2012) college students. The majority of participants were male (n = 112,
80.6%), with 19.4% females (n = 27). Most of the sample identified themselves as White non-Hispanic (n = 121, 87.1%), with 5 (3.6%) Hispanics, 4
(2.9%) Asians, 3 (2.2%) African Americans, 2 (1.4%) Native Americans, and 4
(2.9%) self-identified as Other.

Measures
DAILY DRINKING QUESTIONNAIRE
To measure alcohol consumption during a typical week, the Daily Drinking
Questionnaire (DDQ) was used. Participants report the number of standard
alcoholic drinks they consume on each day of a typical week during the past
month (Collins, Parks, & Marlatt, 1985). Standard drinks are defined as: 12
ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor (NIAAA, 2013).
Total drinks per week are calculated by summing all drinks consumed during
a typical week (Lewis, Rees, & Lee, 2009). Participants can be classified as
infrequent drinkers (3 drinks or less per week), moderate drinkers (between
4 and 11 drinks per week), and high-volume drinkers (12 or more drinks
per week) based on their total drinks per week (Collins et al., 1985). The
DDQ was utilized to determine whether or not participants engaged in HED
in the past 30 days.

PROTECTIVE BEHAVIORAL STRATEGIES SCALE-REVISED


The revised Protective Behavioral Strategies Scale-Revised (PBSS-r) assesses
participants use of PBS (Madson et al., 2013). The original PBSS was a
15-item measure in which participants rate the degree to which they use
different strategies such as avoid drinking games using a Likert-type scale
ranging from 1 (never) to 6 (always) (Martens et al., 2005). Higher scores
on the PBSS represent greater PBS use. There is evidence supporting the

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reliability and validity of the PBSS with college students (Martens et al., 2005;
Martens et al., 2007). However, Madson and colleagues (2013) expanded the
PBSS into an 18 item measure. The PBSS-r contains two subscales, compared
with the three in the original measure (Martens et al., 2005). The Serious
Harm Reduction (SHR) subscale consists of six items pertaining to reducing
serious or life threatening consequences related to alcohol consumption
(e.g., sexual assault, driving under the influence [DUI]) and the Controlled
Consumption (CC) subscale has 12 items addressing strategies regulating
ones drinking behaviors (e.g., avoid drinking games, put extra ice in your
drink). The responses are summed and can yield a total score as well as
the two subscale scores, with higher scores indicating greater endorsement
of PBS (Madson et al., 2013). The internal consistency of the full PBSS-r in
this study was .86, with alpha for the SHR and CC scores being .65 and .83,
respectively.

RUTGERS ALCOHOL PROBLEM INDEX


The Rutgers Alcohol Problem Index (RAPI) is a 23-item measure that assesses alcohol-related negative consequences experienced. Participants indicate how often they experienced negative consequences as a result of alcohol
consumption such as missed a day of school or work or neglected your
responsibilities within the past year using a 5-point Likert-type scale from
0 (never) to 4 (more than 10 times). Higher scores represent more negative consequences experienced. There is empirical support for using the
RAPI with college students (Neal, Corbin, & Fromme, 2006). The internal
consistency in this study was .90.

Data Analytic Approach


All data were screened for outliers and missing items prior to conducting
analyses. Additionally, truncation was used to correct for outliers on the
DDQ, and linear trend at point imputation was used to correct for missing
values on the PBSS-r and RAPI. Thus, there were no missing data included in
our moderation analyses. In order to examine the degree to which PBSas
well as two distinct types of PBS, controlled consumption and serious harm
reduction strategieswould moderate the association between alcohol consumption and alcohol-related negative consequences with a sample of LGB
college students, a series of simple moderation analyses were conducted.
The moderation analyses were performed utilizing the SPSS PROCESS macro
(Hayes, 2013). Hayes suggests conducting moderating analyses (i.e., conditional effects) when one variables (X) effect on another (Y) is qualified by
a third variable (M). In order to interpret the significant interactions, these
analyses were followed by simple slopes tests as recommended by Aiken

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PBS Among LGB Students


TABLE 1 Intercorrelations of Variables

1. Protective Behavioral Strategies


2. Alcohol Consumption
3. Negative Consequences
4. Controlled Consumption
5. Serious Harm Reduction
Mean
Standard Deviation
p

.24
.41
.97
.78
69.32
15.33

.51
.22
.21
12.52
10.04

.40
.30
8.17
10.22

.59
39.13
11.88

30.19
4.94

< .01.

and West (1991). Our simple slopes tests were conducted using values that
were one standard deviation above the mean to represent those with high
levels of alcohol consumption and one standard deviation below the mean
to represent those with low levels of alcohol consumption.

RESULTS
The means, standard deviations, and intercorrelations for all variables of interest are presented in Table 1. Participants reported an average of 12.52
drinks per week (SD = 10.04). Sixty-one participants (43.9%) were classified as high-volume, 56 (40.3%) as moderate drinkers, and 22 (15.8%)
as infrequent drinkers (Collins et al., 1985). According to the NIAAA
(2004) standards, 40.74% (n = 11) of the female participants engaged in
HED at least once in the past month, meaning they reported consuming
four or more standard drinks in a single drinking episode. Additionally,
74.10% (n = 83) of the male participants engaged in HED at least once in
the past month, meaning they reported consuming five or more drinks in
a single sitting (NIAAA, 2004). Overall, 67.63% (n = 94) of the sample engaged in HED at least once over the past month. The five most frequently
endorsed Protective Behavioral Strategies (PBS) can be seen in Table 2, and
the five most frequently endorsed alcohol-related negative consequences
are shown in Table 3. Alcohol consumption had a positive association with
negative consequences (r = .51, p < .01) and a negative association with
TABLE 2 Five Most Frequently Endorsed Protective Behavioral Strategies
Strategy
Avoid mixing alcohol with prescription drugs
Avoid getting in the car with someone who has been drinking
Always know what you are drinking
Know where your drink has been at all times
Use a designated driver

SD

5.45
5.42
5.28
5.20
4.82

0.94
1.00
1.29
1.32
1.67

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R. C. Ebersole et al.

TABLE 3 Five Most Frequently Endorsed Alcohol-Related Negative Consequences


Consequence
Tried to control your drinking by trying to drink only
at certain times of the day
Went to work or school high or drunk
Had a bad time
Neglected your responsibilities
Felt you needed more alcohol than you used to use in
order to get the same effect

SD

0.71

1.24

0.65
0.64
0.59
0.58

1.12
0.82
0.96
1.04

PBS (r = -.24, p < .01), the Controlled Consumption subscale (CC; r = 22,
p < .01) and the Serious Harm Reduction subscale (SHR; r = -.21, p < .01).
Alcohol-related negative consequences were negatively associated with PBS
(r = -.41, p < .01), CC (r = 40, p < .01) and SHR (r = .30, p < .01).

Alcohol Consumption, Protective Behavioral Strategies,


and Alcohol-Related Negative Consequences
The first moderation analysis was performed to assess whether or not overall PBS qualified the association between alcohol consumption and alcoholrelated negative consequences. A main effect emerged for alcohol consumption such that increased drinks per week was associated with increased
alcohol-related negative consequences ( = 2.07, t = 7.71, p < .001). This
main effect was qualified by the interaction of alcohol consumption and
PBS ( = .024, t = 6.25, p < .001). The predicted values for this interaction are presented in Table 4. Simple slopes tests were then conducted
and the slope of the line representing the association between PBS and
alcohol-related negative consequences was negative for LGB students with
high alcohol consumption ( = 0.17, t = 4.04, p < .001), but positive
for LGB students with low alcohol consumption ( = .31, t = 3.37, p =
.001). Taken together, these results show that increased PBS was associated
with significantly fewer alcohol-related negative consequences for LGB students who typically consume more alcohol per week, but that greater PBS
was actually associated with slightly more alcohol-related negative consequences for LGB students who typically consume less alcohol per week (see
Figure 1).

Alcohol Consumption, Controlled Consumption Strategies,


and Alcohol-Related Negative Consequences
A second simple moderation analysis was used to assess whether controlled
consumption strategies qualified the relationship between alcohol consump-

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PBS Among LGB Students

TABLE 4 Analyses Regressing Alcohol-Related Negative Consequences Alcohol Consumption


and Protective Behavioral Strategies

Total PBS
Step 1
Alcohol Consumption
PBS Use
Step 2
Alcohol x PBS
CC
Step 1 (CC)
Alcohol Consumption
CC Use
Step 2 (CC)
Alcohol x CC
SHR
Step 1 (SHR)
Alcohol Consumption
SHR Use
Step 2 (SHR)
Alcohol x SHR
p

< .001,

R2

R 2

.59

.34

.49

.15

.34

.34

.51

.16

.29

.30

.49

.15

.44
.20

6.07
4.24

.02

6.25

.45
.26

6.16
6.68

.04

6.68

.47
.42

6.33
2.77

.05

4.16

= .006.

tion and alcohol-related negative consequences. A main effect emerged for


alcohol consumption such that increased drinks per week was associated
with increased alcohol-related negative consequences ( = 1.81, t = 8.48,
p < .001). This main effect was qualified by the interaction of alcohol consumption and controlled consumption strategies ( = .03, t = 6.68, p
< .001). The predicted values for this interaction are presented in Table 4.
Simple slopes tests were then conducted and the slope of the line represent-

FIGURE 1 Graphed interaction of alcohol consumption as the independent variable (X) and
protective behavioral strategies (PBS) as the moderating variable (M), with alcohol-related
negative consequences as the outcome variable (Y). ( = .024, t = 6.25, p < .001).

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FIGURE 2 Graphed interaction of alcohol consumption as the independent variable (X) and
protective behavioral strategies (CC) as the moderating variable (M), with alcohol-related
negative consequences as the outcome variable (Y). ( = .035, t = 6.68, p < .001).

ing the association between controlled consumption strategies and alcoholrelated negative consequences was negative for LGB students with high
alcohol consumption ( = .24, t = 4.39, p < .001), but positive for LGB
students with low alcohol consumption ( = .47, t = 3.85, p < .001). Taken
together, these results show that increased controlled consumption was associated with significantly fewer alcohol-related negative consequences for
LGB students who typically consume more alcohol per week, but that more
controlled consumption strategies was actually associated with slightly more
alcohol-related negative consequences for LGB students who typically consume less alcohol per week (see Figure 2).

Alcohol Consumption, Serious Harm Reduction Strategies,


and Alcohol-Related Negative Consequences
A third simple moderation analysis was used to assess whether serious
harm reduction strategies would moderate the association between alcohol
consumption and alcohol-related negative consequences. The main effect
emerged for alcohol consumption such that increased drinks per week was
associated with increased alcohol-related negative consequences ( = 1.99,
t = 5.36, p < .001). This main effect was qualified by the interaction of
alcohol consumption and serious harm reduction strategies ( = .053, t =
4.16, p = .001), and the predicted values for this interaction are presented
in Table 4. Simple slopes tests were then conducted and the slope of the
line representing the association between serious harm reduction strategies
and alcohol-related negative consequences to be negative for LGB students
with high alcohol consumption ( = .28, t = 1.90, p = .06), but positive

PBS Among LGB Students

193

FIGURE 3 Graphed interaction of alcohol consumption as the independent variable (X) and
serious harm reduction strategies (SHR) as the moderating variable (M), with alcohol-related
negative consequences as the outcome variable (Y). ( = .053, t = 4.16, p = .001).

for LGB students with low alcohol consumption ( = .78, t = 2.42, p =


.02). Taken together, these results show that increased use of serious harm
reduction strategies was associated with significantly fewer alcohol-related
negative consequences for LGB students who typically consume more alcohol per week, but that greater use of serious harm reduction strategies
was actually associated with slightly more alcohol-related negative consequences for LGB students who typically consume less alcohol per week (see
Figure 3).

DISCUSSION
The purpose of this study was to better understand alcohol consumption,
the use of protective behavioral strategies, and alcohol-related negative consequences among lesbian, gay, and bisexual college students. Our observations of drinking frequencies in this sample support our initial hypothesis
that LGB students would engage in greater heavy episodic drinking supporting similar results in previous research (Reed et al., 2010). Further, we found
that LGB students experienced alcohol-related negative consequences as a
result of this consumption. It is important to note that developing a tolerance to alcohol was among the five most frequently endorsed consequences.
These findings emphasize the need to further examine alcohol consumption
among LGB students. As alcohol tolerance essentially increases the amount
of alcohol needed to obtain the same result, and increasing alcohol tolerance among this population might lead to more alcohol consumption.
Thus, among LGB students more alcohol-related negative consequences

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will likely follow this increased consumption as noted by Hingson et al.


(2009).
As predicted, we found that PBS did moderate the association between
alcohol consumption and alcohol-related negative consequences, such that
students who reported higher alcohol consumption and higher PBS use also
reported fewer alcohol-related negative consequences. This is meaningful,
in that it illustrates the relevance of PBS as a harm reduction approach
among LGB college students, a particularly at-risk group of college drinkers.
When we dismantled PBS to its two types, Controlled Consumption and Serious Harm Reduction, we found that, among heavier drinkers, CC behaviors
were associated with fewer alcohol-related negative consequences than SHR.
That is, among heavier drinkers, direct strategies aimed at reducing alcohol
consumption (e.g., avoiding shots, alternating alcoholic and nonalcoholic
drinks) were associated with fewer alcohol-related negative consequences
compared to indirect strategies aimed at reducing the likelihood of serious
consequences (e.g., have a designated driver, always know where your drink
has been). Frank, Thake, and Davis (2012) reported that PBS focusing on
changing the manner of consumption (which would be addressed in CC)
were most effective at reducing negative consequences whereas PBS focusing on SHR strategies were not associated with fewer negative consequences.
A possible explanation may simply be a pragmatic one: CC strategies, rather
than SHR, may be better represented in assessments of PBS. Specifically,
strategies for SHR are targeted to address a small number of specific consequences (e.g., drunk driving, sexual assault; Frank et al.). However, further
study on the use of PBS in this population is needed to explore possible
explanations for this difference.
Among lighter drinkers we found that more PBS use was associated with
more alcohol-related negative consequences. This was found with both the
CC and SHR. However, this runs counter to findings that increased alcohol
consumption was associated with fewer PBS (Patrick, Lee, & Larimer, 2011).
This finding indicates a potential gap in the literature on PBS among LGB
students and may be a result of inexperience with drinking. PBS are associated primarily with alcohol consumption in social atmospheres (Martens
et al., 2008) and perhaps for infrequent drinkers, their inexperience with
drinking may yield more alcohol-related negative consequences than a frequent drinker who likely is more experienced in these types of settings. Also,
perhaps light drinkers inexperience may prevent them from effectively utilizing PBS. Frank and colleagues (2012) found that strategies aimed at limiting
alcohol consumption were associated with more frequent negative consequences. However, again, this finding indicates a need to explore the utility
of PBS among those who consume alcohol less frequently. Either way, the
implication of this finding is that for LGB students, PBS are more effective in
reducing alcohol-related negative consequences among heavy drinkers than
they are among lighter drinkers.

PBS Among LGB Students

195

Implications
Our findings have implications for prevention and intervention efforts with
LGB college student drinkers who report heavy alcohol use. Specifically,
behavioral interventions to increase self-regulation of alcohol use among
LGB college students ought to include education on protective behavioral
strategies, especially when the goal is harm reduction. The prevalence of
heavy episodic drinking in our sample was notably higher than observed in
samples of the general population (Hingson, 2010). Given this at-risk status,
targeted alcohol interventions would likely be beneficial to harm-reduction in
this population. For instance, targeted harm reduction alcohol programming
could be beneficial to LGB-specific groups such as gay-straight alliances,
especially if these approaches include education on PBS versus abstinence.
However, counselors may need to address more than simply alcohol use
when working with this population. It is important to emphasize that this
heightened risk for heavy alcohol use likely does not occur in a vacuum.
In addition to developmentally normative stressors experienced by college
students, LGB students often experience additional stressors related to their
sexual orientation (Zubernis, Synder, & McCoy, 2011). Despite changing national views, LGB students continue to experience heterosexist discrimination
(Rankin, 2003; Woodford et al., 2012) and perceive their campuses and even
residence halls as unwelcoming (Brown, Clarke, Gortmaker, & RobinsonKelig, 2004; Fanucce & Taub, 2010). There is evidence that this victimization
is associated with poorer mental health outcomes, including depression, in
the LGB college and college-age population (Silverschanz, Cortina, Konik,
& Magley, 2008; Toomey, Ryan, Diaz, Card, & Russell, 2010) and that this
is associated with more frequent alcohol use than their heterosexual peers
(Reed et al., 2010; Woodford et al.). The relationship between stigmatization,
depression and alcohol use in this population is of important clinical utility.
For example, Ebersole, Noble, and Madson (2012) observed that PBS partially mediated the relationship between drinking specifically to cope with
depression and alcohol-related negative consequences among lesbian, gay,
bisexual, and transgender (LGBT) students. This finding has not been seen in
non-sexual minority focused studies, largely because PBS are often used in
social environments, whereas alcohol use to cope with depression typically
occurs in solitary environments. They postulated that perhaps LGBT college students may cope with depression differently than non-LGBT students,
possibly due to contextual factors related to their sexuality (Ebersole et al.,
2012). To that end, individualized evidence based prevention approaches
such as the Brief Alcohol Screening and Intervention (BASICS; Dimeff, Baer,
Kivlahan, & Marlatt, 1999) might be utilized to identify heavy drinkers, and
could be adapted to address contextual diversity-related issues, such as being
a sexual minority or experience of stigma, that relate to students drinking
patterns.

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Limitations and Future Research


While our results add notable contributions to the literature, it is important to
recognize the limitations of this study. Although we found that the frequency
of heavy episodic drinking among our sample is higher than the general
population, it is important to note that we specifically recruited participants
who reported drinking in the past 30 days, as this may inflate our conclusions
about HED rates among the general LGB student population. The sample
was overwhelmingly male, which limits the overall generalizability of the
results to the general LGB student population. As the study is largely White
non-Hispanic, it cannot accurately account for the unique experiences of
LGB racial minorities. A low response rate from transgender participants lead
to that group being excluded from our analyses; however, future research
in this area ought to seek out a sufficient sample size from this group to
explore their experiences with alcohol. Finally, we are unable to present
demographic data on the geographic distribution of our sample, which may
limit how nationally representative it is.
While our sample size was large enough to provide adequate power
for our analyses, it did limit our overall generalizability. Additionally, this
small sample size excluded the possibility of addressing subgroup differences in the alcohol consumption, PBS use, and alcohol-related negative
consequences between the gay, bisexual (male and female), and lesbian
participants in any meaningful way. Finally, there exist limitations in our
recruitment. We recruited participants via an LGBT message board on a
popular website; thus, participants motivated to participate through this
venue may or may not necessarily be representative of the LGB student
population.
Future research should attempt to study differences between selfidentified heterosexual and self-identified LGB college students in order to
provide for more accurate comparisons of alcohol consumption and alcoholrelated negative consequences between these groups. Thus far, there is limited literature that directly compares alcohol consumption between LGB and
heterosexual students, rather current comparisons rely on comparing LGB
students with other samples from the general population (which includes
LGB students), and no studies directly comparing PBS usage between LGB
and heterosexual college students. Comparing LGB and heterosexual students in a single study with a single methodology would serve to make
future comparisons more meaningful, especially when making conclusions
about LGB samples, and may also be helpful in identifying risk factors unique
to LGB students. It is becoming increasingly important to identify predictors
of increased PBS use and it will be valuable to examine predictors within
at risk college student subgroups such as LGB students. Exploring the experience of LGB college students at different types of higher educational
campuses (community college, public and private universities, religious

PBS Among LGB Students

197

universities) would explore possible effects of campus environments on LGB


student alcohol behaviors. Finally, given that Holland, Matthews, and Schott
(2013) recently found that tolerance of homosexuality toward LGB students
increases as students advance in college, it would be beneficial to examine
the extent to which year in school, the experience of anti-LGB stigma, as well
as out status, influences alcohol consumption, PBS use, and alcohol-related
negative consequences.

Conclusion
Limited data exist on alcohol use and alcohol-related negative consequences
among LGB college students, as well as the efficacy of PBS in reducing both
alcohol consumption and alcohol-related negative consequences among this
population. We observed that LGB college students engage in heavy episodic
drinking at a larger frequency than the general college population, and
that PBS was a significant moderator for the relationship between alcohol
consumption and negative consequences in this population. Overall, our
results contribute to the literature by providing support for PBS as a buffer
for the effect of alcohol consumption on negative alcohol consequences in
a sample of LGB college students.

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