University students use fewer protective behavioural strategies on high-intensity drinking days

Introduction and Aims: High-intensity drinking (HID), or consuming 8+ (10+) drinks in one sitting for women (men), is associated with significant harm. We compared the likelihood of individuals using protective behavioural strategies (PBS) on days with varying levels of drinking (HID, heavy episodic-only drinking [4-7/5-9 drinks for women/men], moderate drinking [1-3/1-4 drinks]). Design and Methods: We used an intensive repeated measures longitudinal design with four 14-day measurement bursts across 2 years (N = 258 university students [50.0% female, average age of 19.95 (SD = 0.41) years] who provided 3176 daily drinking reports). Each drinking day, participants reported the amount of alcohol consumed and whether they used PBS. Results: Multilevel models indicated that, relative to heavy episodic drinking-only days, students were more likely to use strategies of avoiding drinking too quickly on moderate drinking days (odds ratio = 1.90, confidence interval 1.50–2.40) but less likely on HID days (odds ratio = 0.38, confidence interval 0.29–0.48). Relative to heavy episodic drinking-only days, students were less likely to use strategies to protect themselves from serious harm on moderate days (odds ratio = 0.53, confidence interval 0.41–0.67) and equally likely on HID days (odds ratio = 0.84, confidence interval 0.93–1.41). Discussion and Conclusions: Despite elevated risk for alcohol-related harms when drinking most heavily, PBS may be under-utilised on higher-risk drinking occasions. In light of prior work supporting the effectiveness of PBS at reducing harms on HID days, increasing PBS should be emphasised in future prevention and intervention efforts.