Addictive Behaviors 39 (2014) 1033–1037

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Addictive Behaviors

Short Communication

Protective behavioral strategies mediate problem-focused coping and alcohol use in college students Robrina Walker a,⁎, Robert S. Stephens b a b

Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, United States Department of Psychology, Virginia Polytechnic Institute and State University, 109 Williams Hall (0436), Blacksburg, VA 24061, United States

H I G H L I G H T S • • • • •

General coping, protective behavioral strategies (PBS), and alcohol use were examined. Analyses were conducted using structural equation modeling. PBS partially mediated problem-focused coping and alcohol use. Behaviorally oriented problem-focused coping was associated with more use of PBS. Cognitively oriented problem-focused coping was associated with less use of PBS.

a r t i c l e

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Available online 19 February 2014 Keywords: Protective behavioral strategies Coping styles Alcohol use Drinking to cope Drinking self-regulation

a b s t r a c t Objective: Protective behavioral strategies have emerged as a construct protective against alcohol use. The current study examines the theoretical associations among general coping styles, protective behavioral strategies, drinking to cope motives, and alcohol use in college students. Method: Analyses of fully latent variables were conducted using structural equation modeling in a sample of 327 college students. Results: Protective behavioral strategies partially mediated the association between problem-focused coping and alcohol use. Behaviorally oriented problem-focused coping strategies accounted for the positive relationship between problem-focused coping and protective behavioral strategies whereas cognitively oriented problemfocused coping strategies were associated with less use of protective behavioral strategies and increased alcohol use. Conclusions: This is the first study to find that protective behavioral strategies are more likely to be used by college students who endorse using a problem-focused coping style, especially if they tend to use behaviorally oriented problem-focused coping strategies. These findings extend the literature on protective behavioral strategies and indicate that students less likely to use problem-focused coping skills to deal with stress in general may need additional interventions to increase their use of protective behavioral strategies. © 2014 Elsevier Ltd. All rights reserved.

1. Introduction Data continue to reflect that a significant portion of college students drink frequently, heavily, and experience serious consequences (American College Health Association, 2011). To effectively intervene, constructs responsive to intervention must be better understood. Coping skills are one such category of modifiable behaviors. Alcoholspecific coping skills include limiting drinking as well as the resulting

⁎ Corresponding author at: 5323 Harry Hines Boulevard, Dallas, TX 75390-9119, United States. Tel.:+1 214 645 6980. E-mail addresses: [email protected] (R. Walker), [email protected] (R.S. Stephens).

http://dx.doi.org/10.1016/j.addbeh.2014.02.006 0306-4603/© 2014 Elsevier Ltd. All rights reserved.

consequences and are referred to as protective behavioral strategies (PBS). A growing literature on PBS indicates that people vary in the number and types of strategies they use; the more strategies used, the fewer negative consequences experienced (Pearson, 2013; Prince, Carey, & Maisto, 2013). Several have examined variables related to PBS (e.g., Zeigler-Hill, Madson, & Ricedorf, 2012). However, with a few exceptions (LaBrie, Lac, Kenney, & Mirza, 2011; Ray, Turrisi, Abar, & Peters, 2009), how PBS fit within a theoretical model has not been examined. Theoretically, coping styles and alcohol-specific coping skills are immediate determinants of heavy drinking, but it is unknown how they are associated. Determining how they may be associated with one another and, in turn, with alcohol use, may further inform theoretical and treatment models of alcohol use. The current study evaluates coping style as a potential predictor of the use of PBS.

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1.1. Problem-focused coping and protective behavioral strategies Problem-focused coping (PFC; Lazarus, 1991) is associated with better outcomes (Miller & Schnoll, 2000) and predicts less alcohol use. PBS are naturally problem-oriented and can be thought of as PFC applied specifically to drinking situations. Thus, we hypothesized that the protective effect of PFC on alcohol use is explained via the mediating effect of PBS. It is likely that specific facets of PFC will contribute more to the mediated relationship. The PFC facets of ‘planning’ and ‘active coping’ require forethought, skills also necessary for controlling drinking. The ‘suppression of competing activities’ and ‘restraint coping’ facets represent strategically not acting, similar to PBS that moderate drinking by not acting (e.g., avoiding heavy-drinking environments). It was proposed that these four behaviorally oriented PFC facets, collectively, will contribute the most to the prediction of PBS. 1.2. Avoidant coping and drinking to cope Conversely, avoidant, emotion-focused coping (AVC) is predominantly a cognitive process (Lazarus, 1991) and is associated with greater alcohol use (Britton, 2004; Park, Armeli, & Tennen, 2004). Drinking to cope (DTC) motives are a proximal determinant of increased alcohol use (Kuntsche, Knibbe, Gmel, & Engels, 2005) and, over several studies, Cooper et al. (Cooper, Frone, Russell, & Mudar, 1995; Kuntsche et al., 2005; Windle & Windle, 1996) determined that DTC motives mediate avoidant coping and drinking. Martens, Ferrier, and Cimini (2007) previously determined that PBS do not mediate DTC motives and alcohol use. 1.3. The current study The purpose of the current study was to evaluate hypothesized associations among general coping styles, protective behavioral strategies, drinking to cope, and alcohol use in an initial effort to embed PBS within a social cognitive model of alcohol use. Fully latent models were estimated to determine if PBS mediate the association of PFC with less alcohol use and, if supported, which PFC facets drive this relationship. Four behaviorally oriented PFC facets were hypothesized to contribute the most to the prediction of protective behavioral strategies. Furthermore, to study PBS within a more comprehensive model, models were estimated to determine if avoidant coping and greater alcohol use were fully mediated via DTC motives. 2. Method 2.1. Participants Students (≥18 years, drank ≥1 time in the past 30 days) at a southeastern university were recruited online, were emailed the IRBapproved consent form and directions for online study completion, and received extra credit. Participants (N = 327) were primarily female (57%), Caucasian (85%), and 19.57 (1.84 SD) years old. The majority of the sample was freshmen and sophomores (30% each). Participants drank on average 2.01 (1.10 SD) days per week, had 5.72 (3.13 SD) drinks per drinking day, and binge drank on 5.24 (4.41 SD) days out of the past 30. 2.2. Measures 2.2.1. Alcohol use A quantity–frequency measure based on the literature (e.g., Cherpitel, 1997) assessed past 30 day alcohol use. Indices of quantity, frequency, and binge days (α = .70) served as indicators of the latent variable Alcohol Use (ALC).

2.2.2. Coping skills The 60-item COPE (Carver, Scheier, & Weintraub, 1989) has 15 subscales of 4 items each that were summed for a total subscale score. Participants indicated how often they used each strategy when stressed, from 1 (I usually don't do this at all) to 4 (I usually do this a lot). Three subscales were excluded due to limited theoretical and empirical basis (Religion; Humor) and similarity to other measures (Substance Use). Active Coping, Planning, Suppression of Competing Activities, Positive Reinterpretation, Restraint, and Acceptance subscales were indicators of the latent construct Problem-Focused Coping (PFC). Mental Disengagement, Denial, and Behavioral Disengagement subscales were indicators for Avoidant Coping (AVC). Subscale reliability was adequate to excellent (.70 to .95), except for three with low reliability (.64 to .68) and one with very low reliability (Mental Disengagement, .42), similar to other findings (e.g., Ingledew, Hardy, Cooper, & Jemal, 1996). 2.2.3. Protective behavioral strategies The 50-item Drinking Self-Regulation Questionnaire was created from strategies generated by college students (Adams, 2000; Fearer, 2004) and is composed of 3 scales: cognitive (15 items; tell myself I'll get sick if I drink too much), behavioral (15; drink slowly), and environmental (20; only go out once a week). Participants indicated how often in the past 30 days, from 0 (never) to 4 (often), they used each strategy. The measure had very good reliability (.85 to .93). The total score for the three scales was calculated and each served as an indicator of the latent construct Protective Behavioral Strategies (PBS). When the study was conducted, no published PBS scales were available. 2.2.4. Drinking to cope The five items from the drinking to cope subscale of the Drinking Motives Questionnaire (Cooper, 1994) served as indicators of the latent construct Drinking to Cope (DTC). Subscale reliability was good (.83). 3. Results 3.1. Analytical plan LISREL 8.8 was used to conduct structural equation modeling. Since the data were nonnormal, SCALED χ2 (Satorra & Bentler, 1990) was produced by invoking robust maximum likelihood estimation. Nested structural models were compared using the SCALED χ2 difference test1 (Satorra & Bentler, 1994), with a nonsignificant result indicating that the nested, more parsimonious model fits the data better. CFI (Bentler, 1988), RMSEA (Browne & Cudeck, 1993), and SRMR (Byrne, 1998; Ullman, 2001) were also used to evaluate the models. Parameter estimates were deemed significant at p b .05. Prior to estimating the structural models, confirmatory factor analysis was performed to identify the best fitting measurement model, which was then used to estimate the structural models. Complete details are available from author RW. 3.2. Structural equation modeling analyses An alternative models approach was taken whereby the most parsimonious hypothesized Model 3 was evaluated by comparing it to alternative, nested a priori Models 1 and 2 (see Table 1's Model column). The fully saturated Model 1 was estimated first, then Model 2 was estimated by setting the AVC to ALC path to zero, and Model 3 was estimated by setting the PFC to ALC path to zero. The SCALED χ2diff test and fit indices

1 The equation for calculating the SCALED χ2 difference test is as follows: (MLE χ2nested − MLE χ2comparison) divided by the solution of {[dfnested ∗ (MLE χ2nested / SCALED χ2nested)] minus [dfcomparison ∗ (MLE χ2comparison / SCALED χ2comparison)]} / (dfnested − dfcomparison) where MLE is the maximum likelihood χ2 and “comparison” refers to the least restricted model (Satorra & Bentler, 1994).

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Table 1 Model χ2 and Supplementary fit statistics for estimated structural models. Model 1 2 3

Parameters set to zero AVC → ALC AVC → ALC PFC → ALC

df

SCALED x2

MILE x2

ECVI (90% CI)

RMSEA (90% CI)

CFI

SRMR

163 164 165

399.39 399.61 409.96

408.42 408.37 418.21

1.51 (1.35–1.71) 1.51 (1.34–1.70) 1.57 (1.40–1.77)

0.67 (.058–.075) .066 (.058–.075) .067 (.059–.076)

.94 .094 .94

.080 .080 .084

SCALED x2 diff −0.055 13.566⁎

Note. Model 1: PFC → PBS → ALC; PFC → ALC; AVC → ALC; AVC → DTC → ALC. ⁎ p b .05 (indicates rejection of the model on the corresponding row).

indicated that Model 2 best fit the data (see Table 1). As hypothesized, PFC significantly predicted using more PBS (β = .32), which significantly predicted less alcohol use (β = − .58). Unexpectedly, PFC had a

significant direct relationship with greater Alcohol Use (β = .18). AVC did result in greater DTC (β = .38), but the effect of DTC on alcohol use (β = .12) was not significant (see Fig. 1, upper panel).

Fig. 1. Structural equation models. Standardized path coefficients are above the arrows; unstandardized path coefficients/standard errors are below the arrows. All path coefficients are significant unless marked by ns. d = standardized disturbances. Upper panel, final structural model estimates for Model 2: exogenous factors' residuals = 1.0. Lower panel, problemfocused coping facet model estimates: exogenous factors were scaled to 1.0.

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3.2.1. Evaluating the mediation hypotheses The indirect effect of PFC on ALC via PBS was significant (standardized estimate = −.19), indicating for every one standard deviation increase in PFC, ALC is reduced by .19 standard deviations via PBS. The total effect of PFC on ALC was −.01, suggesting no relationship. However, mediation may still occur (Kenny, 2011; MacKinnon, 2000) but be suppressed by the opposite signs of the direct and indirect effects (Shrout & Bolger, 2002; Tzelgov & Henik, 1991). Suppression is also indicated when a predictor's direct effect on a criterion is greater in absolute value than the correlation between the two (Kline, 2005). Each of these conditions for suppression was met in the current study; therefore, we conclude that PBS partially mediated PFC and alcohol use. 3.2.2. Evaluating facets of problem-focused coping and protective behavioral strategies Four behaviorally oriented PFC indicators were hypothesized to account for the relationship between PFC and PBS. The remaining two PFC indicators represent post-event cognitive reinterpretations dissimilar to PBS. Model 2 was re-estimated by replacing PFC with PFCbehavioral (reliability = .79) and PFC-cognitive (reliability = .57). The PFC-behavioral to PBS path was significant (β = .40) while the PFC-cognitive to PBS path was nonsignificant (β = .09; see Fig. 1, lower panel). This supports the hypothesis that the PFC and PBS relationship is largely explained by the more active facets of PFC that deal with stressors by anticipating them. The path estimate from PFCcognitive to ALC (.32; p b .10), although nonsignificant, indicates that the cognitive facets account for the unexpected positive association between PFC and ALC in Model 2.

measure has not yet been established and further testing of existing measures is needed (Pearson, 2013; Prince et al., 2013). Finally, although a reasonably fitting model was found, this only means the model is plausible (MacCallum & Austin, 2000) and should be evaluated against others. For example, potential antecedents or correlates of problem-focused coping, such as self-control constructs (D'Lima, Pearson, & Kelley, 2012; Pearson, Kite, & Henson, 2013), could better account for use of protective behavioral strategies. Our results indicate that approach-oriented, problem-focused coping styles are potential antecedents of protective behavioral strategies while avoidance-based coping styles are risk factors for drinking to cope. This is consistent with the coping and alcohol literature as well as with the larger coping and health literature in which more adaptive coping is associated with better outcomes (Penley, Tomaka, & Wiebe, 2002). Furthermore, behaviorally oriented PFC, as opposed to cognitively oriented PFC, may lead to greater use of PBS. This suggests that efforts aimed at increasing PBS should target students who tend to not use adaptive, behaviorally-oriented problem focused coping strategies. These findings add to the growing protective behavioral strategy literature, and future studies aimed at replicating and examining these results experimentally are appropriate next steps. Role of funding sources No funding was provided for this study.

Contributors Authors RW and RSS designed the study. RW conducted the study, conducted the statistical analysis, and wrote the first draft of the manuscript. RSS contributed to and has approved the final manuscript.

4. Discussion The current study examined associations among protective behavioral strategies, general coping styles, drinking to cope, and alcohol use and is the first to find that use of protective behavioral strategies partially mediates the well-established inverse association between problem-focused coping and alcohol use. Individuals who used a problem-focused coping style in response to stress in general used more adaptive, protective behavioral strategies to control their alcohol use. Additional analyses suggested that this was driven by four behaviorally oriented problemfocused coping facets that predicted increased use of protective behavioral strategies which, in turn, predicted less alcohol use. This study indicates that students who tend to engage in behaviorally oriented, problemfocused coping may be more likely to naturally select and successfully implement protective behavioral strategies to manage their alcohol use. There was also a direct, positive effect of problem-focused coping on alcohol use, contrary to expectations. Additional analyses indicated that this was due to two cognitively oriented coping facets. While potentially helpful for some stressors, these do not appear to be adaptive strategies for avoiding excessive drinking. This indicates that students who rely on cognitive reinterpretation and acceptance strategies to deal with stress are less likely to utilize effective protective behavioral strategies in drinking situations. Drinking to cope did not mediate the relationship between avoidant coping and alcohol use. Two study limitations may have contributed to these findings. First, drinking to cope is a less common drinking motive for students (Kuntsche et al., 2005). Second, low reliability of avoidant coping, while not unique to this study, could have affected the path coefficients downstream (Kline, 2005). Future studies can compensate for this by including many indicators to help increase reliability. Limitations of the study include the cross-sectional design; longitudinal or experimental studies are needed to establish causality. A second limitation is the use of an unpublished protective behavioral strategy measure because one was not available during the study; however, the measure was developed using college student samples following best practices of measure development and had excellent psychometric properties. Of note, recent reviews indicate that a gold standard PBS

Conflict of interest All authors declare that they have no conflicts of interest.

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