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. Author manuscript; available in PMC: 2020 Jun 1.
Published in final edited form as: Addict Behav. 2019 Jan 14;93:1–8. doi: 10.1016/j.addbeh.2019.01.009

Alcohol-related Protective Behavioral Strategies as a Mediator of the Relationship between Drinking Motives and Risky Sexual Behaviors

Alison Looby a,*, Adrian J Bravo b, Tess M Kilwein a, Lauren Zimmerman a, Matthew R Pearson b; Protective Strategies Study Team**
PMCID: PMC6488375  NIHMSID: NIHMS1519190  PMID: 30669060

Abstract

Risky sexual behaviors (RSB) frequently occur in the context of alcohol use and are associated with distinct drinking motives among college students. Use of alcohol protective behavioral strategies (PBS) is associated with reductions in alcohol use and related problems, which may extend to alcohol-related RSB. Moreover, as PBS use mediates the relationship between positive reinforcement drinking motives and alcohol-related problems, the same may be true for alcohol-related RSB, specifically. The current study examined whether PBS mediates the relationship between drinking motives and RSB among college students. Participants (N=2039, 72.8% female, Mage=19.79) from ten universities across ten U.S. states completed an online survey assessing past-month drinking motivation, alcohol PBS, alcohol consumption, and RSB. To test study aims, a saturated path model in which drinking motives were modeled as predictors of RSB via PBS use subscales and alcohol consumption was conducted. Several double mediation effects were found, such that stronger endorsement of motives (i.e., social, enhancement, conformity, coping for depression) were associated with lower PBS (particularly manner of drinking and serious harm reduction), which was associated with higher alcohol use, which was associated with higher RSB. Multi-group models found the mediation effects to be gender invariant, although several differences in direct associations were found across genders. For college students high in positive reinforcement motives (i.e., social or enhancement) for drinking, interventions that aim to increase PBS use, specifically related to modifying the manner in which one drinks and avoiding very dangerous consequences, may be effective in reducing alcohol-related RSB.

Keywords: protective behavioral strategies, alcohol use, risky sexual behavior, drinking motives, college students

1. Introduction

Collegiate alcohol use is common, as evidenced by recent data indicating that 63% of students reported past-month drinking and 32% reported past-two-week binge drinking (Schulenberg et al., 2017). Drinking contributes significant risk for students, including accidents, academic difficulties, physical and sexual assaults, and increased potential for death (White & Hingson, 2013). Risky sexual behaviors (RSB), which carry their own risk of negative emotional, social, and health consequences (O’Hare, 2001; Scott et al., 2011), also most commonly occur among college-aged adults (Chandra, Billioux, Copen, & Sionean, 2012). Examples of RSB include engaging in sexual activity without protection against pregnancy or sexually transmitted infections (STIs), having multiple sexual partners, choosing poor or risky sexual partners, and failing to discuss risk related to sexual activity. These behaviors are associated with increased likelihood of contracting STIs, experiencing unwanted sexual encounters or sexual regret, and developing symptoms of anxiety, depression, and problematic substance use, among other possible consequences (Cooper, 2002; Fisher, Worth, Garcia, & Meredith, 2012; O’Hare, 2001; Ramrakha et al., 2013; Scott et al., 2011). As alcohol facilitates and motivates sexual interaction among college students (Fielder & Carey, 2010a; Lindgren, Pantalone, Lewis, & George, 2009), RSB may be particularly likely to occur in the context of drinking (Fielder & Carey, 2010a, 2010b; Grello, Welsh, & Harper, 2006). For example, college students are more likely to have sex with a casual or hardly known partner and to fail to discuss risk topics (e.g., prevention of STIs) prior to intercourse while drinking (Cooper, 2002). Alcohol use is also associated with lower rates of condom usage (Cooper, 2002) and greater intentions to engage in unsafe sex (Rehm, Shield, Joharchi, & Schuper, 2012). Thus, identifying factors that promote both alcohol use and alcohol-related RSB may inform intervention efforts to reduce associated harms.

One relevant variable may be drinking motives (i.e., acute reasons for consuming alcohol). Motives are theorized as the most proximal contributor to alcohol consumption (Cox & Klinger, 1988) and are known predictors of both alcohol use and alcohol-related consequences among college students (Dvorak, Pearson, & Day, 2014; Merrill & Read, 2010; Merrill, Wardell, & Read, 2014). Specific motivations include social (i.e., to improve social interaction), enhancement (i.e., to enhance positive mood), coping (i.e., to alleviate negative mood), and conformity motives (i.e., to fit in; Cooper, 1994). Social and enhancement motives are the most commonly endorsed (Cooper, Kuntsche, Levitt, Barber, & Wolf, 2016) and positively associated with drinking in university settings (Dvorak et al., 2016; Read, Wood, Kahler, Madock, & Palfai, 2003). This may be due to the unique social milieu including several social contexts in which to drink (e.g., Greek housing, residence halls; Bersamin, Paschall, Saltz, & Zamboanga, 2012) and the high perceived permissibility/acceptability surrounding drinking behavior (Borsari & Carey, 2003; Bravo et al., 2017). Recent research examining whether drinking motives also relate to engagement in RSB as a specific alcohol-related problem indicates that social and enhancement motives predict RSB while drinking for college students (Blanchard et al., 2018; Dvorak et al., 2016; Kilwein & Looby, 2018). Accordingly, interventions that successfully target these motives may effectively reduce alcohol use, RSB, and associated consequences.

One approach may be through promotion of protective behavioral strategies (PBS; i.e., behavioral techniques to reduce alcohol use and associated harm), which are increasingly emphasized in prevention efforts to decrease college student drinking (Martens et al., 2004). There is a robust inverse relationship between PBS use and alcohol consumption and associated consequences (Pearson, 2013; Prince, Carey, & Maisto, 2013). Further, sex-related alcohol negative consequences are similarly negatively associated with PBS use (Lewis, Rees, Logan, Kaysen, & Kilmer, 2010; Palmer, McMahon, Rounsaville, & Ball, 2010). Importantly, PBS use partially mediates the relationship between social and enhancement motives and both alcohol use and alcohol-related problems (Bravo, Prince, & Pearson, 2015; Martens, Ferrier, & Cimini, 2007). Specifically, individuals with strong drinking motives employ fewer PBS, which is associated with higher levels of alcohol use and negative consequences. Thus, drinking for positive reinforcement purposes may reduce the likelihood of engaging in PBS that could interfere with obtaining anticipated rewards, yet consequently increase risk for experiencing harm. As event-level social and enhancement motives predict the subsequent occurrence of alcohol-related RSB (Kilwein & Looby, 2018), RSB may be a specific consequence that is influenced by the relationship between drinking motives and PBS use.

It is presently unknown whether the relationships among drinking motives, PBS use, and alcohol-related problems applies to RSB when conceptualized as an alcohol-related consequence. Research examining indirect relations among these variables has not assessed RSB as a negative consequence (Bravo et al., 2015; Martens et al., 2007). Thus, the current study aimed to examine whether a similar mediational model explaining the relationship between drinking motives and alcohol-related consequences through the influence of PBS could be extended to RSB, specifically. We hypothesized that positive reinforcement motives (i.e., social and enhancement motives) would be associated with lower PBS use, which would be associated with greater alcohol use, and subsequently more frequent engagement in RSB.

2. Method

2.1. Participants and Procedures

College students (n=7,307) completed an online survey via Psychology Department Participant Pools at ten universities across ten U.S. states (for more information, see Bravo, Villarosa-Hurlocker, Pearson, & Protective Strategies Study Team, 2018). After providing informed consent, participants completed demographic information and substance use measures followed by a random selection of study instruments to reduce effects of fatigue (i.e., matrix sampling design; Graham, Taylor, Olchowski, & Cumsille, 2006; Schafer, 1997). Participants received research participation credit for completing the study. This was a multi-site, multi-investigator project approved by each participating university’s Institutional Review Board.

The analytic sample for the present study was limited to 2,039 students who disclosed their gender, reported an age between 18 and 24, reported past-month alcohol use, and completed measures of drinking motives, alcohol PBS, alcohol consumption, and RSB. The majority of participants identified as being either White, non-Hispanic (n=1,425; 69.89%) or of Hispanic/Latino ethnicity (n=282; 13.83%), female (n=1,485; 72.83%), with a mean age of 19.79 (SD=1.59) years.

2.2. Measures

2.2.1. Drinking Motives.

Past-month drinking motives were assessed using the 28-item Modified Drinking Motives Questionnaire-Revised (M-DMQ-R; Grant, Stewart, O’Connor, Blackwell, & Conrod, 2007) measured on a 5-point scale (1=never/almost never, 5=almost always/always). Reasons for drinking are assessed across four domains (drinking to cope (DTC) is split by specific negative affect): social (α=.86), conformity (α=.91), enhancement (α=.83), DTC-depression (α=.95), and DTC-anxiety (α=.76). Items were averaged for each motive such that higher scores indicate greater endorsement of a specific motive.

2.2.2. Alcohol PBS use.

Past-month alcohol PBS use was assessed using a 21-item version of the Protective Behavioral Strategies Scale-20 (PBSS-20; Treloar, Martens, & McCarthy, 2015) measured on a 6-point scale (1=never, 6=always). The PBSS-20 evaluates use of alcohol PBS within three domains (items were averaged): limiting/stopping drinking (i.e., strategies related to stopping or slowing down one’s alcohol consumption; α=.84), manner of drinking (i.e., strategies related to different ways that individuals can consume alcohol; α=.85), and serious harm reduction (i.e., strategies related to avoiding potentially very dangerous consequences; α=.85). Although Treloar et al. (2015) dropped a manner of drinking item (i.e., “drink shots of liquor”) from the original PBSS (Martens et al., 2005) for psychometric reasons, we found that this item can be maintained by modifying it to be consistent with the remaining items (i.e., “avoid drinking shots of liquor”).

2.2.3. Alcohol use.

Typical quantity of alcohol use was measured with a modified version of the Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt, 1985). Participants indicated how much they drank during a typical week in the past 30 days using a 7-day grid from Monday to Sunday. We summed number of standard drinks consumed on each day of the typical drinking week (i.e., “weekly drinks”).

2.2.4. Risky sexual behavior.

Past-month RSB was assessed via the Risky Sexual Behavior subscale of the Cognitive Appraisal of Risky Events–Revised–Frequency of Incidence Scale (CARE-R-FOI; Fromme, Katz, & Rivet, 1997; Katz, Fromme, & D’Amico, 2000). The subscale assesses participants’ frequency of engagement in RSB along a 7-point scale (1=never/not at all, 7=31 or more times). Items that did not describe RSB (e.g., “Chose to abstain from sexual activity due to concerns about pregnancy or STDs”) were removed from analyses. Further, all participants responded to items about sexual coercion and coerciveness, while the original CARE-R asks only males about sexual coercion and females about sexual coerciveness. For the present study, we calculated a single total score of risky sexual behavior (23 items were summed; α=.89) such that higher scores indicate greater frequency of RSB.

2.3. Data Analysis Plan

To test study aims, a saturated path model in which drinking motives were modeled as predictors of RSB via PBS use subscales and alcohol consumption (see Figure 1) was conducted using Mplus 7.4 (Muthén & Muthén, 1998–2018). Missing data were handled using full information maximum likelihood (Muthén & Muthén, 1998–2018). We examined the total, direct, and indirect effects using bias-corrected bootstrapped estimates (Efron & Tibshirani, 1993), which provides a powerful test of mediation (Fritz & MacKinnon, 2007) and is robust to small departures from normality (Erceg-Hurn & Mirosevich, 2008). Given our large sample size (i.e., high statistical power), statistical significance was determined by 99% bias-corrected bootstrapped confidence intervals (based on 10,000 bootstrapped samples) that do not contain zero.

Figure 1.

Figure 1.

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Depicts the significant standardized effects of the path model. Significant associations were determined by a 99% bias-corrected standardized bootstrapped confidence interval (based on 10,000 bootstrapped samples) that does not contain zero. Non-significant paths and the covariances among drinking motives and PBS subscales are not depicted for parsimony but are available upon request. DTC=Drinking to Cope.

3. Results

Descriptive statistics and bivariate correlations among study variables are presented in Table 1. With few exceptions, drinking motives were significantly (p<.001) negatively correlated with PBS use and positively correlated with alcohol consumption and RSB. PBS use was negatively associated with both alcohol consumption and RSB. Finally, alcohol consumption was significantly positively associated with RSB. The total and indirect effects for the path model are summarized in Table 2. Direct effects are depicted in Figure 1.

Table 1:

Bivariate correlations and descriptive statistics among all study variables

1 2 3 4 5 6 7 8 9 10 11 M SD
1.Social Motives --- 3.40 0.98
2.Enhancement Motives .69 --- 2.88 0.99
3.DTC-Anxiety Motives .51 .55 --- 2.36 0.97
4.DTC-Depression Motives .26 .41 .70 --- 1.75 0.92
5.Conformity Motives .22 .24 .41 .53 --- 1.45 0.75
6. Limiting/Stopping Drinking −.22 −.26 −.11 −.07 −.02 --- 3.51 1.20
7.Manner of Drinking −.39 −.41 −.18 −.17 −.09 .59 --- 3.43 1.23
8.Serious Harm Reduction −.07 −.18 −.18 −.24 −.26 .42 .41 --- 5.26 0.84
9.Alcohol Consumption .28 .33 .18 .18 .08 −.27 −.38 −.29 --- 6.52 7.21
10. Risky Sexual Behavior .09 .15 .11 .21 .21 −.12 −.17 −.32 .23 --- 29.45 9.95
11. Gender −.06 −.07 −.02 −.02 −.07 .16 .16 .24 −.21 −.05 --- 0.73 0.45
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Note. Gender was coded 0=men, 1=women. Significant correlations are in bold typeface for emphasis and were determined by a 99% bias-corrected bootstrapped confidence interval (based on 10,000 bootstrapped samples) that does not contain zero. DTC=Drinking to Cope.

Table 2:

Summary of total, indirect, and direct effects of drinking motives on risky sexual behavior via PBS use and alcohol consumption

 Outcome Variable: Risky Sexual Behavior
Predictor: Social Motives β 99% CI
Total −.015 −0.09, 0.06
Total indirecta −.011 −0.05, 0.02
 Limiting/stopping Drinking −.006 −0.02, 0.000
 Manner of Drinking .003 −0.02, 0.023
 Serious Harm Reduction −.026 −0.05, −0.001
 Alcohol Consumption .012 0.001, 0.03
 Limiting/stopping Drinking – Alcohol Consumption .0000 −0.001, 0.001
 Manner of Drinking – Alcohol Consumption .008 0.003, 0.02
 Serious Harm Reduction – Alcohol Consumption −.003 −0.01, −0.001
Direct −.005 −0.08, 0.07
Predictor: Enhancement Motives β 99% CI
Total .132 0.07, 0.20
Total indirecta .070 0.04, 0.11
 Limiting/stopping Drinking −.012 −0.03, 0.002
 Manner of Drinking .003 −0.02, 0.03
 Serious Harm Reduction .042 0.02, 0.07
 Alcohol Consumption .023 0.01, 0.05
 Limiting/stopping Drinking – Alcohol Consumption .000 −0.002, 0.003
 Manner of Drinking – Alcohol Consumption .009 0.004, 0.02
 Serious Harm Reduction – Alcohol Consumption .004 0.002, 0.01
Direct .062 −0.01, 0.13
Predictor: DTC-Anxiety β 99% CI
Total −.087 −0.16, −0.02
Total indirecta −.015 −0.05, 0.01
 Limiting/stopping Drinking .004 -0.001, 0.01
 Manner of Drinking −.002 −0.02, 0.01
 Serious Harm Reduction −.004 −0.03, 0.02
 Alcohol Consumption −.006 −0.02, 0.01
 Limiting/stopping Drinking – Alcohol Consumption .000 −0.001, 0.001
 Manner of Drinking – Alcohol Consumption −.006 −0.01, −0.002
 Serious Harm Reduction – Alcohol Consumption .000 −0.003, 0.002
Direct −.072 −0.14, −0.003
Predictor: DTC-Depression β 99% CI
Total .095 0.02, 0.17
Total indirecta .047 0.02, 0.08
 Limiting/stopping Drinking −.001 −0.01, 0.003
 Manner of Drinking .002 −0.01, 0.01
 Serious Harm Reduction .030 0.01, 0.06
 Alcohol Consumption .011 −0.003, 0.03
 Limiting/stopping Drinking – Alcohol Consumption .000 0.00, 0.001
 Manner of Drinking – Alcohol Consumption .004 0.001, 0.01
 Serious Harm Reduction – Alcohol Consumption .003 0.001, 0.01
Direct .048 −0.02, 0.12
Predictor: Conformity Motives β 99% CI
Total .161 0.07, 0.25
Total indirecta .045 0.02, 0.08
 Limiting/stopping Drinking .002 −0.001, 0.01
 Manner of Drinking .000 −0.01, 0.002
 Serious Harm Reduction .049 0.03, 0.08
 Alcohol Consumption −.009 −0.02, 0.000
 Limiting/stopping Drinking – Alcohol Consumption .000 −0.001, 0.000
 Manner of Drinking – Alcohol Consumption −.001 −0.003, 0.001
 Serious Harm Reduction – Alcohol Consumption .005 0.002, 0.01
Direct .116 0.03, 0.20
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Note. Significant associations are in bold typeface for emphasis and were determined by a 99% bootstrapped confidence interval (based on 10,000 bootstrapped samples) that does not contain zero.

a

Reflects the combined indirect associations within the model. DTC = Drinking to Cope.

3.1. Mediation Effects

3.1.1. Social motives as predictor.

There were four significant indirect effects: 1) serious harm reduction mediated the association between social motives and RSB (negative indirect effect due to positive association between social motives and serious harm reduction but a negative association between serious harm reduction and RSB), 2) alcohol consumption mediated the association between social motives and RSB, 3) a negative serial mediation effect via serious harm reduction and alcohol consumption, and 4) a positive serial mediation effect such that social motives was associated with lower manner of drinking; which in turn was associated with higher alcohol consumption; which in turn was associated with higher engagement of RSB.

3.1.2. Enhancement motives as predictor

There were four significant indirect effects: 1) serious harm reduction mediated the association between enhancement motives and RSB, 2) alcohol consumption mediated the association between enhancement motives and RSB, 3) a serial mediation effect such that enhancement motives was associated with lower manner of drinking; which in turn was associated with higher alcohol consumption; which in turn was associated with higher engagement of RSB, and 4) a serial mediation effect such that enhancement motives was associated with lower serious harm reduction; which in turn was associated with higher alcohol consumption; which in turn was associated with higher engagement of RSB.

3.1.3. DTC-anxiety motives as predictor

There was one significant serial mediation effect such that DTC-anxiety motives was associated with higher manner of drinking; which in turn was associated with lower alcohol consumption; which in turn was associated with lower engagement of RSB. It is important to note that compared to its positive bivariate correlation (r=.11, see Table 1), DTC-anxiety motives presented an inverse association with RSB (β=−.07) once controlling for all other predictors. These contradictory results may reflect a statistical suppressor situation (see Bravo & Pearson, 2017) as opposed to DTC-anxiety motives having a protective role on RSB.

3.1.4. DTC-depression motives as predictor

There were three significant indirect effects: 1) serious harm reduction mediated the association between DTC-depression motives and RSB, 2) a serial mediation effect such that DTC-depression motives was associated with lower manner of drinking; which in turn was associated with higher alcohol consumption; which in turn was associated with higher engagement of RSB, and 3) a serial mediation effect such that DTC-depression motives was associated with lower serious harm reduction; which in turn was associated with higher alcohol consumption; which in turn was associated with higher engagement of RSB. It is important to note that there was a significant serial mediation effect via stopping/limiting and alcohol consumption; however, caution should be taken given non-significant direct effects between DTC-depression and stopping/limiting drinking and between stopping/limiting drinking and alcohol consumption.

3.1.5. Conformity motives as predictor

There were two significant indirect effects: 1) serious harm reduction mediated the association between conformity motives and RSB and 2) a serial mediation effect such that conformity motives was associated with lower serious harm reduction; which in turn was associated with higher alcohol consumption; which in turn was associated with higher engagement of RSB. It is important to note that even when accounting for all other predictors, conformity motives still had a significant direct association with RSB (β=0.12).

3.2. Exploratory Gender Invariance Testing

Given prior research demonstrating gender differences on all of the variables in the model, an exploratory multi-group analysis was conducted to determine whether the associations in the model were gender invariant. Given that the χ2 test statistic is sensitive to sample size (Brown, 2015), invariance was determined at p>.01. Results for the fully constrained model suggested that this model was not invariant across gender (p<.001). To identify an invariant model, we identified the path with the greatest contribution to reducing model fit within the fully constrained model. Once we identified this path and allowed it to be freely estimated, we identified the next path with the greatest contribution at reducing model fit and repeated this procedure until we obtained a p>.01, compared with the baseline model.

In the final multi-group model (p=.012), all associations were constrained except for: (a) a correlation between limiting/stopping drinking and serious harm reduction (both significantly positive but stronger association for men [β=.48] than women [β=.38]); (b) a correlation between manner of drinking and serious harm reduction (both significantly positive but stronger association for men [β=.46] than women [β=.35]); (c) the path between RSB and conformity motives (significant positive association for men [β=.19] but non-significant positive association for women [β=.07]); and (d) the path between social motives and alcohol consumption (significant positive association for men [β=.18] but non-significant positive association for women [β=.04]). It is important to note that the significant mediation effects described above were found to be gender invariant.

4. Discussion

The high rates of collegiate alcohol use and associated problems, including consequences from alcohol-related RSB, necessitates examination of mechanistic variables that increase risk for these behaviors. The current study provides continued support for the role of drinking motives in increasing risk for alcohol use and associated problems among college students, and extends this relationship to RSB. Use of a saturated path model allowed us to integrate several individual findings from prior work into a cohesive model to explain this effect, in that enhancement, social, conformity, and coping with depression drinking motives are associated with lower utilization of PBS, which is associated with increased alcohol use, and in turn increased frequency of RSB. While these results are not unexpected, this is the first mechanistic demonstration of these specific indirect pathways. Importantly, this explanation provides numerous points of intervention to decrease the occurrence of RSB, particularly within the context of alcohol use.

As individual drinking motives differentially relate to PBS use and alcohol-related consequences (Bravo et al., 2015), we specifically hypothesized a relation of positive reinforcement motives (i.e., social and enhancement) to PBS use, alcohol, and RSB. These motives are not only the most commonly endorsed by college student drinkers (Dvorak et al., 2016; Read et al., 2003), but they overlap with students’ reported sex motives. For example, enhancement and intimacy (i.e., to bond with socially significant others) motives are the most common reasons college students report for engaging in sex (Cooper, Shapiro, & Powers, 1998). Further, enhancement motives for sex are associated with having more sexual partners and using alcohol during or before sex among student athletes (Grossbard, Lee, Neighbors, Hendershot, & Larimer, 2007). Thus, drinking to amplify mood or social experiences may consequently increase risk for RSB because students may engage in sex for similar reasons, which resultantly becomes risky due to intoxication. Further, these positive reinforcement motives are associated with lower PBS use (Patrick, Lee, & Larimer, 2011), consequently increasing risk for alcohol-related consequences, including RSB.

It is also possible that PBS use conflicts with students’ motivated drinking behavior when they aim to enhance mood or social experiences. For example, setting a predetermined drink or time duration limit may conceivably constrain the potential for mood enhancement, and avoiding drinking games may interfere with attempts to improve social interaction. Thus, holding strong social and enhancement drinking motives may deter students from engaging in proactive attempts to minimize their alcohol use due to concern that it would impede their desired alcohol-related outcomes. In support of this explanation, students report goal conflict as one of the reasons they view using PBS as negative (Bravo, Pearson, Stevens, & Henson, 2018). Risk for RSB may be further compounded when students simultaneously hold strong enhancement or intimacy sex motives. For example, students with strong positive reinforcement drinking and sex motives may decide against making sure to go home with a friend because it could hinder opportunities for enhanced socialization and for sex. Future research should examine the combined influence of drinking and sex motives on alcohol PBS use and RSB.

In addition to positive reinforcement drinking motives, conformity and DTC-depression motives also related to RSB through PBS and alcohol use. Though prior research finds higher PBS use is related to conformity motives, it also finds that college students with strong conformity motives who do not employ PBS may be particularly at risk for alcohol-related problems (Patrick et al., 2011). This may be reflected in the associations between conformity motives and RSB in our study. Though coping motives are not reliably related to increased alcohol use among young people (e.g., Merrill & Read, 2010; Read et al., 2003), they are independently associated with alcohol-related problems (Merrill et al., 2014). Further, depressive symptoms are associated with alcohol-related consequences, and this relationship is partially mediated by lower PBS use (Martens et al., 2008). Thus, DTC-depression motives may result in lower PBS use, perhaps due to limited cognitive resources stemming from depressed mood (Gotlib & Joormann, 2010), yielding increased alcohol-related consequences including RSB. Coping with anxiety motives may not have shown a strong relation with other variables in this study, including RSB, because some anxious individuals may be apt to avoid environments conducive to both alcohol use and sexual behavior (Norberg, Norton, Olivier, & Zvolensky, 2010).

Though we had no a priori hypotheses regarding the influence of specific types of PBS, the finding that only manner of drinking and serious harm reduction PBS mediate the relation between drinking motives and RSB corroborates prior research. Manner of drinking PBS tends to be most strongly associated with reduced drinking (Martens, Martin, Littlefield, Murphy, & Cimini, 2011; Napper, Kenney, Lac, Lewis, & LaBrie, 2014; Pearson, Kite, & Henson, 2012a, 2012b), and research specifically examining the relationship between PBS and alcohol-related RSB finds associations with both serious harm reduction (Sargent et al., 2018) and with manner of drinking PBS (Lewis et al., 2010). Consistently, our research indicates that strategies focused on limiting serious harms by planning one’s behavior during and after drinking (e.g., using a designated driver), or on limiting participation in activities associated with increased drinking (e.g., drinking games) relate to lower engagement in RSB. We found one peculiar finding in that social motives were actually positively associated with serious harm reduction PBS. This may reflect that using in more social contexts (e.g., at a bar or party) necessitates use of more serious harm reduction strategies like using a designated driver or going home with a friend, which is consistent with the positive associations between serious harm reduction PBS and alcohol outcomes observed at the daily level (Pearson, D’Lima, & Kelley, 2013). Alternatively, this could simply reflect the interpersonal nature of serious harm reduction PBS, which necessitates access to and reliance on others, and may be more likely to be employed if drinking for social reasons. It is interesting that focusing on minimizing alcohol use more generally via limiting/stopping drinking strategies (e.g., alternating alcoholic and nonalcoholic drinks) was not associated with fewer RSB. It is possible that RSB is particularly associated with engaging in other risky, impulsive, or dangerous behavior that is limited through an increase in manner of drinking or serious harm reduction PBS, rather than alcohol use in general.

Finally, exploratory analyses revealed that our model was largely gender invariant. This is importantly true for all significant serial mediation paths, including our specific hypothesized pathways involving positive reinforcement motives. Thus, interpretations of the relation between drinking motives and RSB through PBS and alcohol use may be applied similarly across both men and women. However, we did find that use of serious harm reduction PBS was more strongly related to use of both other types of PBS for men compared to women. As PBS use in the present study was significantly correlated with being female, this finding may reflect prior knowledge that PBS use in general is lower among men (LaBrie, Lac, Kenney, & Mirza, 2011). Additionally, the direct associations between conformity motives and RSB, and social motives and alcohol, were significant only for men. Further research is needed to clarify how gender may differentially influence these direct relations that comprise the larger mediational model to best inform intervention.

The present study is limited in that, despite collecting data from ten geographically diverse universities, the sample consisted primarily of White, non-Hispanic female undergraduates. Thus, results may not necessarily generalize to other groups (e.g., non-White students, non-college young adults). In addition, the self-report nature of socially sensitive information may have resulted in inaccurate responding; however, use of a confidential internet survey likely reduced this possibility (Brener, Billy, & Grady, 2003). Similarly, retrospective data collection may have limited accurate responding (i.e., retrospective recall bias), and measures of careless responding or insufficient effort responding (Ward & Pond, 2015) were not included in the online survey. Finally, the temporal ordering of study variables was not assessed, limiting our ability to make causal assertions. Importantly, we did not assess RSB specifically within the context of alcohol use, so it is unknown how frequently RSB occurred while drinking or intoxicated. Future research should clarify this relationship via event-level or ecological momentary assessments; yet it is clear that RSB in general is associated with positive reinforcement drinking motives, lower PBS use, and higher levels of alcohol use.

Knowledge that PBS and alcohol use mediate the relation between social and enhancement motives and RSB confers important clinical implications, predominantly that there are several potential areas of intervention to reduce RSB. Alcohol-related RSB may of course be reduced or prevented by directly reducing alcohol use, but this may also occur through weakening drinking motives. Identifying alternatives to drinking that still allow for desired goal attainment is negatively associated with alcohol use (Sugarman & Carey, 2007). Thus, motive-based interventions that aim to increase engagement in other, non-alcohol-related behaviors to obtain mood and socialization enhancement may limit drinking, which should reduce likelihood of RSB. Further, increasing use of PBS, particularly related to manner of drinking or serious harm reduction, should also be associated with reduced risk of RSB, perhaps even in the absence of modifying drinking motives. In fact, increasing the utilization of both sexual assault-related and alcohol-related PBS may contribute to the prevention of sexual assault (Gilmore, Stappenbeck, Lewis, Granato, & Kaysen, 2015; Neilson et al., 2018). Future research examining whether sexual assault-related PBS mediates the relation between drinking motives and RSB would provide another specific avenue for intervention. As instruction in protective strategies may be brief, easily disseminated, and combined with other intervention/prevention components (Kenney, Napper, LaBrie, & Martens, 2014), efforts should be made to increase use of these strategies among college students, which have the potential to exert significant effects on both alcohol use and RSB.

Highlights.

  • Social and enhancement drinking motives are associated with risky sexual behavior

  • Protective behavioral strategies mediate the motives-risky sex relationship

  • Manner of drinking PBS mediates the relationship for both types of motives

  • Serious harm reduction PBS mediates the relationship only for enhancement motives

Footnotes

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