Descriptive Drinking Norms and Alcohol-Related Negative Consequences: A Moderated Mediation Model Involving Drinking Quantity and Protective Behavioral Strategies

Abstract

We examined whether drinking quantity mediated the relationship between descriptive drinking norms and alcohol-related negative consequences, and if this was moderated by protective behavioral strategies (PBS) use. Undergraduate students (n = 538, 78.0% female, mean age = 21.21 [SD = 3.62]) from three Spanish universities completed a questionnaire. Simple and moderated mediation analyses were conducted. Drinking quantity fully mediated the relationship between descriptive drinking norms and alcohol consequences, and PBS moderated this relationship. Among participants with high PBS use, the impact of descriptive drinking norms on drinking quantity disappeared. The indirect effect of descriptive drinking norms on alcohol consequences through drinking quantity was significant for individuals with low/moderate PBS use levels, but not for those with high PBS use. Our findings shed light on how descriptive drinking norms influence alcohol-related negative consequences, and suggest that promoting the utilization of PBS could be an effective approach to ameliorate the impact of peer influences on drinking behavior.

Keywords

alcohol use descriptive drinking norms alcohol-related consequences protective behavioral strategies college students

Introduction

Alcohol is the most commonly consumed psychoactive substance worldwide, and is a leading cause of disability and poor physical and mental health. Globally, it is estimated that alcohol use is responsible for approximately three million deaths each year (World Health Organization, 2019). Alcohol consumption has been associated with a wide range of negative consequences (i.e., adverse or harmful effects associated with alcohol consumption) such as academic or occupational-related problems, injuries, fights and violent behavior, unsafe driving, traffic accidents, and risky sexual behavior (Kuntsche et al., 2017; Nayak et al., 2019; Patrick et al., 2020).

Emerging adulthood as defined by Arnett (2005), and college life (Cho et al., 2015; Derefinko et al., 2016), are considered critical periods for the development of heavy alcohol use patterns and increased alcohol-related negative consequences. Research has consistently shown that alcohol use and intensive drinking patterns (e.g., getting drunk and binge drinking) are more prevalent among college students than their non-college peers (Kuntsche et al., 2017; Quinn & Fromme, 2011; Schulenberg et al., 2020). Additionally, alcohol-related negative consequences such as regrettable behaviors, emotional and physical consequences, and academic/job performance failures, have shown to be more prevalent among college students than in their non-college peers (Patrick et al., 2020). Given the elevated risk for alcohol misuse and its associated negative consequences among college students, numerous studies have focused on identifying risk and protective factors that could be helpful to develop effective prevention and early intervention strategies.

Perceived drinking norms have been examined as a potential factor influencing drinking behavior among college students in several studies. Perceived drinking norms refer to individual´s beliefs about the prevalence and acceptability of drinking by others (Borsari et al., 2003). This concept was developed within the framework of Social Norms theory (Perkins & Berkowitz, 1986). This theory suggests that individuals' behavior is often influenced by their perceptions of others' behaviors (also known as descriptive norms) and attitudes (also known as injunctive norms), which may or may not be accurate (Chung & Rimal, 2016). The social norms approach (Perkins & Berkowitz, 1986) posits that overestimating peers’ risk behaviors, such as drinking behavior, can increase personal risk behaviors, while underestimating healthy behaviors, such as using protective strategies, can discourage engagement in such healthy behaviors (Perkins, 2002). Consistent with this theory, it has been consistently found that college students tend to overestimate their peers’ drinking behavior (i.e., perceive that they drink larger amounts than they actually do), and that their perceptions of how much other students drink, also known as descriptive drinking norms, are positively related to personal alcohol use (Dumas et al., 2019; Neighbors et al., 2007b; Pearson & Hustad, 2014; Rinker & Neighbors, 2014). For example, Neighbors et al. (2007b) conducted a study with a sample of 818 college students and found that students who overestimated their peers’ alcohol consumption tended to consume greater amounts of alcohol themselves. Moreover, descriptive drinking norms emerged as the most influential factor in predicting weekly drinking quantity, surpassing other identified risk factors for alcohol use.

Descriptive drinking norms are also positively associated to alcohol-related negative consequences (Hustad et al., 2014; Litt et al., 2012; Neighbors et al., 2007b; Wood et al., 2004). Indeed, in a sample of 481 college students, Litt et al. (2012) found that individuals who perceived that the typical student consumed a greater number of drinks per week reported more alcohol-related negative consequences. However, some studies have suggested that the effect of descriptive drinking norms on alcohol-related negative consequences is mainly mediated by their impact on drinking quantity (Arterberry et al., 2014; Hustad et al., 2014; Neighbors et al., 2007b). In fact, some studies have found that the positive relationship between descriptive drinking norms and alcohol-related negative consequences disappears when controlling for drinking quantity, suggesting that the effect of descriptive drinking norms on consequences is partly explained by an increase in drinking quantity (Arterberry et al., 2014; Neighbors et al., 2007b).

Many existing intervention approaches focused on college student drinking, target descriptive drinking norms (i.e., correcting exaggerated norms) as a means of reducing drinking quantity and alcohol-related negative consequences (Lewis et al., 2014; Neighbors et al., 2016). Although this approach has shown to be fairly effective, some of these interventions have shown no or little effect on changing drinking behavior (Foxcroft et al., 2015; Wechsler et al., 2003). In light of these mixed findings, it is important to identify personal and social factors that moderate the relationship between descriptive drinking norms and drinking behaviors. Recent research has highlighted the importance of such moderating factors, as they can help identify for whom descriptive norms have the greatest impact (Chung & Rimal, 2016). Actually, several factors have been found to moderate the relationship between descriptive drinking norms and drinking behavior, including alcohol resistance self-efficacy (Chen et al., 2022), social drinking motives (Choi et al., 2016), social anxiety (Neighbors, Fossos et al., 2007a), self-monitoring (Jang et al., 2013), and emotional intelligence (Ghee & Johnson, 2008).

One such important moderating factor is the use of alcohol protective behavioral strategies (PBS). PBS are conceptualized as behaviors individually implemented before (e.g., determining a maximum number of drinks that will be consumed), during (e.g., drinking slowly), or after drinking alcohol (e.g., returning home with a trusted person), with the aim of reducing its potential consequences (Martens et al., 2005; Pearson, 2013). Research has consistently shown that college students who use more PBS or use them more frequently drink less and experience fewer alcohol-related negative consequences, such as blackouts, accidents, and academic problems (Bravo et al., 2017; Frank et al., 2012; Lewis et al., 2012; Napper et al., 2014). Interestingly, PBS use has been proven to moderate the relationship between several risk factors (e.g., self-regulation and impulsivity) and alcohol consumption (D'Lima et al., 2012; Doumas et al., 2017; González-Ponce et al., 2022; Schwebel et al., 2021). These studies typically report that the influence of a particular risk factor for alcohol use and its related consequences is ameliorated or nullified when individuals employ more PBS or employ them on a frequent basis. For example, Doumas et al. (2017) found that the positive impact of sensation seeking on alcohol use and alcohol-related consequences disappeared among participants who reported higher levels of PBS usage. To our knowledge, no previous study has explored the moderating role of PBS use on the relationship between descriptive drinking norms and drinking quantity or alcohol-related negative consequences. This information could be useful for improving the effectiveness of norms-based interventions and campaigns seeking to curb drinking among college students.

Taking the above into consideration, the main objective of this study was to investigate the moderating role of PBS use on the relationship between descriptive drinking norms, drinking quantity, and alcohol-related negative consequences. Furthermore, considering previous findings indicating the mediating effect of drinking quantity on the relationship between descriptive drinking norms and alcohol-related negative consequences, this mediation was also examined. Therefore, our specific aims were to explore whether drinking quantity mediated the link between descriptive drinking norms and alcohol-related negative consequences, and whether this mediation was moderated by PBS use (see Figure 1). Additionally, it has been observed that the impact of descriptive drinking norms on drinking behaviors varies depending on the proximity of reference groups (Collins & Spelman, 2013; Neighbors et al., 2010). Specifically, descriptive drinking norms from closer referents (e.g., same-sex college students) exert a greater influence on alcohol use among college students compared to more distant referents (e.g., typical college students). Hence, for this study, the reference group for descriptive drinking norms chosen was same-sex typical college student from their university. Based on previous research results (Hustad et al., 2014; Neighbors et al., 2007b), it is expected that drinking quantity will mediate the relationship between descriptive drinking norms and alcohol-related negative consequences. Besides, following findings from previous studies involving other risk factors for alcohol use (e.g., Doumas et al., 2017), it is anticipated that PBS use will moderate the relationship between descriptive drinking norms and drinking quantity. Specifically, it is hypothesized that among those with greater use of PBS, the impact of descriptive drinking norms on drinking behavior will decrease or even disappear.

Methods

Participants and Procedure

The data for this study were gathered through a convenience sampling procedure. Specifically, with prior authorization from university authorities and the responsible professors, the researchers approached classrooms and invited all the students present to participate in the study. A total of 603 undergraduate students from three Spanish universities (Almeria, Huelva and Seville), that were studying for the degree in Psychology, Social Education or Education and who informed using alcohol at least once during the previous three months, completed a paper-and-pencil questionnaire. Forty-nine participants reported having never consumed alcohol, 14 participants reported no alcohol use during the previous three months and two participants did not inform about their frequency of alcohol use, and their responses were discarded. Thus, the final analytical sample for this study included 538 college students (78.0% female, mean age = 21.21 [SD = 3.62]). The majority (59.3%) were studying at the University of Huelva, 34.5% at the University of Almeria and the remaining 16.2% were undergraduate students from the University of Seville. Most students were studying the degree in Psychology (66.9%) and 20.1% and 13.0% were studying for the degree in Social Education, and Education, respectively.

The study protocol was approved by the bioethics committee of the University of Almería (Spain). Once the approval was obtained, the three universities were contacted and their students were invited to participate. Those who agreed to participate, provided written informed consent and completed a self-administered questionnaire. The questionnaire was completed in the classrooms, in groups of 20–50 students, under the supervision of an interviewer. Before completing the questionnaire, researchers emphasized the confidentiality and anonymity of the data.

Instruments

Drinking Quantity

A modified version of the Daily Drinking Questionnaire (DDQ, Collins et al., 1985) was used to assess the quantity of alcohol used in a typical week during the past month. The DDQ asks about the consumption of six types of alcoholic beverages. To facilitate the task, each question was accompanied by images of the beverages, as established by the Spanish Observatory of Drugs and Addictions (Observatorio Español de las Drogas y las Adicciones [OEDA], 2019). Subjects had to report on the number of drinks consumed on each day of a typical week during the previous month. The number of drinks reportedly used by the participants was converted into Standard Drink Units (SDUs) based on the known alcoholic contents in each alcoholic beverage, considering each SDU as equivalent to 10 grams of pure alcohol (Rodríguez-Martos et al., 1999). Thus, quantity of alcohol used in a typical week was computed as the total sum of SDUs consumed on each day of a typical week.

Descriptive Drinking Norms

Descriptive drinking norms for typical college students were assessed using a modified version of the DDQ (Collins et al., 1985). Participants were asked to indicate how many drinks they thought a same-sex typical college student of their university drank during a typical week within the previous month. As with personal alcohol use, the perceived number of drinks consumed was converted into perceived number of SDUs consumed by a typical student in a week.

Alcohol-Related Negative Consequences

The Spanish version of the Young Adult Alcohol Consequences Questionnaire (YAACQ, Read et al., 2006) adapted to the Spanish culture by Bravo et al., 2019 was used to assess 48 alcohol-related negative consequences experienced during the last three months. To answer the questionnaire, participants have to indicate whether or not they had experienced each consequence within the specified period. The total score reflects the total number of consequences that an individual has experienced. The internal consistency, estimated with the tetrachoric correlation coefficient, as the authors of the original scale recommended (Read et al., 2006), was .96.

Protective Behavioral Strategies

The Spanish version (S-PBSS-20, Sánchez-García et al., 2020) of the Protective Behavioral Strategies Scale (Treloar et al., 2015) was employed to assess protective behavioral strategies (PBS) use. The S-PBSS-20 asks about the frequency of use of 20 PBS during the previous three months. Each item is answered using a five-point Likert scale ranging from never (1) to always (5). Although items could be grouped into three sub-scales (manner of drinking strategies [MOD], stopping/limiting drinking strategies [SLD], and serious harm reduction strategies [SHR]) we used the total score of the PBSS (Sánchez-García et al., 2020). Adequate levels of internal consistency were found for the total scale (.82) using Cronbach´s Ordinal Alpha.

Data Analysis

To achieve our aims, the PROCESS macro (version 3.5, Hayes, 2017) for SPSS was employed. The PROCESS macro facilitates estimation of the indirect effect using a bootstrap approach to obtain confidence intervals. Typically, 95% confidence intervals are used to assess significance of the indirect effect, with ranges not including zero indicating that the indirect effect is statistically significant (Hayes, 2017). First, a simple mediation model (5000 bootstrap samples, confidence interval 95%) was computed, in which descriptive drinking norms was entered as the predictor, drinking quantity was included as the mediator, and alcohol-related negative consequences as the outcome variable. Then, we used a moderated mediation model to examine whether PBS use moderated the relationship between descriptive drinking norms and drinking quantity (Figure 1). Biological sex and age were included as covariates in the analyses, since previous research has shown that descriptive drinking norms, drinking quantity and alcohol-related negative consequences vary according to these sociodemographic variables (Erol & Karpyak, 2015; Lewis & Neighbours, 2004; OEDA, 2022). Significant moderation was probed at three levels of the continuous moderator: low (mean – 1 standard deviation), moderate (mean) and high (mean +1 standard deviation).

Results

Descriptive statistics and correlations among key variables of this study are shown in Table 1. An inspection of the correlation matrix reveals that descriptive drinking norms were positively correlated with both, drinking quantity and alcohol-related negative consequences. In contrast, protective behavioral strategies were negatively related to drinking quantity and alcohol-related negative consequences (all p values were < .001).

Table 1.

Correlations Among study Variables and descriptive Statistics for the Total Sample.

	1	2	3	4	5	6	Mean (SD)/%
1. Descriptive drinking norms	–						27.13 (26.61)
2. Drinking quantity	.274^***	–					11.42 (13.4)
3. Alcohol-related negative consequences	.205^***	.506^***	–				10.79 (7.77)
4. Protective behavioral strategies use	ns	−0.322^***	−0.345^***	–			63.75 (11.22)
5. Age	ns	ns	ns	ns	–		21.21 (3.62)
6. Gender (female = 0)	ns	ns	ns	ns	ns	–	78.0%

***p < .001. ns = non-significant.

We then tested whether drinking quantity mediated the relationship between descriptive drinking norms and drinking consequences. The results showed that drinking quantity fully mediated (indirect effect = .061, CI = .031, .086) the relationship between descriptive drinking norms and alcohol-related negative consequences. As seen in Figure 2, descriptive drinking norms were positively associated with drinking quantity (β = .233, SE = .02, 95% CI [.193, .273], p < .001). Further, descriptive drinking norms were not directly associated with alcohol-related negative consequences (β = −.017, SE = .013, 95% CI [–.043, .009], p = .209). Finally, as seen in Figure 2, drinking quantity was positively associated with alcohol-related negative consequences (β = .263, SE = .026, 95% CI [.213, .314], p < . 001) such that those with higher levels of drinking quantity experience more alcohol-related negative consequences.

Regarding the moderated mediation model, PBS use moderated the effect of descriptive drinking norms on drinking quantity (β = −.018, SE = .002, 95% CI [–.022, −.014]). As it can be seen in Figure 3, the positive relation between descriptive drinking norms and drinking quantity tended to decrease as PBS use increased. Indeed, among college students with high PBS use, the positive relationship between descriptive drinking norms and drinking quantity became statistically non-significant.

The results showed a significant moderated mediation effect (Index = −.004, 95% CI [−.006, −.001]) as the indirect coefficient decreased as PBS use level increased. The effect of descriptive drinking norms on alcohol-related negative consequences through drinking quantity was significant only among those with low (β = .08, 95% CI [.038, .115]) and moderate (β = .035, 95% CI [.019, .055]) levels on PBS use, while this relationship ceased to be significant among those with high PBS use (β = −.013, 95% CI [−.031, .020]).

Discussion

Descriptive drinking norms is considered a risk factor for alcohol use and alcohol-related negative consequences (Dumas et al., 2019; Hustad et al., 2014), and PBS use has shown to lessen the impact of numerous risk factors for alcohol consumption and its consequences (González-Ponce et al., 2022). However, to our knowledge, no previous study explored the moderating role of PBS use on the relationship between descriptive drinking norms and drinking behavior. The present study extended social norms research by incorporating PBS as a potential moderator of the descriptive norms-behavior link. In the present study, we examined whether drinking quantity mediated the relationship between descriptive drinking norms and alcohol-related negative consequences, and whether PBS use moderated this mediation. Our results showed that alcohol use fully mediated the relationship between descriptive drinking norms and alcohol-related negative consequences, and that PBS use moderated this relationship.

Consistent with previous studies (Dumas et al., 2019; Hustad et al., 2014; Pearson & Hustad, 2014), our study´s results indicated that increased descriptive drinking norms were associated with increased drinking quantity and greater number of alcohol-related negative consequences experienced. Supporting our hypothesis, we found that drinking quantity mediated the relationship between descriptive drinking norms and alcohol-related negative consequences. This finding aligns with previous research (Hustad et al., 2014; Neighbors et al., 2007b) demonstrating that much of the effect of drinking norms on alcohol-related consequences depends on drinking quantity. Our findings provided empirical support for this relationship. Specifically, in our study, the effect of descriptive drinking norms on alcohol-related negative consequences was fully mediated by drinking quantity. This finding suggests that the perception of peers consuming large quantities of alcohol may have an indirect influence on individual alcohol-related consequences. Instead of having a direct effect, perceived norms appear to exert their influence by increasing personal alcohol use, which, in turn, leads to a higher likelihood of experiencing alcohol-related consequences.

Study findings also did support PBS use as a moderator of the relationship between descriptive drinking norms and drinking behavior. The results of our study are in line with previous research, which have shown that the positive association between a variety of well-known risk factors for elevated alcohol use, such as trait impulsivity and drinking motives, is attenuated among individuals with high levels of PBS use (González-Ponce et al., 2022; Schwebel et al., 2021). Specifically, we found that among those individuals with high PBS use, the impact of descriptive drinking norms on drinking quantity was no longer significant. Furthermore, our findings revealed that PBS use played a moderating role in the indirect effect of descriptive drinking norms on alcohol-related negative consequences through drinking quantity (i.e., moderated the mediation effect). Specifically, the indirect effect of descriptive drinking norms on alcohol-related negative consequences was observed to be significant for individuals with relatively low and moderate levels on PBS use, while it became non-significant for those with high PBS use. Together, our findings add to the extensive body of research suggesting that using protective behavioral strategies can act as a general protective factor that buffers the influence of risk factors on alcohol consumption, including a widely supported risk factor for alcohol use and alcohol consequences such as exaggerated drinking norms (Merrill & Carey, 2016).

The information provided by these results could be valuable for improving the effectiveness of norm-based interventions aimed at reducing alcohol consumption among college students. As mentioned earlier, some of these interventions have shown limited effectiveness in reducing both alcohol consumption and alcohol-related negative consequences (Foxcroft et al., 2015). One approach to address these limitations is to design interventions that not only focus on changing drinking norms but also incorporate modifiable variables such as PBS that can buffer the impact of social norms on drinking behavior. In this regard, interventions that promote the use of PBS have demonstrated effectiveness in reducing alcohol use and its associated consequences (Dvorak et al., 2018; Leary et al., 2021). By integrating the concept of PBS into interventions and preventive campaigns, researchers and practitioners have the potential to enhance their effectiveness in reducing alcohol consumption among college students. The manipulable nature of PBS and the possibility of incorporating them into training interventions make them a promising avenue for promoting healthier drinking behaviors and mitigating the influence of descriptive drinking norms.

Our results should be interpreted in light of several limitations. Firstly, it is important to acknowledge that our sample primarily comprised college students. While this population is known to be at a higher risk for alcohol-related problems, their characteristics may differ from those of non-college peers. Thus, although previous research has shown a similar pattern of results in young adults from the general population (Fernández-Calderón et al., 2021; Simons-Morton et al., 2018), further studies are needed to determine the generalizability of our findings to young adults who are not enrolled in college. Furthermore, the sample was predominantly composed of women and psychology students. This may have influenced the salience of the “female psychology student” figure when considering descriptive drinking norms, thus limiting the generalizability of our results. Besides, since we used a convenience sampling method to recruit our sample and since we do not have information on the response rate, our results cannot be considered as representative of the college student population. The cross-sectional design employed in our study should also be considered when interpreting our results, limiting the possibility of making causal or predictive inferences. As noted by previous research (Shrout, 2011), mediation analyses based on cross-sectional data have their limitations in establishing causality. However, it should be noted that cross-sectional studies play a valuable role in generating hypotheses, identifying potential associations, and informing future research directions. By conducting this cross-sectional study, we have laid the foundation for future investigations and provided valuable preliminary findings that can guide the design of longitudinal studies or experiments which allow for a more compelling test of our mediation and moderated mediation hypotheses. Finally, it should be noted that here, only descriptive drinking norms were included in the tested models. However, several previous studies have indicated that peers’ perceived approval of drinking behavior, also known as injunctive drinking norms, influences personal alcohol use and related consequences among college students (Foster et al., 2015; Krieger et al., 2016). Thus, future research should also examine the mechanisms through which injunctive norms impact alcohol consumption and related consequences, and whether PBS also moderates the impact of other types of social influences on drinking behavior, such as injunctive drinking norms.

Beyond these limitations, our findings shed light on the underlying mechanism through which descriptive drinking norms influence alcohol-related negative consequences, highlighting the potential effectiveness of correcting distorted perceptions of peers’ drinking behavior. Specifically, our results demonstrate that correcting these perceptions can directly reduce drinking quantity and, consequently, mitigate negative consequences associated with alcohol use. Notably, the present research expands on previous findings by demonstrating that higher use of PBS is associated with weakened relationships between descriptive drinking norms and drinking behavior. Importantly, this aligns with previous research emphasizing the role of PBS as a general protective factor against various risk factors related to alcohol consumption. The information provided in this study represents an initial step in identifying a factor that could potentially mitigate the impact of social norms on alcohol consumption. Importantly, PBS are malleable and amenable to training, making them a feasible target for interventions and preventive campaigns aimed at reducing alcohol consumption and its impact on college students.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this study was provided by the Consejería de Salud (Junta de Andalucía, Andalucía, Spain) under Grant Number PI-0503-2018 (Principal Investigator: Fermín Fernández Calderón).

Disclosure

The authors report there are no competing interests to declare.

ORCID iDs

Belén del Valle Vera

Alberto Parrado-González

Bella M. González-Ponce

Fermin Fernandez-Calderon

Data Availability Statement

Materials and used in this manuscript will be available by emailing the corresponding author.

Author Biographies

Belén del Valle Vera PhD in Psychology. Post-doctoral researcher at the Institute of Psychological Research (IIPsi-UNC-CONICET) in Córdoba (Argentina) and Assistant Professor at the National University of Córdoba (UNC), Argentina. Her research interests focus on substance and polysubstance use on recreational settings with a special emphasis on harm reduction.

Alberto Parrado-González MS in Psychology. Assistant professor at the Department of Social, Educational and Developmental Psychology at the University of Huelva. His research interests are focused on psychosocial aspects of health risk behaviors during adolescence.

Bella M. González Ponce M.S in Behaviors Science Research. PhD student at the Department of Experimental and Clinical Psychology at the University of Huelva (Spain). Her research interests focus on alcohol and recreational cannabis use, psychosocial factors and psychological theories associated to substances use, and harm reduction among young adults.

Fermín Fernández Calderón PhD in Psychology. Associate Professor at the Department of Experimental and Clinical Psychology at the University of Huelva (Spain). His main research areas of interest are: drug use in recreational settings (substance use patterns and substance-related consequences), psychosocial determinants of substance use and harm reduction strategies, and substance use disorders.

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