This observational study sought to improve our understanding of factors that contribute to risky sexual behavior among women seeking treatment for alcohol and other substance use disorders. Women were recruited at the start of outpatient (n=236) or inpatient (n=166) treatment. At intake, a Timeline Follow-back interview was used to obtain retrospective reports of daily drinking, drug use, and sexual behavior for a 90-day pre-treatment baseline period. Additional interview and questionnaire measures also were obtained. Measures were re- administered at four 90-day follow-up interviews. Among women who reported sex with a primary partner during baseline (n=261), 15% reported consistent condom use for all events with this partner, whereas 80% reported no condom use with this partner. Among women who reported sex with a non-primary partner (n=159; doesn’t include commercial sex trading), 26% reported consistent condom use and 45% reported no condom use with such partners. Significant correlates of non-use of condoms included negative beliefs and attitudes and low self-efficacy regarding condom use and AIDS prevention, as well as psychological distress, sexual impulsiveness and sensation seeking, history of severe assault by a male partner, and (with primary partners) negative partner attitudes toward condom use. Some of these correlates also predicted unprotected sex with a primary partner during the first 90 days after treatment entry, after controlling for baseline. However, unsafe sex with a non-primary partner during follow-up was most notably associated with follow-up levels of substance use, i.e., more drinks per drinking day and greater frequency of alcohol, marijuana, and cocaine use. In sum, preliminary analyses of baseline and follow-up data indicate a high prevalence of unprotected sex in this population. Identification of factors related to baseline and follow-up levels of risky behavior may suggest targets for future intervention development.

The present study includes baseline data from 2867 students (77.8% from Sweden, 22.2% from US) and evaluates the relationships among self-reported disabilities, alcohol use, other substance use, and psychosocial adjustment. There were 114 (4.6%) ‘‘hard-of-hearing’’ (HH) students, 129 (5.2%) reported visual disabilities, 33 (1.3%) reported motor disabilities, 223 (9.0%) reported a reading/writing disability, and 97 (3.6%) reported they had ‘‘other’’ disabilities. Of these, 70 (14.1%) reported more than one disability. Presence of a disability was significantly higher among Sweden students (2 (1)=19.93, p< 0.001), with 19.1% of Sweden students and 11.5% of US students reporting at least one disability. Reporting any type of disability was associated with significantly greater alcohol use frequency, intensity, and related problems (all p < 0.02), significantly more mental health symptoms and conduct problems (p < 0.005), and significantly greater likelihood of illicit and prescription drug use (all p < 0.001). With respect to specific disabilities, individuals with motor disabilities reported the highest levels of alcohol use and mental health symptoms, whereas individuals who reported ‘‘other’’ disabilities had higher rates of illicit drug use and conduct problems. Further, there was a significantly positive correlation between the number of disabilities and intensity of alcohol use, mental health symptoms, conduct problems, illicit and prescription drug use, and alcohol related problems (all p < 0.001). The association between conduct problems and disability (any disability and number of disabilities) was moderated by country of origin, gender, and drinking for coping reasons on the Drinking Motives Questionnaire. Participants in Sweden, males, and those who drank for coping reasons were more likely to report a relationship between disability and conduct problems (p < 0.001). Participants who drank for coping reasons were also more likely to report a relationship between disability and alcohol related problems (p=0.001). These findings indicate students with disabilities are an important risk group for preventive interventions for alcohol, substance, and mental health problems, and may benefit from interventions which target healthy coping skills. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglund

Aims: Perceived risk is related to use of cannabis, alcohol, and tobacco among youth. Sweden and US have different policies and customs related to these substances thatmay influence both risk perception and behavior regarding use of these substances. Differences in perceived risk of cannabis, cigarettes, chewing tobacco and alcohol in Sweden and the US have been reported but no direct systematic comparison has been performed. Design and setting: The ATLAS Project is a long-term longitudinal study comparing the development of substance use from high school to the young adult life period (18–23 years) in the US and Sweden. Participants: Baseline data for 3352 17–19 year-old high school students (65%from Sweden, 56% women, mean age 17.8, 35%from US 58%women,mean age 17.6). Measurements: Surveys of perceived risk items, ever use of cannabis, cigarettes and alcohol, as well as conduct problems, mental health symptoms, and impulsivity. Findings: The largest differences between the countries were found for the risk of cannabis use. Swedish participants reported much higher perceived risk both for continuous and occasional use than US students. For cigarettes, chewing tobacco and alcohol students from the US reported higher risk perception than the Swedish students did. Females reported higher perceived risk for all substances than male students.Conduct problems were associated with less perceived risk in all examples and impulsivity in cannabis and alcohol issues. Increasedmental health symptoms were associated with increased perceived risk for alcohol. Those who have used the specific drug reported lower levels of risk for that drug butmostly not for other drugs. Conclusions: Perceived risk for cannabis was higher in Swedish students than in US students while cigarette smoking, chewing tobacco and alcohol use were perceived as more risky in the US. One possibility could be that Sweden has much tougher drug laws than the US while less stringent alcohol and tobacco laws.

The transition fromadolescence to emerging adulthood is a period of increased risk for heavy drinking behavior. Prior research has found that college students drink more and experience more consequences than their non-college counterparts. However, sparse research has examined whether students who are college- versus work-bound show differences in drinking and related consequences in high school (HS) as well. In addition, little research has explored whether alcohol expectancies also change over time as a function of selection into college versus non-college environments. The current study examined whether alcohol-related expectancies, consequences, and drinking changed over the course of a year as a function of whether participants transitioned into a four-year university (UNI), community college/trade school (CC), or workforce setting (WF). Participants (N=848) were HS seniors (mean age=17.5 years; 37%male, 73%Caucasian) taking part in a larger study examining alcohol use trajectories.Measures included alcohol expectancies (CEOA), drinking (DDQ), and alcohol-related problems (RAPI) assessed during their senior year and one year later. Repeatedmeasures ANOVAs revealed significant main effects for time, indicating increases in drinks per week F(1, 807)=19.18, p>0.001 and alcohol-related problems F(1, 808)=8.78, p>0.01 and a decrease in alcohol expectancies F(1, 808)=14.35, p>0.001 from baseline to 12 month follow-up. Results also found a main effect for group, indicating UNI students held higher expectancies F(2, 808)=8.15, p>0.001 and drank more F(2, 807)=6.26, p>0.01 than other participants. A significant time9group interaction showed that whereas UNI-bound students drank less thanWF-bound students in HS, the roles reversed one year later with UNI students drinking more thanWF students F (2, 807)=27.56, p>0.001. Similarly, WF-bound students had more alcohol-related problems in HS followed by CC-bound students and UNI-bound students, but one year later the order reversed with UNI students exhibiting the most alcohol-related problems F(2, 807)=5.21, p>0.01. Results indicate that whereas UNI-bound seniors exhibit the highest expectancies, drink less, and experience fewer problems during HS, upon entry into UNI, they experience more problems and out-drink their CC andWF counterparts. These results highlight the importance of prevention strategies, including an expectancy challenge component, especially for UNI-bound HS seniors.

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

A key developmental period for alcohol misuse is emerging adulthood (roughly ages 18–25). Personalized Feedback Interventions (PFI) are effective in reducing alcohol-related harmin college populations, however little research has evaluated PFIs given during high school.Moreover, cultural differences influence both alcohol misuse and response to interventions. The purpose of this study is to evaluate the efficacy of a web-based PFI given to high school seniors (ages 17-19) in the USA and Sweden. 1181 participants (42.3%male; 28.3%risky drinkers based on AUDIT-C) in the USA and 2171 in Sweden (44.1%male; 52.3% risky drinkers based on AUDIT-C) were assessed during their high school senior year. Approximately 1/3 were randomized to receive PFI. Approximately 1 week after viewing the PFI, participants were asked to complete a post-feedback satisfaction survey (3 subscales: information motivated change, shared information with friends, information was educational), and their “stage” on the readiness to change scale. Results showed 1) information motivated change subscale was associated with increases in contemplation and action stages of change and decreases in precontemplation; Swedish participants and those with higher AUDIT-C scores had lower scores; (2) USA sample was less likely to share information with friends; those with higher AUDIT-C scores were more likely to share information with friends; and (3) those with higher AUDIT-C scores were less likely to find information educational. Participants completed 6- and 12- month follow up surveys. After controlling for key baseline variables and using appropriate distributions for analyses, 6 month outcomes from 2236 participants (852 in USA; 1384 in Sweden; 731 received PFI), found those who received PFI drank significantly less alcohol per occasion (typical and peak), had lower blood alcohol concentration (typical and peak) and drank on fewer occasions than those who did not receive the PFI (effect size range: d = .12 to d = .22). There were no significant effects of PFI on alcohol-related problems or readiness to change and no significant interactions between country of residence and intervention on drinking outcomes. Results suggest web-based PFIs given during senior year of high school are efficacious in reducing alcohol use during transition to adulthood. Twelve-month outcomes and mediators will also be presented. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglund.

Decreases in alcohol consumptions have been linked to the use of protective behavioral strategies (PBS) a number of times (Arterberry et al., 2014; Kenny et al., 2014; & Braitman et al., 2014). Trait mindfulness has been researched looking for a link in substance use treatment. Promising results have been found (Grow et al., 2015; Vinci et al., 2014) that have led to the creation of treatment modalities such as Mindfulness-Based Relapse Prevention (Bowen, Charla, Marlatt, 2010). The present study investigates the relation between PBS, mindfulness, and negative outcomes due to alcohol consumption. The participants are part of a larger study (N = 3,352) investigating a brief online alcohol use intervention amongWashington state (n = 1,181) and Swedish high school seniors (n = 2,171). Data was collected at a six-month follow-up via an online survey. Participants completed the 15-item Protective Behavioral Strategies Scale that measures PBS with responses ranging from 1-Never to 6-Always (PBSS; Martens et al., 2007); a 12-item trait mindfulness measure with responses ranging from1-Rarely/Not at all to 4-Almost always (Cognitive and AffectiveMindfulness Scale Revised; Feldman et al., 2007); and the Young Adult Alcohol Problem Screening Test (Hurlbut & Sher, 1992), which measures social and personal problems related to drinking. A regression analysis was performed to assess the relationship between the measures. Significant main effects were found for PBS (p < 0.001) and mindfulness (p < 0.01) on negative consequences of alcohol use. However, there was no moderating effect of mindfulness on the relation between PBS and negative effects of alcohol (p = 0.10). Results support past research on the impact of mindfulness on negative effects of alcohol. Results regarding PBS were not consistent with past literature regarding their impact on decreasing negative effects of alcohol. This may be attributed to a relationship between those individuals using PBS and the amount of negative drinking consequences they already experience. There was not enough evidence to suggest amoderating effect ofmindfulness as a factor that would further decrease negative alcohol effects. Future research could investigate whether a treatment designed to increase the effectiveness of PBS through increased mindfulness is a suitable intervention. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglund.

Mindfulness-based interventions have become increasingly utilized with individuals with alcohol and substance use disorders (e.g., Bowen et al., 2014); however, the relationship between mindfulness and substance use is complex (Karyadi et al., 2014). Mindfulness is a multifaceted construct and includes factors related to attentional control, present moment focus, and an attitude of non-judgment and acceptance. Thus, the relationship between different mindfulness factors and substance use, and negative consequences related to its use, may differ. In the present study, we examined which specific elements of mindfulness would best predict drinking consequences 6 months later in a sample of American and Swedish adolescents. Additionally, we examined whether adolescents’ nationality would moderate the relationship between mindfulness and drinking consequences. Our sample included Washington St, USA and Swedish adolescents participating in a larger study investigating a brief online intervention for alcohol use (N = 3,352). Participants completed an online survey at 6- and 12-month follow up. At the 6-month follow up, trait-mindfulness wasmeasured using the Cognitive and AffectiveMindfulness Scale-Revised (Feldman et al., 2007). At 12-month follow up, alcohol related negative consequences were measured using the Rutgers Alcohol Problem Index (White & Lobouvie, 1989). Linear regression analysis revealed that mindfulness factors did explain a significant proportion of variance in drinking consequences scores, R2 = 0.02, F(4, 620) = 2.67, p = 0.03. Specifically, the mindfulness factor of attention predicted drinking consequences, such that lower levels of attention predictedmore drinking consequences, b = 0.23, p = 0.02. None of the other mindfulness factors significantly predicted drinking consequences. Adolescents’ nationality did notmoderate the relationship between the mindfulness factors and drinking consequences 6 month later. The present study findings differ from previous findings, which found a relationship between awareness and drinking consequences (Fernandez et al., 2010), although this may be due to differences in how mindfulness factors were conceptualized and assessed. Nationality was not shown to moderate the relationship between mindfulness factors and drinking consequences, suggesting that mindfulness factors may not be culturally bound and may operate consistently across cultures, although examination of additional cultures is needed.

Purpose: Alcohol use reaches its peak during young adulthood. The current study examined transitions in drinking status across a one year period in Swedish and American young adults while also examining the association between country of origin, educational status, tobacco use, andmarijuana use on the probabilities of heavy drinking and transitions in heavy drinking over time. Methods: Young adults (N=3342; mean age=17.7 (SD=0.53; 56.6% female) were recruited from Sweden (n=2171) and US (n=1181) schools and assessed prospectively at 6- and 12-months following the baseline assessment. The Daily Drinking Questionnaire was used to assess changes in the quantity and frequency of alcohol use. Educational status, tobacco use, andmarijuana use were also assessed prospectively at 6- and 12-months. Results: Latent Markov models were used to examine changes in alcohol use from baseline to the 12-month follow-up, as well as cross-sectional and cross-lagged associations between heavy drinking and educational status, tobacco use, and marijuana use over time. The “low drinking class” had, on average,