Examining Cross-Country and Sex Differences on a Comprehensive Assessment of Protective Behavioral Strategies for Alcohol.

Objective: Use of protective behavioral strategies (PBS) has been associated with reduced alcohol-related harms among college students. However, most of this research has been conducted among U.S. samples. The present study examines the use of PBS in an international context.

Method: Participants (=1512) were recruited from universities in Spain (=298), Argentina (=439), and the U.S. (=775) to determine if there are differences in PBS use across countries and/or across sex. Further, we examined whether the association between PBS use and negative consequences differ across country and sex.

Results: We found that U.S. students reported the most frequent use of Stopping/Limiting Drinking PBS (=3.32, SD=1.23) compared to Argentine (=2.89, SD=0.97) and Spanish (=2.83, SD=0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (=4.57, SD=0.99) compared to U.S. (=5.09, SD=0.98) and Spanish (=5.03, SD=0.78) students. Elastic net regression analyses stratified by country indicated most individual PBS predicted decreased negative alcohol-related consequences, although two items consistently predicted increased consequences and we observed some variability in the most predictive specific strategies in each country. Across each subscale and for 32 of 40 individual items, females reported more frequent use of PBS than males (<.05).

Conclusions: From the perspective of developing and adapting interventions, we recommend the cultural context in which PBS are used is taken into account. Although future work is needed to delineate cultural factors underlying the country-level differences we found, these findings have implications for the most promising PBS to target for college students in each country.