Clarifying observed relationships between protective behavioral strategies and alcohol outcomes: The importance of response options

Abstract

Protective behavioral strategies (PBS), or harm-reduction behaviors that can potentially reduce alcohol consumption or associated problems, have been assessed in varied ways throughout the literature. Existing scales vary in focus (i.e., broad vs. narrow), and importantly, in response options (i.e., absolute frequency vs. contingent frequency). Absolute frequency conflates PBS use with number of drinking occasions, resulting in inconsistencies in the relationship between PBS use and alcohol outcomes, whereas contingent frequency is less precise, which could reduce power. The current study proposes the use of absolute frequencies to maximize precision, with an adjustment for number of drinking days to extricate PBS use from drinking occasions, resulting in a contingent score. Study 1 examined the associations between PBS subscales using the Strategy Questionnaire (Sugarman & Carey, 2007) and alcohol outcomes, finding that in raw score form the association between PBS and typical alcohol outcomes varied greatly from significantly positive to significantly negative, but adjusted score relationships were all consistent with harm reduction perspectives. In addition, curvilinear relationships with typical alcohol use were eliminated using the score adjustment, resulting in linear associations. Study 2 confirmed the findings from Study 1 with a more precise timeframe, additional alcohol assessments, and heavier college drinkers. The relationships between alcohol outcomes and PBS in raw score form were again varied, but became consistently negative using the score adjustment. Researchers examining PBS and related constructs should consider modifying current scales to include a precise frequency response scale that is adjusted to account for number of drinking occasions. (PsycINFO Database Record

Figure 1

Raw protective behavioral strategies (PBS), adjusted PBS, and alcohol outcomes by frequency of drinking. Note that “low frequency” refers to 1–2 drinking days per typical drinking week, and “high frequency” refers to 3–7 drinking days per typical drinking week. PBS refers to the total PBS score including all three subscales. Asterisks indicate significant mean differences at p < .001. The y-axis represents a different unit of measurement for each pair of bars in the chart. It reflects PBS score for raw PBS and adjusted PBS, the number of drinks for “typical quantity” and “heavy quantity,” and the number of alcohol-related problems for “problems.”