Project

Cross-Cultural Addictions Study Team

Goal: The Cross-Cultural Addiction Study Team (CAST) is a collective of international scientists in the behavioral sciences with a shared vision of answering meaningful research questions regarding addictive behaviors (predominately substance use) that have important global policy, prevention, and/or treatment implications.

To date three studies have been proposed/completed that examine whether the relationships between risk/protective factors and substance misuse among college students differentiate cross-culturally.

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Laura Mezquita
added a research item
The present work aimed to extend the evidence of the structure validity of the Ruminative Thought Style Questionnaire (RTSQ) 15-item version testing: (1) the structure of two competing models (i.e., four-factor correlated model vs a second-order factor model); (2) the measurement invariance of the final model across four countries (U.S., Spain, Argentina, and the Netherlands) and gender groups (male and female); and (3) the invariance across three assessment waves in a subsample of Spanish youths. Participants were college students (mean age = 20.87, SD = 4.47) from the U.S. (n = 1875; 67.1% of females), Spain (T1, n = 732, 63.9% females; T2, n = 370, 71.6% females: T3, n = 307, 60.6% females), Argentina (n = 368, 65.6% females) and the Netherlands (n = 295, 74.8% females). Confirmatory Factor Analyses supported both correlated factors and second-order factor structure in the whole sample. Due to similar fit indices being observed for both models, and considering the theoretical and practical advantages, we kept the second-order model to examine its invariance across groups and time. Measurement invariance analyses showed that the second-order model was invariant across countries, gender, and over time. Comparisons of the total mean score and the subfacet mean scores (i.e., Repetitive Thoughts, Counterfactual Thoughts, Problem-focused Thoughts, and Anticipatory Thoughts) reveled only small differences across country and gender groups. The present work extends the structural validity evidence of the RTSQ, and provides the first evidence concerning its longitudinal stability across time.
Adrian J. Bravo
added a research item
While there is evidence that histories of adverse childhood experiences (ACEs) are common in university students and are associated with an increased risk of mental health difficulties, current research has limited geographic and cross-cultural representation. Comparing ACEs across diverse contexts using a standardized measure can illuminate geographic and sociocultural similarities or differences in exposure. The present study aimed to assess ACE exposure and its relationship with mental health symptoms in university students from seven countries. We sampled 5945 university students from the United States, Canada, England, South Africa, Spain, Argentina, and Uruguay. Participants completed the Adverse Childhood Experiences International Questionnaire (ACE-IQ) and the Inventory of Depression and Anxiety Symptoms (IDAS). Most participants (94.8%) reported exposure to at least one type of ACE and 61% reported exposure to four or more types. Repeated exposure to at least one ACE was reported by 70.2% and repeated exposure to at least four ACEs was reported by 21.2%. Spanish students had significantly lower ACE exposure than other students. Cumulative ACE exposure was significantly higher among students in lower income countries, but when repeated exposure was considered these differences fell away. For the total sample, cumulative ACE exposure was significantly associated with severity of depression symptoms, anxiety symptoms, and suicidality. Findings indicate that universities globally should be guided by a trauma-informed approach that recognizes students as a psychologically vulnerable group carrying a long-standing burden of childhood adversity.
Adrian J. Bravo
added a research item
Objective Among instruments that assess cannabis-related problems, the Cannabis Use Disorders Identification Test - Revised (CUDIT-R) is one of the most broadly employed worldwide. However, minimal research has tested the measurement invariance of the CUDIT-R among cannabis users from different countries, hindering cross-national comparisons. Thus, the present research tested the psychometric properties (examining factor structure and different sources of reliability and validity evidence) of the CUDIT-R in college student cannabis users (i.e., endorsed lifetime marijuana use) from seven countries. Measurement invariance between country samples and gender groups were also tested. Methods A sample of 4,712 undergraduates (mean age = 20.57, SD = 3.97; 70.4% females) from seven countries completed the CUDIT-R, a measure of cannabis-related problems, and measures of cannabis frequency, quantity and motives. Results Multigroup analysis showed configural, metric and scalar invariance of the CUDIT-R across five countries and across gender groups. Cronbach’s alphas and ordinal omegas ranked from .72 and .85. Large correlations were found between the CUDIT-R and another cannabis-related problem scale. Small to large associations were found between the CUDIT-R and other criterion variables (frequency and quantity of consumption and cannabis-related motives). Only a few differences in the magnitude of the correlations across countries were found. Conclusions The results suggest that the CUDIT-R is a suitable measure to assess cannabis-related problems among college student cannabis users from the US, Canada, South Africa, Spain, and Argentina and across gender groups.
Adrian J. Bravo
added a research item
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 (n = 1512) were recruited from universities in Spain (n = 298), Argentina (n = 439), and the U.S. (n = 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 (M = 3.32, SD = 1.23) compared to Argentine (M = 2.89, SD = 0.97) and Spanish (M = 2.83, SD = 0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (M = 4.57, SD = 0.99) compared to U.S. (M = 5.09, SD = 0.98) and Spanish (M = 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 (ps<.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.
Adrian J. Bravo
added a research item
Introduction Many young adults report frequent co-use of alcohol and marijuana, with some individuals engaging in simultaneous use (SAM; use of both substances within the same occasion resulting in an overlap of their effects) and others in concurrent use (CAM; use of both substances during a similar time period [e.g., past 30 days] but not within the same occasion). Emerging work demonstrates that SAM relative to CAM use places individuals at a greater risk for substance-related harms; however, these results primarily rely on U.S. samples. The goal of the present multi-country study was to examine prevalence rates of CAM and SAM use and examine differences in past 30-day SAM/CAM use on alcohol/marijuana substance-related outcomes among college students from seven countries. Methods: A total of 9,171 (70.5% women; Mean age=20.28, SD=3.96) college students participated in the cross-sectional online survey study. Results: Among students who endorsed use of both alcohol and marijuana in the past 30-days (n=2,124), SAM use (75.8%) was far more prevalent than CAM use (24.2%). Moreover, ∼75% of students endorsed SAM use within each country subsample. Regression models showed that SAM vs. CAM use was associated with greater alcohol and marijuana use and negative consequences. Conclusions: College students from around the world endorse high rates of SAM use, and this pattern of co-use is associated with greater frequency of use and substance-related harms. On college campuses, SAM use should be a target of clinical prevention/intervention efforts and the mechanisms underpinning the unique harms of SAM need to be clarified.
Adrian J. Bravo
added a research item
Objective: Normative perceptions have been shown to mediate the effect of personality traits on cannabis outcomes. We examined descriptive norms, injunctive norms, and the role of cannabis in college life as possible mediators of the association between impulsivity-related traits (i.e., negative urgency, positive urgency, sensation seeking, perseverance, and premeditation) and cannabis outcomes (i.e., frequency of cannabis use and negative consequences) among college students from five countries. Method: A total of 1,175 college students (United States, n = 698; Argentina, n = 153; Spain, n = 178; Uruguay, n = 79; and Netherlands, n = 67) who were also cannabis users (i.e., reported cannabis use at least once within the previous month) completed an online survey. We used path analysis to test whether the proposed double-mediated paths (impulsivity-like traits→perceived cannabis norms→cannabis use frequency→negative cannabis-related consequences) were invariant across countries/cultures. Results: Cannabis-related perceptions, particularly college cannabis beliefs and injunctive norms, significantly mediated the association between impulsivity and cannabis outcomes. Two significant double-mediated paths, which were invariant across sex and countries, were found: (a) higher positive urgency→higher endorsement of internalized norms→higher cannabis use frequency→more negative cannabis-related consequences and (b) higher sensation seeking→higher endorsement of injunctive norms→higher cannabis use frequency→more negative cannabis-related consequences. Conclusions: The study corroborates previous findings on normative perceptions mediating the effects of impulsivity-like traits on cannabis outcomes and suggests that these processes may operate similarly among college student cannabis users in different legal and cultural contexts. The findings highlight the need to address internalized norms and suggest these normative perceptions may be a good intervention candidate to reduce cannabis use/consequences.
Adrian J. Bravo
added a research item
Objective Emotion regulation has been proposed as a mechanism driving sexual orientation disparities in suicide ideation (SI), but little research has examined the role of affect lability in the association of sexual minority identity and SI. As prior research has found trait mindfulness to be associated with lower SI, the objective of the present study was to examine the buffering role of mindfulness in the associations of sexual orientation, affect lability, and SI. Method The present study used a moderated mediation model to examine a cross-sectional dataset consisting of heterosexual (n = 1511) and sexual minority (n = 355) U.S. college students (N = 1866), to examine whether five facets of mindfulness moderated the indirect association of sexual minority identity on SI via affect lability. Results As predicted, sexual minority identity was associated with higher affect lability, which in turn was associated with higher SI. Acting with awareness (i.e., attending to the present activities), describing (i.e., the ability to verbalize inner experiences), and non-judging (i.e., refraining from judging inner experiences) buffered the indirect association of sexual minority identity on SI via affect lability, such that the indirect association weakened at higher levels of those mindfulness facets. Conclusions Our results provide a better understanding of the emotion regulation mechanisms underlying the higher risk of SI among sexual minorities. Future research is needed to examine mindfulness facets as buffers against SI among other communities, and to examine the efficacy of emotion regulation and mindfulness interventions in reducing suicide ideation and other aspects of suicidality (i.e., plans/attempts). • Highlights • Sexual orientation disparities in suicide ideation (SI) and affect lability. • Sexual minority identity linked to higher SI via higher affect lability. • Three mindfulness facets attenuated indirect association of identity on SI.
Adrian J. Bravo
added a research item
Background: Problematic cannabis use is common among young adults across the world. However, limited research has examined whether etiological models predicting negative consequences are universal. Objective: The present study examined whether the Five-Factor Model of personality (openness, conscientiousness, extraversion, agreeableness, and neuroticism) relates to cannabis outcomes via use of cannabis protective behavioral strategies (PBS) in a cross-national sample of college student cannabis users (i.e., used cannabis in the last 30 days). Method: Participants were 1175 university students (63.27% female) across five countries (United States, Argentina, Spain, Uruguay, and the Netherlands) recruited to complete an online survey. Results: PBS use mediated the associations between personality traits and cannabis consequences, such that higher conscientiousness (β = .20), agreeableness (β = .11), and lower emotional stability [i.e., higher neuroticism] (β = −.14) were associated with more PBS use. Higher PBS use was, in turn, associated with lower frequency of cannabis use (β = −.32); lower frequency of use was then associated with fewer cannabis consequences (β = .34). This sequential pathway was invariant across sex, but not countries. Notably, there were a number of differences in links between PBS and cannabis outcomes when comparing countries (e.g., negative associations in the US sample, but positive associations in the Argentina sample). Conclusions: Cannabis PBS mediates the relationship between personality traits and cannabis outcomes, but there are nuanced differences across countries (i.e., relationship between PBS and cannabis outcomes). Overall, students that are low in conscientiousness, agreeableness, and neuroticism and/or report low rates of PBS use may benefit from cannabis PBS-focused interventions that promote utilization of PBS.
Adrian J. Bravo
added a research item
The present research built on the Self-Reported Delinquency interview and the Antisocial Behavior Scale to develop an updated brief instrument to measure antisocial behavior. College students ( n = 3188, 67.75% women) from the USA, Argentina, the Netherlands and Spain completed an online survey. Analyses that combined approaches from the Classical Test Theory and Item Response Theory were conducted to select the items for the brief version. Findings suggested that a 13-item Brief Antisocial Behavior Scale (B-ABS) fulfilled the high-quality criteria: salient factor loadings, adequate discrimination, variability in response endorsement, adequate fit based on infit/outfit values, nondifferent item functioning across the four participating countries, and Cronbach’s alpha and ordinal omega coefficients higher than .70. The B-ABS scores generally significantly correlated with personality scores, mental health and marijuana outcomes, showing criterion-related validity evidence. Our overall findings suggest that B-ABS adequately assesses antisocial behavior in young adults from different countries/cultures.
Adrian J. Bravo
added a research item
The Community Reinforcement Approach Happiness Scale (CRA-HS) is widely used for assessing the quality of life in addiction treatment, but the amount of research on the psychometric properties has been scant. The present study sought to (a) test for measurement invariance of the CRA-HS across college students (n = 3388) in five countries (i.e., United States., Spain, Argentina, Uruguay, and the Netherlands); (b) evaluate differences on the CRA-HS (i.e., latent mean differences) as a function of sex and country, and (c) compare criterion-related validity. Using multi-group confirmatory factor analyses, we found a shortened 10-item version of the CRA-HS to be invariant across sex, but only configural and metric invariance was found across countries. Across all countries, criterion-related validity of the CRA-HS scores across different countries emerged. Our findings serve as a foundation for future cross-cultural work testing models in which subjective well-being (i.e., happiness) is an important clinical/routine outcome among college students.
Laura Mezquita
added 2 research items
The present study examined the measurement invariance of the Big Five Personality Trait Short Questionnaire (BFPTSQ) across language (Spanish and English), Spanish-speaking country of origin (Argentina and Spain) and gender groups (female and male). Evidence of criterion-related validity was examined via associations (i.e., correlations) between the BFPTSQ domains and a wide variety of mental health outcomes. College students (n = 2158) from the USA (n = 1117 [63.21% female]), Argentina (n = 353 [65.72% female]) and Spain (n = 688 [66.86% female]) completed an online survey. Of the tested models, an Exploratory Structural Equation Model (ESEM) fit the data best. Multigroup ESEM and ESEM-within-CFA generally supported the measurement invariance of the questionnaire across groups. Internalizing symptomatology, rumination and low happiness were related mainly to low emotional stability across countries, while low agreeableness and low consci-entiousness were related chiefly to externalizing symptomology (i.e., antisocial behavior and drug outcomes). Some correlational differences arose across countries and are discussed. Our findings generally support the BFPTSQ as an adequate measure to assess the Big Five personality domains in Spanish-and English-speaking young adults. PLOS ONE | https://doi.org/10.1371/journal.pone.
Adrian J. Bravo
added a research item
Background: Previous studies have evidenced that rumination and drinking motives may mediate the association between depressive symptoms and alcohol outcomes. The present study cross-culturally examined whether a similar mediation model may extend to marijuana. Specifically, we tested distinct rumination facets (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) and marijuana use motives (social, coping, expansion, conformity, enhancement) as double-mediators of the paths from depressive symptoms to marijuana outcomes (use and consequences). Method: A comprehensive mediation path model was tested in a cross-sectional sample of college student marijuana users (n = 1175) from five countries (U.S., Argentina, Uruguay, Spain, Netherlands). Multi-group models were tested to determine if the proposed mediational model was invariant across sex and different cultures/countries. Results: Depressive symptoms and marijuana outcomes were indirectly associated through ruminative thinking and marijuana motives. Specifically, higher depressive symptoms were associated with higher problem-focused thoughts; which in turn were associated with: a) higher endorsement of coping motives which in turn was associated with higher marijuana use and related consequences and b) lower endorsement of enhancement motives which in turn was associated with lower marijuana use and related consequences. The multi-group analyses showed that the model was invariant across sex and the five countries. Conclusions: The present research supports the existence of a universal (i.e., cross-national invariant) negative affect regulation pathway to marijuana use/misuse similar to those previously found with alcohol. Additional research is needed to confirm the role of enhancement motives in the associations of depression, rumination and marijuana outcomes.
Adrian J. Bravo
added 2 research items
Marijuana internalized norms, measured by the Perceived Importance of Marijuana to the College Experience Scale (PIMCES; 8 items), has been found to be distinct from marijuana descriptive/injunctive norms and to be a unique robust predictor of marijuana-related outcomes among college students, yet the role of these beliefs has not been studied outside the U.S. Using confirmatory factor analysis, the present work examined the level of measurement invariance (i.e., configural, metric, and scalar) of the PIMCES across five different countries with distinct marijuana-related regulations (i.e., U.S., Argentina, Spain, Uruguay, and the Netherlands), sex, and marijuana user status among college students (n = 3424) recruited between September 2017 and January 2018. To make valid comparisons across groups, metric invariance is needed to compare correlations and scalar invariance is needed to compare latent means. We found strong measurement invariance (i.e., scalar invariance) for the PIMCES across countries, across males and females, and across marijuana users and non-users. College students in the U.S. reported the highest levels of marijuana internalized norms compared to college students from all other countries. As expected, males and marijuana users showed significantly higher scores on the PIMCES than females and non-users, respectively. Bivariate correlations between PIMCES scores and other marijuana-related variables were remarkably similar across males and females, though differences across countries warrant further exploration. Taken together, the degree to which college students view marijuana use to be an integral part of the college experience may be an important target for college student marijuana interventions across various countries/cultures.
Adrian J. Bravo
added a research item
The present study examined measurement invariance of the 48-item, 8-factor, Young Adult Alcohol Consequences Questionnaire (YAACQ) across nationality in college students from the United States, Spain, and Argentina. We also compared latent mean differences and criterion-related validity (i.e., correlation with other alcohol-related outcomes) across countries. Last month drinkers (1,511) from the United States (n = 774, 70.5% female), Argentina (n = 439, 50.6% female), and Spain (n = 298, 72.1% female) completed an online survey measuring alcohol use, drinking motives, college alcohol beliefs, and negative alcohol-related consequences. Multigroup confirmatory factor analyses supported configural and scalar invariance of a 47-item, 8-factor YAACQ across countries. Overall, the correlation analysis supported criterion-related validity (i.e., strong bivariate correlations between the 8 subscales and alcohol consumption, drinking motives and college alcohol beliefs) across countries. Some nonsignificant bivariate correlations and differences in the magnitude of the correlations across countries are discussed. Our findings expand previous work, mostly focused on U.S. samples, by supporting the YAACQ as an adequate measure to assess alcoholrelated consequences in youths across countries marked by unique cultural traditions, attitudes, and policies pertaining to alcohol.
Laura Mezquita
added a research item
Background: Previous research has identified different, but not mutually exclusive, etiological pathways (i.e., the positive affect regulation pathway, the negative affect regulation pathway and the deviance proneness pathway) to alcohol use and misuse in which personality characteristics play a key role. Objectives: The present study aimed to simultaneously and cross-culturally examine all these personality pathways to alcohol use in a large sample of young adult drinkers (N = 1280) from the US, Argentina, and Spain. Method: Structural equation modeling was conducted to test the models. Multi-group models were conducted to test model invariance across countries and gender groups. Results: In the whole sample, low conscientiousness and extraversion were related to alcohol outcomes through enhancement drinking motives (i.e., positive affect regulation pathway), low emotional stability was related through coping drinking motives (i.e., negative affect regulation pathway), and low conscientiousness and low agreeableness were related through antisocial behavior (i.e., deviance proneness pathway). The model was invariant between gender groups. Some minor, yet significant, differences across countries arose. Specifically, antisocial behavior was a significant mediator of the association between agreeableness and alcohol use, but only in the US subsample. Conclusions: The present findings suggest that risky-personality pathways for alcohol use and alcohol-related problems may be generalized across gender groups and cultures in young adults.
Adrian J. Bravo
added a research item
The present study aimed to adapt and validate a Spanish version of the Ruminative Thought Style Questionnaire (RTSQ) and test for measurement invariance of the RTSQ across college students in the US, Spain, and Argentina (n = 1,632). Additionally, we examined/compared across these countries, criterion-related (i.e., concurrent) validity of RTSQ factors (i.e., problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) on constructs theoretically-associated with rumination. Consistent with previous findings, we found that a 15-item 4-factor RTSQ provided a more adequate model compared to single-factor CFA models (15- and 20-item versions) in every country. The reliability and validity of the subscales for the Spanish version were satisfactory-to-good in Spain and Argentina. Using multigroup confirmatory factor analyses, we found the 15-item 4-factor version of the RTSQ to be invariant across countries and sex. Bivariate correlations provided evidence for the criterion-related validity of the 4-factor RTSQ across the countries. Our findings suggest that self-report items of the RTSQ convey the same meaning, and that responses to those items load onto the same set of factors, across languages and cultures of administration. Taken together, our findings serve as a foundation for future cross-cultural work testing models in which rumination is a central facet.
Adrian J. Bravo
added a research item
Objectives: The present study examined (both cross-sectionally and prospectively) the mediational role of college alcohol beliefs in the relationship between impulsivity-related traits and alcohol outcomes (i.e., alcohol use and negative consequences) among college student drinkers from the United States (U.S.), Spain, and Argentina. Method: A sample of 1429 (U.S. = 733, Spain = 292, Argentina = 404) drinkers (at least one drinking episode within the previous month) completed the baseline survey, and 242 drinkers completed the follow-up. To test study aims, a cross-sectional model was first employed to examine whether the proposed double-mediated paths (i.e., each dimension of impulsivity → college alcohol beliefs → alcohol use → negative alcohol-related consequences) extends across samples with different cultural backgrounds (i.e., structural invariance testing). A longitudinal model was then conducted to assess if college alcohol beliefs prospectively mediate the associations between trait impulsivity and alcohol outcomes. Results: College alcohol beliefs were concurrently and prospectively associated with both greater alcohol use and increased number of negative alcohol-related consequences. These internalized beliefs about college student drinking culture significantly mediated the effects of several distinct impulsivity-related traits on alcohol-related outcomes including urgency (positive and negative), sensation seeking, and perseverance. These findings were invariant across gender and across three countries (Argentina, Spain, and the U.S.). Conclusions: Our findings highlight the modulatory role of cognitive factors on problematic alcohol use among college students with different cultural backgrounds. Our results suggest that, despite the cultural differences exhibited by these three countries, the unique and mediational effects of college alcohol beliefs appear relatively universal.
Adrian J. Bravo
added an update
We currently have 3 manuscripts published (or accepted for publication) and have a few more under review. We will update the project folder as new articles are published.
 
Adrian J. Bravo
added a project goal
The Cross-Cultural Addiction Study Team (CAST) is a collective of international scientists in the behavioral sciences with a shared vision of answering meaningful research questions regarding addictive behaviors (predominately substance use) that have important global policy, prevention, and/or treatment implications.
To date three studies have been proposed/completed that examine whether the relationships between risk/protective factors and substance misuse among college students differentiate cross-culturally.