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BRIEF REPORT

Protective Behavioral Strategies and Hazardous Alcohol Use Among Male College Students: Conformity to Male Gender Norms as a Moderator

Robert B. Whitley and Michael B. Madson University of Southern Mississippi

Virgil Zeigler-Hill Oakland University

Male college students engage in more hazardous alcohol use and use fewer protective behavioral strategies than females. However, most college students use at least 1 protective behavioral strategy, and increasing use of these strategies is an effective component of alcohol harm-reduction efforts. Thus, it is important to study factors that may predict increased or decreased use of these strategies. One factor may be conformity to male gender norms because it has been linked with hazardous alcohol use among college males. However, the research on how conformity to male norms relates to college men’s use of protective behavioral strategies has yet to be investigated. The present study explored the moderating role of conformity to male norms in the relationship between protective behavioral strategy use and hazardous alcohol use in a sample of college men. Data were collected from 205 male college students between the ages of 18 and 25 years via an Internet-based survey. A moderated multiple regression analysis revealed a significant moderation such that males who reported higher levels of conformity to male norms and less use of protective behavioral strategies tended to engage in the most hazardous alcohol use. Potential implications for prevention and intervention concerning alcohol use with college men are discussed.

Keywords: hazardous alcohol use, protective behavioral strategies, conformity to male norms, college students

Alcohol use among college students is a public health concern in the United States because of the relatively normative nature and high prevalence rates on college campuses (Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2016). More concerning is the link between hazardous alcohol use and negative consequences such as academic and social problems, physical violence, injuries, sexual assaults, and death (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2015). Thus, prevention and interven- tion efforts will benefit from a deeper understanding of the factors that influence college students’ hazardous alcohol use. One of these factors appears to be gender.

Alcohol tends to be the most widely used substance by college men (Geisner, Larimer, & Neighbors, 2004), and they are more likely than women to engage in hazardous alcohol use (Johnston et al., 2016). The NIAAA’s (2015) definition of hazardous alcohol use includes an increased risk for developing an alcohol use disorder (AUD) based on drinking at rates in which the frequency/ quantity of consumption exceed daily (4 drinks) and weekly (14

drinks) low-risk drinking guidelines as well as engaging in heavy episodic drinking (sometimes referred to as “binge-drinking,” which is defined for males as consuming five or more drinks in 2 h). Thus, although college students engaging in hazardous drink- ing may not develop an AUD, they are often drinking at rates that are hazardous and increase the likelihood of experiencing alcohol- related negative consequences even if they do not meet the thresh- old of an AUD. As a result, considerable focus has been placed on uncovering the precipitating factors that may be the focus of group-specific prevention and intervention efforts aimed at miti- gating these behaviors and the resulting consequences.

One of the precipitating factors involved in college men’s ex- cessive use of alcohol appears to be their consistent underutiliza- tion of protective health behaviors. Mahalik, Burns, and Syzdek (2007) define health behaviors as behaviors that influence an individual’s health, including diet, exercise, substance use, and social support. College men are more likely to put their physical and mental health at risk compared with their female counterparts and are less likely to engage in healthy behaviors (Addis & Mahalik, 2003; Courtenay, 2000; Griffith & Thorpe, 2016; Ma- halik et al., 2007). This relationship holds true especially when examining college male alcohol use. In general, college men are more likely to ignore health risks associated with hazardous alco- hol use and are less likely to take measures to prevent harm (del Pilar Sánchez-López, Cuellar-Flores, & Dresch, 2012; Kimmel, 2008; Mahalik et al., 2007).

These findings offer partial insight as to why college men are at such an increased risk for engaging in hazardous drinking. How-

This article was published Online First June 26, 2017. Robert B. Whitley and Michael B. Madson, Department of Psychology,

University of Southern Mississippi; Virgil Zeigler-Hill, Department of Psychology, Oakland University.

Correspondence concerning this article should be addressed to Michael B. Madson, Department of Psychology, University of Southern Missis- sippi, 118 College Drive, #5025, Hattiesburg, MS 39406. E-mail: michael [email protected]

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Psychology of Men & Masculinity © 2017 American Psychological Association 2018, Vol. 19, No. 3, 477– 483 1524-9220/18/$12.00 http://dx.doi.org/10.1037/men0000121

477

ever, although research has clearly outlined a lack of health be- havior utilization among college men, developing a deeper under- standing of constructs with specific clinical utility may prove useful in guiding interventions that seek to enhance health-related behaviors. One such set of strategies that have proven useful in enhancing alcohol-related health behaviors are protective behav- ioral strategies (PBS). PBS is encompassed within the overarching construct of protective health behaviors, but studying this construct may help further the current literature by shedding light on poten- tial safe drinking behaviors that college men may be more inclined to use given that most college students report using at least one PBS (Martens, Martin, Littlefield, Murphy, & Cimini, 2011).

PBS are self-regulatory strategies that college students can use when drinking to help prevent or reduce hazardous alcohol use (Pearson, D’Lima, & Kelley, 2013) through controlling the amount one drinks (e.g., setting a limit on the number of drinks one drinks in a night) or reducing the risk of serious harm (e.g., using a designated driver; Madson, Arnau, & Lambert, 2013). In other words, PBS represent a harm-reduction approach to alcohol con- sumption versus an abstinence approach, which makes it more likely that college students will be inclined to use them. Strong evidence has emerged supporting the link between increased use of PBS and reduced alcohol consumption, hazardous drinking, and alcohol-related negative consequences (see Pearson, 2013 for a review) and that they are a key element to the effectiveness of brief motivational interventions (BMIs) in reducing hazardous drinking patterns (e.g., Kenney, Napper, LaBrie, & Martens, 2014). How- ever, the inverse relationship between PBS use and these alcohol use behaviors tend to be stronger in college women compared with college men because college women tend to report using PBS more often than college men (e.g., Delva et al., 2004; Madson, Moorer, Zeigler-Hill, Bonnell, & Villarosa, 2013; Walters, Roud- sari, Vader, & Harris, 2007). Limited PBS use among males may help to explain why they are much more likely to engage in hazardous alcohol use than their female peers. However, at pres- ent, there is an increasing need to understand why such differences exist between college men and women, specifically in terms of PBS use. For instance, DeMartini, Carey, Lao, and Luciano (2011) found that males reported higher acceptance of negative conse- quences as a result of drinking than did females and suggested that male norms concerning PBS use may help to explain their higher levels of hazardous alcohol use. In fact, a unifying construct that helps to explain why college males engage in hazardous alcohol use excessively and underuse protective behaviors appears to be social norms— especially those social norms concerning male gender roles.

Research on men and masculinity has largely demonstrated that alcohol use is seen as a sign of masculinity and entry into adult- hood, especially among college students (Kimmel, 2008; Lemle & Mishkind, 1989). The ability to consume and tolerate large quan- tities of alcohol is often viewed as reflective of a male’s level of masculinity whereas those who refrain from drinking or drink less are often viewed as more feminine (Kimmel, 2008; Peralta, 2007; Vandello & Bosson, 2013). By engaging in behaviors perceived to be more masculine, men can demonstrate their status and assert dominance within the peer group, which in turn leads to accep- tance within the group (Addis, Mansfield, & Syzdek, 2010; Ca- praro, 2000; Vandello & Bosson, 2013). This phenomenon is often explained using Gendered Social Learning Theory, which posits

that the most dominant members of a society define the norms of the genders within it, and conformity or nonconformity to those norms can translate into costs or benefits for the individual. Van- dello and Bosson (2013) extended this notion by demonstrating through experimental manipulation that masculinity is generally precarious in nature and that males often strive to maintain and achieve this elusive status of masculinity by conforming to male gender norms.

Because Gendered Social Learning Theory relates to college men, there is growing evidence that college men’s precarious need to conform to social norms concerning masculinity is associated with hazardous alcohol use and lack of healthy behaviors (Addis et al., 2010; Capraro, 2000; Courtenay, 2000; Kimmel, 2008; Peralta, 2007; Vandello & Bosson, 2013). On the basis of this theoretical framework, one may infer that college men are socialized to engage in hazardous drinking as a way to prove their masculinity to their peers and demonstrate their masculinity to a potential mate. This would suggest that PBS are incongruent with these socialized norms and in turn are less likely to be used by college men.

Researchers such as Mahalik et al. (2007) and Parent and Moradi (2009) have worked to outline the specific norms to which men feel compelled to conform. These include heterosexual self- presentation, playboy, risk-taking, winning, emotional control, vi- olence, power over women, self-reliance, and primacy of work. Several studies have examined the association between conformity to these specific norms and hazardous alcohol use. In general, research has demonstrated that higher conformity to the male gender norms of playboy, risk-taking, winning, and violence pre- dict higher levels of hazardous alcohol use among college men (Iwamoto, Cheng, Lee, Takamatsu, & Gordon, 2011; Iwamoto, Lejuez, MacPherson, & Corbin, 2014; Wells et al., 2013; Zambo- anga, Audley, Iwamoto, Martin, & Tomaso, 2016). By extension, some studies have found the norms of heterosexual self- presentation and power over women to be predictors of hazardous alcohol use (e.g., Iwamoto & Smiler, 2013; Zamboanga et al., 2016).

The primary purpose of this study was to examine how confor- mity to specific male gender norms influences the association between PBS and hazardous alcohol use among college men. Although several studies have demonstrated that higher confor- mity to male norms is associated with less healthy behavior (e.g., Addis & Mahalik, 2003; Capraro, 2000; Griffith & Thorpe, 2016; Mahalik et al., 2007), there remains a need to define and identify specific protective health behaviors, such as PBS, as they relate to hazardous alcohol use. Research has identified that PBS are an effective component of harm-reduction interventions among col- lege students (Borsari et al., 2015). Therefore, the purpose of this study was to examine the degree to which gender role conformity attenuates the relationship between PBS use and hazardous drink- ing. First, we hypothesized that stronger adherence to male norms would predict hazardous alcohol use. Second, we hypothesized that conformity to male norms would moderate the relationship between PBS and hazardous alcohol use such that the relationship would be weaker for those who more strongly adhered to male gender norms. Specifically, based on findings from recent studies (e.g., Iwamoto et al., 2011; Iwamoto & Smiler, 2013; Wells et al., 2013; Zamboanga, Iwamoto, Pesigan, & Tomaso, 2015), we be- lieved that the specific norms of playboy, risk-taking, heterosexual

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478 WHITLEY, MADSON, AND ZEIGLER-HILL

self-presentation, winning, and violence would significantly mod- erate the association.

Method

Participants and Procedure

Participants were 205 male college students between 18 and 25 years of age (M � 19.94, SD � 1.52) enrolled at a university in the southeastern region of the United States who participated in ex- change for partial fulfillment of a research participation require- ment. Participants signed up for the study using the Department of Psychology subject pool management system. To be eligible, participants had to have consumed alcohol at least once within the 30 days before completing the survey. Most participants identified as White, non-Hispanic (56.9%), or African American (35.8%), with the remaining 7.3% self-identifying as “other.” Most partic- ipants identified as freshmen (40.0%) or sophomores (28.8%), with the remaining participants (31.2%) identifying as juniors or seniors. Participants were directed to a secure Internet-based sur- vey. After completing a university institutional review board- approved informed consent outlining the nature of the study, confidentiality, and the right to skip questions or end the study at any time, participants completed measures of hazardous alcohol use, protective strategies, and conformity to male norms that were presented in a random order.

Measures

PBS. The 18-item Revised Protective Behavioral Strategies Scale (PBSS-r; Madson et al., 2013) was used to assess partici- pants’ use of PBS. Participants reported how often they engage in various behaviors such as “avoiding shots” or “knowing where your drink is at all times” using a scale ranging from 1 (Never) to 6 (Always). Scores ranged from 18 to 108, with higher scores indicating more PBS use. The internal consistency of the PBSS-r was good for the present sample (� � .93).

Conformity to male norms. The 46-item Conformity to Mas- culine Norms Inventory (CMNI-46; Parent & Moradi, 2009) was used to assess male gender norm adherence. The CMNI-46 is designed to assess the following nine male gender norms: winning

(six items; e.g., “In general, I will do anything to win” [� � .76]), emotional control (six items; e.g., “I never share my feelings” [� � .72]), risk-taking (five items; e.g., “I enjoy taking risks” [� � .64]), violence (six items; e.g., “I am willing to get into a physical fight if necessary” [� � .79]), power over women (four items; e.g., “In general, I control the women in my life” [� � .76]), playboy (four items; e.g., “If I could, I would frequently change sexual partners” [� � .73]), self-reliance (five items; e.g., “I hate asking for help” [� � .60]), primacy of work (four items; e.g., “My work is the most important part of my life” [� � .69]), and heterosexual self-presentation (six items; e.g., “I would be furious if someone thought I was gay” [� � .83]). Participants were asked to rate their level of agreement with each item using scales that ranged from 0 (Strongly disagree) to 3 (Strongly agree). Higher scores indicate higher male gender norm adherence.

Hazardous alcohol use. Hazardous alcohol use was assessed using the 10-item Alcohol Use Disorders Identification Test (AU- DIT; Saunders, Aasland, Babor, De La Fuente, & Grant, 1993). Participants responded to the items using a response scale ranging from 0 (Never) to 4 (Daily), with higher scores indicating that the respondent endorsed more hazardous alcohol use. The AUDIT has been shown to be a valid assessment with college students (Babor, Biddle-Higgins, Saunders, & Monteiro, 2001). The internal con- sistency for the AUDIT was .84 for the present study.

Results

Means, standard deviations, and intercorrelations are presented in Table 1. The average score on the AUDIT was above the cutoff score of 7 for identifying hazardous drinkers in male college students (M � 8.57, SD � 6.41; DeMartini & Carey, 2012). On average, participants reported drinking on 5.9 (SD � 5.5) days during the past month. Most participants reported exceeding the NIAAA safe drinking guidelines for males, which is 5 or more drinks within 2 h (84.7%), 4 or more drinks in 1 day (85.2%), or 14 or more drinks in a week (69.3%). Participants reported using levels of PBS when drinking (M � 70.07, SD � 21.10) that are similar to those observed for college-age males in previous studies (e.g., Madson & Zeigler-Hill, 2013).

A series of moderation analyses was conducted to determine whether conformity to specific male norms qualified the associa-

Table 1 Descriptive Statistics and Intercorrelations for PBS, Conformity to Male Norms, and Hazardous Alcohol Use

1 2 3 4 5 6 7 8 9 10 11

1. PBS — 2. Winning �.08 — 3. Emotional control �.09 .24��� — 4. Risk-taking �.11 .06 �.03 — 5. Violence �.32��� .28��� .09 .14 — 6. Power over women �.13 .10 .21�� .34��� .10 — 7. Playboy �.25��� .15� .19�� .28��� .13 .32��� — 8. Self-reliance �.13 .08 .33��� .10 �.04 .29��� .20�� — 9. Primacy of work .25��� �.03 �.07 �.16� �.16� .09 �.03 �.11 —

10. Heterosexual self-presentation .11 .20�� .24��� .08 .08 .27��� .07 .09 .04 — 11. Harmful alcohol use �.37��� .01 .12 .12 .12 .30��� .24��� .13 �.12 .01 — M 70.07 10.48 9.09 7.13 10.16 4.56 5.03 7.20 6.15 10.55 8.57 SD 21.10 3.36 3.13 2.48 3.61 2.47 2.60 2.52 2.36 4.31 6.41

� p � .05. �� p � .01. ��� p � .001.

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479PBS AND MALE NORMS

tion between PBS and hazardous alcohol use. This was accom- plished by conducting a separate hierarchical moderated multiple regression analysis for each male norm in which hazardous alcohol use was regressed onto PBS, conformity to each male norm, and their interaction. We conducted a separate analysis for each male norm because of concerns about multicollinearity. The main ef- fects of PBS and conformity to male norms were entered on Step 1 with the two-way interaction of these main effect terms being entered on Step 2. The continuous predictor variables were cen- tered for the purpose of testing interactions (Darlington & Hayes, 2017; Frazier, Tix, & Barron, 2004). To compensate for the number of analyses, we used a Bonferroni correction to control the Type I error (e.g., Armstrong, 2014). As a result of this correction, the only results from the regression analyses that are reported as reaching conventional levels of significance are those for which p � .006.

Winning

The main effect of PBS (� � �.37, t � �5.60, p � .001) emerged from this analysis. However, the main effect of winning was not significant (� � �.02, t � �0.35, p � .73), nor was the interaction of PBS � winning (B � .00, SE � .01, t � 0.31, p � .98).

Emotional Control

The main effect of PBS (� � �.36, t � �5.48, p � .001) emerged from this analysis. However, the main effect of emotional control was not significant (� � .08, t � 1.26, p � .21), nor did the interaction of PBS � emotional control (B � �.01, SE � .01, t � �2.20, p � .03) meet the Bonferroni-adjusted criterion for statistical significance (i.e., p � .006).

Risk-Taking

The main effects of PBS (� � �.35, t � �5.37, p � .001) and risk-taking (� � .18, t � 2.73, p � .01) emerged from this analysis. However, the interaction of PBS � risk-taking (B � �.02, SE � .01, t � �2.24, p � .03) did not meet the Bonferroni-adjusted criterion for statistical significance (i.e., p � .006).

Violence

The main effect of PBS (� � �.37, t � �5.31, p � .001) emerged from this analysis. However, the main effect of violence was not significant (� � .00, t � �0.03, p � .98), nor was the interaction of PBS � winning (B � .00, SE � .01, t � 0.39, p � .70).

Power Over Women

The main effects of PBS (� � �.33, t � �5.25, p � .001) and power over women (� � .26, t � 4.03, p � .001) emerged from this analysis. However, the interaction of PBS � power over women (B � �.01, SE � .01, t � �1.83, p � .07) was not significant.

Playboy

The main effects of PBS (� � �.33, t � �4.90, p � .001) and playboy (� � .16, t � 2.33, p � .02) emerged from this analysis. However, the interaction of PBS � playboy (B � �.01, SE � .01, t � �1.26, p � .21) was not significant.

Self-Reliance

The main effect of PBS (� � �.36, t � �5.40, p � .001) emerged from this analysis. However, the main effect of self- reliance was not significant (� � .09, t � 1.32, p � .19), nor was the interaction of PBS � self-reliance (B � �.01, SE � .01, t � �1.91, p � .06).

Primacy of Work

The main effect of PBS (� � �.36, t � �5.31, p � .001) emerged from this analysis. However, the main effect of primacy of work was not significant (� � �.03, t � �0.45, p � .66), nor was the interaction of PBS � primacy of work (B � .00, SE � .01, t � 0.25, p � .81).

Heterosexual Self-Presentation

The main effect of PBS (� � �.37, t � �5.65, p � .001) emerged from this analysis, but the main effect of heterosexual self-presentation was not significant (� � .05, t � 0.73, p � .47). However, the main effect of PBS was qualified by the PBS � heterosexual self-presentation interaction (B � �.01, SE � .00, t � �3.20, p � .002). The predicted values for this interaction are presented in Figure 1. As suggested by Aiken, West, and Pitts (2003), simple slopes tests were used to probe this interaction. These simple slopes tests revealed a significant negative associa- tion between PBS and hazardous alcohol use for men with high levels of heterosexual self-presentation (� � �.58, t � �6.34, p � .001) that was stronger than the negative association that emerged for men with low levels of heterosexual self-presentation (� � �.20, t � �2.31, p � .02). Furthermore, heterosexual self-presentation was associated with hazardous alcohol use for men who reported low levels of PBS (� � .27, t � 2.84, p � .005)

Figure 1. Predicted values for hazardous alcohol use illustrating the interaction of PBS and heterosexual self-presentation at values that are 1 SD above and below their respective means.

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480 WHITLEY, MADSON, AND ZEIGLER-HILL

but not for men who reported high levels of PBS (� � �.12, t � �1.40, p � .16). Taken together, these results show that the highest levels of hazardous alcohol use were reported by men who had low levels of PBS use combined with high levels of hetero- sexual self-presentation.

Discussion

The present study examined the moderating role of conformity to specific male norms in the relationship between PBS and hazardous alcohol use among college males. Researchers have recently identified that traditional male gender norm conformity is strongly associated with hazardous alcohol use in male college students (e.g., Iwamoto et al., 2011, 2014). By developing a better understanding of how these male gender norms influence the link between PBS and hazardous alcohol use, we may be able to better individualize interventions that are intended to enhance safe drink- ing behaviors among college men.

The first hypothesis that conformity to male norms would pre- dict hazardous alcohol use was partially supported in that men who conformed more strongly to the risk-taking, power over women, and playboy norms also engaged in hazardous alcohol use. This finding is consistent with past research that suggests that confor- mity to male norms is associated with hazardous drinking (e.g., Courtenay, 2000; Peralta, 2007). Furthermore, these findings are also consistent with research suggesting that conformity to the risk-taking, power over women, and playboy norms is associated with hazardous drinking (e.g., Iwamoto et al., 2011; Iwamoto & Smiler, 2013; Wells et al., 2013; Zamboanga et al., 2015).

Considered within the context of Gendered Social Learning Theory, these findings add further support to the notion that conformity to male norms may be an essential contributing factor to hazardous alcohol use among college men. College men who endorse greater male norm conformity are more inclined to engage in behaviors that are normatively viewed as masculine, such as hazardous alcohol use (Kimmel, 2008; Peralta, 2007). Broken down further, these findings suggest that college men who enjoy taking risks, desire multiple sexual partners, and desire having power over women are more inclined to engage in hazardous drinking. It may be that college men who more strongly conform to these specific norms are more driven to perform masculine behaviors (i.e., hazardous alcohol use; Peralta, 2007) that will demonstrate their own masculinity to their peers. This is partially consistent with findings from Mahalik et al. (2007), which suggest that the risk-taking and playboy norms are associated with an elevated sense of self-presentation.

Our second hypothesis was partially supported in that only the heterosexual self-presentation norm moderated the relationship between PBS and hazardous drinking. The norms of playboy, risk-taking, winning, and violence were not found to moderate the association as was hypothesized, although risk-taking approached our adjusted significance level. It is unclear why these specific norms did not emerge as moderators considering past research (e.g., Iwamoto et al., 2011; Wells et al., 2013). The moderating effects of heterosexual self-presentation are an intriguing finding considering that only a few studies have found this norm to be positively associated with drinking variables (e.g., Iwamoto & Smiler, 2013; Zamboanga et al., 2015). These findings suggest that PBS may have particular harm-reduction value for men who

strongly conform to the heterosexual self-presentation norm. An alternative view may be that college men who strongly conform to heterosexual self-presentation and who endorse high use of PBS may hold different perceptions of normative health behaviors of men when compared with their low PBS use counterparts. Still, this seems unlikely given the findings of past literature on mas- culinity and men’s health behaviors (e.g., Addis et al., 2010; Kimmel, 2008).

Findings from Vandello and Bosson’s (2013) research concern- ing precarious manhood may help to better explain why PBS played such an important role in reducing hazardous drinking for men with high conformity to the heterosexual self-presentation norm. As Vandello and Bosson (2013) highlight, perceived expec- tations about one’s masculinity appear to play a significant role in the extent to which males engage in certain behaviors (e.g., haz- ardous alcohol use) to prove their masculinity to other men. Specifically, men may be highly responsive and attuned to situa- tional, contextual factors that may threaten their masculinity and are more inclined to take measures to restore that status (Vandello, & Bosson, 2013). Applied to the current study, perhaps men who perceive greater situational threats to their masculinity when en- gaging in alcohol use are less inclined to use PBS to avoid appearing feminine.

Moreover, considering the “self-presentation” component of the heterosexual self-presentation norm, perhaps the men who strongly conform to the heterosexual self-presentation norm and highly use PBS may use alcohol in contexts that pose a low threat to their masculinity and as a result feel less pressure to refrain from using PBS. Conversely, men who strongly conform to the heterosexual self-presentation norm but use less PBS may be experiencing relatively higher threats to their masculine status in the contexts in which they are drinking. Thus, these individuals may be less inclined to take protective measures when drinking because of awareness that engaging in PBS may pose a perceived threat to their heterosexuality or, more broadly, their masculinity. However, because of the limitations in both the literature and the design of this study, little is known about the specific contexts in which this paradigm may apply.

Our findings pose several considerations for future research. If men’s use of PBS is a factor of precarious masculinity, then future studies examining this relationship will need to implement meth- odologies that capture these facets. In particular, conducting event- based studies that monitor situational, gender-relevant motivators for PBS use as well as hazardous alcohol use would be instrumen- tal in furthering this area of study. For example, studies that use a longitudinal, daily diary method could prove beneficial in captur- ing potential context-specific variables that may influence college men’s PBS use. Even more beneficial would be an experimental design (such as the designs used by Vandello & Bosson, 2013) that directly examines individuals’ alcohol use after a gender-relevant threat.

These findings—although they are preliminary— have implica- tions for alcohol prevention and interventions with male college student drinkers. Perhaps the most salient implication from this study is that teaching PBS to college men has the potential to lead to lower levels of hazardous alcohol use for all college men, especially those who conform highly to the heterosexual self- presentation norm. More generally, this study suggests that PBS can be successfully taught to college men. This study is consistent

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481PBS AND MALE NORMS

with past research in that it shows that high conformity to the heterosexual self-presentation norm is associated with hazardous alcohol use, but it extends those findings by identifying a modi- fiable behavioral factor for college men’s alcohol use—PBS. Therefore, this may suggest that prevention and intervention ef- forts that seek to teach PBS and enhance the normative perception of PBS use could prove beneficial in reducing hazardous drinking among college men, particularly among those who conform highly to the heterosexual self-presentation norm.

One approach that may accomplish this is Shen-Miller, Isacco, Davies, St. Jean, and Phan’s (2013) Men’s Center Approach (MCA), which suggests that interventions that focus on developing discrepancies between the actual masculine self and the idealized masculine self may prove beneficial in developing more healthy, norm-congruent behaviors. Thus, interventions developed to en- hance the normative perception of PBS use by framing PBS in the context of one’s masculine identity in a norm-congruent manner could be beneficial for all college men, particularly for those who conform highly to the heterosexual self-presentation norm. Thus, BMIs may prove to be a beneficial approach for discussing mas- culinities and PBS use by college men. Thus, including an assess- ment of gender norm conformity (e.g., the CMNI-46; Parent & Moradi, 2009) may be beneficial in informing the application of BMIs.

Although our results are promising, it is important to acknowl- edge some of the limitations of this study. First, it is unclear whether these results will generalize to other populations because data were collected from a single institution in the southeastern region of the United States. Future research should use a broader sample from multiple regions to obtain a clearer understanding of these associations. Second, we used a cross-sectional design, which prevents us from making causal inferences. Thus, we cannot affirm that the combination of low PBS and high levels of mas- culine gender role conformity cause hazardous alcohol use among male college students. Future research should consider using ex- perimental manipulations or longitudinal designs to gain a better understanding of the connections among PBS, conformity to male norms, and hazardous alcohol use.

The results of the current study also suggest areas for further investigation. Future studies should attempt to replicate and extend these results by considering different aspects of male gender norm conformity. As noted previously, future studies that monitor situ- ational, gender-relevant motivators for PBS use as well as hazard- ous alcohol use would be helpful in advancing this area of study. By examining context-specific motivators, future studies may parse out the differences noted between the high and low PBS use groups in this study. In addition, considering the consistent con- nection between high gender role conflict and low help-seeking behaviors (e.g., Groeschel, Wester, & Sedivy, 2010; Lane & Addis, 2005), future studies that include this construct in the presented paradigm may have particularly important clinical im- plications for reducing hazardous drinking among male college students. The role of other social-cognitive predictors (e.g., alcohol outcome expectancies) should also be considered in future studies because they may also be important for understanding the links that male gender norm conformity has with hazardous alcohol use. In addition, a study that examines perceptual differences of PBS implementation, as noted by Walters and colleagues (2007), be- tween college men and women may be beneficial in furthering our

understanding of gender differences in PBS use. Finally, it may be beneficial to consider the links that PBS and conformity to male norms have with hazardous alcohol use in a sample exclusively made up of hazardous binge drinkers.

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Received November 19, 2016 Revision received May 12, 2017

Accepted May 14, 2017 �

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483PBS AND MALE NORMS