The differential development of adolescent alcohol expectancies may predict adult alcoholism

Alcohol expectancy profile in late childhood with alcohol drinking and purchasing behaviors in adolescence

BACKGROUND

The study aims to (i) identify the evolving profile of endorsed alcohol expectancies (AEs) during the transition from late childhood into early adolescence, and (ii) examine the connection between such profiles and subsequent alcohol drinking and purchasing in adolescence.

METHODS

A prospective cohort of 928 sixth graders was recruited from 17 elementary schools in northern Taiwan in 2006 with follow-ups conducted in seventh and eighth grade. Information concerning AEs, individual characteristics, and social attributes were collected by self-administered questionnaires at baseline and in seventh grade; drinking behaviors and alcohol purchasing were assessed in eighth grade. Longitudinal latent profile and survey regression analyses were used to evaluate association estimates.

RESULTS

Three distinct profiles of positive AEs were identified: stably low (37%), stably high (35%), and increasing (28%). Regardless of childhood-onset alcohol experience, endorsing the stably high-profile AEs was associated with increased drinking occasions (adjusted relative risk [aRR] = 1.49, 95% CI = 1.24-1.80), and having the increasing-profile AEs may elevate the likelihood of alcohol purchase in adolescence (adjusted odd ratio [aOR] = 2.57, 95% CI = 1.33-4.96). Additionally, parental drinking was the most influential social factor for drinking occasions (aRR = 1.43) whereas peer drinking was prominent for alcohol purchasing (aOR = 3.06).

CONCLUSIONS

The evolving profile of alcohol expectancy in late childhood may predict alcohol drinking occasion and purchasing behaviors in adolescence. Underage drinking prevention efforts should target not only pro-alcohol social environments but also cognitive constructs (e.g., alcohol expectancy).

Television and drinking expectancies: the influence of television viewing on positive drinking expectanc and alcohol use among US and Norwegian adolescents: a comparative analysis

Objective

Exposure to incidental portrayals of drinking on television and cleverly crafted advertisements has been linked to the development of positive alcohol expectancies in children and teenagers. Researchers hoping to demonstrate this connection, however, have difficultly in finding adolescent groups with little or no exposure to alcohol advertising for comparative purposes. One of the cornerstones of Norwegian alcohol policy has been a government-enacted ban on all forms of advertising for alcohol products containing more than 2.5% alcohol by volume. As a consequence, Norwegian youth have almost no experience with alcohol advertising. This study represents a comparative analysis of Norwegian and US teenagers that seeks to improve our understanding of television's and alcohol advertising's potential role in shaping attitudes about alcohol.

Method

Self-report data on television viewing, normative beliefs about teenage drinking, and alcohol expectancies were collected from convenience samples of 972 junior high students in the US and 622 junior high students in Norway.

Results

Although students in both countries watch about the same amount of television and about equal numbers have tried alcohol, the Norwegian students were more likely to see drinking as a normal teenage behavior and to have more positive outcome expectancies. For students from both countries who had no personal experience with alcohol, frequent television viewers were more likely than light viewers to see drinking as a normative behavior with positive outcomes. This was particularly true for Norwegian students who viewed large amount of US and British programs as well as music videos.

Conclusion

The absence of alcohol advertising in Norway may be overshadowed by the general cultural acceptance of adolescent and young adult drinking. For students with no personal experience with alcohol, however, television may be functioning as an important socializing agent, providing them with portrayals of drinking behaviors, cultivating normative beliefs, and presenting opportunities to cognitively model and rehearse the behaviors shown.

The Role of Alcohol Expectancies in Sexual Risk Behaviors Among Adolescents and Young Adults in the Democratic Republic of the Congo

PURPOSE

Considering the increased risk of HIV among alcohol users, we explored the role of individual alcohol expectancies in risk behaviors among youth in the Democratic Republic of the Congo.

METHODS

We surveyed 1,396 adolescents (ages 15-19) and young adults (ages 20-24) on alcohol and sexual behaviors in May, 2010. We assessed expectancies of alcohol use (1) leading to sex or positive sexual experiences; (2) diminishing one's ability to resist unwanted sex; and (3) diminishing one's ability to use or negotiate use of condoms. Adjusted logistic regression models assessed the association between alcohol use and alcohol expectancies with unprotected sex and multiple sex partners (MSP).

RESULTS

Participants reporting alcohol use (36.8%) were more likely to have engaged in unprotected sex and MSP than nondrinkers (adjusted odds ratio [AOR]: 2.87, 95% confidence interval [CI]: 2.29-3.60; AOR: 3.73 95% CI: 2.94-4.72, respectively). Among alcohol users, after adjusting for drinking quantity, moderate expectancies of alcohol leading to positive sexual experiences were significantly associated with MSP among adolescent boys (AOR: 4.20, 95% CI: 1.49-11.86) and girls (AOR: 3.97, 95% CI: 1.36-11.60), whereas high expectancies were significant among young adult men (AOR: 2.70, 95% CI: 1.19-6.10). Among adolescent girls who used alcohol, adjusted odds of unprotected sex were elevated among those with expectancies of diminished ability to refuse unwanted sex (AOR: 5.13, 95% CI: 1.41-16.64) or to negotiate condom use (AOR: 16.22; 2.08-126.8).

CONCLUSIONS

HIV prevention efforts for youth should acknowledge the role of alcohol expectancies in sexual risk behaviors and tailor programs to address different roles of expectancies in males and females.

Self-Reported Expected Effects of Alcohol by Nonalcoholic Adult Men and Women

150 Swedish men and women were asked about their alcohol-related expectancies by letting them state the three most probable effects they expected for themselves and for others from drinking alcohol. The three effects were to be rank-ordered. Answers were classified into 11 different categories and the emerging picture indicated that both men and women expected mostly positive effects both for themselves and for others. Results were discussed by comparing the present results with those from other descriptive studies concluding that previous findings were largely confirmed. Theoretical and methodological points of view were also discussed.

Alcohol Advertising and Youth: A Focus-Group Analysis of What Young People Find Appealing in Alcohol Advertising

In an effort to ascertain how youths interpret, understand and respond to the themes and images portrayed in television alcohol advertisements, focus-group discussions were conducted with students ages 9–15 in a Northern California community. These discussions revealed that students like lifestyle and image-oriented elements of television beer commercials that are delivered with humor and youth-oriented music and/or characters. Conversely, they dislike product-oriented elements of alcohol commercials. Students identified the main message of television beer commercials as an exhortation to purchase the product based on its quality and its relationship to sexual attractiveness. Participants indicated that beer commercials imply that attractive young adults drink beer to personally rewarding ends. These findings suggest that television beer commercials may need to focus less on youthful lifestyle images and more on the product itself in order to appeal less to young people.

Alcohol Expectancies Mediate the Relationship Between Age of First Intoxication and Drinking Outcomes in College Binge Drinkers

BACKGROUND

While prior research has shown that age of first intoxication (AI) is associated with negative alcohol outcomes, limited research has examined factors accounting for this relationship. Alcohol expectancies, or beliefs about the effects of alcohol, may explain such associations as both positive and negative expectancies have been shown to be key predictors of drinking outcomes.

OBJECTIVE

The present study examined expectancies as mediators between early AI and alcohol-related outcomes.

METHOD

Data collection occurred in 2012 and 2013. Participants were college students (N = 562, 65.8% women) who completed an online survey including measures of alcohol use history, alcohol expectancies, typical alcohol consumption, and alcohol-related problems. Structural equation modeling was used to test the hypothesized model.

RESULTS

Our findings support a model whereby AI is associated with drinking through its influence on both positive and negative expectancies. Specifically, an earlier AI was associated with stronger alcohol expectancies, which in turn, was associated with heavier alcohol use and alcohol-related problems.

CONCLUSIONS/IMPORTANCE

These findings are consistent with expectancy theory and previous research suggesting that more experienced drinkers hold stronger drinking-related beliefs, be it positive or negative, and these expectancies ultimately explain variability in alcohol use and problems. Our findings further support that expectancies play an important role in the initiation of drinking behavior.

Drinking experience uncovers genetic influences on alcohol expectancies across adolescence

AIMS

To test whether drinking onset moderates genetic and environmental contributions to individual differences in the etiology of alcohol expectancies across adolescence.

DESIGN

Longitudinal twin design.

SETTING

Community sample from Los Angeles, CA, USA.

PARTICIPANTS

A total of 1292 male and female twins, aged 11–18years, were assessed at 1 (n = 440), 2 (n = 587) or 3 (n = 265) occasions as part of the risk factors for the Antisocial Behavior Twin Study.

MEASUREMENTS

Social behavioral (SB) alcohol expectancies were measured using an abbreviated version of the Social Behavioral subscale from the Alcohol Expectancy Questionnaire for adolescents (AEQ-A). Drinking onset was defined as >1 full drink of alcohol.

FINDINGS

Alcohol expectancies increased over age and the increase became more rapid following onset of drinking. The importance of genetic and environmental influences on SB scores varied with age and drinking status, such that variation prior to drinking onset was attributed solely to environmental influences, whereas all post-onset variation was attributed to genetic influences. Results did not differ significantly by sex.

CONCLUSION

Only environmental factors explain beliefs about the social and behavioral consequences of alcohol use prior to drinking onset,whereas genetic factors explain an increasing proportion of the variance in these beliefs after drinking onset.

Impulsivity, expectancies, and evaluations of expected outcomes as predictors of alcohol use and related problems

BACKGROUND

While the association between outcome expectancies and drinking is well documented, few studies have examined whether evaluations of expected outcomes (outcome evaluations) moderate that association.

OBJECTIVES

The present study tested the hypotheses that outcome evaluations moderate the outcome expectancy-drinking association and that outcome expectancies mediate the association between impulsive personality and drinking.

METHODS

College students (N = 201; 55.5% female) enrolled in a mid-sized metropolitan university completed measures assessing outcome expectancies and evaluations, alcohol consumption, and drinking-related problems.

RESULTS

Consistent with study hypotheses, expectation of negative outcomes predicted lower levels of drinking, but only when these outcomes were evaluated as highly aversive. However, impulsivity was found to be a far stronger predictor of both drinking and related problems than were outcome expectancies or evaluations.

CONCLUSION

The association between negative expectancy and drinking was moderated by negative evaluation, such that individuals who both expected that negative outcomes were likely to occur and who judged such outcomes as highly undesirable consumed significantly fewer drinks per week. Impulsivity was found to be a strong predictor of both alcohol consumption and alcohol-related problems.

Patterns of alcohol expectancies and alcohol use across age and gender

AIMS

To investigate the relationship between alcohol expectancies and alcohol use in a community sample as a function of age and gender.

METHODS

The study is based on a national probability sample of 6467 German adults. Respondents were grouped into five age groups ranging from 18 to 59 years. A brief version of the Comprehensive Alcohol Expectancy Questionnaire was used to assess alcohol expectancies. Alcohol use was assessed by the number of drinking days during the past month and the number of drinks on an average drinking day.

RESULTS

Prior to conducting group comparisons, measurement invariance across age and gender was established. Latent mean level comparisons showed that the endorsement of both positive and negative expectancies almost linearly decreased with increasing age. However, this decrease was not reflected in alcohol consumption patterns. Structural analysis of the expectancy factors and drinking variables showed that the predictive power of expectancies varied by age and gender. Particularly, expectancies related to social assertiveness and sexual enhancement were strong predictors only in younger, but not in older respondents. Conversely, expectancies related to tension reduction and impairment were the most important predictors of drinking in respondents older than 30 years, but not in younger age groups. Additionally, the onset and course of age-related changes in expectancies was moderated by gender.

CONCLUSIONS

The present study demonstrates substantial age-related changes in the relationship between alcohol expectancies and alcohol use. Moreover, the profile of alcohol expectancies appears to be more important than their absolute strength.

The theory of planned behavior: precursors of marijuana use in early adolescence?

BACKGROUND

Precursors of marijuana use in early adolescence are largely unknown because studies generally focus on marijuana use among older adolescents or adults.

METHODS

In this study, we examined precursors of marijuana use in a sample of 1023 Dutch early adolescents (aged 11-14 at Time 1) who were never-marijuana user at baseline, by applying a 3-wave longitudinal design. The theory of planned behavior (TPB) was used as a theoretical framework and posits that marijuana-specific cognitions (i.e., positive and negative expectancies, evaluative attitude, social approval, and self-efficacy) are antecedents of marijuana use and that this relationship is mediated by the intention to start using marijuana.

RESULTS

In accordance with these premises, our results indicated that evaluative attitude, social approval, and self-efficacy at Time 1 are related to marijuana use at Time 3 (20 months follow-up) via the intention to start using marijuana at Time 2 (8 months follow-up). More specifically, the structural equation models showed that more positive marijuana attitudes, more approval from the social environment, and lower self-efficacy were related to marijuana use initiation through a stronger intention to start using marijuana.

CONCLUSION

This outcome is important for prevention efforts in that our results underline the importance of weakening adolescents' positive attitudes toward marijuana, decrease social approval of marijuana use, and stimulating the development of early adolescents' refusal skills with respect to marijuana use.

Variation in substance use relapse episodes among adolescents: a longitudinal investigation

Substance use disorders are chronically relapsing conditions, and there is a need to evaluate whether relapse precursors are consistent across multiple relapses. We identified latent groups of relapse characteristics over time in adolescents with alcohol and substance use disorders following an inpatient treatment episode. Youth (N = 124, mean age = 16 years, 56% male, 60% Caucasian) were interviewed while in treatment and biannually during the first year after treatment to gather contextual information about first and second relapse episodes. We identified two latent classes of relapse precursors labeled aversive-social (41% at initial relapse, 57% at subsequent relapse) and positive-social (59% at initial relapse, 43% at subsequent relapse). Classes were stable in structure over time; however, only 61% of those assigned to aversive-social and 39% assigned to positive-social classes at initial relapse remained there for the subsequent relapse. Findings highlight the dynamic nature of relapse for youth and have important clinical implications.

Paradoxical effects of alcohol information on alcohol outcome expectancies

BACKGROUND

Cognitive associations with alcohol predict both current and future use in youth and young adults. Much cognitive and social cognitive research suggests that exposure to information may have unconscious influences on thinking and behavior. The present study assessed the impact of information statements on the accessibility of alcohol outcome expectancies.

METHODS

The 2 studies reported here investigated the effects of exposure to alcohol statements typical of informational approaches to prevention on the accessibility of alcohol outcome expectancies. High school and university students were presented with information statements about the effects of alcohol and other commercial products. The alcohol statements were taken from expectancy questionnaires. Some of these statements were presented as facts and others as myths. The retention of detailed information about these statements was manipulated by (i) divided attention versus focused attention or (ii) immediate versus delayed testing. Accessibility of personal alcohol outcome expectancies was subsequently measured using an open-ended question about the expected effects of alcohol.

RESULTS

Participants reported more alcohol outcomes seen during the information task as personal expectations about the effects of alcohol use than similar unseen items. Paradoxically, myth statements were also more likely to be reported as expectancies than unseen items in all conditions. Additionally, myth statements were generated less often than fact statements only under the condition of immediate testing with strong content processing instructions.

CONCLUSIONS

These observations are consistent with findings from cognitive research where familiarity in the absence of explicit memory can have an unconscious influence on performance. In particular, the exposure to these items in an informational format increases accessibility of the seen items even when the participants were told that they were myths. The findings have implications for the development of effective prevention materials.

Cognitive processes in alcohol binges: a review and research agenda

Alcohol abuse is associated with a cluster of long-term changes in cognitive processes, as predicted by contemporary models of addiction. In this paper we review evidence which suggests that similar changes may occur during an alcohol binge, and as such they may play an important role in explaining the loss of control over alcohol consumption that occurs during alcohol binges. As a consequence of both acute alcohol intoxication (alcohol 'priming' effects) and exposure to environmental alcohol-related cues, we suggest that a number of changes in cognitive processes are likely. These include increased subjective craving for alcohol, increased positive and arousing outcome expectancies and implicit associations for alcohol use, increased attentional bias for alcohol-related cues, increased action tendencies to approach alcohol, increased impulsive decision-making, and impaired inhibitory control over drives and behaviour. Potential reciprocal relationships between these different aspects of cognition during an alcohol binge are discussed. Finally, we discuss the relationship between the current model and existing models of cognitive processes in substance abuse, and we speculate on the implications of the model for the reduction binge drinking and its consequences.

Gender differences in factors influencing alcohol use and drinking progression among adolescents

While prevalence rates for alcohol use and related disorders differ widely between adult men and women, male and female adolescents do not exhibit the same disparity in alcohol consumption. Previous research and reviews do not address the emergence of differences in drinking patterns that occur during late adolescence. Therefore, a developmental perspective is presented for understanding how various risk and protective factors associated with problematic drinking affect diverging alcohol trajectories as youth move into young adulthood. This review examines factors associated with risk for developing an alcohol use disorder in adolescent girls and boys separately. Findings indicate that certain biological (i.e., genetic risk, neurological abnormalities associated with P300 amplitudes) and psychosocial (i.e., impact of positive drinking expectancies, personality characteristics, and deviance proneness) factors appear to impact boys and girls similarly. In contrast, physiological and social changes particular to adolescence appear to differentially affect boys and girls as they transition into adulthood. Specifically, boys begin to manifest a constellation of factors that place them at greater risk for disruptive drinking: low response to alcohol, later maturation in brain structures and executive function, greater estimates of perceived peer alcohol use, and socialization into traditional gender roles. On an individual level, interventions which challenge media-driven stereotypes of gender roles while simultaneously reinforcing personal values are suggested as a way to strengthen adolescent autonomy in terms of healthy drinking decisions. Moreover, parents and schools must improve consistency in rules and consequences regarding teen drinking across gender to avoid mixed messages about acceptable alcohol use for boys and girls.

Building Xperience: a multilevel alcohol and drug prevention intervention

"Xperience" is an innovative alcohol and drug prevention program that has adopted a multilevel, community-based strategy to promote drug-and-alcohol free social activities, venues and norms among urban youth ages 14-20. The intervention aims to strengthen protective factors and reduce risk factors for alcohol and other substance use among high school age youth by addressing multiple factors at the individual, peer, community and city level. The purpose of this paper is to discuss the process of building the different levels of this intervention during the 3-year formative phase. We will explain: (1) Why we chose to adopt a multilevel and participatory strategy, (2) Formative research leading to the intervention model, (3) The theoretical framework underlying the methodology, (4) Pilot intervention development (Years One and Two), (5) Current program methods and outcome goals, and lastly, (6) Some of the lessons learned, goals achieved, and plans for the future. This descriptive account of building a multilevel intervention aims to serve as a useful guide for others wishing to develop similar approaches, and for theorizing about some of the common challenges involved in this process.

Prescription stimulant expectancies in recreational and medical users: results from a preliminary expectancy questionnaire

Given the rise of prescription stimulant misuse, examination of effect expectancies could prove helpful. The Prescription Stimulant Expectancy Questionnaire (PSEQ) was designed to explore positive and negative prescription stimulant-related expectancies. In 2006, 157 participants nationwide completed an Internet survey of prescription stimulant use, attention-deficit/hyperactivity disorder symptoms, and expectancies. Multiple regressions demonstrate that positive, but not negative expectancies, predicted frequency of use. Recreational and medical users were classified by hierarchical cluster analysis. Recreational users reported fewer positive and negative expectancies than medical users. Implications and limitations are discussed. Future research is warranted on prescription stimulant expectancies and the utility of the PSEQ.

Psychometric Properties of a Revised Form of the Drug-Taking Confidence Questionnaire for Use with Adolescents

Self-efficacy is an important cognitive predictor of substance abuse treatment outcome. While measures of coping self-efficacy are related to substance use relapse in adults, their properties are not well known in adolescent populations. The present study examined 223 adolescents while in treatment for substance abuse and comorbid psychiatric disorders. Responses on the Drug-Taking Confidence Questionnaire (DTCQ; Sklar et al., 1997) were used to construct a 37-item, 5-factor version for use with adolescents. Exploratory and confirmatory factor analysis identified the following factors: 1) Negative Situations, 2) Social/Drugs, 3) Pleasant Emotions, 4) Testing Personal Control, and 5) Physical/Intimate. Data preliminarily support the construct, concurrent, and predictive validity of the revised instrument.

Cognitive predictors of alcohol involvement and alcohol consumption-related consequences in a sample of drunk-driving offenders

Motivational theories of alcohol involvement emphasize a wide range of cognitive factors as precursors to "heavy" or high-risk drinking. Central to this consideration has been expectancies, drinking urges, triggers, and situational cues, all of which can synergistically or independently stimulate drinking. Unfortunately, empirical studies have scrutinized low-level or moderate drinkers drawn from the general population, and less is known about the role of cognitive factors as precursors to high-risk drinking. The present study examines the unique contribution of several measures of cognitive motivation to harmful alcohol use in a sample of convicted drunk drivers. Confirmatory factor analysis indicated the psychometric soundness of a model positing four latent predictor constructs assessing drinking urges/triggers, situational cues, positive and negative expectancies and outcome constructs assessing harmful alcohol use and perceived consequences of harmful drinking. A structural equation model indicated that each motivational construct was associated uniquely with both drinking and perceived consequences, with the largest overall effect in both cases associated with situational cues. Results are discussed in terms of identifying prominent cognitive factors that may foster harmful drinking among high-risk populations and their implications for treatment.

Classes of substance abuse relapse situations: a comparison of adolescents and adults

Research in the process of relapse has uncovered important developmental differences in the situations that make adolescents and adults most vulnerable to relapse after substance abuse treatment. This study takes a developmental, person-centered approach to relapse by examining the latent class structure of relapse precursors in adolescents and adults. Adults (N = 160) and adolescents (N = 188) in substance abuse and psychiatric treatment were followed up to 18 months after discharge to gather detailed information about their first relapse after treatment. Both adolescents and adults exhibited a 2-class structure of relapse precursors. Adult classes were labeled social and urges situations (primary precursors: social pressure and urges; 67%) and negative and urges situations (primary precursors: negative affect and urges; 33%), while teen classes were labeled social and positive situations (primary precursors: enhancing a positive emotional state and social pressure; 69%) and complex situations (primary precursors: negative affect, negative interpersonal situations, social pressure, and urges; 31%). Findings are discussed in relation to developmental and clinical considerations in treating clients with substance use disorders and comorbid psychopathology.

Depressed mood in childhood and subsequent alcohol use through adolescence and young adulthood

CONTEXT

Despite prior evidence supporting cross-sectional associations of depression and alcohol use disorders, there is relatively little prospective data on the temporal association between depressed mood and maladaptive drinking, particularly across extended intervals.

OBJECTIVE

To assess the association between depressed mood in childhood and alcohol use during adolescence and young adulthood by mood level and sex and race/ethnicity subgroups.

DESIGN

Cohort study of individuals observed during late childhood, early adolescence, and young adulthood.

SETTING

Urban mid-Atlantic region of the United States.

PARTICIPANTS

Two successive cohorts of students from 19 elementary schools have been followed up since entry into first grade (1985, cohort I [n = 1196]; 1986, cohort II [n = 1115]). The students were roughly equally divided by sex (48% female) and were predominantly African American (70%). Between 1989 and 1994, annual assessments were performed on students remaining in the public school system, and between 2000 and 2001, approximately 75% participated in an interview at young adulthood (n = 1692).

MAIN OUTCOME MEASURES

Among participants who reported having used alcohol, Cox and multinomial regression analyses were used to assess the association of childhood mood level, as measured by a depression symptom screener, with each alcohol outcome (incident alcohol intoxication, incident alcohol-related problems, and DSM-IV alcohol abuse and dependence).

RESULTS

In adjusted regression analyses among those who drank alcohol, a high level of childhood depressed mood was associated with an earlier onset and increased risk of alcohol intoxication, alcohol-related problems during late childhood and early adolescence, and development of DSM-IV alcohol dependence in young adulthood.

CONCLUSIONS

Early manifestations associated with possible depressive conditions in childhood helped predict and account for subsequent alcohol involvement extending across life stages from childhood through young adulthood.

Alcohol and drug expectancies as anticipated changes in affect: negative reinforcement is not sedation

Goldman and Darkes (2004) argued that all three basic alcohol-expectancy factors can be assessed with a brief questionnaire (AEMax), related to the circumplex model of emotion. I argue that negative reinforcement, one of the three basic expectancy factors, is not assessed with the AEMax. Importantly, negative reinforcement is positively related to problem drinking while sedation (the AEMax-factor that comes closest) is not. In a new dataset (from 119 students, collected in 2002), I demonstrate that sedation is related to negative expectancies and not to negative reinforcement. Different ways to assess all major expectancy factors are proposed.

Is depressed mood in childhood associated with an increased risk for initiation of alcohol use during early adolescence?

OBJECTIVE

Using prospective data, we tested the hypothesis that early depressed mood was associated with an increased risk for initiation of alcohol use. In addition, we examined whether these associations varied according to the youths' report that alcohol consumption occurred with or without parental permission.

METHODS

The participants for these analyses were students, ages 9 to 13 years old, participating in a longitudinal study in an urban sample of public schools (n=2311). As part of the prospective annual assessments of the students, in 1990 through 1994, data on depressive mood and alcohol use were gathered. Logistic regression models were used to assess the association between the level of baseline depressed mood in 1990 and initiation of alcohol use between 1991 through 1994 in the sample of youth at risk for new onset drinking (n=1526). Other characteristics assessed in the analyses included age, sex, race-ethnicity, alcohol use by peers, neighborhood environment, and receipt of subsidized lunch.

RESULTS

Higher level of early depressed mood was associated with an earlier and increased estimated risk of initiating alcohol use without parental permission for boys but not for girls. Depressed mood was not associated with alcohol use initiation that occurred with parental sanctions.

CONCLUSIONS

Findings from the current study support the hypothesis that among urban youth, early depressed mood influences the initiation of alcohol consumption without parental permission for boys.

Socio-environmental influences on adolescents' alcohol outcome expectancies: a prospective analysis

AIMS

To investigate the prospective influence of social influence and social bonding variables on the development of alcohol outcome expectancies among adolescents with and without drinking experience.

DESIGN

Longitudinal data from students in the control schools of a field trial designed to evaluate a school-based drug prevention program.

SETTING

A total of 19 middle schools in South Dakota, USA.

MEASUREMENTS

An alcohol outcome expectancy scale administered to 1410 students in grades 8 and 9. After using confirmatory factor analysis (CFA) to develop an expectancies measure, multiple-group (grade 8 drinkers versus grade 8 non-drinkers) path analysis was used to model 9th grade alcohol expectancies. Grade 8 social influence and bonding variables were used as predictors, controlling for grade 8 expectancies.

FINDINGS

At the bivariate level, peer and adult influences and social bonding variables were related consistently to alcohol outcome expectancies among drinkers and non-drinkers. A bivariate relationship between alcohol advertising and alcohol expectancies was found among drinkers only. In the multivariate model, greater alcohol use by important adults predicted independently increased alcohol positivity among drinkers; greater perceived approval of alcohol use by parents and peers predicted diminished perceived potency of alcohol among non-drinkers. Advertisement exposure and social bonding variables were not independent predictors of alcohol expectancies in the multivariate model.

CONCLUSIONS

These findings suggest that attempts to alter adolescents' alcohol expectancies are likely to fail unless they address the influence of immediate social models on these beliefs.

The relationship between viewing US-produced television programs and intentions to drink alcohol among a group of Norwegian adolescents

The aim of this study was to examine the influence of exposure to US-produced television programs and family rules prohibiting alcohol use on the development of normative beliefs, expectancies, and intentions to drink alcohol in the next 12 months among a group of Norwegian adolescents who reported that they had not previously consumed alcohol. Data were collected via a survey administered to 622 eighth and ninth graders enrolled at ten junior highs in southeastern Norway. To examine these relationships we tested the fit of a structural equation model which was based on the Theory of Planned Behavior (Ajzen, 1988). Data from the non-drinkers (n= 392, 63% of the respondents) were used. To control for the influence of peer drinking on behavioral intentions, our model was tested under two group conditions: (1) those subjects reporting that they have no friends who drink alcohol and (2) those subjects reporting that they have one or more friends who drink. The findings indicate that the influence of TV exposure was a significant predictor (directly) of normative beliefs, expectancies (indirectly) and intentions to drink (both directly and indirectly) only for those subjects who reported having no friends who drink. For the group with non-drinking friends, family rules constrain intentions only indirectly by influencing normative beliefs. For those with friends who drink, however, family rules have a direct (inverse) effect on intentions. It is concluded that exposure to US-produced television programs functions as a limited knowledge source only for those subjects who had little or no personal experience with alcohol while the presence of family rules have limited impact on behavioral intentions.

Measuring developmental changes in alcohol expectancies

The goal of this study was to measure shifts in alcohol expectancies from childhood into adolescence while controlling for changes in the psychometric properties of the instrument. One thousand nine hundred ninety-three 4th-grade and 1,632 9th-grade students from South Dakota rated the likelihood that 23 outcomes would result from alcohol use. These expectancies were modeled using a 2-factor confirmatory factor analysis. After differences in the psychometric properties of the instrument were controlled, the cohorts were distinguished by a large difference in Alcohol Positivity, with older participants viewing alcohol's effects more positively. Additionally, older participants displayed greater Alcohol Potency, believing that alcohol has a larger impact on all outcomes. There were also significant differences in the interpretation of the alcohol expectancies items across cohorts.

Trajectories of dynamic predictors of disorder: their meanings and implications

Developmental psychopathologists are increasingly focused on characterizing heterogeneity of trajectories of psychological disorders across the life course (e.g., developmentally limited vs. chronic forms of disorder). Although the developmental significance of trajectories has been highlighted, there has been little attention to relations between trajectories and their etiologically and clinically relevant time-varying covariates (dynamic predictors). Depending upon the functional relation between a disorder and a dynamic predictor, we expect to see different trajectories of dynamic predictors. Thus, we propose a taxonomy of trajectories of dynamic predictors of course of disorder and provide an initial investigation into its validity. Using a mixed-gender, high-risk sample of young adults followed over 7 years, we identified dynamic predictors that covary with the course of alcohol use disorder (AUD). Based on a logically derived classification to facilitate interpretation of findings, three comparison groups were examined: persons whose AUD "remitted" (n = 33), those with a chronic AUD (n = 29), and nondiagnosers (n = 274). We hypothesized seven patterns of dynamic prediction (stable vulnerability indicators, course trackers, deterioration markers, developmentally specific variables, developmental lag markers, course-referenced variables, and recovery behaviors) and found evidence for five of them. The interpretation of markers of risk for development and course of AUDs and their implications for prevention, early intervention and formal/self-change treatments are discussed.

A cognitive model of binge drinking: the influence of alcohol expectancies and drinking refusal self-efficacy

While binge drinking-episodic or irregular consumption of excessive amounts of alcohol-is recognised as a serious problem affecting our youth, to date there has been a lack of psychological theory and thus theoretically driven research into this problem. The current paper develops a cognitive model using the key constructs of alcohol expectancies (AEs) and drinking refusal self-efficacy (DRSE) to explain the acquisition and maintenance of binge drinking. It is suggested that the four combinations of the AE and DRSE can explain the four drinking styles. These are normal/social drinkers, binge drinkers, regular heavy drinkers, and problem drinkers or alcoholics. Since AE and DRSE are cognitive constructs and therefore modifiable, the cognitive model can thus facilitate the design of intervention and prevention strategies for binge drinking.

Assessment of binge drinking of alcohol in highly educated employees

This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session.

The Smoking Effects Questionnaire for adult populations. Development and psychometric properties

Outcome expectancies are central to a social learning model of smoking and of smoking cessation. The Smoking Effects Questionnaire (SEQ) was developed for use in general adult populations. Items were administered to 257 smokers and ex-smokers including worksite employees, hospital visitors, and clients entering smoking cessation treatment. Principal components analysis (PCA) found seven components with good reliability that were reduced into scales of four or five items each with internal consistencies above alpha=.80. The final measure has 33 items. The scales were divided by secondary factor analysis into three negative effect and four positive effect scales. The SEQ showed good construct and concurrent validity in comparison with measures of similar constructs and with other smoking variables. Women expected fewer negative physical effects and attributed more importance to positive stimulating effects from smoking but otherwise were comparable to men in expected effects of smoking. More dependent smokers ascribed more importance to negative physical effects and positive stimulating effects than did less dependent smokers but did not differ significantly on other expectancy domains. Both true/false scoring and importance ratings of effects produced mostly comparable results so that either scoring method could be used. Treatment implications were discussed. This brief scale is likely to be useful in a variety of research and clinical settings.

Effects of negative and positive mood phrases on priming of alcohol words in young drinkers with high and low anxiety sensitivity

This study investigated whether potential emotional cues for drinking activate alcohol concepts in young drinkers. Participants were 84 university freshmen with high or low levels of anxiety sensitivity (AS). A verbal priming task measured activation (i.e., priming) of alcohol concepts (e.g., beer) by positive and negative mood phrases. Time to read alcohol target words was the dependent measure. Negative mood phrases consistently primed alcohol targets; positive mood phrases did not. Degree of negative mood priming did not differ as a function of gender or AS. Reported tendency to drink in bad moods predicted negative mood priming in women, whereas men showed negative mood priming irrespective of their reported drinking tendency. A general association between negative mood priming and severity of alcohol problems also emerged.

Alcohol expectancies and motives in a substance abusing male treatment sample

Although prior research has demonstrated the utility of both alcohol expectancies and drinking motives in the prediction of alcohol use and problems, the specific relationship between these domains has not been examined in a clinical sample. One-hundred, forty-seven veterans on an inpatient substance abuse unit completed questionnaires measuring alcohol expectancies and alcohol motives and provided information on their alcohol consumption and related problems. Covariance structure modeling was used to test four theoretically competing models. Findings indicated that: (1) motives mediate the effects of expectancies on use and problems and expectancies do not exert an independent influence on consumption and alcohol problems and (2) contrary to past findings, alcohol use only partially mediates the relationship between enhancement motives and alcohol problems.

Psychometric evaluation of the marijuana and stimulant effect expectancy questionnaires for adolescents

Alcohol expectancies are important in the mediation and prediction of alcohol use. Expectancies for the effects of other drugs, although less well delineated, appear equally important. Therefore, development and validation of expectancy measures for drugs other than alcohol is necessary for evaluating the importance of these constructs. We examined the factor structure, reliability, and validity of the Marijuana Effect Expectancy Questionnaire (MEEQ) and the Stimulant Effect Expectancy Questionnaire (SEEQ) in clinical and community samples of adolescents as they moved into young adulthood (N=279). Confirmatory factor analyses (CFAs) supported the a priori factors, and we found good reliability for most individual scales. Temporal stability and convergent and discriminant validity of drug effect expectancies were supported in this sample of adolescents and young adults. Drug effect expectancies were associated with drug preference and drug use patterns over 2 years. Use of these measures may aid our understanding of the etiology and course of marijuana and stimulant involvement during adolescence and young adulthood.

Practice parameters for the assessment and treatment of children and adolescents with substance use disorders. American Academy of Child and Adolescent Psychiatry

These practice parameters describe the assessment and treatment of children and adolescents with substance use disorders and are based on scientific evidence regarding diagnosis and effective treatment as well as on the current state of clinical practice. Given the paucity of research on the treatment of substance use disorders in children and adolescents, many of the recommendations are drawn from the adult literature and current clinical practice. These parameters consider risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities.

Direct and indirect effects of selected risk factors in producing adverse consequences of drug use

A path analysis was performed to examine the usefulness of multiple pathway risk factors in explaining and predicting youthful alcohol, tobacco, and other drug (ATOD) misuse and its adverse consequences. The risk factors alienation, trait anger, interaction anxiety, and cognitive motivation for drinking were used as exogenous variables with earliness of onset, ATOD use, and adverse consequences of ATOD use serving as endogenous variables. Firm support emerged for both direct and indirect effects of the risk factors on both use and adverse consequences of use.

Predicting underage drinking and driving behaviors

A social-psychological model of underage drinking and driving (DUI) and riding with drinking drivers (RWDD) was tested with data from a random digit dial telephone survey of 706 16-20-year-old drivers from seven western states in the United States. Consistent with the model, a structural equations analysis indicated that DUI and RWDD were primarily predicted by (a) expectancies regarding the physical risks of DUI, (b) normative beliefs about the extent to which friends would disapprove of DUI, (c) control beliefs about the ease or difficulty of avoiding DUI and RWDD and (d) drinking. Expectancies concerning enforcement had a significant effect on RWDD, but not on DUI. Among the background and environmental variables included in the analysis, only night-time driving and age had significant direct effects on DUI and RWDD. Drinking and involvement in risky driving had indirect effects on DUI and RWDD that were mediated through expectancies and normative beliefs. Males, European Americans, Latinos, respondents who drove more frequently and respondents who were less educated held beliefs that were more favorable toward DUI and RWDD, drank more and engaged more frequently in risky driving. As a result, such individuals may be at greater risk for DUI and RWDD.

Adolescent health-threatening and health-enhancing behaviors: a study of word association and imagery

PURPOSE

To examine the ways in which perceived risks and benefits relate to health-threatening and health-enhancing behaviors by adolescents.

METHOD

The study used a word association methodology to explore adolescents' thoughts and affective feelings associated with five health-threatening behaviors (e.g., drinking beer, smoking cigarettes) and three health-enhancing behaviors (e.g., exercising, using a seat belt).

RESULTS

Each behavior elicited a mix of positive and negative associations. Health-threatening behaviors had many positive associations in common, such as having fun, social facilitation, and physiological arousal. Health-enhancing behaviors had much less commonality in their positive associations. Patterns of negative associations were not highly similar across behaviors. The content and affective tone of the associations were closely linked to participation in health-threatening behaviors and health-enhancing behaviors. Participants in an activity were far more likely than nonparticipants to associate that activity with positive outcomes, concepts, and affect and less likely to produce outcomes, concepts, and affect and less likely to produce negative associations.

CONCLUSIONS

The word association methodology provides a useful technique for exploring adolescents' cognitions and affective reactions with regard to health-related behaviors. The data provided by this method have implications for prevention and intervention programs, as well as for future research.

Early modeling of drinking behavior by Native American elementary school children playing drunk

A report of games played by elementary school children on a Native American reservation in the United States illustrates how intoxicated adult behavior is perceived as funny. Only later does one develop an awareness that the consequences of misuse can be injury, illness, and death. Prevention messages targeted at elementary school children need to provide positive alternatives to the humor in drunkenness and may need to be culturally adapted. Examples of some culturally specific approaches are discussed.

Adolescent drinking and driving: etiology and interpretation

In the adolescent population, drinking and driving is an important cause of injury, disability and premature death. A literature review of the demographics and etiology of drinking and drinking/driving reveals: 1) which subgroups of the adolescent population are more likely to drink and drink/drive; 2) where and why adolescents drink and drink/drive; 3) peer and family issues associated with adolescent drinking and drinking/driving; and 4) adolescent expectancies and perceived efficacies associated with drinking and drinking/driving. A discussion of the role of theory and the use of etiologic data in intervention research precedes an overview of several types of school-based alcohol-prevention programs and recommendations for more theory based interventions.

The effects of alcohol, expectancy, and alcohol beliefs on anxiety and self-disclosure in women: do beliefs moderate alcohol effects?

This study investigates the effects of alcohol, expectancy, and alcohol-related beliefs on self-reported anxiety and self-disclosure behavior in a social interaction situation. Seventy-two female social drinkers were assigned to eight conditions in a 2 x 2 x 2 factorial balanced-placebo design, controlling for drink content, expectancy, and beliefs. Results show that alcohol expectancy resulted in an anxiety reduction in subjects who believed that alcohol has a positive influence on social behavior, whereas expectancy had no effect in subjects with negative alcohol beliefs. Furthermore, subjects who expected alcohol were less anxious when they had positive alcohol beliefs than when they had negative beliefs, whereas beliefs made no difference in subjects who expected tonic. Our results suggest that the effect of alcohol expectancy on social anxiety in women is moderated by differences in the content of their alcohol-related beliefs. We conclude that the inconsistency in previous results about the effect of alcohol expectancy on social behavior might be explained by differences in subjects' alcohol beliefs. Finally, as neither of the three factors had any effect on self-disclosure behavior, we suggest that this behavioral measure is unrelated to self-reported anxiety.