Explaining adolescents' smoking and drinking behavior: the concept of smoker and drinker prototypes in relation to variables of the theory of planned behavior

Tracking COVID-19 vaccination expectancies and vaccination refusal in the United States

To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling - which is required when data availability is a result of behavioral choice - predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.

“Intervention Program Based on Self”: A Proposal for Improving the Addiction Prevention Program “Unplugged” through Self-Concept

The “Intervention Program based on Self” (IPSELF) project was created to address the gap between the acquisition of life skills during prevention programs and their application with a session for developing one’s self-concept included in the European program “Unplugged”. The present study evaluated its effectiveness. A total of 157 middle school students (94 girls, 63 boys, M_AGE= 12.89, SD = 0.45) from three schools in France participated in this study. The participants attended one of two programs (Unplugged/IPSELF). The effectiveness of the IPSELF add-on session was measured with the Self-Concept Clarity Scale, and the differences between the two programs was measured with the prototype willingness model. Adolescents in IPSELF rated the typical nonsmoker and cannabis nonsmoker more favorably, and the typical drinker less favorably. They felt more different from the typical smoker and drinker after participation in IPSELF. More alcohol experimenters were observed in Unplugged. The knowledge gained in IPSELF appeared to help adolescents more than that gained in Unplugged to change their smoking behavior. Furthermore, IPSELF had a more beneficial effect for girls, who felt that they had gained more control over their alcohol and cannabis use than boys, whereas Unplugged had a more positive effect on boys, who gained better control over their consumption. Moreover, the girls felt that they had gained more knowledge about the substances discussed in IPSELF than in Unplugged. We therefore recommend the use of IPSELF especially with female audiences.

The importance of prototype similarity for physical activity: Cross-sectional and longitudinal associations in a large sample of young adolescents

Objectives

Physical activity declines during adolescence. The Theory of Planned Behaviour (TPB) is a useful framework for investigating activity but leaves variance unexplained. We explored the utility of a dual‐process approach using the TPB and the Prototype Willingness Model (PWM) to investigate correlates of physical activity, and 1‐year change in physical activity, among a large sample of adolescents.

Design

A cross‐sectional and longitudinal analysis of baseline and follow‐up data from the Fit to Study cluster‐randomized trial.

Methods

A total of 9,699 secondary school pupils at baseline and 4,632 at follow‐up (mean age = 12.5 years) completed measures of past week physical activity and constructs from both behaviour‐change models, at time‐points 1 year apart. Cross‐sectional analyses used multilevel, stepwise regression models to measure the strength of associations between model constructs and physical activity, and variance in behaviour explained by PWM over and above TPB. In longitudinal analyses, change scores were calculated by subtracting follow‐up from baseline scores. Models controlling for trial treatment status measured the strength of associations between change scores, and variance explained.

Results

At baseline, after controlling for past behaviour, physically active prototype similarity had the strongest relationship with activity after the intention to be active. Change in prototype similarity had the strongest relationship with change in activity after the change in intention and attitudes. Prototype perceptions and willingness explained additional variance in behaviour.

Conclusion

A dual‐process model incorporating prototype perceptions could more usefully predict physical activity than models based on rational expectations alone. Behaviour‐change interventions promoting an active self‐image could be tested for effects on physical activity.

Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users

Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students' latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual's latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

Applicability of the Theory of Planned Behavior for Predicting Alcohol Use in Spanish Early Adolescents

According to the theory of planned behavior (TPB), intentions to perform a specific behavior are the result of attitudes, norms, and perceived control, and in turn, intentions and perceived control are the main predictors of the behavior. This study aimed to test the applicability of TPB in predicting alcohol use in normative pre-adolescents. The sample was composed of 755 Spanish adolescents aged 11 to 15 (M = 12.24; SD = 0.56), 47.1% females, from 12 state secondary schools in Spain. The results of path analysis indicate that positive attitudes towards alcohol, favorable norms towards alcohol, and offer vulnerability (perceived control) are significantly positively related to intentions to use alcohol as well as negatively related to actual behavioral control (i.e., actual strategies to avoid alcohol use). In turn, intentions to use and actual control predict higher alcohol frequency and heavy drinking. Significant indirect effects of these antecedents were found on alcohol outcomes through the mediation of intentions and actual control. The findings suggest that the validity and applicability of the TPB in normative pre-adolescents depend on the severity of alcohol use and point to a need to consider negative social influence in decision making processes in early adolescence.

Adolescents' Sexy Self-Presentation on Instagram: An Investigation of Their Posting Behavior Using a Prototype Willingness Model Perspective

Some adolescents use social media platforms, such as Instagram, for sexualized self-presentation, which includes posting images in which someone is scarcely dressed, has a sexy gaze or in which sexual willingness is suggested. These behaviors could be a first step towards sexting. Given that adolescents are highly influenced by peer perceptions, this study uses the prototype willingness model to assess how teenagers' perceptions of others could influence their posting behaviors. The study was conducted among 2626 students (n = 1530; 58.4% girls) between the ages of 14 and 21 (M = 16.14; SD = 1.02) in 10 secondary schools in the Dutch-speaking community in Belgium. The results show that older adolescents and girls were more likely to post images of themselves on Instagram. The models showed that peer norms and willingness and attitudes were significantly associated with posting intention. The perceived norms of adolescents' parents were not significantly related to the behaviors. There were also significant associations between perceived similarity, prototype favorability and the willingness to engage in sexualized self-presentation on Instagram. The implications for education and practice are discussed.

Patient Prototypes

Abstract. Despite large bodies of research examining perceptions of illnesses and perceptions of people who engage in various health behaviors, very little research has examined perceptions of people who have a specific illness. The aims of this research were to create a measure of “patient prototypes,” mental representations of the type of person who has a specific illness, and to examine their associations with other health cognitions and behaviors. Two survey studies (Study 1: N = 208 and Study 2: N = 246) assessed patient prototype favorability for three illnesses (skin cancer, Human papillomavirus (HPV), and type 2 diabetes) as well as constructs from the common-sense model and prototype willingness model. Patient prototypes for the three illnesses were distinct in terms of specific traits and overall favorability. Generally, patient prototype favorability was unrelated to illness representation dimensions in the common-sense model but was positively associated with some constructs in the prototype/willingness model. All three prototypes were positively correlated with perceived vulnerability. The skin cancer prototype was positively correlated with measures of behavioral willingness, behavioral intention, and actual health behavior (UV exposure). Limitations include the use of young adult participants who have relatively little experience with the illnesses examined. Measures of patient prototype favorability and health behaviors need to be further examined and refined. The novel construct of patient prototype favorability provides a foundation for future inquiry into the role that patient perceptions play in health behavior and the implications for the prototype/willingness model and the common-sense model.

Adolescents have unfavorable opinions of adolescents who use e-cigarettes

Introduction

While evidence suggests positive opinions of smokers are associated with tobacco use, research exploring adolescents’ opinions of e-cigarette users is nascent. We hypothesized that adolescents harbor positive opinions of e-cigarette users, and that these opinions will be more positive among adolescents willing to try or who have used e-cigarettes.

Methods

Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015–2016. Analyses examined whether these variables were associated with willingness to try and use (ever vs. never) of e-cigarettes.

Results

The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users. Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users. Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users (all p < .01). Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users. Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users (all p < .01).

Conclusions

Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents’ negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.

Can attitudes about smoking impact cigarette cravings?

Cigarette cravings, especially those in response to environmental stressors and other smoking-related triggers (e.g., passing by a favorite smoking spot), are important contributors to smoking behavior and relapse. Previous studies have demonstrated significant individual differences in such cravings. This study explores the possibility that attitudes about smoking can influence the experience of cigarette craving. Consistent with classical theories of the links between cognition and motivation, we predicted that smokers who exhibit more favorable attitudes towards smoking would have greater cravings. Daily smokers (n=103, mean age=41.8years, 33% female) were instructed to imagine smoking, stress, and neutral scenarios. Cravings were measured prior to and after each exposure. Participants also completed an abridged version of the Smoking Consequence Questionnaire (SCQ) that had them rate the: 1) desirability and 2) likelihood, for eighteen separate negative smoking consequences (e.g., "The more I smoke, the more I risk my health", "People will think less of me if they see me smoking"). Findings revealed that favorable attitudes about the consequences of smoking, as measured by the SCQ-desirability index, significantly predicted cigarette cravings. Findings suggest that individual attitudes toward smoking may play an important role in better understanding cigarette cravings, which may ultimately help identify targets for more efficient and effective cognitive/attitude-based interventions for smoking cessation.

Does Alcohol Catch the Eye? Investigating Young Adults' Attention to Alcohol Consumption

Many studies on young adults' motivations for drinking overlook the symbolic aspects of alcohol use. However, research indicates that young adults' alcohol consumption is also driven by signaling motivations. Although the interest of a receiver is a necessary prerequisite of a signal, no previous studies have verified whether drinking behavior indeed attracts young adults' attention. Therefore, we conducted two studies. A two-part eye-tracking study ( N1 = 135, N2 = 140) showed that both young men and young women pay special visual attention to male and female drinking behavior. Additionally, a recall experiment ( N = 321) confirmed that observed male and female drinking is better remembered than observed nonsignaling, functional behavior. Moreover, alcoholic beverages also receive special attention, as they were recalled better than other functional products, and also nonalcoholic drinks similar in color and shape. In summary, the experiments clearly showed that male and female drinking behavior can be used as a signal, as both behaviors clearly function as an attention-attracting cue. Additionally, as alcoholic beverages draw more attention than nonalcoholic drinks, this attention is clearly linked to the alcohol element of the drinking behavior.

Trajectories of Adolescent Alcohol Use: The Effect of Individual and Social Risk Factors by Race

This study examined racial differences across African American, Hispanic, and White participants in the impact that individualand social risk factorshave on drinking behaviortrajectories.Data from the National Longitudinal Study of Adolescent Health was usedfrom 7-9^th graders (N = 4,372).Participants reported on frequency of drinking across the four waves and risk factors at wave 1. Growth mixture modeling revealed four trajectories for alcohol use that includedAbstainers, Early Starters, Late Starters, and De-Escalators. Social and individual indicators of risk were differently predictive of group membership to the problematic drinking trajectories. Differences across racial groups suggested that a lack of future orientation may be a salient risk factor for African Americanand Hispanicyouth's alcohol use, and peer alcohol use may be a salient risk factor for White youth's alcohol use. The findings of this study suggest that there may be individual differences in risk factors that provide insight for prevention efforts.

Drinking High Amounts of Alcohol as a Short-Term Mating Strategy: The Impact of Short-Term Mating Motivations on Young Adults' Drinking Behavior

Previous research indicates that drinking large quantities of alcohol could function as a short-term mating strategy for young adults in mating situations. However, no study investigated whether this is actually the case. Therefore, in this article, the link between short-term mating motivations and drinking high amounts of alcohol is tested. First, a survey study ( N = 345) confirmed that young adults who engage in binge drinking are more short-term oriented in their mating strategy than young adults who never engage in binge drinking. Also, the more short-term-oriented young adults were in their mating strategy, the more often binge drinking behavior was conducted. In addition, an experimental study ( N = 229) empirically verified that short-term mating motivations increase young adults' drinking behavior, more so than long-term mating motivations. Results of the experiment clearly showed that young men and young women are triggered to drink more alcoholic beverages in a short-term mating situation compared to a long-term mating situation. Furthermore, the mating situation also affected young adults' perception of drinking behavior. Young adults in a short-term mating context perceived a higher amount of alcoholic beverages as heavy drinking compared to peers in a long-term mating context. These findings confirm that a high alcohol consumption functions as a short-term mating strategy for both young men and young women. Insights gained from this article might be of interest to institutions aimed at targeting youth alcohol (ab)use.

The social image of drinking - mass media campaigns may inadvertently increase binge drinking

Mass media campaigns that promote responsible drinking are rarely tested for their usefulness in reducing heavy alcohol consumption. Existing campaigns that appeal to responsible drinking while simultaneously displaying young people in social drinking situations may even have paradoxical effects. To examine such possible effects, we drew on a real-world media campaign, which we systematically modified on the basis of recent prototype research. We pilot tested questionnaires (using n = 41 participants), developed two different sets of posters in the style of an existing campaign (n = 39) and investigated their effectiveness (n = 102). In the main study, young men were randomly assigned to one of three conditions: sociable or unsociable binge drinker prototype condition or a control group. Outcome variables were intention, behavioural willingness, attitude, subjective norm, self-efficacy, prototype evaluation and prototype similarity with respect to binge drinking. Binge drinking as a habit was included to control for the fact that habitual drinking in social situations is hard to overcome and poses a particular challenge to interventions. The manipulation check showed that the experimental variation (sociable vs. unsociable drinker prototype condition) was successful. Results of the main study showed that the sociable drinker prototype condition resulted in a higher willingness and - for those with less of a habit - a higher intention to binge drink the next weekend. The unsociable drinker prototype condition had no effects. The results imply that the social components of mass media campaigns might inadvertently exacerbate binge drinking in young men. We therefore advocate against campaigns including aspects of alcohol consumption that might be positively associated with drinker prototype perception. Finally, we provide suggestions for future research.

Examining daily variability in willingness to drink in relation to underage young adult alcohol use

A key component of the Prototype Willingness Model is willingness, which reflects an openness to opportunity to perform a behavior in situations that are conducive to that behavior. Willingness has traditionally been tested using global, hypothetical assessments, and has not been examined at the daily level. We expected to find within-person variability in willingness to drink, such that on days with greater willingness, individuals would report greater drinking. A national sample (N=288) of young adults aged 18 to 20 (31.60% female) completed a Web-based survey that was comprised of measures of drinking and sexual behavior, including the Timeline Follow-Back (Sobell & Sobell, 1992). Findings show daily variability in willingness to drink (ICC=0.54), which suggests that there are substantial differences from day-to-day in this drinking-related cognition. Participants drank more on days when individuals also reported feeling more willing to drink than their own average level across the two weeks. Daily process level mechanisms allow greater insight into factors contributing to increased risk in-the-moment, which may point to targets for interventions aimed at improving adolescents' and young adults' abilities to make healthier choices in moments when they may be at greater risk for engaging in risky behaviors.

Do students use contextual protective behaviors to reduce alcohol-related sexual risk? Examination of a dual-process decision-making model

Recent studies suggest drinking protective behaviors (DPBs) and contextual protective behaviors (CPBs) can uniquely reduce alcohol-related sexual risk in college students. Few studies have examined CPBs independently, and even fewer have utilized theory to examine modifiable psychosocial predictors of students' decisions to use CPBs. The current study used a prospective design to examine (a) rational and reactive pathways and psychosocial constructs predictive of CPB use and (b) how gender might moderate these influences in a sample of college students. Students (n = 508) completed Web-based baseline (mid-Spring semester) and 1- and 6-month follow-up assessments of CPB use; psychosocial constructs (expectancies, normative beliefs, attitudes, and self-concept); and rational and reactive pathways (intentions and willingness). Regression was used to examine rational and reactive influences as proximal predictors of CPB use at the 6-month follow-up. Subsequent path analyses examined the effects of psychosocial constructs, as distal predictors of CPB use, mediated through the rational and reactive pathways. Both rational (intentions to use CPB) and reactive (willingness to use CPB) influences were significantly associated with increased CPB use. The examined distal predictors were found to effect CPB use differentially through the rational and reactive pathways. Gender did not significantly moderate any relationships within in the model. Findings suggest potential entry points for increasing CPB use that include both rational and reactive pathways. Overall, this study demonstrates the mechanisms underlying how to increase the use of CPBs in programs designed to reduce alcohol-related sexual consequences and victimization.

How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis

This study aimed to quantify correlations between theory of planned behaviour (TPB) variables and (i) intentions to consume alcohol and (ii) alcohol consumption. Systematic literature searches identified 40 eligible studies that were meta-analysed. Three moderator analyses were conducted: pattern of consumption, gender of participants and age of participants. Across studies, intentions had the strongest relationship with attitudes (r₊ = .62), followed by subjective norms (r₊ = .47) and perceived behavioural control (PBC; r₊ = .31). Self-efficacy (SE) had a stronger relationship with intentions (r₊ = .48) compared with perceived control (PC; r₊ = −.10). Intention had the strongest relationship with alcohol consumption (r₊ = .54), followed by SE (r₊ = .41). In contrast, PBC and PC had negative relationships with alcohol consumption (r₊ = −.05 and −.13, respectively). All moderators affected TPB relationships. Patterns of consumption with clear definitions had stronger TPB relations, females reported stronger attitude–intention relations than males, and adults reported stronger attitude–intention and SE–intention relations than adolescents. Recommendations for future research include targeting attitudes and intentions in interventions to reduce alcohol consumption, using clear definitions of alcohol consumption in TPB items to improve prediction and assessing SE when investigating risk behaviours.

It takes a mother to practise breastfeeding: Women's perceptions of breastfeeding during the period of intention

BACKGROUND

In the Netherlands, 81% of mothers initiate breastfeeding. After one month the percentage of mothers still breastfeeding drops, despite positive intentions. Little is known about women's perceptions of breastfeeding during the period of intention.

AIM

This qualitative study aimed to gain insight into these perceptions among first-time mothers from middle and high socioeconomic backgrounds in the northern part of the Netherlands.

METHODS

We used the theory of planned behaviour as the deductive model. In 2008, 16 in-depth interviews were conducted with 8 mothers who intended to breastfeed. The interviews were conducted at two time points (prepartum and postpartum) and covered the same period (that is, from the time when the intention was formed until after childbirth). The interviews were transcribed verbatim and analysed using grounded theory.

FINDINGS

Five inductive themes were identified: combining breastfeeding with work, learning about breastfeeding, making arrangements for childbirth, reflecting on the intention, and becoming a mother. During the extended period of intention, the women anticipated breastfeeding, but were cautious in expressing their intentions. They felt that the experience of becoming a mother would be critical to their breastfeeding outcomes.

CONCLUSION

The theory of planned behaviour has been widely used in breastfeeding research. However, the period of intention is relatively long for breastfeeding. Rather than recommending an intensification of antenatal breastfeeding education, recommendations must incorporate the awareness that practising breastfeeding should not be considered the continuous outcome of the intention to do so - it takes a mother to practise breastfeeding.

Social norms in the development of adolescent substance use: a longitudinal analysis of the International Youth Development Study

Identifying specific aspects of peer social norms that influence adolescent substance use may assist international prevention efforts. This study examines two aggregated measures of social norms in the school setting and their predictive association with substance (alcohol, tobacco and marijuana) use 2 years later in a large cross-national population-based cohort of adolescents. The primary hypothesis is that in Grade 7 both "injunctive" school norms (where students associate substance use with "coolness") and "descriptive" norms (where student substance use is common) will predict Grade 9 substance use. Data come from the International Youth Development Study, including 2,248 students (51.2% female) in the US and Australia attending 121 schools in Grade 7. Independent variables included injunctive norms (aggregating measures of school-wide coolness ratings of each substance use) and descriptive norms (aggregating the prevalence of school substance use) in Grade 7. Dependent variables included binge drinking and current use of alcohol, tobacco and marijuana in Grade 9. Associations between each type of school-wide social norm and substance use behaviors in Grade 9 were tested using multilevel logistic regression, adjusting for covariates. In unadjusted models, both injunctive and descriptive norms each significantly predicted subsequent substance use. In fully adjusted models, injunctive norms were no longer significantly associated with Grade 9 use, but descriptive norms remained significantly associated with tobacco and marijuana use in the expected direction. The findings identify descriptive social norms in the school context as a particularly important area to address in adolescent substance use prevention efforts.

Predictors of non- hookah smoking among high-school students based on prototype/willingness model

BACKGROUND

The aim of the study was to determine predictors of refraining from hookah smoking among high-school students in Bandar Abbas, southern Iran based on Prototype/Willingness model.

METHODS

This cross- sectional with analytic approach was performed on 240 high-school students selected by a cluster random sampling. The data of demographic and Prototype-Willingness Model constructs were acquired via a self-administrated questionnaire. Data were analyzed by mean, frequency, correlation, liner and logistic regression statistical tests.

RESULTS

Statistically significant determinants of the intention to refrain from hookah smoking were subjective norms, willingness, and attitude. Regression model indicated that the three items together explained 46.9% of the non-smoking hookah intention variance. Attitude and subjective norms predicted 36.0% of the non-smoking hookah intention variance. There was a significant relationship between the participants' negative prototype about the hookah smokers and the willingness to avoid from hookah smoking (P=0.002). Also willingness predicted non-smoking hookah better than the intention (P<0.001).

CONCLUSION

Deigning intervention to increase negative prototype about the hookah smokers and reducing situations and conditions which facilitate hookah smoking, such as easy access to tobacco products in the cafés, beaches can be useful results among adolescents to hookah smoking prevention.

Perceptions of organ donors and willingness to donate organs upon death: a test of the prototype/willingness model

Understanding people's organ donation decisions may narrow the gap between organ supply and demand. In two studies, participants who had not recorded their posthumous organ donation decision (Study 1, N = 210; Study 2, N = 307) completed items assessing prototype/willingness model (PWM; attitude, subjective norm, donor prototype favorability and similarity, willingness) constructs. Attitude, subjective norm, and prototype similarity predicted willingness to donate. Prototype favorability and a Prototype Favorability × Similarity interaction predicted willingness (Study 2). These findings provide support for the PWM in altruistic health contexts, highlighting the importance of people's perceptions about organ donors in their donation decisions.

Perceptions of Organ Donors and Willingness to Donate Organs Upon Death: A Test of the Prototype/Willingness Model

Understanding people's organ donation decisions may narrow the gap between organ supply and demand. In two studies, participants who had not recorded their posthumous organ donation decision (Study 1 N = 210; Study 2 N = 307) completed items assessing Prototype/Willingness Model (PWM) (attitude, subjective norm, donor prototype favorability and similarity, willingness) constructs. Attitude, subjective norm, and prototype similarity predicted willingness to donate. Prototype favorability and a prototype favorability x similarity interaction predicted willingness (Study 2). These findings provide support for the PWM in altruistic health contexts, highlighting the importance of people's perceptions about organ donors in their donation decisions.

How to reduce the latent social risk of disease: the determinants of vaccination against rabies in Taiwan

To control the latent social risk of disease, the government usually spreads accurate information and attempts to improve the public’s attitude toward adopting prevention. However, these methods with the Knowledge, Attitudes, and Practices (KAP) model do not always work. Therefore, we used the theory of planned behavior (TPB) to understand dog owners’ behavior and distinguished the knowledge effect as objective knowledge (OK) and subjective knowledge (SK). A total of 310 dog owners completed a questionnaire based on our model. We employed structural equation modeling to verify the structural relationships and found three main results. First, our model was fit, and each path was significant. People with better attitudes, stronger subjective norms, and more perceptive behavioral control have stronger behavioral intention. Second, perceived behavioral control, not attitude, was the best predictive index in this model. Finally, on perceived behavioral control, subjective knowledge showed more influence than objective knowledge. We successfully extended TPB to explain the behavioral intention of dog owners and presented more workable recommendations. To reduce the latent social risk of disease, the government should not only address dog owners’ attitudes, but also their subjective norms and perceptive behavioral control. Indeed, perceptive behavioral control and SK showed the most influence in this model. It is implied that the self-efficacy of dog owners is the most important factor in such a behavior. Therefore, the government should focus on enhancing dog owners’ self-efficacy first while devoted to prevention activities.

A qualitative exploration of attitudes towards alcohol, and the role of parents and peers of two alcohol-attitude-based segments of the adolescent population

Background

An earlier study using social marketing and audience segmentation distinguished five segments of Dutch adolescents aged 12–18 years based on their attitudes towards alcohol. The present, qualitative study focuses on two of these five segments (‘ordinaries’ and ‘ordinary sobers’) and explores the attitudes of these two segments towards alcohol, and the role of parents and peers in their alcohol use in more detail.

Methods

This qualitative study was conducted in the province of North-Brabant, the Netherlands. With a 28-item questionnaire, segments of adolescents were identified. From the ordinaries and ordinary sobers who were willing to participate in a focus group, 55 adolescents (30 ordinaries and 25 ordinary sobers) were selected and invited to participate. Finally, six focus groups were conducted with 12–17 year olds, i.e., three interviews with 17 ordinaries and three interviews with 20 ordinary sobers at three different high schools.

Results

The ordinaries thought that drinking alcohol was fun and relaxing. Curiosity was an important factor in starting to drink alcohol. Peer pressure played a role, e.g., it was difficult not to drink when peers were drinking. Most parents advised their child to drink a small amount only. The attitude of ordinary sobers towards alcohol was that drinking alcohol was stupid; moreover, they did not feel the need to drink. Most parents set strict rules and prohibited the use of alcohol before the age of 16.

Conclusions

Qualitative insight into the attitudes towards alcohol and the role played by parents and peers, revealed differences between ordinaries and ordinary sobers. Based on these differences and on health education theories, starting points for the development of interventions, for both parents and adolescents, are formulated. Important starting points for interventions targeting ordinaries are reducing perceived peer pressure and learning to make one’s own choices. For the ordinary sobers, an important starting point includes enabling them to express to others that they do not feel the need to drink alcohol. Starting points for parents include setting strict rules, restricting alcohol availability at home and monitoring their child’s alcohol use.

Parental co-viewing and susceptibility for smoking and drinking in adolescents: an experimental pilot study

BACKGROUND AND OBJECTIVES

The current pilot study is the first experiment to examine whether parents are able to diminish the adverse influences of smoking and drinking depicted in movies through co-viewing.

METHODS

For this study, 99 adolescents (M = 12.82 years old; SD = .95; 38.8% boys) watched the 3D version of Titanic in the cinema. Through randomization, adolescents were invited to come with either a parent or a friend. After watching the movie, adolescents filled out a questionnaire that assessed their susceptibility for smoking and drinking and their social images concerning these behaviors.

RESULTS

The findings revealed that adolescents who co-viewed the movie with their parents, compared to with their friends, were at the same or an even higher risk for future smoking or drinking after watching the movie. The findings also indicated that only a few parents communicated about smoking and drinking while watching the movie.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Simply co-viewing might not be an effective way for parents to blunt the effect of smoking and drinking in movies. In addition to ensuring more caution when advising parents to simply co-view movies, the present findings encourage additional research on the impact of instructive mediation strategies.

[Attitudes towards consumption and non-consumption of alcohol among high school students in Mexico]

The objective of this study was to identify differences in high school students' attitudes towards the consumption or non-consumption of alcohol using the theory of planned behavior. This was a qualitative, descriptive, cross-sectional study that included a sample of 131 students. We found that 74% of students had consumed alcohol, and 18.3% exhibited a harmful level of consumption. We also found that behavioral beliefs towards consumption were higher among alcohol consumers (mean=29.32, median=27.50) than those who did not consume alcohol. Moreover, positive beliefs towards consumption were higher among alcohol consumers (mean=17.72, median=9.52) than non-consumers, which demonstrates a need for preventative programs to strengthen adolescents' beliefs concerning alcohol as well as protective factors and healthy lifestyles.

Biofortified cassava with pro-vitamin A is sensory and culturally acceptable for consumption by primary school children in Kenya

Background

Biofortification of cassava with pro-vitamin A can potentially reduce vitamin A deficiency in low-income countries. However, little is known about consumer acceptance of this deep yellow variety of cassava compared to the commonly available white varieties. We aimed to determine the sensory and cultural acceptability of the consumption of pro-vitamin A rich cassava in order to identify key factors predicting the intention to consume pro-vitamin A rich cassava by families with school-aged children in Eastern Kenya.

Methods

Sensory acceptability was measured by replicated discrimination tests and paired preference tests among 30 children (7–12 yr) and 30 caretakers (18–45 yr) in three primary schools. Cultural acceptability was assessed with a questionnaire based on the combined model of The Theory of Planned Behavior and The Health Belief Model in one primary school among 140 caretakers of children aged 6 to 12 years. Correlations and multivariate analyses were used to determine associations between summed scores for model constructs.

Results

Caretakers and children perceived a significant difference in taste between white and pro-vitamin A rich cassava. Both preferred pro-vitamin A rich cassava over white cassava because of its soft texture, sweet taste and attractive color. Knowledge about pro-vitamin A rich cassava and it's relation to health (‘Knowledge’ ((β = 0.29, P = <.01)) was a strong predictor of ‘Health behavior identity’. Worries related to bitter taste and color (‘Perceived barriers 1’ (β = −0.21, P = .02)), the belief of the caretaker about having control to prepare cassava (‘Control beliefs’ (β = 0.18, P = .02)) and activities like information sessions about pro-vitamin A rich cassava and recommendations from health workers (‘Cues to action’(β = 0.51, P = <.01)) were the best predictors of intention to consume pro-vitamin A rich cassava.

Conclusions

Pro-vitamin A rich cassava is well accepted by school children in our study population.

Clustering of drinker prototype characteristics: what characterizes the typical drinker?

Prototypes (social images) have been shown to influence behaviour, which is likely to depend on the type of image. Prototype evaluation is based on (un)desirable characteristics related to that image. By an elicitation procedure we examined which adjectives are attributed to specific drinker prototypes. In total 149 young Dutch adults (18-25 years of age) provided adjectives for five drinker prototypes: abstainer, moderate drinker, heavy drinker, tipsy, and drunk person. Twenty-three unique adjectives were found. Multilevel latent class cluster analysis revealed six adjective clusters, each with unique and minor overlapping adjectives: 'negative, excessive drinker,' 'moderate, responsible drinker,' 'funny tipsy drinker,' 'determined abstainer cluster,' 'uncontrolled excessive drinker,' and 'elated tipsy cluster.' In addition, four respondent classes were identified. Respondent classes showed differences in their focus on specific adjective clusters. Classes could be labelled 'focus-on-control class,' 'focus-on-hedonism class,' 'contrasting-extremes-prototypes class,' and 'focus-on-elation class.' Respondent classes differed in gender, educational level and drinking behaviour. The results underscore the importance to differentiate between various prototypes and in prototype adjectives among young adults: subgroup differences in prototype salience and relevance are possibly due to differences in adjective labelling. The results provide insights into explaining differences in drinking behaviour and could potentially be used to target and tailor interventions aimed at lowering alcohol consumption among young adults via prototype alteration.

Smoker identity and smoking escalation among adolescents

OBJECTIVE

We investigated whether there is a positive, unique relation between smoker identity and smoking escalation.

METHODS

Adolescents from the Chicago area (n = 1263) completed paper-and-pencil questionnaires and in-person interviews at baseline, 6 months, 15 months, and 24 months of a longitudinal study. Smoking behavior, smoker identity, nicotine dependence, smoking expectancies, smoking motives, and novelty seeking were assessed.

RESULTS

There was a unique relation between smoker identity and smoking escalation. The more that adolescents thought smoking was a defining aspect of who they were, the more likely their smoking escalated.

CONCLUSIONS

The findings suggest that smoker identity could be targeted for preventing escalation. Research on its development is needed.

Stereotypic information about drinkers and students' observed alcohol intake: an experimental study on prototype-behavior relations in males and females in a naturalistic drinking context

BACKGROUND

Cross-sectional and longitudinal research has shown that favorable drinker prototypes (i.e., perceptions about the typical drinker) are related to higher levels of alcohol consumption in adolescents and college students. So far, few studies have experimentally tested the causality of this relationship and it is not clear what type of manipulation affects drinker prototypes and drinking levels.

METHODS

In an experimental 1-factor design with two levels, we tested the short-term effects of exposing students to either positive or negative stereotypic information about drinkers on their drinker prototypes and actual drinking behaviors. We exposed 192 male and female college students to positive drinker prototype information (drinkers in general were presented as being attractive, sociable and successful), or to negative information (unattractive, unsociable and unsuccessful). Subsequently, participants' levels of alcohol consumption were observed unobtrusively while they were interacting with peers in a naturalistic drinking context, namely a bar lab.

RESULTS

Participants exposed to positive stereotypic information about drinkers reported more favorable drinker prototypes than participants exposed to negative stereotypic information. Multilevel analyses revealed that men's subsequent alcohol consumption in the bar lab was higher in the positive prototype condition than in the negative prototype condition. For women, no prototype effects on alcohol use were found.

CONCLUSIONS

These findings underline that drinker prototypes affect actual alcohol use in men and suggest that changing perceptions of drinkers may be a useful tool in alcohol prevention programs.

Influence of smoking cues in movies on children's beliefs about smoking

OBJECTIVE

Experimental research has revealed that short exposure to movie smoking affects beliefs about smoking in adolescents. In this study, we tested that association in children.

METHODS

In 2 experiments, participants were exposed to either a cartoon or family-oriented movie and randomly assigned to 20-minute segments with or without smoking characters. Data collection took place at elementary schools. A total of 101 children (8-10 years; 47.5% boys) were exposed to a cartoon, and in a second experiment, 105 children (8-11 years; 56.2% boys) were exposed to a family-oriented movie. Beliefs about smoking (assessed by questionnaire) and implicit associations toward smoking (single target implicit association task) were assessed after watching the movie.

RESULTS

The majority of both samples of children viewed smoking unfavorably. Exposure to movie smoking had no effect on implicit associations toward smoking when experiments were analyzed separately or if the results were combined. For smoking beliefs, effects were again small and only statistically significant for social norms regarding smoking.

CONCLUSIONS

Short-term exposure to smoking in cartoon and family-oriented movies had little immediate impact on beliefs about smoking in preadolescent children, but a significant cumulative impact on norms cannot be ruled out.

Predicting resistance to health education messages for cannabis use: The role of rebelliousness, autic mastery, health value and ethnicity

The prevalent use of cannabis by adolescents and young adults, combined with the common misconception that smoking cannabis is relatively harmless, warrants the exploration of factors influencing resistance to health education messages about cannabis use. This investigation did so within a Reversal Theory framework. One hundred and thirteen undergraduate students responded to an informative leaflet detailing the health effects of smoking cannabis. The most significant independent predictor of message resistance was frequency of cannabis use, followed by proactive rebelliousness, autic mastery, health value and ethnicity. These findings have implications for the development, design and targeting of cannabis health education programmes.

HealthMpowerment.org: development of a theory-based HIV/STI website for young black MSM

Black men who have sex with men (BMSM) are disproportionately affected by the HIV epidemic, yet few prevention interventions have been developed specifically for them. Recent studies suggest that the Internet is a promising intervention delivery avenue. We describe results from our formative work in developing a theory-based online HIV/STI prevention intervention for young BMSM including focus groups, semistructured interviews, and usability testing. The Intervention, HealthMpowerment.org , was created based on the Institute of Medicine's integrated model of behavior change with extensive input from young BMSM. Key interactive Web site features include live chats, quizzes, personalized health and "hook-up/sex" journals, and decision support tools for assessing risk behaviors. Creating an interactive HIV/sexually transmitted infection web site for BMSM was a complex process requiring many adjustments based on iterative feedback throughout all development stages. Preliminary satisfaction, content acceptability, and usability findings support the use of the Internet to deliver risk reduction messages to young BMSM.

Theory of planned behavior and smoking: meta-analysis and SEM model

To examine if the theory of planned behavior (TPB) predicts smoking behavior, 35 data sets (N = 267,977) have been synthesized, containing 219 effect sizes between the model variables, using a meta-analytic structural equation modeling approach (MASEM). Consistent with the TPB's predictions, 1) smoking behavior was related to smoking intentions (weighted mean r = 0.30), 2) intentions were based on attitudes (weighted mean r = 0.16), and subjective norms (weighted mean r = 0.20). Consistent with TPB's hypotheses, perceived behavioral control was related to smoking intentions (weighted mean r = -0.24) and behaviors (weighted mean r = -0.20) and it contributes significantly to cigarette consumption. The strength of the associations, however, was influenced by the characteristics of the studies and participants.

Young adults’ images of abstaining and drinking: Prototype dimensions, correlates and assessment methods

This research investigated contents of actor and abstainer prototypes with regard to young adults’ social drinking combining quantitative and qualitative approaches (adjective ratings, N = 300; open answers, N = 90). Exploratory and confirmatory factor analyses yielded two factors (sociability/hedonism, responsibility) in both prototypes, confirmed by qualitative data. Given the importance for intention and willingness to drink alcohol, interventions should focus on the factor ‘sociability/hedonism’ of the actor and the abstainer prototype to reduce heavy drinking; addressing ‘responsibility’ may be ineffective. Participants’ evaluations appeared to be less prone to mean tendencies subsequent to open answers compared with adjective scales.

Young adults' social drinking as explained by an augmented theory of planned behaviour: the roles of prototypes, willingness, and gender

OBJECTIVE

This study focused on young adults' alcohol consumption in social contexts. A dual-process model (including reasoned action and social reaction) was applied by combining the theory of planned behaviour (TPB) and the prototype/willingness model. A key question was whether willingness and actor and abstainer prototype variables would augment the TPB by increasing explained variance.

DESIGN

Participants completed questionnaires prior to spending an evening socializing over the weekend (Time 1). Behavioural data were obtained by telephone interviews a few days after the social drinking occasion (Time 2).

METHOD

N=300 people (mean age 25 years) took part in the study. The outcome measure of pure alcohol in grams was calculated based on participants' reports about their consumed drinks. Multigroup path analyses were conducted because of sex differences on behavioural and psychological variables.

RESULTS

The TPB explained 35% of the variance in men's and 41% in women's alcohol consumption. Augmentation with prototype perception and willingness contributed significantly to the prediction of intention (DeltaR(2)=.07) and alcohol consumption for men (DeltaR(2)=.14). A significant interaction implied that willingness led to heavy drinking particularly among those men who made negative evaluations of the abstainer prototype.

CONCLUSION

Women's alcohol consumption is explained by TPB variables via a more controlled reasoned-action path only, whereas additional processes (e.g., pursuing the actor image intentionally, rejecting the abstainer image more intuitively) are important for men. The moderating role of gender is discussed in light of traditional gender roles and recent trends in alcohol consumption.

Cool and independent or foolish and undisciplined? Adolescents' prototypes of (un)healthy eaters and their association with eating behaviour

PURPOSE

The Prototype/Willingness model states that adolescents' willingness to engage in health-related behaviours is determined by the favourability of prototypes of persons engaging in this behaviour. The objective of the present study is to systematically investigate the content and evaluation of adolescents' prototypes of (un)healthy eaters and examine their associations with eating behaviour.

METHODS

Four studies (including a pilot study) were conducted that addressed the salience (N=79), the characteristics (N=287), and the evaluation (N=167) of eater prototypes, and their association with eating behaviour (N=97), respectively.

RESULTS

These studies revealed that (1) adolescents hold salient and distinct images of typical (un)healthy eaters; (2) the healthy eater prototype mostly consists of positive traits whereas the unhealthy eater prototype reflects mostly negative traits; (3) eater-specific prototypes are distinct from generic risk prototypes and unrelated to age, bodyweight, and social desirability; and (4) unhealthy eater prototypes are significantly associated with unhealthy eating behaviour.

CONCLUSION

Adolescents hold relatively unfavourable social images of unhealthy eaters and relatively favourable images of healthy eaters. Only unhealthy eater prototypes are associated with actual food consumption, suggesting that addressing unhealthy eater prototypes may be an important and novel ingredient of interventions aimed at changing adolescents' unhealthy eating habits.

Measuring Rebelliousness and Predicting Health Behaviour and Outcomes

The Social Reactivity Scale is a questionnaire measure of individual differences in rebelliousness. The associations between rebelliousness, health behaviours and health outcomes were examined in two Dutch samples by means of cross-sectional survey data. We found moderate support for the reliability and construct validity of the scale. Findings were suggestive of rebelliousness, first, being associated with low control beliefs, second, being related to hostility and, third, also heightening the risk of engaging in unhealthy behaviours and that of poor health (perhaps through deliberately rejecting health education messages). Findings thus contribute to the ongoing emergence of an empirically viable theoretical construct.

Using the Prototype/Willingness model to predict smoking behaviour among Norwegian adolescents

This paper examines cognitive antecedents of non-smoking among adolescents who reported smoking less than 1-2 times a week, and reported non-smoking intentions and willingness, in the framework of the Prototype/Willingness model. Two waves of data were obtained from a nation-wide sample of 760 Norwegian adolescents who responded to a school-based survey on smoking. Structural equation modelling was used to evaluate the predictive power of the social reaction pathway (prototype and willingness) of the P/W model, and in addition, the constructs from the Theory of Reasoned Action (subjective norm, attitude and intention). Results demonstrated the unique importance of the social reaction path when examining smoking behaviour among non-smoking adolescents. Implications of the findings and possible applications are discussed.

The effect of early cognitions on cigarette and alcohol use during adolescence

The present study predicts cigarette and alcohol use in adolescence from the development of children's cognitions in the elementary years. Using latent growth modeling, the authors examined a model using data from 712 participants in the Oregon Youth Substance Use Project, who were in the 2nd through 5th grade at the 1st assessment and followed for 6 annual or semiannual assessments over 7 years. Growth in children's prototypes and subjective norms in the elementary years (Times 1 through 4) were related to their substance use in adolescence (Time 6) through their willingness and intentions (Time 5) to smoke and drink. Across the sample, for both substances, the intercept and slope of prototypes were either indirectly related to use through willingness or directly related to use. Both the intercept and slope of subjective norms were indirectly related to use of both substances through both willingness and intentions and directly related to cigarette use. Results suggest that elementary children have measurable cognitions regarding substance use that develop during the elementary years and predict use later in adolescence. These findings emphasize the need for prevention programs targeted at changing children's social images of substance users and encouraging more accurate perceptions of peers' use.

The theory of planned behavior and binge drinking: assessing the impact of binge drinker prototypes

The present study assessed the value of including prototype perceptions within the theory of planned behavior (TPB) when predicting young people's binge drinking intentions and behavior. Undergraduate students (N=94) completed questionnaires assessing the main constructs of the TPB as well as measures of prototype evaluation and prototype similarity. Binge drinking behavior was assessed at one-week follow-up (N=79). The TPB explained 58% of the variance in binge drinking intentions and 22% of the variance in binge drinking at one-week follow-up. The prototype perception measures explained additional variance in both binge drinking intentions (DeltaR(2)=.04) and behavior (DeltaR(2)=.09), although only prototype similarity emerged as a significant predictor. In addition, a significant interaction was found between prototype similarity and subjective norm in relation to the prediction of binge drinking behavior, suggesting that the perception of supportive norms may enhance the impact of prototype perceptions on health-risk behavior. The implications of the findings for interventions to encourage more appropriate drinking behavior are outlined.

Substance use among American Indian youth in an Eastern city

This study represents one of the first efforts to examine substance use among American Indian (AI) youth in an Eastern city. As part of a school-based study in metropolitan Columbus, Ohio, 596 self-identified AI youth (grades 6-12) completed surveys describing their use of alcohol, cigarettes, smokeless tobacco, marijuana and inhalants. Net of gender, grade and family structure, AI youth were more likely than their white peers to regularly use most substances while overall prevalence resembled estimates from studies of urban AI youth in the Western United States. These findings highlight the complex interactions of geography, identity and risk behavior among ethnic minority adolescents.

Utility of the theory of reasoned action and theory of planned behavior for predicting Chinese adolescent smoking

One third of smokers worldwide live in China. Identifying predictors of smoking is important for prevention program development. This study explored whether the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) predict adolescent smoking in China. Data were obtained from 14,434 middle and high school students (48.6% boys, 51.4% girls) in seven geographically varied cities in China. TRA and TPB were tested by multilevel mediation modeling, and compared by multilevel analyses and likelihood ratio tests. Perceived behavioral control was tested as a main effect in TPB and a moderation effect in TRA. The mediation effects of smoking intention were supported in both models (p<0.001). TPB accounted for significantly more variance than TRA (p<0.001). Perceived behavioral control significantly interacted with attitudes and social norms in TRA (p<0.001). Therefore, TRA and TPB are applicable to China to predict adolescent smoking. TPB is superior to TRA for the prediction and TRA can better predict smoking among students with lower than higher perceived behavioral control.