Using alcohol expectancies to predict adolescent drinking behavior after one year

Social Cognitive Theory and Willingness to Perform Recommended Health Behavior: The Moderating Role of Misperceptions

More than 6 million people have died due to the COVID-19 pandemic. In order to slow down the spread of COVID-19, health authorities have created numerous guidelines. In the current study, we use survey data from the U.S. and social cognitive theory (SCT) to examine the associations among self-efficacy, outcome expectancies, and willingness to perform recommended COVID-19 related health behavior. Considering the misinformation-filled information ecology during the pandemic, we also examine the moderating role of misperceptions in these relationships. Our findings show that in general the SCT hypotheses hold for COVID-19 related behavior willingness. The interaction effects with COVID-19 misperceptions show that self-efficacy is not enough to understand people's health behavior. Higher outcome expectancies are important and may be able to overcome even if people held high misperceptions. Our findings have direct implications for communication theory and for health organizations in the contemporary information ecology.

Social epidemiology of early adolescent alcohol expectancies

PURPOSE

To determine the sociodemographic correlates of alcohol expectancies (i.e., beliefs regarding positive or negative effects of alcohol) in a national (U.S.) cohort of early adolescents 10-14 years old. A second aim was to determine associations between alcohol sipping and alcohol expectancies.

METHODS

We analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,868; Year 2). Linear regression analyses were conducted to estimate associations between sociodemographic factors (sex, race/ethnicity, sexual orientation, household income, parental education, parent marital status, religiosity) and positive (e.g., stress reduction) and negative (e.g., loss of motor coordination) alcohol expectancies. Additional linear regression analyses determined associations between alcohol sipping and alcohol expectancies, adjusting for sociodemographic factors.

RESULTS

Overall, 48.8% of the participants were female and 47.6% racial/ethnic minorities, with a mean age of 12.02 (SD 0.67) years. Older age among the early adolescent sample, male sex, and sexual minority identification were associated with more positive and negative alcohol expectancies. Black and Latino/Hispanic adolescents reported less positive and negative alcohol expectancies compared to White non-Latino/Hispanic adolescents. Having parents with a college education or greater and a household income of $200,000 and greater were associated with higher positive and negative alcohol expectancies. Alcohol sipping was associated with higher positive alcohol expectancies.

CONCLUSIONS

Older age, White non-Latino/Hispanic race, male sex, sexual minority status, higher parental education, and higher household income were associated with higher positive and negative alcohol expectancies. Future research should examine the mechanisms linking these specific sociodemographic factors to alcohol expectancies to inform future prevention and intervention efforts.

Social influences on alcohol outcome expectancy development from childhood to young adulthood: A narrative review

Purpose of Review

Alcohol outcome expectancies emerge in early childhood, develop throughout adolescence, and predict alcohol outcomes well into adulthood. Social factors shape how expectancies are learned in myriad ways, yet such social learning influences seldom are examined in the context of developmental factors. This review summarized literature on the social origins of alcohol expectancies through vicarious (observational) and experiential (direct) alcohol-related learning from childhood to young adulthood within a social learning framework.

Recent Findings

Young children primarily endorse negative expectancies, which decline rapidly with age amidst escalations in positive expectancies across adolescence. Parents and peers can contribute to vicarious learning about alcohol and facilitate experiential learning in different ways and to varying degrees across development. Media and social media, which children are increasingly exposed to as they mature, often depict alcohol-outcome relations that may further contribute to expectancy development in later adolescence and young adulthood.

Summary

Social influences on alcohol expectancy learning are complex and change over time, although this dynamic complexity typically is not depicted in extant literature. Developmentally-informed research capturing co-occurring shifts in social influences and alcohol expectancies is needed.

COVID-19 Vaccine Intention and Social Cognitive Theory: The Role of Individual Responsibility and Partisan Media Use in a Moderated Moderated Mediation Model

Despite the sheer devastation caused by the COVID-19 pandemic in the United States, vaccine hesitancy is a major barrier to a successful implementation of the vaccine. We apply two moderators to examine the associations of efficacy and expectancies with COVID-19 vaccine intention. Specifically, we use national survey data collected online in 2020 (N = 1264) and a moderated moderated mediation PROCESS model to examine 1) the associations between self-efficacy about COVID-19 and vaccine intention mediated by positive outcome expectancies and 2) moderating roles of individual responsibility and partisan media use. The findings show that the path from efficacy to expectancies is moderated by individual responsibility, while the path from expectancies to vaccine intention is moderated by liberal media use. Our findings support the strategic application of SCT to emphasize the role of personal responsibility in campaigns to encourage vaccination for the COVID-19 virus.

Parent Alcohol Use and Problems in Children's Alcohol-Related Learning and Subsequent Alcohol Use

Background: Alcohol cognitions can emerge early in life and have lasting associations with alcohol use behavior. Observational learning theories suggest that witnessing alcohol use and its consequences may be an important mechanism underlying early development of alcohol cognitions. Parents are among the earliest contributors to children's alcohol-related learning, although findings regarding the association of parental alcohol use and problems with children's alcohol-related beliefs and attitudes are considerably mixed. This study tested associations of parent alcohol use and problems with adolescent alcohol expectancies, motives, and subsequent alcohol use to help clarify this literature. Methods: Families (N = 227) comprising family alcohol use disorder cases and demographically matched controls were recruited as part of a longitudinal investigation on child development. Parents reported on their alcohol use and problems at seven assessments throughout the index adolescents' childhood, and adolescents reported on their own alcohol expectancies in 6th grade, alcohol motives in 8th grade, and alcohol use in 12th grade. Results: Father alcohol problems and mother alcohol use were linked to more positive and less negative child alcohol expectancies, respectively. However, these cognitions did not contribute unique variance in adolescent alcohol use after accounting for additional risks included in the model. Conclusions: Findings highlight the need for future research aimed at modeling broader and potentially indirect sources of parent influences on adolescent alcohol-related learning and subsequent drinking behavior.

Alcohol consumption, alcohol expectancies, and drinking contexts in young Argentinean college students before and during the COVID-19 pandemic: a one-year follow-up study

Background: The COVID-19 pandemic and lockdowns are known to affect alcohol consumption. This study examines drinking expectancies and contexts upon alcohol consumption of Argentinean students.Objectives: To assess within-person changes in alcohol consumption in Argentinean college students (aged 18-24), from August 2019 with a one-year follow-up during the COVID-19 lockdown, considering alcohol expectancies, drinking contexts, and main socio-demographic variables. To validate the stability of these predictors, we discuss the effects on the alcohol consumption across dependent and independent measures.Methods: We assessed one longitudinal (N = 300, 70% female) and one cross-sectional (N = 165, 78% female) sample via online surveys and applied multilevel analysis and regressions, respectively.Results: Alcohol consumption significantly increased during lockdown compared to one-year before (mean: 6.91 and 8.26 alcohol units, correspondingly). In the longitudinal sample, social facilitation (medium effect sizes [ES]: 0.21, 0.22) and parental presence (medium ES: 0.12, 0.21) significantly and stable (through time) predicted increasing effects on consumption. In the cross-sectional sample, stress control (high ES: 0.78) and parental presence (high ES: 0.42) were associated with higher consumption during lockdown.Conclusion: College students increased their alcohol consumption during lockdown, suggesting that restrictive sanitary measures may negatively affect consumption. Literature is not conclusive as both decreases and increases in alcohol consumption in students from developed countries were reported. Before and during COVID-19 lockdown, parental presence is a stable predictor of increased alcohol consumption, though unusual according to the literature. Health policies aimed at modifying the behavior of parents who promote/share alcohol consumption with their offspring may help reduce drinking in college students.

Delivery of a Prevention Program in Large College Classes: Effectiveness of the Expectancy Challenge Alcohol Literacy Curriculum

Background: Despite modest reductions in alcohol use among college students, drinking-related harms continue to be prevalent. Group-delivered programs have had little impact on drinking except for experiential expectancy challenge interventions that are impractical because they rely on alcohol administration. Expectancy Challenge Alcohol Literacy Curriculum (ECALC), however, offers a non-experiential alternative suitable for widespread implementation for universal, selective, or indicated prevention. Objectives: ECALC has been effective with mandated students, fraternity members, and small classes of 30 or fewer first-year college students. Larger universities, however, typically have classes with 100 students or more, and ECALC has not yet been tested with groups of this size. To fill this gap, we conducted a group randomized trial in which five class sections with over 100 college students received either ECALC or an attention-matched control presentation and completed follow-up at four weeks. Results: ECALC was associated with significant changes on six subscales of the Comprehensive Effects of Alcohol Scale (CEOA), post-intervention expectancies predicted drinking at four-week follow-up, and there were significant expectancy differences between groups. Compared to the control group, students who received ECALC demonstrated significant expectancy changes and reported less alcohol use at follow-up. Conclusions: Findings suggest ECALC is an effective, single session group-delivered intervention program that can be successfully implemented in large classes.

Hazardous drinking and alcohol use disorders

Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.

Risk Factors for Substance Use across the Lifespan

Substance use is a perennial public health concern with associated health risks and economic impacts on society. In this article, we present a selective review of the epidemiological and clinical literatures on alcohol and substance use from a lifespan developmental perspective. We compare and contrast risk factors for the initiation of use and the development of a substance use disorder in adolescence, young adulthood, middle-age and later life. During adolescence, alcohol use experimentation is at its peak. Specific risk factors have been identified including trauma and parenting style that can increase the risk of substance use for teenagers. Emerging adults and college students are likely to experiment with other substances in addition to alcohol such as nicotine, marijuana, cocaine, and prescription medication such as Adderall. Middle-age and older adults with alcohol and substance use in their developmental histories may have an undiagnosed alcohol use disorder. Others will develop a late-onset substance use disorder in older age, possibly due to a dearth of social support, coping with bereavement, and medical complication. Based on Social Cognitive Theory, the roles of expectancies and self-efficacy are hypothesized to impact substance use and the risk of substance use disorder across the lifespan. Implications of the present review for future research on age-specific risk factors in alcohol use in relation to underlying developmental processes are considered.

Analysis of related factors for adolescents' intention to use alcohol in Korea

The harmful effects of alcohol consumption by adolescents have been increasingly emphasized. Thus, it is necessary to identify individual and environmental factors that encourage drinking. This study investigated factors associated with the sustainable use of alcohol (SUA) in adolescents who consume alcohol, and the possibility of future drinking (PFD) in non-drinking adolescents. Data from "The Adolescents Awareness Survey of Alcohol Encouraging Environment" by the Ministry of Health and Welfare and the Korea Health Promotion Institute (2017) were used. The survey was completed by 1,038 participant, selected through a proportional allocation extraction method, who were aged 13-18 years and lived in five cities with a population of over 1 million. The factors associated with SUA included gender (β = 0.634, p = 0.004), grade (8th β = 1.591, p<0.001, 9th β = 1.674, p<0.001, 10th β = 1.497, p = 0.001, 11th β = 1.041, p = 0.004, 12th β = 2.610, p<0.001), drinking alone (β = -2.147, p = 0.002), liquor commercial (β = 1.644, p<0.001), ease of alcohol purchase (β = 1.541, p = 0.025), parent's recommendation for drinking (β = 1.084, p<0.001), not knowing the mother's education level (β = -0.685, p = 0.045), positive expectancy of drinking (β = 0.141, p<0.001), number of pubs (β = 0.303, p = 0.002), internet game cafes (β = 0.456, p = 0.019), and karaokes (β = -0.098, p = 0.023) in the community. The factors associated with the PFD in non-drinkers were grade (8th β = 0.531, p = 0.024, 10th β = 0.717, p = 0.035, 12th β = 1.882, p = 0.001), liquor commercial (β = -1.355, p<0.001), parent's recommendation for drinking (β = 0.783, p = 0.020), positive expectancy of drinking (β = 0.139, p<0.001), and relationship with the father (β = 0.072, p = 0.033). Multidimensional interventions, including those by individuals, parents, peers, and local communities, are needed to prevent SUA and the PFD in adolescents.

Drinking Expectancies among Chinese Young Adults: A Qualitative Study from Hong Kong

BACKGROUND

Alcohol expectancies, i.e., the perceived consequences of drinking, have been reported to be important factor in predicting drinking behaviors. However, studies in the Asia region were largely limited to school-based samples. This study aimed to be the first to explore drinking expectancies among urban Chinese young adults.

METHODS

In 2020, eight focus group discussions were conducted with Hong Kong Chinese young adults aged 18-34 (n = 53). The participants included heavy drinkers, light drinkers, and non-drinkers from a wide range of occupations and educational backgrounds. Thematic analysis was conducted to uncover common alcohol expectancies.

RESULTS

Six themes emerged from this study. Four themes that were commonly reported in the literature were the negative consequences of drinking, social bonding, confidence enhancement, and tension reduction. The study also uncovered two culturally relevant alcohol expectancies: health benefits and business drinking expectancies. In contrast to Western samples, Chinese young adults did not report drinking expectancies related to cognitive enhancement or increased sexual interest.

CONCLUSION

Alcohol harm reduction strategies will need to address the positive drinking expectancies uncovered in this study. Future policy discussions in this emerging alcohol market region should consider greater scrutiny of the role of alcohol marketing in the propagation of positive drinking expectancies.

Pathways of personality and learning risk for addictive behaviors: A systematic review of mediational research on the Acquired Preparedness model

OBJECTIVE

The Acquired Preparedness (AP) model proposes that impulsive personality traits predispose some individuals to learn certain behavior-outcome associations (expectancies), and that these expectancies in turn influence the escalation of risky behaviors. This theory has been applied to the development of behaviors such as drinking, drug use, gambling, and disordered eating. In the current study, we aimed to summarize empirical tests of this model over the 20 years since it was proposed.

METHOD

We used a descriptive approach to summarize tests of mediation across 50 studies involving n=21,715 total participants.

RESULTS

We observed a consistent effect of personality on expectancies (median effect size = .22), of expectancies on behavior (.24), and a small mediated effect (.05) of personality on behavior via expectancies. Impulsive traits that involve positive or negative affect showed the most consistent support for AP, as did positive expectancies. Most studies testing AP focused on alcohol, but research on other behaviors also showed support for AP.

CONCLUSIONS

The literature appears to support a small mediated effect consistent with the AP model. Future research should continue to clarify which AP pathways are most influential in explaining risky behaviors, and supplement correlational research with experimental and quasi-experimental designs.

Know Your Safe Drinking Skills: Adaptation Strategies for the College Effect

Objective: The current study investigates the effects of an alcohol-prevention program delivered to college students in a formal classroom setting. Participants: The sample comprised 231 first-year college students who enrolled in a multisection “First Year Experience” course at a large northeastern university in the United States. Method: A naturalistic experiment was conducted, with a baseline evaluation at the beginning of the semester and a post-experiment evaluation near the end of the semester. Results: Social drinking attitudes, proximal drinking norm and the college effect are significant predictors of pre- and post-intervention episodic drinking frequency. The intervention reduced episodic drinking frequency as well as perceived distal and proximal drinking norms. It also increased drinking attitudes and did not change perceived efficacy or drinking-outcome expectancies. Conclusions: Practitioners could consider implementing a similar intervention to allow students to learn and practice safe drinking skills in the first year of their college life.

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.

Association between childhood negative life events with alcohol expectancies in early adolescence: Cumulative risk and latent class approaches

BACKGROUND

The present study aims to investigate the effects of childhood negative life events (NLEs) on alcohol expectancies (AEs) in early adolescence through cumulative risk and latent class approaches.

METHODS

Data were obtained from a prospective cohort of 945 sixth graders (age 11-12) ascertained from 17 elementary schools in northern Taiwan (response rate = 61.0 %_wt); subsequent assessments were conducted during eighth grade (n = 775, follow-up rate [FR] = 82.6 %_wt). Information concerning socio-demographics, 14 NLEs, alcohol-related experience, and four-domain AEs was collected by self-administered questionnaires at childhood and follow-up. Latent class and multivariate analyses were used to evaluate the association estimates.

RESULTS

Nearly one half of children had experienced at least one NLE in sixth grade, with one-tenth experiencing four or more NLEs. Three latent classes of NLEs were identified: "lesser experience (68.1 %_wt)," "stressed relationship (27.6 %_wt)," and "family instability (4.3 %_wt)." The observed NLE-associated increase in AEs was relatively stronger in the cumulative approach: children experiencing four or more NLEs (β_wt = 1.27, 95 % CI = 0.27-2.27) and in the "stressed relationship" NLE class appeared to develop greater AEs (β_wt = 0.86, 95 % CI = 0.30-1.42). Moreover, such NLE-associated increase was especially salient in the AE domains regarding "global positive transformation" and "promoting relaxation or tension reduction".

CONCLUSIONS

Our results provide insight into which experiences of multiple and "stressed relationship" negative life events arising from the family context in childhood may shape endorsed alcohol expectancies in adolescence, and implied that such effects may not uniformly operate across AE domain.

Effects of an Alcohol-Related Harm Prevention Program among Out-of-School Female Adolescents

This study aimed to evaluate the effects of an alcohol-related harm prevention program on out-of-school adolescent girls. This was a quasi-experimental study employing a randomized controlled non-synchronized design. There were 23 and 22 participants in the experimental and control groups, respectively. The program comprised three sessions aiming to motivate voluntary changes and promote autonomous decision-making. The experimental group showed significantly higher alcohol-related knowledge and substantially lower alcohol outcome expectancy than the control group. No significant differences emerged from drinking refusal, self-efficacy, or alcohol abstinence intention. This program could improve alcohol-related knowledge and reduce out-of-school adolescent girls' positive alcohol outcome expectancy.

The association between child alcohol sipping and alcohol expectancies in the ABCD study

BACKGROUND

Underage drinking is a serious societal concern, yet relatively little is known about child sipping of alcohol and its relation to beliefs about alcohol. The current study aimed to (1) examine the contexts in which the first sip of alcohol occurs (e.g., type of alcohol, who provided sip, sip offered or taken without permission); (2) examine the association between sipping and alcohol expectancies; and (3) explore how different contexts of sipping are related to alcohol expectancies. We expected to find that children who had sipped alcohol would have increased positive expectancies and reduced negative expectancies compared to children who had never sipped alcohol.

METHODS

Data were derived from the 2.0 release of the Adolescent Brain Cognitive Development (ABCD) study, a longitudinal study of children in the United States. We utilized data from 4,842 children ages 9-11; 52% were male, 60% were White, 19% were Hispanic/Latinx, and 9% were Black/African American.

RESULTS

We found that 22% of the sample had sipped alcohol. Children reported sipping beer most frequently, and the drink most often belonged to the child's father. We found that children who had sipped had higher positive alcohol expectancies than children who had not while accounting for variables related to alcohol expectancies. Child sipping was not significantly associated with negative expectancies and the context of the first sip of alcohol was not significantly associated with positive and negative expectancies.

CONCLUSIONS

Providing sips of alcohol to children is associated with them having more favorable expectations about drinking.

To Infuse or Ingest in Human Laboratory Alcohol Research

Human alcohol laboratory studies use two routes of alcohol administration: ingestion and infusion. The goal of this paper was to compare and contrast these alcohol administration methods. The work summarized in this report was the basis of a 2019 Research Society on Alcoholism Roundtable, "To Ingest or Infuse: A Comparison of Oral and Intravenous Alcohol Administration Methods for Human Alcohol Laboratory Designs." We review the methodological approaches of each and highlight strengths and weaknesses pertaining to different research questions. We summarize methodological considerations to aid researchers in choosing the most appropriate method for their inquiry, considering exposure variability, alcohol expectancy effects, safety, bandwidth, technical skills, documentation of alcohol exposure, experimental variety, ecological validity, and cost. Ingestion of alcohol remains a common and often a preferable, methodological practice in alcohol research. Nonetheless, the main problem with ingestion is that even the most careful calculation of dose and control of dosing procedures yields substantial and uncontrollable variability in the participants' brain exposures to alcohol. Infusion methodologies provide precise exposure control but are technically complex and may be limited in ecological validity. We suggest that alcohol ingestion research may not be the same thing as alcohol exposure research; investigators should be aware of the advantages and disadvantages that the choice between ingestion and infusion of alcohol invokes.

Alcohol Expectancies Moderate the Association Between School Connectedness and Alcohol Consumption

BACKGROUND

In this study, we investigate the moderated association of school connectedness and alcohol expectancies with adolescent drinking.

METHODS

Two large community samples were obtained with 2 repeated attempted censuses of all students attending a large suburban school district. Participants completed a self-administered questionnaire that assessed substance use, alcohol expectancies, and school connectedness. We used logistic regression analyses on the training sample and confirmed with Bayesian test intervals with the test sample.

RESULTS

Party related alcohol expectancies and school connectedness interacted in their explanatory association with recent drinking and binging, such that school connectedness had a protective association only for youth with lower positive expectancies. These findings were the result of pre-planned exploratory analysis, which were confirmed with out-of-sample test data.

CONCLUSIONS

The potential benefits for student health behaviors resulting from improved school connectedness may be dependent on at least one dimension of alcohol expectancies, at the individual level.

Mis-anaesthetized society: expectancies and recreational use of ketamine in Taiwan

Background

The popularity of ketamine for recreational use has been increasing in Asia, including Taiwan. Still, little known about the pattern of ketamine expectancies and whether such patterns are related to ketamine use. This study aimed to examine whether the positive and negative ketamine expectancies are differentially associated with ketamine-using behavior, and whether such relationship may differ by early-onset use of tobacco or alcohol.

Methods

Participants were recruited using respondent-driven sampling (RDS) among regular tobacco and alcohol users, aged 18 to 50, residing in Taipei from 2007 to 2010. Totally 1115 participants (with an age distribution skewed to the right, median = 26; interquartile range: 22–32) had information on substance use and completed a 12-item ketamine expectancies questionnaire (with 6 positive and 6 negative statements). Using two axes of High and Low expectancies, the four combinations of binary positive and binary negative ketamine expectancies were created. Each participant’s drug-using experience was categorized into illicit drug naïve, exclusive ketamine use, polydrug ketamine use, or other illicit drug use. Using the weights in the network output by RDS Analysis Tool, multivariable logistic regression analysis was then conducted.

Results

The weighted prevalence was 2.4% for exclusive ketamine use, 9.0% for polydrug ketamine use, and 9.1% for the other illicit drug use. Ketamine users (11.4%) had greater positive expectancies and lower negative expectancies, particularly the combination of High Positive with Low Negative, as compared to the illicit drug-naïve or other illicit drug users. After adjustment for early-onset tobacco (or alcohol) use and sociodemographic characteristics, High Positive, Low Negative, and their combination of High Positive-Low Negative expectancies remained strongly associated with ketamine uses, without evidence of moderation from early-onset use of tobacco or alcohol.

Conclusions

Positive and negative ketamine expectancies were associated in opposite directions with ketamine use, independent of early-onset use of tobacco or alcohol. Our results indicate ketamine expectancies as possible targets for future intervention and prevention of ketamine use, with a less confrontational feedback on decreasing an individual’s positive expectancies is essential in preventing young people from the initiation of ketamine use.

Mediation analysis with zero-inflated substance use outcomes: Challenges and recommendations

Mediating mechanisms are important components of substance use research, as many substance use interventions work by targeting mediating variables. One issue that is common in substance use research is the presence of many responses of zero in a count variable that is the primary outcome of interest, such as number of drinks per week or number of substances used in the past month. The goal of this paper is to highlight the unique challenges that substance use researchers face when conducting mediation analysis with a zero-inflated count outcome. In this paper, we first describe the models that are commonly used for zero-inflated count data, and when it is appropriate to use them. We then describe general mediation analysis and summarize the small body of work that has focused on mediation for count and zero-inflated count outcomes. We identify the main issue of computing the mediated effect when outcomes are zero-inflated, namely, that the path leading to the zero-inflated count outcome (or mediator) is modeled in two parts. We then provide two examples of mediation models with different conclusions that have zero-inflated count outcomes using adolescent substance use data and define the issues that arise when assessing mediation for each. Finally, we describe the directions in which we must target future methodological research to create accessible solutions for handling mediation with zero-inflated count data in substance use research.

Gender differences in associations between pain-related anxiety and alcohol use among adults with chronic pain

Background: Over 100 million Americans live with chronic pain, and adults with chronic pain may be more likely to experience alcohol-related problems or Alcohol Use Disorder. An evolving conceptual model posits that bidirectional effects between pain and alcohol exacerbate both pain and drinking. Pain has been shown to motivate alcohol urge and consumption, and drinking for pain-coping predicts escalations in alcohol use over time. Pain-related anxiety is a transdiagnostic vulnerability factor that has been implicated in both pain and substance-related (i.e., tobacco, opioids, cannabis) outcomes, but has not yet been studied in relation to alcohol use. Objective: We sought to conduct the first test of cross-sectional associations between pain-related anxiety, gender, and alcohol use. Methods: Adults with chronic pain (N = 234; M_age = 29.54, 67% Female) self-reported pain-related anxiety, gender, and alcohol use (i.e., consumption frequency/quantity, alcohol-related consequences, and dependence symptoms measured with the Alcohol Use Disorders Identification Test; AUDIT). Hierarchical regression and conditional effects models were used to test associations between pain-related anxiety, gender, and alcohol use. Results: Pain-related anxiety was positively associated with alcohol-related consequences and alcohol dependence symptoms measured by the AUDIT among males, but not females. Pain-related anxiety was not associated with the frequency/quantity of alcohol consumption in our sample. Conclusions: These findings are consistent with prior research, which has demonstrated associations between pain-related anxiety and deleterious substance use outcomes. Results provide initial evidence that pain-related anxiety may be a relevant factor to consider in the context of alcohol research and treatment among male drinkers.

Perspectives on substance use among youth with chronic medical conditions and implications for clinical guidance and prevention: A qualitative study

Increasing numbers of youth globally live with a chronic illness. These youth use alcohol and marijuana at levels equal to or greater than their healthy peers and, when using, are at elevated risk for regular or problem use and adverse consequences to their condition. Little is known about whether behavioral theories commonly invoked to explain adolescent substance use apply to this group, limiting our ability to develop, tailor and target preventive interventions. We interviewed youth ages 16-19 years in care for a chronic disease to gain knowledge of this group's perspectives on substance use risk, decision-making, and preferences for clinical guidance. Interviews were transcribed and thematically analyzed. Three principal themes emerged: first, having a chronic disease frames understanding of and commitment to health protecting behaviors and impacts decisions to avoid behaviors that carry risks for disease complications and flares; second, developmental impulses typical of adolescence can amplify an adolescent's propensity to take risks despite medical vulnerability and direct youth toward maladaptive choices to mitigate risk; and third, poor knowledge about effects of substance use on specific features of a disease shapes perceived risk and undermines health protecting decisions. Youth navigate these issues variously including by avoiding substance use at a specific time or entirely, using while cognitively discounting risks and/or adjusting treatment outside of medical advice. Their perceptions about substance use are complex and reveal tension among choices reflecting a chronic illness frame, developmental impulses, and knowledge gaps. Delivery of targeted guidance in healthcare settings may help youth navigate this complexity and connect patient-centered goals to optimize health with health protecting behavioral decisions.

Alcohol Expectancy and Cerebral Responses to Cue-Elicited Craving in Adult Nondependent Drinkers

BACKGROUND

Positive alcohol expectancy (AE) contributes to excessive drinking. Many imaging studies have examined cerebral responses to alcohol cues and how these regional processes related to problem drinking. However, it remains unclear how AE relates to cue response and whether AE mediates the relationship between cue response and problem drinking.

METHODS

A total of 61 nondependent drinkers were assessed with the Alcohol Expectancy Questionnaire and Alcohol Use Disorder Identification Test and underwent functional magnetic resonance imaging while exposed to alcohol and neutral cues. Imaging data were processed and analyzed with published routines, and mediation analyses were conducted to examine the interrelationships among global positive score of the Alcohol Expectancy Questionnaire, Alcohol Use Disorder Identification Test score, and regional responses to alcohol versus neutral cues.

RESULTS

Alcohol as compared with neutral cues engaged the occipital, retrosplenial, and medial orbitofrontal cortex as well as the left caudate head and red nucleus. The bilateral thalamus showed a significant correlation in cue response and in left superior frontal cortical connectivity with global positive score in a linear regression. Mediation analyses showed that global positive score completely mediated the relationship between thalamic cue activity as well as superior frontal cortical connectivity and Alcohol Use Disorder Identification Test score. The alternative models that AE contributed to problem drinking and, in turn, thalamic cue activity and connectivity were not supported.

CONCLUSIONS

The findings suggest an important role of the thalamic responses to alcohol cues in contributing to AE and at-risk drinking in nondependent drinkers. AEs may reflect a top-down modulation of the thalamic processing of alcohol cues, influencing the pattern of alcohol use.

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).

Using Placebo Beverages in Group Alcohol Studies

BACKGROUND

Placebo beverage conditions remain a key element in the methodological toolkit for alcohol researchers interested in evaluating pharmacological and nonpharmacological factors influencing the effects of alcohol consumption. While interest in experimentally examining alcohol in social context is on the rise, there has been little research examining the effectiveness of placebo manipulations in group settings, when just 1 suspicious participant could potentially jeopardize the effect of the placebo on group members. Moreover, research has rarely considered the association between individual difference factors (e.g., gender) and placebo manipulation effectiveness. The present study, using an uncommonly large sample of placebo-consuming participants, was well suited to investigate fundamental questions regarding placebo efficacy that have not been assessed previously. Specifically, we aimed to examine placebo efficacy and general processes of placebo functioning in a group context. We also assessed potential associations between a variety of individual difference factors and placebo response.

METHODS

A total of 240 participants (50% male) consumed placebo beverages during a triadic drinking period (across 80 three-person groups). Participants reported their subjective intoxication, stimulation, and sedation 8 minutes following drink consumption and estimated the alcohol content of their drink at the end of the study.

RESULTS

Participants consuming placebo beverages in groups were nearly universal in reporting that they had consumed alcohol (>99%) and had experienced an increase in feelings of intoxication [t(239) = 22.03, p < 0.001] and stimulation [t(239) = 5.53, p < 0.001], levels that were similar to those observed in prior studies conducted with participants drinking placebos in isolation. Further, participants' placebo responses were independent of their 2 group members and were largely unaffected by a variety of individual difference factors.

CONCLUSIONS

Placebo response generally operated independently of group-member influences, suggesting that researchers can successfully conduct placebo beverage studies utilizing group drinking designs.

Longitudinal Associations Between Alcohol-Related Cognitions and Use in African American and European American Adolescent Girls

BACKGROUND

African American (AA) girls initiate alcohol use later and drink less than European American (EA) girls, potentially reflecting differences in the development of drinking behaviors. This study examined alcohol-related cognitions: expectancies, attitudes, and intention to drink, as possible sources of variation by race in alcohol use. The aim of this study was to characterize the nature and degree of association between cognitions and use over time and by race in EA and AA girls.

METHODS

Data were drawn from the longitudinal Pittsburgh Girls Study (N = 2,450), an urban population-based sample of girls and their caregivers recruited when girls were between ages 5 and 8, and assessed annually through adolescence. Cross-lagged panel models were conducted separately by race (56.2% AA, 43.8% EA) to identify patterns of association between alcohol use and cognitions from ages 12 to 17 in 2,173 girls.

RESULTS

Endorsement of cognitions and use was higher overall in EA than AA girls but the magnitude of cross-lagged path coefficients did not differ significantly by race. In both groups, bidirectional effects emerged between intentions and use, and alcohol use largely predicted cognitions across ages. However, intention to drink was the only alcohol-related cognition that consistently predicted subsequent use (odds ratios ranged from 1.55 to 2.71).

CONCLUSIONS

Although rates of alcohol use and endorsement of cognitions were greater in EA than AA girls, the anticipated racial differences in longitudinal associations between cognitions and use did not emerge, indicating that variation in associations between use and cognitions does not account for the lower prevalence of alcohol use in AA compared with EA girls. Furthermore, our finding that intention to drink is a consistent, robust predictor of subsequent alcohol use suggests the need to investigate potentially modifiable factors that influence intention to drink across racial groups.

When parents supply alcohol to their children: Exploring associations with drinking frequency, alcohol-related harms, and the role of parental monitoring

BACKGROUND

Youth obtain alcohol from many sources, including friends, siblings, parents and other adults. Whether parental supply, relative to other sources, is associated with experiencing a negative alcohol-related outcome is an area of considerable debate. Less well understood is whether the observed association is further contextualized by level of parental monitoring of the child.

OBJECTIVES

This study has two main objectives: 1) determine if there is a relationship between parental supply, drinking frequency, and alcohol-related harms among youth; and 2) assess whether parental monitoring moderates this relationship.

METHODS

Participants were drawn from the 2012 Student Drug Use Survey in Canada's Atlantic Provinces, an anonymous cross-sectional survey of high school students (ages 15-19 years). Adjusted regression models assessed the association between drinking frequency, experiencing alcohol-related harms, and four different sources of supply. Additional analyses stratified on levels of parental monitoring.

RESULTS

Relative to receiving alcohol from friends, parental supply was associated with lower odds of experiencing any alcohol-related harm (AOR 0.42; 95% CI 0.28-0.61) and loss of control (AOR = 0.42; 95% CI 0.29-0.62). Drinking frequency did not differ by source of supply. Associations between parental supply and harm were absent among youth reporting low levels of parental monitoring.

CONCLUSIONS

Youth who receive alcohol from parents' report fewer alcohol-related harms relative to those who obtain their alcohol from friends, despite no observed differences in drinking frequency. Understanding how parents may help to minimize experiences of alcohol-related harm among youth beyond the simple promotion of abstinence from drinking is warranted.

What Did You Expect? Substance Use Expectancies Mediate the Relationships Between Dark Triad Traits, Substance Use, and Substance Preference

This study explores the role of substance use expectancies as mediators between the Dark Triad of personality, substance use, and substance use preferences. A sample of college students ( M = 19.38, SD = 2.63, N = 207) completed an online questionnaire that assessed the Dark Triad traits, substance use history, substance preferences, and substance use expectancies. Three specific substance use expectancies-increased confidence, tension reduction, and cognitive enhancement-were shown to either partially or fully mediate the relationships between the Dark Triad and substance use behaviors and preference for certain substances of abuse. These findings may hold clinical implications for the treatment of substance use disorders and further the understanding of factors contributing to the etiology and progression of substance abuse and substance use disorders.

Peer norms and susceptibility mediate the effect of movie alcohol exposure on alcohol initiation in adolescents

Movie alcohol exposure is a known and consistent predictor of adolescent alcohol use initiation and escalation. Nearly 90% of the top U.S. movies contain alcohol content. Social-cognitive theory posits reciprocal links among environmental influences (e.g., movie alcohol exposure), social-cognitive processes (e.g., perceived norms, susceptibility, alcohol outcome expectancies), and behavior (alcohol use), but these links have been tested in only 1 direction. In the current study, we assessed movie alcohol exposure, alcohol cognitions, and alcohol initiation among adolescents (N = 1,023; 52% female, mean age = 13.7 years) in 4 annual survey waves. Cross-lagged panel models tested bidirectional relations between cognitions and movie alcohol exposure. Finally, we tested bidirectional mediation effects in the prospective prediction of alcohol initiation. Movie alcohol exposure prospectively predicted increases in descriptive norms, injunctive norms, and susceptibility but not positive or negative alcohol outcome expectancies. All factors predicted subsequent alcohol initiation. Close friend injunctive and descriptive norms, peer descriptive norms, and susceptibility mediated the effect of earlier movie alcohol exposure on subsequent alcohol initiation. Movie alcohol exposure mediated the effect of earlier close friend descriptive norms on subsequent alcohol initiation. Movie alcohol exposure and social-cognitive processes are interrelated facets that impact alcohol initiation. Permissive cognitions infrequently predicted higher subsequent exposure to movie alcohol. Clinical and preventative implications of this work are discussed. (PsycINFO Database Record

Trajectories of positive alcohol expectancies and drinking: An examination of young adults in the US and Sweden

Positive alcohol expectancies and alcohol use tend to increase from adolescence to young adulthood, yet little is known about the associations between these constructs across cultures. The current study adds to the extant literature by examining the growth trajectories of positive alcohol expectancies and drinking behavior among United States (US) and Swedish participants during a critical period where significant change in these outcomes may be expected to occur. A total of 870 (US, N=362; Sweden, N=508) high school seniors completed baseline, 6-month, and 12-month assessments of alcohol expectancies and drinking (i.e., drinks per week). Changes in positive alcohol expectancies and drinking behavior were examined using a parallel process latent growth model. In both samples, higher baseline levels of positive alcohol expectancies were associated with a higher number of drinks consumed per week at baseline. In the US sample, lower baseline levels of positive alcohol expectancies were associated with a greater increase in positive alcohol expectancies at 12-month follow-up, and lower baseline levels of drinks per week were associated with a greater increase in drinks consumed per week at 12-month follow-up. In the Swedish sample, an increase in positive alcohol expectancies over time was associated with an increase in drinks consumed per week over the same period of time. Additional research is needed to examine when and for whom expectancy-based alcohol interventions are most efficacious.

Young people's attitudes towards illicit drugs: A population-based study

AIMS

Previous studies indicate that young people who have positive attitudes towards illicit drugs are more inclined to experiment with them. The first aim of our study was to identify the sociodemographic and risk behaviour characteristics of young people (16-24 years) with positive attitudes towards illicit drug use. The second aim was to identify the characteristics of young people with positive attitudes towards illicit drugs among those who had never tried drugs, those who had tried cannabis but no other illicit drugs, and those who regularly used cannabis and/or had tried other illicit drugs.

METHODS

The analysis was based on a population-based survey from 2013 ( N = 3812). Multiple logistic regression was used to analyse the association between sociodemographic and risk behaviour characteristics and positive attitudes towards illicit drugs.

RESULTS

Young men had twice the odds of having positive attitudes towards illicit drug use compared with young women (AOR = 2.1). Also, young age, being single, being employed, smoking tobacco, practising unprotected sex, and experimental cannabis use were associated with positive attitudes towards illicit drug use. Finally, use of cannabis at least 10 times during the previous year and/or use of other illicit drugs had the strongest association with positive attitudes to illicit drug use (AOR = 6.0).

CONCLUSIONS

Young people who have positive attitudes towards illicit drug use are characterized by a broad range of risky behaviours. These findings may help to identify young people at risk of initiating illicit drug use and thereby support the development and implementation of prevention programmes.

The Myriad Influences of Alcohol Advertising on Adolescent Drinking

Purpose of Review

This review investigates effects of alcohol advertising on adolescent drinking. Prior reviews focused on behavioral outcomes and long-term effects. In contrast, the present review focuses on subgroups with greater exposure to alcohol advertising, research methods to study alcohol advertising, potential mechanisms underlying relationships between adolescent exposure to alcohol advertising and increased drinking and points to prevention/intervention strategies that may reduce effects of alcohol advertising.

Recent Findings

Alcohol advertising influences current and future drinking. Further, evidence suggests adolescents may be targeted specifically. Alcohol advertisements may influence behavior by shifting alcohol expectancies, norms regarding alcohol use, and positive attitudes. Media literacy programs may be an effective intervention strategy.

Summary

Adolescents are exposed to large quantities of alcohol advertisements, which violates guidelines set by the alcohol industry. However, media literacy programs may be a promising strategy for adolescents to increase critical thinking and create more realistic expectations regarding alcohol.

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.

Racial differences in the link between alcohol expectancies and adolescent drinking

INTRODUCTION

Alcohol expectancies are important determinants and predictors of adolescent alcohol use. Research with African Americans has shown that the endorsement of positive alcohol expectancies differs from that of Whites during childhood and predicts different alcohol outcomes during young adulthood. However, limited research has explored racial differences in the relationship between expectancy endorsement and alcohol use in school-aged adolescents. The current study examines the effect of White or African American race on the relationship between positive alcohol expectancies and alcohol use.

METHODS

Participants were 104 adolescents ages 12-18 who identified as either non-Hispanic White or non-Hispanic African American. Participants completed self-report measures of alcohol consumption and positive social alcohol expectancies.

RESULTS

Preliminary analyses revealed no racial differences in alcohol expectancies or consumption. However, race moderated the relationship between alcohol expectancies and alcohol use such that more positive expectancies predicted alcohol use among White youth, but not African American youth.

CONCLUSIONS

These results suggest that alcohol expectancies, which were thought to be important mediators of the relationship between social and personality factors and adolescent alcohol use may not be as impactful for African Americans. Future research should focus on identifying factors posing unique risk for alcohol consumption in this population.

Cognitive appraisals of alcohol use in early adolescence: Psychosocial predictors and reciprocal associations with alcohol use

Early adolescence is a dynamic period for the development of alcohol appraisals (expected outcomes of drinking and subjective evaluations of expected outcomes), yet the literature provides a limited understanding of psychosocial factors that shape these appraisals during this period. This study took a comprehensive view of alcohol appraisals and considered positive and negative alcohol outcome expectancies, as well as subjective evaluations of expected outcomes. Developmental-ecological theory guided examination of individual, peer, family, and neighborhood predictors of cognitive appraisals of alcohol and use. A community sample of 378 adolescents (mean age 11.5 years at Wave 1, 52% female) was assessed annually for 4 years. Longitudinal path analysis suggested that the most robust predictors of alcohol appraisals were peer norms. Furthermore, perceived likelihood of positive and negative alcohol outcomes prospectively predicted increases in drinking. There was limited support for appraisals operating as mediators of psychosocial risk and protective factors.

Early life predictors of alcohol-related attitudes among 11-year-old never drinkers

Alcohol-related attitudes are evident before children have personal experience drinking alcohol and represent key proximal predictors of alcohol use, but relatively little is known about how early life characteristics predict these attitudes. Among late childhood lifetime alcohol abstainers (M_age=10.67years; 51% girls), we examine predictors of positive alcohol expectancies and perceived risk of alcohol use. Data from the Millennium Cohort Study, an ongoing nationally representative longitudinal study of children born in the UK, were available from 11,097 children who completed the self-report survey at modal age 11 and reported never drinking alcohol. A sequential structural model suggested that sociodemographic factors were distal predictors of age 11 alcohol attitudes that operated, in part, through family and child risk factors (measured at ages 3 to 7). Alcohol attitudes varied by sociodemographics; for example, boys had higher positive expectancies than girls and White British children had higher positive expectancies and lower perceived risk than Black British and Asian British children. In terms of family factors, parent alcohol problems predicted children's lower perceived risk, and higher parent-child conflict predicted more positive expectancies. For child factors, children's greater cognitive skills predicted higher perceived risk, and internalizing problems predicted more positive expectancies. Indirect effects from sociodemographics through parent-child conflict and internalizing problems predicted positive expectancies; indirect effects through parent alcohol problems and cognitive skills predicted perceived risk. Future research should delve further into mechanisms underlying the development of alcohol attitudes and their potential as malleable targets for prevention.

Interactions Between Internalizing Symptoms and Urgency in the Prediction of Alcohol Use and Expectancies Among Low-Income, Minority Early Adolescents

This study examined whether urgency, a disposition to rash action under conditions of strong emotion, moderates associations between internalizing symptoms and alcohol use and related expectancies. Data from the Camden Youth Development Study, a longitudinal, community-based study of early adolescents (N = 144, mean age at intake = 11.9 years; 65% Hispanic, 30% African-American; 50% male), were used. Self-report questionnaire measures of depressive symptoms, social and generalized anxiety symptoms, urgency, alcohol use, and alcohol expectancies were used. Mixed models were used to examine the effects of internalizing symptoms, urgency, and their interaction on alcohol use and expectancy trajectories over time. Depressive symptoms interacted with urgency such that youth with high levels of both tended to have elevated levels of global positive alcohol expectancies. Social anxiety symptoms interacted with urgency to be associated with increasing levels of social behavior alcohol expectancies such that youth with high levels of both tended to experience particular increases in these expectancies over time. Generalized anxiety was not found to be associated with alcohol-related constructs. Therefore, high levels of urgency combine with depressive and social anxiety symptoms to be associated with particularly increased risk for alcohol expectancies that are associated with later alcohol use and problems, indicating particular risk for youth with these combinations of personality traits and psychopathology symptoms.

Implications of an Emerging Integration of Universal and Culturally Specific Psychologies

Psychological researchers increasingly recognize that human behavior reflects a complex interplay of universal human capacities, cultural responses to unique histories and circumstances, and individual differences. Many psychological processes appear to reflect culturally specific instantiations of universal capacities. Current integrative research focuses on further clarifying definitions of universality and on refining methods for identifying universal and cultural components of psychological processes. In this article, we consider implications of this emerging integration. To illustrate possible implications for psychology, we apply it to the study of psychopathology. We report on formal models that explain why some cultures embrace dysfunction among members. We then use the integrative framework to describe methods for determining whether putative disorders bring universal or contextual life dysfunction and to clarify etiological models of three disorders. Models of psychopathology can be more informed and precise if they include careful consideration of both universal and cultural influences on behavior.

Mechanistic Role of Emotion Regulation in the PTSD and Alcohol Association

OBJECTIVE

Posttraumatic Stress Disorder (PTSD) has been linked to problematic alcohol use. Those with PTSD have greater difficulty regulating emotions, which may help to explain the PTSD-drinking co-occurrence. However, emotion regulation as a mediator of PTSD-alcohol associations has been limited. In the present study, we examined this association.

METHOD

College students (N = 466, M_age = 19.5, 53% female) were assessed for PTSD by structured clinical interview, and were categorized into three groups: those who had not experienced a significant trauma (No Trauma, n = 182), those who had experienced a significant trauma but did not have current PTSD symptoms (Trauma Only, n = 171), and those with significant trauma and with current PTSD (partial or full; PTSD, n = 113). Alcohol use over the past six months and emotion regulation were assessed via self-report (DDQ; Collins, Parks, & Marlatt, 1985; DERS; Gratz & Roemer, 2004).

RESULTS

Findings revealed that those with trauma and clinically significant PTSD reported greater difficulty with emotion regulation than those who had not been exposed to trauma, which in turn significantly predicted alcohol use. This mediating effect was not found in those with trauma exposure alone, suggesting an important role for PTSD in this pathway. Findings also indicated that the ability to control emotion-based impulses is a particularly relevant mediating facet of emotion regulation.

CONCLUSION

These results implicate emotion regulation as a potential explanatory link between PTSD and alcohol use, lending further support to the inclusion of emotion regulation training in PTSD treatment.

Television viewing and alcohol advertising with alcohol expectancies among school-aged children in Taiwan

OBJECTIVES

This study is aimed to examine the strength of association between television watching and potential exposure to alcohol advertising with multidimensional alcohol expectancies in school-aged children.

METHODS

A total of 779 4th (age 10) and 768 6th (age 12) grade students were recruited from 17 public elementary schools in northern Taiwan in 2006, with two waves of follow-up at 6 months apart. Self-administered questionnaires were used to collect information concerning individual characteristics, parental attributes, past-week screen time, drinking behaviors, and alcohol expectancies. Data of aired alcohol advertisements at baseline were obtained from the Nielsen Media Research Advertising Information Services; parenting styles were ascertained from the 1st follow-up. Alcohol Expectancies Questionnaire-Children version was used to measure alcohol expectancies (AEs) at baseline and the 2nd follow-up.

RESULTS

Nearly 27% of students reported watching television for more than two hours per day and 58% watching television after 9 p.m. Dimension-related heterogeneity exists in the relationship between TV viewing and alcohol advertising with AEs. With statistical adjustment for covariates, spending more than two hours watching TV per day was associated with increased levels of positive AEs "Promoting Relaxation or Tension Reduction [PRTR]" (β=1.52, 95% CI=0.92, 2.12; p<0.001); the exposure to alcohol advertising was associated with decline in negative AEs "Deteriorated Cognitive and Behavioral Function" (e.g., >8.0 ads: β=-1.06, 95% CI=-1.66, -0.47, p<0.01).

CONCLUSIONS

Greater screen time is associated with elevated positive expectancies of PRTR and alcohol advertising exposure is linked with lowered negative expectancies in late childhood. School-based anti-underage drinking programs may consider integrating the media literacy curriculum.

The road to drink is paved with high intentions: Expectancies, refusal self-efficacy, and intentions among heavy drinking college students

The present study examined the effects of drinking intentions (DI) on alcohol expectancies (AE) and drink refusal self-efficacy (DRSE) in regard to alcohol consumption among heavy drinking undergraduates. Research shows that DRSE buffers against drinking (Young, Hasking, Oei, & Loveday, 2007) and interacts with AE to predict alcohol consumption (Oei & Burrow, 2000). Studies further show that DI is predicted by DRSE (Norman, 2011) and AE (Fleming, Thorson, & Atkin, 2004). However, additional research is needed to understand DI's influence on both DRSE and AE among heavy college drinkers. This research included 344 heavy drinking college students (mean age = 23.06 years, SD = 5.61, 74.71% female) from a large southern university who completed study material as part of a larger intervention. Findings showed that DI, DRSE, and AE interacted with respect to heavy drinking such that DRSE was negatively associated with alcohol consumption, particularly among those low in positive AE and high in negative AE. This relationship was stronger among individuals low in DI relative to those high in DI. DI seems to be an important factor influencing heavy drinking among undergraduate students. Present findings further support DI's associations with heavy drinking, regardless of an individual's DRSE or AE. Implications of this research suggest that it may be beneficial for interventions to target specific aspects of AE, including anxious drinking.

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.

The Effect of Inconsistency Appeals on the Influence of Direct-to-Consumer Prescription Drug Advertisements: An Application of Goal Disruption Theory

Scholars across multiple domains have identified the presence of inconsistency-arousing information in direct-to-consumer prescription drug advertisements and have suggested that these appeals, which highlight differences between people's actual and desired lives, may create psychological disequilibrium. However, experimental assessment of the distinct influence of inconsistency-arousing information in this domain is rare. Guided by goal disruption theory-a framework that outlines people's reactions to goal expectation violations-we created direct-to-consumer advertisements designed to make people's life inconsistencies salient. The influence of these ads on people's perceptions of, and intentions to use, prescription drugs was then assessed. Results from a structural equation modeling analysis supported the proposed model, indicating that compared to a control ad, an ad containing a goal expectation violation manipulation resulted in higher levels of psychological disequilibrium; in turn, psychological disequilibrium led to positive evaluations of the ad and the drug, positive outcome expectations of the drug, increased purposive harm endurance, and increased usage intentions. The current results suggest a psychological pathway that begins with a negative goal expectation violation and ends with increased usage intentions and a greater willingness to endure harm to make use possible.

Testing a model of caffeinated alcohol-specific expectancies

INTRODUCTION

The present study sought to further understand the association between caffeinated alcoholic beverage (CAB) use and alcohol-related risks. In particular, we focused on the role of two identified expectancies specific to CAB use: intoxication enhancement and avoidance of negative consequences. Although outcome expectancies are consistent predictors of substance use, limited research has examined expectancies related to CAB use and their association with alcohol-related behaviors, such as protecting themselves from alcohol-related harms. Consequently, the present study examined CAB-specific expectancies and protective behavioral strategies (PBS) as mediators of CAB use and negative consequences.

METHODS

Participants were 322 (219 women) college drinkers who completed self-report measures of typical CAB and alcohol use, CAB-specific expectancies, PBS use, and alcohol-related harms.

RESULTS

Structural equation modeling revealed, after controlling for typical non-CAB heavy alcohol use, a significant indirect effect of CAB use to alcohol-related problems through avoidance of negative consequences CAB expectancies and PBS use. However, intoxication enhancement expectancies did not mediate this association.

CONCLUSIONS

Our findings indicate that heavier CAB use was associated with stronger expectations that drinking CABs can help avoid negative consequences. These beliefs were related to using fewer PBS when drinking and a greater likelihood of experiencing problems. Given that these expectancies may be underlying mechanisms of CAB use, their inclusion in existing alcohol interventions may be beneficial.

Decision making about alcohol use: the case for scientific convergence

Research on cognitive processes related to the decision to drink alcohol has yielded assessment tools that predict drinking as well or better than any other predictor. Although largely overlapping in content, some of these tools have been issued from different theoretical perspectives and consequently have been named to reflect separate cognitive constructs. This article describes a single theme that may be shared by what now appear to be separate constructs: anticipatory information processing. These anticipatory processes are reviewed at multiple levels of analysis, from neurobiology, to learning and memory, and finally to behavioral choice. Evidence supporting anticipatory processing as a causal influence on drinking also is reviewed, along with evidence that these ideas may be usefully applied to prevention/treatment efforts.