Students' estimates of the prevalence of drug use: evidence for a false consensus effect

Initial evidence of reliability and validity of an implicit association test assessing attitudes toward individuals who use substances

Background: Substance use disorders (SUDs) are stigmatized conditions, with individual biases driving poor health outcomes. There are surprisingly few validated measures of bias or stigma toward individuals who use substances. Bias can be classified as explicit (self-report) or implicit (behaviorally based).Objectives: The goal of the present study was to establish preliminary indices of reliability and validity of an implicit association test (IAT) designed to measure implicit bias toward individuals who use substances.Methods: A large United States-based, crowd-sourced sample (n = 394, 51.5% male, 45.4% female, 2.5% nonbinary) completed the IAT and a small battery of survey instruments that assessed social distance to mental illness (including heroin use), attitude toward and perceived controllability of injection drug use, perception of public stigma, and social desirability.Results: Nearly all (92%; n = 363) scores on the IAT indicated greater negative than positive attitudes toward those who use substances. Spearman-Brown corrected split-half reliability on the IAT scores was excellent, r = .953. Controlling for social desirability, IAT scores positively correlated with all included measures pertaining to substance use as well as social distance for heroin and schizophrenia (but not diabetes). A principal component analysis resulted in two interpretable components representing disapproval (perceived controllability and negative attitudes) and perceived stigma (social stigma and social distance). Scores on the IAT positively correlated to scores on both components, again, controlling for social desirability.Conclusion: These results provide compelling preliminary evidence of validity of an IAT designed to measure bias toward individuals who use substances.

I'm wearing a mask, but are they?: Perceptions of self-other differences in COVID-19 health behaviors

As information about COVID-19 safety behavior changed, people had to judge how likely others were to protect themselves through mask-wearing and vaccination seeking. In a large, campus-wide survey, we assessed whether University of Kansas students viewed others' protective behaviors as different from their own, how much students assumed others shared their beliefs and behaviors, and which individual differences were associated with those estimations. Participants in our survey (N = 1, 704; 81.04% white, 64.08% female) estimated how likely they and others were to have worn masks on the University of Kansas campus, have worn masks off-campus, and to seek a vaccine. They also completed measures of political preference, numeracy, and preferences for risk in various contexts. We found that participants estimated that others were less likely to engage in health safety behaviors than themselves, but that their estimations of others were widely shared. While, in general, participants saw themselves as more unique in terms of practicing COVID-19 preventative behaviors, more liberal participants saw themselves as more unique, while those that were more conservative saw their own behavior as more similar to others. At least for masking, this uniqueness was false-estimates of others' health behavior were lower than their actual rates. Understanding this relationship could allow for more accurate norm-setting and normalization of mask-wearing and vaccination.

Marijuana use and intentions among American Indian adolescents: Perceived risks, benefits, and peer use

OBJECTIVE

The present study examines how perceptions of peer use, risks of use, and benefits to oneself and others from marijuana use are associated with past-month marijuana use and intentions to use marijuana socially among American Indian (AI) youth.

METHOD

The American Drug and Alcohol Survey (ADAS), a measure of substance use and related factors, was administered to AI youth living on or near reservations across six geographic regions (n = 3,498, 49.5% female, M age = 14.8).

RESULTS

Greater perceived peer use was significantly associated with more frequent past-month marijuana use (b = .05, p = .038) and intentions to use marijuana socially (b = .74, p < .001). Greater benefits to oneself were associated with greater marijuana use intentions (b = .35, p < .001). Greater perceived risks and benefits to others were significantly associated with less frequent past-month use (b = -.02, p = .002; b = -.01, p = .007, respectively) and intentions to use marijuana socially (b = -.05, p = .001; b = -.03, p = .002, respectively). Multilevel moderation analyses revealed that the effects of perceived peer use and benefits to oneself were related to intentions to use although stronger for those who had used; however, the effects of perceived risks and benefits to others were only significantly related to intentions to use marijuana for those who had used marijuana.

CONCLUSIONS

Results suggest that perceived benefits to others and risks are malleable factors that may be effective components of treatment programs for youth who report lifetime marijuana use, but that perceived peer use and benefits to oneself may be useful in both treatment and prevention efforts for youth who have or have not used marijuana. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations of cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults in Washington State

BACKGROUND

This study examined associations of local cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults.

METHODS

Data were from annual cross-sectional surveys administered from 2015 to 2019 to individuals ages 18-25 residing in Washington State (N = 10,009). As outcomes, this study assessed self-reported cannabis use at different margins/frequencies (any past year, at least monthly, at least weekly, at least daily) and perceived ease of access to cannabis and acceptability of cannabis use in the community. Cannabis retail outlet availability was defined as the presence of at least one retail outlet within a 1-kilometer road network buffer of one's residence. Sensitivity analyses explored four other spatial metrics to define outlet availability (any outlet within 0.5-km, 2-km, and the census tract; and census tract density per 1000 residents). Census tract level disadvantage was a composite of five US census variables.

RESULTS

Adjusting for individual- and area-level covariates, living within 1-kilometer of at least one cannabis retail outlet was statistically significantly associated with any past year and at least monthly cannabis use as well as high perceived access to cannabis. Results using a 2-km buffer and census tract-level metrics for retail outlet availability showed similar findings. Neighborhood disadvantage was statistically significantly associated with at least weekly and at least daily cannabis use and with greater perceived acceptability of cannabis use.

CONCLUSIONS

Results may have implications for regulatory and prevention strategies to reduce the population burden of cannabis use and related harms.

Face-evoked thoughts

The thoughts that come to mind when viewing a face depend partly on the face and partly on the viewer. This basic interaction raises the question of how much common ground there is in face-evoked thoughts, and how this compares to viewers' expectations. Previous analyses have focused on early perceptual stages of face processing. Here we take a more expansive approach that encompasses later associative stages. In Experiment 1 (free association), participants exhibited strong egocentric bias, greatly overestimating the extent to which other people's thoughts resembled their own. In Experiment 2, we show that viewers' familiarity with a face can be decoded from their face-evoked thoughts. In Experiment 3 (person association), participants reported who came to mind when viewing a face-a task that emphasises connections in a social network rather than nodes. Here again, viewers' estimates of common ground exceeded actual common ground by a large margin. We assume that a face elicits much the same thoughts in other people as it does in us, but that is a mistake. In this respect, we are more isolated than we think.

Overestimation of Prescription Pain Reliever Misuse and Heroin Use among Adults

Estimates from the National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019) suggest 3.6% of persons aged 12 and older misused prescription pain relievers in the past year and 0.3% used heroin. However, research suggests that most individuals drastically overestimate rates of substance use and misuse. Those who overestimate substance misuse are often more likely to misuse substances themselves (Kilmer et al., 2015; McCabe, 2008). Purpose: To compare perceived versus actual rates of prescription pain reliever misuse and heroin use among a statewide sample of adults and identify correlates of these differences. Methods: Participants (N = 689) recruited through social media estimated rates of prescription pain reliever misuse and heroin use. Participants also indicated whether they engaged in pain reliever misuse or heroin use, and whether they knew anyone who misused prescription pain medications or heroin. Results: Almost all participants (98.11%) overestimated the prevalence of prescription pain reliever misuse (mean estimate = 41.25%) and heroin use (99.71%, mean estimate =25.46%). Women and African Americans were more likely to overestimate prescription pain reliever misuse and heroin use. Knowing someone who misused prescription pain relievers was significantly associated with overestimating prescription pain reliever misuse. Personal use was not associated with overestimating prevalence of either substance. Conclusions: Adults consistently overestimate rates of prescription pain reliever misuse and heroin use. Overestimation may increase normative perceptions of substance use and ultimately lead to increased substance use. Social-norms based education and interventions may be particularly important among groups that are more likely to overestimate use.

Drug Use-Related Normative Misperceptions and Behaviors Among Persons Seeking Heroin Withdrawal Management

OBJECTIVE

Normative perceptions about substance use are well-established predictors of substance use risk behaviors, yet no research to date has examined how people who use heroin perceive the drug use behaviors and their association with personal behaviors. In a sample of persons seeking heroin withdrawal, we compared normative beliefs (descriptive norms) about others' drug use behaviors, and examined the association between normative beliefs and behaviors.

METHOD

Participants (n = 241) were patients undergoing short-term inpatient heroin withdrawal management in Massachusetts. t-Tests were used to compare participants' perceptions about various substance use behaviors among both US adults and persons seeking heroin withdrawal at the same site. We also examined associations between participants' normative beliefs and personal substance use behaviors.

RESULTS

Participants significantly overestimated drug-related risk behaviors of adults nationally; overall, participants estimated that 44.7% had tried heroin, 37.6% had injected drugs in the past year, and 63.2% had smoked marijuana in the past month when actual national rates are 2.0%, 0.3%, and 5.5%, respectively. Participants also held significant misperceptions about contemporaneous patients in the heroin withdrawal program; behaviors about sharing works, diverting buprenorphine or methadone, and exchanging sex for drugs or money were most substantially overestimated. Normative perceptions were associated with a range of personal drug-using behaviors (eg, injection drug use, exchanging sex for drugs or money).

CONCLUSIONS

Consistent with existing substance use norms research, participants in the current sample tended to overestimate others' engagement in risky substance use, and these normative perceptions were associated with increased personal risk. Leveraging norms in heroin harm reduction interventions may hold substantial promise.

Using social network analysis to examine alcohol use among adults: A systematic review

Background

Alcohol use and abuse constitute a major public health problem and identifying their determinants is a priority. Social network analysis can indicate how characteristics of social networks are related to individual health behaviors. A growing number of studies have used social network analysis to examine how social network characteristics influence adult alcohol consumption, but this literature has never been systematically reviewed and summarized. The current paper systematically reviews empirical studies that used social network analysis to assess the influence of social network characteristics on drinking behaviors in adults.

Methods

A literature search of PubMed/MEDLINE, EMBASE, PsycINFO and Web of Science databases and a review of the reference lists of retrieved articles was conducted in March 2019. Two reviewers independently screened 5,510 non-duplicate records, and further screened the full text of 150 articles to determine their eligibility for inclusion. Seventeen articles were judged eligible and included.

Results

Most studies were conducted among young adults (mean age<30), in university settings or follow up visits with adolescent networks moving into adulthood. The objectives and methods of the included studies were heterogeneous. All included studies reported a statistically significant association between a social network characteristic and an alcohol consumption-related outcome. Social network members drinking behaviors were associated with participants’ drinking behaviors in multiple ways.

Discussion

In young adults, among whom the majority of identified studies were conducted, with whom they socialize and how they socialize appears to be associated with alcohol consumption; this was observed across methodologies and settings. We still know very little about the relationship of social networks to drinking in older age groups, and in populations most impacted by alcohol. As social networks appear to play a role in the consumption of alcohol in young adulthood, interventions that utilize social networks to help reduce harmful alcohol consumption should be considered.

The accuracy of young adult cannabis users' perceptions of friends' cannabis and alcohol use

OBJECTIVE

Understanding the complex influence of peers on young adult substance use is an important component of intervention research and is challenging methodologically. The false consensus theory suggests that individuals falsely attribute their own substance use behaviors onto others, producing biased data.

METHODS

We tested this theory with 39 young adults who had a cannabis use disorder and a mean age of 20. Participants (egos) recruited three of their close friends (alters). Egos reported their past 30-day cannabis and alcohol use and their perceptions of alters' use. Alters also reported their actual past 30-day cannabis and alcohol use.

RESULTS

Results demonstrated that egos were very accurate in their perceptions of the frequency of alters' cannabis (ρ = 0.82, p < 0.001) and alcohol (ρ = 0.74, p < 0.001) use. Linear regression models predicted alters' actual cannabis and alcohol use based on egos' perceptions of alters' use, controlling for egos' own substance use. Egos' perceptions of alters' cannabis use strongly predicted alters' actual use (β = 0.80, p < 0.001, adj-R² = 0.67), and egos' perceptions of alters' alcohol use also predicted alters' actual use (β = 0.66, p < 0.001, adj-R² = 0.62). Egos' own substance use did not predict alters' use in either model.

CONCLUSIONS

Results provide evidence that the false consensus theory may be limited when applied to young adults with cannabis use disorder within a close-friend research framework. The results support the hypothesis that young adults are very accurate in their perceptions of the frequency of close friends' substance use and that these perceptions are independent of egos' own use. These findings support the continued use of ego-centric reported close peer substance use for understanding peer effects.

Simultaneous Alcohol and Marijuana Use Among College Students: Patterns, Correlates, Norms, and Consequences

BACKGROUND

Alcohol and marijuana users often engage in simultaneous alcohol and marijuana (SAM) use (i.e., using the 2 substances together so that their effects overlap), which can result in more negative consequences than using either substance alone. Nevertheless, little is known about SAM use among contemporary college students to aid in the development of preventive interventions. This study examined SAM use patterns, demographic correlates of SAM use, and normative influences on SAM use and related negative consequences among college students.

METHODS

Students who had used alcohol and marijuana in the past year were recruited from 3 state universities in states with different laws regarding recreational marijuana use (N = 1,389). They completed an online survey, which assessed their own alcohol, marijuana, and SAM use and related consequences, their perceptions of the proportion of same-gender peers and close friends who engaged in SAM use, marijuana access, and demographic characteristics.

RESULTS

About three-fourths of participants reported at least 1 occasion of SAM use in the past year with an average frequency of twice per month among SAM users. There were significant differences in SAM use prevalence and frequency by sociodemographic characteristics controlling for past-year alcohol and marijuana frequency. Students in a state with decriminalized recreational marijuana use reported higher frequency of past-year SAM use than students in states with legalized or criminalized use. There were significant demographic differences in perceived norms regarding SAM use among close friends and same-gender peers. SAM users endorsed significantly higher perceived peer and friend norms than nonusers. Also, higher perceived norms predicted more frequent SAM use and more negative consequences of use.

CONCLUSIONS

Results indicate a need for prevention programs on college campuses that address SAM use. Interventions that use personalized normative feedback may be effective.

Disconfirmation modulates the neural correlates of the false consensus effect: A parametric modulation approach

The false consensus effect (FCE) - the tendency to (erroneously) project our attitudes and opinions onto others - is an enduring bias in social reasoning with important societal implications. In this fMRI investigation, we examine the neural correlates of within-subject variation in consensus bias on a variety of social and political issues. Bias demonstrated a strong association with activity in brain regions implicated in self-related cognition, mentalizing, and valuation. Importantly, however, recruitment of these regions predicted consensus bias only in the presence of social disconfirmation, in the form of feedback discrepant with participants' own attitudes. These results suggest that the psychological and neural mechanisms underlying the tendency to project attitudes onto others are crucially moderated by motivational factors, including the desire to affirm the normativity of one's own position. This research complements social psychological theorizing about the factors contributing to the FCE, and further emphasizes the role of motivated cognition in social reasoning.

Changing social norms: The impact of normative feedback included in motivational enhancement therapy on cannabis outcomes among heavy-using adolescents

INTRODUCTION

Heavy cannabis use is a problematic behavior, particularly among some adolescents. Adolescents are particularly prone to social influence. As such, injunctive norms (perceptions of others' approval of cannabis use) and descriptive norms (perception of frequency of others' cannabis use) influence cannabis behavior. Given that norms are not always accurate, motivational enhancement therapy aims to reduce cannabis use through normative feedback and correction of normative misconceptions. The purpose of this study was to evaluate the relationships between perceived norms (descriptive and injunctive) and cannabis-related outcomes (use, cannabis-related problems, and cannabis use disorder symptoms) in a heavy cannabis-using adolescent population receiving motivational enhancement therapy.

METHODS

Heavy cannabis-using individuals (n=252, 68% male, mean age 13.38, 59% Caucasian) were recruited from six Seattle high schools for a motivational enhancement therapy-based intervention involving normative feedback.

RESULTS

Participants perceived higher rates of cannabis use among close friends than other same age teens and reported a higher perception of approval for cannabis use from close friends as compared to perceived approval of other same aged peers. Personal approval and the perceived approval of other same age teens were reduced following the intervention but there was no evidence of change in normative perceptions for close friends following the normative feedback interventions. Changes in normative perceptions were related to decreases in cannabis use and -related outcomes.

CONCLUSIONS

Results suggest the importance of normative feedback in changing behavior in adolescent cannabis users, but also highlight the ongoing influence of close friends.

Perceived injunctive norms and cannabis-related problems: The interactive influence of parental injunctive norms and race

Cannabis use among college students is associated with negative consequences, including those that can negatively affect academic functioning. Perceived descriptive and injunctive norms are among the strongest predictors of college cannabis use and related problems, and perceived norms differentially relate to cannabis outcomes depending on the reference group (e.g., close friends, family members). However, no known studies have examined the effect of race on these relationships. Yet, given that African American students are more strongly affected by parental influence than Caucasian students and that they endorse more social motives for cannabis use, African American students may be affected by perceived norms regarding parents and friends differentially from Caucasian students. The current study tested the moderational role of race on the relationship between perceived norms and cannabis use and related problems. Cannabis-using undergraduates (N = 103; 78.6% female) completed an online survey. Race moderated the relationship between injunctive norms regarding parents and cannabis-related problem severity such that among African American students (but not Caucasian students), endorsement of more permissive perceived parental injunctive norms was related to greater cannabis-related problem severity (but not cannabis use frequency). Interactions were not significant between race and descriptive norms or between race and peer injunctive norms. African American students who perceive that their parents are more accepting of cannabis use may be especially at risk for cannabis-related problems. Results underscore the importance of considering cultural factors in identification of vulnerability factors related to cannabis problems.

College Student Drug Prevention: A Review of Individually-Oriented Prevention Strategies

The current paper highlights the college years as a risk period for development, continuation, and escalation of illicit substance use and substance use disorders and reviews the literature related to the prevention and treatment of these disorders in college populations. Despite widespread implementation of college drug prevention programs, a review of the literature reveals few controlled trials targeting this population. However, alcohol prevention has been extensively studied, and many efficacious interventions for college drinking share theoretical and methodological underpinnings with interventions shown to be efficacious in drug prevention and treatment with other populations (i.e., school-based prevention, adolescent and adult drug treatment). These interventions could be adapted to target drug prevention on college campuses. Barriers to implementation and evaluation of these interventions on campus are discussed, and suggestions are made for future research and programmatic directions.

Longitudinal Relationships Among Perceived Injunctive and Descriptive Norms and Marijuana Use

OBJECTIVE

The current study uses longitudinal data to examine the relative influence of perceived descriptive and injunctive norms for proximal and distal referents on marijuana use.

METHOD

Participants were 740 undergraduate students (67% female) who completed web-based surveys at two time points 12 months apart. Time 1 measures included reports of marijuana use, approval, perceived descriptive norms, and perceived injunctive norms for the typical student, close friends, and parents. At Time 2, students reported on their marijuana use.

RESULTS

Results of a path analysis suggest that, after we controlled for Time 1 marijuana use, greater perceived friend approval indirectly predicted Time 2 marijuana use as mediated by personal approval. Greater perceived parental approval was both indirectly and directly associated with greater marijuana use at follow-up. Perceived typical-student descriptive norms were neither directly nor indirectly related to Time 2 marijuana use.

CONCLUSIONS

The findings support the role of proximal injunctive norms in predicting college student marijuana use up to 12 months later. The results indicate the potential importance of developing normative interventions that incorporate the social influences of proximal referents.

Prevalence and determinants of resistance to use drugs among adolescents who had an opportunity to use drugs

BACKGROUND

As drugs remain ubiquitous and their use increasingly viewed as socially normative, vulnerable population groups such as adolescents face continued and growing risk. A better understanding of the factors that discourage individuals from initiating drug use, particularly in enabling scenarios, is therefore needed. This study aims to identify individual, interpersonal and school-contextual factors associated with resistance to using drugs in the presence of a drug use opportunity among adolescents in Bogotá, Colombia.

METHODS

Data are analyzed from 724 school-attending adolescents (15.1 years, SD=1.3) who have had an opportunity to use drugs. Schools were selected in a multistage probability cluster sample. Random intercept multilevel logistic regression models were implemented to estimate the effect of individual, interpersonal and school-contextual level variables on the likelihood of resisting using drugs.

RESULTS

Drug use resistance was observed in less than half (41.4%) of those students who experienced an opportunity to use drugs. Drug use resistance was strongly associated with having experienced a passive drug use opportunity (AOR = 3.1, 95% CI = 2.0, 4.9), the number of drugs offered (AOR = 0.7, 95% CI = 0.6, 0.8) and family factors such as not having a drug-using first-degree relative (AOR = 2.3, 95% CI=1.2, 4.3) and a high degree of parental supervision (AOR = 1.9, 95% CI = 1.0, 3.2).

CONCLUSIONS

A large proportion of students who experienced a drug-use opportunity did not initiate drug use despite living in a context of high drug availability and social disorganization. The findings highlight the need for effective family-based drug use prevention interventions within the Colombian context.

Illicit substance use among university students from seven European countries: a comparison of personal and perceived peer use and attitudes towards illicit substance use

OBJECTIVE

To compare European students' personal use and approval of illicit substance use with their perceptions of peer behaviours and attitudes, and investigate whether perceptions of peer norms are associated with personal use of illicit substances and attitudes.

METHOD

This study used baseline data from the Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project involving 4482 students from seven European countries in 2012. Students completed an online survey which included questions on personal and perceived peer illicit substance use and personal and perceived peer attitude towards illicit substances.

RESULTS

8.3% of students reported having used illicit substances at least once in their life. 49.7% of students perceived that the majority of their peers have used illicit substances more frequently than themselves. The perception was significantly associated with higher odds for personal illicit substance use (OR: 1.97, 95% CI: 1.53-2.54). The perception that the majority of peers approve illicit substance use was significantly associated with higher odds for personal approval of illicit substance use (OR: 3.47, 95% CI: 2.73-4.41).

CONCLUSION

Students commonly perceived that their peers used illicit subtances more often than themselves. We found an association between the perceived peer norms/attitudes and reported individual behaviour/attitudes.

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.

Cannabis use behaviors and social anxiety: the roles of perceived descriptive and injunctive social norms

OBJECTIVE

Individuals with greater social anxiety are particularly vulnerable to cannabis-related impairment. Descriptive norms (beliefs about others' use) and injunctive norms (beliefs regarding others' approval of risky use) may be particularly relevant to cannabis-related behaviors among socially anxious persons if they use cannabis for fear of evaluation for deviating from what they believe to be normative behaviors. Yet, little research has examined the impact of these social norms on the relationships between social anxiety and cannabis use behaviors.

METHOD

The current study investigated whether the relationships of social anxiety to cannabis use and use-related problems varied as a function of social norms. The sample comprised 230 (63.0% female) current cannabis-using undergraduates.

RESULTS

Injunctive norms (regarding parents, not friends) moderated the relationship between social anxiety and cannabis-related problem severity. Post hoc probing indicated that among participants with higher (but not lower) social anxiety, those with greater norm endorsement reported the most severe impairment. Injunctive norms (parents) also moderated the relationship between social anxiety and cannabis use frequency such that those with higher social anxiety and lower norm endorsement used cannabis less frequently. Descriptive norms did not moderate the relationship between social anxiety and cannabis use frequency.

CONCLUSIONS

Socially anxious cannabis users appear to be especially influenced by beliefs regarding parents' approval of risky cannabis use. Results underscore the importance of considering reference groups and the specific types of norms in understanding factors related to cannabis use behaviors among this vulnerable population.

Perception of tobacco, cannabis, and alcohol use of others is associated with one's own use

Background

Interventions have been developed to reduce overestimations of substance use among others, especially for alcohol and among students. Nevertheless, there is a lack of knowledge on misperceptions of use for substances other than alcohol. We studied the prevalence of misperceptions of use for tobacco, cannabis, and alcohol and whether the perception of tobacco, cannabis, and alcohol use by others is associated with one’s own use.

Methods

Participants (n = 5216) in a cohort study from a census of 20-year-old men (N = 11,819) estimated the prevalence of tobacco and cannabis use among peers of the same age and sex and the percentage of their peers drinking more alcohol than they did. Using the census data, we determined whether participants overestimated, accurately estimated, or underestimated substance use by others. Regression models were used to compare substance use by those who overestimated or underestimated peer substance with those who accurately estimated peer use. Other variables included in the analyses were the presence of close friends with alcohol or other drug problems and family history of substance use.

Results

Tobacco use by others was overestimated by 46.1% and accurately estimated by 37.3% of participants. Cannabis use by others was overestimated by 21.8% and accurately estimated by 31.6% of participants. Alcohol use by others was overestimated by more than half (53.4%) of participants and accurately estimated by 31.0%. In multivariable models, compared with participants who accurately estimated tobacco use by others, those who overestimated it reported smoking more cigarettes per week (incidence rate ratio [IRR] [95% CI], 1.17 [range, 1.05, 1.32]). There was no difference in the number of cigarettes smoked per week between those underestimating and those accurately estimating tobacco use by others (IRR [95% CI], 0.99 [range, 0.84, 1.17]). Compared with participants accurately estimating cannabis use by others, those who overestimated it reported more days of cannabis use per month (IRR [95% CI], 1.43 [range, 1.21, 1.70]), whereas those who underestimated it reported fewer days of cannabis use per month (IRR [95% CI], 0.62 [range, 0.23, 0.75]). Compared with participants accurately estimating alcohol use by others, those who overestimated it reported consuming more drinks per week (IRR [95% CI], 1.57 [range, 1.43, 1.72]), whereas those who underestimated it reported consuming fewer drinks per week (IRR [95% CI], 0.41 [range, 0.34, 0.50]).

Conclusions

Perceptions of substance use by others are associated with one’s own use. In particular, overestimating use by others is frequent among young men and is associated with one’s own greater consumption. This association is independent of the substance use environment, indicating that, even in the case of proximity to a heavy-usage group, perception of use by others may influence one’s own use. If preventive interventions are to be based on normative feedback, and their aim is to reduce overestimations of use by others, then the prevalence of overestimation indicates that they may be of benefit to roughly half the population; or, in the case of cannabis, to as few as 20%. Such interventions should take into account differing strengths of association across substances.

College cannabis use: the unique roles of social norms, motives, and expectancies

OBJECTIVE

Given that the majority of college cannabis use occurs in social situations, descriptive norms (beliefs about others' use) and injunctive norms (others' approval of risky use) may be particularly relevant to cannabis-related behaviors. Yet, little research has examined the unique impact of these norms on one's own behaviors when accounting for the variance attributable to other relevant cognitive factors. The current study is the first known investigation of the unique impact of social norms, cannabis use motives, and cannabis effect expectancies on cannabis use.

METHOD

Data came from 223 (64.1% female) current cannabis-using undergraduates who completed an online questionnaire in exchange for psychology-course research credit.

RESULTS

Descriptive norms regarding friends (not students in general) and injunctive norms (friends and parents) were related to cannabis use frequency. Descriptive norms (friends, not students in general) and injunctive norms (friends, not parents) were related to cannabis problems. Relevant norms, expectancies, and motives accounted for 66.8% of the variance in cannabis use frequency and 28.7% of the variance in cannabis problems. In multivariate analyses, descriptive norms (friends) accounted for the greatest amount of unique variance in cannabis use frequency, whereas coping motives accounted for the greatest amount of unique variance in cannabis-related problems.

CONCLUSIONS

Descriptive norms (friends) and coping motives may be two cognitive vulnerability factors that could be particularly important targets for interventions.

Online network influences on emerging adults' alcohol and drug use

Researchers have reported that network characteristics are associated with substance use behavior. Considering that social interactions within online networks are increasingly common, we examined the relationship between online network characteristics and substance use in a sample of emerging adults (ages 18-24) from across the United States (N = 2,153; M = 21 years old; 47% female; 70% White). We used regression analyses to examine the relationship between online ego network characteristics (i.e., characteristics of individuals directly related to the focal participant plus the relationships shared among individuals within the online network) and alcohol use and substance use, respectively. Alcohol use was associated with network density (i.e., interconnectedness between individuals in a network), total number of peer ties, and a greater proportion of emotionally close ties. In sex-stratified models, density was related to alcohol use for males but not females. Drug use was associated with an increased number of peer ties, and the increased proportion of network members' discussion and acceptance of drug use, respectively. We also found that online network density and total numbers of ties were associated with more personal drug use for males but not females. Conversely, we noted that social norms were related to increased drug use and this relationship was stronger for females than males. We discuss the implications of our findings for substance use and online network research.

The influence of uncertainty and social support on information seeking concerning illicit stimulant use among young adults

Using the Theory of Motivated Information Management (TMIM) and the concept of desired informational support as a framework, this project examined factors in the information management process young adults employ in potential information seeking about illicit stimulant drug use with members of their social networks. One hundred and seventy-three individuals participated in the study. Results indicated that (a) uncertainty discrepancy and the desire for informational support covaried, and (b) uncertainty discrepancy, anxiety, and outcome expectancy had significant impacts on the efficacy judgments made by individuals with regard to potential information seeking with their social networks about their stimulant drug use. The study thus provides further evidence for the utility of TMIM as a framework for understanding health communication in regard to drug use, and suggests that desired informational support may be a useful addition to the model for this health issue.

Sexual assault programming on college campuses: using social psychological belief and behavior change principles to improve outcomes

Sexual assault programming is often delivered without a theoretical framework and does not typically utilize applicable research that could help to induce change among participants. Such interventions may target male and/or female students, although the focus of this review is on men. It is important to examine these programs in light of current theoretical knowledge and empirical findings from the social psychological attitudinal and behavioral change literatures. To this end, current programming efforts and their limitations are briefly reviewed. Three social psychological theories targeting belief and behavior change (i.e., social norms, hypocrisy salience, decision, and deterrents) are discussed and their application to such programming is elaborated. Given this information, recommendations for the research and practice of such interventions are provided.

Elite athletes' estimates of the prevalence of illicit drug use: evidence for the false consensus effect

INTRODUCTION AND AIMS

The false consensus effect (FCE) is the tendency for people to assume that others share their attitudes and behaviours to a greater extent than they actually do. The FCE has been demonstrated for a range of health behaviours, including substance use. The study aimed to explore the relationship between elite athlete's engagement in recreational drug use and their consensus estimates (the FCE) and to determine whether those who engage in the behaviour overestimate the use of others around them.

DESIGN AND METHOD

The FCE was investigated among 974 elite Australian athletes who were classified according to their drug use history.

RESULTS

Participants tended to report that there was a higher prevalence of drug use among athletes in general compared with athletes in their sport, and these estimates appeared to be influenced by participants' drug use history. While overestimation of drug use by participants was not common, this overestimation also appeared to be influenced by athletes' drug use history.

DISCUSSION AND CONCLUSIONS

The results suggest that athletes who have a history of illicit drug use overestimate the prevalence of drug use among athletes. These findings may be helpful in the formulation of normative education initiatives.

Effects of risk perception of marijuana use on marijuana use and intentions to use among adolescents in Bogotá, Colombia

BACKGROUND

Perceived risk is a key concept of behavioral theories used to predict substance use among youth and a core component of drug use prevention interventions. The present study aimed to (1) assess degrees of risk perception of regular marijuana use, (2) identify factors associated with risk perception, and (3) explore the associations between perceived risk and marijuana use and intentions to use marijuana among school-attending adolescents in Bogotá, Colombia.

METHODS

Data from 2079 standardized questionnaires administered in 23 schools were analyzed in this study. Schools were selected in a multi-stage probability cluster sample to reflect the socio-economic characteristics of Bogotá's student population.

RESULTS

Just over 11% of participants perceived regular marijuana use to be a low risk behavior. Older age (>16 years) (adjusted odds ratio=2.9; 95% confidence interval=1.4-6.0) and low level of knowledge regarding the physical and psychological harms of illegal drugs (AOR=2.9; 95%CI=2.0-4.3) were the strongest predictors of low risk perception, Low perceived risk was also significantly associated with ever having used marijuana (AOR=2.5; 95%CI=1.7-3.7), monthly marijuana use among ever marijuana users (AOR=2.7; 95%CI=1.4-5.0), and a positive intention to use marijuana within the next 12 months among non-users (AOR=2.1; 95%CI=1.4-3.5).

CONCLUSIONS

Consistent with previous findings, perceiving regular marijuana use as a risky behavior functions as a protective factor against the intention to use, use and occasional use of marijuana. Incorporation of this message into drug use prevention activities for non-users and early-stage users may enhance their effectiveness.

[Perceived norms among Honduran university students about peers and tobacco, alcohol, marijuana and cocaine use]

The purpose of this study was to assess the difference between perceived norms and peers' drug use among sophomore and junior university students (from the field of education) aged 18 to 24 years. The Social Norms Theory was used as the theoretical framework. In total, 286 students participated in the study, 67% of which reported having consumed alcohol at least once in a lifetime and 28% stated being daily users. Students perceived that 62% of their peers used tobacco and 63% used alcohol. The perceived norm for drug use was slightly higher in women than in men. In conclusion, there is an overestimation between the perceived norm and use of alcohol, tobacco, marijuana and cocaine.

Peer substance use overestimation among French university students: a cross-sectional survey

Background

Normative misperceptions have been widely documented for alcohol use among U.S. college students. There is less research on other substances or European cultural contexts. This study explores which factors are associated with alcohol, tobacco and cannabis use misperceptions among French college students, focusing on substance use.

Methods

12 classes of second-year college students (n = 731) in sociology, medicine, nursing or foreign language estimated the proportion of tobacco, cannabis, alcohol use and heavy episodic drinking among their peers and reported their own use.

Results

Peer substance use overestimation frequency was 84% for tobacco, 55% for cannabis, 37% for alcohol and 56% for heavy episodic drinking. Cannabis users (p = 0.006), alcohol (p = 0.003) and heavy episodic drinkers (p = 0.002), are more likely to overestimate the prevalence of use of these consumptions. Tobacco users are less likely to overestimate peer prevalence of smoking (p = 0.044). Women are more likely to overestimate tobacco (p < 0.001) and heavy episodic drinking (p = 0.007) prevalence. Students having already completed another substance use questionnaire were more likely to overestimate alcohol use prevalence (p = 0.012). Students exposed to cannabis prevention campaigns were more likely to overestimate cannabis (p = 0.018) and tobacco use (p = 0.022) prevalence. Other identified factors are class-level use prevalences and academic discipline.

Conclusions

Local interventions that focus on creating realistic perceptions of substance use prevalence could be considered for cannabis and alcohol prevention in French campuses.

Rethinking equal access: agency, quality, and norms

In 2005 the Global Health Council convened healthcare providers, community organizers, policymakers and researchers at Health Systems: Putting Pieces Together to discuss health from a systems perspective. Its report and others have established healthcare access and quality as two of the most important issues in health policy today. Still, there is little agreement about what equal access and quality mean for health system development. At the philosophical level, few have sought to understand why differences in healthcare quality are morally so troubling. While there has been considerable work in medical ethics on equal access, these efforts have neglected health agency (individuals' ability to work toward health goals they value) and health norms, both of which influence individuals' ability to be healthy. This paper argues for rethinking equal access in terms of an alternative ethical aim: to ensure the social conditions in which all individuals have the capability to be healthy. This perspective requires that we examine injustices not just by the level of healthcare resources, but by the: (1) quality of those resources and their capacity to enable effective health functioning; (2) extent to which society supports health agency so that individuals can convert healthcare resources into health functioning; and (3) nature of health norms, which affect individuals' efforts to achieve functioning.

University students' perceived norms of peers and drug use: a multicentric study in five Latin American countries

This cross-sectional study compared perceived peer drug use and actual drug use in a sample of Latin American university students. Students from nine universities in five countries (Brazil, Chile, Colombia, Honduras and Peru) completed a questionnaire that addressed the use of tobacco, alcohol, marijuana and cocaine. Analysis focused on comparing perceptions to actual drug use. The findings largely, but not completely, confirmed the idea that students overestimate peer drug use. The unexpected findings were those relating to alcohol. While students generally overestimated peer use of tobacco, marijuana and cocaine, they accurately estimated or underestimated peer use of alcohol. Apart from the anomalous findings with regard to alcohol, this study shows that perceived drug use relates to actual drug use in Latin America as it does elsewhere. The results also support the suggestion that interventions using normative feedback would be useful to strengthen drug use prevention programs aimed at youth in Latin America.

Normas percibidas por los estudiantes universitarios acerca de sus pares y el uso de drogas en Bogotá, Colombia

Este estudio tuvo como objetivo estimar la diferencia entre las normas percibidas sobre uso de drogas en universitarios y sus pares, entre 18 a 24 años, de las áreas de salud y educación. Se trata de un estudio transversal, por encuesta y cuestionario autoaplicado anónimo. Participaron 365 estudiantes. En el último año, la proporción de consumo real de tabaco fue 43,6%, de alcohol 96,2%, de marihuana 8,2%; y 2,2%, de cocaína. La norma percibida de la proporción de consumo de tabaco el último año fue 78,9%, alcohol 88,3%, marihuana 35,4% y 20,9% cocaína. La proporción de consumo real de alcohol entre los estudiantes y la norma percibida por ellos estuvieron muy próximas; para el tabaco, marihuana y cocaína la percepción estuvo sobreestimada. De las drogas de acceso fácil o muy fácil en el campus, se encontró una subestimación para cigarrillo y cocaína, y sobreestimación para marihuana. Se concluye que los universitarios sobrestiman el consumo de tabaco, marihuana y cocaína, parte de sus pares, y tienen una percepción exacta del consumo de alcohol. La sustancia de consumo más sobreestimada de los últimos doce meses fue el tabaco.

Percepção dos estudantes universitários sobre o consumo de drogas entre seus pares no ABC Paulista, São Paulo, Brasil

O objetivo deste estudo foi analisar a relação entre o uso de drogas e as normas percebidas pelos estudantes universitários entre seus pares. Trata-se de estudo transversal, baseado em um censo. Foram avaliados todos os estudantes dos 2 e 3 anos dos cursos de medicina e enfermagem. O projeto incluiu estudantes entre 18 e 24 anos da Faculdade de Medicina do ABC, em Santo André, Brasil. Os estudantes foram convidados a, voluntariamente, responder um questionário que avalia, entre outras variáveis, consumo próprio de drogas e percepção sobre o uso dos pares. Houve participação de 274 estudantes. A fim de analizar os dados, foi utilizado o pacote SPSS e técnicas descritivas, incluindo-se frequências e médias. Houve superestimativa da percepção do consumo de drogas em relação à frequência descrita de uso próprio pelos estudantes.

Normas percibidas por estudiantes peruanos acerca de sus pares y el uso de drogas

El objetivo de este estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por sus pares y el uso real de drogas entre universitarios, entre 18 y 24 años, de las áreas de salud. Se trata de un estudio transversal, basado en un censo y en un cuestionario anónimo y autoaplicado. Participaron 306 estudiantes (82%). La proporción del consumo, en el último año, fue de 51,3% para el tabaco, 90,8% para el alcohol, 5,9% para la marihuana y 0,7% para la cocaína. Se observó una diferencia entre la norma percibida de consumo y la proporción de uso real informado para el tabaco (70% vs. 51.3%), marihuana (10% vs. 5.9%) y cocaína (8.3% vs. 0.7%). Se concluye que los universitarios sobrestiman el consumo de tabaco, marihuana y cocaína de sus pares.

Comparing entering freshmen's perceptions of campus marijuana and alcohol use to reported use

Use of marijuana and alcohol among current college students (N = 1101) was compared to the perceptions and use of entering freshmen (N = 481) surveyed before the start of classes. Entering freshmen significantly misperceived campus norms for marijuana use, over-estimating that almost every student used in the last 30 days, p <.001. Perceptions of alcohol use were relatively accurate. These discrepancies in perception could account for why 40.5% of entering students perceived the campus atmosphere to be promoting marijuana use, whereas only 16.2% perceived the campus atmosphere to be promoting alcohol use. How these misperceptions of social norms might be influenced by the reputation of the campus-and how this might affect potential applicants and enrolled students' behaviors are discussed.

Consumo percibido y uso de drogas lícitas e ilícitas en estudiantes universitarios en la Ciudad de Medellín, Colombia

El propósito de este estudio fue estimar la diferencia entre el consumo percibido en los pares y el uso real de drogas que tienen los estudiantes universitarios de segundo y tercer año, entre 18 y 24 años de edad, de una universidad pública en la ciudad de Medellín, Colombia. Se trata de un estudio descriptivo transversal basado en una encuesta. Todos los estudiantes de segundo y tercer año de las facultades de Medicina, Odontología, Enfermería y Salud Publica fueron invitados a responder un cuestionario anónimo. Participaron 427 estudiantes. Se encontró una sobreestimacion del consumo de tabaco, marihuana y cocaina en los ultimos doce meses. El consumo de alcohol es percibido de manera exacta. Los estudiantes que consumieron drogas, en el periodo mencionado, sobreestiman más que los que no lo hicieron; también se encontró que las mujeres sobreestiman más que los hombres el consumo de marihuana.

An ecological system approach to adolescent smoking behavior

The aim of the present study was to simultaneously examine the effect of factors related to school, leisure, family and the individual on adolescent smoking. These determining factors occupy the micro- and mesosystems of Bronfenbrenner's Ecological Theory. Data were collected using questionnaires from a nationally representative sample of 15-year-olds (1404 pupils) and 73 staff members from 73 schools in Norway. Males formed 51% of the sample size. Consistent with previous studies, the various factors were linked to adolescent smoking when examined separately. However, in an ecological setting, factors related to the individual and leisure (i.e., attitudes towards smoking, perceived behavioural control and evenings with friends) emerged as the strongest predictors. School and family factors were completely mediated by individual and leisure factors, although when examined alone, they explained quite a substantial amount of the variance and a considerable amount of school difference in adolescent smoking. The implications are discussed.

Ethics in American health 2: an ethical framework for health system reform

I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination.

Enhancing prediction of inhalant abuse risk in samples of early adolescents: a secondary analysis

The theory of reasoned action (TRA) was used to estimate adolescents' vulnerability to inhalant abuse, operationalized by intentions to use or avoid inhalants. The model correctly differentiated 78% of all respondents (N=596). A second analysis highlighted variables that discriminated properly identified from misclassified youth. False positives, those defined as being at-risk, but who repudiated inhalants, were significantly less likely than their at-risk peers to have used inhalants; they used inhalants and marijuana less frequently; were monitored more closely by parents; and were less rebellious (all p<.05). False negatives, defined as not at-risk, but who had not unequivocally rejected inhalants, were significantly more likely than their similarly classed peers to have used inhalants and marijuana, and to have used both more frequently; also, they were less highly acculturated. This study reaffirmed the utility of the TRA and underscored factors that might improve classification accuracy. This approach may facilitate prevention efforts, and may be extrapolated to any context in which risk categorization is used as a basis for prevention or amelioration.

Misperceptions of non-medical prescription drug use: a web survey of college students

OBJECTIVES

This study compared undergraduate students' perceived versus actual prevalence rates of non-medical use of marijuana, prescription opioids and prescription stimulants.

METHODS

In 2005, a randomly selected sample of 3639 college students self-administered a Web survey regarding their substance use behaviors and attitudes (68% response rate).

RESULTS

The majority of undergraduate students overestimated the prevalence of non-medical use of prescription stimulants (70.2%) and prescription opioids (69.9%) and marijuana use (50.5%) among peers on their campus. The mean difference between perceived versus actual past-year use was considerably greater for non-medical use of prescription stimulants (mean difference=12.2, 95% CI=11.7-12.7) and prescription opioids (mean difference=8.8, 95% CI=8.3-9.2) than marijuana (mean difference=2.9, 95% CI=2.2-3.6). Multivariate regression analysis revealed overestimation of non-medical use of prescription drugs was significantly associated with gender and medical use of prescription drugs.

CONCLUSIONS

The findings provided strong evidence of misperception of non-medical prescription drug use among college students. Future research and prevention efforts should assess the impact of correcting misperceived norms on reducing non-medical prescription drug use.

Relative risks of adolescent and young adult alcohol use: the role of drinking fathers, mothers, siblings, and friends

The present study examined to what extent regular drinking of fathers, mothers, co-twins, siblings, and friends was related to adolescent regular drinking in three age groups: 12-15, 16-20 and 21-15-year olds. The sample consisted of 3760 twins (1687 boys, 2073 girls) with a mean age of 17.8 years. Data were based on twins' self-reported alcohol uses and reports about siblings' and friends' alcohol use, and on parents' self-reports. Results showed that generally in each of the three age groups, regular drinking of same-sex co-twins and friends posed the highest risk for regular drinking. Age differences indicated that these risks decreased with age. Irrespective of age, regular drinking of fathers and mothers posed the lowest risk. Findings were generally the same for males and females.

The Myth of Peer Influence in Adolescent Smoking Initiation

The widespread belief that peer influence is the primary cause of adolescent smoking initiation is examined and called into question. Correlational and longitudinal studies purporting to demonstrate peer influence are analyzed, and their limitations described. Qualitative interview studies of adolescent smoking initiation are presented as depicting the more complex role of the peer context. Finally, a new model of the role of peers in smoking initiation is offered, with an emphasis on how adolescents' characteristics lead to the selection of their friends, who then provide a peer context that may or may not support smoking.