Explaining young adults' drinking behaviour within an augmented Theory of Planned Behaviour: temporal stability of drinker prototypes

Factors associated with risk behaviours towards hepatitis B among migrant workers: a cross-sectional study based on theory of planned behaviour

OBJECTIVES

Rural-to-urban migrant workers are susceptible to hepatitis B because of lack of self-protection awareness and social support. The aim of this study was to explore the factors influencing risk behaviours for hepatitis B among migrant workers based on the theory of planned behaviour (TPB).

DESIGN

A cross-sectional survey.

SETTING

Chongqing, China PARTICIPANT: Migrant workers PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were the TPB variables. The secondary outcomes were factors explored by logistic regressions which were associated with hepatitis B related risk behaviours and behavioural intentions (BI).

RESULTS

Of 1299 recruited migrant workers, 384 (29.56%) participants undertook risk behaviours related to hepatitis B virus infection in the 6 months prior to the survey, and 1111 (85.53%) migrant workers had the BI of doing so. Of 842 migrant workers who undertook sexual activities, 58.19% did not use condoms. Binary logistic regressions showed that migrant workers who were men (p<0.05), less educated (p<0.01), lacked hepatitis B knowledge (p<0.05) and of a young age (p<0.01), were more intent on conducting hepatitis B-related behaviours. Alcohol drinking (p<0.01) was also positively associated with hepatitis B risk. The scores of TPB variables, including attitude towards behaviour and subjective norms, were positively associated with BI when adjusted for sociodemographics (p<0.001). Meanwhile, experience of behaviour and regret feeling were positively associated with BI and actual behaviours (p<0.01 and p<0.05, respectively).

CONCLUSIONS

A considerable proportion of migrant workers undertake hepatitis B-related risk behaviours, and condoms are seldom used. Health education campaigns targeting the identified TPB variables may play a significant role in improving awareness of hepatitis B prevention among migrant workers, especially for those who are men, younger, alcohol drinkers, less educated and lacking hepatitis B knowledge.

The development of a dynamically tailored mobile alcohol intervention entitled ‘What Do You Drink’ to reduce excessive drinking among Dutch lower educated (MBO) students aged 16 to 24 years: An Intervention Mapping approach (Preprint)

Background

The high prevalence and adverse consequences of excessive drinking among lower-educated adolescents and young adults are public concerns in the Netherlands. Evidence-based alcohol prevention programs targeting adolescents and young adults with a low educational background are sparse.

Objective

This study aimed to describe the planned process for the theory- and evidence-based development, implementation, and evaluation of a dynamically tailored mobile alcohol intervention, entitled What Do You Drink (WDYD), aimed at lower-educated students from secondary vocational education and training (Middelbaar Beroepsonderwijs in Dutch).

Methods

We used intervention mapping as the framework for the systematic development of WDYD. It consists of the following six steps: assessing needs (step 1), formulating intervention objectives (step 2), translating theoretical methods into practical applications (step 3), integrating these into a coherent program (step 4), anticipating future implementation and adoption (step 5), and developing an evaluation plan (step 6).

Results

Reducing excessive drinking among Dutch lower-educated students aged 16 to 24 years was defined as the desired behavioral outcome and subdivided into the following five program objectives: make the decision to reduce drinking, set realistic drinking goals, use effective strategies to achieve drinking goals, monitor own drinking behavior, and evaluate own drinking behavior and adjust goals. Risk awareness, motivation, social norms, and self-efficacy were identified as the most important and changeable individual determinants related to excessive drinking and, therefore, were incorporated into WDYD. Dynamic tailoring was selected as the basic intervention method for changing these determinants. A user-centered design strategy was used to enhance the fit of the intervention to the needs of students. The intervention was developed in 4 iterations, and the prototypes were subsequently tested with the students and refined. This resulted in a completely automated, standalone native app in which students received dynamically tailored feedback regarding their alcohol use and goal achievement via multiple sessions within 17 weeks based on diary data assessing their alcohol consumption, motivation, confidence, and mood. A randomized controlled trial with ecological momentary assessments will be used to examine the effects, use, and acceptability of the intervention.

Conclusions

The use of intervention mapping led to the development of an innovative, evidence-based intervention to reduce excessive alcohol consumption among lower-educated Dutch adolescents and young adults. Developing an intervention based on theory and empirical evidence enables researchers and program planners to identify and retain effective intervention elements and to translate the intervention to new populations and settings. This is important, as black boxes, or poorly described interventions, have long been a criticism of the eHealth field, and effective intervention elements across mobile health alcohol interventions are still largely unknown.

Trial Registration

Netherlands Trial Registry NTR6619; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6619

Similarity to prototypical heavy drinkers and non-drinkers predicts AUDIT-C and risky drinking in young adults: prospective study

OBJECTIVE

The aim of the present study was to explore whether constructs within the Prototype Willingness Model (PWM) predicted risky drinking as measured by AUDIT-C, drinking harms and unplanned drunkenness in a sample of UK young adults. Previous studies exploring the PWM often do not use validated measures of alcohol consumption, and the outcomes of risky drinking are underexplored.

DESIGN

An online prospective study design with 4 week follow-up was employed and 385 young adults completed the study (M age = 21.76, SD = 3.39, 69.6% female; 85.2% students).

MAIN OUTCOME MEASURES

Intentions to get drunk, AUDIT-C, drinking harms experienced in the last 4 weeks, and unplanned drunkenness in the last 4 weeks.

RESULTS

Heavy and non-drinker prototype similarity predicted AUDIT-C, drinking harms and unplanned drunkenness when controlling for past behaviour and reasoned action pathway constructs. Intentions and willingness both mediated the relationship between prototype perceptions and AUDIT-C.

CONCLUSION

This study supports the use of the PWM in the prediction of AUDIT-C, drinking harms and unplanned drinking in a UK sample. Prototype perceptions influenced behaviour via both reasoned and reactive cognitions. Targeting similarity to heavy and non-drinker prototypes should be the focus of future interventions in this population.

Positive excessive drinker prototypes predict greater drinking and alcohol problems

OBJECTIVES

According to the prototype willingness model, risky behaviours such as heavy drinking may be influenced by images of others who engage in this behaviour. In this study, we examined whether college students' prototypes of an individual who frequently drinks "over the limit" were associated with their own alcohol consumption and experience of alcohol-related problems during their first 2 years in college.

METHODS

We assessed students' (N = 340) prototypes of excessive drinkers and their own alcohol consumption and problems at four time points, across their first 2 years in college. Along with examining the trajectory of prototypes, consumption, and problems, we tested whether prototypes significantly predicted consumption and problems across the 2 years. Additional analyses examined whether the predictive value of prototypes was unique from related variables including perceived descriptive norms, perceived injunctive norms, and peer pressure to drink alcohol.

RESULTS

Primary analyses indicated that more positive prototypes of an excessive drinker were significantly associated with greater alcohol consumption in both year 1 and year 2. More positive prototypes were also significantly associated with experiencing more alcohol-related problems in year 2. These findings held when controlling for perceived descriptive and injunctive norms, and peer pressure.

CONCLUSIONS

Findings further support the importance of drinker prototypes to one's own drinking behaviour. By examining prototypes over time and their relationship to alcohol-related problems, this study makes a novel contribution to the existing research. Statement of contribution What is already known on this subject? Perceived norms (beliefs about how much others drink and what they approve of) are associated with own drinking. Individuals construct "risk prototypes," or images of people who engage in risky behaviours like drinking alcohol. Positive risk prototypes of drinkers have been associated with own willingness to drink and subsequent drinking. What does this study add? This study shows the trajectory of drinker prototypes across the first 2 years of college. Findings highlight consistent patterns of positive associations between drinker prototypes and own drinking. More positive drinker prototypes are associated with a greater number of problems with alcohol.

Alcohol consumption, drinker identity, and quality of life among students: why there cannot be one prevention strategy for all

INTRODUCTION

The objective for this study was to combine drinking characteristics and two subjective measures, drinker identity and alcohol-related quality of life, i.e., negative impact of alcohol on quality of life, to determine relevant profiles for indicated prevention programs. In particular, we hypothesized that different profiles of students with high level of alcohol consumption exist when exploring subjectivity.

METHODS

We performed an online survey among 16,930 students. We collected sociodemographics and environmental data, including alcohol-related quality of life, drinker identity, and drinking characteristics. We performed a hierarchical clustering on principal components. We described all variables in each cluster and explored between clusters differences by Kruskal-Wallis tests.

RESULTS

We identified five clusters as regarding drinker identity, drinking characteristics, and alcohol-related quality of life. Among these five clusters, three clusters presented high drinking characteristics. A very vulnerable cluster showed high level of alcohol consumption, impact on quality of life and on academic results, and strong drinker identity. An egodystonic cluster showed high level of consumption, mild impact on quality of life and on academic results, but low drinker identity. A cluster seemed short-term super-adapted in heavy drinking environment, showing high level of alcohol consumption and drinker identity, but low impact on quality of life and on academic results (all between clusters p values < 0.001 with Kruskal-Wallis tests).

CONCLUSION

The subjective experience of students from these clusters was significantly different (p value < 0.001), and could explain some inadequacy of certain prevention strategies, considering binge drinker student as a homogeneous group. Prospective studies are needed to explore changes over time of these clusters.

Cool or Fool? The Association Between Drinker Prototypes and Alcohol Consumption Using Multiple Time-Point Diary Assessments in Adolescent Males

OBJECTIVES

There is still limited understanding of how different kinds of drinker prototypes are associated with adolescent drinking. This study uses the strengths of multiple time-point diary measures (enhanced validity of alcohol use measurement) to test the predictive value of abstainer, moderate and heavy drinker prototypes in social situations. We examined whether the favorability of these prototypes (i.e., "prototype evaluation"), the perceived similarity of these prototypes to one's self-image (i.e., "prototype similarity") assessed at baseline, and their interaction predict alcohol use assessed in social situations.

METHODS

Drinker prototypes were assessed in a baseline sample of 599 adolescents. Subsequently, a sample of 77 alcohol-using 16 to 18-year-old males reported their Friday and Saturday evening drinking behavior the next day during eight weeks (resulting in 495 daily measures). Alcohol use was assessed in the company of peers.

RESULTS

The more adolescents perceived themselves as similar to heavy drinker prototypes the higher their alcohol consumption in social situations. The more adolescents held favorable abstainer prototypes, the lower their alcohol consumption. The interaction between prototype evaluation and similarity was not significant.

CONCLUSIONS

By using a more reliable and valid method to assess adolescents' alcohol use, the present study showed that more "extreme" drinker prototypes (i.e., heavy drinker and abstainer prototypes) are most predictive of adolescent alcohol use in social situations. Increasing the perceived dissimilarity to heavy drinker prototypes and the favorability of abstainer prototypes may therefore be important targets in interventions aimed at reducing adolescents' alcohol consumption.

Drinkers' identification with varying alcohol consumption prototypes

INTRODUCTION AND AIMS

Efforts to reduce excessive alcohol consumption need to take into account drinkers' perceptions of their risk of alcohol-related harm. The aim of the present study was to profile adult Australian drinkers according to their self-identification with various drinker prototypes to determine the extent to which these prototypes are associated with perceived and actual risk of alcohol-related harm.

DESIGN AND METHODS

A large web panel provider disseminated an online survey to a national sample of 2168 drinkers aged 18+ years who consumed alcohol at least twice per month. Respondents reported whether they considered themselves to be a light, occasional, social, heavy or binge drinker. The nominated category was compared with perceived and actual risk of alcohol-related harm.

RESULTS

The prototype most commonly nominated by respondents was 'social drinker' (45%), and the least common was 'binge drinker' (7%). Although the heaviest drinkers in terms of actual reported consumption typically selected prototypes indicative of harmful consumption, many of those selecting prototypes indicative of moderate consumption were at risk of alcohol-related harm.

DISCUSSION AND CONCLUSIONS

Many adult drinkers may be unaware of their risk of alcohol-related harm. The results suggest that there may be a need to recalibrate Australian drinkers' perceptions of high-risk drinking. [Pettigrew S, Jongenelis MI, Pratt IS, Slevin T, Chikritzhs T. Drinkers' identification with varying alcohol consumption prototypes. Drug Alcohol Rev 2017;36:464-467].

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

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

Drinker prototype alteration and cue reminders as strategies in a tailored web-based intervention reducing adults' alcohol consumption: randomized controlled trial

BACKGROUND

Excessive alcohol use is a prevalent and worldwide problem. Excessive drinking causes a significant burden of disease and is associated with both morbidity and excess mortality. Prototype alteration and provision of a cue reminder could be useful strategies to enhance the effectiveness of online tailored interventions for excessive drinking.

OBJECTIVE

Through a Web-based randomized controlled trial, 2 strategies (ie, prototype alteration and cue reminders) within an existing online personalized feedback intervention (Drinktest) aimed to reduce adults' excessive drinking. It was expected that both strategies would add to Drinktest and would result in reductions in alcohol consumption by intrinsic motivation and the seizure of opportunities to act.

METHODS

Participants were recruited online and through printed materials. Excessive drinking adults (N=2634) were randomly assigned to 4 conditions: original Drinktest, Drinktest plus prototype alteration, Drinktest plus cue reminder, and Drinktest plus prototype alteration and cue reminder. Evaluation took place at 1-month posttest and 6-month follow-up. Differences in drinking behavior, intentions, and behavioral willingness (ie, primary outcomes) were assessed by means of longitudinal multilevel analyses using a last observation carried forward method. Measures were based on self-reports.

RESULTS

All conditions showed reductions in drinking behavior and willingness to drink, and increased intentions to reduce drinking. Prototype alteration (B=-0.15, P<.05) and cue reminder usage (B=-0.15, P<.05) were both more effective in reducing alcohol consumption than when these strategies were not provided. Combining the strategies did not produce a synergistic effect. No differences across conditions were found regarding intentions or willingness.

CONCLUSIONS

Although individuals' awareness of their cue was reasonable, their reported alcohol consumption was nevertheless reduced. Individuals appeared to distance their self-image from heavier drinking prototypes. Thus, prototype alteration and cue reminder usage may be feasible and simple intervention strategies to promote reductions in alcohol consumption among adults, with an effect up to 6 months.

TRIAL REGISTRATION

Nederlands Trial Register (NTR): 4169; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4169 (Archived by WebCite at http://www.webcitation.org/6VD2jnxmB).

Examining the role of abstainer prototype favorability as a mediator of the abstainer-norms-drinking-behavior relationship

Past research has indicated that peer influence is associated with risky health behaviors, such as alcohol and other substance use (e.g., Maxwell, 2002; Santor, Messervey, & Kusumakar, 2000). Specifically, research has indicated that believing that more of one's peers use alcohol predicts more favorable prototypes (risk images) of the typical alcohol user (Litt & Stock, 2011; Teunissen et al., 2014). However, it is unclear if this same relationship would hold when considering abstainer (i.e., people who do not use alcohol) cognitions. The primary goal of the present study was to determine whether normative perceptions of peer abstinence from alcohol predict alcohol consumption and whether this relationship is mediated by abstainer prototypes. Results from 2,095 college students (42% male) indicated that the relation between abstainer norms and drinking behavior was mediated by abstainer prototypes such that believing that more peers abstained from alcohol use predicted more favorable prototypes of the typical alcohol abstainer, which in turn predicted lower alcohol use. Results from this study provide important first steps to delineating the relationship between abstainer cognitions and alcohol use. (PsycINFO Database Record