The Theory of Planned Behavior and the Social Identity Approach: A New Look at Group Processes and Social Norms in the Context of Student Binge Drinking

Social identity and health-related behavior: A systematic review and meta-analysis

This paper examined the relationship between social identity and health-related behavior, exploring whether social identities are associated with multiple health-related behaviors or only specific ones, and whether this association varies on the type of social identity, the type of social identity measures or the expected relationship between identity and behavior. In a systematic review and meta-analysis we assessed whether the pattern of findings can be explained by the social identity approach. An extensive literature search was conducted in several databases including EBSCO-host and PubMed, using elaborate search terms related to social identity and health-related behavior. This resulted in 10728 potential articles, with 115 articles (with 248 effect sizes from 133 independent samples, N = 112.112) included in the meta-analysis. We found a small but positive overall association between social identification and health-related behavior, which was present for actual behavior, as well as for intention and attitudes. This association was stronger for health-related social identities, positive health-related behaviors, when the expected relationship was positive and when indirect social identity measures were used. However, not all findings could be explained by the social identity approach, indicating a need for further research to better understand the relationship between social identity and health-related behavior, in order to more effectively incorporate social identity into health interventions.

A Study of Reasons for Self-Disclosure on Social Media among Chinese COVID-19 Patients: Based on the Theory of Planned Behavior Model

BACKGROUND

With a massive population of internet users, China has witnessed a shift in the behavior of social media users towards the COVID-19 pandemic, transitioning from reticence to frequent sharing of information in response to changing circumstances and policy adjustments of the disease. This study aims to explore how perceived benefits, perceived risks, subjective norms, and self-efficacy influence the intentions of Chinese COVID-19 patients to disclose their medical history on social media, and thus to examine their actual disclosure behaviors.

METHODS

Based on the Theory of Planned Behavior (TPB) and Privacy Calculus Theory (PCT), a structural equation model was constructed to analyze the influence paths among perceived benefits, perceived risks, subjective norms, self-efficacy, and behavioral intentions to disclose medical history on social media among Chinese COVID-19 patients. A total of 593 valid surveys were collected via a randomized internet-based survey, which constituted a representative sample. Firstly, we used SPSS 26.0 to conduct reliability and validity analyses of the questionnaire, as well as the tests of demographic differences and correlations between variables. Next, Amos 26.0 was employed to construct and test the model fit degree, identify the relationships among latent variables, and conduct path tests.

RESULTS

Our findings revealed the following: (1) There were significant gender differences in the self-disclosure behaviors of medical history on social media among Chinese COVID-19 patients. (2) Perceived benefits had a positive effect on self-disclosure behavioral intentions (β = 0.412, p < 0.001); perceived risks had a positive effect on self-disclosure behavioral intentions (β = 0.097, p < 0.05); subjective norms had a positive effect on self-disclosure behavioral intentions (β = 0.218, p < 0.001); self-efficacy had a positive effect on self-disclosure behavioral intentions (β = 0.136, p < 0.001). (3) Self-disclosure behavioral intentions had a positive effect on disclosure behaviors (β = 0.356, p < 0.001).

CONCLUSIONS

Our study, by integrating TPB and PCT to examine the influencing factors of the self-disclosure behaviors among Chinese COVID-19 patients on social media, found that perceived risks, perceived benefits, subjective norms, and self-efficacy had a positive influence on the self-disclosure intentions of Chinese COVID-19 patients. We also found that self-disclosure intentions, in turn, positively influenced disclosure behaviors. However, we did not observe a direct influence of self-efficacy on disclosure behaviors. Our study provides a sample of the application of TPB in the context of social media self-disclosure behavior among patients. It also introduces a novel perspective and potential approach for individuals to address the feelings of fear and shame related to illness, particularly within the context of collectivist cultural values.

Educating Substance Use Treatment Center Providers on Tobacco Use Treatments Is Associated with Increased Provision of Counseling and Medication to Patients Who Use Tobacco

Tobacco use is the leading preventable cause of death in America and is elevated among patients with non-tobacco substance use disorders. Substance use treatment centers (SUTCs) do not commonly address their patients' tobacco use. Lack of knowledge on treating tobacco use with counseling and medication may be a barrier that underlies this inaction. A multi-component tobacco-free workplace program implemented in Texas SUTCs educated providers on treating tobacco use with evidence-based medication (or referral) and counseling. This study examined how center-level changes in knowledge from pre- to post-implementation (i.e., over time) affected center-level behavioral changes in providers' provision of tobacco use treatment over time. Providers from 15 SUTCs completed pre- and post-implementation surveys (pre N = 259; post N = 194) assessing (1) perceived barriers to treating tobacco use, specifically, a lack of knowledge on treating tobacco use with counseling or medication; (2) receipt of past-year education on treating tobacco use with counseling or medication; and (3) their intervention practices, specifically, the self-reported regular use of (a) counseling or (b) medication intervention or referral with patients who use tobacco. Generalized linear mixed models explored associations between provider-reported knowledge barriers, education receipt, and intervention practices over time. Overall, recent counseling education receipt was endorsed by 32.00% versus 70.21% of providers from pre- to post-implementation; the regular use of counseling to treat tobacco use was endorsed by 19.31% versus 28.87% from pre- to post-implementation. Recent medication education receipt was endorsed by 20.46% versus 71.88% of providers from pre- to post-implementation; the regular use of medication to treat tobacco use was endorsed by 31.66% versus 55.15% from pre- to post-implementation. All changes were statistically significant (ps < 0.05). High versus low reductions in the provider-reported barrier of "lack of knowledge on pharmacotherapy treatment" over time were a significant moderator of effects, such that SUTCs with high reductions in this barrier were more likely to report greater increases in both medication education receipt and medication treatment/referral for patients who use tobacco over time. In conclusion, a tobacco-free workplace program implementation strategy that included SUTC provider education improved knowledge and resulted in increased delivery of evidence-based treatment of tobacco use at SUTCs; however, treatment provision rates-in particular, offering tobacco cessation counseling-remained less than desirable, suggesting that barriers beyond lack of knowledge may be important to address to improve tobacco use care in SUTCs. Moderation results suggest (1) differences in the mechanisms underlying uptake of counseling education versus medication education and (2) that the relative difficulty of providing counseling versus providing medication persists regardless of knowledge gains.

The reciprocal relationship between social identity and adherence to group norms

Previous research has focused on how social identification influences people's adherence to group norms, but has rarely considered how norm adherence might in turn influence how strongly people identify with the group. We proposed a reciprocal relationship between social identification and norm adherence that is shaped by the salience of the social identity in question. Drawing on data from a longitudinal field study of young people attending a mass gathering (N = 661, 1239 unique observations), we used cross-lagged panel modelling across five timepoints to test the reciprocal relationship between social identification with friends and anticipated adherence to perceived drinking norms among friends before (T0), during (T1-T3), and after (T4) the event. Greater social identification at T1 significantly predicted greater norm adherence at T2 which, in turn, predicted greater social identification at T3. These bidirectional effects were only significant during the mass gathering event, when the referent social identity was salient and thus relevant and meaningful in the social context. Findings indicate a complex interplay between social identity and norm adherence that is context dependent and evolves over time. Not only does social identity promote norm adherence but also adherence to those same norms can reinforce a sense of connection to the group.

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.

Vaping identity in adolescent e-cigarette users: A comparison of norms, attitudes, and behaviors

INTRODUCTION

Using the tenets underlying social identity theory and the theory of planned behavior, the current study compared the perceptions, attitudes, and behaviors of e-cigarette users that reported vaping as self-defining ("vapers") compared to users that denied vaping was central to their identity ("non-vapers").

METHOD

Secondary analyses of data from the 2017-2018 California Student Tobacco Survey were utilized. A weighted, multivariable regression model (N = 82,217) compared the demographic characteristics, beliefs, and behaviors of vapers and non-vapers. A path analytic model examined whether norms and attitudes mediated the relationship between vaper identity and use behavior.

RESULTS

Self-identified sexual and/or gender minority youth were more likely to identify as vapers compared to heterosexual and cisgender respondents. Youth that identified as vapers viewed e-cigarette use as more normative, held more favorable attitudes (i.e., lower harm beliefs), used e-cigarettes more frequently and in greater quantities, were more likely to use fruit and mint flavored e-cigarettes, and were more likely to acquire e-cigarettes from commercial sellers (i.e., vape/tobacco shops; all p < 0.05). Additionally, descriptive norms and attitudes mediated the relationship between vaper identity and use frequency/quantity.

CONCLUSIONS

Differences in e-cigarette beliefs and behaviors were found for youth e-cigarette users that perceived vaping as self-defining versus those that did not view vaping as part of their self-concept. Future studies are needed to examine causal directionality between identity, norms, attitudes, and behavior. Tobacco control efforts might use these findings to further denormalize vaping using evidence-based media campaigns and policy implementation.

"I'll eat meat because that's what we do": The role of national norms and national social identification on meat eating

Through meat-eating choices, people are able to express their national social identification and adhere to broader cultural norms. The current research examines the relationship between people's perceptions of national descriptive and injunctive meat-eating norms and their national social identification, on the one hand, and their attitudes toward meat-eating and their intentions to eat meat, on the other hand. In a sample that includes American, British, and Australian participants, we observe that: (1) favorable attitudes toward meat eating are positively predicted by national injunctive but not descriptive norms, and (2) intentions to eat meat are positively predicted by national descriptive but not injunctive norms. National social identification positively predicts both attitudes and intentions. Intentions to eat meat were also predicted by a three-way interaction between descriptive and injunctive norms, and social identification. Alignment of relatively high descriptive and injunctive meat-eating norms predicted meat-eating intentions more than alignment of relatively low descriptive and injunctive norms. With normative misalignment, however, people began to rely on their national social identifications as a basis for meat-eating intentions. The data are discussed with reference to the impact of social factors in influencing meat consumption. Moreover, we consider the potential for national social identification to have a normative component of meat consumption independent of descriptive and injunctive norms. This work advances our understanding of meat consumption by revealing national-level normative and identity processes beyond more focused identities of, for example, an environmentalist, a health conscious person, or an animal rights activist.

The Theory of Planned Behavior: Selected Recent Advances and Applications

This editorial gives a brief introduction to the articles included in the thematic section of Europe's Journal of Psychology, which is devoted to selected recent advances and applications of the theory of planned behavior (TPB). The five contributions address two thematic streams: (1) adjustments and extensions of the original theory and (2) applications of the TPB in public health and the political sciences.