The development of alcohol use and outcome expectancies among American Indian young adults: a growth mixture model

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

Purpose of Review

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

Recent Findings

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

Summary

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

PrEP risk perception and adherence among men who have sex with men: a prospective cohort study based on growth mixture model

BACKGROUND

It can be considered that pre-exposure prophylaxis (PrEP) risk perception is the negative experiences or concerns about taking PrEP. The aim of this study is to explore the longitudinal trajectory of PrEP risk perception among men who have sex with men (MSM) and its impact on adherence.

METHODS

Data related to PrEP risk perception and adherence were derived from a prospective cohort study in Western China from 2013 to 2015. Subjects were categorized into the time-driven, event-driven and blank control groups. Tenofovir disoproxil fumarate (TDF) was administered to subjects in the time-driven and event-driven groups, and all subjects were followed up every 12 weeks. The PrEP risk perception scale was constructed, and the growth mixture model (GMM) was used to classify longitudinal PrEP risk perception. The effect of different levels of PrEP risk perception on drug adherence was explored using generalized estimating equations (GEE) with relative risk (RR) and 95% confidence interval (CI).

RESULTS

The PrEP risk perception scale consists of 4 dimensions and 16 items with Cronbach's alpha = 0.828 and a good model fit. According to the GMM analysis, the subjects' PrEP risk perceptions were separated into two groups: a "high-risk perception group" (n = 133) and a "low-risk perception group" (n = 493), where the proportion of high levels of drug adherence were 57.89% and 68.35%, respectively (p = 0.024). High levels of PrEP risk perception in the MSM population hinder drug adherence (RR = 0.71, 95% CI 0.50 to 0.99, p = 0.046). The results of this study were validated in the subsequent PrEP projects conducted in 2019 to 2021.

CONCLUSION

This study demonstrates that high levels of PrEP risk perception in the MSM population are an obstacle to drug adherence, emphasizing the necessity of focusing on PrEP risk perception in this population and the value of its application in the current context.

The Altered Course of Learning: How Alcohol Outcome Expectancies Are Shaped by First Drinking Experiences

According to expectancy theory, outcome expectancies are first formed vicariously (through observing other people) and then through direct experience. This cohort-sequential longitudinal study explored these expectancy origins in 1,023 youths (52% female, ages 10.5-15.5 years at recruitment, M = 12.47 years, SD = 0.95). Discontinuous multilevel growth models described patterns of change in expectancies before and after the first experience of distinct drinking milestones (i.e., first sip, first full drink, first heavy-drinking situation). Youths' expectations for positive and negative drinking outcomes generally increased and decreased over adolescence, respectively, reflecting general developmental trends. Drinking experiences altered learning trajectories, however, reifying positive expectancies and invalidating negative expectancies at each milestone and altering the course of expectancy change thereafter. For positive outcome expectancies, the influence of direct experience on learning was stronger when drinking milestones were met at an earlier age. Conversely, invalidation of negative expectancies was stronger when the first-drink milestone was met at a later age.

Positive expectancies mediate the link between race and alcohol use in a sample of Native American and Caucasian college students

BACKGROUND

Though abundant research suggests that Native Americans report high rates of alcohol use and related consequences, little research has examined drinking patterns among Native American college students. It is possible that drinking rates for this group may differ from their non-college counterparts and also from those of Caucasian college students. The aim of this study was to examine whether alcohol use differs between Native American and Caucasian college students, and specifically whether alcohol expectancy effects mediate the relationship between race and drinking.

METHOD

Participants were 43 Native American and 87 Caucasian college students who reported on their positive and negative expectancy effects and past-6-month drinking.

RESULTS

Caucasians reported drinking significantly more alcohol and holding stronger positive expectancies. Bootstrapping mediational analysis with 95% confidence intervals indicated that positive but not negative expectancy effects mediated the relationship between race and past-6-month drinking.

CONCLUSIONS

This preliminary research is the first to examine expectancy effects as mediators of the relationship between Native American and Caucasian race and drinking. Further understanding of the differences in positive expectancy effects between groups may have important implications for prevention and treatment of alcohol use among Native American college students.

Outcome expectancies, descriptive norms, and alcohol use: American Indian and white adolescents

This study examined the relationships between adolescent alcohol use and outcome expectancies and descriptive norms for a sample of American Indian and white youth living on or near reservations. Three outcome expectancies proposed by the theory of normative social behavior (perceived benefits to self, perceived benefits to others, and anticipatory socialization) were examined. Survey data were collected from high school students in the 2009-2010, 2010-2011, and 2011-2012 school years. Stronger descriptive norms for use and higher perceived benefits to self from use were associated with alcohol use in the last month, drunkenness in the last month, and binge drinking. Perceived benefits to self also moderated the relationship between descriptive norms and both alcohol use in the last month and binge drinking, and the effect of descriptive norms on use became more robust as perceived benefits to self increased. Outcome expectancies of perceived benefits to others and anticipatory socialization did not moderate the relationship between norms and alcohol use. Implications for prevention are discussed.

Epidemiology and etiology of substance use among American Indians and Alaska Natives: risk, protection, and implications for prevention

BACKGROUND

The epidemiology and etiology of substance use and disorder in American Indian and Alaska Native (AI/AN) communities have received increasing attention over the past 25 years and accumulating evidence provides important insights into substance use patterns in these populations.

OBJECTIVES AND METHODS

We provide a descriptive sketch of the AI/AN population in the United States today, present a brief review of the literature on the epidemiology and etiology of substance use within these populations, and discuss key implications of this literature for prevention efforts.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Patterns of alcohol use and abuse in AI/AN populations are complex and vary across cultural groups, but alcohol clearly impacts both physical health and mental health within these communities. Tobacco use - and associated health consequences - is typically higher in these populations than among other US groups, although significant variation across Native communities is apparent here as with alcohol. Evidence regarding drug use and disorder is less extensive and thus less conclusive, but evidence demonstrates higher rates of use as well. Etiological explanations for substance use and disorder cut across individual characteristics (e.g., genetics) or experiences (e.g., exposure to trauma), to social contexts (e.g., family disruption), and to cultural factors (e.g., historical trauma). Protective factors likely cut across these multiple levels as well and deserve more focused attention for informing prevention efforts. The development of effective prevention strategies, built through collaboration between researchers and Native communities, drawing from the wisdom of both, is a high priority.

Negative urgency, problem drinking and negative alcohol expectancies among members from one First Nation: a moderated-mediation model

Problematic alcohol use is a major health concern for many Native communities in both Canada and the United States (Spillane & Smith, 2007, 2010; Spillane, Smith, & Kahler, in press). Because health disparities related to alcohol use are pronounced in this population (Beauvais, 1996; Whitesell et al., 2007), it is important to study factors that may contribute to risk for this set of problems. Alcohol expectancies represent a well known risk factor for alcohol use in non-Natives. This study sought to examine the relationship between negative urgency and negative alcohol expectancies, and to determine if this relationship is influenced by problem drinking behaviors. We hypothesized that negative urgency's effects on the development of negative alcohol expectancies would be mediated by negative urgency's influence to increase drinking behaviors in a First Nation sample (see Spillane & Smith, 2010). We also hypothesized that this relationship would be moderated by sex. We administered measures of alcohol use, negative urgency, and negative alcohol use expectancies to a total of 209 First Nation people (96 men; 113 women). Following the steps of moderated mediation outlined by Preacher, Rucker, and Hayes (2007), we found that the relationship between negative urgency and negative alcohol expectancies was significantly mediated by problem drinking for males (β=0.42, p<0.001), but not for females (β=0.13, p=0.32). The current study suggests that for males in this First Nation sample, negative urgency's effects on development of negative alcohol expectancies is mediated by problem drinking behavior.

Alcohol use trajectories and the ubiquitous cat's cradle: cause for concern?

In recent years, trajectory approaches to characterizing individual differences in the onset and course of substance involvement have gained popularity. Previous studies have sometimes reported 4 prototypic courses: (a) a consistently "low" group, (b) an "increase" group, (c) a "decrease" group, and (d) a consistently "high" group. Although not always recovered, these trajectories are often found, despite these studies varying in the ages of the samples studied and the duration of the observation periods employed. Here, the authors examined the consistency with which these longitudinal patterns of heavy drinking were recovered in a series of latent class growth analyses that systematically varied the age of the sample at baseline, the duration of observation, and the number and frequency of measurement occasions. Data were drawn from a 4-year, 8-wave panel study of college student drinking (N = 3,720). Despite some variability across analyses, there was a strong tendency for these prototypes to emerge regardless of the participants' age at baseline and the duration of observation. These findings highlight potential problems with commonly employed trajectory-based approaches and the need to not over-reify these constructs.

From early to late adolescence: American Indian youths' behavioral trajectories and their major influences

OBJECTIVE

This article identifies behavioral trajectories of American Indian adolescents and examines their predictors.

METHOD

A total of 401 urban and reservation American Indian adolescents were interviewed yearly from 2001 to 2004 (with 341 youths, or 85%, retained to 2004, and 385 completing at least two interviews). The Youth Self-Report total problem score is used to model behavior change trajectories, with psychological (addictions and mental health) and environmental (family, peer, community, and services) variables as independent variables. Analyses were based on PROC TRAJ, an SAS macro.

RESULTS

Five trajectory groups were found. Youths who started with a Youth Self-Report score less than the clinical cutoff were low stable (n = 142) or low improving (n = 175). Youths with initial scores over the cutoff were very high chronic (n = 5), high improving (n = 30), or high chronic (n = 33). High improvers scored close to the low improving group by 2004. At baseline, the high improving group was more likely than the high chronic group to be from the reservation (odds ratio 5.94), have greater family satisfaction (1.14), and have fewer school problems (0.84). Over time, the high improving group had substance use and depression drop, family satisfaction increase, fewer parents with mental health or addictions problems, fewer peers using substances, and a decrease in neighborhood problems and stressors.

CONCLUSIONS

A significant majority (more than 82%) of the youths exhibited relatively low levels of problem behaviors over all 4 years, and 42% of those with clinically significant problems improved over time.