Change in alcohol outcome expectancies from childhood to emerging adulthood: A meta-analysis of longitudinal studies

A just-in-time adaptive personalized mobile app intervention produces limited short-term reductions in heavy episodic drinking frequency in college students: A randomized control trial during the COVID-19 pandemic

BACKGROUND

High-risk drinking among college students is common, and alcohol expectancies and experienced consequences are proximal predictors of use. This study tested short- and long-term efficacy of a personalized just-in-time adaptive intervention with daily messages about alcohol use, alcohol expectancies, and consequences delivered via mobile app.

METHODS

Participants were 408 students enrolled at a 2- or 4-year college (75% 4-year; 64% female) who completed twice-daily assessments for 21 days and follow-up surveys at 1-, 6-, and 12-months. Data collection spanned January 2020 through April 2022. Participants were randomized to either an intervention condition receiving daily intervention messages and other related alcohol and expectancy-focused content via the app or an assessment-only control condition. Both conditions were administered daily surveys through the app.

RESULTS

Poisson multilevel models were conducted to examine intervention effects on alcohol outcomes (i.e., drinks per week, heavy episodic drinking frequency, peak estimated blood alcohol concentration, and alcohol-related consequences, as well as positive and negative alcohol expectancies) at each follow-up assessment. On average, participants in both conditions reported decreased alcohol use outcomes, consequences, and expectancies at 1-, 6-, and 12-month follow-up compared to baseline. A single statistically significant difference between participants in the intervention and control conditions was observed at 1-month follow-up. Specifically, participants in the intervention condition reported a 17% greater decrease in heavy episodic drinking frequency than participants in the control condition, on average.

CONCLUSIONS

Findings highlight the complexities of developing, implementing, and testing adaptive interventions, particularly within the context of the COVID-19 pandemic.

Expectancies for Alcohol Analgesia Among Emerging Adults: Confirmatory Factor Analysis, Reliability, and Validity

BACKGROUND

Alcohol and pain frequently co-occur and interact in a positive feedback loop that maintains and exacerbates both conditions. The Expectancies for Alcohol Analgesia (EAA) is a recently developed, single-factor measure that assesses the extent to which individuals expect alcohol will reduce their pain. Alcohol-related outcome expectancies motivate drinking and predict drinking trajectories among emerging adults (18-24). The EAA was initially validated among adults with chronic pain who drink alcohol and has been associated with several indices of pain and alcohol. We are unaware of prior work that examined the psychometric properties of the EAA among emerging adults, who are at high-risk for developing positive expectancies regarding the utility of alcohol for pain management.

OBJECTIVES

The goal of this study was to examine the factor structure, reliability, and validity of the EAA among emerging adult college students.

METHODS

Emerging adult college students who endorsed lifetime alcohol use and varying pain levels (N = 555, 74.4% Female, 75.2% White) completed an online survey of pain and alcohol use.

RESULTS

Confirmatory factor analysis indicated the single-factor structure was a good fit (CFI = 0.99, TLI = 0.99, SRMR = 0.01, RMSEA = 0.04). Internal consistency was excellent (α = .95), and EAA scores were positively associated with alcohol consumption, alcohol-related consequences, drinking motives, and pain intensity and disability (ps < .01).

CONCLUSION

These findings suggest the EAA is a valid and reliable measure for assessing expectancies for alcohol analgesia among emerging adult college students, which may also be a promising intervention target to include in expectancy challenge interventions.

Longitudinal tracking of alcohol expectancies and their associations with impulsivity in alcohol naïve youth in the adolescent brain cognitive development (ABCD) study

Background

Positive and negative alcohol expectancies (PAEs and NAEs, respectively) and impulsivity are key risk factors for the onset of alcohol use. While both factors independently contribute to alcohol initiation, the developmental aspects of AEs and their nuanced relationship with impulsivity are not adequately understood. Understanding these relationships is imperative for developing targeted interventions to prevent or delay alcohol use onset in youth.

Methods

This study utilized the Adolescent Brain Cognitive Development cohort to examine how PAEs and NAEs develop over time and relate to each other. We also explored how self-reported and behavioral impulsivity at baseline (~10 years old) are associated with the longitudinal development of PAEs and NAEs in youth Ages 11, 12, and 13 (n = 7493; 7500; and 6981, respectively), as well as their time-specific relationships.

Results

Findings revealed while PAEs increased steadily over all three years, NAEs increased from ages 11-12 and then remained unchanged between 12 and 13. Overall, PAEs and NAEs were inversely related. Moreover, PAEs positively correlated with sensation seeking and lack of premeditation, while NAEs negatively correlated with positive urgency. Interestingly, a time-specific association was observed with PAEs and lack of perseverance, with a stronger correlation to PAEs at Age 11 compared to Age 12.

Conclusions

Overall, this study provides valuable insights into the divergent developmental trajectory of PAEs and NAEs, and their overall and time-specific associations with impulsivity. These findings may guide focused and time-sensitive prevention and intervention initiatives, aiming to modify AEs and reduce underage drinking.

Subtypes of Alcohol Expectancies Are Differentially Associated With Alcohol Use for Bisexual and Heterosexual Women

Background: Bisexual women, compared to heterosexual women, report greater amounts of alcohol use and heavy drinking. Alcohol expectancies (i.e., beliefs about alcohol outcomes) are a strong predictor of alcohol use, but few studies have examined the importance of alcohol expectancies in relation to alcohol use among bisexual women specifically or in comparison to heterosexual women. Objectives: The current study examined 262 heterosexual and 225 bisexual women using an online survey about alcohol use, sexual risk-taking, and alcohol expectancy subtypes (sexuality, tension reduction, and aggression). Results: Compared to heterosexual women, bisexual women reported greater sexuality and tension reduction expectancies after accounting for their level of drinking, but groups did not differ on aggression expectancies. Moreover, sexual identity status moderated the associations between sexuality and tension reduction expectancies and alcohol use, respectively. Specifically, our study findings suggested that sexuality and tension reduction alcohol expectancies were more strongly tied to alcohol use among bisexual women than heterosexual women. Conclusions: Taken together, in our study, bisexual women held stronger sexuality and tension reduction expectancies, as compared to heterosexual women. Interventions targeting alcohol expectancies may be considered when tailoring intervention content for this population.

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.

Daily Positive Alcohol Expectancies and Alcohol Use Outcomes among College Students

Expectancy theory supports alcohol expectancies, or the expected effects of drinking, as an important factor in alcohol use behaviors. Recent research supports that alcohol expectancies fluctuate daily, but scant research has examined specific types of expectancies and their associations with alcohol use at the daily level. Consequently, the present study examined (1) the daily association between select expectancies (i.e., sociability, tension reduction, liquid courage) and likelihood of drinking, and (2) whether daily expectancies predict alcohol use outcomes (i.e., alcohol-related problems, heavy drinking) on drinking days. Participants (N = 221; 79.2% women) were primarily White (48.4%) and Black (29.7%) university students. Participants completed daily measures of expectancies, alcohol use, and alcohol-related problems each day for 14 days. Results from multilevel models revealed daily sociability as the only expectancy subscale linked with increased odds of drinking. Daily expectancies did not predict heavy drinking or alcohol-related problems on drinking days. At the between-person level, average levels of sociability and tension reduction expectancies were associated with a greater likelihood of engaging in heavy drinking and experiencing a problem. Findings highlight that fluctuations in sociability expectancies may be proximally linked to likelihood of alcohol use, which may inform just-in-time intervention efforts targeting alcohol expectancies.

Subjective response to alcohol: Interactive effects of early life stress, parental risk for mood and substance use disorders, and drinking context

Early life stress, specifically childhood maltreatment, and parental risk for mood and substance use disorders (SUDs) are associated with increased risk for alcohol use disorder (AUD). There is limited data on how these factors interact to contribute to alcohol-related outcomes. Prior work has suggested early life stress may increase sensitivity to psychostimulants and that subjective response to alcohol is heritable. It is unclear if early life stress alters sensitivity to alcohol and interacts with parental risk for mood/SUDs, which in turn may act as a risk factor for AUD. The current study uses within-subjects placebo-controlled alcohol administration methods to investigate the effects of childhood maltreatment on subjective response to alcohol in young adults with and without parental risk of mood/SUDs. Additionally, we explored interactions with drinking context (i.e., drinking in a bar vs. non-bar context). Within individuals with parental risk for mood/SUDs, there was a positive relation between total Childhood Trauma Questionnaire (CTQ) score and how drunk individuals reported feeling across both alcohol and placebo conditions (parental risk group-by-CTQ interaction p = .01; main effect of CTQ within individuals with parental risk for mood/SUDs p = .005). When exploring interactions with drinking context (bar vs. non-bar context), we observed a significant drinking context-by-parental risk-by-CTQ interaction (p = .03), with CTQ score positively associated with greater positive valence/positive arousal feelings in the parental risk group if they consumed their beverages in the bar context (p = .004) but not if they consumed their beverages in the non-bar context. Results suggest childhood maltreatment may contribute to variation in subjective response to the positive effects of alcohol-possibly mediated by alcohol cues and/or expectancies-in young adults with parental risk for mood/SUDs.

Factors influencing adolescent experimental and current smoking behaviors based on social cognitive theory: A cross-sectional study in Xiamen

Introduction

China has the largest youth population in the world. To better implement the Smoke-free School Initiative, this study aims to examine the protective and risk factors for different smoking behaviors (never smoked, experimental smoking, and current smoking) among school adolescents based on social cognitive theory.

Methods

This research was a secondary analysis of a cross-sectional survey of middle schools in Huli District of Xiamen, China. The final sample consisted of 1937 participants with an average age of 15.41 (SD = 1.64). Descriptive statistics were used to summarize the sociodemographic characteristics of the sample. Multivariate multinomial logistic regression analysis was performed using four models.

Results

Of the respondents, 1685 (86.99%) were never smokers, 210 (10.84%) were experimental smokers, and 42 (2.17%) were current smokers. Social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies were associated with adolescents' smoking behaviors. The number of smoking family members, classmates smoking, the perception that smoking is cool and attractive, and attitudes toward control tobacco policies were the predictors of current smoking behavior (p < 0.05). In contrast, friends smoking and individual and social relationship motivation were associated with only experimental smoking (p < 0.05).

Discussion

The relationship of social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies varied across smoking behaviors. Family, school, society and the government need to cooperate in prevention and intervention programs for adolescent smoking. The relationships between these factors and adolescents' different smoking behaviors needs to be further verified.

Ambivalence in Adolescents’ Alcohol Expectancies: A Longitudinal Mixed Methods Study Among 12-to-18-Year-Olds

Drawing on the framework of alcohol expectancies and their importance for drinking behaviors, this longitudinal mixed-methods study examined changes and continuities in development of alcohol expectancies during adolescence. Quantitative and qualitative data were prospectively collected at four time points between 2015 and 2020 from nationwide, socio-economic, and gender-balanced samples of Norwegian adolescents aged 12–18. Quantitative data ( n = 3425) were analyzed using linear mixed-effects models, and qualitative data ( nT1 = 118) using thematic analysis. Quantitative and qualitative results were juxtaposed in the discussion. Quantitative results indicated an increase in social facilitation and tension reduction expectancies from age 13 to 18, and a simultaneous decrease in negative emotional expectancies. This development could partly be explained by experience with alcohol use in adolescence. Similarly, qualitative findings showed adolescents’ expectancies of alcohol evolving with age; from one-sided negative expectancies of aggression and harm to increased positive expectancies of fun, sociability, and relaxation. Both analyses showed that negative expectances remained high throughout the study period, but by late adolescence, many participants held positive and negative expectations simultaneously. The qualitative data illustrated how adolescents’ alcohol expectancies became increasingly ambivalent and complex with age, as alcohol use became more common. Prevention strategies aiming to reduce underage alcohol use should acknowledge this complexity.

A meta-theoretical framework for organizing and integrating theory and research on motivation for health-related behavior

The concept of motivation is broad and multi-faceted. In health psychology, motivation has been conceptualized as cravings, urges, or desires for unhealthy behaviors, such as consumption of alcohol, cigarettes, or calorie-dense foods; or as behavioral intentions or proximal goals for healthy behaviors, such as smoking cessation, physical activity, or condom use. Because of the differences in terminology and associated theoretical underpinnings, it is difficult to characterize the state of the science or integrate research findings on motivation for health-related behavior. The present paper introduces a meta-theoretical Automatic-Reflective Motivation Framework (ARM-F) with the goals of organizing and integrating theory and research on motivation for health-related behaviors. At the first and broadest level, the ARM-F defines general motivation as a wanting or desire to do something. At the second level, it distinguishes between automatic and reflective motivation types, consistent with emerging perspectives in health psychology, historical and contemporary philosophical views on desire, and dual-processing perspectives in psychology. At the third level, the ARM-F preserves the nuanced terminologies and conceptualizations within the automatic (e.g., craving, urge, desire) and reflective (e.g., behavioral intention) motivation categories. The ARM-F has potential utility for organizing and integrating theory and research on motivation for health-related behavior, with implications for future research.