Elsevier

Addictive Behaviors

Volume 36, Issue 5, May 2011, Pages 448-455
Addictive Behaviors

Early adolescent cognitions as predictors of heavy alcohol use in high school

https://doi.org/10.1016/j.addbeh.2010.12.011Get rights and content

Abstract

The present study predicts heavy alcohol use across the high school years (aged 14 through 18) from cognitions regarding the use of alcohol assessed in middle school. Using Latent Growth Modeling, we examined a structural model using data from 1011 participants in the Oregon Youth Substance Use Project. In this model, social images and descriptive norms regarding alcohol use in grade 7 were related to willingness and intention to drink alcohol in grade 8 and these variables were subsequently related to the intercept and slope of extent of heavy drinking across the high school years (grades 9 through 12). Across the sample, both descriptive norms and social images influenced the intercept of heavy drinking (in the 9th grade) through willingness to drink alcohol. Multiple sample analyses showed that social images also were directly related to the intercept of heavy drinking, for girls only. Results suggest that cognitions regarding alcohol use in middle school predict subsequent heavy drinking in high school. These findings emphasize the need for prevention programs targeting changing students' social images and encouraging a more accurate perception of peers' use when students are in middle school.

Research Highlights

►Prospective study relating cognitions in early adolescence to heavy drinking. ►Norms and social images in early adolescence predict subsequent heavy drinking. ►The pathway to heavy drinking is reactive, through willingness. ►Social images are directly related to subsequent heavy drinking for girls only.

Introduction

The identification of modifiable early risk factors is central to the design of prevention programs targeting behaviors that have deleterious effects on the health of adolescents. Heavy or binge drinking is one such health behavior. Deleterious health effects occur both as a direct consequence of heavy drinking and as a consequence of behaviors associated with heavy drinking. Heavy drinking during adolescence has more serious neurological effects than heavy drinking later in adulthood as a result of the number of structural and functional changes that occur in the brain during adolescence, (White, Ghia, Levin, & Schwartwelder, 2000). For example, preliminary evidence suggests that heavy drinking during this developmental period results in a reduction in the volume of the hippocampus (DeBellis, Clark, Beers, Soloff, Boring et al., 2000) and lower coherence of white matter fibers in several regions of the brain, which could compromise decision making and emotional functioning (McQueeny et al., 2009). Several surveys including the Harvard School of Public Health College Alcohol Study and the Southern Illinois University's Core Institute study, suggest that adolescents who engage in heavy drinking are likely to experience a number of problems beyond that of drunkenness (Jackson, Sher, & Park, 2006). Problems include driving while drunk or being driven by someone who has been drinking extensively, unwanted or unintended sexual intercourse, physical and sexual assault, lowered academic achievement, and increased risk for homicide and suicide (Jackson et al., 2006). Thus, heavy drinking directly and indirectly contributes to significant problems in mid to late adolescence, including a substantial proportion of deaths (Chikritzhs, Jonas, Stockwell, Heale, & Dietze, 2001).

Adolescents in the United States tend to initiate heavy drinking when they reach high school age. According to the most recent Monitoring the Future Study (Johnston, O'Malley, Bachman, & Schulenberg, 2009), the annual prevalence of heavy alcohol use, as defined by “being drunk,” among 8th graders is 12.7% increasing to 30.0% among 10th graders and 45.6% among 12th graders. Thus, heavy drinking increases as a function of grade, and almost half of all students engage in heavy drinking in the last year by the time they are in the 12th grade, at age 18.

In this paper we examined the effect of health behavior cognitions, specifically descriptive norms and social images in early adolescence, on the initial level and growth in heavy drinking across the high school years, encompassing ages 14 to 18. Health behavior cognitions have been shown to be modifiable (Andrews, Gordon, Hampson, Christiansen, Gunn, Slovic & Severson, in press; Andrews et al., 2009, Sussman, 1989) and thus are important etiological mechanisms to target in prevention programs. However previous research has not linked health behavior cognitions regarding alcohol use in early adolescence to heavy drinking in mid adolescence, when youth are aged 14 to 18.

The Prototype/Willingness Model of Gibbons and Gerrard (Gibbons et al., 1998, Gibbons and Gerrard, 1997, Gibbons et al., 2003, Gibbons et al., 2009) and the Theory of Planned Behavior (Ajzen, 1988) guided our selection of health behavior cognitions as risk factors. The Prototype/Willingness model is based on the assumption that much of adolescent risky behavior, such as alcohol use and heavy drinking, is the result of responding to fortuitous risk-taking opportunities. In other words, behavior is the result of social reaction rather than intentional action. The path to reactive behavior is through the adolescent's willingness to engage in that behavior. In contrast, within the Theory of Planned Behavior, adolescent risky behavior is planful and rational, and the path to intentional behavior is through the adolescent's deliberate intention to engage in the behavior.

In the proposed model, shown in Fig. 1, both intentions and willingness predict growth in heavy drinking during the high school years. Consistent with the Prototype/Willingness model, prototypes influence the adolescent's willingness to engage in the behavior. Prototypes are the social images adolescents have of those who engage in risky behaviors, such as their social images of a typical young person who uses alcohol. Adolescents believe that if they engage in the behavior, others will view them as having the attributes of the prototype. The more favorable the social image (prototype), the more likely adolescents are to be willing to engage in the behavior (Gibbons and Gerrard, 1997, Gibbons et al., 2003). Thus, in the model, social images are hypothesized to influence heavy drinking through willingness.

According to the Theory of Planned Behavior, attitudes and normative beliefs influence behavioral intentions. Since social images are evaluative, they are also considered attitudes. Normative beliefs include both descriptive norms, which are operationalized as beliefs about the extent to which other people are perceived to be engaging in the activity, and prescriptive norms or social approval of use. We included descriptive norms in the model which we measured by participants' perceptions of how many of their peers were drinking alcohol. In the model, consistent with the Theory of Planned Behavior, both social images (comparable to attitudes) and descriptive norms influence heavy drinking through intentions, the rationale or planned pathway. The Prototype/Willingness model also incorporates descriptive norms as antecedent to behavior. However, the Prototype/Willingness model suggests that the influence of descriptive norms on behavior is mediated by willingness rather than intentions. Thus, consistent with the Prototype/Willingness model, these two variables influence behavior through willingness, the social reaction pathway. Our etiological research (Andrews et al., 2008, Hampson et al., 2006) and that of others (Marcoux and Shope, 1997, Webb et al., 1995) has shown that descriptive norms influence early adolescents' willingness and intentions to drink alcohol, and eventual use. However, whether descriptive norms regarding alcohol use among middle school students influence the extent of heavy drinking in high school is an empirical question.

Although behavioral intentions and behavioral willingness are moderately correlated, they are expected to have independent effects on behavior (Andrews et al., 2008, Gibbons et al., 1998). Young people may not intend to try alcohol but, under risk-conducive circumstances, they may be willing to try. Therefore, it is important to address factors influencing the development of both intentions and willingness in alcohol prevention programs. In summary, drawing on these theoretical frameworks, the purpose of the present study is to examine a model relating social images and descriptive norms regarding alcohol use in early adolescence to the growth of their subsequent heavy use of alcohol in mid adolescence (across high school). We hypothesize that both social images and descriptive norms, at grade 7, will influence subsequent behavior through both adolescents’ willingness and intentions, assessed at grade 8. Alcohol use, assessed at grade 6, was included in the model as a control variable.

Gender differences in parameter estimates were also explored. There is some suggestion that, compared to girls, more boys engage in heavy drinking (Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2000), binge drink more frequently (Johnston, O'Malley, & Bachman, 2002) and engage in daily drinking more often (Gilvarry, McCarthy, & McArdle, 1995). Therefore, we hypothesized a higher initial level and greater growth in heavy drinking for boys than girls. There is also some suggestion of gender differences in the etiological process associated with heavy drinking (See Andrews, 2005, for a review). Both social images and descriptive norms can be conceptualized as cognitions that are affected by perceptions of peers. Results from adolescent studies investigating gender differences on the effects of peer influences on substance use have been mixed. While a majority of studies do not find gender differences (e.g., Andrews et al., 2002, Schulenberg et al., 1999, Tucker et al., 2008, when gender differences were found, the effect of peer influence was stronger for girls than boys (Berndt and Keefe, 1995, Brooks et al., 1998, Duncan et al., 1994, Kung and Farrell, 2001). Thus, we hypothesized a stronger relation between social images and descriptive norms and subsequent willingness and intentions, and ultimate heavy use, for girls than boys.

Data are from a community sample of youth, participating in an ongoing cohort-sequential longitudinal study, the Oregon Youth Substance Use Project (OYSUP). Our previous work with this data set (Andrews et al., 2008, Hampson et al., 2006, Hampson et al., 2007), and that of others (Gibbons & Gerrard, 1997) suggests that adolescent's cognitions are reliable and valid predictors of subsequent behavior.

Section snippets

Overview of design

OYSUP is an ongoing cohort-sequential longitudinal project (Schaie, 1965, Schaie, 1970), funded by the National Institute of Drug Abuse (DA10767). OYSUP began in the 1997–1998 school year wherein students in five grade cohorts (defined by grade at T1), were in the first through fifth grade. These five grade cohorts were assessed annually or biannually for 10 assessments, across 11 years until the 2007–2008 school year. Funding necessitated skipping one assessment, between T4 and T5. For this

Cohort differences

Within this cohort sequential design, we collapsed across cohorts to examine and predict growth in heavy alcohol use as a function of grade in school. Predictors included social images and descriptive norms at grade 7 and intention and willingness at grade 8. There were no significant differences as a function of cohort, as defined by grade at T1, on social images of alcohol users at grade 7, descriptive norms regarding alcohol use at grade 7, and willingness and intentions at grade 8. There

Discussion

Despite controlling for the alcohol use in the 6th grade, this study showed that both adolescents' social images regarding alcohol use and their descriptive norms assessing perception of alcohol use among their peers when they are in 7th grade predict the initial level of heavy use in the 9th grade. This finding is particularly important since it emphasizes the influence of children's cognitions in early adolescence, affecting their behavior in mid adolescence. It is also of interest that

Role of Funding Sources

This research was supported by Grant DA10767 from the National Institute of Drug Abuse. NIDA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Contributors

Judy Andrews and Sarah Hampson designed the study and wrote the protocol. Judy Andrews conducted literature searches and provided summaries of previous research studies. Missy Peterson conducted the statistical analysis. Judy Andrews wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.

Conflict of Interest

All authors declare that they have no conflicts of interest.

Acknowledgements

We gratefully acknowledge the assistance of Niraja Lorenz, Martha Hardwick, and Erika Westling for managing the collection of data, the assessment staff for helping with data collection, and Christine Lorenz for manuscript preparation.

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