Download - Urbán Róbert PhD Eötvös Loránd University
Are outcome expectancies the possible targets of smoking prevention?The roles of smoking outcome
expectancies in adolescent smoking
Urbán Róbert PhD
Eötvös Loránd University
Funding
• This presentation was made possible by grant number 1 R01 TW007927-01 from the Fogarty International Center, the National Cancer Institute, and the National Institutes on Drug Abuse, within the National Institutes of Health.
Outcome expectancies
• Social-learning theory proposes two types of expectancies:– Self-efficacy– Outcome expectancies
• Other theories and models also use the outcome expectancies– Theory of reasoned action / theory of planned behavior
models– Social-cognitive theory
• Recent research demonstrated that outcome expectancies mediate between antecedents like personality and drug-use behavior, including– alcohol ( e.g. Williams & Clark, 1998, Urbán et al., 2008)– marijuana (Vangsness,Bry, & LaBouvie, 2004 )– cocaine use ( Stacy et al., 1995).
Outcome expectancies in the present research
• Negative consequences– long-term negative health consequences of smoking
• Positive/sensory reinforcement– expectancies of individual sensory satisfaction from
smoking• Negative reinforcement
– expectancies regarding coping and negative emotion regulation through smoking
• Appetite and weight control– expectancies that smoking helps to manage
appetite and weight• (Short-term negative consequences)• (Boredom reduction)
Budapest Adolescent Smoking Study
Methodology
Fall 2008 Spring 2009. Fall 2009 Spring 2010 Fall 2010
Longitudinal design
Sampling method: cluster sampling Sampling unit: classes
Representative sample of the highschools in Budapest
Sample• 70 schools• 106 classes (9th
grade)• The total number of
participants: 3565 students (49.8 % boys and 50.2 % girls).
• Mean age 15.3 yrs (SD=0.56) in the first wave.
Data collection• During a class hour• Self-report questionnaire includes:
– Question related to smoking, nicotine addiction, perceived parental attitude, peer smoking, parental smoking, etc.
– The Short form of Smoking Consequences Questionnaire
– A short form of Sensation Seeking questionnaire– Susceptibility to smoking scale for the nonsmokers– Tobacco Advertisement Receptivity scale– Alcohol use, physical activity– Depression (CESD)– Body image questions
and many others
Householdsmoking
Age
Sensationseeking
Delinquency
Depressivesymptoms
Weightconcerns
Parental attitudetoward smoking
Availability ofcigarette
TAR
Peer normsand pressure
Alcohol use
Physical activity
Negativeconsequences
Positivereinforcement
Negativereinforcement
Appetite andweight control
First exp.from smoking
Susceptibilityto smoking
Smoking status
Smokingprevention
Nicotinedependence
Readinessto quit
Householdsmoking
Age
Sensationseeking
Delinquency
Depressivesymptoms
Weightconcerns
Parental attitudetoward smoking
Availability ofcigarette
TAR
Peer normsand pressure
Alcohol use
Physical activity
Negativeconsequences
Positivereinforcement
Negativereinforcement
Appetite andweight control
First exp.from smoking
Susceptibilityto smoking
Smoking status
Smokingprevention
Nicotinedependence
Readinessto quit
The role of expectancies in smoking initiation
Are the outcome expectancies important before the
experimentation with smoking?
Predictors of experimentation with smoking between Wave 1 and Wave 2
Negative consequences
Positivereinforcement
Negativereinforcement
Appetite and weight control
Susceptibility (intention) to smoking
Trying smoking
-0.095(0.022)***
0.034 (0.015)**
0.060(0.016)***
0.63(0.016)***
R²=9%
R²=18%
χ²=566.7 df=284; CFI=.933 TLI=.923 RMSEA=.032 [.028-.036]; N=828. Based on students who had not tried smoking in Wave 1 and provided data in Wave 2
Unstandardized coefficients (SE)
The role of outcome expectancies in smoking initiation
• Expectancies are developed far before the experimentation with smoking.
• Thinking about the possible negative consequences can reduce the risk of smoking initiation.
• Thinking about the reinforcement properties of smoking can increase the intention to try and the risk of smoking initiation.
The role expectancies in smoking intensity
Crosslagged analysis – an analysis of the cause and effect
Smoking intensity
• Smoking intensity is defined with– number of days smoked during the past 30
days– number of cigarettes smoked a day on
average
• Smoking intensity is a rough estimation of the number of cigarettes during the past 30 days.
Smoking intensity
Smoking intensity
Smoking intensity
Smoking intensity
Smoking intensity
Negativereinforcement
Negativereinforcement
Negativereinforcement
Negativereinforcement
Negativereinforcement
Wave 1 Wave 2 Wave 3 Wave 4 Wave 5
Correlations between uniquenesses are not presented.
χ²=48.1 df=15; RMSEA=0.025 [0.018-0.034]; CFI=0.99 TLI=0.97
Cross-lagged association between negative reinforcement expectancies and smoking intensity
0.14***0.06** 0.08*
0.07**
0.11**
R²=27.2% R²=50.6% R²=59.4% R²=55.0%
The role expectancies in smoking intensity
Two parallel process models
Time 1 Time 2 Time 3 Time 4 Time 5
Intercept Slope Quadratic
1 1 1 1
1 1
2 34 1
4 916
A growth model
Linear change
Non-linear change
Smokingintensity_1
Smokingintensity_2
Smokingintensity_3
Smoking intensity_4
Smoking intensity_5
NR_1 NR_2 NR_3 NR_4 NR_5
InterceptSmoking
SlopeSmoking
QuadraticSmoking
Intercept NR
SlopeNR
QuadraticNR
0.77
***
-0.26***
0.26
***
NR=negative reinforcement
Smokingintensity_1
Smokingintensity_2
Smokingintensity_3
Smoking intensity_4
Smoking intensity_5
PR_1 PR_2 PR_3 PR_4 PR_5
InterceptSmoking
SlopeSmoking
QuadraticSmoking
Intercept PR
SlopePR
QuadraticPR
0.97
***
-0.90***
1.16
***
-1.50***
PR=positive reinforcement
Further questions: Do expectancies change over time?
A latent class growth analysis (LCGA)
Time 1 Time 2 Time 3 Time 4 Time 5
Intercept Slope Quadratic
Latent classes
1 1 1 1
1 1
2 34 1
4 916
A latent class growth analysis (LCGA)
Days of smokingduring the last 30 days
0
5
10
15
20
25
30
35
1 2 3 4 5
class 1 (6.8 %)
class 2 (13.5 %)
class 3 (4.9 %)
class 4 (3.7 %)
class 5 (7.7 %)
class 6 (53.4 %)
class 7 (10.0%)
Based on the students who provided data at least 3 occasions, and smoked a cigarette at least on day during the research. N=1147.
Negative consequences
0
5
10
15
20
25
30
35
40
1 2 3 4 5
class 1 (12%)
class 2 (3.9%)
class 3 (64.6%)
class 4 (4.9%)
class 5 (14.3%)
Based on all students.
Positive reinforcement
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5
class 1 (3.4%)
class 2 (8.2%)
class 3 (59.2%)
class 4 (3.9%)
class 5 (10.2%)
class 6 (5.6%)
class 7 (9.5%)
Based on all students.
Negative reinforcement
0
10
20
30
40
50
60
70
1 2 3 4 5
class 1 (4.8%)
class 2 (12.6%)
class 3 (5.4%)
class 4 (9.7%)
class 5 (12.0%)
class 6 (8.9%)
class 7 (12.7%)
class 8 (34.0%)
Based on all students.
Appetite and weight control
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5
class 1 (17.7%)
class 2 (11.7%)
class 3 (7.4%)
class 4 (4.4%)
class 6 (44.5%)
class 8 (14.3%)
Based on all students.
Conclusions
• Outcome expectancies are important factors in smoking initiation and smoking intensity in adolescents.
• Outcome expectancies are changing in time. In different age, the strength of these expectancies change.
• Targeting outcome expectancies is an important focus of prevention work, but one time shot might be not enough.