The influence of cultural orientation,alcohol expectancies and self‐efficacy on adolescent drinking behavior in Beijing

Objective We hypothesized that the drinking behavior of adolescents in China is influenced by expectancies and self‐efficacy and that adolescents' cultural orientation towards western versus traditional Chinese values influences expectancies, self‐efficacy and drinking behavior, with western values leading to more dysfunctional patterns of beliefs and drinking, and that these beliefs are influenced by students' gender and school environment. Methods A total of 1020 high school students from Beijing completed the Chinese Adolescent Alcohol Expectancy, the Chinese Cultural Orientation and the Chinese Self‐regulation Self‐efficacy questionnaires. Results Results generally confirmed our hypotheses. Higher negative expectancies and higher self‐efficacy reduced the likelihood of drinking significantly. Higher positive expectancies increased the likelihood of regular drinking but not occasional drinking. Having western cultural orientation increased the likelihood of drinking. Higher levels of western cultural orientation also increased positive expectancies, lowered negative expectancies and lowered self‐efficacy. Having more western (less traditional) views towards traditional Chinese values decreased positive and negative expectancies. Gender influenced beliefs, with males having higher positive and lower negative expectancies, lower self‐efficacy and more traditional cultural orientation. Students in key and general schools had less traditional cultural orientation and key school students had higher self‐efficacy. Conclusions Results indicate that cultural orientation influences adolescent drinking and this influence is mediated partially through cultural orientation influences on adolescent drinking expectancies and self‐efficacy. Having more western and less traditional Chinese cultural orientation leads to more drinking, lower self‐efficacy for regulating drinking and more risk‐promoting alcohol expectancies.     

Evaluating a cognitive model of ALDH2 and drinking behavior

Background: Despite evidence for genetic influences on alcohol use and alcohol‐related cognitions, genetic factors and endophenotypes are rarely incorporated in cognitive models of drinking behavior. This study evaluated a model of ALDH2 and drinking behavior stipulating cognitive factors and alcohol sensitivity as accounting for genetic influences on drinking outcomes. Methods: Participants were Asian‐American young adults (n = 171) who completed measures of alcohol cognitions (drinking motives, drinking refusal self‐efficacy, and alcohol expectancies), alcohol sensitivity, drinking behavior, and alcohol‐related problems as part of a prospective study. Structural equation modeling (SEM) evaluated a model of drinking behavior that stipulated indirect effects of ALDH2 on drinking outcomes through cognitive variables and alcohol sensitivity. Results: The full model provided an adequate fit to the observed data, with the measurement model explaining 63% of the variance in baseline heavy drinking and 50% of the variance in alcohol‐related problems at follow‐up. Associations of ALDH2 with cognitive factors and alcohol sensitivity were significant, whereas the association of ALDH2 with drinking was not significant with these factors included in the model. Mediation tests indicated significant indirect effects of ALDH2 through drinking motives, drinking refusal self‐efficacy, and alcohol sensitivity. Conclusions: Results are consistent with the perspective that genetic influences on drinking behavior can be partly explained by learning mechanisms and implicate cognitive factors as important for characterizing associations of ALDH2 with drinking.     

Alcohol Expectancies and Drinking Refusal Self‐Efficacy Mediate the Association of Impulsivity With Alcohol Misuse

Background: Recent work suggests that 2 biologically based traits convey risk for alcohol misuse: reward sensitivity/drive and (rash) impulsiveness. However, the cognitive mechanisms through which these traits convey risk are unclear. This study tested a model predicting that the risk conveyed by reward sensitivity is mediated by a learning bias for the reinforcing outcomes of alcohol consumption (i.e., positive alcohol expectancy). The model also proposed that the risk conveyed by rash impulsiveness (RI) is mediated by drinkers’ perceived ability to resist alcohol (i.e., drinking refusal self‐efficacy). Methods: Study 1 tested the model in a sample of young adults (n = 342). Study 2 tested the model in a sample of treatment‐seeking substance abusers (n = 121). All participants completed a battery of personality, cognitive, and alcohol use questionnaires and models were tested using structural equation modeling. Results: In both studies, the hypothesized model was found to provide a good fit to the data, and a better fit than alternative models. In both young adults and treatment‐seeking individuals, positive alcohol expectancy fully mediated the association between reward sensitivity and hazardous alcohol use. For treatment seekers, drinking refusal self‐efficacy fully mediated the association between RI and hazardous drinking. However, there was partial mediation in the young adult sample. Furthermore, neither trait was directly associated with the other cognitive mediator. Conclusions: The hypothesized model was confirmed on a large sample of young adults and replicated on a sample of treatment‐seeking substance abusers. Taken together, these findings shed further light on the mechanisms through which an impulsive temperament may convey risk for alcohol misuse.     

Pathways to heroin dependence: time to re‐appraise self‐medication

The self‐medication hypothesis emphasizes the role of distressing affect as the primary motivator for the compulsive use that leads to substance dependence. The model also postulates that there will be psychopharmacological specificity between symptom presentation and the primary drug of dependence. In this review, the self‐medication hypothesis is examined in relation to the development and chronicity of heroin dependence. It is argued that if self‐medication has a role in engendering and extending substance dependence, it should be apparent in the use of a drug that carries such overwhelming personal risk. The psychopathology seen among adult users is certainly consistent with the model. More importantly, however, are the extraordinarily high levels of childhood trauma and psychopathology that occur typically well before the initiation of heroin use. In contrast, the postulate of drug specificity appears less supported by the polydrug use patterns typical of heroin users, and does not appear to be a necessary corollary of the model.     

Self‐management education programs for age‐related macular degeneration: A systematic review

Objective: To review the effectiveness of education programs to improve emotional status, daily living and self‐efficacy in adults older than 60 years with age‐related macular degeneration (AMD). Method: Electronic searches of three databases and manual searches of references lists located randomised controlled trials (RCTs) and quasi‐experimental studies. Health education programs aimed at increasing knowledge of AMD, skills training or behavioural change were included. Data extraction and quality assessment were undertaken by two reviewers. A narrative analysis was possible. Results: Three protocols were reported in four studies (n = 532) with three follow‐up studies – all contained elements of self‐management programs. Effect sizes for the three outcomes ranged from small to very large (0.14–1.21). Conclusions: Self‐management programs appear effective for older adults with AMD. Small sample size, use of non‐traditional statistics and methodological quality meant only a narrative analysis was possible. Future studies with more robust methodology including intent‐to‐treat analysis are still required.     

A view through the gateway: expectancies as a possible pathway from alcohol to cannabis

Aim. The aim of this study was to test the hypothesis that cannabis outcome expectancies would be more positive in adolescents who drink alcohol than in non-drinkers. Participants and setting. The participants in the study were 4544 11-16-year-olds attending eight secondary schools located in the north-west midlands of England. Procedure. Participants completed an anonymous self-report questionnaire that incorporated sections designed to tap adolescents' expectancies of positive and negative outcomes of alcohol and cannabis use, together with other questions relating to substance use and associated issues. Results. Four reliable six-item scales were derived, and used to measure positive and negative alcohol and cannabis outcome expectancies. Negative expectancies were relatively stable across age and frequency of substance use, particularly for alcohol. However, positive expectancies for both substances increased markedly with age and, independently, with frequency of use. Positive alcohol and cannabis outcome expectancies were meaningfully related to expectancies of future substance use, and to measures of problem drug use and resistance to peer influence, supporting the validity of these expectancy measures, and their possible value as diagnostic screening instruments. The main hypothesis of the study was supported: among respondents who reported never using cannabis, positive cannabis outcome expectancies increased and negative cannabis outcome expectancies decreased with increasing frequency of alcohol use. Conclusions. The results are consistent with a version of the 'gateway hypothesis' for the relationship between alcohol and cannabis use (alcohol use leads to changes in cannabis expectancies and thereby to cannabis use), but a proper test of the hypothesis requires a longitudinal study.     

Effects of health literacy to self‐efficacy and preventive care utilization among older adults

Aim: This study examined the relationships between health literacy, self‐efficacy and preventive care utilization among older adults in Taiwan. Methods: The data were from a longitudinal survey, “Taiwan Longitudinal Study in Aging” in 2003 and 2007. A total of 3479 participants who completed both two waves were included for analysis. Health literacy first was constructed through education, cognitive function and disease knowledge through structural equation modeling (SEM); then, the associations of health literacy to later self‐efficacy and preventive care were examined. Results: The model fit of SEM was good, indicating that the construct of health literacy was appropriate. Healthy literacy showed a moderate positive effect on self‐efficacy and a small positive effect on preventive care utilization. Conclusions: Health literacy increases self‐efficacy and utilization of preventive care. Promoting people's health knowledge and health literacy is suggested. Geriatr Gerontol Int 2013; 13: 70–76 .     

Disease severity and domain‐specific arthritis self‐efficacy: Relationships to pain and functioning in patients with rheumatoid arthritis

Objective

To examine the degree to which disease severity and domains of self‐efficacy (pain, function, and other symptoms) explain pain and functioning in rheumatoid arthritis (RA) patients.

Methods

Patients (n = 263) completed the Arthritis Impact Measurement Scales 2 to assess pain and functioning (physical, affective, and social), the Arthritis Self‐Efficacy Scale to assess 3 self‐efficacy domains (pain, physical function, and other). Disease severity was assessed with C‐reactive protein level, physician's rating, and abnormal joint count. Structural equation modeling was used to examine 3 hypotheses: does disease severity have a direct relationship with pain and each area of functioning, does disease severity have a direct relationship with each arthritis self‐efficacy domain, and do the self‐efficacy domains mediate the relationship between disease severity and RA pain and each area of functioning.

Results

Disease severity was related to pain, physical functioning, and each self‐efficacy domain (β = 0.28–0.56, P < 0.001). Each self‐efficacy domain was related to its respective domain of functioning (e.g., self‐efficacy for pain was related to pain; β = 0.36–0.54, P < 0.001). Self‐efficacy mediated the relationship between disease severity and pain and functioning (β = 0.12–0.19, P < 0.001). Self‐efficacy for pain control and to perform functional tasks accounted for 32–42% of disease severity's total effect on their respective outcomes (e.g., self‐efficacy for pain control accounted for 32% of disease severity's total effect on pain). Variance accounted for by the total model was 52% for pain, 53% for physical functioning, and 44% for affective and social functioning.

Conclusion

Disease severity and self‐efficacy both impact RA functioning, and intervening in these areas may lead to better outcomes.     

Hair testing and self-report of cocaine use by heroin users

Aim Failure to disclose cocaine use can have a negative impact on medical care and research validity. This study was performed to identify predictors of cocaine non‐disclosure among individuals who self‐reported heroin use during a medical care encounter. Design A prospective comparison of self‐report of cocaine use among heroin users and hair analysis for cocaine. Setting Four health‐care clinics at an academic, inner‐city hospital. Participants Patients presenting for a health‐care visit who were willing to self‐report use of heroin and were not engaged in any form of drug treatment. Measurements (1) Self‐report using standardized instruments: the Drug Addiction Severity Test (DAST), the Addiction Severity Index (ASI) and quantity/frequency questions for heroin and cocaine use. (2) Biochemical evidence: analysis of hair by radioimmunoassay (RIA) for cocaine and opiate levels. Findings Among 336 heroin users who tested positive for cocaine in hair, 34.2% did not report their recent cocaine use. The mean cocaine level for discordant individuals was significantly lower than for concordant individuals (109.6 ng/10 mg versus 470.57 ng/10 mg; P < 0.0001). Multivariate predictors of disclosure included opiate and cocaine levels in hair and the ASI drug severity subscore. Conclusions Although self‐report has been validated for treatment system patients, almost a third of the out‐of‐treatment heroin users in this medical clinic study failed to disclose concomitant cocaine use. The likelihood of non‐disclosure was greatest for heavy users of heroin and light users of cocaine. Confirmation of self‐report with biochemical analysis in the medical setting may be necessary to improve both clinical care and research validity.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Predictors of Alcohol Attitudes and Expectancies in Hispanic National Groups

Background: Multiple theoretical frameworks identify attitudes and expectancies as important predictors of alcohol behavior. Few studies have examined demographic predictors of these evaluative and belief‐based cognitive mediators in the general population, and none have examined them in large‐scale studies of Hispanics, a group at higher risk for drinking behavior and problems. This study probes the extent to which dimensions of attitudes and expectancies share common demographic predictors in a large sample of Puerto Ricans, Cuban‐Americans, Mexican‐Americans, and South/Central Americans. Methods: The 2006 Hispanic Americans Baseline Alcohol Survey (HABLAS) used a multistage cluster sample design to interview 5,224 individuals randomly selected from households in Miami, New York, Philadelphia, Houston, and Los Angeles. This study focused on 2,773 respondents self‐identified as current drinkers. Multiple linear regression was used to identify predictors of positive and negative dimensions of attitudes and expectancies, controlling for various background variables. Results: Religious affiliation selectively predicted alcohol attitudes, with Catholics having more positive and fewer negative attitudes than other religious groups. Hispanic group selectively predicted alcohol expectancies, with Cuban‐Americans having less positive and less negative expectancies than other groups. Being U.S.‐born or male predicted more positive attitudes and expectancies, but birthplace and gender did not predict negative dimensions of attitudes or expectancies. Higher acculturation and more education were linked to a decreased tendency to agree with any item. Age was positively and negatively associated with negative expectancies and positive attitudes, respectively, and having never been married, higher income, and unemployment were each linked to fewer negative attitudes. Conclusions: Although there is some overlap, attitudes and expectancies are influenced by different sociodemographic variables. Positive and negative dimensions of those constructs also show distinct patterns of relations. Prevention and treatment programs targeting cognitive mediators of behavior should be mindful of these differential determinants and future modeling endeavors should incorporate them.     

Eating Disorders,Normative Eating Self‐Efficacy and Body Image Self‐Efficacy: Women in Recovery Homes

Although eating disorders (EDs) and ED symptoms are common among individuals in recovery for substance abuse (SA), long‐term SA treatment programmes rarely address these problems. The present study examined the prevalence of EDs among women residing in Oxford Houses—low‐cost, self‐governed recovery homes for SA. Further, among women both with and without an ED diagnosis, the association between duration of Oxford House residency and eating‐related self‐efficacy scores was examined as an indicator of potential treatment effects on ED symptoms. During a telephone assessment, participants were administered the Structured Clinical Interview for DSM‐IV‐TR Axis I Disorders and the Eating Disorder Recovery Self‐Efficacy Questionnaire. Results indicated that 12 of the 31 women analysed met criteria for an ED (bulimia nervosa, 2; ED not otherwise specified, 10). Differential findings were evident for eating‐related self‐efficacy measures depending on ED diagnostic status and duration of residency. Potential interpretations, limitations and implications are discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Change processes in residential cognitive therapy for bulimia nervosa

The purpose of the study was to examine the relationships of process variables derived from the cognitive model of bulimia nervosa (BN) and weekly outcome. The participants were 39 patients with BN or subthreshold bulimia consecutively admitted to an inpatient treatment program for bulimia. Theory‐derived process and outcome variables were measured repeatedly during the course of therapy with a gap of a week between each measurement. The data were analysed with time series methods (ARIMA). Weekly variations in the process variables: self‐efficacy about resisting binge eating, dysfunctional beliefs, negative affect and positive affect influenced variations in subsequent outcome, whereas weekly outcome did not influence subsequent process. These results are consistent with the cognitive model of BN and suggest that self‐efficacy, dysfunctional beliefs, negative affect and positive affect are potential targets for treatment that need further investigation. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating disorders and non‐suicidal self‐injury: Structural equation modelling of a conceptual model

Evidence suggests several risk factors for both eating disorders (ED) and nonsuicidal self‐injury (NSSI), but the relationships between these factors are not well understood. Considering our previous work and a conceptual model, this cross‐sectional study aimed to assess the relationships among distal and proximal factors for the presence of NSSI in ED. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. Structural equation modelling revealed that both distal and proximal factors were related to the presence of NSSI in ED, disclosing a mediating role of the proximal factors. Stressful life events mediated the relationship between childhood sexual abuse, peer aggression, and both ED and NSSI. Childhood physical abuse was related to ED and NSSI via substance use, negative self‐evaluation, and suicide attempts. Findings provided support for the conceptual model and highlight the possible mechanisms by which psychosocial factors may lead to ED and NSSI.     

The Smoking Abstinence Questionnaire: measurement of smokers' abstinence-related expectancies

Aims To develop and validate a measure of smokers' expectancies for the abstinence process upon quitting smoking: the Smoking Abstinence Questionnaire (SAQ). Design Principal component analysis and other psychometric analyses of self‐report data. Setting San Francisco, California. Participants A total of 507 adult smokers of at least 10 cigarettes per day diverse in gender, sexual orientation and ethnoracial status. Measurements The primary measure was a draft version of the SAQ. Additional measures assessed a variety of other smoking‐related constructs. Findings Analyses yielded 10 scales of the SAQ: Withdrawal, Social Improvement/Non‐smoker Identity, Adverse Outcomes, Treatment Effectiveness, Common Reasons, Barriers to Treatment, Social Support, Optimistic Outcomes, Coffee Use and Weight Gain. The SAQ scales demonstrated internal consistencies ranging from 0.62 to 0.85 and were associated with tobacco dependence, motivation to quit, abstinence self‐efficacy, withdrawal symptoms, dietary restraint, shape and weight concern and tobacco use expectancies. The SAQ predicted smoking‐related constructs above and beyond tobacco use expectancies, suggesting that abstinence‐related expectancies and tobacco use expectancies are distinct from one another. Conclusions A newly developed questionnaire, the Smoking Abstinence Questionnaire, appears to capture reliably smokers' expectancies for abstinence (Withdrawal, Social Improvement/Non‐smoker Identity, Adverse Outcomes, Common Reasons, Optimistic Outcomes, Coffee Use, and Weight Gain) and expectancies related to the success of a quit attempt (Treatment Effectiveness, Barriers to Treatment and Social Support). It remains to be seen how far any of these expectancies predict attempts to quit, withdrawal, treatment utilization and response and quitting success above and beyond existing measures.     

The complexity of emotions in later life

The complexity of positive and negative emotions was examined in a sample of 40 adults between the ages of 60 and 85 years. Participants' emotional experiences were assessed by use of a 30-day assessment protocol. Results suggest that different vulnerability and resilience factors are implicated in the intraindividual experience of positive and negative emotions. Individual differences in perceived stress and neuroticism were associated with less differentiation and fewer co-occurrences of positive and negative emotional experiences. In contrast, dispositional resilience predicted greater differentiation and more co-occurrences of affective states. Findings are interpreted within the framework of life-span theories of emotions.     

Variability in Affective Activation Predicts Non‐suicidal Self‐injury in Eating Disorders

We examined whether affective variability can predict non‐suicidal self‐injury (NSSI) in eating disorders. Affect was represented by valence (positive versus negative) and activation (high versus low). Twenty‐one patients with anorexia nervosa‐restricting type, 18 patients with anorexia nervosa‐binge‐purging type and 20 patients with bulimia nervosa reported their momentary affect at nine random times a day during a one week period using a hand‐held computer. Affective variability was calculated as the within‐person standard deviation of valence and activation over time. Results indicate that patients displaying greater variability in activation and using selective serotonin reuptake inhibitors have a higher probability to engage in lifetime NSSI after adjustment for depression and borderline personality disorder. Neither variability of valence nor mean level of valence and activation had any predictive association with engaging in NSSI. It is suggested that the treatment of NSSI should focus on affect stabilization rather than reducing negative affect. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers

Background Sublingual buprenorphine is an effective maintenance treatment for opioid dependence, yet intravenous buprenorphine misuse occurs. A buprenorphine/naloxone formulation was developed to mitigate this misuse risk. This randomized, double‐blind, cross‐over study was conducted to assess the intravenous abuse potential of buprenorphine/naloxone compared with buprenorphine in buprenorphine‐maintained injection drug users (IDUs). Methods Intravenous heroin users (n = 12) lived in the hospital for 8–9 weeks and were maintained on each of three different sublingual buprenorphine doses (2 mg, 8 mg, 24 mg). Under each maintenance dose, participants completed laboratory sessions during which the reinforcing and subjective effects of intravenous placebo, naloxone, heroin and low and high doses of buprenorphine and buprenorphine/naloxone were examined. Every participant received each test dose under the three buprenorphine maintenance dose conditions. Results Intravenous buprenorphine/naloxone was self‐administered less frequently than buprenorphine or heroin (P < 0.0005). Participants were most likely to self‐administer drug intravenously when maintained on the lowest sublingual buprenorphine dose. Subjective ratings of ‘drug liking’ and ‘desire to take the drug again’ were lower for buprenorphine/naloxone than for buprenorphine or heroin (P = 0.0001). Participants reported that they would pay significantly less money for buprenorphine/naloxone than for buprenorphine or heroin (P < 0.05). Seven adverse events were reported; most were mild and transient. Conclusions These data suggest that although the buprenorphine/naloxone combination has intravenous abuse potential, that potential is lower than it is for buprenorphine alone, particularly when participants received higher maintenance doses and lower buprenorphine/naloxone challenge doses. Buprenorphine/naloxone may be a reasonable option for managing the risk for buprenorphine misuse during opioid dependence treatment.     

College Drinking among Latinos(as) in the United States and Mexico

Background and Objectives: Existing studies of Latino(a) college students in the United States suggest that self‐reported alcohol consumption tends to be higher among males, and that drinking among Latinas is often influenced by social and contextual factors. The current study extended this work by examining both self‐reported drinking levels and predictors of drinking among Latino(a) college students in the United States and Mexico (MX). Methods: Latino(a) college students (N = 376) from three universities in the South Central United States and Northern Mexico completed pencil‐and‐paper surveys about alcohol. Results: US Latino students (vs. MX males), reported drinking more frequently and had more positive expectancies about alcohol. Latinas in the United States (vs. MX females) were more likely to report regular drinking. Across countries, both female gender and the Mexican orientation component of acculturation predicted lower reported alcohol consumption. Positive expectancies about drinking predicted increased drinking. Conclusions and Scientific Significance: Self‐reported college drinking and expectancies about alcohol may differ subtly among individuals in the United States and Mexico based on gender and endorsement of traditional Mexican values. These findings could ultimately be applied to the development of more tailored programs for the treatment and prevention of alcohol abuse on college campuses. (Am J Addict 2012;21:544–549)     

Emotional Support and Affect: Associations with Health Behaviors and Active Coping Efforts in Men Living with HIV

The present study represents a cross-sectional examination of the relationship between affect, social support and illness adjustment in men diagnosed with HIV/AIDS. Positive and negative affect were examined as separate mediators of the relationship between emotional support received from a primary support provider and illness adjustment in 105 men living with HIV. Results suggested that depressive symptoms emerged as a mediator between emotional support and engaging in healthy lifestyle behaviors (assessed by summary index). In contrast, positive affect emerged as the primary mediator between emotional support and greater amounts of active coping. Overall, findings suggested that emotional support from close others was indirectly associated with health behaviors and coping through recipients’ affective states, and that these positive and negative affective states had differential relationships with multiple aspects of illness adjustment in men living with HIV.