Are outcome expectancies the possible targets of smoking prevention? The roles of smoking outcome expectancies in adolescent smoking

1
Are outcome expectancies the possible targets of
smoking prevention?The roles of smoking outcome
expectancies in adolescent smoking

• Urbán Róbert PhD
• Eötvös Loránd University

2
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.

3
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).

4
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)

5
Budapest Adolescent Smoking Study

• Methodology

6
Longitudinal design
Fall 2008
Spring 2009.
Fall 2009
Spring 2010
Fall 2010
Sampling method cluster sampling Sampling unit
classes
7
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 (SD0.56) in the first wave.

8
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

9
Parental attitude toward smoking
Household smoking
Nicotine dependence
Negative consequences
Availability of cigarette
Age
TAR
Positive reinforcement
Sensation seeking
Susceptibility to smoking
Smoking status
Peer norms and pressure
Negative reinforcement
Delinquency
First exp. from smoking
Readiness to quit
Depressive symptoms
Appetite and weight control
Alcohol use
Weight concerns
Smoking prevention
Physical activity
10
Parental attitude toward smoking
Household smoking
Nicotine dependence
Negative consequences
Availability of cigarette
Age
TAR
Positive reinforcement
Sensation seeking
Susceptibility to smoking
Smoking status
Peer norms and pressure
Negative reinforcement
Delinquency
First exp. from smoking
Readiness to quit
Depressive symptoms
Appetite and weight control
Alcohol use
Weight concerns
Smoking prevention
Physical activity
11
The role of expectancies in smoking initiation

• Are the outcome expectancies important before the
  experimentation with smoking?

12
Predictors of experimentation with smoking
between Wave 1 and Wave 2
Negative consequences
-0.095 (0.022)
0.060 (0.016)
Positive reinforcement
R²18
Susceptibility (intention) to smoking
Trying smoking
0.63 (0.016)
Negative reinforcement
0.034 (0.015)
R²9
Unstandardized coefficients (SE)
Appetite and weight control
?²566.7 df284 CFI.933 TLI.923 RMSEA.032
.028-.036 N828. Based on students who had not
tried smoking in Wave 1 and provided data in Wave
2
13
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.

14
The role expectancies in smoking intensity

• Crosslagged analysis an analysis of the cause
  and effect

15
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.

16
Cross-lagged association between negative
reinforcement expectancies and smoking intensity
Wave 1
Wave 2
Wave 3
Wave 4
Wave 5
R²27.2
R²50.6
R²59.4
R²55.0
Smoking intensity
Smoking intensity
Smoking intensity
Smoking intensity
Smoking intensity
0.07
0.14
0.08
0.11
0.06
Negative reinforcement
Negative reinforcement
Negative reinforcement
Negative reinforcement
Negative reinforcement
Correlations between uniquenesses are not
presented. ?²48.1 df15 RMSEA0.025
0.018-0.034 CFI0.99 TLI0.97
17
The role expectancies in smoking intensity

• Two parallel process models

18
A growth model
Time 1
Time 2
Time 3
Time 4
Time 5
1
1
1
1
2
9
3
4
16
1
1
4
1
Intercept
Slope
Quadratic
Linear change
Non-linear change
19
Smoking intensity_1
Smoking intensity_2
Smoking intensity_3
Smoking intensity_4
Smoking intensity_5
Intercept Smoking
Slope Smoking
Quadratic Smoking
-0.26
0.26
0.77
Intercept NR
Slope NR
Quadratic NR
NR_1
NR_2
NR_3
NR_4
NR_5
NRnegative reinforcement
20
Smoking intensity_1
Smoking intensity_2
Smoking intensity_3
Smoking intensity_4
Smoking intensity_5
Intercept Smoking
Slope Smoking
Quadratic Smoking
-0.90
1.16
-1.50
0.97
Intercept PR
Slope PR
Quadratic PR
PR_1
PR_2
PR_3
PR_4
PR_5
PRpositive reinforcement
21
Further questions Do expectancies change over
time?

• A latent class growth analysis (LCGA)

22
A latent class growth analysis (LCGA)
Time 1
Time 2
Time 3
Time 4
Time 5
1
1
1
1
2
9
3
4
16
1
1
4
1
Intercept
Slope
Quadratic
Latent classes
23
Days of smokingduring the last 30 days
Based on the students who provided data at least
3 occasions, and smoked a cigarette at least on
day during the research. N1147.
24
Negative consequences
Based on all students.
25
Positive reinforcement
Based on all students.
26
Negative reinforcement
Based on all students.
27
Appetite and weight control
Based on all students.
28
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.