Integrative model for alcohol and drug education.
Article Type: Editorial
Subject: Health behavior (Management)
Health behavior (Educational aspects)
Integrative medicine (Educational aspects)
Alcoholism (Study and teaching)
Alcoholism (Models)
Drug abuse (Study and teaching)
Drug abuse (Models)
Author: Sharma, Manoj
Pub Date: 08/01/2012
Publication: Name: Journal of Alcohol & Drug Education Publisher: American Alcohol & Drug Information Foundation Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Psychology and mental health; Social sciences Copyright: COPYRIGHT 2012 American Alcohol & Drug Information Foundation ISSN: 0090-1482
Issue: Date: August, 2012 Source Volume: 56 Source Issue: 2
Topic: Event Code: 200 Management dynamics Canadian Subject Form: Health behaviour; Health behaviour Computer Subject: Company business management
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 311184019
Full Text: Martin Fishbein (1967) suggested a reasoned action approach for explaining and predicting behavior in the 1960s. He has recently modified this approach and developed an Integrative Model of Behavioral Prediction (IM) by summarizing constructs from the health belief model, social cognitive theory, theory of reasoned action and theory of planned behavior (Fishbein, 2008 a, 2008b). The IM has identified a definitive set of constructs that can account for a substantial proportion of the variance in any given behavior. Like the theory of reasoned action and theory of planned behavior it assumes that intention is the best predictor of behavior. The IM acknowledges the role of environmental factors and skills and abilities in moderating the intention-behavior relationship. IM also proposes that intentions are a function of attitudes, norms (perceived normative pressure) and self-efficacy or perceived behavioral control. The attitudes are shaped by behavioral beliefs and outcome evaluations while norms are shaped by injunctive (i.e. subjective) and descriptive normative beliefs, and self-efficacy (perceived behavioral control) are shaped by control beliefs and perceived power. The model also posits background influence of past behavior, demographics and cultural knowledge, attitudes toward targets, personality, moods, emotions, other individual differences, intervention exposure and media exposure. These background influences shape the attitudes, norms, and self-efficacy which then influence intention and behavior.

The IM has been used in the field of alcohol and drug education. Zhao and colleagues (2006) applied IM to evaluate the effects of anti-marijuana advertisements in adolescents. Their study randomly assigned 435 adolescents to experimental conditions, where they were shown three advertisements that challenged undesirable normative beliefs about using marijuana. The results found that the advertisement exposure provided positive though small anti-drug effect on adolescents' choice of using marijuana and influenced their opinions about the social normative environment around marijuana use. Another study applied the IM to predict alcohol dependency in a sample of first-year undergraduate students (Atwell, Abraham, & Duka, 2011). The results showed that age of onset, sensation-seeking, social drinking motives, self-efficacy in the ability to drink within government guidelines, and the perceived quantity and frequency of alcohol consumed by university friends were significant constructs in predicting alcohol dependency. Self-efficacy and social drinking motives were particularly important predictors.

The IM model has also been used with other behaviors. For example, it has been used for identifying psychosocial determinants of cancer-related information seeking among cancer patients (Smith-McLallen, Fishbein, & Hornik, 2011), and predicting intentions to engage in cancer prevention and detection behaviors (Smith-McLallen, & Fishbein, 2009). It has also been used in examining the role of religiosity in delaying the onset of coitus in virgin adolescents (Hull, Hennessy, Bleakley, Fishbein, & Jordan, 2011), explaining how exposure to sexual media content influences adolescent sexual behavior (Bleakley, Hennessy, Fishbein, & Jordan, 2011), explaining how adolescents seek sexual content in media (Bleakley, Hennessy, & Fishbein, 2011), and predicting women's intention to be vaccinated against HPV (Dillard, 2011).

Most of the studies with this model have been done to explain and predict behavior. Not much work has been done to develop health behavior interventions aimed at modifying health behaviors. More research in the alcohol and drug education field is needed to operationalize this model in developing interventions and testing their efficacy and effectiveness. The model offers some advantages. First, it underscores the importance of intentions in predicting behavior. This line of thinking has been supported by the theory of reasoned action and the theory of planned behavior. Intentions are indeed important predictors of behavior. Second, it identifies salient constructs from four popular health behavior theories and integrates them into a single framework. This can boost the predictability of the model though it has not been seen in intervention research yet. Finally, the IM model acknowledges the role of environmental factors in predicting behavior. So it is not just confined to only personal level factors but importantly acknowledges the role of environment in shaping the behavior.

There are some disadvantages also in the model. One disadvantage of the model is that it has used constructs from four different theories and thus there is a chance of overlap of constructs. The constructs should ideally be mutually exclusive and when we combine constructs from different theories we find that there is shared variance among constructs which interferes with statistical testing. The other disadvantage with this model is that it has limited evidence with regard to its predictability and not much with interventions. Future research will tell how useful this model is in enhancing efficacy and effectiveness of health behavior interventions. Practitioners and researchers in the field of alcohol and drug education must utilize and test this model to build an empirical basis and evidence in favor of this model.


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Bleakley, A., Hennessy, M., & Fishbein, M. (2011). A model of adolescents' seeking of sexual content in their media choices. Journal of Sex Research, 48(4), 309-315.

Bleakley, A., Hennessy, M., Fishbein, M., & Jordan, A. (2011). Using the Integrative Model to explain how exposure to sexual media content influences adolescent sexual behavior. Health Education & Behavior, 38(5), 530-540.

Dillard, J. P. (2011). An application of the integrative model to women's intention to be vaccinated against HPV: implications for message design. Health Communication, 26(5), 479-486.

Fishbein, M. (1967). Attitude and prediction of behavior. In M. Fishbein (ed.), Readings in attitude theory and measurement (pp. 477-492). New York: Wiley.

Fishbein, M. (2008a). An integrative model for behavioral prediction and its application to health promotion. In R. J. Diclemente, R. A. Crosby, & M. C. Kegler (Eds.), Emerging theories in health promotion practice and research (2nd ed., pp. 215-234). San Francisco: Jossey-Bass.

Fishbein, M. (2008b). A reasoned action approach to health promotion. Medical Decision Making, 28(6), 834-844.

Hull, S. J., Hennessy, M., Bleakley, A., Fishbein, M., & Jordan, A. (2011). Identifying the causal pathways from religiosity to delayed adolescent sexual behavior. Journal of Sex Research, 48(6), 543-553.

Smith-McLallen, A., & Fishbein, M. (2009). Predicting intentions to engage in cancer prevention and detection behaviors: examining differences between Black and White adults. Psychology Health & Medicine, 14(2), 180-189.

Smith-McLallen, A., Fishbein, M., & Hornik, R. C. (2011). Psychosocial determinants of cancer-related information seeking among cancer patients. Journal of Health Communication, 16(2), 212-225.

Zhao, X., Sayeed, S., Cappella, J., Hornik, R., Fishbein, M., &Ahern, R. K. (2006). Targeting norm-related beliefs about marijuana use in an adolescent population. Health Communication, 19(3), 187-196.

Manoj Sharma, MBBS, MCHES, Ph.D., FAAHB

Editor, Journal of Alcohol & Drug Education

University of Cincinnati

526 Teachers College

PO Box 210068

Cincinnati, OH 45221-0068
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