The belief that alcohol use is inconsistent with personal autonomy: a promotive factor for younger adolescents.
This study explored an understudied promotive factor, a belief that
alcohol use is inconsistent with personal autonomy, which may reduce
adolescent intention to drink and subsequent alcohol use. Autonomy was
examined as an attitudinal construct within the Theory of Reasoned
Action. Longitudinal data from 2,493 seventh grade students nested in 40
schools were analyzed using a structural equation model. Autonomy was
negatively correlated with intention to use alcohol and subsequent
alcohol use at a later wave, and intention to use fully mediated the
effect of autonomy on subsequent alcohol use. These results are
consistent with the proposition that when personal autonomy is perceived
as inconsistent with alcohol use among younger adolescents, students
indicate a lower intention to use alcohol and use less alcohol during
the following school year.
Keywords: adolescent protective factors, alcohol use, autonomy, subjective norms, theory of reasoned action
Youth (Alcohol use)
Drinking of alcoholic beverages
Alcohol and youth
Henry, Kimberly L.
Comello, Maria Leonora G.
Slater, Michael D.
|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 2011 American Alcohol & Drug Information Foundation ISSN: 0090-1482|
|Issue:||Date: August, 2011 Source Volume: 55 Source Issue: 2|
|Product:||Product Code: E121930 Youth|
Adolescence is a key time for alcohol use experimentation. For many
adolescents, this experimentation does not lead to deleterious
consequences, but for others alcohol use leads to short and long term
consequences, including abuse of alcohol and other substances throughout
the life course (DeWit, Adlaf, Offord & Ogborne, 2000). Accordingly,
much work has focused on the risk and promotive factors for adolescent
alcohol use (Hawkins, Catalano & Miller, 1992). In this context,
risk factors are positively associated with alcohol use, while promotive
factors are negatively associated with alcohol use. Identifying these
factors is prerequisite to designing effective prevention strategies,
which can target factors--typically promotive factors--that may be
beneficially influenced. Continuing high levels of adolescent alcohol
use (Johnston, O'Malley, Bachman & Schulenberg, 2009) suggest
that more remains to be done in attempting to reduce adolescent
Examination of novel or understudied promotive factors has the potential to advance both scientific understanding and prevention practice with respect to adolescent risk behaviors. In this paper, we explore methodological and conceptual issues regarding one understudied promotive factor: identity formation that emphasizes alcohol use as inconsistent with personal autonomy. We do so utilizing the Theory of Reasoned Action (TRA) (Fishbein & Ajzen, 1975) as a framework.
We incorporate this attitudinal-based construct of autonomy in a TRA model along with subjective norms (the other major component of TRA) as represented by peer pressures regarding the respondents' alcohol use. We emphasize these factors in the belief that linking non-use to personal autonomy is more consistent with adolescent developmental motivations and needs than efforts to motivate risk-avoidance or decrease general positive attitudes toward alcohol use.
Our objectives here are to (a) provide expanded evidence regarding the importance of perceptions that alcohol use is inconsistent with personal autonomy as a promotive factor for adolescents, notably in the context of alcohol use; and (b) offer a brief and reliable measure of such autonomy perceptions for use by the drug education community.
An Identity Autonomous from Alcohol Use
In this study, we consider a specific type of belief related to autonomy: the extent to which an adolescent perceives that his/ her identity is autonomous from alcohol use. The belief must be distinguished from merely believing that one is free from any compulsion to drink. Rather, the belief involves the incompatibility of alcohol use with the expression and regulation of self. That is, rather than viewing alcohol use as an expression of autonomy, the adolescent believes that staying away from alcohol is supportive of his/her independence, being in control of his/her life, and being true to him/herself. Such a view is an alternative to the perhaps more typical view conveyed in ads that alcohol use is a choice that leads toward desirable ends (e.g., being perceived as attractive and as someone who knows how to have a good time).
It is our argument that, since establishment of personal autonomy is a central task of adolescence, believing that alcohol use is a way to demonstrate autonomy is likely to lead to attitudes about alcohol that promote use. By the same token, believing that nonuse is a way to demonstrate autonomy can lead to attitudes about alcohol that are protective against use. While we recognize that an adolescent's perception that alcohol use can be harmful is likely to serve as a promotive factor, we point out that a certain amount of risk-taking is developmentally normative during adolescence. Adolescents most at-risk for alcohol and other substance use tend to be high sensation-seekers for whom risk is attractive rather than aversive (Zuckerman, 1979), and who have particularly strong autonomy needs and tendencies toward reactance (Quick & Stephenson, 2008). Thus, holding a belief that alcohol avoidance is a way in which one can express his/her autonomy may be quite important to delaying the onset of use and/or reducing the level of use.
Healthy Subjective Norms Surrounding Alcohol Use
Subjective norms, one of the major components of TRA, can be viewed as an individual's belief that important social referents (e.g., friends, peers, parents) think that he/she should or should not engage in a certain behavior (Fishbein, 1980). A healthy subjective norm surrounding alcohol use would imply that adolescents believe that important others do not support drinking alcohol. Subjective norms capture social pressures that may influence an adolescent's intention to use alcohol (Armitage & Conner, 2001; Webb & Sheeran, 2006). Kuther (2002) further suggests that adolescents' subjective norms regarding alcohol use is the primary basis for their decision to initiate. Given the critical importance of peers in influencing substance use behavior among adolescents (Oetting & Donnermeyer, 1998), we focus on the perceived subjective norms put forth by friends and peers.
The Intersection of Autonomy and Subjective Norms within the Framework of TRA
TRA (Fishbein & Ajzen, 1975) is a predictive model that posits that volitional behavior stems from a rational thought process that is conscious and controlled (Gibbons, Gerrard, Blanton & Russell, 1998). The central tenet of this theory is that attitudes and subjective norms about the behavior influence intentions to perform a given behavior such as to drink alcohol (Webb & Sheeran, 2006). Attitudes are determined by evaluations of behavioral beliefs, that is, beliefs about the implications and consequences of the behavior. Subjective norms are the belief that influential others in one's social sphere would or would not approve of one's engaging in the behavior (Trafimow, 2009). Intentions reflect the motivational, volitional factors underlying behaviors (Ajzen, 2009) and mediate the effects of attitudes and norms on behavior (Webb & Sheeran, 2006).
We employ TRA in preference to TRA's later variant, the Theory of Planned Behavior (TPB, Ajzen, 1991), in the interest of parsimony and better theoretical fit to this particular substantive area. Research on adolescent alcohol use suggests that peer influences (the key subjective norms in this case) are of particular importance with respect to this use; control beliefs around the ability to drink or not drink, the additional variable suggested by the TPB, appears to be of less relevance in this particular domain than in many others to which the TPB is typically applied.
In this study, we consider an identity autonomous from alcohol use to capture a specific type of attitude toward alcohol use that may be particularly salient to young adolescents. We regard autonomy as inherently positively evaluated by adolescents (consistent with the developmental literature as noted above), with the important variation being in the extent to which autonomy is associated with non-use or use of alcohol. Again, we emphasize that the autonomy-related construct we measure is not about freedom from compulsion to drink; if this were the case, control beliefs added to TRA by TPB would be important to consider, but because the focus is not on controllability, TRA is preferred for reasons of parsimony.
In addition to autonomy we also consider peer subjective norms. Several factors motivate this choice. First, peer norms and expectations regarding alcohol use are well-recognized as key predictors of adolescent alcohol use (Armitage & Conner, 2001; Kuther, 2002; Webb & Sheeran, 2006). Therefore, incorporating subjective norms provides a point of comparison regarding the relative strength of the autonomy path on alcohol use intentions and behavior. Second, it is possible that autonomy is merely reflective of peer norms--peer groups that do not support alcohol use also promote beliefs about autonomy consistent with these norms. Including peer subjective norms provides a control for these spurious relations. Third, including this crucial normative component allows us to look at the effects of autonomy more appropriately within the TRA framework which looks simultaneously at attitudinal and social influences on behavior.
Aims of the Current Study
In this study we test a TRA mediation model in which autonomy and subjective norms measured in 7th grade predict intention to use alcohol in 7th grade, which in turn predicts alcohol use in 8th grade. We focus on intentions measured at the same time as autonomy and subjective norms, because we believe that these factors have an immediate effect on an adolescent's weighing of the pros and cons of alcohol use and hence on his/her intention to use alcohol in the future. We focus on alcohol use during the following school year (8th grade) in order to assess the longitudinal influence of autonomy, subjective norms, and intention, holding constant alcohol use in 7th grade. We also limit our sample to students who hadn't yet been drunk in 7th grade; this involved the exclusion of 9.1% of the students. We chose to focus on youth with very limited or no alcohol experience at the beginning of the study, because it is these youth who are most likely to be influenced by the promotive factor of interest in this study and believe that alcohol use is inconsistent with personal autonomy. Youth who are alcohol users presumably have already rejected that belief. The strategy of interest here is, after all, a prevention and not a treatment strategy.
We hypothesize that autonomy and subjective norms will independently predict both intention to use alcohol and subsequent alcohol use. Moreover, we hypothesize that intention to use alcohol, as suggested by TRA, will mediate the effects of autonomy and subjective norms on subsequent use of alcohol.
The data used in this study were obtained from the evaluation of a media-based intervention in ten communities from across the U.S. receiving a community-media intervention and ten communities serving as controls. Within each community, two middle schools were recruited and randomized to receive an additional in-school media intervention. Schools were recruited based on National Center for Educational Statistics (NCES) district listings; eligible districts were not in the largest urban category (because of the long delays required to obtain clearance in these districts) and had at least two middle schools of comparable size. Because of the demands of implementation, the two-year intervention was staggered across three groups, the first beginning fall 2005, the second in fall of 2006, the third in fall of 2007, with data collection concluding in spring of 2009.
Four waves of data were collected in each school during the 7th and 8th grade school years. The first wave was a preintervention baseline. A total of 3,236 students, approximately 35% of those eligible, participated in at least one survey; active parental consent and youth assent were given for participation as required by the responsible Institutional Review Boards. Of these, 57.1% provided data at all four measurement occasions, 27.2% provided data on three, 9.4% provided data on two, and 5.3% provided data on just one of the measurement occasions. We excluded students who responded that they had tried all drugs listed including one that had been invented for the purpose of the survey. This represented no more than one percent of the students at any given wave. Substance use overall was lower than in a prior study (Slater, Kelly, Edwards et al., 2006) in similar schools using a similar instrument in which, due to more liberal human subjects requirements, response rates were substantially higher. We therefore believe that the samples studied had relatively lower rates of substance use than the overall school populations. However, the effect of this selectivity in our sample should tend to bias our results in a conservative direction, given that it would restrict variability in alcohol use, our outcome variable.
In this study we utilize the Wave 2 (middle to end of 7th grade) and Wave 4 (middle to end of 8th grade) data from 2,493 adolescents who were observed on at least one of the key variables assessed in the present analysis and had not yet been drunk by the Wave 2 survey. In this subsample, 48% of the students are male, 59% are non-Hispanic White (10% African American, 22% Latino, and 9% reported some other ethnicity or did not report an ethnic group). The average age at the second seventh grade survey (Wave 2) was 12.8 (SD=.6). We begin with the Wave 2 survey as variation in use behavior was greatest at Wave 4 (the final wave), and Wave 1 seemed too distant in time to provide optimal prediction--a one-year time span seemed to provide time for attitudes to translate into changing social groups and changing behavior. Autonomy, subjective norms and intention to use alcohol come from the Wave 2 survey. In our view, capturing both autonomy and intention at the same time point did not contradict the sequential relationship proposed to exist between them, as the influence of autonomy on intention may well occur within a very short timeframe that would be missed by the approximately six-month lags between measurement occasions. The outcome of interest in this study is alcohol use measured at Wave 4, which took place from mid to end of 8th grade.
The primary construct of interest in this study is an identity autonomous from alcohol use (i.e., referred to here as autonomy). Consistent with TRA, we also consider subjective norms surrounding alcohol use. The items making up each of these latent constructs and the associated descriptive statistics are presented in Table 1. In all analyses, the items were treated as ordered categorical variables.
Autonomy and subjective norms are used to predict intention to use alcohol contemporaneously and alcohol use during the following year (i.e., measured in 8th grade). Intention to use is defined by four items and alcohol use in 8th grade is defined by six items. These items and the associated frequencies are presented in Table 1. All indicators for intentions and alcohol use were treated as ordered categorical variables.
Several control variables were included in all models, including alcohol use in 7th grade (a binary indicator to differentiate between youth who had used alcohol in the past three months and those who had not), treatment condition, age at the wave 2 survey, gender, race/ethnicity (defined as three dummy variables that compare African American, Latino, and youths of some other ethnicity or missing ethnicity, to White, non-Hispanic youths) and the length of time that elapsed between the wave 2 (7th grade) and wave 4 (8th grade) survey. This latter value differs to a small degree across schools (M=354 days, SD=34).
The hypotheses were tested using a mediation model, following the guidelines for testing indirect effects put forth by MacKinnon (2008). All analyses were conducted in Mplus, Version 6.1 (Muthen and Muthen, 1998-2007) using a robust weighted least squares estimator for categorical data (WLSMV). With the WLSMV estimator, parameter estimates are based on the polychoric correlations for all pairwise present data (Muthen and Muthen, 1998-2007); therefore, cases were not deleted for having just some missing data, as would be the case if listwise deletion were employed.
In order to account for the nested structure of these data (i.e., students nested in schools), a sandwich estimator to obtain robust variance estimates that adjust for violation of the independence assumption (i.e., cluster-correlated data due to nesting) was utilized (Williams, 2000). This method for analyzing complex survey data, where individuals are nested in upper level units, adjusts the standard errors and test statistics to account for the nesting of students in schools.
Table 2 presents the correlation matrix of the key variables of interest. Autonomy and subjective norms are positively correlated. Each is strongly and negatively correlated with intention to use alcohol as well as alcohol use in 8th grade. Also as expected, intention to use and subsequent use in the next year are positively correlated.
Before estimating the full mediation model, we first examined the direct effects of autonomy and subjective norms on alcohol use in 8th grade, controlling for alcohol use in 7th grade and the other control variables. The results of the model are presented in Figure 1. As hypothesized, autonomy and subjective norms each exerts a unique influence on alcohol use in 8th grade, with greater autonomy and healthier norms both associated with less alcohol use.
Next we fit the full mediation model. The results are presented in Figure 2. Autonomy and subjective norms are both associated with a lower intention to use in 7th grade (the mediator). In turn, a higher intention to use is associated with a higher level of alcohol use in 8th grade. These effects adjust for alcohol use in 7th grade as well as the other control variables. As reported in the figure caption, the indirect effect of autonomy and subjective norms on alcohol use in 8th grade is mediated (i.e., explained) by intention to use alcohol in 7th grade. In both cases, the mediation is full, as direct effects are not significantly different from zero. That is, intention to use fully explains the relationship between the antecedents and subsequent alcohol use.
These results are consistent with the proposition that when personal autonomy is perceived as inconsistent with alcohol use, there is a protective effect with respect to future alcohol use. Consistent with TRA, this effect is mediated via use intentions. It is impressive that these effects are apparent even after adjusting for use of alcohol in 7th grade and subjective norms. Subjective norms, a critically important predictor of adolescent alcohol use as demonstrated here, are highly correlated with autonomy.
The brief, 4-item scale used to measure autonomy in this study demonstrates favorable basic psychometric properties, though more work is needed to determine if it is valid and reliable in a new sample. Coefficient alpha equals .97 at Wave 2, and the factor loadings in the models tested in this paper are all large (i.e., [greater than or equal to].98). This construct is substantially correlated with both intentions to use alcohol (r=-.63) and alcohol use during the subsequent school year (r=-.32). Therefore, it seems reasonable to infer that adolescent beliefs that alcohol use is inconsistent with personal autonomy is in fact an important promotive factor and worthy of further study with respect to etiology, mechanisms, and interventions. In particular, these findings are supportive of prevention programs (e.g., Slater et al, 2006) that attempt to reduce alcohol use behavior by linking non-use to autonomy and thereby utilize adolescent motivation toward independence and agency in alcohol use prevention efforts. These efforts are gaining increasing prominence; the national anti-marijuana campaign called "Above the Influence", sponsored by the Office of National Drug Control Policy, appears to operate at least in part by attempting to influence perceptions of marijuana's impact on personal autonomy (Slater et al., in press). This study offers a measure of the construct and provides initial evidence that it is also meaningfully related to alcohol outcomes while controlling for subjective peer norms regarding alcohol use.
It is important to recognize the limitations of this study. First, the use of self-report measures of alcohol use may not perfectly correlate with actual use. Second, self-selection bias in terms of willingness to enroll in this study limits generalizability, as does a sample that, while geographically and ethnically diverse, is not a random sample of American adolescents. Although self-report and self-selection likely reduce the accuracy of estimates by increasing error and reducing variability in our dependent measure, at the same time they do not undermine the central claims of this study. It is also possible that urban youth would respond differently than the youth from smaller towns and suburbs studied here; however, there is no clear theoretical reason for presuming differences in basic motivational processes and resultant relationships. We note also that issues of identity formation are influenced by factors of family, community, and larger culture that are beyond the scope of this investigation.
Despite these limitations, this study introduces a new, brief scale to measure adolescents' beliefs that their identities are autonomous from alcohol use. Results indicate that the scale has favorable basic psychometric properties and is moderately to highly correlated (negatively) with alcohol intentions and subsequent alcohol use. These findings provide novel evidence indicating that these autonomy perceptions are protective with respect to alcohol use. It is our intention that these findings will draw attention to the potential preventive effects of alcohol education efforts that focus on a developmentally appropriate goal for adolescents--the development of an identity that is autonomous from alcohol use.
We acknowledge the efforts of project manager Linda Stapel, the Tri-Ethnic Center for Prevention Research, Colorado State University, and the students and staff of participating schools, who together made this research possible. This research was supported by grant R01 DA12360 from the National Institute on Drug Abuse to the fourth author. The work of the first author is supported by grant K01 DA017810 from the National Institute on Drug Abuse. This manuscript is respectfully dedicated to the memory of Marty Fishbein, whose scholarship and insights have been the foundation of this and so much other work in the prevention field.
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(1) The degrees of freedom for the robust weighted least squares estimator (WLSMV) in Mplus, Version 6.1 are estimated using a formula given in the Mplus Technical Appendices at www.statmodel.com.
Correspondence concerning this article should be addressed to: Kimberly L. Henry, Colorado State University, Department of Psychology, Fort Collins, CO 80523-1876, telephone: 970-491-5109, email: email@example.com
Kimberly L. Henry & Annette Shtivelband
Colorado State University
Maria Leonora G. Comello
University of North Carolina-Chapel Hill
Michael D. Slater
The Ohio State University
TABLE 1 Descriptive statistics for key study variables Item Value 1 2 3 4 5 Autonomy ([alpha] = .97) Not drinking alcohol is a way to be true to myself. (AUT1) 4.3% 2.8% 10.8% 82.1% Not drinking alcohol is an important part of who I am. (AUT2) 4.4% 3.2% 10.2% 82.2% Not drinking alcohol is a way of being in control of my life. AUT3) 4.1% 2.9% 8.4% 84.7% Not drinking alcohol is a way of showing my own independence. (AUT4) 4.5% 2.8% 10.6% 82.1% Subject Norms for Alcohol Use (r between items =.41) How much would your friends try to stop you from getting drunk? (SN1) 7.3% 5.1% 12.5% 75.2% Would your friends be more likely or less likely to want to be around you if you were getting drunk? (SN2) 1.7% 1.1% 9.1% 13.6% 74.5% Intentions to Use Alcohol ([alpha] = .83) I've decided for sure I will not drink alcohol. (INT1) 62.5% 17.3% 12.8% 7.3% I've told a friend that I will stay away from alcohol. (INT2) 65.3% 15.1% 8.9% 10.7% Which statement best describes your alcohol use, I will (INT3) 49.7% 30.5% 8.8% 11.0% Do you plan to try or use alcohol in the next two years? (INT4) 73.0% 16.4% 5.0% 3.9% 1.7% Alcohol Use in 8th grade (a=.84) Used alcohol in the past 3 months (ALC1) 76.5% 23.5% Been drunk in the past 3 months (ALC2) 93.7% 6.3% Used alcohol in the past 1 month (ALC3) 81.4% 18.6% Been drunk in the past 1 month (ALC4) 94.9% 5.1% Ever used alcohol (ALC5) 56.0% 44.0% Ever been drunk (ALC6) 89.1% 10.9% Notes: Item values for autonomy are 1=definitely disagree, 2=disagree somewhat, 3=agree somewhat, 4=definitely agree; subjective norms for SN1 are 1=not at all, 2=not much, 3=some, 4=a lot; subjective norms for SN2 are 1=a lot more, 2=more, 3=the same, 4=less, 5=a lot less; intentions for INT1 and INT2 are 1=definitely true, 2=mostly true, 3=maybe true, 4=not at all true; intentions for INT3 are 1=never used alcohol and never will, 2=never used alcohol, but may in the future, 3=used alcohol, but don't plan to use again, 4=used alcohol, and probably will use again; intentions for INT4 are 1=definitely won't try, 2=might try, 3=will try, 4=will use, 5=will use a lot; alcohol use in 8th grade are 1=no, 2=yes. TABLE 2 Correlation matrix for the latent variables 1 2 3 4 1. Autonomy in 7th grade 1.00 2. Subjective Norms in 7th grade 0.55 1.00 3. Intentions to Use in 7th grade -0.63 -0.63 1.00 4. Alcohol use in 8th grade -0.32 -0.36 0.52 1.00 Notes: All correlations are statistically significant (p<.01). Estimates derived from full mediation model (Figure 2).
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