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

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


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






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%)


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%)


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%)


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.

Urbán Róbert PhD Eötvös Loránd University

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