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. Fall 2008Spring 2009.Fall 2009Spring 2010Fall 2010 Longitudinal design 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 (SD=0.56) 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. Household smoking Age Sensation seeking Delinquency Depressive symptoms Weight concerns Parental attitude toward smoking Availability of cigarette TAR Peer norms and pressure Alcohol use Physical activity Negative consequences Positive reinforcement Negative reinforcement Appetite and weight control First exp. from smoking Susceptibility to smoking Smoking status Smoking prevention Nicotine dependence Readiness to quit

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

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 Positive reinforcement Negative reinforcement 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% χ ² =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)

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. Smoking intensity Smoking intensity Smoking intensity Smoking intensity Smoking intensity Negative reinforcement Negative reinforcement Negative reinforcement Negative reinforcement Negative reinforcement Wave 1Wave 2Wave 3Wave 4Wave 5 Correlations between uniquenesses are not presented. χ ² =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%

17. The role expectancies in smoking intensity Two parallel process models

18. Time 1Time 2Time 3Time 4Time 5 Intercept SlopeQuadratic 1 1 1 1 1 1 2 3 41 4 9 16 A growth model Linear change Non-linear change

19. Smoking intensity_1 Smoking intensity_2 Smoking intensity_3 Smoking intensity_4 Smoking intensity_5 NR_1NR_2NR_3NR_4NR_5 Intercept Smoking Slope Smoking Quadratic Smoking Intercept NR Slope NR Quadratic NR 0.77*** -0.26*** 0.26*** NR=negative reinforcement

20. Smoking intensity_1 Smoking intensity_2 Smoking intensity_3 Smoking intensity_4 Smoking intensity_5 PR_1PR_2PR_3PR_4PR_5 Intercept Smoking Slope Smoking Quadratic Smoking Intercept PR Slope PR Quadratic PR 0.97*** -0.90*** 1.16*** -1.50*** PR=positive reinforcement

21. Further questions: Do expectancies change over time? A latent class growth analysis (LCGA)

22. Time 1Time 2Time 3Time 4Time 5 InterceptSlopeQuadratic Latent classes 1 1 1 1 1 1 2 3 41 4 9 16 A latent class growth analysis (LCGA)

23. Days of smoking during 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. N=1147.

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.