Emma L. Davies

Young people talking about alcohol: Focus groups exploring constructs in the prototype willingness model

Aim: This study aimed to explore constructs in the prototype willingness model (PWM) to establish if it provides a basis for understanding and preventing alcohol misuse in teenagers in the UK. Methods: Four focus groups were carried out with 11–13 and 16–17 year olds. There were 13 males and 14 females. Transcripts of the focus groups were analysed using thematic analysis in NVivo. Findings: Three PWM relevant themes were identified. The first theme brought together the alcohol prototypes described by participants. The second theme addressed drinking contexts and contrasts evidence that suggests that some drinking is planned and some is unplanned. The final theme looks at attitudes and norms including participants’ attitudes towards alcohol education. Conclusions: The findings from this study show that young people in this sample held clear prototypes in relation to alcohol. The evident difference between ‘planned’ and ‘unplanned’ drinking contexts suggests that the PWM provides a more satisfactory explanation of young peoples drinking than a decisional model based on intentions alone. Drinking alcohol was reported by the participants as a normative teenage behaviour. Implications for an intervention programme targeting alcohol prototypes and future research are discussed.

Age differences in alcohol prototype perceptions and willingness to drink in UK adolescents

Using the prototype willingness model (PWM) as a framework, this study sought to explore the relationship between prototype perceptions, willingness and alcohol consumption in a sample of adolescents in the United Kingdom (UK). Adolescents aged 11–17 were asked about their alcohol prototype perceptions, willingness to drink, intentions, alcohol consumption, drunkenness and harms using a cross-sectional online survey. Participants were recruited through opportunity sampling via schools and parents. The survey was completed by 178 respondents (51% female; 91 aged 11–15, 87 aged 16–17). Multivariate analysis revealed significant differences between participants aged 11–15 and 16–17 on PWM measures, even when experience with drinking was accounted for (p < .001). There were significant interactions (p < .001) between age and prototype perceptions; younger participants rated non-drinker prototypes as more favourable and more similar to the self than 16- and 17-year-old participants. Willingness and intentions interacted with age; both measures were similar in 16- and 17-year-olds, whereas younger participants scored significantly higher on willingness than intentions (p < .001). Three distinct scales of prototype descriptions were identified in principal components analysis. Characteristics related to sociability significantly predicted willingness to drink alcohol in the sample (p < .001). This study extends previous research by demonstrating that the PWM can provide a theoretical explanation of adolescent drinking in the UK. The results suggest that 11- to 15-year-olds may be the most suitable age for an intervention that targets alcohol prototypes, with a focus on sociability characteristics.

Motivations for reducing alcohol consumption: an international survey exploring experiences that may lead to a change in drinking habits

AIMS Brief interventions delivered by doctors and other healthcare practitioners might be meaningfully enhanced by understanding what individual experiences might lead patients to cut down. The aim of the current paper was to explore the experiences that might lead people to reduce their alcohol consumption and to compare these findings between respondents from 21 different countries. METHODS Global Drug Survey is an online cross sectional, opportunistic anonymous survey. This paper includes 72,209 respondents from 21 counties with over 250 respondents (60.8% male). RESULTS Almost a third (32.9%) of participants reported that they would like to drink less alcohol over the next 12months, and a third thought their GP would tell them to cut down if they were honest about their drinking. The primary experiences that were rated as most likely to lead to a change in behaviour were related to physical health, sexual assault and having to seek emergency medical treatment. Respondents from Germany were more likely to select embarrassment as a motivation to reduce drinking than those from other counties. Females were more likely to report indicate motivations related to sexual regret, sexual assault or seeking treatment. Older participants and those in the low risk audit category were more likely to report embarrassment or forgetfulness as potential motivation for change. CONCLUSION Understanding the different motivations that may lead individuals to change their drinking behaviours can be used to inform targeted brief interventions and targeted public health guidance.

Effectiveness of the strengthening families programme 10–14 in Poland: cluster randomized controlled trial

Background : The Strengthening Families Programme for youth aged 10-14 and parents/carers (SFP10-14) is a family-based prevention intervention with positive results in trials in the United States. We assessed the effectiveness of SFP10-14 for preventing substance misuse in Poland. : Cluster randomized controlled trial with 20 communities (511 families; 614 young people) were allocated to SFP10-14 or a control arms. Primary outcomes were alcohol, smoking and other drug use. Secondary outcomes included parenting practices, parent-child relations, and child problem behaviour. Interview-based questionnaires were administered at baseline and at 12- and 24-months post-baseline, with respective 70.4 and 54.4%, follow-up rates. : In Bayesian regression models with complete case data we found no effects of SFP10-14 for any of the primary or secondary outcomes at either follow-up. For example at 24-months, posterior odds ratios and 95% credible intervals for past year alcohol use, past month binge drinking, past year smoking, and past year other drug use, were 0.83 (0.44-1.56), 0.83 (0.27-2.65), 1.94 (0.76-5.38) and 0.74 (0.15-3.58), respectively. Although moderate to high attrition rates, together with some evidence of systematic attrition bias according to parent education and family disposable income, could have biased the results, the results were supported in further analyses with propensity score matched data and 40 multiple imputed datasets. : We found no evidence for the effectiveness of SFP10-14 on the prevention of alcohol or tobacco use, parenting behaviour, parent-child relations or child problem behaviour at 12- or 24-month follow-up in a large cluster randomized controlled trial in Poland.

Implicit alcohol attitudes predict drinking behaviour over and above intentions and willingness in young adults but willingness is more important in adolescents: Implications for the Prototype Willingness Model

OBJECTIVES Dual process models, such as the Prototype Willingness Model (PWM), propose to account for both intentional and reactive drinking behaviour. Current methods of measuring constructs in the PWM rely on self-report, thus require a level of conscious deliberation. Implicit measures of attitudes may overcome this limitation and contribute to our understanding of how prototypes and willingness influence alcohol consumption in young people. This study aimed to explore whether implicit alcohol attitudes were related to PWM constructs and whether they would add to the prediction of risky drinking. DESIGN The study involved a cross-sectional design. The sample included 501 participants from the United Kingdom (Mage 18.92; range 11-51; 63% female); 230 school pupils and 271 university students. METHODS Participants completed explicit measures of alcohol prototype perceptions, willingness, drunkenness, harms, and intentions. They also completed an implicit measure of alcohol attitudes, using the Implicit Association Test. RESULTS Implicit alcohol attitudes were only weakly related to the explicit measures. When looking at the whole sample, implicit alcohol attitudes did not add to the prediction of willingness over and above prototype perceptions. However, for university students implicit attitudes added to the prediction of behaviour, over and above intentions and willingness. For school pupils, willingness was a stronger predictor of behaviour than intentions or implicit attitudes. CONCLUSIONS Adding implicit measures to the PWM may contribute to our understanding of the development of alcohol behaviours in young people. Further research could explore how implicit attitudes develop alongside the shift from reactive to planned behaviour. Statement of contribution What is already known on this subject? Young peoples drinking tends to occur in social situations and is driven in part by social reactions within these contexts. The Prototype Willingness Model (PWM) attempts to explain such reactive behaviour as the result of social comparison to risk prototypes, which influence willingness to drink, and subsequent behaviour. Evidence also suggests that risky drinking in young people may be influenced by implicit attitudes towards alcohol, which develop with repeated exposure to alcohol over time. One criticism of the PWM is that prototypes and willingness are usually measured using explicit measures which may not adequately capture young peoples spontaneous evaluations of prototypes, or their propensity to act without forethought in a social context. What does this study add? This study is novel in exploring the addition of implicit alcohol attitudes to the social reaction pathway in the model in order to understand more about these reactive constructs. Implicit alcohol attitudes added to the prediction of behaviour, over and above intentions and willingness for university students. For school pupils, willingness was a stronger predictor of behaviour than intentions or implicit attitudes. Findings suggest that adding implicit alcohol attitudes into the PWM might be able to explain the shift from reactive to intentional drinking behaviours with age and experience.

Development and Acceptability of a Co-Produced Online Intervention to Prevent Alcohol Misuse in Adolescents: A Think Aloud Study

Background The prototype willingness model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse. An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to the PWM. Objective This study sought to determine the acceptability and relevance of the intervention content to young people, to incorporate their feedback into a final version. Methods A qualitative think aloud study with follow-up semistructured interviews was undertaken with 16 young people aged 11-15 (50%). Transcripts were analyzed using thematic analysis. Results The following 3 main themes relating the acceptability of the intervention were identified: “challenging expectations of alcohol education”; “motivations for drinking or not drinking,” and “the inevitability of drinking.” Participants found the intervention appealing because it was counter to their expectations. The content appeared to reflect their experiences of social pressure and drinking encounters. There was evidence that a focus on drinker/nondrinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink. Conclusions An online intervention based on the PWM has the potential to engage and interest adolescents. A wide range of alcohol prototypes should be targeted and a focus on short-term harms should ensure that the intervention is credible to young people.

Personalized Digital Interventions Showed no Impact on Risky Drinking in Young Adults: A Pilot Randomized Controlled Trial

Aim To assess the effectiveness of two personalized digital interventions (OneTooMany and Drinks Meter) compared to controls. Method Randomized controlled trial (AEARCTR-0,001,082). Volunteers for the study, aged 18-30, were randomly allocated to one of two interventions or one of two control groups and were followed up 4 weeks later. Primary outcomes were AUDIT-C, drinking harms and pre-loading. Drinks Meter provided participants with brief screening and advice for alcohol in addition to normative feedback, information on calories consumed and money spent. OneTooMany presented a series of socially embarrassing scenarios that may occur when drinking, and participants were scored according to if/how recently they had been experienced. Results The study failed to recruit and obtain sufficient follow-up data to reach a prior estimated power for detecting a difference between groups and there was no indication in the analysable sample of 402 subjects of a difference on the primary outcome measures (Drinks Meter; AUDIT-C IRR = 0.98 (0.89-1.09); Pre-loading IRR = 1.01 (0.95-1.07); Harms IRR = 0.97 (0.79-1.20); OneTooMany; AUDIT-C IRR = 0.96 (0.86-1.07); Pre-loading IRR = 0.99 (0.93-1.06); Harms IRR = 1.16 (0.94-1.43). Conclusion Further research is needed on the efficacy of such instruments and their ingredients. However, recruitment and follow-up are a challenge.

Feasibility of the Prototype Willingness Model as the basis for school-delivered alcohol misuse prevention: A qualitative think-aloud study to explore acceptability of ‘The Alcohol Smart Quiz’ with adolescents and teachers

This study sought feedback from teachers and adolescents on a novel intervention to reduce alcohol misuse based on the Prototype Willingness Model. A qualitative, think-aloud interview study was conducted with 17 adolescents aged 11–14 years and nine teachers. Transcripts were analysed using thematic analysis. Adolescents found the content of the intervention appealing and credible. Teachers welcomed the content and format as a means of generating discussion. ‘Moderate’ drinking appeared to be an acceptable message, although difficult to define. Enacting ‘if-then’ plans in real social situations might be challenging and representations of drinking on social media should be considered.

You Have to Be Prepared to Drink: Students' Views about Reducing Excessive Alcohol Consumption at University.

Purpose Many existing interventions to reduce excessive drinking in university students attempt to target individual cognitions, which ignore the wider contextual features that drive excessive drinking and mark this as an important aspect of university life. The purpose of this paper is to explore students’ views about preventing excessive drinking at university, specifically by using frameworks that take into both account individual and social influences. Design/methodology/approach In all, 23 young adults aged 20-30 (12 females; M age=22.91; SD=2.57; 18 students, five recent graduates) took part in semi-structured interviews to explore their views about drinking and measures to reduce excessive consumption. Transcripts were analysed using thematic analysis. Findings There were three themes identified in the analysis. These themes were named “the role of alcohol in student life”, drinking transitions’, and “prevention challenges” and each had related sub-themes. Practical implications Targeting students before they commence their course and highlighting aspects of university life that do not involve alcohol may help to reduce the pressure often felt to drink in social situations. Providing novel, credible alternative socialising options that do not involve alcohol should be explored to determine their acceptability, and their potential to reduce excessive drinking. Originality/value Few studies explore what students themselves think about reducing alcohol consumption and most interventions focus on changing individual cognitions rather than features of the social environment. This study highlights that changing social practices related to drinking in combination with targeting individuals may be more fruitful avenue to reduce excessive alcohol consumption.

The Classification and Organisation of Alcohol Misuse Prevention with a Focus on Environmental Prevention

Purpose of ReviewClassifying prevention as universal, selective or indicated only considers the form of interventions. This is limited as it fails to explain the function, or purpose, of interventions. This paper discusses a taxonomy for alcohol misuse prevention that considers both the form and function of prevention interventions. It adds to the previous literature by incorporating subcategories of classification for environmental prevention.Recent FindingsWithin each taxonomy category there are interventions which are more, and less effective, but not one single category has comprehensive evidence of efficacy. Environmental prevention may have the greatest potential to deliver interventions that are efficient, cost effective and reduce health inequalities. However, comprehensive, systems oriented, prevention coverage should combine all three functional approaches.SummaryThis taxonomy can be used to organise and classify alcohol misuse prevention interventions and to determine where alcohol misuse prevention strategies and research is warranted. Furthermore, it can help practitioners and researchers to consider the subcategories of environmental prevention: an area that is rapidly gaining traction in the prevention field.