Pham Bich Diep Addiction Therapy 2015 Florida, USA August 03-08, 2015

w w w. y h d p. e d u. v n THE LINK BETWEEN ALCOHOL EXPECTANCIES AND ALCOHOL OUTCOMES IS MEDIATED BY DRINKING MOTIVES AMONG STUDENTS IN VIETNAM. Pham Bich Diep 1,2, Schelleman-Offermans K 3, Kuntsche E 4, Nanne De Vries 2, Ronald A. Knibbe 2 1 Institute for Preventive Medicine and Public Health, Hanoi Medical University, Vietnam. 2 Dept. of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands 3 Nuchter Centre for Research on Age Restrictions, Nijmegen, the Netherlands 4 Addiction Switzerland, Research Institute, Lausanne, Switzerland. Correspondence may be sent to Pham Bich Diep via TRƯỜNG ĐẠI HỌC Y HÀ NỘI

w w w. y h d p. e d u. v n 1. INTRODUCTION Alcohol expectancies and drinking motives are well known cognitive factors explaining alcohol use among adolescents and young adults. However, research in this area has mainly focused on North America and Europe. No studies have documented the role of alcohol expectancies and the mediating role of motives in explaining alcohol consumption in Asian countries or, in particular, among students in Vietnam.

w w w. y h d p. e d u. v n Vietnam differs from most Western countries in terms of recent socio-economic developments and cultural values, and that alcohol consumption is increasing rapidly, especially among younger persons such as students. Hypothesize: Despite the fact that the drinking culture in Vietnam differs from that in Western countries, drinking motives mediate the link between particular alcohol expectancies and different alcohol outcomes, as in most other developed countries.

w w w. y h d p. e d u. v n 2. METHOD

w w w. y h d p. e d u. v n 2.2. Sampling strategy:

w w w. y h d p. e d u. v n 2.3. Sampling in reality:

w w w. y h d p. e d u. v n 2.4. Measures -Drinking volume = How often drink x how many drinks per occasion on a typical day  The total number of drinks consumed in the previous 12 months was calculated as the product of quantity of drinking on a typical day and frequency of drinking.

w w w. y h d p. e d u. v n -6+ drinks per occasion  How often do you have six or more drinks on one occasion?” Five answer categories were used; (never=0; less than monthly=0.5; monthly=1; weekly = 4; daily or almost daily=30).

w w w. y h d p. e d u. v n - Alcohol problems  “How often during the last year have you: (1) had a feeling of guilt or remorse after drinking?”; (2) “ --- been unable to remember what happened the night before because you had been drinking?” Five answer categories were used; never=0; less than monthly=0.5; monthly=1; weekly=4; daily or almost daily=30). The summary score of the two items (r=0.56) was used as alcohol problems score.

w w w. y h d p. e d u. v n - Alcohol dependence  “How often during the last year have you: (1) found that you were not able to stop drinking once you had started”; (2) “Failed to do what was normally expected from you because of drinking”; (3) “Needed a first drink in the morning to get yourself going after a heavy drinking session”. Five answer categories were used; never=0; less than monthly=0.5; monthly=1; weekly = 4; daily or almost daily=30). The mean score of the three items (Cronbach’s alpha=0.66) was used as the alcohol dependence score.

w w w. y h d p. e d u. v n - Drinking motives  The 20-item Drinking Motive Questionnaire Revised (DMQ-R, Cooper, 1994) was used. Summary scores were created for the four factors: social motives (Cronbach’s alpha=0.81), enhancement motives (Cronbach’s alpha=0.87), coping motives (Cronbach’s alpha=0.85); and conformity motives (Cronbach’s alpha=0.71).

w w w. y h d p. e d u. v n - Alcohol expectancies  The 27-item adolescent version of alcohol expectancies (AEQ-A) was used (Aas 1993).Aas 1993 The factors showing the highest correlation with alcohol use were used  (1)tension reduction expectancies (Cronbach’s alpha=0.48), (2)global positive change expectancies (Cronbach’s alpha=0.56), (3)improve cognitive and motor abilities expectancies (Cronbach’s alpha=0.24); and (4)change in social behavior expectancies (Cronbach’s alpha=0.45).

w w w. y h d p. e d u. v n 2.5. Statistical analysis -All outcome variables were log-transformed to reduce the impact of extreme values. -Structural equation modeling was used with maximum likelihood ratio estimation to test: 1) the direct paths from expectancies to motives; from motives to alcohol outcomes; and from expectancies to alcohol outcomes; and, simultaneously, the 2) indirect paths via all mediators to the alcohol outcomes. All alcohol outcomes were tested together in the model. Separate models were estimated for male and female students.

w w w. y h d p. e d u. v n 3. RESULTS

w w w. y h d p. e d u. v n Mediation effect: Change in social behavior is most strongly correlated with social and enhancement motives (coefficient from to 0.306).

w w w. y h d p. e d u. v n Global positive change is most strongly correlated with coping and conformity motives in both male and female students(coefficient from to 0.296). Alcohol expectancies among female and male explained more variance in social (R 2 = 14.6 to 21%) and enhancement (R 2 =12.3 to 20.9%) motives than in the other motives.

w w w. y h d p. e d u. v n Among female students (except for improve cognitive and motor abilities): the links between tension reduction and global positive change factors and all outcomes were entirely mediated by coping motives (the indirect effects range from to and the p-values from < 0.05 to < 0.001); and the links between change in social behavior and two outcomes (drinking volume and 6+ drinking) were entirely mediated by enhancement motives

w w w. y h d p. e d u. v n Among male students (except for the effect of improved cognitive and motor abilities): the links between three other expectancy factors and all outcomes were entirely mediated, mainly by coping and enhancement motives, and by social motives (drinking volume and 6+ drinking). While almost all mediation paths were positive mediations, the links between improved cognitive and motor-abilities expectancies, change in social behavior and drinking volume, were negatively mediated by conformity motives.

w w w. y h d p. e d u. v n 4. CONCLUSIONS All four motive dimensions mediated the link between particular expectancies and particular alcohol outcomes and (with the exception of improved cognitive and motor-abilities motives), concerned full mediation. The partial mediation (improved cognition and motor abilities) might be explained by students with a particular expectancy who might not drink to achieve what they expected. Complete mediation suggests that particular expectancies do not directly impact on alcohol outcome but rather via drinking motives which, in turn, were related to alcohol outcome.

w w w. y h d p. e d u. v n Among female students there was no mediation via social and conformity motives on alcohol outcomes. Among females, the mediation was mainly found through coping followed by enhancement motives, mediation through all four motive dimensions was found among males.

w w w. y h d p. e d u. v n Acknowledgement. Thank you very much for the project: ‘Strengthening Teaching and Research Capacity of Preventive Medicine in Vietnam’ And the project: ‘Developing Centers of Excellent in Training and Consulting among eight Medical Universities in Vietnam’. For funding for the research and travelling to come to the conference. Thank you for the conference committee for accepting for some discount in accommodation and registration fee for the conference.

w w w. y h d p. e d u. v n THANK YOU FOR YOUR ATTENTION!

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