Understanding Adolescents’ Willingness to Drink and Alcohol Use: The Moderating Roles of Consequence Portrayals on Social Media & Alcohol Expectancies

Open Science Framework · 2026-01-01

Alcohol use is fairly prevalent among adolescents, with 32.9% of those aged 12-20 reporting lifetime drinking, and 27% reporting past-year drinking (NSDUH, 2024). Adolescents are particularly at risk of experiencing negative consequences due to their general naiveté to alcohol use and patterns of intermittent heavy use, often in social contexts that facilitate drinking even when adolescents plan not to drink. The prototype-willingness model proposes that an adolescent’s behavioral willingness to drink predicts their actual alcohol use through a ‘social reaction’ path, in which they may be more likely to drink alcohol in social settings when their willingness to do so is higher, as a result of having more positive attitudes and prototypes of what a ‘typical drinker’ looks like. Since willingness is a consistent predictor of adolescent alcohol use initiation and escalation, it is important to identify moderating factors that magnify or attenuate this relationship. Social learning theory posits that attitudes toward alcohol (e.g., willingness) are shaped through witnessing the negative or positive consequences of alcohol use vicariously experienced by their peers, friends, and family. Understanding the social-cognitive factors that influence the relationship between willingness and alcohol use is critical for identifying targets for prevention programming aimed at reducing alcohol use progression during adolescence. Alcohol outcome expectancies, which refer to cognitions about alcohol use and its reinforcing effects, are one social-cognitive factor that may influence the degree to which an adolescent’s willingness to drink alcohol influences their future alcohol use. Social learning theory (Maisto et al., 1999) suggests that adolescents develop alcohol expectancies not only through direct experience, but through direct and symbolic ‘models’ in their immediate social context (e.g., seeing their peers and parents drink, depictions of alcohol in the media). Expectancies about alcohol use have been shown to directly predict alcohol use behaviors and consequences of drinking (e.g., Reese et al., 1994), likely through the ‘reasoned path’ described in the prototype-willingness model. Yet, given that these dual-paths likely operate in tandem in a given social context, expectancies may also influence whether one’s willingness to drink predicts their subsequent drinking behaviors as a function of whether they hold more positive or more negative outcome expectancies about alcohol use. Specifically, willingness may be more strongly related to greater alcohol use for adolescents with positive alcohol outcome expectancies. In contrast, willingness may be less strongly associated with reductions in use when adolescents have negative expectancies about drinking alcohol. Examining alcohol expectancies during adolescence may be key in identifying adolescents who are at greater risk for escalation of drinking as a result of their willingness to engage in drinking behaviors. Social context may also influence the degree to which willingness relates to future alcohol use. Social media is an increasingly important social context, where adolescents spend significant amounts of their time (4+ hours/day on average; Gallup Familial and Adolescent Health Survey, 2023). Although previous research has examined social influence on drinking through peers or traditional media (e.g., movies), social media is distinct due to its ubiquity in adolescents’ social lives, and because social media depictions of drinking overemphasize positive consequences of drinking (Niland et al., 2014). Unlike peer influence, which typically occurs in person and in drinking contexts, the unique features of social media (e.g., likes, shares, algorithmic feeds) facilitate new opportunities for adolescents to vicariously learn about alcohol and its consequences from peers, family members, influencers, or others whose content is recommended to them. Since adolescents are more intimately involved in witnessing, engaging with, and learning about consequences of drinking on social media as a result of these unique features (Nesi et al., 2018), they are more consistently exposed to content depicting consequences (given the ease of scrolling through social media platforms) and may engage with such content even outside of drinking contexts (e.g., while “doomscrolling”). Thus, the relationship between adolescents’ willingness to drink and their alcohol use may be a function of whether they engage with content depicting more positive or more negative consequences of drinking. Adolescents’ greater alcohol use as a result of their willingness may be amplified when they also primarily consume content depicting positive consequences of alcohol use; this shift in magnitude may be reversed when adolescents consume content that primarily depicts negative consequences instead, such that alcohol use is reduced. The purpose of this study is to examine the degree to which adolescents’ alcohol use is influenced by their willingness to drink, and whether this association varies as a function of their alcohol outcome expectancies and their exposure to positive or negative portrayals of consequences of alcohol use on social media. We will examine this among a sample of high school-aged teenagers participating in a longitudinal study of media and alcohol use.

Real-Time Exposure to Intersectional Minority Stressors and Alcohol Use: Protocol for an Ecological Momentary Assessment Study With Latinx and Non-Latinx Sexual Minority Youth

JMIR Research Protocols · 2025-12-09

BACKGROUND: Sexual minority youth (SMY) are significantly more likely to use alcohol compared with their heterosexual peers. Recent national data also suggest a turning point in alcohol use disparities: Latinx youth now report higher alcohol use than non-Latinx youth. Despite this, little is known about the social context and reasons why Latinx SMY may engage in alcohol use. OBJECTIVE: This manuscript describes the protocol for a study designed to assess real-time exposure to minority stressors and protective factors, and their relationship to alcohol use among Latinx and non-Latinx White SMY. METHODS: The project is being conducted in 3 phases with a combined sample of approximately 140 participants. Phase 1 (completed) involved cognitive interviews with 23 SMY participants, which refined and adapted survey measures to ensure cultural and developmental appropriateness for the next study phases. Phase 2 was a pilot ecological momentary assessment (EMA) survey with 20 participants to evaluate feasibility, acceptability, and compliance (completed). Phase 3 will recruit approximately 100 SMY aged 15-19 years, with equal representation of Latinx and non-Latinx White SMY. Participants will complete a baseline survey and repeated EMA surveys to capture daily experiences of stressors, protective factors, and alcohol use. RESULTS: Results for the study sample, recruitment (between April 2022 and November 2023), and challenges confronted are presented for Phase 1. Findings showed that the study sample included 23 Latinx and non-Latinx SMY, split almost in half by ethnicity. Participants were mostly female and affluent. Recruitment efforts showed that certain flyers and locations (eg, Facebook/Instagram) performed better at recruiting this sample. We present issues faced with screening out ineligible participants and bots, recruiting participants assigned male at birth, recruiting 15- to 17-year-old participants, and building overall trust with this population. Results from the rest of the data in this study will be analyzed and disseminated through peer-reviewed scientific journals. CONCLUSIONS: This study will provide novel data on the real-time contexts of alcohol use among SMY with particular attention to Latinx youth, an understudied and marginalized population. By identifying stress and protective mechanisms linked to alcohol use, findings can inform tailored prevention and intervention strategies. Furthermore<strong>,</strong> the protocol offers a replicable framework for future EMA research on intersectionality, minority stress, and alcohol use among diverse SMY populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/87201.

Factors Associated With Alcohol Use After Metabolic and Bariatric Surgery: Protocol for an Ecological Momentary Assessment (Preprint)

2025-11-06

<sec> <title>BACKGROUND</title> Individuals who undergo metabolic and bariatric surgery (MBS) are at increased risk for postoperative alcohol use disorder. Reducing postoperative alcohol use could prevent the development of alcohol use disorder; however, the factors leading to episodic alcohol use are not known. </sec> <sec> <title>OBJECTIVE</title> The purpose of this paper is to describe the protocol for a study that will examine distal and proximal factors associated with episodic alcohol use and hazardous alcohol use among individuals who undergo MBS. </sec> <sec> <title>METHODS</title> We will enroll 100 participants who undergo MBS at a single health care system. Participants will complete measures of substance use, psychiatric symptoms, and disordered eating behaviors at baseline and at 6- and 12-week follow-ups. Participants will also complete a 3-week ecological momentary assessment protocol in which they will complete brief surveys each morning and evening, reporting on their mood, disordered eating, and substance use. </sec> <sec> <title>RESULTS</title> This study received funding from the National Institute on Alcohol Abuse and Alcoholism (R21 AA029423) in May 2023. This part of the grant was approved by the institutional review board in March 2024, and data collection occurred between November 2024 and December 2025. We anticipate that our study protocol will be feasible and that we will observe at least 80% participant retention at the follow-up assessments and their response to at least 75% of ecological momentary assessment signals. We hypothesize that depressive symptoms (distal factor) and negative affect (proximal factor) will be associated with increased alcohol use, and alcohol use will occur in lieu of disordered eating behaviors. </sec> <sec> <title>CONCLUSIONS</title> Findings will help us understand distal and proximal factors leading to episodic alcohol use after undergoing MBS. This knowledge will allow us to construct better monitoring strategies for postoperative alcohol use within MBS programs and identify targets for intervention to reduce alcohol use after undergoing MBS. </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> DERR1-10.2196/87209 </sec>

Personalized Feedback in Parent-Based Interventions to Prevent or Reduce Adolescent Drinking

Journal of Studies on Alcohol and Drugs · 2025-04-20

Examining the relationship between cannabis use and drinking levels on co‐use days

Alcohol Clinical and Experimental Research · 2025-07-03

BACKGROUND: Co-use of alcohol and cannabis among young adults is often associated with more alcohol consumption than alcohol-only use, yet little work has examined cannabis use specifically during heavy drinking. Much of the work examining heavy drinking has focused on heavy episodic drinking (HED, 4+/5+ drinks/occasion for females/males); however, young adults report drinking levels that far exceed this, frequently reporting high-intensity drinking (HID; 8+/10+ drinks/occasion for females/males), double the HED threshold, which confers greater risk of acute negative consequences. This study examined whether day-level co-use (vs. alcohol-only use) was associated with greater odds of heavier drinking levels: HID vs. HED vs. moderate drinking (1-3/1-4 drinks/occasion for females/males). We explored whether within-person variations in cannabis use characteristics (frequency, form, and quantity) differentiated moderate drinking, HED, and HID on co-use days. METHODS: Young adults who reported simultaneous alcohol and cannabis use (N = 318) from three US universities completed five repeated daily surveys for 54 days reporting number of drinks and number of cannabis uses (i.e., frequency/events), forms, and quantity. RESULTS: Participants reported increased likelihood of HID and HED versus moderate drinking on co-use versus alcohol-only days. HID versus HED did not differ between co-use and alcohol-only days. On co-use days, heavier drinking was more likely on days with more cannabis use. The form of cannabis used and the use of multiple versus single forms of cannabis were not associated with drinking level. Yet, HID was more likely than HED and moderate drinking when more grams of flower were used and HID was also more likely than moderate drinking when more hits of concentrates were used. CONCLUSIONS: Findings show heavy drinking (HID, HED) was more likely than moderate drinking on co-use days and cannabis use characteristics may influence drinking levels. Co-use interventions may benefit from a focus on heavy drinking and cannabis use characteristics.

Real-Time Exposure to Intersectional Minority Stressors and Alcohol Use: Protocol for an Ecological Momentary Assessment Study With Latinx and Non-Latinx Sexual Minority Youth (Preprint)

2025-11-06

<sec> <title>BACKGROUND</title> Sexual minority youth (SMY) are significantly more likely to use alcohol compared with their heterosexual peers. Recent national data also suggest a turning point in alcohol use disparities: Latinx youth now report higher alcohol use than non-Latinx youth. Despite this, little is known about the social context and reasons why Latinx SMY may engage in alcohol use. </sec> <sec> <title>OBJECTIVE</title> This manuscript describes the protocol for a study designed to assess real-time exposure to minority stressors and protective factors, and their relationship to alcohol use among Latinx and non-Latinx White SMY. </sec> <sec> <title>METHODS</title> The project is being conducted in 3 phases with a combined sample of approximately 140 participants. Phase 1 (completed) involved cognitive interviews with 23 SMY participants, which refined and adapted survey measures to ensure cultural and developmental appropriateness for the next study phases. Phase 2 was a pilot ecological momentary assessment (EMA) survey with 20 participants to evaluate feasibility, acceptability, and compliance (completed). Phase 3 will recruit approximately 100 SMY aged 15-19 years, with equal representation of Latinx and non-Latinx White SMY. Participants will complete a baseline survey and repeated EMA surveys to capture daily experiences of stressors, protective factors, and alcohol use. </sec> <sec> <title>RESULTS</title> Results for the study sample, recruitment (between April 2022 and November 2023), and challenges confronted are presented for Phase 1. Findings showed that the study sample included 23 Latinx and non-Latinx SMY, split almost in half by ethnicity. Participants were mostly female and affluent. Recruitment efforts showed that certain flyers and locations (eg, Facebook/Instagram) performed better at recruiting this sample. We present issues faced with screening out ineligible participants and bots, recruiting participants assigned male at birth, recruiting 15- to 17-year-old participants, and building overall trust with this population. Results from the rest of the data in this study will be analyzed and disseminated through peer-reviewed scientific journals. </sec> <sec> <title>CONCLUSIONS</title> This study will provide novel data on the real-time contexts of alcohol use among SMY with particular attention to Latinx youth, an understudied and marginalized population. By identifying stress and protective mechanisms linked to alcohol use, findings can inform tailored prevention and intervention strategies. Furthermore&amp;lt;strong&amp;gt;,&amp;lt;/strong&amp;gt; the protocol offers a replicable framework for future EMA research on intersectionality, minority stress, and alcohol use among diverse SMY populations. </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> DERR1-10.2196/87201 </sec>

1063 Simulated Live Interpreter-Patient Encounters: Impact on Pharmacy Students Communication Skills and Confidence

Journal of the American Pharmacists Association · 2025-09-01

Post-Operative Alcohol Use Interview Guide

PsycTESTS Dataset · 2025-01-01

What apps and websites do those in treatment for substance-related problems use to help them in their recovery? A cross-sectional study of products and use patterns

Journal of Substance Use and Addiction Treatment · 2025-01-27

Factors that increase risk for alcohol‐induced blackouts in high‐intensity drinking young adults

Alcohol Clinical and Experimental Research · 2025-05-20

BACKGROUND: Alcohol-induced blackouts are prospectively associated with negative drinking outcomes. While typically requiring heavy drinking, blackouts are not reported on all heavy drinking events or by all individuals who drink heavily. This study extends previous research by identifying the young adults most likely to experience blackouts assessed prospectively. Hypotheses focused on previously supported (female sex, White race, younger age, family history of alcohol problems, lower subjective response to alcohol, and higher tolerance) and novel predictors (possible traumatic brain injury; TBI) of alcohol-induced blackouts. METHODS: = 22.07) recruited for high-intensity drinking (8/10+ drinks/occasion for females/males) completed a baseline survey and a 28-day ecological momentary assessment protocol. Hierarchical linear modeling was used to test between-person predictors of fragmentary (temporary) or en bloc (permanent) blackout likelihood during the 28 days, and moderators of the effect of day-level estimated blood alcohol concentration (eBAC) on blackout likelihood. RESULTS: Controlling for event-level and average eBAC, both types of blackouts were more likely among those with higher subjective response to alcohol. Fragmentary blackouts were more likely among younger participants and those with possible prior TBI. Day-level eBAC was more strongly associated with both types of blackouts among non-Hispanic White participants and those with lower mean eBACs. Day-level eBAC was most strongly associated with fragmentary blackouts among those with a first-order family history of alcohol problems. CONCLUSIONS: Younger age and greater sensitivity to alcohol may confer risk for blackouts above and beyond intoxication levels. Future work is needed to understand mechanisms that explain why these factors confer risk for blackouts.