# Disentangling the temporal relationship between alcohol‐related attitudes and heavy episodic drinking in adolescents within a randomized controlled trial

## TL;DR

This study found that alcohol-related attitudes in adolescents are more influenced by past drinking behavior than they predict future drinking.

## Contribution

The study provides new evidence that attitudes toward alcohol are not precursors to drinking behavior but rather reflect prior drinking status.

## Key findings

- Heavy episodic drinking (HED) significantly predicts future alcohol-related attitudes (ARA), but not vice versa.
- Autoregressive effects for HED were stronger than those for ARA across all time points.
- Changes in ARA did not precede changes in HED during the prevention trial.

## Abstract

Within many alcohol prevention interventions, changes in alcohol‐related attitudes (ARA) are often proposed as precursors to changes in drinking behaviour. This study aimed to measure the longitudinal relationship between ARA and behaviour during the implementation of a large‐scale prevention trial.

This study was a two‐arm school‐based clustered randomized controlled trial. A total of 105 schools in Northern Ireland and Scotland participated in the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) Trial.

A sample of 12 738 pupils (50% female; mean age = 12.5 years at baseline) self‐completed questionnaires on four occasions (T1–T4). The final data sweep (T4) was 33 months post baseline.

Individual assessments of ARA and heavy episodic drinking (HED) were made at each time‐point. Additional covariates included location, school type, school socio‐economic status and intervention arm. Estimated models examined the within‐individual autoregressive and cross‐lagged effects between ARA and HED across the four time‐points (Bayes estimator).

All autoregressive effects were statistically significant for both ARA and HED across all time‐points. Past ARA predicted future ARA [e.g. ARAT1 → ARAT2 = 0.071, credibility interval (CI) = 0.043–0.099, P < 0.001, one‐tailed]. Similarly, past HED predicated future HED (e.g. HEDT1 → HEDT2 = 0.303, CI = 0.222–0.382, P < 0.001, one‐tailed). Autoregressive effects for HED were larger than those for ARA at all time‐points. In the cross‐lagged effects, past HED statistically significantly predicted more positive ARA in the future (e.g. HEDT2 → ARAT3 = 0.125, CI = 0.078–0.173, P < 0.001, one tailed) except for the initial T1–T2 path. In contrast, past ARA did not predict future HED across any time‐points.

Changes in alcohol‐related attitudes were not a precursor to changes in heavy episodic drinking within the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) Trial in Scotland and Northern Ireland. Rather, alcohol‐related attitudes were more likely to reflect prior drinking status than predict future status. Heavy episodic drinking status appears to have a greater impact on future alcohol attitudes than attitudes do on future heavy episodic drinking.