A Model of Determinants Influencing the Development of Child and Adolescent Psychiatrist Self-efficacy for Discussing Substance Use with Patients.

Child and adolescent psychiatrists are well situated to have meaningful conversations with a population at high risk of substance use: youth receiving psychiatric care. However, there has been a dearth of research about behavioral determinants that may influence psychiatrists' willingness to engage in these discussions. This study proposes a model of determinants to help identify influences on psychiatrists' levels of self-efficacy, which theoretically should predict their discussions about substance use. A national survey of child and adolescent psychiatrists was conducted to gather data to test this model, which predicted that training, past experiences with substance use discussions, and communication apprehension would influence self-efficacy. Results showed that the model was an excellent fit to the data, accounting for 49% of the variance in self-efficacy. We discuss how these findings could inform future training initiatives for child and adolescent psychiatrists.

Identifying Conversational Strategies for Psychiatrists in Discussing Substance Use with Adolescent Patients.

Child and adolescent psychiatrists are uniquely positioned to discuss substance use with high risk patients; however, there has been little research about these conversations and their characteristics. To identify communication strategies for navigating conversations about substance use with adolescent patients, we conducted 21 in-depth interviews with practicing child and adolescent psychiatrists. Findings from this study identify four strategies that child and adolescent psychiatrists reported as being successful: expressing empathy, avoiding resistance, honoring autonomy, and managing family involvement. In addition to describing these strategies, we briefly describe a theoretical framework that might help to explain the perceived success of these strategies, and we offer recommendations for how to apply our findings to improve psychiatric practice.

Social Support for Active Substance Users: A Content Analysis of r/Drugs.

Substance abuse remains an important and dangerous societal issue. In this study, we build on previous literature that identified online social support communities that encouraged unhealthy behaviors, by investigating a platform that provides social support related to engaging in illicit drug use. Three days' worth of posts, amounting to almost 400 pages of written data, was collected and analyzed to identify what types of support were being requested and provided by users. The analysis identified 19 total topics for support, with 14 of those topics relating to action-facilitating support, and five of them relating to nurturant support. The results show that the website is primarily used to discuss topics like drug effects and drug dosages. This raises questions as to whether these discussions increase safety by allowing users to dose accurately, or whether they give users a false sense of security related to their continued substance use.

"It Just Kind of Happens": College Students' Rationalizations for Blackout Drinking.

Nearly half of college students engage in binge drinking, and blackouts (i.e., episodes of periodic memory loss) represent one common consequence of this behavior. Although researchers have begun to understand the extent to which students black out, little is known about why they do so. We conducted two studies to further our understanding of this risky health behavior. In Study 1, we conducted face-to-face interviews (N = 19) to explore students' blackout experiences. Our findings suggest that students recognize that blacking out is an unhealthy behavior; however, because such a recognition contradicts group norms about alcohol consumption, it causes them to experience dissonance, which they manage via a variety of rationalization strategies. We investigated these findings more systematically through an online survey in Study 2, in which students (N = 254) reported on their own and others' beliefs and behaviors about blacking out. Our results indicate that many of the rationalization strategies students identified in Study 1 were grounded in fallacious reasoning. We discuss the collective implications of these findings for future interventions addressing students' excessive drinking behaviors.

Does Yik Yak Promote Risky Health Behavior on College Campuses?

This study offers an analysis of how healthy and risky behaviors are discussed on an emerging social media platform. We sought to understand what behaviors are communicated and if they are encouraged or discouraged. We completed a content analysis of messages (n = 3,776) posted to Yik Yak captured three times a day on 4 days of the week across two separate weeks. We analyzed messages to determine the category of the behavior, an appraisal of the behavior, and normative voting feedback. Our results show that risky behaviors were discussed with greater frequency and received more user votes than healthy behaviors. Exposure to these messages could influence other students' perceptions of norms associated with these risky behaviors. We suggest further research to determine how Yik Yak may affect normative perceptions on college campuses.

Using the Integrative Model of Behavioral Prediction to Understand College Students' Hookup Sex Beliefs, Intentions, and Behaviors.

Guided by the integrated model of behavioral prediction, this study explored the attitudinal, normative, and perceived control beliefs that predict college student hookup intentions and behavior. We first conducted elicitation research with six focus groups of undergraduate students to identify salient beliefs to inform questionnaire development, and then we collected and analyzed questionnaire data from 268 undergraduate students to explore the direct and indirect determinants that drive hookup behaviors. We compared proposed models that tested separate paths from determinants to intention and behavior to theoretical models that treated intention as a mediator of the determinant-behavior relationship. The results indicate that in both the proposed and theoretical models, direct and indirect attitudes were the strongest predictors of intentions and behavior. Positive attitude beliefs were consistently and significantly correlated with both intention and behavior, while only select normative and control beliefs were so correlated. Finally, although the data fit both the proposed and theoretical models, the proposed models provided a more accurate fit. We discuss theoretical and practical implications of our results, and we offer directions for future research.

NekNominate: Social Norms, Social Media, and Binge Drinking.

This study examines the social-media-based binge drinking game NekNominate and how this phenomenon is related to social norms. NekNominate is a game wherein players are nominated to film themselves "neking" or chugging copious amounts of alcohol or drinking alcohol in a novel or humorous manner. The player then nominates other players via social media who then have a specific timeframe in which they must complete their challenge or face ridicule. Health communication research on drinking behaviors has often looked at the role of social norms in determining these behaviors. News stories (n = 44) of NekNominate and tweets (n = 851) culled using the hashtag #NekNominate during three different time periods are analyzed to identify the normative forces at play in this recent phenomenon.

Framing medical tourism: an analysis of persuasive appeals, risks and benefits, and new media features of medical tourism broker websites.

This study explores the benefits and risks featured in medical tourism broker websites, as well as the types of persuasive appeals that these websites use to attract potential customers, from a framing theory perspective. In addition, it examines relationships among types of appeals and specific types of health-related services offered by medical facilities abroad and the role of new media modalities within medical tourism broker sites. A content analysis of 91 medical tourism broker websites was conducted. The results indicate that the websites highly emphasized benefits while downplaying the risks. Specifically, despite offering consumers complicated and risky medical procedures, the websites failed to report any procedural, postoperative, or legal concerns associated with them. Moreover, the results indicated that the websites relied on heavy use of new media features to enhance the appeal of the medical services that were offered. The implications of these findings, future directions for research, and limitations of the study are discussed.

Communication apprehension mediates the effects of past experience discussing substance use on child and adolescent psychiatrists' self-efficacy.

Objective Child and Adolescent Psychiatrists (CAPs) treat patients who are at an increased risk of developing a substance use disorder in their lifetime. However, CAPs often experience apprehension when it comes to discussing substance use with their patients, and this apprehension may come from past experiences when these discussions have gone poorly. This study seeks to understand whether or not apprehension moderates the relationship between past experiences and self-efficacy for CAPs when discussing substance use with their patients. Methods This study used a national online survey of CAPs (n = 170) to test the extent to which apprehension mediated the relationship between past experiences discussing substance use and self-efficacy to do so. Results The results showed that past experience affects self-efficacy and apprehension serves as a mediator of this relationship. Conclusion This study helps to shed light on the determinants that influence providers' perceptions of self-efficacy. Understanding what factors affect self-efficacy is important because these factors can then be targeted through training. Practice implications Patient-provider communication skills training for CAPs should happen early in their education so that they are less likely to become apprehensive about discussing substance use with their patients.

Using the integrative model of behavioral prediction to understand college students' STI testing beliefs, intentions, and behaviors.

OBJECTIVES: To identify salient behavioral determinants related to STI testing among college students by testing a model based on the integrative model of behavioral (IMBP) prediction. PARTICIPANTS: 265 undergraduate students from a large university in the Southeastern US. METHODS: Formative and survey research to test an IMBP-based model that explores the relationships between determinants and STI testing intention and behavior. RESULTS: of path analyses supported a model in which attitudinal beliefs predicted intention and intention predicted behavior. Normative beliefs and behavioral control beliefs were not significant in the model; however, select individual normative and control beliefs were significantly correlated with intention and behavior. CONCLUSIONS: Attitudinal beliefs are the strongest predictor of STI testing intention and behavior. Future efforts to increase STI testing rates should identify and target salient attitudinal beliefs.