Behavior Change Techniques That Prevent or Decrease Obesity in Youth With a Low Socioeconomic Status: A Systematic Review and Meta-Analysis.

Background: Interventions, targeting youth, are necessary to prevent obesity later in life. Especially youth with low socioeconomic status (SES) are vulnerable to develop obesity. This meta-analysis examines the effectiveness of behavioral change techniques (BCTs) to prevent or reduce obesity among 0 to 18-year-olds with a low SES in developed countries. Method: Intervention studies were identified from systematic reviews or meta-analyses published between 2010 and 2020 and retrieved from PsycInfo, Cochrane systematic review, and PubMed. The main outcome was body mass index (BMI), and we coded the BCTs. Results: Data from 30 studies were included in the meta-analysis. The pooled postintervention effects of these studies indicated a nonsignificant decrease in BMI for the intervention group. Longer follow-up (≥12 months) showed favorable differences for intervention studies, although that BMI change was small. Subgroup analyses showed larger effects for studies with six or more BCTs. Furthermore, subgroup analyses showed a significant pooled effect in favor of the intervention for the presence of a specific BCT (problem-solving, social support, instruction on how to perform the behavior, identification of self as role model, and demonstration of the behavior), or absence of a specific BCT (information about health consequences). The intervention program duration and age group of the study population did not significantly influence the studies' effect sizes. Conclusions: Generally, the effects of interventions on BMI change among youth with low SES are small to neglectable. Studies with more than six BCTs and/or specific BCTs had a higher likelihood of decreasing BMI of youth with low SES.

360° Diagnostic Tool to Personalize Lifestyle Advice in Primary Care for People With Type 2 Diabetes: Development and Usability Study.

BACKGROUND: Various multifaceted factors need to be addressed to improve the health and quality of life of people with type 2 diabetes (T2D). Therefore, we developed a web-based decision support tool that comprises a more holistic diagnosis (including 4 domains: body, thinking and feeling, behavior, and environment) and personalized advice. This 360° diagnostic tool enables people with T2D and health care professionals at the general practice to obtain an overview of the most important T2D-related issues and, subsequently, determine the most suitable intervention for the person with T2D. OBJECTIVE: This study aimed to describe the systematic and iterative development and evaluation of the web-based 360° diagnostic tool. METHODS: We defined the requirements for the web-based 360° diagnostic tool based on previously developed tools, a literature review, and inputs from a multidisciplinary team of experts. As part of the conceptualization, we defined 3 requirements: diagnostics; feedback; and advice, consultation, and follow-up. Next, we developed and designed the content for each of these requirements. We evaluated the diagnostic part of the tool (ie, measurement instruments and visualization) with a qualitative design, in a usability study with a think-aloud strategy and interview questions, among 8 people with T2D at a Dutch general practice. RESULTS: For each of the 4 domains, specific parameters and underlying elements were selected, and measurement instruments (including clinical data and questionnaires) were chosen. Cutoff values were defined to identify high-, middle-, and low-ranking scores, and decision rules were developed and implemented using R scripts and algorithms. A traffic light color visual design was created (profile wheel) to provide an overview of the scores per domain. We mapped the interventions that could be added to the tool and developed a protocol designed as a card deck with motivational interview steps. Furthermore, the usability study showed that people with T2D perceived the tool as easy to use, useful, easy to understand, and insightful. CONCLUSIONS: Preliminary evaluation of the 360° diagnostic tool by experts, health care professionals, and people with T2D showed that the tool was considered relevant, clear, and practical. The iterative process provided insights into the areas of improvement, which were implemented. The strengths, shortcomings, future use, and challenges are also discussed.

Predictors of the Acceptance of an Electronic Coach Targeting Self-management of Patients With Type 2 Diabetes: Web-Based Survey.

BACKGROUND: Type 2 diabetes (T2D) is a lifestyle-related disease whose prevalence increases with age. Diabetes self-management through mobile health (mHealth) apps enables patients with T2D to improve their health. According to the Technology Acceptance Model (TAM), technology acceptance (ie, intended use) is necessary to ensure mHealth can be implemented successfully. Therefore, the specific acceptance requirements of patients with T2D should be considered. OBJECTIVE: This cross-sectional study aims to examine the extent to which different TAM predictors are associated with the acceptance of a diabetes app including an electronic coach (eCoach; Iris app) among patients with T2D. METHODS: Using a web-based survey, data on 92 patients with T2D (mean age 62.76 years, SD 8.29 years) were collected. Acceptance of the Iris app with the TAM predictors (ie, perceived usefulness, perceived ease of use, social influence, perceived self-efficacy, perceived security, prior usage experience, perceived health, and propensity of data/information sharing) was assessed. Further, control variables (ie, gender, age, education, ethnicity, household, BMI, amount of years with diabetes, diabetes-related complaints, and medication use) were assessed. RESULTS: Multiple linear regression analyses showed that acceptance of the Iris app was positively associated with perceived usefulness (ß=.57, P<.001), social influence (subjective norm; ß=.20, P=.004), and willingness to share data (ß=.25, P<.001). In addition, acceptance regarding the Iris app was higher among patients with T2D with overweight (ß=.23, P=.01) or obese BMI (ß=.21, P=.01). The model explained 75.8% of the variance in the acceptance of the Iris app by patients with T2D. In addition, perceived usefulness of the Iris app was positively related to perceived ease of use (ß=.32, P<.001), subjective norm (ß=.26, P=.004), perceived control (ß=.19, P=.03), willingness to share data (ß=.20, P=.01) regarding the Iris app, and perceived security regarding general use of apps/smartphone/internet (ß=.15, P=.04). The model explained 58.2% of the variance in patients' perceived usefulness about the Iris app. CONCLUSIONS: Among patients with T2D, the belief that the use of the Iris app is helpful/beneficial, the willingness to share their Iris app data, and others' approval of using this app can stimulate the acceptance of this app. In addition, the belief that the use of (health) apps is reliable and secure, the belief that the use of the Iris app is easy to use, a higher perceived capability and personal control with using this app, the willingness to share their Iris app data, and others' approval of using this app can stimulate the perceived usefulness of such an app. These TAM predictors explained a high variance in acceptance and perceived usefulness of the Iris app. Implications for practice are addressed.

Parental alcohol-specific rules effectively reduce adolescents' tobacco and cannabis use: A longitudinal study.

AIMS: The current study aimed to longitudinally examine the direct and indirect effects (via alcohol use) of parental alcohol-specific rule-setting on adolescent tobacco and cannabis use. Based on the gateway hypothesis, we expected parental alcohol-specific rules to affect adolescent tobacco and cannabis use through adolescent alcohol use. DESIGN AND PARTICIPANTS: A longitudinal design including three waves and 906 Dutch adolescents (Mage = 13.51 years, SD = 0.60) was used to apply zero-inflated Poisson models (ZIP). MEASUREMENTS: Self-report questionnaires measured adolescents' perceived rules about alcohol at T1, cigarette use at T1 and T3 (frequency of life-time and current smoking), cannabis use at T1/T3 (frequency of yearly and monthly use) and frequency of monthly alcohol use at T1/T2. FINDINGS: Stricter alcohol-specific rules at T1 predicted lower incidence and prevalence rates of cigarette (life-time: ß = -0.20, p < .00; current: ß = -0.21, p = .04) and cannabis use (monthly: ß = -0.43, p = .02; yearly: ß = -0.28, p = .19) two years later (T3). This direct effect was no longer significant when alcohol use at T1 was controlled for. Moreover, a significant indirect effect of alcohol-specific rules at T1 on tobacco and cannabis use T3 via monthly alcohol use T2 was found. CONCLUSIONS: The current study demonstrated that strict rules regarding alcohol may not only reduce alcohol but subsequently also other substance use such as tobacco and cannabis. Thus, interventions targeting the prevention of alcohol use, which appears to serve as a gateway, also affects the involvement in other substances.

Associations between Ethnic Minority Status and Popularity in Adolescence: the role of Ethnic Classroom Composition and Aggression.

Although there are theoretical reasons to expect an association between ethnic minority status and popularity, research on this topic is scarce. Therefore, this association was investigated including the moderating role of the ethnic classroom composition and the mediating role of aggression. Data from the longitudinal Dutch SNARE (Social Network Analysis of Risk behavior in Early adolescence) project were used among first-year students (comparable to 5th grade) (N = 1134, Nclassrooms = 51, M = 12.5 years, 137 non-Western ethnic minority students). Popularity and aggression were assessed with peer nominations. Multi-level Structural Equation Models showed that ethnic minority status was indirectly associated with higher popularity, through higher aggression. Moreover, with increasing numbers of ethnic minority students in the classroom, popularity levels of both ethnic majority and ethnic minority students decreased. Only when differences in aggression between ethnic minority and majority students were included in the analyses, while the ethnic classroom composition was not included, lower popularity levels were found for ethnic minority than ethnic majority students. Scientific and practical implications of this study were addressed in the discussion.

Who Sets the Aggressive Popularity Norm in Classrooms? It's the Number and Strength of Aggressive, Prosocial, and Bi-Strategic Adolescents.

Previous work has shown that during adolescence, classrooms vary greatly in the extent to which aggression is rewarded with popularity (the 'popularity norm'). Aggressive popularity norms may promote the proliferation of aggression and negatively affect the classroom climate. It is, however, unknown how these norms emerge in the first place. This longitudinal study therefore investigated whether aggressive popularity norms can be predicted by the classroom composition of students. We examined whether the prevalence of six student types - socially and non-socially dominant prosocial, aggressive, and bi-strategic adolescents (adolescents who are both highly prosocial and aggressive) - contributed to the norm by establishing a popularity hierarchy: strong classroom asymmetries in popularity. We collected peer-nominated data at three secondary schools in the Netherlands (SNARE-study; Nstudents = 2843; Nclassrooms = 120; 51.4% girls; Mage = 13.2). Classroom-level regression analyses suggest that the classroom percentage of socially dominant aggressive and bi-strategic students predicted higher aggressive popularity norms, both directly and by enhancing the classrooms' popularity hierarchy. Instead, the presence of non-socially dominant aggressive students and socially dominant prosocial students contributed to lower aggressive popularity norms. Socially dominant prosocial students also buffered against the role of socially dominant aggressive adolescents in the aggressive popularity norm (moderation), but not against bi-strategic adolescents' role. Our findings indicate that interventions aimed at reducing aggressive popularity norms should first and foremost take the composition of classrooms at the start of the school year into account; and should not only encourage prosocial behavior, but also actively discourage aggression.

The Role of Prosocial and Aggressive Popularity Norm Combinations in Prosocial and Aggressive Friendship Processes.

Prior work has shown that popular peers can set a powerful norm for the valence and salience of aggression in adolescent classrooms, which enhances aggressive friendship processes (selection, maintenance, influence). It is unknown, however, whether popular peers also set a norm for prosocial behavior that can buffer against aggressive friendship processes and stimulate prosocial friendship processes. This study examined the role of prosocial and aggressive popularity norm combinations in prosocial and aggressive friendship processes. Three waves of peer-nominated data were collected in the first- and second year of secondary school (N = 1816 students; 81 classrooms; Mage = 13.06; 50.5% girl). Longitudinal social network analyses indicate that prosocial popularity norms have most power to affect both prosocial and aggressive friendship processes when aggressive popularity norms are non-present. In prosocial classrooms (low aggressive and high prosocial popularity norms), friendship maintenance based on prosocial behavior is enhanced, whereas aggressive friendship processes are largely mitigated. Instead, when aggressive popularity norms are equally strong as prosocial norms (mixed classrooms) or even stronger than prosocial norms (aggressive classrooms), aggression is more important for friendship processes than prosocial behavior. These findings show that the prosocial behavior of popular peers may only buffer against aggressive friendship processes and stimulate prosocial friendship processes if these popular peers (or other popular peers in the classroom) abstain from aggression.

Classroom Popularity Hierarchy Predicts Prosocial and Aggressive Popularity Norms Across the School Year.

This study examined the coevolution of prosocial and aggressive popularity norms with popularity hierarchy (asymmetries in students' popularity). Cross-lagged-panel analyses were conducted on 2,843 secondary school students (Nclassrooms  = 120; Mage  = 13.18; 51.3% girls). Popularity hierarchy predicted relative change in popularity norms over time, but not vice versa. Specifically, classrooms with few highly popular and many unpopular students increased in aggressive popularity norms at the beginning of the school year and decreased in prosocial popularity norms at the end of the year. Also, strong within-classroom asymmetries in popularity predicted relatively higher aggressive popularity norms. These findings may indicate that hierarchical contexts elicit competition for popularity, with high aggression and low prosocial behavior being seen as valuable tools to achieve popularity.

The effect of active and passive peer encouragement on adolescent risk-taking.

INTRODUCTION: In this experiment, we investigated the effect of active (pressure) and passive (imitation) peer encouragement on adolescent risk-taking and assessed gender differences. METHOD: The participants performed the Balloon Analogue Risk Task (BART) with the same-sex e-confederate. The experiment consisted of a 2 (passive encouragement: no/yes updates about the number of pumps of the e-confederate) by 2 (active encouragement: no/yes messages received from the e-confederate) by 2 (gender: girls/boys) by 3 (time: baseline/first message or update/second message or update) mixed design. The participants comprised 138 Dutch secondary-school students aged 11-19 years old of whom 46% boys. They were assigned to one of the four conditions: 1. neutral (e-confederate present), 2. passive (two updates received), 3. active (two messages received), or 4. combined (two updates and two messages received). RESULTS: Only a significant main effect of passive peer encouragement and a significant interaction effect of passive peer encouragement*time were shown. The participants exposed to passive peer encouragement took significantly more risk compared to other participants. Moreover, adolescent risk-taking significantly increased after the first and second update compared to baseline (no update). CONCLUSION: The findings suggest that adolescents are more likely to engage in risk-taking because of passive rather than active peer encouragement. Thus, communication through text-based messages in which young people provide information solely about their own risk-taking may be an important aim of prevention and intervention programs.

The role of academic status norms in friendship selection and influence processes related to academic achievement.

This study examined the role of academic status norms in friendship selection and influence processes related to academic achievement across the 2nd year of secondary school (SNARE project; N = 1,549 students from 70 classes; Mage = 13.69 years). Academic status norms were operationalized as the class-level correlation between academic achievement and 4 types of peer status: popularity, acceptance, unpopularity, and rejection. Longitudinal social network analyses indicated that the unpopularity and popularity norm play a role in friendship selection processes (but not influence processes) related to academic achievement. In line with our hypotheses, the unpopularity norm in the classroom strengthened similarity-based friendship selection among low-achieving adolescents and predicted greater avoidance of academically similar friends among high-achieving adolescents. Also, the popularity norm strengthened friendship selection among similar peers, both among low and high achievers. Acceptance and rejection norms did not play a role in friendship processes. In sum, the average achievement of popular and unpopular peers shapes friendship preferences in the classroom, which may have important implications for adolescent academic development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Imitating the Risky Decision-Making of Peers: An Experimental Study Among Emerging Adults.

This experiment examined whether emerging adults imitate the risky decision-making of peers and whether peer susceptibility functions as a moderator. Overall, 63 emerging adults participated with a confederate of the same gender. The participants were randomly assigned to the experimental (confederate engaged in risky decision-making) or control (confederate did not engage in risky decision-making) condition. Risky decision-making was measured with the Stop-Light Game task, and peer susceptibility was measured with a questionnaire. Linear regression analyses showed that the participants engaged in more risky decision-making when the peer displayed risky decision-making. Peer susceptibility was not found to be a significant moderator of this relationship. The findings showed that health education programs need to consider imitation to reduce the risky decision-making of emerging adults more effectively.

The Effect of Rap/Hip-Hop Music on Young Adult Smoking: An Experimental Study.

BACKGROUND: Music may influence young people's behavior through its lyrics. Substance use references occur more frequently in rap/hip-hop than in other music genres. OBJECTIVES: The aim was to examine whether the exposure to rap/hip-hop lyrics referring to substance use affected cigarette smoking. METHODS: An experiment with a 3-group between subject design was conducted among 74 daily-smoking young adults ranging in age from 17 to 25 years old. Three conditions were tested in a mobile lab (camper vehicle) from May to December 2011, i.e., regular chart pop music (N = 28), rap/hip-hop with non-frequent references to substance use (N = 24), and rap/hip-hop with frequent references to substance use (N = 22). RESULTS: One-way ANOVA showed that participants listening to substance use infused rap/hip-hop songs felt significantly less pleasant, liked the songs less, and comprehended the songs less compared to participants listening to pop songs. Poisson loglinear analyses revealed that compared to the pop music condition, none of the two rap/hip-hop music conditions had a significant effect on acute smoking. Thus, contrary to expectations, the two different rap/hip-hop conditions did not have a significantly different effect on acute smoking. CONCLUSIONS: Listening to rap/hip-hop, even rap hip/hop with frequent referrals to substance use (primarily alcohol and drug use, and general smoking referrals), does not seem to encourage cigarette smoking among Dutch daily-smoking young adults, at least short term.

The Effect of Active and Passive Peer Discouragement on Adolescent Risk taking: An Experimental Study.

This experiment investigated the effect of peer discouragement on adolescent risk taking. Overall, 269 Dutch adolescents aged 11-15 years completed a risk taking computer task in the presence of an e-confederate who demonstrated very little risk taking (passive peer discouragement) and/or sent risk-discouraging messages to participants (active peer discouragement). The results showed that, compared to a situation with no peer discouragement, adolescents took significantly less risk only when they encountered a combination of active and passive peer discouragement; hence, when peers practiced what they preached. No gender differences were found in the effect of passive and active peer discouragement on risk taking. The results showed that digital peer messages play a promising role in diminishing adolescent risk taking.

The Norms of Popular Peers Moderate Friendship Dynamics of Adolescent Aggression.

This study examined whether peer norms for aggression within the classroom impact friendship selection, maintenance, and socialization processes related to aggression across the 1st year of secondary school (N = 1,134 students from 51 classes, Mage  = 12.66). As hypothesized, longitudinal social network analyses indicated that friendship selection and influence processes related to aggression depended on the popularity norm within the classroom (i.e., the class-level association between popularity and aggression) rather than the descriptive norm (aggregated average of aggressive behavior). Hence, only in classes where the valence of aggression is high (because it is positively associated with popularity), adolescents tend to select their friends based on similarity in aggression and adopt the aggressive behavior of their friends.

Young People Smokers' Reactions on Peer Influence Not to Smoke.

BACKGROUND: Peers exert influence not to smoke but little is yet known on how this affects young people's behavior and cognitions. OBJECTIVES: This experimental study investigates the impact of two types of peer influence not to smoke on the verbalized attitudes and responses of daily-smoking young people. METHODS: Two conditions were conducted: 1) a peer confederate stating three times that s/he had quit smoking and was glad to have done so (covert peer influence); 2) a peer confederate making similar statements, but urging to quit smoking (overt peer influence). The participant performed a music task with the peer in order to disguise the true nature of the experiment. Thirty-one daily-smoking young people (16-24 years) participated; 44 responses in the overt and 34 responses in the covert condition were analyzed in a discourse analysis. RESULTS: The participants in the covert condition were more elaborative about smoking, i.e., taking an active role in a dialogue about the experiences of the peer or the participant in quitting smoking while in the overt condition participants showed more passive resistance, i.e., not showing an intention to follow the advice but avoid causing the peer embarrassment or discomfort. Open resistance, i.e., demonstration of being well-informed and indicating the redundancy of the advice, does not significantly differ in these two conditions but occurs, for both, primarily at the third discouragement. CONCLUSIONS: Overt and frequent discouragement seems to be less effective in stimulating young people to take an active role in the dialogue with their peers about smoking.

Executive functioning before and after onset of alcohol use disorder in adolescence. A TRAILS study.

INTRODUCTION: The aim of the present study was to investigate whether executive functioning (EF) in early adolescence predicted alcohol use disorder (AUD) in late adolescence and whether adolescents with AUD differed in maturation of EF from controls without a diagnosis. METHODS: We used the data from the Tracking Adolescents' Individual Lives Survey (TRAILS), a cohort of 2230 Dutch adolescents. Working memory, inhibition, and attention were measured at ages 11 and 19. At age 19, lifetime DSM-IV diagnoses were determined, resulting in a control group (n = 1111) and two AUD groups, i.e., alcohol abusers (n = 381) and alcohol dependents (n = 51). Regression analyses assessed whether EF at age 11 predicted the transition to AUD in late adolescence and whether AUD affected maturation of EF from age 11 to 19. RESULTS: EF in early adolescence did not predict AUD in late adolescence. A significant interaction effect emerged between gender and alcohol dependence for shift attention (ß = 0.12, SE=0.36), with girls showing smaller maturational rates. This effect remained significant after controlling for alcohol intake (ages 16 and 19) and comorbid psychiatric disorders. DISCUSSION: Our results do not replicate the finding that EF in early adolescence is a significant predictor of AUD in late adolescence. Furthermore, for the majority of tasks, adolescents with AUD do not differ in EF maturation over the course of adolescence. Alcohol dependent girls however, show less maturation of shift attention. This is independent of the quantity of alcohol intake, which could suggest that non-normative maturation of EF is associated with the behavioural components of AUD.

Early Adolescent Friendship Selection Based on Externalizing Behavior: the Moderating Role of Pubertal Development. The SNARE Study.

This study examined friendship (de-)selection processes in early adolescence. Pubertal development was examined as a potential moderator. It was expected that pubertal development would be associated with an increased tendency for adolescents to select their friends based on their similarities in externalizing behavior engagement (i.e., delinquency, alcohol use, and tobacco use). Data were used from the first three waves of the SNARE (Social Network Analysis of Risk behavior in Early adolescence) study (N = 1144; 50 % boys; M age = 12.7; SD = 0.47), including students who entered the first year of secondary school. The hypothesis was tested using Stochastic Actor-Based Modeling in SIENA. While taking the network structure into account, and controlling for peer influence effects, the results supported this hypothesis. Early adolescents with higher pubertal development were as likely as their peers to select friends based on similarity in externalizing behavior and especially likely to remain friends with peers who had a similar level of externalizing behavior, and thus break friendship ties with dissimilar friends in this respect. As early adolescents are actively engaged in reorganizing their social context, adolescents with a higher pubertal development are especially likely to lose friendships with peers who do not engage in externalizing behavior, thus losing an important source of adaptive social control (i.e., friends who do not engage in externalizing behavior).

The Role of Self-Control and Early Adolescents' Friendships in the Development of Externalizing Behavior: The SNARE Study.

This social network study investigated the moderating role of self-control in the association between friendship and the development of externalizing behavior: Antisocial behavior, alcohol use, tobacco use. Previous studies have shown inconsistent findings, and did not control for possible friendship network or selection effects. We tested two complementary hypotheses: (1) That early-adolescents with low self-control develop externalizing behavior regardless of their friends' behavior, or (2) as a result of being influenced by their friends' externalizing behavior to a greater extent. Hypotheses were investigated using data from the SNARE (Social Network Analysis of Risk behavior in Early adolescence) study (N = 1144, 50 % boys, M age 12.7, SD = 0.47). We controlled for selection effects and the network structure, using a data-analysis package called SIENA. The main findings indicate that personal low self-control and friends' externalizing behaviors both predict early adolescents' increasing externalizing behaviors, but they do so independently. Therefore, interventions should focus on all early adolescents' with a lower self-control, rather than focus on those adolescents with a lower self-control who also have friends who engage in externalizing behavior.

Adolescent Heavy Drinking Does Not Affect Maturation of Basic Executive Functioning: Longitudinal Findings from the TRAILS Study.

BACKGROUND AND AIMS: Excessive alcohol use is assumed to affect maturation of cognitive functioning in adolescence. However, most existing studies that have tested this hypothesis are seriously flawed due to the use of selective groups and/or cross-sectional designs, which limits the ability to draw firm conclusions. This longitudinal study investigated whether patterns of alcohol use predicted differences in maturation of executive functioning in adolescence. Additionally, gender was tested as a possible moderator. METHODS: We used data from the Tracking Adolescents' Individual Lives Survey (TRAILS), which comprises a cohort of 2,230 Dutch adolescents. Maturation of executive functioning was measured by assessing the standardized improvement on each of four basic executive functions (i.e., inhibition, working memory, and shift- and sustained attention) between ages 11 and 19. Participants were assigned to one of six (heavy) drinking groups (i.e., non-drinkers, light drinkers, infrequent heavy drinkers, increased heavy drinkers, decreased heavy drinkers, and chronic heavy drinkers). We conducted linear regression analyses, and adjusted for relevant confounders. RESULTS: The six drinking groups did not reveal significant differences in maturation between drinking groups. E.g., maturation executive functioning of chronic heavy drinkers in comparison to non-drinkers; inhibition: B = -0.14, 95% CI [-0.41 to 0.14], working memory: B = -0.03, 95% CI [-0.26 to 0.21], shift attention: B = 0.13, 95% CI [-0.17 to 0.41], sustained attention: B = 0.12, 95% CI [-0.60 to 0.36]. Furthermore, gender was not found to be a significant moderator. CONCLUSIONS: Four years of weekly heavy drinking (i.e., chronic heavy drinkers) did not result in measurable impairments in four basic executive functions. Thus, regular heavy drinking in adolescence does not seem to affect these basic behavioural measures of executive functioning.