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

Background and aims: 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. Design and setting: 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. Participants: 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. Measurements: 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). Findings: All autoregressive effects were statistically significant for both ARA and HED across all time-points. Past ARA predicted future ARA [e.g. ARA _T1 → ARA _T2 = 0.071, credibility interval (CI) = 0.043–0.099, P < 0.001, one-tailed]. Similarly, past HED predicated future HED (e.g. HED _T1 → HED _T2 = 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. HED _T2 → ARA _T3 = 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. Conclusions: 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.