JOURNAL OF SUBSTANCE USE

2018, VOL. 23, NO. 3, 268–273

https://doi.org/10.1080/14659891.2017.1394377

The relationship between social influences and adolescents’ substance use-related

cognitions
Zohre Fathian Dastgerdia and Ahmad Ali Eslamib
a
Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; bSchool of Health, Isfahan
University of Medical Sciences, Isfahan, Iran

ABSTRACT ARTICLE HISTORY

Background: Increasing substance use among adolescents has prompted investigation in the emergence Received 15 January 2017
and evolution of substance use behaviors. Two basic elements which are influenced in person’s behavior Revised 26 August 2017
are self-efficacy and outcome expectancies. While the importance of these construct is high, their origin Accepted 8 October 2017
is less clear. In the present study we sought to elucidate influences of social influence on the develop- KEYWORDS
ment of cognition factors as predictors of substance use behavior. Adolescent; outcome
Methods: Structural equation modeling was used to assess the fit of a model that proposes that self- expectancy; self-efficacy;
efficacy and outcome expectancies are mediators of the association between social influences and substance use
substance use behavior in 720 adolescents, aged between 14 and 18, in the cross-sectional survey in
Isfahan, Iran.
Results: Positive expectancies, in contrast to negative ones, form positive attitudes regarding drug use.
The phenomenon combined with a sense of low resistance self-efficacy leaded to the substance use
behavior. The model provided a good fit to the data and explained 53% of the variance in substance use
behavior in adolescents.
Conclusions: Results of the study shed light on the development of substance use-related cognitions
and contribute to our understanding of the structural relationship between social influence, expectan-
cies, and self-efficacy in substance use behavior in adolescents.

Introduction was significantly associated with cigarette smoking in adoles-

cents in Iran (Nazarzadeh et al., 2013).
Rapid changes in multiple domains, including cognitive pro-
To date, several theoretical paradigms have been developed
cesses and social attachment, originally thought to be evolu-
to explain the causes for early onset drug use and the mechan-
tionarily beneficial, have been linked to age-related increases
isms underlying the progression of drug use disorder
in certain behavioral problems including substance use and
(Gorman, 1992; Parolin & Simonelli, 2016; Thibodeau,
misuse in young people in recent decade (Dahl, 2004; Spear &
August, Cicchetti, & Symons, 2016). In this regard, social
Varlinskaya, 2005; Steinberg, 2005; Witt, 2010). Because of
cognitive theory establishes the most contemporary, claim
social, religious, cultural, and economical reasons, consump-
that the two basic elements which are influenced in a person’s
tion of addictive substances in Iran is different from other
behavior are self-efficacy and outcome expectancies. The beliefs
countries especially western countries. Overall, there is a
about individual’s confidence in their ability to resist using a
limited amount of information available on adolescent’s sub-
particular substance in specific situations and the likely out-
stance abuse in Iran. The results of one study which was
comes following substance use that clearly influence their
conducted on 15-year-old students in Shiraz in 2003 showed
decision to use the substance. These cognitions are respec-
that 32% of students had experienced alcohol consumption
tively referred to refusal self-efficacy (Young, Connor,
and 2.1% of them had lifetime drug abuse (Alireza Ayatollahi,
Ricciardelli, & Saunders, 2006) and outcome expectancies
Mohammadpoorasl, & Rajaeifard, 2005). Another study con-
(Jones, Corbin, & Fromme, 2001).
ducted on 15-year-old students in Tabriz in 2005 and 2006
Outcome expectancies refer to a person’s beliefs as to
longitudinally showed that 12.7% of students had ever used
whether their involvement in certain behaviors will result in
alcohol and 2.0% had used drugs (Mohammadpoorasl,
the anticipated outcomes or not. Outcome expectancies are
Fakhari, Rostami, & Vahidi, 2007). Despite of legislative
formed either through the person’s instant experience of a
restrictions of sale tobacco and other drug to adolescents in
certain behavior or through observation of other people’s
Iran, majority of them (78.2%) revealed easy access to cigar-
experiences regarding the outcomes of the behavior. These
ettes. The results revealed that older age, having more risk
people may be the person’s family members, friends and/or
taking behaviors including lower self-efficacy and self-esteem,
famous people, who symbolize dominant models for the indi-
positive attitude toward smoking and having smoker friend
vidual (Sarafino, 2006).

CONTACT Ahmad Ali Eslami eslamiaa@gmail.com School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
© 2017 Taylor & Francis Group, LLC
 JOURNAL OF SUBSTANCE USE 269

Perceived self-efficacy is a cognitive process describing Methods

adolescences’ confidence in their ability to abstain from drug
Participants: Data were collected from 720 adolescents in a
use in high-risk situations (Bandura, 1977a, 1977b). Such
cross-sectional survey, using stratified, two stages, cluster sam-
cognitive expectancies are thought to be proximal mediators
pling, based on a population of different areas in Isfahan,
of the choice to engage in various activities and serve a
according to the Wolf’s recommendations for determining
prominent role in the initiation and maintenance of beha-
sample size requirements for structural equation modeling
vioral change. Ratings of self-efficacy have predicted drinking
(SEM) (Wolf, Harrington, Clark, & Miller, 2013). Participants
behavior (Annis & Davies, 1988) and smoking cessation
completed a paper-and-pencil questionnaire, in public places
(Condiotte & Lichtenstein, 1981).
including: libraries, internet cafes, gyms, etc. with trained inter-
Oei and Jardim (2007) found that both outcome expectan-
viewers. The inclusion criteria were the age range between 14
cies and refusal self-efficacy contributed unique variances to
and 18 and willingness to complete the questionnaires.
the prediction of alcohol consumption in college students (Oei
Informed consent was obtained from each participant and
& Jardim, 2007).
they were informed of the voluntary nature of their participa-
While the importance of outcome expectancies and self-effi-
tion, i.e., they could withdraw at any time prior to submitting
cacy in adolescence substance use is undisputable, their origin is
their responses and to preserve anonymity, no identifying
yet to be clearly known. In the present, study we sought to
information was collected. The participating gift which
elucidate possible distal influences on development of these
included a pack of stationery was also given to all participants
constructs.
after completing their questionnaires. The study was approved
Many scientific researchers who have explored the risk and
by the committee of faculty members and the ethics committee
protective factors related to adolescent substance use put
of Isfahan University of Medical Sciences.
emphasis on social context and its key aspects, which include
Measures: Questionnaires used in this study were extracted
parental drug use and parent-youth relationship quality
from the EMCDDA (European Monitoring Center of Drug and
(Dishion, Nelson, & Bullock, 2004), social skill related to drug
Drug Addiction) questionnaires (emcdda, 2012) that were loca-
use in high-risk situation (Fathian, Eslami, Ghofranipour,
lized in Iran by Fathian and colleagues (2015a) and were con-
Mostafavi, & Ebrahimi, 2015a) and peer relationships
firmed to have adequate internal consistency for Iranian
(Barrera, Biglan, Ary, & Li, 2001; Brook, Brook, Arencibia-
adolescents (Cronbach’s alpha = 0.75–0.85) (Fathian, Eslami,
Mireles, Richter, & Whiteman, 2001).Thus, parental and peer
Ghofranipour, & Mostafavi, 2015b). The questionnaires include:
social contexts should be studied in terms of the ways in which
they are linked with adolescent substance use, especially in
Iranian adolescents that have high dependence with their – Refusal self-efficacy scale, using 4 items to show the
family until their young age (Parvizy & Ahmadi, 2009). ability of an individual to refuse drug consumption in
Accordingly, in the present study we sought to elucidate situations like having parties with new people, stressful
possible distal influences of social influence including peer, situations like school exams, and celebrations.
parent, and sibling substance use on the development of – Outcome expectancies were measured using a series of 11
cognition factors including outcome expectancies and self- items that each of them was rated on a 4-point scale
efficacy as predictors of substance use behavior in Iranian (strongly agree, agree, disagree, strongly disagree) to ask
adolescents. We also want to test a model predicting that “How likely is each of the following would happen for
the association between social influence and substance use you if you smoke cigarette or consume illegal substances
behavior would be mediated by refusal self-efficacy, positive, in the next month?” The items in positive Outcome
and negative outcome expectancies (Figure 1). expectancies were: “Feel more relax, Have more fun, Be
more popular, Forget my troubles, Be more confident
and outgoing” and for negative outcome expectancies
were: “Get into trouble with police, Have problems in
school, Get into trouble with parents, Have problems
with my friends, Become an addict and Have money
problems.”
– Social influence was assessed via a 4-items scale includ-
ing: “Does your mother, father, sibling or best friend
smoke cigarettes, drink alcohol, use other illegal
drugs?” (Yes, No, I don’t know, and I don’t have a
mother/father. . .)
– The substance use scale included tobacco, alcohol, cannabis,
opiates, and industrial drugs such as ecstasy, LSD, and
Crystal being consumed during the last 30 days, that were
scored with 7 Likert options from never to 30 times or more.

Procedure: A two-step approach was utilized to evaluate

Figure 1. Initially estimated model: Hypothesized model of association between whether the hypothesized model fits the data or not (Anderson
social influence and substance use behavior in adolescents. & Gerbing, 1992). Firstly, a first-order measurement model was
270 Z. FATHIAN DASTGERDI AND A. A. ESLAMI

examined to assess how well the observed measures reflect the Table 1. Description of the sample by age and gender (n = 671).
latent constructions; Secondly, the hypothesized model was tested Age Female n (%) Male n (%) Total
to examine the relationships among constructs. 14–14.9 86 (58.9) 60 (41.1) 146 (100)
15–15.9 70 (49.0) 73 (51.0) 143 (100)
Following data collection, it was determined that nearly 16–16.9 56 (29.3) 135 (70.7) 191 (100)
12% of the questionnaire data were missing. Missing data 17–17.9 113 (59.2) 78 (40.8) 191 (100)
were imputed using Full Information Maximum Likelihood Total 325 (48.4) 346 (51.6) 671 (100)
(FIML) estimation, an optimal strategy for handling missing
data (Graham, 2009).
Table 2. Correlation coefficient among self-efficacy, negative outcome expec-
Before testing the recommended model using Structural tancies, positive outcome expectancies, social influence, and substance use.
Equation Modeling (SEM), the most important assumptions of 1 2 3 4 5
the method, multivariate normality and multicollinearity, were Positive expectancies Mean:2.97
tested using Mardia’s Multivariate Normality test and the SE:.03
Variance Inflation Factor (VIF) approach, respectively. The Negative −.059 Mean:2.27
expectancies SE:.03
inclusion of scales and subscales was determined through assess- Refusal self-efficacy .269** .014 Mean:3.1
ment of existing validity studies. In order to support the validity SE:.02
of the scales in the recommended structural model and reach the Social influence −.081* .021 −.257** Mean:1.12
SE:.01
most appropriate measurement models, Exploratory (Minimal Substance use −.112** .058 −.317** .459** Mean:.7
Residual Method [MINRES]) and Confirmatory Factor Analysis behavior SE:.09
(Maximum Likelihood Estimation [MLE]) were performed, Note:*. Correlation is significant at the 0.05 level (2-tailed).
respectively (Enders & Bandalos, 2001). SEM, using AMOSE, **. Correlation is significant at the 0.01 level (2-tailed)
version 23, was run to examine whether the relationship between
social influence (SI) and substance use behavior (SU) would be positive outcome expectancies contained six observable vari-
mediated by self-efficacy (SE) and outcome expectancy (OE). ables and had loadings ranging from 0.71 to 0.86. The negative
SEM was computed using the robust method, correcting for the outcome expectance contained five observable variables and
expected non-normal distributions. had loadings ranging from 0.75 to 0.88, perceived norm drug
In order to examine the mediational role of attachment, we use contained four observable variables and had loading ran-
computed direct effects (path coefficient from SI to SU) as well ging from 0.73 to 0.88. According to Comrey and Lee (1992) we
as indirect effects (i.e., the product of the path coefficients from observed acceptable factor loadings in our model (Comrey &
SI to SE and from SE to SU and also from SI to OE to SE and Lee, 1992). The latent variables from the first-order confirma-
finally to SU). The significance of the indirect effects was eval- tory model had acceptable indices, based on goodness-of-fit
uated using 95% bootstrapped confidence intervals (MacKinnon indices (Table 3)
& Fairchild, 2009). This bias-corrected method is based on a In the second phase, the effect of exogenous variable
distribution of the product of coefficients, and generates con- include social influence with substance use behavior in
fidence limits for the true value of coefficient for indirect effects. adolescents that were mediated by negative outcome expec-
When zero is not in the confidence interval, the indirect effect is tancies, positive outcome expectancies, and refusal self-effi-
considered significant. Finally, we evaluated the proportions of cacy were tested in the primary model. The initially
the total effect that were mediated through attachment. estimated model showed that some paths were not statisti-
Model fit of all models was evaluated by χ2 values, the Root cally significant. For example, negative outcome expectan-
Mean Square Error of Approximation [RMSEA; (Browne & cies did not have any significant effects on substance use
Cudeck, 1993)], Tucker Lewis index (TLI), and the behavior in direct and indirect paths and this path was
Comparative Fit Index [CFI; (Bentler, 1990)]. Models with removed from the model. Subsequently, the final model
non-significant χ2, RMSEA less than 0.07 and CFI and TLI was re-estimated with only the significant paths (see
greater than 0.90 were considered a good fit to the observed Figure 2). The fit indexes for the estimated final model
data (Hu & Bentler, 1999). were satisfactory (Table 4).

Results
Table 3. Indices of first-order confirmatory models.
Participant: the original dataset contained responses from 720
participants. Twenty participants (2.7%) did not answer com- CMIN/
CMIN df df GFI AGFI NFI TLI CFI RMSEA
pletely and 29(4.02%) questionnaires were also eliminated due
Positive outcome 12.9 4 3.2 0.98 0.94 0.98 0.97 0.99 0.08
to doubts in validity and due to their inconformity with other expectancies
data. 48.4% (325) of the samples were female and Participants’ Negative outcome 28 9 3.1 0.97 0.94 0.97 0.97 0.98 0.07
expectancies
ages ranged from 14 to 17 years (M = 15.6, SD = 1.1) (Table 1). Refusal self- 0.005 1 0.005 0.99 0.99 0.99 0.99 0.99 0.03
Correlations between all factors were relatively meaningful efficacy
(Table 2) except for the negative outcome expectancy that did Social influence 3.50 1 3.50 0.99 0.95 0.99 0.94 0.99 0.08
Substance use 8.56 3 2.85 0.99 0.95 0.99 0.99 0.99 0.07
not have a meaningful correlation with the others. behavior
Five latent variables were specified in the first-order mea- Note: Chi-square values are significant (p < 0.05). S–Bχ2 = Satorra–Bentler Chi-
surement model. The refusal self-efficacy contained four obser- square; NFI = Normed Fit Index; CFI = Comparative Fit Index; TLI = Tucker Lewis
vable variables and had loadings ranging from 0.84 to 0.90. The index; RMSEA = root mean square error of approximation.

Figure 2. Final model: Direct and indirect paths standard coefficients for the effect of social influence on substance use mediated by outcome expectancy and self-
efficacy. SI: social influence: (1: Father, 2: Mother, 3: Sibling, 4: Best friend), OE: Positive outcome expectancy, SE: Refusal self-efficacy, SU: Substance use behavior.
Table 4. Goodness-of-fit statistics in presented model.
CMIN/df NFI CFI TLI PNFI
5 0.92 0.92 0.93 0.63
The hypothesized full mediation model provided a good fit to
the data. This model was compared to an alternative partial
mediation model for substance use that included additional direct
paths from social influence to substance use. This model provided
a superior fit to the full mediation model (Table 4, Figure 2).
As shown in Figure 2, positive outcome expectancy (unstan-
dardized coefficient = 1, SE = .02, p < .001) was significantly
associated with refusal self-efficacy. Refusal self-efficacy, in
turn, predicted substance use (unstandardized coeffi-
cient = −0.22, SE = .18, p < .001). Self-efficacy fully mediated
the association between positive expectancy and substance use
(unstandardized mediation effect, CI95% = .03, .17). It still had
a significant direct association with substance use (unstandar-
dized coefficient = .22, SE = .08, p < .001). The Lagrange
Multiplier (LM) test was used to see whether any other paths
that are left out of the model should be included. Results from
these tests suggest that neither is any path insignificant nor
should any new path be included.
Discussion
The aim of the current study was to examine the role of social
influence in adolescent’s cognition and behavior related to
substance use. The study confirmed good fit of the hypothe-
sized model in which the social influence affected cognitive
variables (outcome’ expectancies and self-efficacy) in a way
that substance use behavior in adolescents was possible to
JOURNAL OF SUBSTANCE USE 271
predict. Additionally, the model proposed the nature by
RMSEA
which these cognitive variables interact, and consequently
0.07
extended our understanding of the relationship between
expectancies and self-efficacy.
The current study found that social influence had a signifi-
cant relationship with refusal self-efficacy (β = .12), positive
expectancies (β = −0.15), and substance use behavior (β = 0.69)
in adolescents. Additionally, the standardized beta coefficient
from positive expectancies to refusal self-efficacy (β = −0.15)
provides support for the argument that expectancies can influ-
ence self-efficacy to impact behavior. Oei and Jardim (2007)
found that alcohol expectancies and drinking refusal self-effi-
cacy each contributed unique variance to the prediction of
alcohol consumption in college students (Oei & Jardim, 2007).
This result provides support that social influence, influ-
ences the improvement either by altering exposure to learning
experiences (e.g., familial modeling of use) or by biasing what
is learned in response to experience with the substance.
In line with our study, expectancies have been tested as a
mediator of a range of risk factors for substance involvement in
other studies. The result showed that expectancies partially med-
iate the effect of social influence, such as familial use/modeling
(Brown, Creamer, & Stetson, 1987), peer use (Hine, McKenzie-
Richer, Lewko, Tilleczek, & Perreault, 2002; Stamates, Lau-
Barraco, & Linden-Carmichael, 2016), and media exposure (Dal
Cin, Worth, Dalton, & Sargent, 2008), as well as individual differ-
ences factors such as delinquent behavior (Meier, 2007), gender
norms (Iwamoto, Corbin, Lejuez, & MacPherson, 2014), and level
of response to alcohol (Schuckit et al., 2012).
The current study also found that negative expectancies
did not have any significant relationships with other factors,
and were then removed from the model. Other studies have
272 Z. FATHIAN DASTGERDI AND A. A. ESLAMI
also considered negative expectancies and come up with dif-
ferent results. In a test of the acquired preparedness model
(APM) of alcohol use for college females, Anderson et al.
(2003) found that both negative and positive expectancies
310 partially mediate the relation between disinhibited per-
sonality and alcohol use (Anderson, Smith, & Fischer, 2003).
In contrast, other studies have found that the meditational
pathway through positive expectancies is fundamentally
stronger than through negative expectancies (Urbán,
Kökönyei, & Demetrovics, 2008) or have failed to demon-
strate the fact that negative expectancies mediate the associa-
tion (Fu, Ko, Wu, Cherng, & Cheng, 2007). To the extent, that
negative expectancies measure awareness of the negative con-
sequences related to substance use, low levels of their endor-
sement should, in theory, be consistent with trait disinhibition
and, could in turn, mediate the pathway to substance use
behavior. Alternatively, it is possible that high levels of endor-
sement among problematic users could indicate continuing
use despite the knowledge of its negative consequences.
Also, the results showed that perceived drug use in
important individuals including family members and friends
(SI) in particular was a more important determinant in
adolescents’ drug use behavior. These results are consistent
with social learning theory, which posits cognitive factors as
critical determinants in substance use and considers them
the result of modeling and indirect and direct drug use
experiences (Bandura, 1977b). Thus, adolescents watching
family members and friends engaging in and experiencing
outcomes of drug use will play an important role in devel-
opment of adolescents own positive expectancies and reduce
refusal self-efficacy regarding drug use. This can be sup-
ported with a study conducted by Brown et al. (1987),
which found that parental alcohol use impacts both adoles-
cents’ alcohol-related cognitions and their drinking behavior
(Brown et al., 1987).
Conclusion
The present study evaluated the effects of social influence
in adolescent’s cognition and behavior related to substance
use. It was demonstrated that self-efficacy (and especially
resistance self-efficacy) and outcome expectancies mediate
the effect of social influence on substance use behavior.
Positive consequences that are derived from social model-
ing, in contrast to negative ones, form positive attitudes
and motivation regarding drug use. The phenomenon
combined with a sense of low resistance self-efficacy
leaded to the decision for substance use.
The results are highly recommending decreasing posi-
tive outcome expectancies about drug use in adolescent
instead of bolding and exaggerating the negative ones. It is
also suggested that parallel to taking advantage of preven-
tion programs in which parents are often encouraged to
talk to their children about risky behaviors and monitor
their potential for drug abuse, social modeling should be
considered as a significant factor since it imposes a
remarkable contribution to adolescents’ intention to use
drug.
Limitation
Perhaps the most evident limitation was the use of self-report
measures causing analyses to rely on adolescents’ drug use
and their perceptions of their family member and friend’s
drug use. It would have been preferable to have had a gold
standard clinical interview or similar external validation mea-
sure. However, studies and literature reviews suggest that self-
report data is often valid and reliable among both adult and
adolescent populations (Babor, Steinberg, Anton, & Del Boca,
2000; Brener & Grady, 2003) (Babor, Steinberg, Del Boca, &
Anton, 2000; Brener, Billy, & Grady, 2003).
Disclosure of potential conflicts of interest
All authors declare that they have no conflicts of interest. The authors
would like to thank the Deputy for Research of Isfahan University of
Medical Sciences for their financial support
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