Health Behaviors Among Adolescents and Emerging Adults - Expectations and Expectation Violations

While health risk behaviors are present among the general population, adolescents and emerging adults often show a critically high incidence of health deteriorating behaviors and are at high probability of related consequences (DiClemente et al., 2009). Risky health behaviors with a high incidence a...

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Bibliographic Details
Main Author: Gesualdo, Chrys
Contributors: Pinquart, Martin (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2023
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Summary:While health risk behaviors are present among the general population, adolescents and emerging adults often show a critically high incidence of health deteriorating behaviors and are at high probability of related consequences (DiClemente et al., 2009). Risky health behaviors with a high incidence among young people include the frequent consumption of unhealthy food (Maillet & Grouzet, 2021), physical inactivity (Deng et al., 2021), and high consumption of alcohol/binge drinking (Romm et al., 2020). Expectations are important cognitions as they can help individuals prepare for future events (Roese & Sherman, 2007), can be significant behavioral predictors (Rief et al., 2015), and can be useful as individuals may enact certain behaviors in order to be coherent with their expectations (e.g., Fan & Chen, 2001). In the context of health behaviors, associations between expectations and actual health behaviors have been demonstrated (e.g., Werner et al., 1993 regarding alcohol use). Nonetheless, expectations are often disconfirmed or violated based on novel evidence. When identified, expectation violations may activate a cognitive response to address the inconsistency, and individuals may react by altering or conserving their original expectations. In addition, individual (e.g., previous experiences and the current state), social (e.g., behavior of social ties), and environmental (e.g., living arrangement) factors can influence an individual’s expectations and the stabilization or change of expectations. Lastly, characteristics of an expectation disconfirming event may predict coping with expectation violations as these may promote or hinder expectation maintenance or change (Pinquart et al., 2021). Research investigating expectations in association with food consumption, physical activity, and alcohol use among young people is limited for the most part. Moreover, the association between these health behaviors and expectation violations has not been widely investigated, and the role of expectations and expectation violations in interventions aimed changing unhealthy behavior among young people has received little attention. This doctoral thesis aimed to narrow these gaps in knowledge by first assessing how expectations, prior experiences, the current state, social tie’s efforts to motivate behavior, and coresidence with parents are related to health behaviors and expectations (Study 1). By longitudinally analyzing data from 163 first-year students (Mage = 21.20, SD = 2.66; 81% female), we found that change in expectations for physical activity and drinking behaviors were predicted by the initial respective behavior. Moreover, perceived parental attempts to influence drinking and physical inactivity predicted the respective student behavior and expectations. Lastly, moving out of the parental home predicted an increase in current and expected drinking behaviors. This leads to the assumption that expectations as well as individual and environmental factors indeed have an impact on first-semester students’ health behaviors. Second, we implemented an experimental design to investigate whether characteristics of an expectation disconfirming event (i.e., valence, discrepancy magnitude, and controllability) predict expectation maintenance or change among 297 university students (Mage = 23.76, SD = 4.42; 75.8% female; Study 2). A questionnaire containing vignettes presenting expectation disconfirming events about healthy food consumption and physical activity was administered. We found that, regarding physical activity, students showed higher expectation change when experiencing a better-than-expected event and higher expectation maintenance when experiencing a worse-than-expected event. In addition, regarding food consumption and physical activity, students experiencing lower discrepancy showed higher expectation maintenance, students with control over the source of disconfirmation showed higher determination to achieve their expectations, while students without control over the source of disconfirmation showed higher expectation change. Third, we investigated the effects of challenging alcohol expectations of high school and college students on their drinking behavior and alcohol expectations (Study 3). Alcohol Expectancy Challenge interventions are, as of now, the best-researched intervention that implements expectation violations to promote healthy behavior among young people. Therefore, we collected all available studies to conduct a meta-analysis (23 studies; 4,122 participants; Mage = 19.0, SD = 2.32; 57% males) on this topic. The intervention showed significant yet small effects at modifying alcohol consumption and alcohol expectancies in the desired direction. Change in expectations explained change in alcohol use. More favorable results were observed for college students as compared to high school students and for interventions delivered at a higher dose. The results of this dissertation show the connection between expectations, expectation violations, and health behaviors among adolescents and emerging adults. Results also show aspects of an expectation disconfirming event that predict expectation maintenance or change, which can inform intervention strategies. As such, important insights to optimize health promotion interventions targeting young people are presented. Lastly, the practical importance of challenging health-behavior-related expectations through interventions targeting adolescents and emerging adults is also demonstrated.