The role of alcohol expectancy and drinking refusal self-efficacy beliefs in university student drinking

Aims: University student alcohol misuse is a considerable problem. Alcohol expectancy research has contributed significantly to our understanding of problem drinking in young adults. Most of this research has investigated positive expectancy alone. The current study utilized two measures of alcohol expectancy, the alcohol expectancy questionnaire (AEQ) and the drinking expectancy profile [consisting of the drinking expectancy questionnaire (DEQ) and the drinking refusal self-efficacy questionnaire] to predict severity of alcohol dependence, frequency of drinking, and the quantity of alcohol consumed per occasion. Methods: Measures of drinking behaviour and alcohol expectancy were completed by 174 undergraduate university students. Results: Positive alcohol expectancy factors accounted for significant variance in all three drinking indices, with the DEQ adding additional variance to AEQ scores on frequency and severity of alcohol dependence indices. Negative expectancy did not add incremental variance to the prediction of drinking behaviour in this sample. Drinking refusal self-efficacy and dependence beliefs added additional variance over positive and negative expectancies in the prediction of all three drinking parameters. Conclusions: Positive expectancy and drinking refusal self-efficacy were strongly related to university student drinking. The incorporation of expectancy as a means of informing prevention approaches in tertiary education shows promise.

Expectancy violation and perceptions of rape victim credibility

Purpose. Rape victims have been found to have a heightened risk of secondary victimization in the legal system through biased perceptions of their credibility. In this study, participants observed a video of a rape victim reporting the crime and evaluated her credibility, to establish the influence of victim emotional expressiveness on evaluations of victim credibility. Methods. The nonverbal (eye-contact, crying) and paralinguistic (tone of voice) behaviour of the rape victim was manipulated such that the emotional presentation viewed by observers was either expressive, or not expressive. One hundred and thirty seven participants were randomly allocated to observe a videotape of either an expressive or a non-expressive victim. Participants' specific expectations about the emotional expressiveness of rape victims in general were also measured. Results. Results revealed no significant main effect of emotional expressiveness on perceptions of credibility. However, among participants with a strong expectation of emotional expressiveness, a rape victim who was emotionally expressive was perceived to be significantly more credible than a victim who was not emotionally expressive. Conclusions. It appears to be expectancy violation rather than emotional expressiveness per se that biases observers' perceptions of rape victim credibility.

Expectancy model of disordered eating : a longitudinal study

This thesis proposes a new model of disordered eating and tests it using a longitudinal design. The Expectancy Model of Disordered Eating maintains that dieting and binge eating can best be explained as a predisposition towards avoidance coping which is triggered by outcome expectancies and negative affect or low self-esteem.

Life expectancy of rigid gas permeable and high water content contact lenses

Purpose: The purpose of this study was to evaluate the life expectancy of various rigid gas permeable (RGP) lens materials used on a daily wear basis and to compare these results with the life expectancy of a matched group of soft lens wearers.

Methods: We retrospectively analyzed the records of 600 contact lens wearing patients (300 soft contact lens users and 300 RGP lens users) fit between September 1987 and September 1994. None of the subjects wore lenses on a planned replacement system. For the purposes of the study, RGP lenses were divided into three groups: <40 Dk were considered low-Dk; 41-89 Dk were considered mid-Dk; and >90 Dk were considered high-Dk. All soft lenses were high water content lenses (>60% water content). Lenses were included if they were replaced due to loss, breakage, deposition, or poor wettability but not if replaced because of changes in fit or prescription.

Results; The mean (+SD) life-spans of each lens type in months were 19.9 +/- 17 for low-Dk RGP lenses, 15.9 +/-13.3 for mid-Dk RGP lenses, 9.0+8.2 for high-Dk RGP lenses, and 6.4 +/-5.2 for high water content soft lenses. Statistical analysis using a one-way ANOVA on ranks indicated that these results were statistically significant (P< 0.0001).

Conclusions: Patients should be informed that high-Dk lenses (RGP and soft) provide substantial clinical benefits and that they should expect to replace high-Dk RGP lenses after approximately 6 months. This lends further credence to the use of high-Dk lenses on a planned replacement basis.

Resolving the theory of planned behaviour's ‘expectancy-value muddle’ using dimensional salience

The theory of planned behaviour is one of the most widely used models of decision-making in the health literature. Unfortunately, the primary method for assessing the theory's belief-based expectancy-value models results in statistically uninterpretable findings, giving rise to what has become known as the ‘expectancy-value muddle’. Moreover, existing methods for resolving this muddle are associated with various conceptual or practical limitations. This study addresses these issues by identifying and evaluating a parsimonious method for resolving the expectancy-value muddle. Three hundred and nine Australian residents aged 18–24 years rated the expectancy and value of 18 beliefs about posthumous organ donation. Participants also nominated their five most salient beliefs using a dimensional salience approach. Salient beliefs were perceived as being more likely to eventuate than non-salient beliefs, indicating that salient beliefs could be used to signify the expectancy component. The expectancy-value term was therefore represented by summing the value ratings of salient beliefs, an approach that predicted attitude (adjusted R 2 = 0.21) and intention (adjusted R 2 = 0.21). These findings suggest that the dimensional salience approach is a useful method for overcoming the expectancy-value muddle in applied research settings.

The dimensional salience solution to the expectancy - value muddle : an extension

The theory of reasoned action (TRA) specifies a set of expectancy-value, belief-based frameworks that underpin attitude (behavioural beliefs × outcome evaluations) and subjective norm (normative beliefs × motivation to comply). Unfortunately, the most common method for analysing these frameworks generates statistically uninterpretable findings, resulting in what has been termed the ‘expectancy-value muddle’. Recently, however, a dimensional salience approach was found to resolve this muddle for the belief-based framework underpinning attitude. An online survey of 262 participants was therefore conducted to determine whether the dimensional salience approach could also be applied to the belief-based framework underpinning subjective norm. Results revealed that motivations to comply were greater for salient, as opposed to non-salient, social referents. The belief-based framework underpinning subjective norm was therefore represented by evaluating normative belief ratings for salient social referents. This modified framework was found to predict subjective norm, although predictions were greater when participants were forced to select five salient social referents rather than being free to select any number of social referents. These findings validate the use of the dimensional salience approach for examining the belief-based frameworks underpinning subjective norm. As such, this approach provides a complete solution to addressing the expectancy-value muddle in the TRA.

Life expectancy of type 1 diabetic patients during 1997-2010: a national Australian registry-based cohort study

AIMS/ HYPOTHESIS:
There is limited information about the impact of type 1 diabetes on life expectancy in a contemporary population. We examined the life expectancy of type 1 diabetic patients and explored the contribution of mortality at different ages and of different causes of death to years of life lost (YLL) compared with the general population.

METHODS:
We derived mortality rates of Australians with type 1 diabetes listed on the National Diabetes Services Scheme (NDSS) between 1997 and 2010 (n = 85,547) by linking the NDSS to the National Death Index. The Chiang method was used to estimate life expectancy and Arriaga's method was used to estimate the contributions of age-specific and cause-specific mortality to the YLL.

RESULTS:
A total of 5,981 deaths were identified during the 902,136 person-years of follow up. Type 1 diabetic patients had an estimated life expectancy at birth of 68.6 years (95% CI 68.1, 69.1), which was 12.2 years (95% CI 11.8, 12.7) less than that in the general population. The improvement in life expectancy at birth in 2004-2010 compared with 1997-2003 was similar for both type 1 diabetic patients (men, 1.9 years [95% CI 0.4, 3.3]; women, 1.5 years [95% CI 0.0, 3.2]) and the general population (men, 2.2 years; women, 1.4 years). Deaths at age <60 years accounted for 60% of the YLL from type 1 diabetes for men and 45% for women. The major contribution to YLL was mortality from endocrine and metabolic disease at age 10-39 years (men, 39-59%; women, 35-50%) and from circulatory disease at age ≥40 years (men, 43-75%; women, 34-75%).

CONCLUSIONS/ INTERPRETATION:
Data from 1997 to 2010 showed that Australian type 1 diabetic patients had an estimated loss in life expectancy at birth of 12.2 years compared with the general population.

Obesity in adulthood and its consequences for life expectancy: a life-table analysis

BACKGROUND: Overweight and obesity in adulthood are linked to an increased risk for death and disease. Their potential effect on life expectancy and premature death has not yet been described. OBJECTIVE: To analyze reductions in life expectancy and increases in premature death associated with overweight and obesity at 40 years of age. DESIGN: Prospective cohort study. SETTING: The Framingham Heart Study with follow-up from 1948 to 1990. PARTICIPANTS: 3457 Framingham Heart Study participants who were 30 to 49 years of age at baseline. MEASUREMENTS: Mortality rates specific for age and body mass index group (normal weight, overweight, or obese at baseline) were derived within sex and smoking status strata. Life expectancy and the probability of death before 70 years of age were analyzed by using life tables. RESULTS: Large decreases in life expectancy were associated with overweight and obesity. Forty-year-old female nonsmokers lost 3.3 years and 40-year-old male nonsmokers lost 3.1 years of life expectancy because of overweight. Forty-year-old female nonsmokers lost 7.1 years and 40-year-old male nonsmokers lost 5.8 years because of obesity. Obese female smokers lost 7.2 years and obese male smokers lost 6.7 years of life expectancy compared with normal-weight smokers. Obese female smokers lost 13.3 years and obese male smokers lost 13.7 years compared with normal-weight nonsmokers. Body mass index at ages 30 to 49 years predicted mortality after ages 50 to 69 years, even after adjustment for body mass index at age 50 to 69 years. CONCLUSIONS: Obesity and overweight in adulthood are associated with large decreases in life expectancy and increases in early mortality. These decreases are similar to those seen with smoking. Obesity in adulthood is a powerful predictor of death at older ages. Because of the increasing prevalence of obesity, more efficient prevention and treatment should become high priorities in public health.

Living healthier for longer: comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease

BACKGROUND: Non-smoking, having a normal weight and increased levels of physical activity are perhaps the three key factors for preventing cardiovascular disease (CVD). However, the relative effects of these factors on healthy longevity have not been well described. We aimed to calculate and compare the effects of non-smoking, normal weight and physical activity in middle-aged populations on life expectancy with and without cardiovascular disease.

METHODS: Using multi-state life tables and data from the Framingham Heart Study (n = 4634) we calculated the effects of three heart healthy behaviours among populations aged 50 years and over on life expectancy with and without cardiovascular disease. For the life table calculations, we used hazard ratios for 3 transitions (No CVD to CVD, no CVD to death, and CVD to death) by health behaviour category, and adjusted for age, sex, and potential confounders.

RESULTS: High levels of physical activity, never smoking (men), and normal weight were each associated with 20-40% lower risks of developing CVD as compared to low physical activity, current smoking and obesity, respectively. Never smoking and high levels of physical activity reduced the risks of dying in those with and without a history of CVD, but normal weight did not. Never-smoking was associated with the largest gains in total life expectancy (4.3 years, men, 4.1 years, women) and CVD-free life expectancy (3.8 and 3.4 years, respectively). High levels of physical activity and normal weight were associated with lesser gains in total life expectancy (3.5 years, men and 3.4 years, women, and 1.3 years, men and 1.0 year women, respectively), and slightly lesser gains in CVD-free life expectancy (3.0 years, men and 3.1 years, women, and 3.1 years men and 2.9 years women, respectively). Normal weight was the only behaviour associated with a reduction in the number of years lived with CVD (1.8 years, men and 1.9 years, women).

CONCLUSIONS: Achieving high levels of physical activity, normal weight, and never smoking, are effective ways to prevent cardiovascular disease and to extend total life expectancy and the number of years lived free of CVD. Increasing the prevalence of normal weight could further reduce the time spent with CVD in the population.

Obesity in older adults and life expectancy with and without cardiovascular disease

BACKGROUND: The prevalence of overweight and obesity is increasing globally and is an established risk factor for cardiovascular disease (CVD). Our objective was to evaluate the impact of overweight and obesity on life expectancy and years lived with and without CVD in older adults.

METHODS: The study included 6636 individuals (3750 women) aged 55 years and older from the population-based Rotterdam Study. We developed multistate life tables by using prevalence, incidence rate and hazard ratios (HR) for three transitions (free-of-CVD-to-CVD, free-of-CVD-to-death and CVD-to-death), stratifying by the categories of body mass index (BMI) at baseline and adjusting for confounders.

RESULTS: During 12 years of follow-up, we observed 1035 incident CVD events and 1902 overall deaths. Obesity was associated with an increased risk of CVD among men (HR 1.57 (95% confidence interval (CI) 1.17, 2.11)) and women (HR 1.49 (95% CI 1.19, 1.86)), compared with normal weight individuals. Overweight and obesity were not associated with mortality in men and women without CVD. Among men with CVD, obesity compared with normal weight, was associated with a lower risk of mortality (HR 0.67 (95% CI 0.49, 0.90)). Overweight and obesity did not influence total life expectancy. However, obesity was associated with 2.6 fewer years (95% CI -4.8, -0.4) lived free from CVD in men and 1.9 (95% CI -3.3, -0.9) in women. Moreover, men and women with obesity lived 2.9 (95% CI 1.1, 4.8) and 1.7 (95% CI 0.6, 2.8) more years suffering from CVD compared with normal weight counterparts.

CONCLUSIONS: Obesity had no effect on total life expectancy in older individuals, but increased the risk of having CVD earlier in life and consequently extended the number of years lived with CVD. Owing to increasing prevalence of obesity and improved treatment of CVD, we might expect more individuals living with CVD and for a longer period of time.

Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes.

AIMS/HYPOTHESIS: The aim of this work was to estimate the life expectancy (LE) and disability-free life expectancy (DFLE) for adults with and without diabetes. METHODS: The Chiang method and the adapted Sullivan method were used to estimate LE and DFLE by age and sex. Mortality data in 2011 were available from the National Diabetes Services Scheme for diabetes and from standard national mortality datasets for the general population. Data on prevalence of disability and severe or profound core activity limitation were derived from the 2012 Australian Survey of Disability, Ageing and Carers (SDAC). The definitions of disability used in the SDAC followed the International Classification of Functioning, Disability and Health. Data on diabetes prevalence were derived from the Australian Diabetes, Obesity and Lifestyle study. RESULTS: The estimated LE and DFLE (with 95% uncertainty interval [UI]) at age 50 years were 30.2 (30.0, 30.4) and 12.7 (11.5, 13.7) years, respectively, for men with diabetes, and the estimates were 33.9 (33.6, 34.1) and 13.1 (12.3, 13.9) years, respectively, for women with diabetes. The estimated loss of LE associated with diabetes at age 50 years was 3.2 (3.0, 3.4) years for men and 3.1 (2.9, 3.4) years for women, as compared with their counterparts without diabetes. The corresponding estimated loss of DFLE was 8.2 (6.7, 9.7) years for men and 9.1 (7.9, 10.4) years for women. Women with diabetes spent a greater number of absolute years and a greater proportion of their life with disability as compared with men with diabetes and women without diabetes. The gains in LE and DFLE across the whole population at age 50 years after hypothetically eliminating diagnosed diabetes were 0.6 (0.5, 0.6) years and 1.8 (1.0, 2.8) years. CONCLUSIONS/INTERPRETATION: In adults, diabetes results in a modest reduction in LE and a substantial reduction in DFLE. Efforts to identify the specific causes of disability and effective interventions are needed.

Mapping site-based construction workers' motivation: expectancy theory approach

The aim of this study is to apply a recently proposed model of motivation based on expectancy theory to site-based workers in construction and confirm the validity of this model for the construction industry. The study drew upon data from 194 site-based construction workers in Iran to test the proposed model of motivation. To this end, the structural equation modelling (SEM) approach based on the confirmatory factor analysis (CFA) technique was deployed. The study reveals that the proposed model of expectancy theory incorporating five indicators (i.e. intrinsic instrumentality, extrinsic instrumentality, intrinsic valence, extrinsic valence and expectancy) is able to map the process of construction workers' motivation. Nonetheless, the findings posit that intrinsic indicators could be more effective than extrinsic ones. This proffers the necessity of construction managers placing further focus on intrinsic motivators to motivate workers.