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Italian validation of the drinking motives questionnaire revised short form (DMQ-R SF)
Addictive Behaviors 35 (2010) 905–908
Contents lists available at ScienceDirect
Addictive Behaviors
Short Communication
Italian validation of the drinking motives questionnaire revised short form (DMQ-R SF) Sonia Mazzardis a, Alessio Vieno a,⁎, Emmanuel Kuntsche b,c, Massimo Santinello a a b c
Department of Developmental and Social Psychology, University of Padova, Italy Research Department, Swiss Institute for the Prevention of Alcohol and Drug Problems, Lausanne, Switzerland Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
a r t i c l e Keywords: Drinking motives Alcohol use Adolescence Italy
i n f o
a b s t r a c t The aim of the study is to validate the four-dimensional structure of the Drinking Motive Questionnaire Revised Short Form (DMQ-R SF) in a sample of Italian adolescents and to investigate associations of these motives with frequency of alcohol use and sensation seeking. The data were gathered through selfadministered questionnaires in classrooms. The questionnaires were filled out by a representative sample of 2725 (56.4% males; mean age = 16.2) 8th to 13th grade alcohol-using students. Confirmatory factor analysis and structural equation models were applied. The four-dimensional structure of the DMQ-R SF was confirmed in the general sample and among subgroups defined by gender and age. Furthermore, enhancement, social and coping motives were found to be positively related to sensation seeking and frequency of alcohol use. Conformity motives were negatively related to sensation seeking and frequency of alcohol use. The results are consistent with previous studies from other countries and indicate that the DMQR SF is a valid instrument to assess drinking motives among Italian adolescents and possibly among those from other Mediterranean countries. © 2010 Elsevier Ltd. All rights reserved.
1. Introduction Alcohol consumption is one of the major risk factors for morbidity and mortality among young people (World Health, 2007). In order to prevent alcohol abuse researchers need to take into account not only the pattern and prevalence of adolescent alcohol use but they also need to have a sound knowledge of the functions which drinking serves for young people (Stewart et al., 2005). Because of the relevance of psychological motives for engaging in alcohol use among adolescents, prevention initiatives should consider drinking motives as well (Stewart et al., 2005). Studies conducted primarily in the US suggest that motives for drinking are an important proximal factor related to heavy and problematic alcohol use (Kuntsche, Wiers, Janssen, & Gmel, in press; Urbán, Kökönyei & Demetrovics, 2008). According to Cox and Klinger (1990), individuals drink to obtain positive outcomes or to attenuate negative ones. Additionally, they may be motivated by internal rewards such as enhancement of a desired affective state or by external rewards such as social approval. Based on these considerations, Cooper (1994) developed the Drinking Motive Questionnaire Revised (DMQ-R) to measure the four drinking motives implied by crossing these two ⁎ Corresponding author. Department of Developmental and Social Psychology, University of Padova, LIRIPAC, Via Belzoni 80, 35131 Padova, Italy. Tel.: +39 049 8278479; fax: +39 049 8278451. E-mail address: [email protected] (A. Vieno). 0306-4603/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2010.05.002
dimensions: enhancement (internal, positive; e.g., to have fun); coping (internal, negative; e.g., to forget problems); social (external, positive: e.g., to be sociable); and conformity (external, negative; e.g., to fit in with a group). The measurement qualities of the DMQ-R have been repeatedly demonstrated in various samples of adolescents and young adults (Cooper, 1994; MacLean & Lecci, 2000). However, the high number of items (i.e., 20 in total) restricts the applicability of the DMQR, especially in large surveys and for clinical purposes. For these reasons, Kuntsche & Kuntsche (2009) developed a short form of the DMQ-R which measures drinking motives in a theoretically-based, reliable and valid way by means of 12 instead of 20 items. Up to now, the short form has been mainly tested in a Swiss cultural context and amongst secondary school students (Kuntsche & Kuntsche, 2009). The objective of this study was to test and validate the short form of the Drinking Motive Questionnaire Revised (DMQ-R SF) in a large sample of adolescents in Italy, in order to investigate the adolescents’ motivation to engage in drinking to better understand the increase of alcohol use and of binge drinking, especially among females and young people, aged 14 to 17 years (Istituto Superiore di Sanità (ISS) [National Institute for Health], 2008). Our first aim was to confirm the fourdimensional structure and other measurement properties such as model fit, item loadings and internal consistencies in this Mediterranean setting. The second aim was to demonstrate if the questionnaire performs as well among younger as among older participants. The third aim was to demonstrate concurrent validity by testing the links between the four dimensions of the DMQ-R SF and adolescent alcohol use and
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S. Mazzardis et al. / Addictive Behaviors 35 (2010) 905–908
sensation seeking, comparing with findings from previous studies (e.g. Cooper, 1994; Kuntsche, Stewart, & Cooper, 2008; Kuntsche, Knibbe, Gmel & Engels, 2006a; Urbàn, Kökönyei & Demetrovics, 2008). In this study, we hypothesize that enhancement motives are particularly strongly associated with sensation-seeking, defined as desire for intense and novel experiences (Zuckerman, 1971). We further expect that enhancement and social motives are positively associated with drinking frequency and, conversely, conformity motives are negatively associated with drinking frequency. 2. Method 2.1. Study design The present study was conducted in northern Italy. Present data were collected by means of a paper–pencil questionnaire between September and December 2008. Random cluster sampling was used, based on a list of all classes from the 8th to the 13th grade of Veneto region schools, where the classes served as the primary sampling unit. 2.2. Participants An overall response rate of 93.4% was achieved. A total of 4355 Italian adolescents participated in this study. In order to be able to address drinking motives, the 1364 adolescents (31.3%) who never used alcohol in the last 12 months were excluded from analysis; 233 students (5.4%) were excluded because they failed to answer more than one question on drinking motives. All students who failed to answer the question about gender (n = 4; 0.09%) and age (n = 29; 0.7%) were also excluded. The analyzed data consists of 2725 (12 to 24 year-old) students (56.4% males), of which 2 students were 24 years old, 3 were 23 years old, 5 were 21 years old, 40 were 20 years old, 132 were 19 years old and 2 students were 12 years old. The mean age of the final sample was 16.2 years (SD = ±1.8). 2.3. Measures 2.3.1. Drinking motives The DMQ-R SF (Kuntsche & Kuntsche, 2009) were used. Each of the 12 items is a statement concerning the frequency of drinking for four distinct dimensions (i.e. enhancement, social, conformity, and coping motives). Participants were asked to consider all the times they have drunk alcohol in the last 12 months and to indicate on how many occasions they have drunk for each given motive. Each dimension consists of 3 items and is rated on a frequency scale ranging from “Never” (coded as 1) to “Almost always” (coded as 3).
2.3.2. Sensation seeking Five items, adapted from Zuckerman (1971) and translated into Italian by Ravenna and Kirchler (2000) were used. The scale included items such as “Do you like to dress and behave in a provocative way?” and is rated on a frequency scale ranging from “For nothing” (coded as 1) to “A lot” (coded as 5). The alpha for the 5-item scale was 0.74. 2.3.3. Alcohol use The current frequency of alcohol use was measured by five items. Participants were asked to consider the frequency of drinking five different types of alcoholic beverages (beer, wine, spirits, alcopops, and spritz, a very common alcoholic aperitif among students in the north-east of Italy). The scale is rated on a frequency scale ranging from “Never” (coded as 1) to “Every day” (coded as 5). The alpha for the 5-item scale was 0.72. 2.4. Statistical analysis A confirmatory factor analysis (CFA) was used to confirm the fourdimensional factor structure in the present sample of 12- to 24-yearold students. To evaluate the overall model fit, the comparative fit index (CFI), the non-normed fit index (NNFI), the root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) were used (Kline, 2005). Internal consistencies of each drinking motive dimensions were assessed by using Cronbach's alpha. To determine the equivalence of factor structure in different subgroups, the model was estimated freely between males and females, early adolescents (12–14 years) and adolescents (15– 24 years). To confirm the concurrent validity of the DMQ-R SF, structural equation models (SEM) were performed. In all models, the latent variables of enhancement, social, conformity, coping motives as well as age and gender were the independent variables, whereas sensation seeking, in the first model, and frequency of alcohol use, in the second, were the dependent variables. The sampling design for this survey is a stratified cluster design. CFA and SEM were performed, after adjusting the analysis for the sampling design effect of clusters (school clusters). 3. Results 3.1. Confirming the factor structure The results of the CFA revealed high and homogenous item loadings, with the exception of the item “Because it's fun” (Table 1). For each dimension, item loadings were 0.50 or higher. The drinking motive factors were also significantly correlated. The highest
Table 1 Results of a confirmatory factor analysis (standardized item loadings), item means and internal consistencies. In the last 12 months, how often did you drink…
Enhancement
Because you like the feeling? To get high? Because it's fun? Because it helps you enjoy a party? Because it makes social gatherings more fun? Because it improves parties and celebrations? To fit in with a group you like? To be liked? So you won't feel left out? Because it helps you when you feel depressed or nervous? To cheer up when you're in a bad mood? To forget about your problems? Correlation with the factor “Social” Correlation with the factor “Conformity” Correlation with the factor “Coping” Internal consistencies (Cronbach's α)
0.90 0.79 0.57
Social
Conformity
Coping
Mean ± SD
0.78 0.90 0.84
1.63 ± 0.71 1.25 ± 0.54 1.95 ± 0.74 1.87 ± 0.70 1.92 ± 0.72 1.63 ± 0.70 1.13 ± 0.38 1.13 ± 0.37 1.17 ± 0.42 1.32 ± 0.56 1.51 ± 0.65 1.43 ± 0.65
0.84 0.84 0.88 0.83 0.96 0.87
0.83 0.41 0.61 0.64
0.48 0.55 0.79
0.43 0.75
0.75
All factor loadings are standardized item loadings; all loadings and all correlations are significant at p b 0.001; model fit: χ2 = 406.09, df = 48; CFI = 0.965, NNFI = 0.952, RMSEA = 0.052 (0.048–0.057), SRMR = 0.073.
S. Mazzardis et al. / Addictive Behaviors 35 (2010) 905–908 Table 2 Drinking motive dimensions as predictors of sensation seeking and frequency of alcohol use (standardized gamma of the structural equation models estimated; t-values in brackets).
Enhancement Social Conformity Coping
Sensation seeking1
Frequency of alcohol use2
0.45***(11.25) 0.43***(11.58) − 0.11***(− 6.20) 0.14***(6.42)
0.32***(7.04) 0.30***(6.92) − 0.22***(− 9.69) 0.24***(8.77)
All models were adjusted for age and gender; model fit: 1CFI=0.933; RMSEA = 0.101 (0.098–0.104); NNFI = 0.914; SRMR = 0.065; 2CFI = 0.934; RMSEA = 0.097 (0.095– 0.100); NNFI = 0.916; SRMR = 0.064. ***p b 0.001.
correlations were found between “enhancement” and “social” (0.83) and between “enhancement” and “coping motives” (0.61). The fit indices reveal a good model fit with CFI and NNFI values of 0.97 and 0.95, respectively. Similarly, the RMSEA value was 0.05 (0.048–0.057) and the SRMR value was 0.07. The internal consistency of all four drinking motive factors was within conventional limits, varying from α = 0.64 to α = 0.79. To assess the validity of the four-dimensional model of drinking motives in subgroups, the confirmatory factor analysis was performed for gender groups separately. In the first step, the factor loadings were freely estimated (CFI = 0.965; NNFI = 0.954; RMSEA = 0.053 (0.048– 0.058); SRMR = 0.068). Subsequently, the factor loadings were set as equal between the groups (CFI = 0.965; NNFI= 0.956; RMSEA = 0.052 (0.047–0.057); SRMR = 0.066). Allowing the parameters to vary between the groups did not increase the model fit considerably. The model fit remained basically the same even when the factor variances were fixed (χ2 F = 509.43 ; χ2 M = 509.43 ; df = 111; CFI = 0.964; NNFI = 0.957; RMSEA = 0.051 (0.046–0.055); SRMR = 0.068) and subsequently when the covariances between the factors were fixed between gender group (χ2F = 515.50; χ2M = 515.50; df= 114; CFI = 0.964; NNFI= 0.958; RMSEA= 0.051 (0.046–0.055); SRMR = 0.067). Furthermore, the confirmatory factor analysis was performed for age groups separately. In a first step, the factor loadings were freely estimated (CFI = 0.964; NNFI = 0.952; RMSEA = 0.055 (0.050–0.060); SRMR = 0.095). Subsequently, the factor loadings in each model were set as equal between the groups (CFI = 0.961; NNFI = 0.952; RMSEA = 0.055 (0.050–0.060); SRMR = 0.103). The model fit remained basically the same even when the factor variances were fixed (χ212–14 = 559.72; χ215–24 = 559.72; df = 111; CFI = 0.960; NNFI = 0.953; RMSEA = 0.054 (0.049–0.058); SRMR = 0.107) and subsequently when the covariances between the factors were fixed between age group (χ212–14 = 564.23; χ215–24 = 564.23; df = 114; CFI = 0.960; NNFI = 0.954; RMSEA = 0.054 (0.049–0.058); SRMR = 0.107).
3.2. Link with sensation seeking and frequency of alcohol To test the concurrent validity of the short form, two SEMs, with the four drinking motives as independent variables and sensation seeking and frequency of alcohol use as dependent variables, were used (Table 2). The results reveal that enhancement motives were most closely related to sensation seeking, followed by social and coping motives in that order. Conformity motives were negatively associated with sensation seeking. Furthermore, enhancement, social and coping motives were also positively related to frequency of alcohol use whereas conformity motives were negatively related. Due to the existence of an alcohol use item in the Sensation Seeking Scale we have re-run the model deleting this item from the scale. The results remain basically the same1, even if for enhancement, conformity, and coping motives, there was a drop in effect size. In the 1
Results to be obtained from the authors upon request.
907
case of conformity motives, the relationship was still negative but the effect size was no longer significant. 4. Discussion The results of the confirmatory factor analysis revealed that the specified four factor model had a good fit, confirming the results of a previous study (Kuntsche & Kuntsche, 2009). Most dimensions had satisfactory internal consistency with the expectancy dimension coming close to the required α = 0.70 threshold (Nunnally & Bernstein, 1994). The inter-factor correlations were similar to those reported in the Swiss validation study of DMQ-R SF (Kuntsche & Kuntsche, 2009). Furthermore, the invariance of the DMQ-R SF across different gender and age groups was confirmed. Structural equation models show that enhancement and social motives were strongly related to frequency of alcohol use, confirming our hypothesis. Enhancement and social motives were also positively related to sensation seeking, confirming the results of previous studies (see Kuntsche, Knibbe, Gmel & Engels, 2006b, for a review). Conformity motives were negatively related both to sensation seeking and to frequency of alcohol use, supporting the hypothesis that those adolescents drinking for external motives, such as conformity drinkers, are motivated by the presence of other people drinking and have lower drinking levels (Kuntsche et al., 2006b). The study has some limitations. Even if we used a representative sample, the data came from one Italian Region, future studies are needed to investigate drinking motives in Italy, including other Italian Regions. Moreover, this study does not include usual quantity when drinking, frequency of drunkenness and other alcohol related problems, which should be included in future studies in order to gain a more comprehensive analysis of drinking motive dimensions. Furthermore, the instrument used to measure sensation seeking contains an item about alcohol consumption. As some researchers pointed out (Ham & Hope, 2003), the association between the measure of alcohol use and sensation seeking can be inflated if the latter contains items pertaining to alcohol use. Lastly, the study might be affected by under-reporting due to possible fear of consequences or fear of a lack of anonymity, as well as by retrospective bias. 4.1. Conclusions In conclusion, the present study is the first one that provides evidence for the usefulness of the DMQ-R SF among adolescents in Italy. The results confirmed the four-dimensional structure in general and among boys and girls, and among 12- to14-year-olds and 15- to 24-year-olds. Role of funding sources Funding for this study was provided by the Local Health Center (ULSS 7, Pieve di Soligo, Treviso, Italia) Grant 311 TIT III cl 17.8. The Local Health Center had no role in the study design, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The Local Health Center had no role in collecting questionnaires. Contributors Authors Santinello and Vieno designed the study and wrote the protocol. Author Kuntsche, Mazzardis and Vieno conducted literature searches and provided summaries of previous research studies. Author Mazzardis and Vieno conducted the statistical analysis. Author Mazzardis wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript. Conflict of interest All authors declare that they have no conflicts of interest.
References Cooper, M. L. (1994). Motivations for alcohol use among adolescents: Development and validation of a four-factor-model. Psychological Assessment, 6(2), 117−128.
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Cox, W. M., & Klinger, E. (1990). Incentive motivation, affective change, and alcohol use: A model. In W. M. Cox (Ed.), Why people drink—Parameters of alcohol as a reinforcer (pp. 291−314). New York, NY: Gardner Press, Inc. Ham, L. S., & Hope, D. A. (2003). College students and problematic drinking: A review of the literature. Clinical Psychology Review, 23(5), 719−759. Istituto Superiore di Sanità (ISS) [National Institute for Health] (2008). Uso e abuso di alcol in Italia—Indagine multiscopo Istat 2007 “Aspetti della vita quotidiana”. [Alcohol use and abuse in Italy—Istat Survey 2007 “Everyday life aspects”.]. At. http: //www.iss.it/ofad/ Kline, R. B. (2005). Principles and practice of structural equation modeling. New York: The Guilford Press. Kuntsche, E., Knibbe, R., Gmel, G., & Engels, R. (2006a). Replication and validation of the Drinking Motive Questionnaire Revised (DMQ-R, Cooper, 1994) among adolescents in Switzerland. European Addiction Research, 12, 161−168. Kuntsche, E., Knibbe, R., Gmel, G., & Engels, R. (2006b). “I drink spirits to get drunk and block out my problems…” Beverage preference, drinking motives and alcohol use in adolescence. Alcohol and Alcoholism, 41(5), 566−573. Kuntsche, E., & Kuntsche, S. (2009). Development and validation of the Drinking Motive Questionnaire Revised Short Form (DMQ-R SF). Journal of Clinical Child and Adolescent Psychology, 38(6), 899−908. Kuntsche, E., Stewart, S. H., & Cooper, M. L. (2008). How stable is the motive—Alcohol use link? A cross-national validation of the Drinking Motive Questionnaire Revised among adolescents from Switzerland, Canada, and the United States. Journal of Studies on Alcohol and Drugs, 69(3), 388−396.
Kuntsche, E., Wiers, R., Janssen, T., & Gmel G. (in press). Same wording, distinct concepts? Testing differences of expectancies and motives in a mediation model of alcohol outcomes. Experimental and Clinical Psychopharmacology. MacLean, M. G., & Lecci, L. (2000). A comparison of models of drinking motives in a university sample. Psychology of Addictive Behaviors, 14(1), 83−87. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory, 3rd ed . New York: McGraw-Hill. Ravenna, M., & Kirchler, E. (2000). Giovani e tempo del loisir. Ricerca di eccitazione, percezione del rischio e rappresentazioni del giorno e della notte [[Young people and leisure time. Sensation seeking, risk perception and day and night representations]]. Giornale Italiano di Psicologia, 27(3), 573−604. Stewart, S. H., Conrod, P. J., Marlatt, G. A., Comeau, M. N., Thush, C., & Krank, M. (2005). New developments in prevention and early intervention for alcohol abuse in youths. Alcoholism, Clinical and Experimental Research, 29(2), 278−286. Urbán, R., Kökönyei, G., & Demetrovics, Z. (2008). Alcohol outcome expectancies and drinking motives mediate the association between sensation seeking and alcohol use among adolescents. Addictive Behaviors, 33(10), 1344−1352. World Health Organization (2007). Alcohol and Injury in Emergency Departments, 2007. At http://www.who.int/substance_abuse/publications/alcohol/en/index. html Zuckerman, M. (1971). Dimensions of sensation seeking. Journal of Consulting and Clinical Psychology, 36(1), 45−52.
Contents lists available at ScienceDirect
Addictive Behaviors
Short Communication
Italian validation of the drinking motives questionnaire revised short form (DMQ-R SF) Sonia Mazzardis a, Alessio Vieno a,⁎, Emmanuel Kuntsche b,c, Massimo Santinello a a b c
Department of Developmental and Social Psychology, University of Padova, Italy Research Department, Swiss Institute for the Prevention of Alcohol and Drug Problems, Lausanne, Switzerland Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
a r t i c l e Keywords: Drinking motives Alcohol use Adolescence Italy
i n f o
a b s t r a c t The aim of the study is to validate the four-dimensional structure of the Drinking Motive Questionnaire Revised Short Form (DMQ-R SF) in a sample of Italian adolescents and to investigate associations of these motives with frequency of alcohol use and sensation seeking. The data were gathered through selfadministered questionnaires in classrooms. The questionnaires were filled out by a representative sample of 2725 (56.4% males; mean age = 16.2) 8th to 13th grade alcohol-using students. Confirmatory factor analysis and structural equation models were applied. The four-dimensional structure of the DMQ-R SF was confirmed in the general sample and among subgroups defined by gender and age. Furthermore, enhancement, social and coping motives were found to be positively related to sensation seeking and frequency of alcohol use. Conformity motives were negatively related to sensation seeking and frequency of alcohol use. The results are consistent with previous studies from other countries and indicate that the DMQR SF is a valid instrument to assess drinking motives among Italian adolescents and possibly among those from other Mediterranean countries. © 2010 Elsevier Ltd. All rights reserved.
1. Introduction Alcohol consumption is one of the major risk factors for morbidity and mortality among young people (World Health, 2007). In order to prevent alcohol abuse researchers need to take into account not only the pattern and prevalence of adolescent alcohol use but they also need to have a sound knowledge of the functions which drinking serves for young people (Stewart et al., 2005). Because of the relevance of psychological motives for engaging in alcohol use among adolescents, prevention initiatives should consider drinking motives as well (Stewart et al., 2005). Studies conducted primarily in the US suggest that motives for drinking are an important proximal factor related to heavy and problematic alcohol use (Kuntsche, Wiers, Janssen, & Gmel, in press; Urbán, Kökönyei & Demetrovics, 2008). According to Cox and Klinger (1990), individuals drink to obtain positive outcomes or to attenuate negative ones. Additionally, they may be motivated by internal rewards such as enhancement of a desired affective state or by external rewards such as social approval. Based on these considerations, Cooper (1994) developed the Drinking Motive Questionnaire Revised (DMQ-R) to measure the four drinking motives implied by crossing these two ⁎ Corresponding author. Department of Developmental and Social Psychology, University of Padova, LIRIPAC, Via Belzoni 80, 35131 Padova, Italy. Tel.: +39 049 8278479; fax: +39 049 8278451. E-mail address: [email protected] (A. Vieno). 0306-4603/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2010.05.002
dimensions: enhancement (internal, positive; e.g., to have fun); coping (internal, negative; e.g., to forget problems); social (external, positive: e.g., to be sociable); and conformity (external, negative; e.g., to fit in with a group). The measurement qualities of the DMQ-R have been repeatedly demonstrated in various samples of adolescents and young adults (Cooper, 1994; MacLean & Lecci, 2000). However, the high number of items (i.e., 20 in total) restricts the applicability of the DMQR, especially in large surveys and for clinical purposes. For these reasons, Kuntsche & Kuntsche (2009) developed a short form of the DMQ-R which measures drinking motives in a theoretically-based, reliable and valid way by means of 12 instead of 20 items. Up to now, the short form has been mainly tested in a Swiss cultural context and amongst secondary school students (Kuntsche & Kuntsche, 2009). The objective of this study was to test and validate the short form of the Drinking Motive Questionnaire Revised (DMQ-R SF) in a large sample of adolescents in Italy, in order to investigate the adolescents’ motivation to engage in drinking to better understand the increase of alcohol use and of binge drinking, especially among females and young people, aged 14 to 17 years (Istituto Superiore di Sanità (ISS) [National Institute for Health], 2008). Our first aim was to confirm the fourdimensional structure and other measurement properties such as model fit, item loadings and internal consistencies in this Mediterranean setting. The second aim was to demonstrate if the questionnaire performs as well among younger as among older participants. The third aim was to demonstrate concurrent validity by testing the links between the four dimensions of the DMQ-R SF and adolescent alcohol use and
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S. Mazzardis et al. / Addictive Behaviors 35 (2010) 905–908
sensation seeking, comparing with findings from previous studies (e.g. Cooper, 1994; Kuntsche, Stewart, & Cooper, 2008; Kuntsche, Knibbe, Gmel & Engels, 2006a; Urbàn, Kökönyei & Demetrovics, 2008). In this study, we hypothesize that enhancement motives are particularly strongly associated with sensation-seeking, defined as desire for intense and novel experiences (Zuckerman, 1971). We further expect that enhancement and social motives are positively associated with drinking frequency and, conversely, conformity motives are negatively associated with drinking frequency. 2. Method 2.1. Study design The present study was conducted in northern Italy. Present data were collected by means of a paper–pencil questionnaire between September and December 2008. Random cluster sampling was used, based on a list of all classes from the 8th to the 13th grade of Veneto region schools, where the classes served as the primary sampling unit. 2.2. Participants An overall response rate of 93.4% was achieved. A total of 4355 Italian adolescents participated in this study. In order to be able to address drinking motives, the 1364 adolescents (31.3%) who never used alcohol in the last 12 months were excluded from analysis; 233 students (5.4%) were excluded because they failed to answer more than one question on drinking motives. All students who failed to answer the question about gender (n = 4; 0.09%) and age (n = 29; 0.7%) were also excluded. The analyzed data consists of 2725 (12 to 24 year-old) students (56.4% males), of which 2 students were 24 years old, 3 were 23 years old, 5 were 21 years old, 40 were 20 years old, 132 were 19 years old and 2 students were 12 years old. The mean age of the final sample was 16.2 years (SD = ±1.8). 2.3. Measures 2.3.1. Drinking motives The DMQ-R SF (Kuntsche & Kuntsche, 2009) were used. Each of the 12 items is a statement concerning the frequency of drinking for four distinct dimensions (i.e. enhancement, social, conformity, and coping motives). Participants were asked to consider all the times they have drunk alcohol in the last 12 months and to indicate on how many occasions they have drunk for each given motive. Each dimension consists of 3 items and is rated on a frequency scale ranging from “Never” (coded as 1) to “Almost always” (coded as 3).
2.3.2. Sensation seeking Five items, adapted from Zuckerman (1971) and translated into Italian by Ravenna and Kirchler (2000) were used. The scale included items such as “Do you like to dress and behave in a provocative way?” and is rated on a frequency scale ranging from “For nothing” (coded as 1) to “A lot” (coded as 5). The alpha for the 5-item scale was 0.74. 2.3.3. Alcohol use The current frequency of alcohol use was measured by five items. Participants were asked to consider the frequency of drinking five different types of alcoholic beverages (beer, wine, spirits, alcopops, and spritz, a very common alcoholic aperitif among students in the north-east of Italy). The scale is rated on a frequency scale ranging from “Never” (coded as 1) to “Every day” (coded as 5). The alpha for the 5-item scale was 0.72. 2.4. Statistical analysis A confirmatory factor analysis (CFA) was used to confirm the fourdimensional factor structure in the present sample of 12- to 24-yearold students. To evaluate the overall model fit, the comparative fit index (CFI), the non-normed fit index (NNFI), the root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) were used (Kline, 2005). Internal consistencies of each drinking motive dimensions were assessed by using Cronbach's alpha. To determine the equivalence of factor structure in different subgroups, the model was estimated freely between males and females, early adolescents (12–14 years) and adolescents (15– 24 years). To confirm the concurrent validity of the DMQ-R SF, structural equation models (SEM) were performed. In all models, the latent variables of enhancement, social, conformity, coping motives as well as age and gender were the independent variables, whereas sensation seeking, in the first model, and frequency of alcohol use, in the second, were the dependent variables. The sampling design for this survey is a stratified cluster design. CFA and SEM were performed, after adjusting the analysis for the sampling design effect of clusters (school clusters). 3. Results 3.1. Confirming the factor structure The results of the CFA revealed high and homogenous item loadings, with the exception of the item “Because it's fun” (Table 1). For each dimension, item loadings were 0.50 or higher. The drinking motive factors were also significantly correlated. The highest
Table 1 Results of a confirmatory factor analysis (standardized item loadings), item means and internal consistencies. In the last 12 months, how often did you drink…
Enhancement
Because you like the feeling? To get high? Because it's fun? Because it helps you enjoy a party? Because it makes social gatherings more fun? Because it improves parties and celebrations? To fit in with a group you like? To be liked? So you won't feel left out? Because it helps you when you feel depressed or nervous? To cheer up when you're in a bad mood? To forget about your problems? Correlation with the factor “Social” Correlation with the factor “Conformity” Correlation with the factor “Coping” Internal consistencies (Cronbach's α)
0.90 0.79 0.57
Social
Conformity
Coping
Mean ± SD
0.78 0.90 0.84
1.63 ± 0.71 1.25 ± 0.54 1.95 ± 0.74 1.87 ± 0.70 1.92 ± 0.72 1.63 ± 0.70 1.13 ± 0.38 1.13 ± 0.37 1.17 ± 0.42 1.32 ± 0.56 1.51 ± 0.65 1.43 ± 0.65
0.84 0.84 0.88 0.83 0.96 0.87
0.83 0.41 0.61 0.64
0.48 0.55 0.79
0.43 0.75
0.75
All factor loadings are standardized item loadings; all loadings and all correlations are significant at p b 0.001; model fit: χ2 = 406.09, df = 48; CFI = 0.965, NNFI = 0.952, RMSEA = 0.052 (0.048–0.057), SRMR = 0.073.
S. Mazzardis et al. / Addictive Behaviors 35 (2010) 905–908 Table 2 Drinking motive dimensions as predictors of sensation seeking and frequency of alcohol use (standardized gamma of the structural equation models estimated; t-values in brackets).
Enhancement Social Conformity Coping
Sensation seeking1
Frequency of alcohol use2
0.45***(11.25) 0.43***(11.58) − 0.11***(− 6.20) 0.14***(6.42)
0.32***(7.04) 0.30***(6.92) − 0.22***(− 9.69) 0.24***(8.77)
All models were adjusted for age and gender; model fit: 1CFI=0.933; RMSEA = 0.101 (0.098–0.104); NNFI = 0.914; SRMR = 0.065; 2CFI = 0.934; RMSEA = 0.097 (0.095– 0.100); NNFI = 0.916; SRMR = 0.064. ***p b 0.001.
correlations were found between “enhancement” and “social” (0.83) and between “enhancement” and “coping motives” (0.61). The fit indices reveal a good model fit with CFI and NNFI values of 0.97 and 0.95, respectively. Similarly, the RMSEA value was 0.05 (0.048–0.057) and the SRMR value was 0.07. The internal consistency of all four drinking motive factors was within conventional limits, varying from α = 0.64 to α = 0.79. To assess the validity of the four-dimensional model of drinking motives in subgroups, the confirmatory factor analysis was performed for gender groups separately. In the first step, the factor loadings were freely estimated (CFI = 0.965; NNFI = 0.954; RMSEA = 0.053 (0.048– 0.058); SRMR = 0.068). Subsequently, the factor loadings were set as equal between the groups (CFI = 0.965; NNFI= 0.956; RMSEA = 0.052 (0.047–0.057); SRMR = 0.066). Allowing the parameters to vary between the groups did not increase the model fit considerably. The model fit remained basically the same even when the factor variances were fixed (χ2 F = 509.43 ; χ2 M = 509.43 ; df = 111; CFI = 0.964; NNFI = 0.957; RMSEA = 0.051 (0.046–0.055); SRMR = 0.068) and subsequently when the covariances between the factors were fixed between gender group (χ2F = 515.50; χ2M = 515.50; df= 114; CFI = 0.964; NNFI= 0.958; RMSEA= 0.051 (0.046–0.055); SRMR = 0.067). Furthermore, the confirmatory factor analysis was performed for age groups separately. In a first step, the factor loadings were freely estimated (CFI = 0.964; NNFI = 0.952; RMSEA = 0.055 (0.050–0.060); SRMR = 0.095). Subsequently, the factor loadings in each model were set as equal between the groups (CFI = 0.961; NNFI = 0.952; RMSEA = 0.055 (0.050–0.060); SRMR = 0.103). The model fit remained basically the same even when the factor variances were fixed (χ212–14 = 559.72; χ215–24 = 559.72; df = 111; CFI = 0.960; NNFI = 0.953; RMSEA = 0.054 (0.049–0.058); SRMR = 0.107) and subsequently when the covariances between the factors were fixed between age group (χ212–14 = 564.23; χ215–24 = 564.23; df = 114; CFI = 0.960; NNFI = 0.954; RMSEA = 0.054 (0.049–0.058); SRMR = 0.107).
3.2. Link with sensation seeking and frequency of alcohol To test the concurrent validity of the short form, two SEMs, with the four drinking motives as independent variables and sensation seeking and frequency of alcohol use as dependent variables, were used (Table 2). The results reveal that enhancement motives were most closely related to sensation seeking, followed by social and coping motives in that order. Conformity motives were negatively associated with sensation seeking. Furthermore, enhancement, social and coping motives were also positively related to frequency of alcohol use whereas conformity motives were negatively related. Due to the existence of an alcohol use item in the Sensation Seeking Scale we have re-run the model deleting this item from the scale. The results remain basically the same1, even if for enhancement, conformity, and coping motives, there was a drop in effect size. In the 1
Results to be obtained from the authors upon request.
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case of conformity motives, the relationship was still negative but the effect size was no longer significant. 4. Discussion The results of the confirmatory factor analysis revealed that the specified four factor model had a good fit, confirming the results of a previous study (Kuntsche & Kuntsche, 2009). Most dimensions had satisfactory internal consistency with the expectancy dimension coming close to the required α = 0.70 threshold (Nunnally & Bernstein, 1994). The inter-factor correlations were similar to those reported in the Swiss validation study of DMQ-R SF (Kuntsche & Kuntsche, 2009). Furthermore, the invariance of the DMQ-R SF across different gender and age groups was confirmed. Structural equation models show that enhancement and social motives were strongly related to frequency of alcohol use, confirming our hypothesis. Enhancement and social motives were also positively related to sensation seeking, confirming the results of previous studies (see Kuntsche, Knibbe, Gmel & Engels, 2006b, for a review). Conformity motives were negatively related both to sensation seeking and to frequency of alcohol use, supporting the hypothesis that those adolescents drinking for external motives, such as conformity drinkers, are motivated by the presence of other people drinking and have lower drinking levels (Kuntsche et al., 2006b). The study has some limitations. Even if we used a representative sample, the data came from one Italian Region, future studies are needed to investigate drinking motives in Italy, including other Italian Regions. Moreover, this study does not include usual quantity when drinking, frequency of drunkenness and other alcohol related problems, which should be included in future studies in order to gain a more comprehensive analysis of drinking motive dimensions. Furthermore, the instrument used to measure sensation seeking contains an item about alcohol consumption. As some researchers pointed out (Ham & Hope, 2003), the association between the measure of alcohol use and sensation seeking can be inflated if the latter contains items pertaining to alcohol use. Lastly, the study might be affected by under-reporting due to possible fear of consequences or fear of a lack of anonymity, as well as by retrospective bias. 4.1. Conclusions In conclusion, the present study is the first one that provides evidence for the usefulness of the DMQ-R SF among adolescents in Italy. The results confirmed the four-dimensional structure in general and among boys and girls, and among 12- to14-year-olds and 15- to 24-year-olds. Role of funding sources Funding for this study was provided by the Local Health Center (ULSS 7, Pieve di Soligo, Treviso, Italia) Grant 311 TIT III cl 17.8. The Local Health Center had no role in the study design, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The Local Health Center had no role in collecting questionnaires. Contributors Authors Santinello and Vieno designed the study and wrote the protocol. Author Kuntsche, Mazzardis and Vieno conducted literature searches and provided summaries of previous research studies. Author Mazzardis and Vieno conducted the statistical analysis. Author Mazzardis wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript. Conflict of interest All authors declare that they have no conflicts of interest.
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