The Adolescent's Competency for Interacting with Alcohol as a Determinant of Intake: The Role of Self-Regulation

The competency for interacting with alcohol is a highly useful Educational Psychology model for preventing and for understanding the different behavioral levels of this interaction. Knowledge of facts, concepts and principles about alcohol use, self-regulated behavior, and attitudes toward alcohol are predictive of adequate interaction with alcohol. The objective of this study was to empirically evaluate this postulated relationship. A total of 328 Spanish adolescents participated, between the ages of 12 and 17. All were enrolled in 1st–4th year of compulsory secondary education, in the context of the ALADO Program for prevention of alcohol intake in adolescents. An ex post facto design was used, with inferential analyses and SEM analyses. Results show an interdependence relationship, with significant structural prediction between the behavioral levels defined and the level of alcohol intake, with principles, self-regulating control and attitudes carrying more weight. Analyses are presented, as are implications for psychoeducational intervention using preventive programs based on this competency model.


INTRODUCTION
Alcohol abuse in adolescents is an old problem (Cortés et al., 2007;Farke and Anderson, 2007;Castellanos-Ryan et al., 2013;Chassin, 2015). The problem stems in part from the firmly entrenched role of alcohol in Western culture. Whether we like it or not, alcohol use is a culturally institutionalized habit in adult social relations; the adolescent simply imitates this. In the period of transition of childhood to adulthood, alcohol use with one's friends is part of the initiation rite in our culture (Ballester et al., 2000;Espada et al., 2008). Social pressure in the case of alcohol is very strong in all spheres of the community, in day-to-day relationships around town, and even in work relationships (Dodge et al., 2009;Zaldívar et al., 2011;Trucco et al., 2014).
In Spain, according to the Ministry of Health and Consumption (Ministerio de Sanidad y Consumo, 2005), adolescents beginning at puberty are more willing to engage in risk behaviors such as alcohol use, and at the same time, their relationship to the school context and even their academic achievement are more likely to decline (Bermúdez et al., 2009). Later, a study carried out by the Spanish Observatory on Drugs and Drug Addiction (Ministerio de Sanidad, Servicios Sociales e Igualdad, 2016;Observatorio Español sobre Drogas, 2017) stated that during 2014, 78.9% of secondary school students between the ages of 14 and 18 years had consumed alcohol regularly during the past month, and initial alcohol intake was established at an average age of 13.8 years. Similarly, the percentage of students who had experienced acute alcohol intoxication in the past month was 33.1%, and binge drinking was practiced by 47.3%.
There is consensus that no one personality type predisposes toward alcoholism, but there are certain important characteristics common to all adolescents who abuse alcoholic drinks, namely, extraversion, nervousness and lack of control. Many studies that have addressed the topic of personality and addiction conclude that some of these characteristics are linked to addictive behavior (Fantín, 2006(Fantín, , 2007Calvete and Estévez, 2009). Behavior patterns from childhood tend to continue into adolescence; if these habits are inadequate, fewer healthy behaviors and more risk behaviors are produced during adolescence and beyond. Likewise, as age increases, poorer personal adjustment is observed. Stress is a risk factor associated with drug use, and the idiosyncrasies of adolescence involve an increase in stress, something that many studies have agreed on (Windie and Windie, 1996;Nadal, 2008).
There is a great deal of current research on this topic, given that consumption of alcoholic beverages has become popular among adolescents and the age of initiation has gone down (Plan nacional sobre Drogas, 2003). Moreover, when addressing this topic, all related factors must be taken into account (Senra, 2003). The effects of alcohol and drug use during early and midadolescence are a real cause for concern, and are related to health problems (Bento et al., 2013), problems at school (Ekberg et al., 2016) mental disorders (Borges et al., 2017), unprotected sex (Boyer et al., 2017), and delinquency (Doherty et al., 2008). As in most Western countries, alcohol use among adolescents in Spain is very high. All this data is evidence of the need to take preventive measures in the spheres of family, school and society (Villatoro et al., 2002).

Limitations of the Classic Models for Preventing Alcohol Intake
Taking the assumptions of a medical approach to primary prevention, traditional strategies for preventing alcohol intake have focused mainly on equipping adolescents with information (Ballesteros et al., 2003). From the bio-psycho-social approach, prior evidence has pointed out the limitations of such an approach, as well as the need to use comprehensive training programs that include self-improvement skills and social skills (Marlatt and Witkiewitz, 2002;De Ridder and de Wit, 2006;Lemstra et al., 2010). Some recent studies from experimental and clinical approaches have reported improvement effects in the adolescents' psychological variables, such as selfesteem and self-efficacy (Alexander and Anderson, 2017), internalizing personality variables (anxiety) and externalizing variables (behavior problems) (Scalco et al., 2014;O'Leary-Barrett et al., 2016;Wills et al., 2016). The role of social identity has also been analyzed, through online contexts (Pegg et al., 2017), and universal programs for preventing alcohol intake in adolescents have been applied (Teesson et al., 2017). Some improvement is seen in all cases, but without conclusive results.
An interactive approach from Educational Psychology, the recent Theory of Self-vs. Externally-Regulated Learning (SRL vs ERL) (de la Fuente, 2015(de la Fuente, , 2017, has focused on the nature of the adolescent (Oliva et al., 2002;Oliva, 2007), and his/her environment-whether regulatory, a-regulatory or dysregulatory. Regulation is assumed to be an essential procedural component of the competency for managing alcohol intake and other chronic health concerns (Clark et al., 2001;Hull and Slone, 2004;Duell et al., 2016). Thus, the worst scenario for primary prevention would consist of an adolescent with a low level of self-regulation, and a profile of dysregulatory behavior (negative proactivity toward alcohol intake) in interaction with a dysregulatory context (actively encouraging consumption), thereby establishing a high probability of consumption and nonadherence to preventive treatments. In accordance with this theory, the competency model incorporates different behavioral levels in a wholistic fashion, and serves as a model of an Educational Psychology intervention, being distinct from other approaches, as has been illustrated in the case of academic stress (de la Fuente, 2015;de la Fuente et al., 2017).

The Interacting with Alcohol Competency, for Preventing Early Alcohol Intake
An individual may be considered competent when, in a given context, he or she is able to effectively and efficiently solve the problems that arise (Roe, 2002(Roe, , 2003. From an Educational Psychology point of view, other authors have established that being competent means having the knowledge, skills and attitudes that allow a person to make an appropriate response to a particular, real, problematic situation (de la Fuente et al., 2005). This gives rise to a three-fold division into subcompetencies that are necessary in order to be competent in any field of knowledge: conceptual (knowing), procedural (being able to, knowing how) and attitudinal (wanting to, being). In the specific case of educational prevention of alcohol intake, this approach means delimiting the level of subcompetencies that adolescents possess at each level. 1) Regarding the conceptual subcompetency: adolescents' knowledge and their perception of the risk involved with alcohol is different from that of adults, and this in itself is a factor that predisposes toward some dangerous or inadequate behavior. All epidemiological studies agree that adolescent alcohol use in our day is abusive, and the authors conclude that this comes from adolescents' not understanding the real risks. For this reason it is very important to collect their opinions and what they conceive to be facts, concepts and principles in regard to alcohol. According to earlier research studies, adolescents' knowledge and principles center on reasons to justify the use of alcohol and the consequences of alcohol use (Arias et al., 2007). 2) Regarding the procedural subcompetency: personal selfregulation is an essential meta-skill for managing behavior. de la Fuente et al. (2009) have established the hypothesis of lack of personal self-regulation as a variable that determines alcohol intake in adolescents. The structural factors of personality and self-regulation, among others, are related to prosociality. Difficulties in exercising self-control may be risk factors for drug use (Barry et al., 2007;Calvete, 2008;O'Connor and Colder, 2015). Cognitive schemas with insufficient self-control are associated with drug use, and this cognitive style, where limits and tolerance to frustration are lacking, is quite common in our present-day environment (Urra, 2006). Adolescents who do not have adequate selfregulation do not usually plan their behavior, they have no fixed goals, nor do they monitor to what extent their behavior would move them toward such goals. Rather, they act impulsively, with disturbing results in both the academic and personal/social spheres (Eisenberg et al., 1996;King et al., 2013). A large number of studies on the importance of self-regulation have focused on addictive disorders linked to gambling and substance abuse (Madden et al., 1997;Hull and Slone, 2004), especially to alcohol use (Brown et al., 1999;Carey et al., 2004;Pearson et al., 2013). These effects are especially relevant in adolescence and youthtwo stages of development that are characterized by a search for personal identity, moving away from the family context and connecting to one's peer group. Consequently, selfregulation might act as an indicator of adolescents' resilience in situations of greater psychosocial risk .

3) Regarding the attitudinal subcompetency. Attitudes, values
and habits toward alcohol intake have been shown to be powerful predictors of adolescents' alcohol intake behavior. Evidence has shown significant relationships between attitudes and values toward alcohol (Moral et al., 2004;Moreno, 2006

Adjustment in Interacting with Alcohol
The concept of adjustment in interacting with alcohol is understood to be modulated by age, context and culture. In adolescence, this adjustment can be conceived as the behavior of delaying contact with alcohol in a proactive regulatory manner (de la Fuente, 2017), that is, voluntary nonconsumption of alcohol and substituting it with other more adaptive behaviors, such as sports, leisure activities or having fun without recurring to harmful substances. In other words, adopting the absence of substance use in order to gain a state of bio-psycho-social wellbeing (Becoña, 2007a,b).

Objectives and Hypotheses
This research study has several motivations. On one hand, prior research on alcohol prevention has addressed many variables from a partial standpoint, seeking to establish probabilistic relationships between isolated variables and alcohol use in adolescents. However, an Educational Psychology approach, adopting the conceptions of competency and subcompetency, would seek to integrate the different variables into a more powerful schema. Based on the foregoing, then, the objectives and hypotheses of this study were as follows: 1. To determine any interdependence relationships between the low-medium-high level of each subcompetency with respect to the other subcompetencies, and to adjustment in interacting with alcohol. Consequently, Hypothesis 1 established that the low-medium-high level of conceptual knowledge (facts, concepts and principles, especially the latter), procedural knowledge (self-regulation, with self-control having greater weight) and attitudinal knowledge (values about alcohol intake) will be mutually determined. Finally, they will determine the level of adjustment in interacting with alcohol. 2. To establish any structural predictive relationships between the different subcompetencies. In this case, Hypothesis 2 established that adjustment in interacting with alcohol (nonconsumption) will be determined by conceptual type factors (more principles than facts/concepts), procedural type (self-regulation, especially level of control) and attitudinal type, although the latter are mediated by procedural variables.

Participants
The population under study were students from public secondary schools in a southern province of Andalusia (Spain). In order to include different types of schools in this investigation, schools were selected from three types of urban areas: (1) center of town, from a medium-high social stratum (n = 106), (2) surrounding neighborhoods, from a medium-low social stratum (n = 101) and (3) outlying, marginalized population areas with compensatory education, from a low social stratum (n = 121). The homeroom teachers from every group participated voluntarily in the experiment, having been invited by the School Psychology adviser of the local Teacher Development Center. Participating students were between the ages of 12 and 17 years [12 (n = 51), 13 (n = 80), 14 (n = 97), 15 (n = 55), 16 (n = 35), and 17 (n = 10)] and were enrolled in compulsory secondary education (grades 7-10) at one of three public secondary schools. This age range was selected for methodological purposes, making it possible to form two groups, the 12-to 14-year-olds (n = 207), corresponding to the first stage of adolescence (puberty, or early adolescence), and the 15-to 17-year-olds (n = 121), corresponding to the second stage of adolescence (adolescence per se). The final sample size from which all measurements were taken contained 328 subjects. Of these, 178 were male (54.3% of the sample) and 150 were female (45.7% of the sample). The mean age of the sample was 13.82 years, with a standard deviation de 1.19.

Conceptual Subcompetency
The  Figure 1 and Appendix A.

Attitudinal Subcompetency
The scale for Evaluación de las Actitudes ante el alcohol, EAA [Assessment of Attitudes toward Alcohol, AAA] was used (Cubero and Sánchez, 2009b Figure 3 and Appendix A.

Adjusted Behavior in Interacting with Alcohol
We used the Escala de Ajuste en la interacción con el alcohol [Scale of Adjustment in interacting with alcohol], which contains four items (Alpha = 0.915). This scale belongs to the Inventario de Evaluación de conocimientos, actitudes e interacción con el alcohol (Cubero and Sánchez, 2009c) (Inventory for Assessment of knowledge, attitudes and interaction with alcohol). See Appendix A.

Procedure
The Alado Program is an online program (de la Fuente et al., 2012), designed for adolescents, to work on the three levels of subcompetencies previously established in the model. The program provides assessment and intervention in different matters of learning. It may be used by students, teachers and parents, but in this case it was applied only to students. The Teacher's Guide and Instructions for Use have been published. Data collection instruments were applied over the course of the school year 2009-10, within the framework of the Alado Project of Excellence (2007)(2008)(2009)(2010), through an online utility created for this purpose (www.alado.es). Specifically, these data correspond to the project baseline, having been collected in September-October, 2008. Previously, cooperation had been requested from the Teacher Development Center, from the students' parents and from the School Board, for their participation. The project was approved by the University Bioethics Commission (University of Almería). The students participated voluntarily. The parents were informed in writing. As the participants in the Project were minors, both the parents and school administrators gave written informed consent for the study. All data was collected in accordance with the principles of the Psychologist's Deontological Code and the Spanish Data Protection Act.

Design and Data Analyses
For this set of data, obtained at the program baseline, an expost facto methodological design was used. Relationships were measured just as they occurred in the natural environment, without any treatment, using inferential and structural analyses based on the Presage-Process-Product Model (Biggs, 2001), and applied to educational problem areas in students in compulsory secondary education. The variables selected were as follows: 1) Presage variables, manipulated by selection: age and year in school, 2) Process variables, referring to intake prevention subcompetencies, 1. Conceptual subcompetency: Knowledge (facts, concepts and principles) related to alcohol intake. 2. Procedural subcompetency: Personal self-regulation skills, referring to planning and behavioral action control. 3. Attitudinal subcompetency: Attitudes and values toward alcohol intake.
3) Product variables, referring to interaction with alcohol, 4. Adequate behavior in interaction with alcohol: no contact.
Inferential statistical analyses (multivariate analysis, ANOVAs) were carried out using SPSS (v. 23.0) for Windows. For levels of the independent variable self-regulation, cluster analysis was used, obtaining three levels: low, medium and high. AMOS (v. 23.0) for Windows was used for the structural validity analysis of each inventory and for constructing the structural prediction model. To interpret the CFA and SEM model fit, we focused on the comparative fit index (CFI) and the root mean square error of approximation (RMSEA). CFI values equal to or more than 0.90 and 0.95 respectively were taken to indicate acceptable and close fit to the data (McDonald and Marsh, 1990). RMSEA values equal to or below 0.05 and 0.08 were taken to indicate close and acceptable levels of fit, respectively (Jöreskog and Sörbom, 1993). Keith (2006) proposed the following educational research benchmarks for direct effects in the form of beta coefficients: less than 0.05 is considered too small to be meaningful, above 0.05 is small but meaningful, above 0.10 is moderate, and above 0.25 is large. For indirect effects, we use Kenny's (2012) definition of an indirect effect as the product of two effects; using Keith's benchmarks above, we propose an educationally meaningful, small indirect effect = 0.003, moderate = 0.01, and large = 0.06.

Interdependence Relationships
Effect  variables planning and control (components of self-regulation). See Table 1.
Effect of the Level of Procedural Competency  Table 3.

Structural Prediction Relationships
The results of structural analysis or pathway analysis (SEM) showed an acceptable model of relationships between variables (model 3). The relationship parameters of both models are set out below. See Table 4.

Standardized Direct Effects
This predictive linear model establishes that latent variable Knowledge of facts (F) was a significant positive predictor (0.63) of the latent variable Knowledge of concepts (C), and this variable is positively predicted (0.63) for latent variable knowledge of principles (P). In addition, the facts (F) variable (0.63) and the principles variable (P) are positively predicted (0.28) of latent variable interaction with alcohol (INT). Complementarily, the latent variable planning of behavior (PL) was a significant predictor (0.36) of the latent variable attitudes (A). At the same time, self-control of behavior (CONTR) was a positively predictor (0.18) of latent variable interaction with alcohol (INT). Complementarily, the latent variable attitudes (A) predicted a positive and significant relationship (0.20) with the latent variable interaction with alcohol (INT). All the variances of errors were significant (p < 0.001). Table 5 shows the direct effects of the variables inherent in the model.

Standardized Indirect Effects
The Complementarily, the attitudinal and latent variable attitudes toward alcohol (A) was an indirect, positive predictor of items of interaction with alcohol (INT). See Table 6.

Graphic representation of the structural model
The final model is graphically represented in Figure 4.

DISCUSSION AND CONCLUSIONS
The first objective of this study was to determine any interdependence relationships between the low-medium-high level of each subcompetency with respect to the other subcompetencies, and to adjustment in interacting with alcohol. Thus, Hypothesis 1 established that the low-medium-high level of conceptual knowledge (facts, concepts and especially principles), procedural knowledge (self-regulation, with self-control having greater weight) and attitudinal knowledge (values about alcohol intake) would be mutually determined, and that finally, these levels would determine the level of adjustment in interacting with alcohol.
This hypothesis was partially confirmed. Results provided evidence that the level of conceptual competence (facts, concepts, principles) determines the level of attitudes toward alcohol and the degree of adjustment in interacting with alcohol, that the level of procedural competence (self-regulation) determines the level of the principles and attitudes, and that the level of attitudinal competency (attitudes) differentially and inversely affects the level of knowledge about alcohol (facts and concepts), while directly affecting the degree of principles and of selfcontrol. These results offer support for the competency model, by showing how each type of learning affects the others. One especially interesting result was that concept learning affected the degree of attitude acquisition, but not the degree of acquisition of self-control. However, the level of self-regulation did affect the learning of principles and attitudes toward alcohol. This represents more evidence on the importance of this behavioral level, corroborating that attitudes also affect the acquisition of principles and the degree of self-control. The second part of the hypothesis was also partially validated, showing that only the level of conceptual competence (principles) was accompanied by a higher level of adjustment. This result reinforces the idea that each variable analyzed, on its own, has a limited effect in determining the level of adjustment. The second objective was to establish any structural prediction relationships between the different subcompetencies, with Hypothesis 2 affirming that adjustment in interacting with alcohol (nonconsumption) would be determined both by conceptual type factors (more principles than facts/concepts), procedural type (self-regulation, especially level of control) and attitudinal type, although the latter are mediated by the procedural variables. In this case, the hypothesis was consistently fulfilled, with the appearance of a significant SEM model that showed different direct effects. Knowledge of facts affects concepts and these in turn affect the principles elaborated; knowledge of facts and of principles are the variables that most affect adjustment in interacting with alcohol. In addition, self-regulation affects adequate interaction via attitudes, and directly through self-control. Finally, attitudes also affect adjustment. However, the indirect effects are what has shown that all the levels of competencies-conceptual (facts, concepts and principles), procedural (planning and self-control) and attitudinal (attitudes)-are joint determinants in the degree of adjustment for nonconsumption of alcohol. These results are consistent with the prior evidence that has shown in part the importance of each of these variables (Moral and Ovejero, 2005;Moral et al., 2006).
From a behavioral point of view, both hypotheses show that different acquisitions are required in order to become competent in alcohol intake: (1) the acquisition of knowing (cognitive level): to have assimilated the information about alcohol and its effects on the immature adolescent brain (Spear, 2015); (2) the acquisition of wanting to not drink (motivational-affective level), of attitudes and values (Foxcroft et al., 2015;O'Connor and Colder, 2015); (3) the acquisition of knowing how (behavioral level): to have skills and meta-skills of self-regulated behavior (O'Connor and Colder, 2015;Yoon et al., 2015). This three-fold acquisition of integrated behavior, on the part of adolescents, having three different levels of complexity, has usually been addressed only partially and separately, from a psychosocial intervention approach.
From a complementary perspective, this investigation also makes a significant methodological contribution, with respect to the type of analyses carried out. Going beyond the usual descriptive or classic association strategies, a two-fold strategy was applied in order to validate the causal relations consistently, using inferential analysis and structural path analysis.
The inferential analysis has shown clear interdependence relationships between the levels of the variables. Path analysis, based on the previous inferential analyses, has corroborated the multidirectionality of the proposed causations, producing an empirical model of this competency consistent with the one proposed, and offering a structural foundation for future interventions (MacCallum and Austin, 2000;Asparouhov and Muthén, 2014).

Implications for Educators and Programs
This empirical evidence suggests different implications for educators who wish to make students competent, by working in primary prevention: (1) The concept of competence is multidimensional (Gagné, 2013); therefore, teaching and learning should work on all the levels of learning involved. (2) While information about alcohol is important-especially information that helps students construct an integrated, explanatory model of the effects of alcohol-excess information and inadequate modeling at a young age can be counterpreventive, with a dysregulatory effect. One notable effect was the inverse predictive relationship between adolescents' level of self-regulation and their degree of knowledge about alcohol. From the assumptions of the SRL vs. ERL Theory, this could be interpreted as an effect of a regulatory vs. dysregulatory context. In other words, adolescents who are growing up in a regulatory educational context (urban school and parents with secondary education) are trained to a higher level of self-regulation and they are protected from environments with excessive information about alcohol. The opposite would occur in dysregulatory educational contexts (marginalized school with compensatory education), where adolescents are allowed to have more direct contact with alcohol consumption, and early alcohol intake, or dysregulation, is encouraged. These results are consistent with the effect of the educational context at school, as seen in a previous dissertation report (Marcos, 2013), but research should continue to investigate this in more depth. (3) In addition, this evidence reaffirms the role and importance of planning for adolescents to learn self-regulation and selfdiscipline (Duckworth et al., 2011) -in association with proactive attitudes of substance rejection, since such attitudes are decisive to whether self-regulation and self-discipline will be practiced. Therefore, from the educational point of view of primary prevention, the experiences, information, modeling and attitudes offered by the educational context (family, school, peers) are determinants in encouraging regulation, nonregulation or dysregulation of the adolescent's alcohol intake (de la Fuente, 2017).
These results corroborate the idea that educational programs focusing on the primary prevention of alcohol intake should rest on two basic pillars: (1) an eminently informational thrust, for learning facts and concepts about the problem (also containing a developmental component); and (2) the more developmental thrust, referring to learning behavioral  principles, behavior management skills or self-regulation, and the motivational or attitudinal aspect. Conceptual, procedural and competence would be impregnated with a holistic model of education, approaching each level of competency as different and needing to be approached differently. This question therefore deserves some profound analysis. In the first place, one must reinforce the importance of principles in alcohol use-norms, standards and goals for behavior (Pons et al., 1995). Without behavioral principles, we cannot determine the direction of selfregulation. It is therefore unadvisable to move toward preventive programs that have a large amount of merely conceptual information; rather, principles of behavior should be emphasized, as representations of reality and of oneself, especially in the stage of adolescence and pre-adolescence. In second place, training in self-regulatory behaviors-as a procedural meta-skill-is a must in educational programs for primary prevention of alcohol  intake, given that this behavioral level has a clear effect on adjustment, as has been demonstrated in prior evidence from secondary and tertiary therapeutic programs (Fernández et al., 2009). Finally, there is no substitute for educational treatment of the attitudinal level. Attitudes must involve a desire for healthful behavior (Fergus and Zimmerman, 2005;García del Castillo and Días, 2007).

LIMITATIONS AND PROSPECTS
This study is not free of limitations. First, the effect of gender and of year in school were not analyzed, in an effort to streamline the design and show the relationships presented here, given that these effects were reported in an earlier research report (Marcos, 2013). However, the most important limitation is the absence of any analysis of the students' contextual variables (Smith et al., 2013) as is explained in the recent Theory of Self-vs. External-Regulation TM (de la Fuente, 2015(de la Fuente, , 2017. Without an interactive view of this problem, we obtain only a partial, personalist view. Future research should take into account the context, be it regulatory, nonregulatory or dysregulatory, in order to consider its likely impact in interaction with each adolescent's competency level (Leal, 2004;Márquez, 2006). In the future, it would be desirable to perform research that incorporates the effect of other variables that recent research has identified as important in managing stress-an important aspect in adolescence, with all its personal, academic and social changes (González et al., 2002;Gómez-Fraguela et al., 2006).
Likewise, longitudinal studies are needed, for prevention and for assessments (Arco and Fernández, 2002;Oliva et al., 2008). This report comes alongside many others that are presently being carried out with regard to adolescence (Casas, 2000;Ruiz-Aranda et al., 2006). Similarly, self-regulation is also the object of much current interest, as a psychological variable that is inherent to personal development competencies in subjects. Results obtained here indicate that it is worthwhile to continue down this road, given the power of this variable, in order that it may be given priority in planning future interventions (de la Fuente et al., 2009;Artuch-Garde et al., 2017).