Mechanisms of Perceived Social Norms: The Mediating and Moderating Role of Morality and Outcome Expectations on Prescription Drug Misuse in the Working Population

ABSTRACT

While the nonmedical use of prescription drugs to enhance cognitive performance (NMUPD-CE) has received increasing media attention and provoked ethical debates, the social drivers of misusing this health-related drug remain understudied. Therefore, this study examined how descriptive and injunctive norms as social influences affect decisions to engage in NMUPD-CE. We tested competing assumptions about whether moral acceptability and positive and negative outcome expectations mediate or moderate the social norms effects. We used data from a Germany-wide, web-based survey with a sample of adult nonusers who were recruited offline (N= 13,443). We found that 62.09% of the respondents indicated at least some willingness for NMUPD-CE. Positive associations occurred between this willingness and both social norms, high positive and low negative outcome expectations, as well as higher moral acceptability. Moral acceptability and positive outcome expectations partially mediated both social norm effects, while negative outcome expectations only partially mediated injunctive norms. Moreover, positive and negative outcome expectations also moderated both social norm effects. This study provides insights into the understanding of social influence in the context of substance misuse and beyond. It suggests that social norms operate via moral acceptability and outcome expectations, while outcome expectations also lead to differential effects of social norms.

Acknowledgments

We thank those who helped to conduct this study, especially Floris van Veen, Fabian Hasselhorn, Dana Pietralla, and the forsa-team, as well as Kelsey Hernandez for language editing.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ While existing scholarship uses multiple terms to describe personal moral acceptability including “moral norms” (Kroneberg, Heintze, and Mehlkop 2010), “personal norms” (Napper et al. 2016), or “moral beliefs” (Hirschi 2002), we will refer to moral acceptability as an overall construct including an individual´s moral attitudes and moral feelings (i.e. shame and guilt) (Svensson et al. 2013).

² The sample comprises of an initial sample of N= 37,003 (with 24,085 (65.1%) consenting participants and 22,024 (91.4%) completers) and an extension sample of N= 10,403 (with 3,064 (29.5%) consenting participants and 2,785 (90.89%) completers). The extension sample increased representativity by counteracting demographic imbalances due to selective survey take-up by more difficult-to-reach participants within the initial sample.

³ The square root transformation is especially useful for data for counts of “rare events” and measures where the ratio of largest to smallest data value is smaller than ten (Maindonald and Braun 2006). Both applied to our measure. We, however, found similar results when using a log-transformed measure.

Additional information

Funding

This work was supported by the German Research Foundation [ME 2082/8-1,SA 2992/2-1].

Notes on contributors

Saskia Huber

Saskia Huber is a MA student in social sciences at Humboldt University of Berlin. Her research interests include sociological theory, the sociology of health and drug use.

Sebastian Sattler

Sebastian Sattler is a senior lecturer in sociology. His research interests include sociological theory, decision-making, the sociology of health, criminology, drug use, and quantitative methods. His work has been published in journals including the Social Science Research, Current Psychology, Deviant Behavior, and PLOS ONE.

Mehlkop Guido

Mehlkop Guido is a professor of empirical research methods. His research interests include criminology, rational choice theory, methodology, and quantitative methods. He has written a monograph regarding the explanation of crime as a rational choice. His work has been published in journals including Criminology, Deviant Behavior, and the Journal of Drug Issues.