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Objective:  Non-alcohol drug (NAD) use and its associated consequences remain a prevalent problem among young adults. Both positive and negative affect play etiological roles in NAD. The perception of one’s ability to refuse a drug in different situations (drug refusal self-efficacy) could be an important mediator between such affect and NAD outcomes (use and consequences). This study examined mediational pathways from affect to NAD use and NAD-related consequences  via  drug refusal self-efficacy. We also examined the moderating role of normative perceptions of peer NAD involvement.  Method:  Across three time points (September, February, April) of their first college year, students ( N  = 355) completed an online self-report questionnaire to assess affect, refusal self-efficacy, NAD use frequency, NAD-related problems, and peer norms. Data were analyzed using longitudinal structural path models.  Results:  Refusal of self-efficacy for situations involving negative affect significantly mediated the relationship between negative affect and NAD use but not consequences, supporting a negative reinforcement pathway. Greater perceptions of peer drug use moderated the mediated negative reinforcement pathway. No significant pathways were found for the refusal self-efficacy positive reinforcement pathways.  Conclusions:  This study provides support for a negative reinforcement pathway to NAD use in which refusal self-efficacy plays an important mechanistic role. These findings may have implications for intervention, as targeting refusal self-efficacy for those with NAD use and addressing peer influences could be helpful in reducing NAD risk. Replication of these findings and extension using daily assessment and more fine-grained assessment of individual NAD types will be important next steps.

Prospective Pathways from Affect to Drug Outcomes: Refusal Self-Efficacy in the Context of Peer Influences