Personality Traits, Learned Beliefs, and Alcohol-Related Behaviors Among Chinese University Students: The Mediating Role of Alcohol Expectancies and Drinking Refusal Self-Efficacy

Background: Risky alcohol use among Chinese university students remains a public health concern. However, little is known about how personality traits and learned alcohol-related beliefs are associated with alcohol-related behaviors. This study examined associations of reward and punishment sensitivity, alcohol expectancies, and drinking refusal self-efficacy with drinking frequency, high-risk drinking, and self-protective behaviors. Methods: A cross-sectional survey was conducted among N = 800 university students in China. Separate path models were estimated, with each model corresponding to one alcohol expectancy dimension. Results: Across the six models, reward sensitivity was positively associated with all expectancy dimensions; punishment sensitivity was positively associated only with arousal and aggression expectancy. Expectancies showed few direct outcome associations but were consistently associated with lower context-specific refusal confidence. Lower refusal confidence showed domain-specific associations: social-pressure and opportunistic confidence with more frequent drinking, emotional-relief confidence with greater high-risk drinking, and social-pressure confidence with fewer self-protective behaviors. Peer alcohol use and social media exposure to peer drinking were positively associated with both drinking outcomes; male students reported fewer self-protective behaviors. Conclusions: These findings highlight alcohol-related beliefs and refusal confidence as potential intervention targets. Prevention programs may benefit from expectancy-focused, scenario-based refusal training addressing peer, social media, and gender-related influences.