Early onset of alcohol drinking is problematic among rural Thai adolescents and can lead to poor health consequences. Adolescents' drinking onset and behaviors are highly influenced by their drinking intention. Within a media-rich environment, adolescents' intention to drink at a young age can be determined by their psychosocial and environmental factors, including alcohol-related media exposure. Nevertheless, it remains elusive how psychological and environmental factors can influence rural Thai adolescents' drinking intention and behaviors. Therefore, three dissertation aims (DAs) were employed to advance the scientific understanding and theoretical underpinnings about rural Thai adolescent drinking intention and behavior. In DA1, an integrative review was conducted to update the state of science by clarifying how adolescents' perceived drinking norms (PDNs) were operationalized in the existing literatures (n=31). The findings revealed that adolescents' PDNs derived from parents, friends, and pro-drinking message exposure from various online platforms were highly associated with their drinking intention and behaviors (i.e., drinking onset and patterns). Two knowledge gaps were identified including the need to expand the narrow domain of adolescents' drinking norms; and to further understand the impacts of alcohol-related media exposure on adolescents' drinking intention and patterns. In DA2, incorporating a broader aspect of PDNs, a structural equation model (SEM) was performed to examine the influence of psychosocial factors of the Theory of Planned Behavior (TPB) on rural Thai adolescents' drinking intention and behaviors. The results demonstrated that all adolescents' psychosocial factors contributed significantly (Îørange = 0.16-0.52, p <.01) to the prediction of drinking intention (R2 = 0.84), which subsequently influenced their drinking onset, current drinking, and binge drinking in the past 30 days. PDNs emerged as the strongest psychosocial predictor of drinking intention. Adolescents' drinking intention significantly mediated the relationship between all psychosocial factors and drinking behaviors either fully or partially. The only different association between adolescent males and females was the path-coefficient from drinking attitude to drinking intention.Finally, in DA3, another SEM was carried out to further examine the influence of alcohol-related media exposures on the TPB-based psychosocial factors and rural Thai adolescents' drinking intention as well as explore the potential mediators and moderators on these associations. The finding demonstrated that, compared to anti-drinking message exposures, pro-drinking message exposure had significantly stronger negative impacts on adolescents' PDNs, attitudes, PBC, and subsequently their drinking intention. Even though the mediation effects were comparable between males and females, the negative effect of pro-drinking message exposures on adolescents' PBC was significantly stronger for males (Îø= -0.76 vs -0.58).Taken together, this dissertation's findings highlighted a paradigm shift in the way rural Thai adolescents perceive their drinking norms. It is critical to focus on adolescents' PDNs when examining their drinking intention and behaviors. Moreover, the findings filled an essential knowledge gap regarding the role of alcohol-related media exposures on adolescents' drinking intentions and behaviors. This nuanced understanding offers valuable recommendations for researchers and Thai policymakers to tackle the issue of underage drinking among rural Thai adolescents more effectively.
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