Parent-based interventions on adolescent alcohol use outcomes: A systematic review and meta-analysis

Alcohol use in Iraq: Perceptions of interviewed students at three Iraqi universities

INTRODUCTION

Iraq has faced decades of conflict and increased exposure to alcohol use. While the majority (60%) of Iraq's population is under the age of 24, there is no research examining their views on alcohol use and related factors. This study explores how the individual, interpersonal and social contexts of university students may influence their experiences and perceptions of alcohol use.

METHODS

We undertook a qualitative study underpinned by a socio-ecological framework and the alcohol use motivational model. Forty students from 11 disciplines at three universities across Iraq were interviewed (45% female). Interviews were conducted in English (n = 3) or Arabic (n = 37). Template analysis was used to examine the data.

RESULTS

Perceptions of the prevalence of alcohol use varied among participants. Perceived motives for drinking included using alcohol to cope with grief, loss, poverty and unemployment; as well as peer pressure, thrill-seeking and social approval. Abstinence was perceived to be associated with knowledge of the adverse effects of alcohol and a commitment to faith. Students reported alcohol use as a clandestine activity. Students suggested education, open communication and employment opportunities as preventative strategies.

DISCUSSION AND CONCLUSION

This is the first study to explore young Iraqi perceptions and experiences of peers' alcohol use in the current context of conflict, political instability and globalisation. Young Iraqis are a vulnerable population who may be at risk of alcohol-related harm. Iraq should consider multidimensional preventive approaches that include evidence-based and culturally appropriate interventions that reflect young people's real-life experiences and challenges.

Parents' perspectives and behaviors regarding their child's access to alcohol: Variation by race/ethnicity, socioeconomic status, and neighborhood

BACKGROUND

Setting rules about alcohol use and minimizing its availability in the home are known effective parent-level strategies for reducing underage drinking risk. However, parents' restrictions and their perceptions of their child's alcohol access have rarely been considered in combination (e.g., determining if rule-setting consistently accompanies perceived easy access), despite the potential to inform targeted prevention. The current study identified patterns in six parent-reported indicators of their child's alcohol restrictions and access and characterized them with respect to race/ethnicity, socioeconomic status, community type (urban, suburban, or rural), and neighborhood (dis)advantage.

METHODS

Latent profile analysis was applied to Follow-up Year 2 data from the parents of Black, Latinx, and White participants in the Adolescent Brain Cognitive Development Study (n = 9586; youth mean age = 12.05; 47.50% girl, 51.32% boy, 0.32% other gender; 14.29% Black, 25.97% Latinx, and 59.74% White) to derive distinct profiles.

RESULTS

Four profiles (subgroups) emerged: High Restrictions/No Drinkers in Household (32.18%), Low Restrictions/High Access (29.58%), High Restrictions/High Access (26.38%), and High Restrictions/Low Access (11.86%). Black and Latinx youth and parents with relatively low educational attainment and income were overrepresented in the High Restrictions/No Drinkers in Household and High Restrictions/Low Access subgroups. By contrast, the low restrictions subgroups were composed primarily of parents of White youth living in advantaged neighborhoods.

CONCLUSIONS

Findings support the notion that parents' perspectives and behaviors around youth alcohol access cannot be divided simply into restrictive and permissive. Further, the observed differences by demographic and neighborhood factors suggest the value of tailoring parent-level prevention approaches to consider community norms.

Adolescent-Reported Changes in Provider Behavior Following Pediatrician Training in Stimulant Diversion Prevention: Results From a Cluster Randomized Controlled Trial

OBJECTIVE

To test whether pediatrician training leads to provider utilization of stimulant diversion prevention strategies as reported by adolescent patients with ADHD.

METHODS

Pediatric practices received a stimulant diversion prevention workshop (SDP) or continued treatment-as-usual (TAU) in a cluster-randomized controlled trial. Surveys were completed by 341 stimulant-treated patients at baseline and three follow-up assessments.

RESULTS

In intent-to-treat analyses of patient reports, SDP adolescents reported more provider use of diversion prevention strategies compared to TAU. They also reported more parent-patient communication about diversion. Provider satisfaction with the training was strong.

CONCLUSIONS

Pediatricians can make use of clinical practice strategies for the prevention of stimulant diversion following a 1-hr training; findings are novel given their reliance on confidential patient report of provider behavior and increase confidence in the results. Coupled with the positive provider satisfaction ratings, results suggest that this brief workshop may be an option for concerned providers that also has the effect of increasing discussion at home about safe use of stimulants.

Method of accessing alcohol and binge drinking status in youth and young adults

AIMS

The study investigated relationships between how youth and young adults access alcohol and their binge drinking behaviors.

METHODS

Data from the Rhode Island Student Survey (11- to 18-year-olds) and the Mobile Screen Time project (18- to 24-year-old) were included. Participants were asked whether they access alcohol through several different methods (e.g. gifts, purchase, theft), and a latent class analysis was conducted to identify patterns of behavior. Logistic regression models were used to determine if class assignment was associated with binge drinking, after adjusting for age, sexual/gender status, and identification as a Black, Indigenous, and other Person of Color.

RESULTS

Among youth, participants who primarily accessed alcohol through friends had 6 times the odds of binge drinking (OR[95%CI] = 6.22 [4.08,9.49]), and those who accessed alcohol through all available sources had 23 times the odds (OR[95%CI] = 23.1 [9.08,58.6]). In young adults, participants who actively purchased alcohol had 3.7 times the odds of binge drinking (OR [95%CI] = 3.69 [1.62,8.37]).

CONCLUSIONS

Distinct means of accessing alcohol in youth and young adult populations can be identified, and different methods of access may be associated with increased binge drinking. Strong availability and ID checking policies are needed for on- and off-premise locations, and the implementation of parent-centered programs should be considered.

The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review

BACKGROUND

The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies.

OBJECTIVE

This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs.

METHODS

This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features.

RESULTS

Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents.

CONCLUSIONS

Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings.

Beyond the Laws: Parental Monitoring, Perceived Acceptability of Underage Drinking and Alcohol Use Among Belgian Youth

Parental monitoring behaviors are negatively associated with adolescent substance use. Yet, the processes explaining these associations are still unclear. The current study examined adolescents' knowledge of minimum legal drinking age laws and their perceived acceptability of underage drinking as potential mediators of the links between parental monitoring behaviors and youth alcohol use. The sample included 1154 Belgian adolescents (Mage = 16.34, SD = 1.33; 71% girls), who were recruited in Wallonia (54.9%) and in Flanders (45.1%). Path analyses revealed that higher parental rule setting, but not solicitation, was related to lower alcohol use. Acceptability of underage drinking mediated this link, but not knowledge of the laws. Results suggest that beyond laws regulating the minimum legal drinking age, alcohol use prevention programs should consider the importance of parental rule setting and youth's perceived acceptability of underage drinking.

Transitions to polysubstance use: Prospective cohort study of adolescents in Australia

BACKGROUND AND AIMS

Adolescent polysubstance use has been associated with adverse social and health outcomes. Our aim was to measure rates and transitions to polysubstance use during adolescence and identify factors associated with initiation and discontinuation of polysubstance use.

DESIGN

Prospective cohort study. Multistate Markov modelling was used to estimate rates and identify correlates of transitions between substance use states.

SETTING AND PARTICIPANTS

Adolescent-parent dyads (n = 1927; adolescents in grade 7, age ≈13 years) were recruited from Australian schools during 2010/11 (Wave 1). Adolescents were surveyed annually until 2016/17 (n = 1503; age ≈19 years; Wave 7) and parents were surveyed annually until 2014/15 (Wave 5).

MEASUREMENTS

Alcohol, tobacco, cannabis and 3,4-methylenedioxymethamphetamine (MDMA) use outcomes were collected at Waves 3-7. Potential confounders were collected at Waves 1-6 and consisted of sex, anxiety and depression symptoms and externalizing problems, parental monitoring, family conflict and cohesion, parental substance use and peer substance use. Covariates were age and family socioeconomic status.

FINDINGS

Few adolescents engaged in polysubstance use at earlier waves (Wave 3: 5%; Wave 4: 8%), but proportions increased sharply across adolescence (Waves 5-7: 17%, 24%, 36%). Rates of transitioning to polysubstance use increased with age, with few (<9%) adolescents transitioning out. More externalizing problems (odds ratio [OR] = 1.10; 99.6% confidence interval [CI] = 1.07-1.14), parental heavy episodic drinking (OR = 1.22; 99.6% CI = 1.07-1.40), parental illicit substance use (OR = 3.56; 99.6% CI = 1.43-8.86), peer alcohol use (OR = 5.68; 99.6% CI = 1.59-20.50) and peer smoking (OR = 4.18; 99.6% CI = 1.95-8.81) were associated with transitioning to polysubstance use.

CONCLUSIONS

Polysubstance use in Australia appears to be rare during early adolescence but more common in later adolescence with low rates of transitioning out. Externalizing problems and greater parental and peer substance use are risk factors for adolescent polysubstance use that may be suitable intervention targets.

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial

BACKGROUND

Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite the recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures.

OBJECTIVE

This randomized effectiveness trial will advance research and scope on SBIRT-A in primary care by conducting a head-to-head test of 2 conceptually grounded, evidence-informed approaches: a standard adolescent-only approach (SBIRT-A-Standard) versus a more expansive family-based approach (SBIRT-A-Family). The SBIRT-A-Family approach enhances the procedures of the SBIRT-A-Standard approach by screening for AOD risk with both adolescents and caregivers; leveraging multidomain, multireporter AOD risk and protection data to inform case identification and risk categorization; and directly involving caregivers in brief intervention and referral to treatment activities.

METHODS

The study will include 2300 adolescents (aged 12-17 y) and their caregivers attending 1 of 3 hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities will occur during a single pediatric visit. SBIRT-A procedures will be delivered digitally on handheld tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, and parent-adolescent communication about AOD use) and secondary outcomes (adolescent quality of life, adolescent risk factors, and therapy attendance) will be assessed at screening and initial assessment and 3-, 6-, 9-, and 12-month follow-ups. The study is well powered to conduct all planned main and moderator (age, sex, race, ethnicity, and youth AOD risk status) analyses.

RESULTS

This study will be conducted over a 5-year period. Provider training was initiated in year 1 (December 2023). Participant recruitment and follow-up data collection began in year 2 (March 2024). We expect the results from this study to be published in early 2027.

CONCLUSIONS

SBIRT-A is widely endorsed but currently underused in pediatric primary care settings, and questions remain about optimal approaches and overall effectiveness. In particular, referral to treatment procedures in primary care remains virtually untested among youth. In addition, whereas research strongly supports involving families in interventions for adolescent AOD, SBIRT-A effectiveness trial testing approaches that actively engage family members in primary care are absent. This trial is designed to help fill these research gaps to inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05964010; https://www.clinicaltrials.gov/study/NCT05964010.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/54486.

Substance Addiction in Adolescents: Influence of Parenting and Personality Traits

BACKGROUND

Substance use in adolescents has been separately related to personality traits and parental socialization styles; in this study, our objective was to study these variables in an integrated way.

METHODS

A cross-sectional observational study was conducted in five institutes in a final sample of 331 students, excluding those with gaming disorder. The sample was stratified into three subgroups: 'no addiction', 'low risk', and 'high risk' of Substance Use Disorders (SUD).

RESULTS

12.9% of the adolescents presented a low risk of SUD, while 18.3% showed a high risk, with both being older (F = 9.16; p < 0.001) than the no addiction group. Adolescents with high risk scored lower in control and structure variables and higher in maternal and paternal indifference factors. Non-addicted subjects presented higher scores in conscientiousness, extraversion, and agreeableness and lower scores in neuroticism. The probability of SUD increased with age (OR = 2.187; p = 0.022), sensation seeking (OR = 1.084; p < 0.001), and neuroticism (OR = 1.049; p = 0.042), while conscientiousness was a protective factor (OR = 0.930; p = 0.008).

CONCLUSIONS

These results reflect that personality traits are directly related to the development of substance abuse in adolescents.

Tailoring parenting styles and family-based interventions cross-culturally as an effective prevention strategy for youth substance use: a scoping review

Background

The challenge of substance use among youth continues to be a highly concerning public health issue across the globe. The notion that parenting lifestyles and family-based intervention can help in the prevention of adolescent substance use have received robust attention from policy makers, researchers' clinicians and general public, nonetheless, there is scarcity of high quality evidence to support these concepts.

Objective

To review available literature which assessed the effects of parenting styles and family-based interventions on the prevention of adolescent substance use.

Methods

A scoping review of literature to identify studies published in English between 2012 and 2022 was conducted searching Scopus, MEDLINE, PsychInfo, and CINAHL databases focused on effects of parenting styles and family-based interventions in the prevention of adolescent substance use.Keywords of family-based intervention strategies and possible outcomes of parenting styles on youth substance use were coded from the results, discussion, or conclusion. Strategies were inductively categorized into themes according to the focus of the strategy.

Results

A total of 47 studies, published between 2012 and 2022 in English language included. Narrative synthesis illustrated that parental involvement, restriction of mature-rated content, parental monitoring, authoritative parenting styles, and parental support and knowledge can help in the prevention of adolescent substance use. On the contrary, poor parent-child bonding, overprotection, permissive parenting, parental frustrations, authoritarian and harsh parenting styles promoted adolescent substance use disorders. Proximal risk factors like peer influence, previous use of other substances, and risky behaviours had more effect than just parenting styles. Culturally tailored family-based intervention strategies such as "Preventive Parenting", "Parent Training", and "Parent Involvement", with focus on "Technology Assisted Intervention", particularly "SMART "(Substance Misuse among Adolescents in Residential Treatment) are found as effective family-based intervention strategies to mitigate substance use in youth.

Conclusion

Culturally tailored family-based behavioural strategies psychosocial intervention strategies can be considered of the most effective strategies to prevent substance use disorders in youth.

Associations Between Parental Drinking and Alcohol Use Among Their Adolescent Children: Findings From a National Survey of United States Parent-Child Dyads

PURPOSE

Underage drinking is common and costly. This study examined associations between parent and child drinking using recent United States national survey data.

METHODS

We analyzed responses of 740 parent-child dyads from 2020 SummerStyles and YouthStyles surveys. Parents and their adolescent children answered questions about past 30-day alcohol use. We estimated prevalence of adolescent drinking and explored differences by sociodemographics. A multivariable logistic regression model assessed whether parents' drinking behaviors were associated with drinking among their children.

RESULTS

Overall, 6.6% of adolescents drank alcohol, with no significant differences by sociodemographics. Adolescents whose parents drank frequently (≥5 days/month), or binge drank, had significantly higher odds of drinking than adolescents whose parents did not drink or did not binge drink, respectively.

DISCUSSION

Parents could drink less to reduce the likelihood of drinking among their children. Implementation of effective population-level strategies (e.g., increasing alcohol taxes, regulating alcohol sales) can reduce excessive drinking among both adults and adolescents.

Prevention of hazardous use of alcohol among high school students: a study protocol for the randomized controlled trial 'Our choice'

BACKGROUND

Adolescent hazardous alcohol use is prevalent and has serious short- and long-term consequences. The trial 'Our Choice' examines efficacy, feasibility and acceptability of prevention interventions targeting school, parent, and student levels at Danish high schools. We hypothesize that students in a structural intervention (school and parent levels) reduce hazardous alcohol use and related health behaviors compared to students in an assessment only control group 12 months post baseline; and that adding group-based Motivational Interviewing (group MI) yields further improvements. The study examines the efficacy of interventions targeting multiple levels with the aim of providing novel insights into prevention of adolescent hazardous alcohol use and related health outcomes.

METHOD

The study employs a parallel group cluster randomized controlled trial design with three conditions: (1) structural condition targeting school and parent levels, (2) structural condition combined with group MI which also targets the student level, and (3) assessment-only control condition. A participatory approach is used to adapt and develop interventions. Sixteen high schools in Denmark and about N = 3100 first-year students (15-18 years) enrolled in high school in August 2023 will be recruited. Data will be collected via online questionnaires pre-interventions (baseline), 2, 6, 9 and 12 month post baseline and analyzed with generalized linear mixed models. The primary outcome is past month high intensity drinking; secondary outcomes are alcohol use, alcohol-related consequences, well-being, tobacco, and illegal substance use. Feasibility and acceptability will be assessed via surveys (students) and interviews (high school staff) to inform future implementation.

DISCUSSION

'Our Choice' is the first trial to compare the efficacy of a structural intervention targeting school- and parent levels to an intervention targeting these levels and the student level via group MI - on hazardous drinking and related health outcomes among students. Preventing and reducing hazardous alcohol use during adolescence is crucial due to the short- and long-term negative consequences. The tested interventions can be implemented at low cost. The study has significant implications for adolescent health and well-being and has potential to inform evidence-based decisions on alcohol prevention policy, education, and health professions.

TRIAL REGISTRATION NUMBER

The trial was retrospectively registered at ClinicalTrials.gov on August 24th, 2023.

TRIAL REGISTRATION NUMBER

ID NCT06018389.

Drinking behaviors of Chinese adolescents over the past three decades: A systematic review and meta-analysis

Adolescent drinking is a major worldwide public health challenge. China is home to the world's second largest youth population, but relatively little is known about adolescent drinking behaviors. This study examined (1) prevalence rates and sex and age differences in drinking behaviors among Chinese adolescents over the past three decades and (2) whether underage drinking declined following the enactment of a strict national underage drinking policy in 2006. Literature search was conducted in one Chinese and five English databases following the PRISMA guidelines. A total of 186 studies were included in the meta-analyses using random-effects models on nine measures (Ns range: 13,489-755,796, number of studies range: 12-110): lifetime, past month, past year, and weekly drinking; lifetime, past year, and past month drunkenness; past month binge drinking, and age at first drinking (≤ 13 years). Males reported higher prevalence on all drinking behaviors except for weekly drinking and past month drunkenness. High school students reported higher prevalence in lifetime drinking, past year drunkenness, and lifetime drunkenness, than middle school students. No measured drinking behavior showed a significant or reliable decline after 2006. The findings suggest that prevalence rates of drinking behaviors remain high among Chinese adolescents but are lower than among European or North American adolescents. The 2006 Chinese national policy to reduce underage drinking did not measurably alter patterns of underage drinking. Implications for prevention, research, and policy are discussed.

Family Matters More Than Friends on Problematic Social Media Use Among Adolescents: Mediating Roles of Resilience and Loneliness

Problematic social media use (PSMU) among adolescents has raised global concern in the current digital age. Despite the important role of perceived social support in adolescents' PSMU has been examined, possible different influences between perceived support from family and friends are still unknown. To address the gap, the present study aimed to examine how perceived support from family and friends is associated differently with PSMU and the mediating roles of resilience and loneliness therein. A sample of 1056 adolescents was recruited to complete standard questionnaires. Mediation analysis showed that resilience and loneliness mediated this association partially between perceived support from family and PSMU but totally between perceived support from friends and PSMU. Further, ANOVA-based analysis showed that influences of perceived support from family and friends on PSMU were mutually independent, and there was no interaction between them. Our results not only highlight different and independent impacts of perceived support from family and friends on PSMU, but also clarify the mediating mechanisms linking perceived social support to adolescent PSMU.

Taking alcohol from one's parents' home without permission as a risk factor for greater alcohol and marijuana use during the transition into college

While adolescents and underage emerging adults typically obtain alcohol from social sources (e.g., parents, friends, parties), taking alcohol from the home without permission is not well understood. The current study investigated plausible individual characteristics associated with taking alcohol from one's parents' home without permission and associations between taking alcohol and drinking, alcohol consequences, and marijuana use. Two cohorts of alcohol-experienced underage emerging adults (N = 562) completed a web-based survey pre-college matriculation. Participants reported sources of alcohol (friend, mother, father, party, took it from home); drinking; consequences; marijuana use (ever and past 30 days); age of alcohol initiation; symptoms of depression, anxiety, and stress; parental modeling of drinking; and demographic information. Results revealed that taking alcohol was significantly associated with several of the measures examined here (e.g., having obtained alcohol from friends, parents, and parties; earlier age of alcohol initiation; parental modeling of alcohol). Having taken alcohol from the home without permission and obtained it from friends were uniquely associated with increased odds of typical weekly drinking, consequences, and marijuana use in the past 30 days when controlling for all other variables assessed in this study (including drinking, in the consequences and marijuana models). Parent-based interventions targeting adolescents and emerging adults should inform parents of the risks associated with taking alcohol from the home and obtaining it from friends. Further, parents should also be informed that supplying their adolescent with alcohol or modeling drinking may increase the likelihood that they take alcohol from their home.

Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis aims to synthesize the efficacy of culturally sensitive prevention programs for substance use outcomes among U.S. adolescents of color (aged 11 to 18 years old) and explore whether the intervention effects vary by participant and intervention characteristics. Eight electronic databases and grey literature were searched for eligible randomized controlled trials through September 2022. Robust variance estimation in meta-regression was used to synthesize treatment effect size estimates and to conduct moderator analysis. After screening, 30 unique studies were included. The average treatment effect size across all substance use outcomes (including 221 effect sizes) was Hedges's g = -0.20, 95% CI = [-0.24, -0.16]. The synthesized effect sizes were statistically significant across types of substances (alcohol, cigarette, marijuana, illicit and other drugs, and unspecified substance use), racial/ethnic groups (Hispanic, Black, and Native American), and different follow-ups (0-12 months, >12 months). Very few studies reported substance use consequences as outcomes and the synthesized effect size was non-significant. Meta-regression findings suggest that the intervention effects may vary based on the type of substance. This meta-analysis found supportive evidence of culturally sensitive prevention programs' efficacy in preventing or reducing substance use among Black, Hispanic, and Native American adolescents. More substance use prevention efforts and evidence is needed for Asian American, Pacific Islander, and multiracial adolescents.

Preventing alcohol use among Hispanic adolescents through a family-based intervention: The role of parent alcohol misuse

Early-life alcohol use raises the risk of poor long-term alcohol and other health outcomes. U.S. Hispanics are less likely to access treatment if they develop alcohol abuse or dependence, making preventive interventions critical. Familias Unidas is a family-based intervention effective in preventing drug and sexual risk behavior among Hispanic youth. The effects of this intervention specifically on youth alcohol use have been less consistent and may be affected by parental factors. The intervention is primarily delivered to parents to ultimately reduce youth risk behaviors, applying research on protective parenting and family influences, such as parental monitoring and positive communication. This study conducted secondary data analysis of an effectiveness randomized controlled trial of the Familias Unidas intervention, examining parent moderators of intervention effects on adolescent alcohol use. A total of 746 Hispanic families with 12-16-year-old adolescents were randomized to intervention or control. Logistic regression analyses confirmed no evidence of intervention effectiveness in reducing 90-day adolescent alcohol use at 30-month follow-up. However, there was evidence that parent misuse moderated intervention effects on adolescent alcohol use. Among youth whose parents reported any episode of alcohol misuse in their lifetime, the intervention was associated with lower odds of youth alcohol use at 30 months compared to youth in the control condition. Potential reasons and intervention implications are reviewed, including how parent alcohol use experiences might raise awareness of youth risks and motivate involvement or protective behaviors. Understanding intervention moderators can help shape, target, and adapt interventions to enhance their effectiveness and reach. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Efficacy of theory-based interventions aimed at reducing binge drinking in adolescents: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND AND AIMS

Binge drinking is a widespread practice among adolescents worldwide and is associated with various harmful consequences. Theory-based interventions are a promising approach to prevent this drinking behaviour in this population. The aim of the present review was to determine: (1) the characteristics of theory-based interventions targeting binge drinking in adolescents, (2) the impact of such interventions on binge drinking, and (3) the quality of theoretical implementation.

METHODS

For this systematic review, randomised controlled trials were eligible for inclusion if the binge drinking-targeting intervention was based at least on one theoretical framework, and if the population's mean age was between 10 and 18 years. Two authors extracted relevant data. A meta-analysis was conducted to evaluate the effect of interventions on binge drinking. Effect sizes were calculated with the Hedges's g. Binge drinking was measured as a continuous or dichotomous outcome. The quality of theoretical implementation of interventions was measured using an existing "theory coding scheme".

RESULTS

Sixteen studies were identified. Ten were based on a single theory, and six on a combination of theories. The number and type of behaviour change techniques used in each intervention varied greatly. Theory-based interventions led to a small but significant decrease in binge drinking (Hedges's g = 0.10; 95% confidence interval = 0.04, 0.16). The quality of theoretical implementation was globally low, and the reciprocal link between behaviour change techniques and theoretical constructs was unclear for most studies.

CONCLUSIONS

Theory-based interventions have a small but significant beneficial impact on decreasing binge drinking in adolescents. Future research should try to be more effective in matching theoretical determinants of behaviour with the content of the intervention.

Assessing Parent-Adolescent Substance Use Discussions Using the Continuous Assessment of Interpersonal Dynamics

Assessing parent-child interactions is critical for understanding family dynamics, however tools available for capturing these dynamics are limited. The current study sought to examine the validity of the Continuous Assessment of Interpersonal Dynamics (CAID) for understanding the dynamics of parent-adolescent substance use discussions. Specifically, we examined how CAID parameters were related to indicators of parenting and substance use. Sixty-one parent-adolescent dyads (M adolescent age = 14.02, 57% female; M parent age = 46.40; 98% female) completed three 9-minute video-taped conflict, alcohol, and cannabis discussions as well as self-report measures of parenting (e.g., monitoring, psychological control) and substance use behaviors (e.g., intentions, use with parental permission). Interactions were coded using the CAID which provides continuous assessments of parent and adolescent warmth and dominance. Parental warmth, adolescent warmth, and dominance complementarity CAID parameters were positively associated with adaptive parenting and negatively associated with maladaptive parenting factors. Parental warmth in the cannabis discussion was negatively associated with the substance use and intentions factor. These findings support CAID as a reliable and valid assessment of interpersonal dynamics that characterize parent-adolescent substance use discussions and suggest that substance use conversations may be most effective when parents and adolescents act warmly throughout the discussion and exhibit dominance complementarity.

Adolescents' Use of Free Time and Associations with Substance Use from 1991 to 2019

Background: Understanding time trends in risk factors for substance use may contextualize and explain differing time trends in substance use. Methods: We examined data (N = 536,291; grades 8/10/12) from Monitoring the Future, years 1991-2019. Using Latent Profile Analyses, we identified six time use patterns: one for those working at a paid job and the other five defined by levels of socialization (low/high) and engagement in structured activities like sports (engaged/disengaged), with the high social/engaged group split further by levels of unsupervised social activities. We tested associations between time use profiles and past two-week binge drinking as well as past-month alcohol use, cigarette use, cannabis use, other substance use, and vaping. We examined trends and group differences overall and by decade (or for vaping outcomes, year). Results: Prevalence of most substance use outcomes decreased over time among all groups. Cannabis use increased, with the largest increase in the group engaged in paid employment. Vaping substantially increased, with the highest nicotine vaping increase in the high social/engaged group with less supervision and the highest cannabis vaping increase in the highly social but otherwise disengaged group. Substance use was lowest in the low social groups, highest in the high social and employed groups. Conclusions: While alcohol, cigarette, and other substance use have declined for all groups, use remained elevated given high levels of social time, especially with low engagement in structured activities or low supervision, or paid employment. Cannabis use and vaping are increasing across groups, suggesting the need for enhanced public health measures.

Testing the specificity of environmental risk factors for developmental outcomes

Developmental theories often assume that specific environmental risks affect specific outcomes. Canonical Correlation Analysis was used to test whether 28 developmental outcomes (measured at 11-15 years) share the same early environmental risk factors (measured at 0-3 years), or whether specific outcomes are associated with specific risks. We used data from the UK Millennium Cohort Study (N = 10,376, 51% Female, 84% White) collected between 2001 and 2016. A single environment component was mostly sufficient for explaining cognition and parent-rated behavior outcomes. In contrast, adolescents' alcohol and tobacco use were specifically associated with their parents', and child-rated mental health was weakly associated with all risks. These findings suggest that with some exceptions, many different developmental outcomes share the same early environmental risk factors.

Trends in the sequence of initiation of alcohol, tobacco, and marijuana use among adolescents in Argentina and Chile from 2001 to 2017

BACKGROUND

Variation in drug policies, norms, and substance use over time and across countries may affect the normative sequences of adolescent substance use initiation. We estimated relative and absolute time-varying associations between prior alcohol and tobacco use and adolescent marijuana initiation in Argentina and Chile. Relative measures quantify the magnitude of the associations, whereas absolute measures quantify excess risk.

METHODS

We analyzed repeated, cross-sectional survey data from the National Surveys on Drug Use Among Secondary School Students in Argentina (2001-2014) and Chile (2001-2017). Participants included 8th, 10th, and 12th grade students (N = 680,156). Linear regression models described trends over time in the average age of first use of alcohol, tobacco, and marijuana. Logistic regression models were used to estimate time-varying risk ratios and risk differences of the associations between prior alcohol and tobacco use and current-year marijuana initiation.

RESULTS

Average age of marijuana initiation increased and then decreased in Argentina and declined in Chile. In both countries, the relative associations between prior tobacco use and marijuana initiation weakened amid declining rates of tobacco use; e.g., in Argentina, the risk ratio was 19.9 (95% CI: 9.0-30.8) in 2001 and 11.6 (95% CI: 9.0-13.2) in 2014. The relative association between prior alcohol use and marijuana initiation weakened Chile, but not in Argentina. On the contrary, risk differences (RD) increased substantially across both relationships and countries, e.g., in Argentina, the RD for tobacco was 3% (95% CI: 0.02-0.03) in 2001 and 12% (95% CI: 0.11-0.13) in 2014.

CONCLUSION

Diverging trends in risk ratios and risk differences highlight the utility of examining multiple measures of association. Variation in the strength of the associations over time and place suggests the influence of environmental factors. Increasing risk differences indicate alcohol and tobacco use may be important targets for interventions to reduce adolescent marijuana use.

Do Alcohol Prevention Programs Influence Adolescents' Drinking Behaviors? A Systematic Review and Meta-Analysis

This study analyzed the effects of various alcohol prevention programs on the drinking behavior of adolescents. There were seven electronic databases used for the literature search. A systematic review and meta-analysis are employed for works published in Korean and English from January 2010 to April 2021, with strict inclusion criteria yielding 12 papers in the review. The type of alcohol prevention interventions included educational and motivational interventions. Six studies had more than 500 participants each, and five studies had more than 10 participating schools. The programs did not effectively reduce the frequency of drinking or binge drinking of adolescents but significantly reduced the amount of alcohol consumed. Based on the results of this study, when planning alcohol prevention programs for adolescents, it is necessary to adopt a multi-level approach, including the engagement of parents and the community.

One rule for one, and a different rule for another: The case of the Parental Rules about Alcohol Questionnaire

BACKGROUND

The parental rules about alcohol questionnaire (Van der Vorst et al., 2005, 2006) uses 10 items to assess how strictly adolescents believe the rules set by their parents about drinking are. An increasing body of literature has attested to the importance of rule setting in the prevention of problematic alcohol use among adolescents. A recent study proposed a two-factor solution in place of the hypothesized unidimensional one, with factors assessing non-normative, and normative rules.

METHODS

The present study used five waves of data to examine the structure of the scale, and how well it relates to a measure of heavy episodic drinking (HED). Participants in Waves one to four {10,954-9,383} were substantively more numerous than those at wave five (N = 2,332).

RESULTS

Confirmatory Factor Analyses did not support either the ten-item hypothesized model, nor the proposed two-factor solution. Results of exploratory factor analyses all pointed to a one factor solution. Using Modification Indices, we obtained a good-fitting, five-item unidimensional model in Waves one to four. At wave five, a good fitting unidimensional model was obtained with the dropping of a further item. Scores on this shortened scale were internally consistent, correlated highly with scores on the original ten-item version, and correlated to a similar degree as the original 10-item measure, with scores on a HED measure.

CONCLUSION

Further work is required in assessing the properties of this scale across cultures and samples before definitively determining that two factors best represent parental rules.

Feasibility and Acceptability of a Novel Primary Care-Based Intervention to Promote Parent-Teen Communication About Teen Strengths

Strength-based approaches to youth development have been tested in community settings and are related to improvements in social, health, and academic realms. However, little is known about similar approaches to enhance parent-teen communication (PTC) in pediatric primary care. The goal of this study was to test the feasibility and acceptability of an intervention to facilitate parent-teen communication about teen strengths. Intervention materials were developed based on a literature review, expert consultation, and feedback from stakeholders. The final intervention was a parent-directed booklet and a parent-teen discussion activity. At the well-adolescent visit (WAV), dyads received an orientation to the materials and were instructed to complete the discussion activity within 2 weeks of the WAV. Health Care Providers verbally endorsed the materials and instructed parents to read the booklet and complete the discussion activity with their teens. Acceptability was assessed at 2-week and 2-month follow-ups. Parent-adolescent dyads from an urban, pediatric primary care practice were enrolled with half assigned to the treatment group. Those in the treatment group (60 dyads) are the focus of this paper. Youth were 13-15 years old, 55% female, and 66% Black. Most participating parents (97%) were female. Fidelity was ≥ 88% for delivery of each of the intervention components. Fifty-four of the 60 parents in the intervention group completed the 2-week call. Of those 54 parents, 96% read the booklet and 62% found the booklet either extremely or very helpful. The majority of parents (67%) and teens (72%) reported that the discussion activity was excellent or very good. Analysis of qualitative data also provided rich insight into the participants' experiences with the intervention materials. Overall results suggest that an intervention to promote PTC about teen strengths is feasible and acceptable to parents and teens within primary care.

Moderators of Friend Selection and Influence in Relation to Adolescent Alcohol Use

Friendships form an important context in which adolescents initiate and establish alcohol use patterns, but not all adolescents may be equally affected by this context. Therefore, this study tests whether parenting practices (i.e., parental discipline, parental knowledge, unsupervised time with peers) and individual beliefs (i.e., alcohol descriptive norms, positive social expectations, moral approval of alcohol use) moderate friend selection and influence around alcohol use. Stochastic actor-based models were used to analyze longitudinal social network and survey data from 12,335 adolescents (aged 11 to 17, 51.3% female) who were participating in the PROSPER project. A separate model was estimated for each moderating variable. Adolescents who reported consistent parental discipline, less unsupervised time with peers, higher descriptive alcohol use norms, and less positive social expectations about alcohol use were less likely to select alcohol-using friends. Those who reported consistent parental discipline, better parental knowledge, lower descriptive alcohol use norms, and less positive social expectations were more influenced by their friends' level of alcohol use. Thus, adolescents with these characteristics whose friends frequently use alcohol are at greater risk whereas those whose friends do not use alcohol are at lower risk of using alcohol. The findings show that, although selection and influence processes are connected, they may function in different ways for different groups of adolescents. For some adolescents, it is particularly important to prevent them from selecting alcohol-using friends, because they are more susceptible to influence from such friends. These peer network dynamics might explain how proximal outcomes targeted by many prevention programs (i.e., parenting practices and individual beliefs) translate into changes in alcohol use.

Gender differences in self-harm and drinking behaviors among high school students in Beijing, China

BACKGROUND

Self-harm and drinking are both serious problems in adolescents and many studies presented evidence of their association. However, gender differences in this association are seldom deeply discussed. Our study aimed to evaluate the prevalence of self-harm and explore its association with drinking behaviors by gender and investigate the extent to which the gender differences exist in the association between self-harm and drinking.

METHODS

A total of 32,362 students in grades 7 to 12 in Beijing, China were anonymously surveyed and included in our study using two-stage, stratified probability proportion sampling. Self-harm, drinking behaviors and other basic information were obtained from an anonymous questionnaire. Demographic variables, self-harm and drinking behaviors were analyzed using the Chi-square test and the Gamma test between genders and the gender differences in this association were analyzed by Log-binomial regression.

RESULTS

The total prevalence of self-harm was 13.7% with no significant gender difference (χ² =0.352, P = 0.553). The prevalence of self-harm in girls decreased with age (G = -0.163, P < 0.001). Self-harm was associated with drinking behaviors in both boys and girls. The Log-binomial regression demonstrated that girls in the 16-19 years old group were at lower risk of self-harm than girls in the 12-15 years old group while this association was weaker in boys (1.493 vs 1.128). The higher OR for self-harm was found among girls with early drinking experiences compared with boys (2.565 vs 1.863). Girls who had previously drunk (i.e. drunk at least once) (2.211 vs 1.636), were currently drinking (3.400 vs 2.122) and performed binge drinking (6.357 vs 3.924) were at greater risk of self-harm than boys.

CONCLUSION

Among high school students, self-harm has a significant positive association with drinking and girls with drinking behaviors are at higher risk of suffering self-harm. Identifying adolescents' drinking behaviors is of vital importance to self-harm prevention and special attention should be focused on younger girls.

Understanding alcohol-specific antecedents among Chinese vocational school adolescents

BACKGROUND

Alcohol use among Chinese vocational school students is widespread and associated with many negative consequences. However, alcohol-specific antecedents for this population are understudied.

OBJECTIVES

The current study explored: (a) which alcohol-specific antecedents are the most salient predictors for alcohol use intentions, (b) whether any mediational relationships exist among these alcohol-specific antecedents, and (c) whether gender-based differences exist among these relationships.

METHODS

This study analyzed data from 1,230 vocational school adolescents in three Chinese cities. Survey data were analyzed using dominance analysis and structural equation modeling.

RESULTS

Personal norms were the most salient antecedents for alcohol use intentions, followed by injunctive norms from friends and parents, descriptive norms from friends and classmates, and positive belief about drinking. We observed a statistically significant mediational chain from descriptive norms to injunctive norms, and in turn to personal norms and positive beliefs, and finally to alcohol use intentions. Gender moderated some of the paths.

CONCLUSIONS

Alcohol use norms and beliefs among Chinese vocational school students have distinct predictive relationships with alcohol use intentions. Alcohol use prevention programs designed for this population need to address normative beliefs (descriptive, injunctive, and personal norms) and the perceived benefit of alcohol use.

Does Drinking Initiation of Young Thai Drinkers Vary Over Time and Generation? Results of the National Surveys on Tobacco and Alcohol Consumption of the Thai Populations 2007 to 2017

BACKGROUND

Early age at drinking initiation may be one factor responsible for underage drinking in Thailand and this may be affected by cultural and generational changes over certain periods of time. This study aimed to explore the effects of time period and generation on drinking onset of young Thai drinkers in the past decade.

METHODS

We analyzed data from a total of 60,018 Thais aged 15 to 24 years from 4 national surveys conducted in 2007, 2011, 2014, and 2017. We used multilevel and event history analysis to examine the effects of period (survey year) and cohort (birth year of participants), adjusted for sex, age, area of residence, and region on drinking onset.

RESULTS

The overall prevalence of past-year drinking was 23.6 % (95% confidence interval [CI]: 23.2, 23.9) among participants of all surveys. Cox proportional hazards model revealed significantly different probabilities to have initiated drinking between participants of different surveys and birth years, indicating significant period and cohort effects. After adjusting for sex, age, cohort, living region, and area of residence, participants in the 2014 survey had the highest likelihood to have started drinking (hazard ratio [HR]: 1.25 CI: 1.15 to 1.36), compared to the participants of the same age in the 2007 survey while those in the 2011 (HR: 0.89, CI: 0.85, 0.93) and 2017 (HR: 0.63, CI: 0.58, 0.68) surveys had less likelihood. Participants born in 1993 to 2002 (later cohort) had higher probability to have started drinking than those born in 1983 to 1992 (HR: 1.80, CI: 1.69, 1.92).

CONCLUSION

Thai youths of the recent generations living in recent years tend to have a higher probability of initiating drinking than those in the past. Interventions to prevent underage drinking should begin earlier for the young generation.

Parenting as an inhibitor of gender disparities in alcohol use: the case of early adolescents in China

BACKGROUND

Gender differences in alcohol use are more substantial among early adolescents in China than in the United States, presumably because of more permissive drinking norms for boys than girls in Chinese culture. This study tested a theory that gender differences in early experimentation with alcohol can be reduced through general parenting practices. Whereas traditional research has identified mediators of gender differences in alcohol use, the current research isolated moderators of gender differences and developed their implications for prevention programs.

METHODS

The study analyzed the data from the China Global School-Based Student Health Survey (n = 8805 middle school students in four cities). Youth completed anonymous surveys in classroom settings. The study examined interaction effects between gender and parenting variables using multiple regression with robust standard errors.

RESULTS

Early adolescent boys exhibited higher levels of drinking than girls for all drinking outcomes. The gender differences in drinking were negatively associated with the level of perceived parental monitoring, parental involvement in adolescent school performance, and parental empathy in a nonlinear way.

CONCLUSIONS

Results suggested that early adolescents' perceptions of general parenting practice nonlinearly moderated gender disparities in alcohol use.

Alcohol Use Disorders in Adolescents

Alcohol use during adolescence is an important and modifiable health risk behavior given the significant acute consequences and long-term impacts on the developing brain. Alcohol is the most common substance used by young adults 12 to 17 years old, with binge drinking, polysubstance use, and co-occurring mental health disorders posing particular concerns in this age group. Physicians can play a crucial role in screening and responding to alcohol use, with targeted brief interventions designed to delay or decrease use.

A systematic review of parent based programs to prevent or reduce alcohol consumption in adolescents

BACKGROUND

Adolescent alcohol consumption is an issue of ongoing concern and programs targeting parents have been identified as an important component in minimizing and preventing alcohol related harm in adolescents. This paper aims to evaluate existing parent based alcohol education programs with a focus on understanding parent specific outcomes including parental attitudes, parent-child communication, alcohol specific rule setting and parental monitoring; study quality, the extent of stakeholder engagement in program design and the level of theory application.

METHOD

A systematic review of electronic databases EBSCO, Emerald, ProQuest, PubMed, Ovid, ScienceDirect, Taylor and Francis and Web of Science was conducted from database inception to August 2019. A total of 4288 unique records were retrieved from the eight databases. Studies were included if they evaluated school based alcohol education programs that included a parent component and detailed outcome measures associated with parent data. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

RESULTS

In total 17 studies qualified for assessment, detailing 13 individual parent programs. Of these, ten programs demonstrated positive effects in at least one parent reported outcome measure. Stakeholder engagement during the design of programs was lacking with the majority of programs. One third of the programs did not report theory use and when theory was used reporting was weak with three programs applying theory, five testing theory and none building theory. According to the EPHPP tool, overall ten programs were rated as weak, three as moderate and none as strong.

CONCLUSION

Future studies are recommended to further enhance the effectiveness of parental programs by improving study quality, increasing stakeholder engagement and increasing the level of theory application and reporting.

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

PURPOSE OF REVIEW

To examine the most recent published evidence (2016-2019) regarding the treatment of adolescent substance use disorders and to provide an update on evidence-based strategies, adjunctive interventions, and methods to improve currently established treatment approaches.

RECENT FINDINGS

Recent evidence suggests that psychosocial treatments such as family-based therapy, cognitive behavioral therapy, and multicomponent approaches remain the most effective methods of treatment; however, innovative ways of improving these treatment strategies may include digital and culturally based interventions. New advances in adjunctive treatments such as pharmacotherapy, exercise, mindfulness, and recovery-oriented educational centers may have some clinical utility. Well-established psychosocial interventions remain the primary modality of treatment. Promising new adjunctive treatments and improvements in our currently established treatments may yield significant improvements.

Declining alcohol consumption among adolescents and schools in Stockholm, 2010-2016

Aims:

The principle aim of this study was to investigate changes in alcohol consumption among adolescents in Stockholm from 2010 to 2016. A further aim was to investigate whether there are divergent or similar trends in alcohol consumption among elementary schools in Stockholm from 2010 to 2016 and, if there are diverging trends, to examine how the differences might be explained.

Methods:

Data were analysed using multilevel mixed effects linear regression, in which individual students represented one level and schools the second level.

Data:

Student-level data were derived from the Stockholm School Survey for the years 2010, 2012, 2014 and 2016 (n = 15481). School-level data (n = 132) were derived from registries of the Swedish National Agency for Education.

Results:

The results showed that there was an almost 45% decline in total alcohol consumption among ninth-grade students in Stockholm between 2010 and 2016. The decline was similar among all analysed consumption groups. Two factors were found to statistically explain some of the general decline: more restrictive parental attitudes towards alcohol and, more importantly, decreasing alcohol consumption among the students’ peers. The downward trends among schools between 2010 and 2016 were universal but not identical, but when parental attitudes towards alcohol and peers’ alcohol behaviour were controlled for, the diverging school trends in alcohol consumption were considerably more equal.

Conclusions:

School constitutes a social context for the student of which both parents and peers are important parts, and the diverging changes may be due to the norms and behaviours, influenced by parents and peers, characterising these schools.

A parent-oriented alcohol prevention program "Effekt" had no impact on adolescents' alcohol use: Findings from a cluster-randomized controlled trial in Estonia

AIM

To evaluate the effectiveness of a universal parent-oriented alcohol prevention program ("Effekt") in Estonia. The main objective of the program was to delay and reduce adolescents' alcohol consumption by maintaining parental restrictive attitudes towards adolescents' alcohol use over time.

METHODS

A matched-pair cluster randomized controlled trial with a three-year assessment period (baseline (T1), 18-months (T2) and 30-months (T3) follow-ups) was undertaken in 2012-2015 among 985 fifth grade adolescents and 790 parents in sixty-six schools (34 intervention, 32 control). The primary outcome measure was adolescents' alcohol use initiation. Secondary outcome measures were lifetime drunkenness and alcohol use in the past year. Intermediate outcomes were restrictive parental attitudes towards adolescents' alcohol use reported by parents and perceived restrictive parental attitudes and parental alcohol supply reported by adolescents.

RESULTS

There were no significant differences in adolescents' alcohol use initiation, lifetime drunkenness, alcohol use in the past year, parental alcohol supply, and adolescent's perception of parental restrictive attitudes between intervention and control school participants at T2 and T3. There were significant differences in parental attitudes - the odds of having restrictive attitudes were 2.05 (95% confidence interval (CI) = 1.32-3.17) times higher at T2 and 1.92 (95% CI = 1.31-2.83) times higher at T3 in the intervention group than in the control group.

CONCLUSIONS

The Estonian version of the "Effekt" program had a positive effect on parental attitudes, but it did not succeed in delaying or reducing adolescents' alcohol consumption.