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Examining engagement with and acceptability and usability of REAL Parenting: A brief online parent-based intervention to reduce alcohol use and consequences among high school students
Abstract
This study is a formative assessment of REAL Parenting (RP): a brief, digital intervention for parents of high school students that encourages parent-teen communication about alcohol and, in turn, aims to prevent teen alcohol use. The aims of this study were to describe engagement with, and acceptability and usability of RP; and to explore the relationship of these measures with each other and with short-term outcomes. Participants were 160 parents randomly assigned to the treatment group who received RP as part of a randomized pilot trial (Mage = 45.43[SD = 7.26], 59.3% female, 56% White, 19% Hispanic). App-based program analytics captured real-time engagement with RP. Parents completed self-report measures of acceptability, usability, perceived communication effectiveness, perceived self-efficacy to communicate, and frequency of communication post-intervention. Descriptive statistics were calculated to describe engagement, acceptability and usability, and zero-order correlations were calculated to examine associations between these and self-report variables. About 75% (n = 118) of parents accessed the intervention and two-thirds (n = 110) accessed at least one module. Self-report ratings of acceptability and usability were neutral to positive, and mothers liked RP more than fathers. Self-report, but not program analytic indicators were associated with short-term outcomes. Findings suggest that, with little incentive, most parents will access an app focused on parent-teen communication about alcohol. While parent feedback was positive, it also highlighted areas for improvement with app content and design. Correlations suggest that analytic metrics of engagement are useful to discern who is and is not using interventions, and self-report measures are important for understanding pathways by which interventions are associated with short-term outcomes.
Objective: This study evaluated FITSTART+, a parent-based intervention (PBI), for preventing risky drinking among first-year college students. Participants: Participants were traditional first-year students aged between 17 and 20. Method: In total, 391 eligible students completed a baseline survey and their parents were then invited to use the FITSTART+ PBI or Control web-applications. 266 students had a parent who created a profile in the app (FITSTART+ PBI, n = 134; FITSTART+ Control, n = 132). Additionally, 58 parents randomized to the FITSTART+ PBI did not complete the personalized normative feedback (PNF) component of the intervention. Results: No significant effect on drinking or related consequences was detected between Intervention and Control groups. However, exploratory analyses revealed that completing PNF in the FITSTART+ PBI condition was associated with a greater likelihood of remaining zero on consequences at follow-ups. Conclusion: The PNF component of the FITSTART+ PBI showed potential in preventing risky drinking, warranting further research.
Acceptability is a core concept in digital health. Available frameworks have not clearly articulated why and how researchers, practitioners and policy makers may wish to study the concept of acceptability. Here, we aim to discuss (i) the ways in which acceptability might differ from closely related concepts, including user engagement; (ii) the utility of the concept of acceptability in digital health research and practice; (iii) social and cultural norms that influence acceptability; and (iv) pragmatic means of measuring acceptability, within and beyond the research process. Our intention is not to offer solutions to these open questions but to initiate a debate within the digital health community. We conducted a narrative review of theoretical and empirical examples from the literature. First, we argue that acceptability may usefully be considered an emergent property of a complex, adaptive system of interacting components (e.g., affective attitude, beliefs), which in turn influences (and is influenced by) user engagement. Second, acceptability is important due to its ability to predict and explain key outcomes of interest, including user engagement and intervention effectiveness. Third, precisely what people find acceptable is deeply contextualized and interlinked with prevailing social and cultural norms. Understanding and designing for such norms (e.g., through drawing on principles of user centered design) is therefore key. Finally, there is a lack of standard acceptability measures and thresholds. Star ratings coupled with free-text responses may provide a pragmatic means of capturing acceptability. Acceptability is a multifaceted concept, which may usefully be studied with a complexity science lens.
Prevention curricula rely on audience engagement to effectively communicate their messages. However, to date, measurement of engagement has primarily focused on self-report that is often an indicator of liking or satisfaction. Emerging technologies for intervention delivery hold promise not only for additional engagement indicators but also for dissemination outside of traditional vehicles such as classroom delivery. The present study, grounded in the theory of active involvement (Greene 2013), explores the role of engagement (as measured by self-report, program analytics, and observation) with short-term substance use prevention outcomes such as self-efficacy to counter-argue and descriptive and injunctive norms. The study tracks 4-H youth (N = 310) engaged with a media literacy focused e-learning substance prevention curriculum, REAL media. Results indicate that self-reports of engagement predicted self-efficacy to counter-argue, but a program-analytic indicator of dosage predicted lower injunctive and descriptive norms, all at 3 months. The observational indicator was correlated with self-efficacy to counter-argue but not significant in the predictive models. The implications and directions for future research regarding how engagement is measured in prevention and included in studying program effects are discussed. Clinical trial: NCT03157700, May 2017.
Engagement is central to the effectiveness of online health messages and the related educational programs that aim to deliver these messages to the intended audience (Li et al. in Educ Tech Res Dev. https://doi.org/10.1007/s11423-019-09709-9, 2019). Drawing from health communication and social learning theories, the Theory of Active Involvement (TAI) (Greene in Health Commun 28:644–656. https://doi.org/10.1080/10410236.2012.762824, 2013) posits that an online prevention program’s impact depends on how engaged participants are. In practice, measuring engagement in this context has relied primarily on self-report measures (e.g., Hamutoglu et al. in Educ Tech Res Dev. https://doi.org/10.1007/s11423-019-09705-z, 2019). However, the emergence and growth of online learning platforms to deliver health-specific information offers other options for assessing engagement. This includes program analytics that capture interaction with content and facilitate examination of patterns via multiple indicators such as responses to interactive questions and time spent in the program (Herodotou et al. in Educ Technol Res Devel 67:1273. https://doi.org/10.1007/s11423-019-09685-0, 2019; Li et al. 2019; van Leeuwen in Educ Tech Res Dev 67:1043. https://doi.org/10.1007/s11423-018-09639-y, 2019). However, little is known about the relationships between these different indicators of engagement as it applies to health curricula. This study uses self-report, observational, and program analytic data collected on a small (N = 38) sample using REAL media, an online substance use prevention program, to examine relationships among various indicators of engagement. Findings suggest a cluster of indicators across the three modalities that provide a useful way of measuring engagement. A cluster centered around complexity suggests a separate factor to be considered when designing engaging interventions.
Purpose
The overarching goal of this study was to provide key information on how adolescents' substance use has changed since the corona virus disease (COVID)-19 pandemic, in addition to key contexts and correlates of substance use during social distancing.
Methods
Canadian adolescents (n = 1,054, Mage = 16.68, standard deviation = .78) completed an online survey, in which they reported on their frequency of alcohol use, binge drinking, cannabis use, and vaping in the 3 weeks before and directly after social distancing practices had taken effect.
Results
For most substances, the percentage of users decreased; however, the frequency of both alcohol and cannabis use increased. Although the greatest percentage of adolescents was engaging in solitary substance use (49.3%), many were still using substances with peers via technology (31.6%) and, shockingly, even face to face (23.6%). Concerns for how social distancing would affect peer reputation was a significant predictor of face-to-face substance use with friends among adolescents with low self-reported popularity, and a significant predictor of solitary substance use among average and high popularity teens. Finally, adjustment predictors, including depression and fear of the infectivity of COVID-19, predicted using solitary substance use during the pandemic.
Conclusions
Our results provide preliminary evidence that adolescent substance use, including that which occurs face to face with peers, thereby putting adolescents at risk for contracting COVID-19, may be of particular concern during the pandemic. Further, solitary adolescent substance use during the pandemic, which is associated with poorer mental health and coping, may also be a notable concern worthy of further investigation.
This study examines effects of a randomized controlled trial for an online, family-based prevention program for older teens, Smart Choices 4 Teens, on alcohol use and related outcomes. Families (N = 411; teen age M = 16.4, SD = 0.5) were randomly assigned to the intervention or control condition in 2014–2015. Both intent to treat (ITT) and dosage models were conducted. ITT models: At the 6-month follow-up, teens in the experimental condition reported fewer friends who had been drunk, and parents in the experimental group reported more communication about social host laws. At the 12-month follow-up, parents in the experimental condition reported consuming fewer drinks than parents in the control group. Dosage models: At the 6-month follow-up, dosage was inversely related to teen drinking in the past 6 months or 30 days, frequency of teen drinking during the past 6 months and 30 days, drinks consumed by teens over the past 6 months, teen drunkenness and binge-drinking during the past 30 days, teen reported communication about safe drinking and positively related to parent and teen reported communication about social host laws. At 12 months, dosage was inversely related to teen alcohol use, frequency of teen drinking over the past 30 days, drinks consumed by teens over the past 6 months and 30 days, and teen drunkenness over the past 6 months. Results suggest that Smart Choices 4 Teens is beneficial for families. Dissemination and implementation strategies that motivate completion of program content will improve outcomes related to older teens’ alcohol use.
Objective:
Engagement with smartphone applications (apps) for alcohol reduction is necessary for their effectiveness. This study explored (1) the features that are ranked as most important for engagement by excessive drinkers and (2) why particular features are judged to be more important for engagement than others.
Methods:
Two studies were conducted in parallel. The first was a focus group study with adult excessive drinkers, interested in reducing alcohol consumption using an app (ngroups = 3). Participants individually ranked their top 10 features from a pre-specified list and subsequently discussed their rankings. The second was an online study with a new sample (n = 132). Rankings were analysed using the intraclass correlation coefficient (ICC) to assess the level of agreement between raters for each study. Qualitative data were analysed using inductive thematic analysis.
Results:
There was low agreement between participants in their rankings, both in the focus groups (ICC = 0.15, 95% confidence interval (CI) = 0.03-0.38) and the online sample (ICC = 0.11, 95% CI = 0.06-0.23). 'Personalisation', 'control features' and 'interactive features' were most highly ranked in the focus groups. These were expected to elicit a sense of benefit and usefulness, adaptability, provide motivational support or spark users' interest. Results from the online study partly corroborated these findings.
Conclusion:
There was little agreement between participants, but on average, the features judged to be most important for inclusion in smartphone apps for alcohol reduction were personalisation, interactive features and control features. Tailoring on users' underlying psychological needs may promote engagement with alcohol reduction apps.
Background:
Online substance-use interventions are effective in producing reductions in harmful-use. However, low user engagement rates with online interventions reduces overall effectiveness of interventions. Identifying optimal strategies with which to engage users with online substance-use interventions may improve usage rates and subsequent effectiveness.
Objectives:
(1) To identify the most prevalent engagement promoting strategies utilised to increase use of online substance-use interventions. (2) To determine whether the identified engagement promoting strategies increased said use of online substance-use interventions.
Review methods:
The reviewed followed Cochrane methodology. Databases were searched for online substance-use interventions and engagement promoting strategies limited by study type (randomised controlled trial). Due to heterogeneity between engagement promoting strategies and engagement outcomes, meta-analytic techniques were not possible. Narrative synthesis methods were used.
Results:
Fifteen studies were included. Five different engagement promoting strategies were identified: (1) tailoring; (2) delivery strategies; (3) incentives; (4) reminders; (5) social support. The most frequently reported engagement promoting strategies was tailoring (47% of studies), followed by reminders and social support (40% of studies) and delivery strategies (33% of studies). The narrative synthesis demonstrated that tailoring, multimedia delivery of content and reminders are potential techniques for promoting engagement. The evidence for social support was inconclusive and negative for incentives.
Conclusions:
This review was the first to examine engagement promoting strategies in solely online substance-use interventions. Three strategies were identified that may be integral in promoting engagement with online substance-use interventions. However, the small number of eligible extracted studies, inconsistent reporting of engagement outcomes and diversity of engagement features prevent firmer conclusions. More high-quality trials examining engagement are required.
Objective
Parents and peers exert significant influence on a young person’s decision to consume alcohol. This study examines the relationship between parental monitoring and adolescent alcohol consumption and tests whether peer substance use and tolerance of use mediates the relationship between monitoring and drinking.
Method
Participants included 116 adolescents (53.5% female; Mage = 15.6). All participants reported drinking alcohol in the past 6 months, and 96 participants had been previously admitted to a hospital emergency department for an alcohol-related event. Mediation analyses were used to test the study hypotheses.
Results
The total effect of baseline parental monitoring on 6-month alcohol use was −1.15 (p < .01), with higher monitoring related to less use. Controlling for peer use and tolerance of use, the effect of parental monitoring was reduced to .46, leaving an indirect effect of .69 (p < .01). Peer use and tolerance of use had no effect on participant alcohol use when controlling for parental monitoring.
Conclusions
Study findings extend current knowledge about the interactive effects of parental supervision and peer influence on the drinking patterns of adolescents. Results underscore the importance of addressing both parental monitoring and peer influence in interventions that target adolescent alcohol use, recognizing peer factors as a potential mechanism of the effect that parental monitoring has on adolescent drinking.
User engagement (UE) and its measurement have been of increasing interest in human-computer interaction (HCI). The User Engagement Scale (UES) is one tool developed to measure UE, and has been used in a variety of digital domains. The original UES consisted of 31-items and purported to measure six dimensions of engagement: aesthetic appeal, focused attention, novelty, perceived usability, felt involvement, and endurability. A recent synthesis of the literature questioned the original six-factors. Further, the ways in which the UES has been implemented in studies suggests there may be a need for a briefer version of the questionnaire and more effective documentation to guide its use and analysis. This research investigated and verified a four-factor structure of the UES and proposed a Short Form (SF). We employed contemporary statistical tools that were unavailable during the UES’ development to re-analyze the original data, consisting of 427 and 779 valid responses across two studies, and examined new data (N=344) gathered as part of a three-year digital library project. In this paper we detail our analyses, present a revised long and short form (SF) version of the UES, and offer guidance for researchers interested in adopting the UES and UES-SF in their own studies.
Background
Implementation outcome measures are essential for monitoring and evaluating the success of implementation efforts. Yet, currently available measures lack conceptual clarity and have largely unknown reliability and validity. This study developed and psychometrically assessed three new measures: the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM).
Methods
Thirty-six implementation scientists and 27 mental health professionals assigned 31 items to the constructs and rated their confidence in their assignments. The Wilcoxon one-sample signed rank test was used to assess substantive and discriminant content validity. Exploratory and confirmatory factor analysis (EFA and CFA) and Cronbach alphas were used to assess the validity of the conceptual model. Three hundred twenty-six mental health counselors read one of six randomly assigned vignettes depicting a therapist contemplating adopting an evidence-based practice (EBP). Participants used 15 items to rate the therapist’s perceptions of the acceptability, appropriateness, and feasibility of adopting the EBP. CFA and Cronbach alphas were used to refine the scales, assess structural validity, and assess reliability. Analysis of variance (ANOVA) was used to assess known-groups validity. Finally, half of the counselors were randomly assigned to receive the same vignette and the other half the opposite vignette; and all were asked to re-rate acceptability, appropriateness, and feasibility. Pearson correlation coefficients were used to assess test-retest reliability and linear regression to assess sensitivity to change.
Results
All but five items exhibited substantive and discriminant content validity. A trimmed CFA with five items per construct exhibited acceptable model fit (CFI = 0.98, RMSEA = 0.08) and high factor loadings (0.79 to 0.94). The alphas for 5-item scales were between 0.87 and 0.89. Scale refinement based on measure-specific CFAs and Cronbach alphas using vignette data produced 4-item scales (α’s from 0.85 to 0.91). A three-factor CFA exhibited acceptable fit (CFI = 0.96, RMSEA = 0.08) and high factor loadings (0.75 to 0.89), indicating structural validity. ANOVA showed significant main effects, indicating known-groups validity. Test-retest reliability coefficients ranged from 0.73 to 0.88. Regression analysis indicated each measure was sensitive to change in both directions.
Conclusions
The AIM, IAM, and FIM demonstrate promising psychometric properties. Predictive validity assessment is planned.
Electronic supplementary material
The online version of this article (doi:10.1186/s13012-017-0635-3) contains supplementary material, which is available to authorized users.
Media literacy interventions offer promising avenues for the prevention of risky health behaviors among children and adolescents, but current literature remains largely equivocal about their efficacy. The primary objective of this study was to develop and test theoretically-grounded measures of audiences' degree of engagement with the content of media literacy programs based on the recognition that engagement (and not participation per se) can better explain and predict individual variations in the effects of these programs. We tested the validity and reliability of a measure of engagement with two different samples of 10(th) grade high school students who participated in a pilot and actual test of a brief media literacy curriculum. Four message evaluation factors (involvement, perceived novelty, critical thinking, personal reflection) emerged and demonstrate acceptable reliability.
This study examined the feasibility and preliminary efficacy of a brief parent-based prevention intervention to delay or prevent the initiation of alcohol and drug use in young adolescents with emotional/behavioral disorders. Findings from a small randomized clinical trial comparing the individualized family substance use preventive intervention based on the Family Check-Up model (FCU condition) to a Psychoeducation (PE) session revealed that parents in both conditions reported an increase in alcohol-related communication at three and six months as well as an increase in general family communication. Parents in the FCU condition reported an increase on overall substance-related communication, and reported experiencing less problematic family communication compared to those in PE. Parents in the PE condition reported greater increases in parental monitoring than parents in the FCU condition. Study findings suggest a larger trial is indicated to test individual and family factors that lead to differential efficacy of these preventive interventions.
The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations.
The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study.
Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
Objective:
The study evaluated the timing and dosage of a parent-based intervention to minimize alcohol consumption for students with varying drinking histories.
Method:
First-year students (N = 1,900) completed Web assessments during the summer before college (baseline) and two follow-ups (fall of first and second years). Students were randomized to one of four conditions (pre-college matriculation [PCM], pre-college matriculation plus boosters [PCM+B], after college matriculation [ACM], and control conditions). Seven indicators of drinking (drink in past month, been drunk in past month, weekday [Sunday to Wednesday] drinking, Thursday drinking, weekend [Friday, Saturday] drinking, heavy episodic drinking in past 2 weeks, and peak blood alcohol concentration <.08) were used in a latent transition analysis (LTA) to examine a stage-sequential model of drinking. LTA models with dummy-coded intervention variables were used to examine the effects of the intervention conditions on changes in drinking patterns.
Results:
Results indicated that four patterns of drinking were present at all waves: (a) nondrinkers, (b) weekend light drinkers, (c) weekend heavy episodic drinkers, and (d) heavy drinkers. Results indicated that the PCM condition was most effective at influencing baseline heavy drinkers' transition out of this pattern to lower risk patterns at first follow-up, whereas the ACM condition was not effective at preventing drinking escalation for baseline nondrinkers at first follow-up. No decay of effects was observed at long-term follow-up for the PCM condition. Finally, the results also indicated that increased dosage of the parental intervention was not significantly associated with either reduction or escalation of use.
Conclusions:
The results underscore the value of pre-college parental interventions and targeted efforts to reduce high-risk drinking among college students.
Many eHealth technologies are not successful in realizing sustainable innovations in health care practices. One of the reasons for this is that the current development of eHealth technology often disregards the interdependencies between technology, human characteristics, and the socioeconomic environment, resulting in technology that has a low impact in health care practices. To overcome the hurdles with eHealth design and implementation, a new, holistic approach to the development of eHealth technologies is needed, one that takes into account the complexity of health care and the rituals and habits of patients and other stakeholders.
The aim of this viewpoint paper is to improve the uptake and impact of eHealth technologies by advocating a holistic approach toward their development and eventual integration in the health sector.
To identify the potential and limitations of current eHealth frameworks (1999-2009), we carried out a literature search in the following electronic databases: PubMed, ScienceDirect, Web of Knowledge, PiCarta, and Google Scholar. Of the 60 papers that were identified, 44 were selected for full review. We excluded those papers that did not describe hands-on guidelines or quality criteria for the design, implementation, and evaluation of eHealth technologies (28 papers). From the results retrieved, we identified 16 eHealth frameworks that matched the inclusion criteria. The outcomes were used to posit strategies and principles for a holistic approach toward the development of eHealth technologies; these principles underpin our holistic eHealth framework.
A total of 16 frameworks qualified for a final analysis, based on their theoretical backgrounds and visions on eHealth, and the strategies and conditions for the research and development of eHealth technologies. Despite their potential, the relationship between the visions on eHealth, proposed strategies, and research methods is obscure, perhaps due to a rather conceptual approach that focuses on the rationale behind the frameworks rather than on practical guidelines. In addition, the Web 2.0 technologies that call for a more stakeholder-driven approach are beyond the scope of current frameworks. To overcome these limitations, we composed a holistic framework based on a participatory development approach, persuasive design techniques, and business modeling.
To demonstrate the impact of eHealth technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate health care. It also requires new concepts and instruments to develop and implement technologies in practice. The proposed framework serves as an evidence-based roadmap.
A randomized controlled trial, using parent-based intervention (PBI) was designed to reduce the incidence of alcohol-involved sexual victimization among first-year college students. The PBI, adapted from Turrisi et al. (2001), was designed to increase alcohol-specific and general communication between mother and daughter. Female graduating high school seniors and their mothers were recruited from the community and randomly assigned to one of four conditions: Alcohol PBI (n = 305), Enhanced Alcohol + Sex PBI (n = 218), Control (n = 288) or Unmeasured Control (n = 167). Mothers in the intervention conditions were provided an informational handbook and encouraged to discuss its contents with their daughters prior to college matriculation. Consistent with hypotheses, PBI, either standard or enhanced, was associated with lower incidence of incapacitated rape in the first year of college relative to controls. Path analysis revealed support for a hypothesized indirect effects model, by which intervention increased mother-daughter communication, which predicted lower frequency of first semester heavy episodic drinking, resulting in lower rates of alcohol-involved sexual victimization in the first year of college.
The current study is a multisite randomized alcohol prevention trial to evaluate the efficacy of both a parenting handbook intervention and the Brief Alcohol Screening and Intervention for College Students (BASICS) intervention, alone and in combination, in reducing alcohol use and consequences among a high-risk population of matriculating college students (i.e., former high school athletes).
Students (n = 1,275) completed a series of Web-administered measures at baseline (in the summer before starting college) and follow-up (after 10 months). Students were randomized to one of four conditions: parent intervention only, BASICS only, combined (parent and BASICS), and assessment-only control. Intervention efficacy was tested on a number of outcome measures, including peak blood alcohol concentration, weekly and weekend drinking, and negative consequences. Hypothesized mediators and moderators of intervention effect were tested.
The overall results revealed that the combined-intervention group had significantly lower alcohol consumption, high-risk drinking, and consequences at 10-month follow-up, compared with the control group, with changes in descriptive and injunctive peer norms mediating intervention effects.
The findings of the present study suggest that the parent intervention delivered to students before they begin college serves to enhance the efficacy of the BASICS intervention, potentially priming students to respond to the subsequent BASICS session.
The research evaluated the efficacy of an intervention to reduce the onset and extent of binge drinking during the 1st year of college. The approach was on influencing the students before they start college, through their parents, during the critical time between high school graduation and the beginning of college. Specifically, parents were educated about binge drinking and how to convey information to their teens, and then encouraged to talk with their teens just before their teens embarked on their college education. Teens whose parents implemented the intervention materials were compared with a control sample during their 1st semester on drinking outcomes, perceptions about drinking activities, perceived parental and peer approval of drinking, and drinking-related consequences. As anticipated, teens in the treatment condition were significantly different (p < .05) on nearly all outcomes in the predicted directions (e.g., lower drinking tendencies, drinking consequences). The benefits of a parent-based intervention to prevent college drinking are discussed.
Purpose
Evaluate changes in early adolescent substance use during the coronavirus disease 2019 (COVID-19) pandemic using a prospective, longitudinal, nationwide cohort.
Methods
Participants were enrolled in the Adolescent Brain Cognitive Development Study. A total of 7,842 youth (mean age = 12.4 years, range = 10.5–14.6) at 21 study sites across the U.S. completed a three-wave assessment of substance use between May and August 2020. Youth reported whether they had used alcohol, nicotine, cannabis, or other substances in the past 30 days. Data were linked to prepandemic surveys that the same youth had completed in the years 2018–2020, before the advent of the COVID-19 pandemic.
Results
Past-30-day substance use remained stable in the 6 months since stay-at-home orders were first issued in U.S. states/counties; was primarily episodic (1–2 days in the past month); and was typically limited to a single substance. Using pretest/posttest and age-period designs, we found that compared to before the pandemic, fewer youth were using alcohol and more youth were using nicotine or misusing prescription drugs. During the pandemic, youth were more likely to use substances when they were more stressed by pandemic-related uncertainty; their family experienced material hardship; their parents used alcohol or drugs; or they experienced greater depression or anxiety. Neither engagement in social distancing nor worry about COVID-19 infection was associated with substance use. Several risk factors were stronger among older (vs. younger) adolescents.
Conclusions
Among youth in early adolescence, advent of the COVID-19 pandemic was associated with decreased use of alcohol and increased use of nicotine and misuse of prescription drugs.
The current study examines the relationships among adolescent reports of parent–adolescent drug talk styles, family communication environments (e.g., expressiveness, structural traditionalism, and conflict avoidance), and adolescent substance use. ANCOVAs revealed that the 9th grade adolescents (N = 718) engaged in four styles of “drug talks” with parents (e.g., situated direct, ongoing direct, situated indirect, and ongoing indirect style) and these styles differed in their effect on adolescent substance use. Multiple regression analyses showed that expressiveness and structural traditionalism were negatively related to adolescent substance use, whereas conflict avoidance was positively associated with substance use. When controlling for family communication environments and gender, adolescents with an ongoing indirect style reported the lowest use of substance. The findings suggest implications and future directions for theory and practice.
Despite the increasing relevance of peers, parents remain important socializing agents for their adolescent children and are therefore promising agents for inclusion in prevention or intervention programs. This systematic review provides an overview of the effectiveness of parent-based programs in preventing, curbing or reducing substance use (i.e. alcohol, tobacco and cannabis) among 10 to 18-year-olds. The databases PubMed, PsychInfo, Eric and Google Scholar were used to identify randomized trials published within the past 12 years evaluating effects on adolescent substance use. Of the 653 identified in the first screening, 39 publications dealing with 13 programs were included. Results reveal desirable effects of parenting measures such as rule-setting, monitoring and parent-child communication. There was also some evidence in terms of preventing, curbing or reducing adolescent substance use. However, this appears to depend particularly on the age group of the adolescents in question, the kind of parents included and the intensity of the program. To conclude, the results of this systematic review underline the importance of including parents in programs aiming to impede initiation of substance use or curb or reduce already existing substance use in adolescence.
This study investigates how changes in alcohol use-specific parenting were associated with adolescent drinking trajectories. Three waves of data from a longitudinal study investigating adolescent substance use were used. The community sample (N=378) was aged 10-13 at the first wave of assessment. Our findings show that over time, parents are less likely to discipline their adolescents' drinking, more likely to grant their adolescent permission to drink, and less likely to communicate the consequences of alcohol use. Moreover, these changes are associated with escalation in adolescent alcohol use. Parental efficacy at preventing alcohol use declined, but did not relate to changes in adolescent drinking.
This study evaluated the effectiveness of a parent based intervention (PBI) in reducing drinking among first year college students (N=443). Students were assigned to one of three conditions: PBI, PBI plus booster brochures (PBI-B), and an assessment only control group (CNT). At a 4-month post-intervention follow-up, results indicated students in the PBI-B group reported significantly less drinking to intoxication and peak drinking relative to the PBI group and CNT group. No significant differences were found between the PBI group and CNT group. Results provide further support for PBIs to reduce college student drinking and suggest that a booster brochure increases the effectiveness of PBIs.
Although parent-adolescent communication has been identified as important in delaying the onset and escalation of alcohol use, both the strength and direction of observed associations have varied in prior research with adolescents and college students. The current study categorizes parents according to alcohol-related communication and relates these categories to other parenting factors and late adolescent alcohol involvement.
As part of a larger study, 1007 college-bound teens and their parents were assessed. Teens were asked to report on their drinking behavior, and parents were asked about the occurrence of several specific alcohol-related communications with their teen, as well as additional parenting characteristics. Profiles of parent alcohol-related communication were derived using latent class analysis. Once the best fitting solution was determined, covariates were entered predicting class membership and investigating how classes were associated with additional parenting characteristics and teen alcohol use.
A five-class solution provided the best fit to the data: Frequent, All Topics (28%); Moderate, All Topics (25%); Frequent, General Topics (25%); Frequent, Consequences and Limits (12%); and Infrequent, All Topics (10%). Covariate analyses demonstrated class differences with regard to parental modeling, monitoring, knowledge, and parent-teen relationship satisfaction, as well as for students' intentions to join fraternities/sororities and alcohol use.
Findings from the current study add to a small but growing literature supporting the continuing influence of parents in late adolescence and suggest that the frequency and specificity of parent-teen communication are potentially informative for refined parent-based preventive interventions.
Despite research suggesting that parental involvement can affect alcohol involvement among adolescents, few studies have focused on parent-based alcohol prevention strategies among college undergraduates. We report the results of a randomized trial of a parent-based intervention (PBI) in a sample of college freshmen.
Across two cohorts, 724 incoming freshman-parent dyads completed baseline assessments and were randomly assigned to PBI or intervention as usual (an alcohol fact sheet for parents). Student follow-up assessments were completed at 4 and 8 months.
Two-part latent growth curve modeling was used to test hypothesized intervention effects. Outcome variables were drinks per week (past month), heavy episodic drinking (past 2 weeks), and alcohol-related problems (past 3 months). Over the 8-month follow-up period, PBI had a significant effect on drinks per week but not heavy episodic drinking or alcohol-related problems. Specifically, compared with students in the intervention-as-usual condition, students receiving the PBI were significantly less likely to transition from nondrinker to drinker status and showed less growth in drinking over the freshman year. However, the direct PBI effect on growth was qualified by a PBI x Gender interaction, with probes indicating that the effect applied to women but not men in the PBI condition.
This study extends previous research by demonstrating the potential utility for PBIs to decrease the likelihood of transitioning into drinker status and, at least for women, for slowing growth in drinking over the freshman year.