Gambling Prevention Program Among Children

Evaluation of Effectiveness of the Unplugged Program on Gambling Behaviours among Adolescents: Study Protocol of the Experimental Controlled Study "GAPUnplugged"

Gambling risk behaviour is an emerging problem among adolescents. "Unplugged" is an effective Social Influence curriculum for preventing substance use among students. This study aims to develop and test a new component focused on gambling added to the Unplugged program. Schools of Piedmont region and Rome city were invited to participate in the study. A self-completed anonymous questionnaire including questions on socio-demographic characteristics, addictive behaviours, beliefs, attitudes and risk perceptions about gambling, normative perceptions, parental practices, school climate, refusal skills, impulsiveness, self-esteem, antisocial behaviours and sensation seeking was prepared for baseline and follow-up surveys. The protocol of the study was submitted and approved by the Novara Ethical Committee and registered in ClinicalTrials.gov (NCT05630157, Protocol ID: 080.742, 11/17/2022). Twenty-nine schools accepted to participate in the study. Sixty-three classes (1325 students) satisfied the eligibility criteria for intervention and were allocated to the intervention arm, and the other 61 (1269 students) were allocated to the control arm. Because of drop-out, absentees, refusals, and invalid questionnaires, data on 1874 students (998 in the intervention and 876 in the control arm), were available for the analysis at baseline. Data management of follow-up questionnaires is in progress. Results of the present study will be useful to clarify the effectiveness of prevention interventions in reducing gambling behaviours among adolescents. Moreover, this will be the first experience of evaluating a new component focused on a different risk behaviour, added to a curriculum previously shown as effective on other risk behaviours.

A School-Based Program for Problematic Internet Use for Adolescents in Japan

Despite the serious influence of problematic Internet use on mental health among Japanese adolescents, no randomized clinical trials have investigated universal school-based interventions for this potential health challenge. Therefore, this study aimed to assess the efficacy of a school-based educational program. This two-armed, parallel, cluster-based randomized clinical trial included 5312 students from 13 high schools situated in a mid-sized Japanese city. The students in the intervention arm received 10 weekly standardized sessions, including a combination of information provision and interactive sessions by schoolteachers. The students in the control group followed a standard school curriculum. A generalized estimating equation model was applied to assess the primary (Korean Scale for Internet Addiction [K-scale] score) and secondary (behavioral change status according to changes in the transtheoretical model smartphone addiction score and Internet usage time) outcomes two months after intervention completion. The intention-to-treat analysis included 2597 (97.2%) and 2504 (94.9%) students in the intervention and control groups, respectively. Nevertheless, a significant discrepancy emerged regarding the behavioral change status. Therefore, this school-based program did not improve the Internet or smartphone addiction scores among Japanese adolescents. Further studies are needed to develop appropriate interventions for adolescents.

Preventive Gambling Programs for Adolescents and Young Adults: A Systematic Review

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

Systematic Review: Preventive Intervention to Curb the Youth Online Gambling Problem

This systematic review focuses on all the gambling addiction prevention programs carried out in schools, with the intention of making their effectiveness known and encouraging the creation of more such programs. During the third quarter of 2021, an exhaustive search was conducted using the databases of Scopus, Medline (via Pubmed), WOS, and PsycINFO. The search strategy was based on a combination of specific search terms: “Gambling Disorder [Mesh]”, “Online Gambling Disorder [Mesh]”, and “Prevention Programs [Mesh]”. A total of 15 articles were chosen for systematic review. All the programs analyzed show effective results, although there are several methodological shortcomings in the way they are conducted. Effective programs need to focus more on long-term results and the emotional aspects of gambling. We need professionals who can convey the causal nature of the problem the youth are facing.

Optimizing large-scale gambling prevention with adolescents through the development and evaluation of a training course for health professionals: The case of PRIZE

In the field of adolescent gambling prevention, there is a lack of intervention studies reporting and assessing training courses for the intervention providers. The present work fills this gap by realizing a dissemination study inside the PRIZE program aimed at modifying a set of cognitive protective factors and affective risk factors. The purpose of this work was twofold: To develop and evaluate a training course with the intervention providers (Study 1), and to assess the short- and long-term effects of the intervention itself (Study 2). The training course was delivered to 44 health professionals (32 females, M_age = 39.34 years). Results showed a significant increase of correct knowledge about gambling and a significant reduction of their susceptibility to probabilistic reasoning biases. Participants also actually learnt the main competencies to conduct the educational activities, they were satisfied for the training course received, and they felt high levels of self-efficacy. The intervention was implemented with 1894 high school students (61% males; M_age = 15.68 years). In the short term, we found a significant increase of adolescents’ correct gambling knowledge, random events knowledge, and probabilistic reasoning ability, and a significant decrease of superstitious thinking, monetary positive outcome expectation, and gambling-related erroneous thoughts and fallacious behavioral choices. In the long-term, a significant decrease of gambling frequency, gambling versatility, and gambling problem severity was obtained. Overall, this work highlights the importance to train prevention program providers in order to optimize the effectiveness of large-scale gambling intervention programs towards adolescents.

Ludens: A Gambling Addiction Prevention Program Based on the Principles of Ethical Gambling

Gambling is legal in most countries. However, despite having some economic benefits, certain characteristics of gambling can have health consequences, rendering it a public health issue. The effects can be summarized according to the following three "laws" of ethical gambling: "Gambling Dynamics Law": companies' economic gains come directly from players' losses; "Expected Loss Law": the more one gambles, the greater the probability of losing; and "Addiction Law": the more one gambles, the greater the need to play again, leading to further losses. Ludens is a gambling addiction prevention program that has four goals: inform participants about gambling and gambling addiction; sensitize participants to the risk of gambling for health, especially addiction; promote a change in attitudes toward gambling; and alert participants to risky behaviors that can lead to addiction. The prevention program was implemented during 2017 to 2019. Fourteen psychologists presented it to 2372 adolescents (48.8% females, 51.2% males) aged 14-19 years, none of whom were university students, recruited from 42 Spanish high schools in 132 groups taking different courses. The main dependent variables analyzed were the monthly frequencies of gambling, at-risk gambling, and gambling addiction (as measured by the National Opinion Research Center DSM-IV Screen for Gambling Problems, adapted to diagnose gambling disorder according to DSM-5, in which pathological gambling is considered an addictive disorder). Given that all of the gamblers were adolescents (most were minors), fulfilment of 1-3 the DSM-5 diagnostic criteria was considered to indicate a risk of problem gambling. After the administration of Ludens, statistically significant reductions were observed in the three variables of interest: monthly frequency of gambling, percentage of adolescents with risky gambling, and percentage of adolescents with gambling disorder. The results were analyzed according to sex and age (minors vs. adolescents between 18 and 19 years old). The results obtained after applying the prevention program indicate that Ludens is effective as a universal prevention program for gambling addiction.

The Efficacy of a Gambling Prevention Program Among High-School Students

Youth problem gambling has become an emergent public health issue, and adolescents constitute a vulnerable age group for the development of gambling-related problems. Although there is research concerning the risk factors of youth problem gambling, rigorous evaluations of the effectiveness of preventive initiatives is still rare. The present study evaluated the efficacy of an integrative intervention to prevent youth problem gambling based on a multidimensional set of factors including gambling-related knowledge, misconceptions, attitudes, gambling frequency, amount of money spent, total hours spent gambling per week, and sensation seeking. A pre- and post-test design was performed with 111 Portuguese high-school students randomly assigned to two groups (experimental and control). The findings demonstrated that the intervention was effective in improving correct knowledge about gambling, reducing misconceptions and attitudes, and in decreasing the total hours spent gambling per week. The intervention was also effective in reducing the number of at-risk/problem gamblers during the study period. Furthermore, these findings were stable after a 6-week follow-up. Overall, the intervention program appeared to be effective in correcting some gambling-related behaviours, and provides suggestions for future interventions.

Gambling in adolescence: a narrative review of the last 20 years

BACKGROUND

Gambling has increasingly become a problem in adolescence over the last 20 years. Previous research has failed to identify exactly the level of involvement of adolescents in gambling, yet a relevant presence of addictive behaviors was noticed.

OBJECTIVE

This narrative review highlights the implications of adolescent gambling, taking into consideration the main risk and protection factors aimed at limiting gambling activity, as well as the main links with the impulse-control disorder, addiction, and behavioral addiction.

METHODS

The review process was conducted through Medline, Scopus, Web of Science and Google Scholar search engines. The considered keywords were "Gambling" AND "Adolescence," "Behavioral addiction," AND "Adolescence." The articles related to gambling and adolescence in the last 20 years were included in compliance with inclusion and exclusion criteria, to perform a consistent analysis of the phenomenon and the related maintenance factors.

RESULTS

Starting from 1067 articles, 107 were selected to denote the main thematic areas involved in the gambling problem. The online search was completed on December 13, 2019.

CONCLUSIONS

The narrative review of literature can facilitate the analysis of gambling problems in adolescence, as the main studies in the last 20 years showed the complexity of the problem, the links between addiction, and the most effective methods of prevention and treatment.

A Perspective on Age Restrictions and Other Harm Reduction Approaches Targeting Youth Online Gambling, Considering Convergences of Gambling and Videogaming

Internet gambling has become a popular activity among some youth. Vulnerable youth may be particularly at risk due to limited harm reduction and enforcement measures. This article explores age restrictions and other harm reduction measures relating to youth and young adult online gambling. A systematic rapid review was conducted by searching eight databases. Additional articles on online gambling (e.g., from references) were later included. To place this perspective into context, articles on adult gambling, land-based gambling, and substance use and other problematic behaviors were also considered. Several studies show promising findings for legally restricting youth from gambling in that such restrictions may reduce the amount of youth gambling and gambling-related harms. However, simply labeling an activity as "age-restricted" may not deter youth from gambling; in some instances, it may generate increased appeal for gambling. Therefore, advertising and warning labels should be examined in conjunction with age restrictions. Recommendations for age enforcement strategies, advertising, education, and warning labels are made to help multiple stakeholders including policymakers and public health officials internationally. Age restrictions in online gambling should consider multiple populations including youth and young adults. Prevention and harm reduction in gambling should examine how age-restriction strategies may affect problem gambling and how they may be best enforced across gambling platforms. More research is needed to protect youth with respect to online gambling.

How learning misconceptions can improve outcomes and youth engagement with gambling education programs

BACKGROUND AND AIMS

Gambling education programs typically focus on promoting gambling as a high-risk activity with harmful effects; however, these programs demonstrate limited effects on the prevention of gambling problems. This paper proposes a clear theoretical framework to inform the content and delivery of gambling education initiatives and draws on psychological and pedagogical research to address some of the practical issues associated with its implementation.

METHODS

Literature was reviewed across fields of psychology, public health, and pedagogy to provide key recommendations to improve the outcomes of gambling education.

RESULTS

Four key recommendations were made for the development of future gambling education programs centering on theoretical approach, specialized content, and delivery.

DISCUSSION AND CONCLUSIONS

Recommended advancements are as follows: (a) evidence suggests shifting away from messages about gambling harms and instead applying a cognitive-developmental framework of problem gambling that may improve youth engagement by increasing personal relevance. (b) The cognitive model of problem gambling suggests that misconceptions about the profitability of gambling games (e.g., the gambler's fallacy) play an important role in the development of problems and should be a key target for education. However, exposing such misconceptions requires the challenge of teaching the mathematical principles that underpin them. (c) The pedagogical field provides valuable insights into teaching complex concepts. Research that applies the conceptual change model to science education suggests misconceptions also facilitate learning new complex information, such as gambling-related mathematical concepts (i.e., randomness and statistics). (d) In addition, improvements in computer-assisted teaching methods provide opportunities to use simulations and visualizations to help teach abstract concepts and correct such misconceptions.

Gambling disorder

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

A process evaluation of the 'Aware' and 'Supportive Communities' gambling harm-minimisation programmes in New Zealand

Background

The Gambling Act 2003 mandated a public health strategy for preventing and minimising gambling harm in New Zealand. Aware Communities and Supportive Communities are two public health programmes subsequently implemented nationwide. These programmes differed from common health promotion initiatives such as media or education campaigns as they were community-action based (requiring community involvement in programme planning and delivery). We carried out a process evaluation to determine their implementation effectiveness and inform improvement and future programme planning.

Methods

Our qualitative dominant mixed methods design comprised analysis of over a hundred implementer progress reports (submitted July 2010 - June 2013), a staff survey and a staff focus group interview.

Results

The programmes demonstrated capacity to not only achieve expected outcomes (e.g. enhanced community awareness about harmful gambling), but also to enhance social sustainability at the community level (e.g. established trustful relationships) and achieve some programme sustainability (e.g. community ownership over ongoing programme delivery).

Conclusions

The evaluation noted the potential for a sustainable gambling harm-minimisation model. Community-action based harm-minimisation programmes offer programme sustainability potential which in turn offers funding cost-effectiveness when there are continual public health outcomes beyond initial funding. Although resource intensive, the community-action based approach enables culturally appropriate public health programmes suitable for societies where specific ethnic groups have higher gambling risk. Recognition of such harm-minimisation programmes' contribution to social sustainability is important considering the potential for broader public health outcomes (e.g. better life quality, lesser social problems) within socially sustainable societies.

Long-term effectiveness of a gambling intervention program among children in central Illinois

Youth gambling is an increasing concern. As a response, the "Don't Gamble Away our Future (DGAOF)" program has been implemented among children in central Illinois. We aim to assess the long-term effectiveness of this school-based youth gambling prevention program in Illinois using the data from 2005 to 2009. The intervention included interactive PowerPoint presentations and prevention materials in parent packets. Students aged 8 to 18 years were eligible to participate in the intervention and the questionnaire pre-post knowledge tests (total score 0-9). Students in 5th grade and above also received a gambling behavior screen test using the Modified South Oaks Gambling Screening for Teens (MSOGST) for identifying probable gamblers. Multivariable generalized mixed models were conducted to detect the effects of a 5-year youth gambling prevention program as controlling potential confounders. A total of 16,262 and 16,421 students completed pre-post tests and MSOGST tests, respectively. Of 16,262, half were female, the majority (76.1%) were from senior high school, and 21.3% received the intervention at least twice. The median gap between interventions was 368 days. Students receiving multiple interventions had higher scores on the pre-test as compared to those receiving a single intervention (P<0.001 for all comparisons among groups), and they demonstrated an increasing trend of awareness about gambling over time (P<0.001 for multiple interventions; P = 0.538 for single intervention). The prevalence of problem gambling had decreased among students receiving the intervention twice as compared to receiving the intervention once (7.9% versus 9.4%; OR = 0.89, 95% CL: 0.82-0.97). However, this effect was not confirmed among students receiving the intervention three or more times. In conclusion, the DGAOF program has demonstrated a positive long-term impact on increasing gambling knowledge and partially reducing pathological gamblers through direct training. It suggests that multiple repeated interventions are important for youth gambling prevention.

School-based Prevention for Adolescent Internet Addiction: Prevention is the Key. A Systematic Literature Review

Adolescents' media use represents a normative need for information, communication, recreation and functionality, yet problematic Internet use has increased. Given the arguably alarming prevalence rates worldwide and the increasingly problematic use of gaming and social media, the need for an integration of prevention efforts appears to be timely. The aim of this systematic literature review is (i) to identify school-based prevention programmes or protocols for Internet Addiction targeting adolescents within the school context and to examine the programmes' effectiveness, and (ii) to highlight strengths, limitations, and best practices to inform the design of new initiatives, by capitalizing on these studies' recommendations. The findings of the reviewed studies to date presented mixed outcomes and are in need of further empirical evidence. The current review identified the following needs to be addressed in future designs to: (i) define the clinical status of Internet Addiction (IA) more precisely, (ii) use more current psychometrically robust assessment tools for the measurement of effectiveness (based on the most recent empirical developments), (iii) reconsider the main outcome of Internet time reduction as it appears to be problematic, (iv) build methodologically sound evidence-based prevention programmes, (v) focus on skill enhancement and the use of protective and harm-reducing factors, and (vi) include IA as one of the risk behaviours in multi-risk behaviour interventions. These appear to be crucial factors in addressing future research designs and the formulation of new prevention initiatives. Validated findings could then inform promising strategies for IA and gaming prevention in public policy and education.

Romanian National Prevalence Study - problem and pathological gambling in children and adolescents

Background and aims

The purpose of the present study was to measure the prevalence of problem and pathological gambling in children and adolescents at a national level, given that previous studies at regional level had demonstrated high rates of prevalence.

Methods

After designing the sample (2006 children and adolescents aged 11–19 years) we used two validated instruments for measuring the prevalence of problem and pathological gambling in children and adolescents – South Oaks Gambling Screen –Revised for Adolescents (SOGS-RA) and 20 Questions of Gamblers Anonymous Revised for Adolescents (20 GA-RA).

Results

The following data have been found: gambling at risk is 7.1% and problem and pathological gambling is 4%, when results were analyzed by SOGS-RA; prevalence of problem gambling is 10.1% and pathological gambling is 2.6% when results were analyzed by 20 GA-RA.

Conclusions

High rates of prevalence are noticed in Romania, similar to other European countries. This rates are based on self-reported questionnaires, meaning that real rates may be higher than reported, being known that children and adolescents tend to give socially expected response. An important issue is that we found pathological gambling at the age of only 11 years. Our results compared to those of other studies from Romania are very similar to those from other European countries.

Who Really Wins? Efficacy of a Croatian Youth Gambling Prevention Program

This paper reports on the development and pilot evaluation of a Croatian school-based youth gambling prevention program "Who really wins?". The program is aimed at minimizing risk and enhancing protective factors related to youth gambling. A short-term evaluation of the program was conducted with a sample of 190 first and second year high-school students (67.6% boys, aged 14-17 years; average age 15.61). An experimental design with two groups (Training vs. No Training) and two measurement sessions (pre-test and post-test sessions) was used to evaluate change in problem gambling awareness, cognitive distortions, knowledge of the nature of random events as well as in social skills. Results showed significant changes in the post-test sessions, which can be attributed to changes in the Training group. We observed a decrease in risk factors, namely better knowledge about gambling and less gambling related cognitive distortions. Immediate effects on protective factors such as problem solving skills, refusal skills, and general self-efficacy were not observed. Findings also show program effects to be the same for both boys and girls, students from different types of schools, for those with different learning aptitudes, as well as for those at different risk levels with regard to their gambling, which speaks in favour of the program's universality. The program had no iatrogenic effects on behaviour change and shows promise as an effective tool for youth gambling prevention. Future research and a long-term evaluation are needed to determine whether the observed changes are also linked to behavioural change.

A review of educational-based gambling prevention programs for adolescents

Educational-based problem gambling prevention programs are important avenues in targeting at-risk behaviors among adolescents to prevent an escalation of problematic behaviors into adulthood. The aim of this review is to examine features pertinent to effective educational-based programs in the area of adolescent problem gambling prevention in hopes of providing a foundation and future suggestions for preventive efforts. A stronger understanding of this research area will be essential in ensuring that past practical and theoretical advancements are integrated into the development of future programs.

Systematic Review of Empirically Evaluated School-Based Gambling Education Programs

Adolescent problem gambling prevalence rates are reportedly five times higher than in the adult population. Several school-based gambling education programs have been developed in an attempt to reduce problem gambling among adolescents; however few have been empirically evaluated. The aim of this review was to report the outcome of studies empirically evaluating gambling education programs across international jurisdictions. A systematic review following guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement searching five academic databases: PubMed, Scopus, Medline, PsycINFO, and ERIC, was conducted. A total of 20 papers and 19 studies were included after screening and exclusion criteria were applied. All studies reported intervention effects on cognitive outcomes such as knowledge, perceptions, and beliefs. Only nine of the studies attempted to measure intervention effects on behavioural outcomes, and only five of those reported significant changes in gambling behaviour. Of these five, methodological inadequacies were commonly found including brief follow-up periods, lack of control comparison in post hoc analyses, and inconsistencies and misclassifications in the measurement of gambling behaviour, including problem gambling. Based on this review, recommendations are offered for the future development and evaluation of school-based gambling education programs relating to both methodological and content design and delivery considerations.

Teacher Awareness and Attitudes Regarding Adolescent Risk Behaviours: a Sample of Finnish Middle and High School Teachers

Empirical evidence has shown that youth gamble on both regulated and unregulated games, despite legislative prohibitions. This study assesses middle and high school teachers' awareness and attitudes regarding adolescent gambling and other potentially high-risk behaviours in Finland. A convenience sample of teachers (N = 157) from 13 provinces participated in the survey. The results suggest that teachers in Finland were more knowledgeable of the age limits of other adolescent high-risk behaviours than the legal age for gambling. Teachers were somewhat familiar with the behaviours and consequences associated with adolescent gambling. All other risk behaviours were perceived as being more important than gambling. Teachers' awareness about gambling prevention material in Finnish schools was limited. Results suggest that initiatives are required to enhance teachers' knowledge of adolescent problem gambling and its harmful short- and long-term consequences. School policies and guidelines including gambling behavior should be implemented in middle and high schools globally.

Theory of Planned Behavior in School-Based Adolescent Problem Gambling Prevention: A Conceptual Framework

Given its serious implications for psychological and socio-emotional health, the prevention of problem gambling among adolescents is increasingly acknowledged as an area requiring attention. The theory of planned behavior (TPB) is a well-established model of behavior change that has been studied in the development and evaluation of primary preventive interventions aimed at modifying cognitions and behavior. However, the utility of the TPB has yet to be explored as a framework for the development of adolescent problem gambling prevention initiatives. This paper first examines the existing empirical literature addressing the effectiveness of school-based primary prevention programs for adolescent gambling. Given the limitations of existing programs, we then present a conceptual framework for the integration of the TPB in the development of effective problem gambling preventive interventions. The paper describes the TPB, demonstrates how the framework has been applied to gambling behavior, and reviews the strengths and limitations of the model for the design of primary prevention initiatives targeting adolescent risk and addictive behaviors, including adolescent gambling.

Parent problem gambling: A systematic review of prevention programs for children

Parent problem gambling (PG) has pervasive adverse effects on children. These children experience considerable losses such as loss of trust, loss of safety and stability, as well as financial and emotional losses. They are at greater risk for maltreatment and mental health disorders, and they are also at risk for intergenerational transmission of PG. These children are two to four times more likely to develop PG than children of non-PG parents. To date, there has been a dearth of research examining the impact of parent PG on children, and even less research focusing on reducing risks in children of PG parents. The goal of this systematic review was to identify PG prevention programs for children and examine the types of prevention used and whether these programs target specific subgroups. Our search retained 16 studies examining PG prevention programs for children. Results indicated that all of the PG prevention programs in the selected studies are universal and do not target children of PG parents or any other specific subgroups. A large gap is the absence of secondary and tertiary PG prevention programs for children. Another gap is the lack of family focused prevention strategies which the substance use literature has shown to be the most effective form of prevention. Further research is needed on parent PG and ways of reducing risks and increasing protective factors in children and families. A public health framework must be adopted to delay onset, reduce risks and minimize consequences in children of PG parents.