Parenting practices and adolescent risk behavior: rules on smoking and drinking also predict cannabis use and early sexual debut

Characteristics and risk factors of Health-Related Risky behaviors in adolescents with Depression

BACKGOUND

To explore the characteristics and risk factors for health-related risky behaviours (HRRBs) in adolescents with depression.

METHODS

A total of 136 adolescents aged 12-18 years who met the diagnostic criteria for depression, and 272 healthy controls. All the subjects were assessed with the Adolescent Health-Related Risky Behavior Inventory (AHRBI), and the AHRBI scores of the two groups were compared with the Mann-Whitney U test. The depression group was assessed with the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Childhood Trauma Questionnaire (CTQ), Cognitive Emotion Regulation Questionnaire (CERQ), Egna Minnen av Barndoms Uppfostran (EMBU), and Family Adaptability and Cohesion Scale (FACES II-CV). Spearman correlation analysis and multiple linear regression were used to explore the risk factors for HRRBs in adolescents with depression.

RESULTS

The AHRBI total score and five-factor scores of self-injury and suicide (SS), aggression and violence (AV), rule-breaking (RB), smoking and drinking (SD), and health-compromising behavior (HCB) in the depression group were higher than those in the control group. The severity of anxiety, catastrophizing, cognitive emotional regulation strategy (self-blame and blaming of others), the frequency of depression, physical neglect, and sexual abuse all increased the risk of HRRBs in adolescents with depression, and paternal emotional warmth and understanding had protective effects.

CONCLUSION

First, depressed adolescents exhibited significantly more HRRBs than healthy adolescents. Second, there are many risk factors for HRRBs in adolescents with depression, and the risk factors for different types of HRRBs are also different.

Child gender and differences in risky health behavior among parents

This paper documents differences in health outcomes and behaviors between parents who raise daughters and those who raise sons. Using Australian panel data from 2001 to 2019, we use OLS regression models to show that parents with daughters are physically healthier, a result linked to a reduced tendency to engage in risky behaviors such as binge drinking and smoking. The random nature of child gender implies our outcome gaps are likely to be causal, and the estimates survive a collection of diagnostics related to identification. We search for evidence that these effects occur via a general change in risk aversion, but this hypothesis is not supported. Fathers with daughters are actually more risk-seeking in both their broader life attitudes, and in their views on financial investment. We argue that this heterogeneity may come from a "breadwinner" effect, as part of a set of gender-varying norms around socially acceptable risk-taking.

Risk Factors for Early Sexual Intercourse in Adolescence: A Systematic Review of Cohort Studies

This systematic review provides a comprehensive assessment of risk factors related to early sexual intercourse (ESI) among adolescents. We used PRISMA guidelines to identify eligible cohort studies published between January 1999 and December 2020. We searched on three databases: PubMed, Embase and LILACS. Studies were screened for quality and eligibility. Of 2787 identified studies, seven met our inclusion criteria. The studies examined a range of factors, which were organized into four dimensions - individual, family, social and environmental, and sociodemographic. Risk factors with strong associations for ESI were: adolescent and parental substance use, aggression and conduct disorders, family attachment, school achievement, family living situation, and maternal education. Three studies were birth cohorts. This review demonstrates the important roles of substance use, family attachment and academic factors in shaping adolescents' sexual behavior. A strength of this review is its focus on longitudinal studies, enabling exploration of exposures collected before initiation of sexual intercourse.

"Our parents kiss in front of us": Reasons for early sexual debut among in-school youth in the Manzini Region in Eswatini

BACKGROUND

Early sexual debut (i.e., sex before the age of 15 years), especially if it is unprotected, may increase the risk of acquiring HIV, sexually transmitted infections, and unwanted pregnancies. We investigated the reasons for early sexual debut among in-school youth in Eswatini, a setting with high HIV incidence among youth.

METHODS

This was a qualitative, exploratory-descriptive study whereby data were collected from 81 sexually active in-school youth through seven focus group discussions (FGDs) in four purposively selected public high schools (two urban and two rural) in the Manzini region, Eswatini. In each school, except one, two FGDs (one for boys and one for girls) were conducted. Qualitative data were coded and analyzed thematically in Dedoose version 8.2.14.

RESULTS

Nearly 40% of the participants reported having initiated sexual activity before 18 years. Six major themes emerged from the data: i) Intrapersonal factors (feeling mature, religiosity, nutritional or dietary patterns); ii) Parenting and household factors (living arrangement, lack of sexuality education, working parents, negative role-modeling from adults); iii) Peer and partner pressure (pressure from friends, threats from sexual partners, intergenerational sexual partnerships and transactional sex, testing sexual prowess, desire to fit in); iv) Contextual factors (neighborhood, location); v) Mass media (cell phone ownership, social media, and television shows or movies); and vi) Cultural factors (attending traditional ceremonies, loss of cultural norms, values, and traditions, and dress code).

CONCLUSION AND RECOMMENDATIONS

The poor monitoring and negative role-modeling by elders highlight the importance of involving parents or guardians as key stakeholders when designing interventions targeting risky sexual behavior among youth. The multifaceted nature of the cited reasons for early sexual debut calls for interventions aimed at curbing risky sexual behavior to be culturally sensitive and responsive to the themes identified in this study.

The moderating effects of alcohol use with and without parent permission on alcohol risk communication in early adolescence

The frequency of parental alcohol risk communication (ARC) is considered an integral component of socializing youth about alcohol, but the literature offers mixed findings on whether such communication is protective. Early adolescents' prior drinking experiences may moderate the effectiveness of ARC, but evidence for such an interaction is inconsistent. One limitation of this work considering prior drinking experience is that it has not distinguished drinking with versus without parental permission. Parents are one of the earliest sources of information about alcohol use and many parents view allowing adolescents to drink alcohol with permission as a harm reduction strategy, despite some work suggesting the opposite effect. Using a random effects multilevel regression, we tested the unique moderating effects of drinking with and without parental permission on the prospective association between alcohol risk communication and later drinking without parental permission. Adolescent and parent dyads completed 3 annual assessments (first assessment mean age = 12.6, 52% girls, 76% White/non-Hispanic). Results supported a three-way interaction. There was a modest protective effect of parental ARC on later adolescent drinking, but only for adolescents who had prior experience drinking both with and without parental permission. For all other combinations of prior drinking experience, parental communication was not prospectively related to later drinking. These results help clarify the mixed literature on alcohol communication and suggests that ARC may help reduce some of the risk associated with allowing youth to drink alcohol but only for youth who also have experience with alcohol outside of parental supervision.

Can Flu-Like Absenteeism in Kindergartens Be Reduced Through Hand Hygiene Training for Both Parents and Their Kindergarteners?

Background: Hand hygiene has been found as an effective method to prevent the spread of infectious diseases. Parents, however, were found to have inadequate knowledge, reporting skills, and parenting practices related to seasonal influenza. The aim of our study was to investigate if there was any correlation between the flu infection among parents and their kindergarteners and ascertain the effectiveness of using hand hygiene interventions in kindergartens to lower kindergarteners’ absenteeism attributable to seasonal flu. Methods: This study was a quasi-experimental study with a pretest-posttest design. Fifteen kindergartens were randomly selected from the kindergarten lists in different districts displayed on the Hong Kong government website. From these 15 kindergartens, parents and their kindergarteners were then randomly selected to participate in our hand hygiene program. To support the validity of the program, the WHO hand hygiene checklist was used to ensure sufficient coverage of the objectives. All kindergarteners attended 45-minute session for 4 weeks, while their parents attended a separate session lasting 1 hour. Parents monitored their kindergartners on a daily basis for any flu symptoms and kindergartens monitored their school attendance. Results: The study results showed that kindergarteners with strong parenting and proper hand hygiene compliance had fewer recorded signs and symptoms of flu-like illnesses. Our findings also showed that the kindergarteners’ absence rates in all participating kindergartens owing to flu decreased from 21.5% to 12% of the study period in 3 months. Conclusion: It was found that the flu infection rates of the parents and their kindergarteners were significantly correlated with P = .005. The awareness and personal hygiene skills of the parents and kindergarteners were both raised after the program. The findings in this study supported that positive parenting on hand hygiene can help reduce kindergarteners’ flu-like absenteeism.

Adolescents’ Risk of Different Sexual Orientation Tendency in Terms of Family Factors (Case Study in Padang and Agam Regency)

BACKGROUND: In the transition period, in adolescents occur the process of physical, cognitive, and social maturation. This period is essential in the formation of sexual identity, which related to gender and sexual orientation. Improper sexual identities will provoke sexual behavior problems. The problems with sexual behavior begin from differences in sexual orientation with a sexual orientation generally accepted by the public (heterosexual). In some adolescents, there is a change in sexual orientation that leads to homosexuality. The factors that play a significant role in adolescent sexual orientation are parenting. AIM: This study aimed to examine the risk of different sexual orientation tendencies in adolescents and the families’ factors in West Sumatra. MATERIALS AND METHODS: This study’s design was a cross-sectional study with 532 adolescents aged 13–18 years old as the respondents. It took 3 months to research by using a questionnaire as the instrument. The questionnaire’s data were analyzed using Chi-square. RESULTS: The results showed that the risk of different sexual behaviors in adolescents was 59.4% normal tendency, 26.7% low tendency, and 13.9% high tendency. Furthermore, family factors related significantly to the risk of different sexual behavior tendencies were gender and family intimacy factors (p < 0.05), while age, family type factors, and family income factors (p > 0.05) are not significantly related. CONCLUSION: Based on that, it concluded that the parents expected to develop closer relationships with family members.

Automatic cognitions as mediators of parental influence on adolescent cannabis use

AIMS

Multiple social influences affect cannabis use in adolescents, including parental and peer cannabis use norms. However, the mechanisms of influence underlying these social influences remain unclear. Recent studies have suggested that cognitions about cannabis use and the effects of cannabis may mediate social influences. The current study explored the relationship between automatic self-generated cognitions and their relationship with parental influences on cannabis use in a sample of n = 675 11 to 16-year-old adolescents over three years (Mean Age: 13.96, SD = 0.88, 56.4% female).

METHODS

Participants reported perceptions of parental cannabis use and completed a cannabis word association task (CWAT), an open-ended cannabis outcome expectancy liking (COEL) task, and measures of cannabis use in the past year.

RESULTS

Perceived parental use did not directly predict cannabis use two years later. However, a latent construct loading on both CWAT and COEL scores strongly predicted cannabis use over the following year. Structural modelling demonstrated that the association between previous cannabis use and parental cannabis use and adolescents' cannabis use over the next two years was fully mediated by cognitions.

CONCLUSION

The results of the study are discussed and interpreted through the lens of dual-process theories.

Parental alcohol-specific rules effectively reduce adolescents' tobacco and cannabis use: A longitudinal study

AIMS

The current study aimed to longitudinally examine the direct and indirect effects (via alcohol use) of parental alcohol-specific rule-setting on adolescent tobacco and cannabis use. Based on the gateway hypothesis, we expected parental alcohol-specific rules to affect adolescent tobacco and cannabis use through adolescent alcohol use.

DESIGN AND PARTICIPANTS

A longitudinal design including three waves and 906 Dutch adolescents (Mage = 13.51 years, SD = 0.60) was used to apply zero-inflated Poisson models (ZIP).

MEASUREMENTS

Self-report questionnaires measured adolescents' perceived rules about alcohol at T1, cigarette use at T1 and T3 (frequency of life-time and current smoking), cannabis use at T1/T3 (frequency of yearly and monthly use) and frequency of monthly alcohol use at T1/T2.

FINDINGS

Stricter alcohol-specific rules at T1 predicted lower incidence and prevalence rates of cigarette (life-time: β = -0.20, p < .00; current: β = -0.21, p = .04) and cannabis use (monthly: β = -0.43, p = .02; yearly: β = -0.28, p = .19) two years later (T3). This direct effect was no longer significant when alcohol use at T1 was controlled for. Moreover, a significant indirect effect of alcohol-specific rules at T1 on tobacco and cannabis use T3 via monthly alcohol use T2 was found.

CONCLUSIONS

The current study demonstrated that strict rules regarding alcohol may not only reduce alcohol but subsequently also other substance use such as tobacco and cannabis. Thus, interventions targeting the prevention of alcohol use, which appears to serve as a gateway, also affects the involvement in other substances.

Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014

INTRODUCTION

Although first sexual experience (understood as first sexual intercourse) is one of the most commonly assessed characteristics of adolescents, recent research emphasizes the importance of understanding other related social factors. This study highlights factors associated with first sexual experience in a nationally representative sample of adolescent students in Mexico.

AIMS

The goals of this study were (i) to determine the proportion of adolescents aged 12-17 who had had their first sexual experience; (ii) to identify the factors associated with first sexual experience; and (iii) to analyze the conditions (condom use, substance use) in which first sexual experience takes place.

METHOD

The data presented in this study are drawn from the 2014 National Survey on Drug Use in Students (Spanish acronym ENCODE), undertaken with the purpose of identifying the prevalence of drug use and associated variables, including sexual activity, in Mexican students. Kaplan-Meier analysis was used to estimate the probability of first sexual experience at a given age, taking sex as an outcome variable and age as a follow-up period. Logistic regression was used to assess possible factors for sexual initiation.

MAIN OUTCOME MEASURES

Validated standard questionnaires were used to assess sociodemographic characteristics, first sexual experience (framed as first sexual intercourse), frequency of sexual relations, sexual partners, sexual preference (framed as preferred sex of partners), substance use, having a physical illness or a behavioral problem, condom or other contraceptive use, as well as the absence or presence of parents, parents' educational attainment, and parents' substance use.

RESULTS

A total of 26,187 students aged 12-17 participated. Of this total, 14.8% had already had their first sexual experience, at a median age of 15; 64.5% used some type of contraceptive, and 53.2% used condoms. Proportional probabilities for having first sexual experience using age as a follow-up period showed that the probability of having sex earlier was higher among boys than girls: the probability of having sex at age of 15 was 26.5% for boys and 13.9% for girls. Predictors of first sexual experience included substance use (alcohol OR = 2.5, tobacco OR = 2.6, and other drugs OR = 2.3), having a mother who used drugs (OR= 2.2), sexual preference (female homosexual, OR = 2.2), and sex (male, OR = 2.1).

CONCLUSIONS

Boys are more likely to have had a first sexual experience than girls. Future strategies should incorporate specifically targeted elements with different messages that consider adolescents' sex and age. Barragán V, Berenzon S, Tiburcio M, et al. Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014. J Sex Med 2019;16:418-426.

Parent/Caregiver Responses to Gender Identity Associated With HIV-Related Sexual Risk Behavior Among Young Trans Women in San Francisco

PURPOSE

Young trans women (YTW) carry a disproportionate burden of HIV. The developmental context of HIV risk for YTW is underexamined. The aim of this analysis was to examine whether parent/caregiver responses to gender identity were associated with engagement in HIV-related sexual risk behavior for YTW and whether these associations varied by racial/ethnic identity or age.

METHODS

Baseline data from the SHINE study (n = 300) at San Francisco Department of Public Health (2012-2014) were analyzed. Multivariable Poisson binomial regression models characterized relationships between parent/caregiver responses to gender identity and HIV-related sexual risk behaviors, adjusting for select participant demographics. Statistically significant interactions (by race/ethnicity or age) were plotted using marginal predicted probabilities of sexual risk behaviors.

RESULTS

Thirty-seven percent of YTW engaged in any condomless anal intercourse; 12% reported income from sex work in the last month. Ever moving away from family and friends because of gender identity was associated with condomless anal intercourse (adjusted prevalence ratio [PR] = 1.44, 95% confidence interval [CI] = 1.08-1.92, p = .01) and sex work (PR = 2.07, 95% CI = 1.14-3.75, p=.02). Ever receiving poor treatment from parents/caregivers because of gender identity was associated with sex work (PR = 3.47, 95% CI = 1.52-7.95, p < .01). Greater parent/caregiver acceptance of gender identity was associated with lower adjusted prevalence of condomless anal intercourse for Hispanic/Latinx YTW.

CONCLUSIONS

Negative parent/caregiver exposures related to YTW's gender identities were associated with increased HIV-related sexual risk behaviors, whereas parent/caregiver acceptance of gender identity was protective against condomless anal intercourse for Hispanic/Latinx YTW. There is a need for additional studies that inform interventions for YTW focusing on parent/caregiver relationships to prevent HIV-related risk behavior.

The vulnerability to alcohol, tobacco, and drug use of adolescents in Hong Kong: a phenomenological study

BACKGROUND

In Hong Kong, the use of alcohol, tobacco, and other drugs (ATOD) is associated with strong peer influences; frequently absent parents; academic pressures; and a lack of interpersonal skills to cope with stress and conflict. It is posited that this social context alters the nature of the adolescent risk of using ATOD. The study aimed to explore how social interactions in their local context shape experiences of adolescents who smoke or use alcohol with their parents and other significant people (e.g., teachers, peers) in their lives.

RESULTS

The participants consistently indicated that the communication of risk was fundamentally influenced by the attachment between the primary parent(s) and the child. In secure attachments, parents could positively discourage ATOD use by instilling fear or expressing regret or disappointment over its use. However, some parents expressed an overly permissive attitude about ATOD use, or stated that they had a limited ability to influence their child, or that the harm arising from their child's use of ATOD would be minimal. Under these conditions, the authors posited that the potential influence of peers to disrupt parental attachments was stronger.

CONCLUSIONS

Descriptive phenomenology was adopted in this study and Colaizzi's method was used to analyse the collected data. Focus group interviews were conducted with 45 adolescents, 11 parents, and 22 school teachers and social workers in two districts in Hong Kong. A secure attachment between a parent and a child enhances the child's sense of self-efficacy in avoiding addictive behaviours such as ATOD use. In contrast, insecure parent-child attachments may trigger children to resist social norms, and disrupt their parental attachments. In these instances, parents may inadvertently convey the message that their children do not need protection from the risks of using ATOD. The key findings suggest that reinforcing secure parental attachments, as well as emphasizing how messages of vulnerability to ATOD are conveyed, may counter balance pressures (including peer influence) to use these substances. Further research is needed to uncover mechanisms of communication that add to the vulnerability of adolescents to using ATOD, and to the negative long-term consequences from ATOD use.

Parenting Practice, Leisure Experience, and Substance Use Among South African Adolescents

There is limited understanding of parents' role in positive youth/adolescent development through leisure in developing countries. Using a sample of 6626 8^th grade students in South Africa, this study examined the interrelationships among parenting practice, adolescents' leisure experience, and substance use. Results of structural equation modeling showed that parental leisure involvement was associated with less substance use, while parental leisure over-control was associated with greater substance use. The relationship of parental leisure involvement to substance use was mediated by healthy leisure engagement. The relationship of parental leisure over-control to substance use, on the other hand, was mediated by leisure boredom and healthy leisure engagement. The model path coefficients had little variation between genders and socioeconomic groups except that parental leisure over-control had a stronger positive relationship with leisure boredom for males than females. Theoretical and practical implications were discussed.

Derivation of some contemporary scales to measure adolescent risk-taking in Canada

OBJECTIVES

To derive a contemporary series of composite indicators of adolescent risk-taking, inspired by the US CDC Framework and Problem Behaviour Theory.

METHODS

Factor analyses were performed on 28-risk behaviours in a nationally representative sample of 30,096 Grades 6-10 students from the 2014 Canadian Health Behaviour in School-aged Children study.

RESULTS

Three composite indicators emerged from our analysis: (1) Overt Risk-Taking (i.e., substance use, caffeinated energy drink consumption, fighting, and risky sexual behaviour), (2) Aversion to a Healthy Lifestyle (i.e., physical inactivity and low fruit and vegetable consumption), and (3) Screen Time Syndrome (i.e., abnormally high screen time use combined with unhealthy snacking). These three composite indicators of risk-taking were observed consistently with strong psychometric properties across different grade groups (6-8, 9-10).

CONCLUSIONS

The three composite indicators of adolescent risk-taking each draw from multiple domains within the CDC framework, and support a novel, empirically directed approach of conceptualizing multiple risk behaviours among adolescents. The measures also highlight the breadth and diversity of risk behaviour engagement among Canadian adolescents. Research and preventive interventions should simultaneously consider the related behaviours within each of these composite indicators.

Being Blunt About Marijuana: Parent Communication About Marijuana with Their Emerging Adult Children

While research suggests that parents continue to influence students' marijuana use after matriculation to college, there is limited data examining how parents communicate about marijuana use and what impact parent marijuana communication has on college student outcomes. The aim of the current study is to investigate the types of parent marijuana messages that college students receive and the relationship between parent communication and students' marijuana attitudes and behaviors. Students (N = 506) completed a survey assessing marijuana approval, use, negative consequences, and parent communication. A factor analysis of parent communication items yielded three factors: risk communication, permissive communication, and marijuana use communication. Risk communication was the most common form of communication. In multivariate models, risk communication was associated with increased odds of a student remaining abstinent but not with frequency of marijuana use or negative consequences. Greater permissive communication was associated with more approving student attitudes, greater odds of non-abstinence, more frequent use in the past year, and more negative consequences. These findings highlight the need to consider the different types of messages parents deliver when designing interventions aimed at engaging parents in marijuana prevention efforts.

Emotional and Psychosocial Factors Associated With Drunkenness and the Use of Tobacco and Cannabis in Adolescence: Independent or Interactive Effects?

BACKGROUND

Although previous research has examined emotional and psychosocial factors associated with substance use, there is a paucity of studies examining both at the same time, and insufficient attention has been paid to how these factors may interact.

OBJECTIVES

The aim of this study was to simultaneously examine the contributions from emotional (emotional control and depression) and psychosocial (peers' conventional behavior, peers' substance use and parent-child relationships) factors to drunkenness and the use of tobacco and cannabis in adolescence.

METHODS

Sample consisted of 1,752 adolescents aged 15 to 16 years who had participated in the 2014 edition of the WHO Health Behaviour in School-aged Children survey in Spain. Data were collected by means of anonymous online questionnaires, and hierarchical multiple regression models (with sex and age as controls and including interactions among the examined predictors) were used for statistical analysis.

RESULTS

Emotional and psychosocial factors showed significant interactive effects on substance use. Emotional control, which tended to buffer the effects of potential risk factors, and peers' substance use were consistent predictors of substance use. In contrast, the role of other factors depended on the substance under study, with depression and peers' conventional behavior being part of interactive terms for tobacco use and cannabis use only, and the quality of parent-child relationships being absent from the final model on cannabis use. Conclusions/Importance: Exploring interactions and potential substance-specific effects is fundamental to reach a better understanding of how emotional and psychosocial factors work in concert relative to substance use in adolescence.

A systematic review and qualitative synthesis of adolescents' views of sexual readiness

AIM

The aim of this study was to synthesize the qualitative evidence investigating adolescents' views on heterosexual readiness.

BACKGROUND

Adolescents' understandings of sexual readiness are often missing in research and debates on sexual health and related concepts like sexual consent. Research to date has predominantly focussed on age and socio-cultural predictors of sexual debut, thus failing to explain how adolescents themselves conceptualize their readiness for heterosexual relations.

DESIGN

A systematic review and thematic synthesis of qualitative evidence.

DATA SOURCES

CINAHL, Psychinfo, PubMed, Web of science were searched, 1985-Feb 2016.

REVIEW METHODS

Critical Appraisal Skills Programme checklist was used to assess methodological quality. A thematic synthesis focused on commonalities and variations in the data from included studies on adolescents' perspectives of their readiness for sex.

RESULTS

Sixteen studies were included. Themes identified were: social learning, relationships and implications for sexual health promotion and practice.

CONCLUSIONS

Adolescents may not view initiating sex as problematic, focusing instead on the rewards sex brings and less on health concerns. Adolescents tend to reproduce dominant gender norms of masculinity and femininity in communication about sexual decision-making, which are sometimes influenced by social scripts of career aspirations and ethnic identity. Age was also significant in adolescents' accounts. Early adolescence is a critical period when understandings of gender equality become embedded, thus an opportunity to engage adolescents in critiquing ideas about gender equality and sexual rights. Further research exploring adolescents' understandings of sexual readiness is required. We recommend a participatory approach to support the inclusion of adolescent voices to inform contextually relevant sexual health promotion strategies.

The Enduring Impact of Parents' Monitoring, Warmth, Expectancies, and Alcohol Use on Their Children's Future Binge Drinking and Arrests: a Longitudinal Analysis

Binge drinking is associated with many health and financial costs and is linked to risks of legal consequences. As alcohol use typically is initiated during adolescence, the current study assessed the relationship between parental behaviors and strategies in forecasting adolescents' likelihood of binge drinking and later arrest. Restricted data from waves I-IV of the National Longitudinal Study of Adolescent Health were used to assess hypotheses. A weighted path analytic model (N = 9421) provided a multifaceted picture of variables linked to later antisocial behavior. Low parental monitoring, low parental warmth, parent alcohol use, and parent expectancies regarding their children's alcohol use were associated with higher incidence of adolescent binge drinking. In turn, low monitoring, low warmth, parent alcohol use, parent expectancies, and underage consumption were associated with binge drinking in early adulthood. Binge drinking during both adolescence and young adulthood were predictive of respondents' likelihood of arrest 8-14 years later. Findings demonstrated the substantial, enduring effects of parental behaviors on child alcohol-related actions and have implications for parent-targeted interventions designed to reduce excessive alcohol consumption. They suggest campaigns focus on parenting strategies that involve setting effective and strict alcohol-related rules and guidelines, while maintaining a warm and supportive family environment.

Secondary Effects of an Alcohol Prevention Program Targeting Students and/or Parents

The secondary effects of an alcohol prevention program (PAS) on onset of weekly smoking and monthly cannabis use are examined among >3000 Dutch early adolescents (M age=12.64) randomized over four conditions: 1) parent intervention (PI), 2) student intervention (SI), 3) combined intervention (CI) and 4) control condition (CC). Rules about alcohol, alcohol use, and adolescents' self-control were investigated as possible mediators. PI had a marginal aversive effect, slightly increasing the risk of beginning to smoke at T1, and increased the likelihood of beginning to use cannabis use at T1 and T2. SI delayed the onset of monthly cannabis use at T3. CI increased the risk to use cannabis at T3. No mediational processes were found. In conclusion, though this study show mixed results, negative side effects of the PI were found, particularly at earlier ages. Moreover, these results indicate the need for multi-target interventions.

Preventing alcohol misuse in young people: an exploratory cluster randomised controlled trial of the Kids, Adults Together (KAT) programme

Background

Involvement of parents/carers may increase the effectiveness of primary school-based alcohol-misuse prevention projects. However, few interventions have been designed for pre-adolescent children, or specifically involve parents/carers. The Kids, Adults Together (KAT) programme in primary schools aimed to reduce alcohol misuse through such an approach.

Objective

To determine the value and feasibility of conducting an effectiveness trial of KAT.

Design

Parallel-group cluster randomised exploratory trial with an embedded process evaluation. Schools were the unit of randomisation.

Setting

Primary schools (n = 9) in south Wales, UK.

Participants

Pupils in Year 5/6 (aged 9–11 years) and their parents/carers; school staff.

Intervention

The Kids, Adults Together programme consisted of (1) classwork addressing the effects of alcohol; (2) a family event for children and parents/carers; and (3) a ‘goody bag’ containing fun items, including a digital versatile disc (DVD) for families to watch together. The intervention comprised KAT plus existing alcohol-related activities and lessons. Control-group schools continued with existing alcohol-related lessons and activities.

Main outcome measures

Key outcomes related to the progression criteria for a potential future effectiveness trial. These included the acceptability, participation equity, feasibility and implementation of KAT; the recruitment and retention of research participants; and the acceptability and feasibility of research processes, including data collection methods and outcome measures.

Results

Nine schools (free school meal entitlement ranging from 1% to 37.2%) participated. Two of five intervention schools withdrew but all four control schools were retained, and these seven schools facilitated all research data collections. Programme acceptability and participation rates were high in all three intervention schools (parent/carer participation rates ranged from 45.1% to 65.7%), although implementation quality varied. At baseline, approximately 75% of eligible children (n = 418) provided data, of whom 257 also provided data at follow-up. Only 27 parents/carers (estimated response rate 6.5%) completed interviews. Most children were willing to complete questionnaires but measures were not appropriate for this age group. Measures of alcohol consumption produced inconsistent responses. Intermediate outcomes on family communication showed no evidence of intervention effectiveness.

Conclusions

In the three schools that received the KAT intervention, it was found to be acceptable to schools and pupils and there were good levels of participation from parents/carers from across a range of socioeconomic groups. However, two intervention schools withdrew from the trial. Findings from intermediate outcomes on family communication did not support programme theory. In addition, the study highlighted challenges in identifying suitable outcome measures for children aged 9–11 years and the feasibility of long-term follow-up via secondary schools.

Future work

It would not be appropriate to proceed to an effectiveness trial of KAT. There are doubts/uncertainties about the potential effects of KAT; suitability of measures; the large number of schools which would be required for an effectiveness trial of KAT, and the cost of this; feasibility of follow-up in secondary schools; and programme implementation and theory. There is a need to develop and validate measures for children aged 9–11 years; to test the feasibility of follow-up data collection methods in secondary schools; and to further consider sample size requirements and feasibility.

Trial registration

Current Controlled Trials ISRCTN80672127.

Funding

The exploratory trial of this project was funded by the National Institute for Health Research Public Health Research programme and the process evaluation was funded by the Economic and Social Research Council. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. This project will be published in full inPublic Health Research; Vol. 3, No. 15. See the NIHR Journals Library website for further project information.

Does a reduction in alcohol use by Dutch high school students relate to higher use of tobacco and cannabis?

Background

Substance use of adolescents was investigated in a region around Amsterdam, the Netherlands, in the period 2005–2009. The study was intended to find out to what extent behaviour related to different substances are interrelated and how trends develop in different subgroups.

Methods

Two cross-sectional surveys were conducted among Dutch students in the second and fourth year of secondary school, aged 13-16 [n = 1,854 in 2005; n = 2,088 in 2009] by making use of an online questionnaire including questions about alcohol consumption, tobacco use (smoking behaviour) and cannabis use. Two educational levels were included.

Results

Decreases in alcohol consumption, tobacco and cannabis use were found between 2005 and 2009. The strongest decline was seen in alcohol consumption. Last month drinking decreased from 61.8 % in 2005 to 36.5 % in 2009. Last month binge drinking decreased from 38.7 % in 2005 to 24.0 % in 2009. Reduced alcohol consumption was found among boys and girls, for all ages and in both educational levels. Changes were strongest among 13-year-olds. Weekly or daily smoking declined between 2005 and 2009 among 13-year-olds, girls and students in the lower schooling level. Last month cannabis use decreased among girls and students in the higher schooling level. In both 2005 and 2009 clustering with alcohol consumption was found for the use of other substances.

Conclusions

Between 2005 and 2009 alcohol consumption strongly decreased among high school students. This may be due to the national prevention campaign which in the same period highlighted the importance of not drinking before the age of 16. The decrease in smoking and cannabis use between 2005 and 2009 may be due to clustering with alcohol consumption. A reduction in the use of alcohol in adolescence did not lead to replacement by tobacco or cannabis use.

Parental Awareness of Substance Use Among Adolescents in a Junior High School Sample

There is a lack of studies assessing parental awareness of adolescent alcohol, cigarette, and drug use in the general adolescent population. A total of 1,426 adolescents aged 14 to 16, and their parents, answered questions about adolescent substance use annually during junior high school. Sensitivity for parental report of adolescent substance use was low: 5.6% to 26% for drunkenness, 14.3% to 20.6% for cigarettes, and 4.9% to 12% for illicit drugs. Higher age and higher frequency of use were positively associated with parental awareness of drunkenness and cigarette use. Female sex was associated with higher parental awareness of drunkenness. Higher school performance was negatively associated with parental awareness of drunkenness in Grade 9 and with cigarette use in Grades 8 to 9. Parental awareness of adolescent drunkenness, and cigarette and illicit drug use in the general population is low. Factors of importance for parental awareness are identified.

The role of general parenting and cannabis-specific parenting practices in adolescent cannabis and other illicit drug use

AIMS

To investigate general and cannabis-specific parenting practices in relation to adolescent cannabis and other illicit drug use.

METHODS

Data were derived from the Dutch National School Survey on Substance Use among students (N=3209; aged 12-16 years) and one of their parents in 2011.

RESULTS

Logistic regression analyses revealed that 1) parental cannabis use was significantly related to more adolescent lifetime and recent cannabis use, and 2) restrictive cannabis-specific parental rules were associated with less adolescent recent cannabis and lifetime use of other illicit drugs, even when controlled for sociodemographic factors, general parenting, adolescent tobacco use, and tobacco-specific parenting. In addition, no significant interaction was observed between parental cannabis use and cannabis-specific rules in their relation to adolescent cannabis and other illicit drug use, indicating that cannabis rules are evenly associated with adolescent drug use for families with and without parental cannabis experience.

CONCLUSIONS

In addition to general parenting practices, restrictive cannabis-specific rules are related to lower adolescent cannabis and other illicit drug rates. Parents who ever used cannabis have children with a higher prevalence of cannabis use. However, their restrictive cannabis-specific rules are equally related to a lower chance of adolescent cannabis use.