The impact of a parent-directed intervention on parent - child communication about tobacco and alcohol

Parents Are Unaware of Their Youths' Tobacco Use: Results from the Population Assessment of Tobacco and Health Study

BACKGROUND

In this study, we determined the prevalence of and factors associated with parent unawareness of youth tobacco use.

METHODS

We used data from waves 1, 2, and 3 (2013-2016) of the Population Assessment of Tobacco and Health study, a nationally representative study of 13,650 US youth ages 12 to 17 and their parents. We conducted weighted multivariate analyses comparing parent unawareness of youth-reported ever use and associations between parents' unawareness of youth use and covariates.

RESULTS

Youth ever tobacco use ranged from 21.8% in 2013-2014, to 24.1% in 2014-2015, to 23.4% in 2015-2016. Parent unawareness ranged from 57.6% in 2013-2014, to 61.9% in 2014-2015, and 64.5% in 2015-2016. Factors associated with higher parent unawareness of youth tobacco use in 2015-2016 were youth being female, black, or Hispanic (adjusted odds ratio [AOR] = 1.24-2.61; all ps < .05). Youth with lower academic performance, relatives who used tobacco, tobacco available in the home, or past 30-day use, were less likely to have parents unaware of their use (AORs 0.33-0.56; all ps < .05).

CONCLUSIONS

Among youth who reported ever using tobacco, most had parents who were unaware of their use. School-based efforts targeting specific sociodemographic factors could increase parent awareness of youth tobacco use.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

E-Cigarettes and Young People: Communicating an Emerging Public Health Risk

E-cigarettes are the most commonly used tobacco product among US youth. Most e-cigarettes contain nicotine, which can cause addiction and can harm the developing adolescent brain. In coordination with the release of a Surgeon General's Report on e-cigarette use among young people, the Centers for Disease Control and Prevention collaborated with the Office of the Surgeon General to launch a campaign to educate parents, youth influencers, and young people about the risks of e-cigarettes. This article describes the development of communication products, including innovative media, about this public health risk, and shares lessons learned to inform public health practice.

Group-based trajectories of parent-child communication and parental knowledge between sexual minority and heterosexual girls and their associations with substance use

INTRODUCTION

Sexual minority girls (SMGs) may be at high risk for substance use partially due to anti-gay discrimination. Low levels of parent-child communication and parental knowledge may contribute to this risk. This study seeks to identify parent-child communication and parental knowledge trajectories, determine the likelihood of SMGs following these trajectories, and describe the relationships between these trajectories, sexual orientation, and substance use.

METHODS

This is a secondary data analysis of the Pittsburgh Girls Study (N = 2450), a longitudinal study on the changes in behaviors among girls throughout childhood. We generated group trajectory models of parentchild communication and parental knowledge starting from age 12 to age 17 years. We then tested the likelihood of SMGs belonging to these group trajectories and the association between group trajectory membership and substance use at age 18 years.

RESULTS

SMGs were more likely than were heterosexual girls to follow the infrequent decreasing parent-child communication trajectory and the slowly decreasing parental knowledge trajectory and were more likely than were heterosexual girls to engage in substance use at age 18 years. Parent-child communication and parental knowledge trajectories were statistically significant mediators between sexual orientation and substance use.

CONCLUSION

Frequency of parent-child communication and levels of parental knowledge may be determinants of substance use among SMGs. These results have implications for developing substance use prevention programs among sexual minority youth targeting parent-child relationships.

Family-focussed interventions to reduce harm from smoking in primary school-aged children: A systematic review of evaluative studies

Children living in families where adults smoke are exposed to harmful effects of tobacco smoke and risk a predisposition to smoking initiation. Interventions to support families to reduce risk of harm from smoking have been developed and tested. The purpose of this review is to identify effective family-based interventions used to promote smoke-free home environments in families with primary school age children (aged 5-12years). A systematic search of MEDLINE, Cochrane and CINAHL electronic databases was conducted. Narrative synthesis of included articles was completed. Guidelines for reporting behaviour change interventions were used to summarise and compare intervention timing, content, intensity and delivery. Quality of included studies was critiqued using United States Preventative Services Taskforce (USPST) procedures for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. Nineteen articles that evaluated 14 intervention studies focussed on child smoking prevention (n=5), parent smoking cessation (n=4) and environmental tobacco smoke reduction (n=6). Interventions and outcomes were heterogeneous, and were rarely informed by theoretical frameworks relating to family, parenting or child development. Family based interventions may be an important strategy to reduce the effects of smoking for children. There is a need for interventions to be informed by theory relevant to children, parenting and families.

Agarra el momento/seize the moment: Developing communication activities for a drug prevention intervention with and for Latino families in the US Southwest

This article presents the development of parent-child communication activities by applying Community-Based Participatory Research and focus group methodology. Three parent-child communication activities were developed to enhance an already efficacious parenting intervention: (1) agarra el momento or seize the moment uses everyday situations to initiate conversations about substance use, (2) hay que adelantarnos or better sooner than later stresses being proactive about addressing critical issues with youth, and (3) setting rules and expectations engages parents in establishing rules and expectations for healthy and effective conversations with youth. Focus group data are presented to illustrate how thematic content from the focus groups was used to inform the development of the activities and, furthermore, how such methods supported the development of a culturally grounded intervention.

Brief Family Based Intervention for Substance Abusing Adolescents

Research has shown that a lack of parental involvement in their children's activities predicts initiation and escalation of substance use. Parental monitoring and supervision, parent-child communication including communication regarding beliefs and disapproval of substance use, positive parenting, and family management strategies, have been shown to protect against adolescent substance abuse and related problems. Family and parenting approaches to preventing and intervening on adolescent substance abuse have received support in the literature. This article discusses the theoretical foundations as well as the application of the Family Check-up, a brief, family-based intervention for adolescent substance use.

Family-based programmes for preventing smoking by children and adolescents

BACKGROUND

There is evidence that family and friends influence children's decisions to smoke.

OBJECTIVES

To assess the effectiveness of interventions to help families stop children starting smoking.

SEARCH METHODS

We searched 14 electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO, CINAHL unpublished material, and key articles' reference lists. We performed free-text internet searches and targeted searches of appropriate websites, and hand-searched key journals not available electronically. We consulted authors and experts in the field. The most recent search was 3 April 2014. There were no date or language limitations.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions with children (aged 5-12) or adolescents (aged 13-18) and families to deter tobacco use. The primary outcome was the effect of the intervention on the smoking status of children who reported no use of tobacco at baseline. Included trials had to report outcomes measured at least six months from the start of the intervention.

DATA COLLECTION AND ANALYSIS

We reviewed all potentially relevant citations and retrieved the full text to determine whether the study was an RCT and matched our inclusion criteria. Two authors independently extracted study data for each RCT and assessed them for risk of bias. We pooled risk ratios using a Mantel-Haenszel fixed effect model.

MAIN RESULTS

Twenty-seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow-up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty-three interventions were tested in the USA, two in Europe, one in Australia and one in India.The control conditions fell into two main groups: no intervention or usual care; or school-based interventions provided to all participants. These two groups of studies were considered separately.Most studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta-analysis.There was moderate quality evidence family-based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non-smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but confidence intervals were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17).Eight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta-analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n = 388).No studies identified any adverse effects of intervention.

AUTHORS' CONCLUSIONS

There is moderate quality evidence to suggest that family-based interventions can have a positive effect on preventing children and adolescents from starting to smoke. There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons. The evidence is therefore strongest for high intensity programmes used independently of school interventions. Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%. However, these findings should be interpreted cautiously because effect estimates could not include data from all studies. Our interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting). This is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting.

An exploration of the factors influencing parental self-efficacy for parents recovering from substance use disorders using the social ecological framework

BACKGROUND

The evidence strongly links parental self-efficacy (PSE) to parenting behaviors and child health outcomes.

PURPOSE

The purpose of this article is to apply the social ecological model to the exploration of contextual factors that influence PSE for parents recovering from substance use disorders (SUDs).

METHODS

An integrative review of the literature was conducted on PSE, parenting behaviors, and parents recovering from alcohol and other SUDs through the application of the social ecological model.

RESULTS

The results indicated that there are many individual, interpersonal, and environmental variables that influence PSE for parents with or without addiction.

CONCLUSIONS

Because PSE is a strong predictor of parenting behaviors and child health outcomes, interventions designed to improve PSE may improve the overall health outcomes of families affected by SUD. These interventions would need to address intrapersonal factors of guilt and shame associated with addiction, parenting knowledge (individual), social support (interpersonal), social networking of church, and other community support programs. The integral role of community support, multiagency collaboration (organizational), and national policies (policy) impacting funding for SUD should also be considered. Intervening on multiple ecological systems simultaneously can mitigate negative factors predictive of PSE, improve access to healthcare and service delivery, and transform and sustain positive behavioral changes for parents recovering from SUD.

Carer-led health interventions to monitor, promote and improve the health of adults with intellectual disabilities in the community: a systematic review

Using carers to help assess, monitor, or promote health in people with intellectual disabilities (ID) may be one way of improving health outcomes in a population that experiences significant health inequalities. This paper provides a review of carer-led health interventions in various populations and healthcare settings, in order to investigate potential roles for carers in ID health care. We used rapid review methodology, using the Scopus database, citation tracking and input from ID healthcare professionals to identify relevant research. 24 studies were included in the final review. For people with ID, the only existing interventions found were carer-completed health diaries which, while being well received, failed to improve health outcomes. Studies in non-ID populations show that carers can successfully deliver screening procedures, health promotion interventions and interventions to improve coping skills, pain management and cognitive functioning. While such examples provide a useful starting point for the development of future carer-led health interventions for people with ID, the paucity of research in this area means that the most appropriate means of engaging carers in a way that will reliably impact on health outcomes in this population remains, as yet, unknown.

Parent-child drug communication: pathway from parents' ad exposure to youth's marijuana use intention

The authors combined the 2-step flow of communication model and the theory of planned behavior to create a framework to evaluate the effectiveness of a set of advertisements from the National Youth Anti-Drug Media Campaign promoting parent-child drug communication. The sample consisted of 1,349 pairs of parents and children who responded to the first and second annual rounds of the National Survey of Parents and Youth, and 1,276 pairs from Rounds 3 and 4. Parents' exposure to the campaign reported at Round 1 was indirectly associated with youth's lowered intentions to use marijuana at Round 2. Ad exposure was associated with positive changes in parental attitudes toward drug communication and perceived social approval of antidrug communications. These two beliefs, along with perceived behavioral control, predicted parents' intentions to discuss drugs with their children. Parental intentions to discuss drugs reported at Round 1 were associated with youth's report of actual drug communication with their parents at Round 2. Frequency and breadth of the topics in parent-child drug communication were associated with less positive attitudes toward marijuana use among youth who spoke with their parents. Together, the child's attitudes toward marijuana use and perceived ability to refuse marijuana use predicted youth's intentions to use marijuana. The proposed model fit well with the data and was replicated in a parallel analysis of the data from Rounds 3 and 4. Implications for future antidrug media campaign efforts are discussed.

PARENTS, SONS, AND GLOBALIZATION IN TANZANIA: IMPLICATIONS FOR ADOLESCENT HEALTH

As the global youth population grows exponentially across Africa, there is increasing recognition of the risky health behaviors impeding boys' healthy transitions through puberty. This study in Tanzania sought to capture boys' voiced experiences of transitioning through adolescence, and the masculinity norms shaping boys' engagement in risky behaviors. A critical finding was the gap in parent-son communication around pubertal body changes and avoidance of risk behaviors. Findings also suggest influences from globalization and modernization are changing boys' pubertal experiences and introducing new challenges for parents attempting to provide guidance. Given evidence from high-income countries indicating parents can serve as protective factors for young people during the transition through adolescence, additional research is needed to understand current parent-son dynamics and potential interventions.

Dealing with a Latent Danger: Parents Communicating with Their Children about Smoking

The purpose of this study was to understand parental approach to the topic of smoking with school-age preadolescent children. In-depth interviews were conducted with 38 parents and yielded a grounded theory that explains how parents communicated with their children about smoking. Parents perceived smoking to be a latent danger for their children. To deter smoking from occurring they verbally interacted with their children on the topic and took action by having a no-smoking rule. There were three interaction approaches, which differed by style and method of interaction. Most parents interacted by discussing smoking with their children. They intentionally took advantage of opportunities. Some interacted by telling their children about the health effects of smoking and their opposition to it. They responded on the spur-of-the-moment if their attention was drawn to the issue by external cues. A few interacted by acknowledging to their children the negative effects of smoking. They responded only when their children brought it up. The parents' intent for the no-smoking rule, which pertained mainly to their homes and vehicles, was to protect their children from second-hand smoke and limit exposure to smoking. The theory can be used by nurses to guide interventions with parents about youth smoking prevention.

A systematic review of parent and family-based intervention effectiveness on sexual outcomes in young people

Limited evidence exists about the effectiveness of parent/family-based interventions for preventing poor sexual health outcomes, thus a systematic review was conducted as part of a wider review of community-based sex and relationships and alcohol education. Method guidance from the UK's National Institute for Health and Clinical Excellence was adhered to. Overall, 18 databases were searched. In total, 12 108 references were identified, of which 440 were retrieved and screened. Overall, 17 studies met the inclusion criteria. Findings showed that parent-based interventions were inconsistently effective at reducing young people's sexual risk behaviours. Parent-based interventions had greater impact on parent/child communication than family-based interventions, which showed no evidence of effectiveness. However, increasing parent/child communication showed no effect on sexual risk behaviours. Preliminary evidence suggests that effectiveness was greater in those studies aiming to affect multiple risk behaviours. However, this may be due to longer programme delivery and follow-up times; further evidence is required. Sexual health communication was sensitive to intervention. Studies addressing multiple risk behaviours may be as effective as targeted interventions at affecting sexual risk behaviours. Longitudinal controlled studies, examining broader sexual activity outcomes, are needed in countries such as the United Kingdom to inform the evidence base, which is primarily US based, and contribute to related policies and practices.

Parent-child communication and substance use among adolescents: do father and mother communication play a different role for sons and daughters?

The purpose of this study was to investigate gender-specific variations in the associations between communication with father and mother, cigarette smoking, alcohol drinking and marijuana use in male and female adolescents. Cross-sectional data were collected from a national sample of 1308 tenth graders who participated in the 2005/06 U.S. HBSC. Outcome variables were self-reported substances used in the past 30 days. Logistic regression analyses controlling for race/ethnicity, family structure and socioeconomic status showed that the association of mother and father communication with adolescent substance use varied by substance and gender. Among sons, father communication was protective against marijuana use and mother communication was protective against smoking. Neither father nor mother communication was protective against substance use by daughters. Research is needed to understand gender-specific differences in correlates of adolescent substance use and the implications for prevention and intervention.