More than just openness: developing and validating a measure of targeted parent-child communication about alcohol

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/54486.

Survivors' perspectives on saying goodbye: Implications for end-of-life engagement across the lifespan and grieving process

Family members are often unaware of their loved ones' final wishes and underestimate the need to talk about them before parents reach end-of-life (EOL). The benefits of engaging in EOL conversations alleviate needless suffering and can allow an opportunity to say goodbye in a meaningful way. We examined final conversations 13 adults recalled having with their aging parents through the lens of the opportunity model for presence (OMP) during the EOL process, a communication process model based on engagement in the dying process from diagnosis through bereavement, to understand the process from the survivor's perspective, looking at content of conversations and where they occurred in the dying process. Findings illustrate final conversations that align with the socio-cultural space of the OMP before the knowledge that a parent was dying, and when entering imminent death engaging in the critical moments, have implications for the grief and bereavement.

Provider Facilitation of Parent-Adolescent Health Communication: Findings From a National Survey

INTRODUCTION

Primary care providers are well-positioned to facilitate parent-adolescent health communication. We examined provider-facilitated parent-adolescent health communication prevalence and associations with parent-adolescent health communication.

METHOD

Using data from a national survey of parent-adolescent dyads (n = 853), we calculated the prevalence of provider-facilitated parent-adolescent health communication about 11 topics as a result of adolescent's last preventive visit. We examined correlates of of provider-facilitatedparent-adolescent communication and associations with with parent-adolescent communication.

RESULTS

Eighteen percent of adolescents reported that a provider helped them talk with their parent about a health concern, with little variability by adolescent, parent, or provider characteristics. Prevalence of parent-adolescent communication because of an adolescent's last preventive visit ranged between 38.4% and 79.5%. Provider facilitation was positively associated with parent-adolescent communication for all topics.

DISCUSSION

Given the low prevalence of provider-facilitated-parent-adolescent health communication and positive associations between provider facilitation and parent-adolescent communication about multiple important health-related topics, efforts to improve this practice could be beneficial.

Grounding evidence-based prevention within cultural context: promising effects of substance use prevention adapted for American Indian families

Background: Effective substance use prevention strategies are needed for American Indian (AI) youth, who face disproportionate risk for early substance use and consequently bear a disproportionate burden of health and developmental disparities related to early use. With few exceptions, significant advances in prevention science have largely excluded this population, leaving gaps in the evidence of effective practice. This paper builds on emerging efforts to address this gap, reporting first outcome findings from an evidence-based early substance use prevention program culturally adapted for young adolescents on a Northern Plains reservation. Methods: Using a community-based participatory approach, the Thiwáhe Gluwáš'akapi Program (TG, sacred home in which family is made strong) was developed by embedding cultural kinship teachings within the Strengthening Families Program for Parents and Youth 10-14 and aligning other elements of program content with local culture and context. Results: Results of pre and post comparisons of proximal program outcomes showed that youth reported significant improvements in parental communication about substance use, substance use resistance skills, stress management, family cohesion, and overall well-being. Adults reported improvements in a wide array of parenting behaviors and indicators of family dynamics. Conclusions: These findings provide an initial glimpse into the potential effects of the TG program and suggest that it holds promise for helping AI families address risks for youth substance use through positive impacts on modifiable risk and protective factors documented to influence early substance use.

A Systematic Review of Parent-Child Communication Measures: Instruments and Their Psychometric Properties

Parent-child communication represents an important variable in clinical child and family psychology due to its association with a variety of psychosocial outcomes. To give an overview of instruments designed to measure the quality of parent-child communication from the child's (8-21 years) perspective and to assess the psychometric quality of these instruments, we performed a systematic literature search in Medline and PsycInfo (last: February 25, 2022). Peer-reviewed journal articles published in English with a child-rated instrument measuring the quality of parent-child communication were included. Initial screening for eligibility and inclusion, subsequent data extraction, and quality assessment were conducted by couples of review team members. Based on the screening of 5115 articles, 106 studies reported in 126 papers were included. We identified 12 parent-child communication instruments across the studies. The Parent-Adolescent Communication Scale (PACS) was used in 75% of the studies. On average, the evidence for psychometric quality of the instruments was low. Few instruments were used in clinical and at-risk samples. Several instruments are available to rate parent-child communication from the child's perspective. However, their psychometric evidence is limited and the theoretical foundation is largely undocumented. This review has limitations with regard to selection criteria and language bias.Registration PROSPERO: CRD42021255264.

Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study

BACKGROUND

To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website's usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period.

OBJECTIVE

Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention.

METHODS

Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants' feedback about Positive Choices.

RESULTS

A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8% to 14% among school staff and from 15% to 22% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants' suggestions for improvement informed a recent website update.

CONCLUSIONS

The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities.

A Parent-Based Intervention for Reducing High-risk Social Media Cognitions, Alcohol Use, and Negative Consequences Among Adolescents: Protocol for a Randomized Controlled Pilot Study

BACKGROUND

The prevalence of adolescent alcohol use continues to be a public health concern. Although adolescents spend an increasing amount of time with their friends, parents remain an important source of support and continue to play a key role in the lives of their adolescents. Extensive research in this area has resulted in parent-based intervention (PBI) efforts to prevent or reduce adolescent alcohol use. However, one major limitation of PBIs is that they do not currently consider the large role that social media plays in adolescents' lives and in relation to their alcohol use. We will add to the literature by developing and refining a web-based PBI designed to reduce both high-risk social media cognitions and alcohol use among adolescents.

OBJECTIVE

The central goal of the proposed study is to develop, refine, and pilot a web-based PBI to reduce both high-risk social media cognitions and alcohol use among adolescents.

METHODS

A total of 100 parent-teen dyads will be randomly assigned to one of the following 2 conditions: intervention or control. Parents in the intervention group will be given access to the web-based PBI and suggestions for working through the PBI modules with their teens. The parent-teen dyads will fill out 3 questionnaires: a baseline questionnaire, 1-month questionnaire, and 6-month questionnaire.

RESULTS

Recruitment and enrollment will begin in August 2022. Upon completion of the intervention trial, we will examine the feasibility, acceptability, and preliminary effect sizes of the newly developed web-based PBI.

CONCLUSIONS

This study has the potential to open doors for future studies examining the clinical implications of an efficacious web-based PBI to reduce alcohol use and high-risk cognitions about alcohol displays on social media.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04333966; https://clinicaltrials.gov/ct2/show/NCT04333966.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/38543.

A Snapshot of Parenting Practices Useful for Preventing Adolescent Vaping

•

Youth with more parental knowledge perceive higher vaping prevalence.

•

Youth with more parental knowledge perceive greater vaping harm.

•

Youth with more parental knowledge perceive less accepting of vaping.

•

Youth with greater parental media mediation report less lifetime vaping.

Introduction

Smoking research demonstrates that parents can influence their adolescent’s tobacco smoking perceptions and behaviors, but little is known about the protective effects of different parenting practices on adolescent vaping. In this study we investigate how adolescent perceptions of parents’ knowledge of their activities and parental media mediation are associated with adolescents’ perceptions of vaping and adolescent vaping behaviors.

Method

Six hundred thirty-nine youth (65.7% female, average age: 14.71 years old) recruited through 4-H clubs in nine states participated in a study evaluating a substance use intervention program. Because the evaluation design could influence participants, we used only baseline data. An online self-reported survey was administrated. Most youth self-identified as White (87.3%) and only handful youth indicated Asian (3.4%), African American (3.4%), American Indian (1.1%), and other or unreported (4.8%). Approximately 60% of youth lived in small town or rural areas in US.

Results

Analyses revealed that parental knowledge was positively related with adolescent perceived harm of vaping and perceived prevalence of vaping, but was negatively related with perceived acceptability of vaping and social expectancy of vaping. In addition, youth who reported greater parental media mediation were more likely to perceive the harm of vaping and less likely to vape compared with youth with lower parental media mediation.

Conclusion

These findings suggest that parental education about vaping, including those promoting conversations regarding vaping and vaping ads, may be important to the prevention of adolescent vaping.

Investigation of college student smoking perceptions, behaviors and communication about smoking with smoking friends and family

Purpose

Communication plays an important role in health decisions and behaviors. Friends and family exert influence through communication and, when considering smoking, this is particularly salient among those friends and family who smoke. Guided by primary socialization theory and integrated behavioral model, the present study examined the effects of having smoking friends and family on smoking beliefs (e.g. negative consequences, positive reinforcement and negative reinforcement), cultural normative beliefs, pro-smoking injunctive norms, smoking intentions and recent smoking behaviors.

Design/methodology/approach

Cross-sectional online survey data were collected from college students (N = 227). Multivariate analysis of covariance and path analysis were performed.

Findings

College students who reported having smoking friends were more likely to report higher levels of positive reinforcement, cultural normative beliefs, pro-smoking injunctive norms, positive attitudes, smoking intentions and recent smoking behaviors than those without smoking friends. Frequent communication with smoking friends was significantly related to cultural normative beliefs, pro-smoking injunctive norms, positive attitudes and smoking intentions. The analysis, however, did not yield statistical support for the associations between frequent communication with smoking family and smoking perceptions, norms and behaviors.

Originality/value

The present study highlights the vital roles of friends' influence for college students' smoking behaviors. Communication-based intervention can help better equip college students with communication strategies that prevent tobacco use by promoting more effective conversations with friends.

The Vicious Cycle: Problematic Family Relations, Substance Abuse, and Crime in Adolescence: A Narrative Review

Despite the copiousness of studies on the risky behaviors of adolescents, we cannot establish with certainty the leading aspects involved in teens' substance abuse and criminal actions. This review aims to explore the interplay among the family system, substance abuse, and criminal behavior. An analysis of the main results of the 61 articles published between 2010 and 2020 shows that adolescents whose parents are justice-involved and often absent from home are more likely to perceive lower cohesion, support, and poor family communication. These factors can involve them in criminal acts and substance abuse. Moreover, these conducts are often linked to a form of uneasiness and a search of autonomy. Indeed, risky behaviors could have more than one meaning. Our findings also suggest that the most diffused drug-related crimes in adolescence are economic crimes, weapon carrying, robberies, dealing, and drug possession. Considering these results, future clinical implications might be based on multidimensional approaches, focusing more on the family context to promote interventions for at-risk adolescents.

Reducing Risk for Adolescent Substance Misuse with Text-Delivered Counseling to Adolescents and Parents

Background: Text-delivered prevention programs provide unique opportunities to deliver substance use prevention interventions to at-risk populations. Methods: A pilot randomized controlled trial was conducted to test the feasibility, acceptability, and preliminary efficacy of a 4-week, automated personalized text-messaging prevention program, designed to reduce risk factors and increase protective factors associated with adolescent substance use and misuse. Sixty-nine adolescents were recruited from a Federally Qualified Health Care clinic and randomized to a text-delivered intervention, or a wait-list control condition. Simultaneously, fifty-two parents of adolescent participants were enrolled into a parenting skills text-delivered intervention. Participants completed a baseline assessment and three follow-up surveys over three-months. Adolescent saliva specimens for drug testing were collected. Results: All intervention-allocated adolescents implemented at least one of the text-based counseling recommendations and 79% indicated that they found the texts helpful. Significant intervention effects were found on risk and protective factors for substance misuse. Adolescents in the intervention group reported reduced depression symptoms (d = -.63) and anxiety symptoms (d = -.57). Relative to controls, adolescents in the intervention group maintained a higher quality of parental relationship (d = .41) and parenting skills (d = .51), suggesting a prophylactic effect. Marginal decrease in the odds of positive drug tests were found for youth in intervention group (77.1% decrease, p = 0.07) but not with controls (54.3% decrease, p = 0.42,). Conclusions: Results provide preliminary evidence in the feasibility, acceptability, and efficacy of targeting risk and protective factors that are implicated in substance use via text-delivered interventions for high-risk populations.

Factors Associated with Smoking and Drinking among Early Adolescents in Vanuatu: A Cross-Sectional Study of Adolescents and Their Parents

This cross-sectional study determined whether various factors, such as parental behavior, attitude, and knowledge and sibling and peer behaviors, were associated with smoking and drinking among early adolescents in the Republic of Vanuatu. For this purpose, logistic regression analysis was used to determine the relative importance of the factors as well as the influences of the parents/guardians, siblings, and peers. The participants consisted of 157 seventh- and eighth-grade adolescents (mean age = 13.3 years; 52.2% girls), including their parents/guardians, from three public schools in Vanuatu. According to the results, the proportions of smokers and drinkers among the adolescents were 12.7% each, while the majority of the parents/guardians disapproved of underage smoking and drinking. In addition, peer influences (i.e., regularly smoking and/or drinking and offering tobacco and/or alcohol) was significantly associated with ever smoking and drinking, whereas parental and sibling influences did not have a significant impact on ever smoking and drinking. In sum, being given tobacco or alcohol from peers had the strongest association with ever smoking and drinking among the adolescents in this study. Thus, future school-based intervention programs should focus on enhancing early adolescents’ life skills, including the ability to resist offers of tobacco and/or alcohol from their peers.

Examining the associations between alcohol-related parental communication, alcohol use, and protective behavioral strategy use among young adults

Underage alcohol use is a public health concern as it remains prevalent and problematic. Protective behavioral strategies (PBS) may prevent or reduce alcohol-related consequences, yet daily-level findings show they instead might be associated with increased drinking and consequences. While parents are a possible source of influence to their child's decision making, it is unclear whether parental communication about alcohol affects drinking outcomes, with mixed findings noted in the literature. Furthermore, little research focuses on understanding how parental communication may impact the use of PBS. This study assessed whether alcohol specific parental communication would be associated with reduced drinking and increased use of PBS. Data from baseline and 3-month follow up were evaluated from a control group of a larger randomized controlled trial on 18- to 20-year-olds in the U.S. (N = 269). Outcomes included drinks per week, peak drinks per occasion, negative consequences and use of PBS. Using negative binomial regression modeling, controlling for age, sex, and whether participants lived with parents, findings revealed that parental communication was not associated with drinks per week, peak drinks per occasion, or negative consequences reported 3 months later. However, it was positively associated with limiting/stopping drinking PBS, manner of drinking PBS, and serious harm reduction PBS reported 3 months later. Results suggest that parental communication about alcohol may be more effective in increasing the use of protective behavioral strategies rather than reduction of drinking. Research is needed to determine why parental communication may influence the use of PBS and how we can strengthen the quality or focus of communication to ultimately increase the impact on risk behaviors.

Is Parent-Adolescent Drug Talk Always Protective? Testing A New Scale of Drug Talk Styles in Relation to Adolescent Personal Norms, Parental Injunctive Norms, Substance Use Intentions, and Behaviors

According to parent-offspring drug talk (PODT) model, the specificity of drug talk styles is identified by the timing and directness of communication about substance use between parent and adolescent (e.g., situated direct, ongoing direct, situated indirect, and ongoing indirect talk style). Given the limitation of the original, single item measure for drug talk styles with a categorical response option, the current study proposed a new scale of drug talk styles and tested its concurrent validity. Using cross-sectional survey data (N = 2,035), confirmatory factor analysis was conducted to test the factor structure of the scale. Consistent with PODT model, the analysis yielded support for a four-factor structure for the drug talk styles. Next, a path analysis was employed to validate the scale. The findings suggested that situated direct talk was positively related to personal anti-substance-use norms and parental anti-substance-use injunctive norms but negatively related to smoking intention, as well as alcohol use in the past 30 days. Ongoing direct talk, however, was found to be positively associated with alcohol and marijuana use in the past 30 days. Research implications and future directions are discussed.

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.

Integrating Community-Engagement and a Multiphase Optimization Strategy Framework: Adapting Substance Use Prevention for American Indian Families

Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwáš'akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact.

Differential Effects of Parental "drug talk" Styles and Family Communication Environments on Adolescent Substance Use

The current study examines the relationships among adolescent reports of parent-adolescent drug talk styles, family communication environments (e.g., expressiveness, structural traditionalism, and conflict avoidance), and adolescent substance use. ANCOVAs revealed that the 9th grade adolescents (N = 718) engaged in four styles of "drug talks" with parents (e.g., situated direct, ongoing direct, situated indirect, and ongoing indirect style) and these styles differed in their effect on adolescent substance use. Multiple regression analyses showed that expressiveness and structural traditionalism were negatively related to adolescent substance use, whereas conflict avoidance was positively associated with substance use. When controlling for family communication environments and gender, adolescents with an ongoing indirect style reported the lowest use of substance. The findings suggest implications and future directions for theory and practice.

Trends of Parent-Adolescent Drug Talk Styles in Early Adolescence

The present study seeks to understand how parents as prevention agents approach substance use prevention messages during the period of early adolescence. Students (N = 410) in a drug prevention trial completed surveys from 7th to 9th grade. Using longitudinal data, a series of latent transition analyses was conducted to identify major trends of parent-adolescent drug talk styles (i.e., never talked, situated direct, ongoing direct, situated indirect, and ongoing indirect) in control and treatment conditions. Findings demonstrate a developmental trend in drug talk styles toward a situated style of talk as youth transitioned from 7th grade to 9th grade. Findings also show that even though the drug prevention trial did not specifically target parental communication, parents in the treatment condition provide more ongoing substance use prevention messages to their adolescent children than do parents in the control condition. The present study discusses relevant developmental issues, potential intervention effects, and future research directions for communication research in substance use prevention.

Why Is It Just So Hard? Making Sense of End-of-Life Communication Between Adult Children and Their Terminally Ill Parental Figures

The aging population in the United States is predicted to become one fifth of the population by 2050. With that increase, more individuals in the country will be experiencing chronic health conditions and the need for care, with end of life (EoL) becoming more of a topic that needs to be discussed. This study aims to explore the ways adult children talk to their parents about EoL, death, and dying. We discovered six themes: protection, meeting needs, guilt and regret, control, family dynamics, and communication type. Each of these was prevalent in responses to how adult children cope, how they cared for their parent, and how hope played into the interactions. We believe these themes will be helpful in developing a quantitative scale to study EoL further and be practical in helping adult children cope following death of their parent.

Prevention of alcohol use in older teens: A randomized trial of an online family prevention program

This study examines effects of a randomized controlled trial for an online, family-based prevention program for older teens, Smart Choices 4 Teens, on alcohol use and related outcomes. Families (N = 411; teen age M = 16.4, SD = 0.5) were randomly assigned to the intervention or control condition in 2014-2015. Both intent to treat (ITT) and dosage models were conducted. ITT models: At the 6-month follow-up, teens in the experimental condition reported fewer friends who had been drunk, and parents in the experimental group reported more communication about social host laws. At the 12-month follow-up, parents in the experimental condition reported consuming fewer drinks than parents in the control group. Dosage models: At the 6-month follow-up, dosage was inversely related to teen drinking in the past 6 months or 30 days, frequency of teen drinking during the past 6 months and 30 days, drinks consumed by teens over the past 6 months, teen drunkenness and binge-drinking during the past 30 days, teen reported communication about safe drinking and positively related to parent and teen reported communication about social host laws. At 12 months, dosage was inversely related to teen alcohol use, frequency of teen drinking over the past 30 days, drinks consumed by teens over the past 6 months and 30 days, and teen drunkenness over the past 6 months. Results suggest that Smart Choices 4 Teens is beneficial for families. Dissemination and implementation strategies that motivate completion of program content will improve outcomes related to older teens' alcohol use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Frequency of Parent-Adolescent Alcohol-Specific Communication and Adolescent Perceptions of Alcohol

To better understand the optimal frequency of parent-adolescent alcohol-specific communication, we conducted a secondary analysis of the National Center on Addiction and Substance Abuse Culture of High School Survey, a 2010 nationally representative online survey of 1000 high school students. Logistic regression models assessed the relationship between alcohol-specific communication and adolescent perceptions ( binge drinking is very dangerous, drinking is cool, and getting drunk is very dangerous), adjusting for grade, sex, race, personal and peer alcohol use, and parental monitoring. Among adolescents reporting personal and peer alcohol use, a dose-response relationship existed between frequency of alcohol-specific communication and thinking binge drinking is very dangerous (often [adjusted odds ratio [AOR] = 7.98; 95% confidence interval [CI] = 2.98-21.36], sometimes (AOR = 6.08; 95% CI = 2.36-15.69), rarely (AOR = 5.27; 95% CI = 1.95-14.26) vs never), and was also associated with decreased perceptions that drinking is cool (often [AOR = 0.22; 95% CI = 0.08-0.66), rarely vs never [AOR = 0.17; 95% CI = 0.06-0.51]); the inverse was true for never-drinkers without peer use.

Perceived Parental Legitimacy as a Moderator of Parent-Child Communication's Effects on Latina/o Adolescent Substance Use

Utilizing primary socialization theory (PST) and longitudinal survey data from 381 Latina/o sixth- through eighth-grade students, we hypothesized that four types of parent anti-substance use messages (i.e., parents' own past substance use, religious beliefs, respect for family, and peer resistance) would discourage Latina/o students' substance use, particularly when the students perceived their parents' anti-substance use messages were legitimate. The results supported moderation. For Latina/o students who thought that their parents' anti-substance use messages were legitimate, many of the anti-substance use messages were negatively related to substance use, but the associations were positive or nonsignificant for Latina/o students who thought that their parents' anti-substance use messages were not legitimate. The findings extend past work on PST and anti-substance use parent-child communication, highlighting the importance of perceived legitimacy and message content.

Parental Messages about Substance Use in Early Adolescence: Extending a Model of Drug-Talk Styles

This study extends a typology of parent-offspring drug talk styles to early adolescents and investigates associations with adolescent substance use. Data come from a self-report survey associated with a school-based, 7th grade drug prevention curriculum. Mixed methods were used to collect data across four measurement occasions spanning 30 months. Findings highlight the frequencies of various drug-talk styles over time (i.e., situated direct, ongoing direct, situated indirect, ongoing indirect, never talked), messages adolescents hear from parents, and comparisons of alcohol, cigarette, and marijuana use by drug-talk style. This study advances an understanding of parent-adolescent communication about substances and holds practical implications for drug prevention efforts.

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.

The effectiveness of online, family-based media literacy education for substance abuse prevention in elementary school children: Study of the Media Detective Family program

The present study investigates the effectiveness of a family-based, online media literacy education (MLE) program for substance abuse prevention in children from rural areas. A total of 83 families were randomly assigned to receive Media Detective Family (MDF) (n = 47) or a control computer program (n = 36) between pre- and posttest questionnaires. Fifty-one percent (N=42) completed a three-month follow-up questionnaire. Children receiving MDF reported a significant reduction in their use of substances over time compared to children in the control group (d = -.80). Parents receiving MDF reported that the program was convenient and engaging. The current study showed that an online substance use prevention program using MLE and designed for families is an effective intervention method for reducing children's substance use.

NekNominate: Social Norms, Social Media, and Binge Drinking

This study examines the social-media-based binge drinking game NekNominate and how this phenomenon is related to social norms. NekNominate is a game wherein players are nominated to film themselves "neking" or chugging copious amounts of alcohol or drinking alcohol in a novel or humorous manner. The player then nominates other players via social media who then have a specific timeframe in which they must complete their challenge or face ridicule. Health communication research on drinking behaviors has often looked at the role of social norms in determining these behaviors. News stories (n = 44) of NekNominate and tweets (n = 851) culled using the hashtag #NekNominate during three different time periods are analyzed to identify the normative forces at play in this recent phenomenon.

A Longitudinal Study of Parental Anti-Substance-Use Socialization for Early Adolescents' Substance-Use Behaviors

The present study examines the role of communication in shaping norms and behaviors with significant personal and societal consequences. Based on primary socialization theory and the general theory of family communication, parental anti-substance-use socialization processes were hypothesized to influence early adolescents' substance use norms and behaviors. Using longitudinal data (N =1,059), the results revealed that parent-adolescent prevention communication about substance use in the media and parental anti-substance-use injunctive norms were positively associated with early adolescents' personal anti-substance-use norms, which, in turn, led to decreases in recent alcohol, cigarette, and marijuana use. It was also found that family expressiveness and structural traditionalism positively related to the hypothesized association between parental socialization processes and early adolescents' norms and behaviors.

Parent Prevention Communication Profiles and Adolescent Substance Use: A Latent Profile Analysis and Growth Curve Model

This current study identifies distinct parent prevention communication profiles and examines whether youth with different parental communication profiles have varying substance use trajectories over time. Eleven schools in two rural school districts in the Midwestern United States were selected, and 784 students were surveyed at three time points from the beginning of 7th grade to the end of 8th grade. A series of latent profile analyses were performed to identify discrete profiles/subgroups of substance-specific prevention communication (SSPC). The results revealed a 4-profile model of SSPC: Active-Open, Passive-Open, Active-Silent, and Passive-Silent. A growth curve model revealed different rates of lifetime substance use depending on the youth's SSPC profile. These findings have implications for parenting interventions and tailoring messages for parents to fit specific SSPC profiles.

Exploring Parental Influence on the Progression of Alcohol Use in Mexican-Heritage Youth: a Latent Transition Analysis

Mexican-heritage youth are members of the fastest growing minority group and are at particular risk for substance use including alcohol consumption. Youth face numerous risk factors including positive descriptions of substance use on media and peer offers that are potentially ameliorated by parental anti-substance use socialization efforts. Guided by primary socialization theory and the theory of planned behavior, the present study posited eight research questions to identify discrete subgroups/patterns of Mexican-heritage youth alcohol use behavior and parental influence on youth outcomes. Longitudinal survey data (n = 1147) from youth in 29 public schools located in Phoenix, Arizona, were collected over 3 years. Latent class and transition analyses identified four discrete subgroups characterized by response patterns of alcohol use behaviors and perceptions in Mexican-heritage youth: (1) non-drinker, (2) potential drinker, (3) experimenter, and (4) regular drinker. Targeted parent-child communication about alcohol and parental monitoring were found to be significant predictors for youth alcohol use. Research implications and future directions are suggested.

Multivariate family factors in lifetime and current marijuana use among American Indian and white adolescents residing on or near reservations

BACKGROUND

Rates of marijuana use are consistently high among reservation-based American Indian adolescents. The roles of family are unique in this ethnic group and can serve as sources of both risk and protection for substance use.

PURPOSE

To assess the relationships between distal and proximal family factors and lifetime and current marijuana use among American Indian and white middle and high school students who attend the same schools on or near reservations.

METHODS

In-school surveys were administered to 3380 American Indian and 1562 white students from 35 middle schools and 17 high schools regarding levels of marijuana use and family characteristics. Three logistic regression models (Control, Control+Distal; Control+Distral+Proximal) estimated effects of multiple family variables on lifetime and current marijuana use.

RESULTS

Strong effects were found for family structure, parental monitoring, family conflict, and family sanctions against marijuana use. Weaker effects were found for family participation in school events, and no relationship was found for family communication about marijuana. Anumber of similar results were found across ethnicity and middle and high school students.

CONCLUSIONS

Family variables exert strong and largely consistent effects across reservation-based American Indian and white youth on lifetime and current marijuana use. Interventions that include a broad range of targeted family components may serve to both limit uptake and forestall increases in adolescent marijuana use in these two groups.

Testing a Brief Substance Misuse Preventive Intervention for Parents of Pre-Adolescents: Feasibility, Acceptability, Preliminary Efficacy

Evidence-based interventions to reduce substance misuse among adolescents are resource and time intensive. We conducted a pilot RCT to evaluate a novel, adaptable, and resource-efficient substance misuse preventive intervention for parents/guardians, focusing on talking with children about substance use and on eating family meals. We randomized 70 parents of children in third-through-sixth grades within a large, urban public school system in New England to the intervention or control condition. Over a six-month follow-up period, we assessed feasibility and acceptability of the intervention and examined frequency of parent-child conversations about alcohol, marijuana, and other drugs, and frequency and duration of family meals. A total of 29 parents were assigned to the intervention and 35 to the control condition. The intervention was found to be feasible and acceptable to participants as evidenced by high recruitment and retention rates and positive feedback from qualitative exit interviews. At three- and six-month follow up, 64.3% and 44.5% of parents in the intervention condition were talking "a lot" to their children about alcohol, compared to 8.7% and 8.7% of the parents in the control condition, respectively (p<0.01 and p=0.03). Patterns in frequency and duration of family meals between the two conditions were not significantly different over time. In conclusion, a higher percentage of parents randomized to the intervention condition spoke with their children about alcohol, marijuana, and other drugs, but the frequency and duration of meals was not impacted. Further testing of the brief intervention with a larger sample to assess efficacy is warranted.

Communication About Problematic Drinking Between Young Adults and their Parents: An Application of Inconsistent Nurturing as Control Theory

Approximately 80% of college students drink, half of whom consume alcohol in the form of binge drinking. The current study applies Inconsistent Nurturing as Control Theory to examine the communication about excessive drinking that takes place between parents and their young adult children. Forty college students were asked to report on a moment or incident that led their parents to label their drinking as concerning and were then asked to report on how their parents acted towards the drinking before and after the moment of labeling. Interviews were transcribed and coded. The findings suggest that parents act with inconsistency when attempting to manage their children's drinking by enacting both reinforcing and punishing behaviors. Parents' reinforcing behaviors included drinking with their children and buying them alcohol, even after labeling the drinking as problematic. Parents' punishment behaviors included expressing concern about their children's sense of responsibility and making their children feel regretful about their drinking. Nearly 88% of the participants were able to recall the moment at which their parents labeled their drinking as problematic. Implications for using inconsistent messages in conversations about alcohol are discussed.

Exploratory trial of a school-based alcohol prevention intervention with a family component

Purpose

– Involvement of parents/carers may increase effectiveness of primary school-based alcohol-misuse prevention projects through strengthening family-based protective factors, but rates of parental engagement are typically low. This paper reports findings from an exploratory trial of a school-based prevention intervention – Kids, Adults Together (KAT), based on the Social Development Model, which aimed to promote pro-social family communication in order to prevent alcohol misuse, and incorporated strategies to engage parents/carers. The purpose of this paper is to assess the feasibility and value of conducting an effectiveness trial of KAT.

Design/methodology/approach

– The study was a parallel-group cluster randomised exploratory trial with an embedded process evaluation. The study took place in south Wales, UK, and involved nine primary schools, 367 pupils in Years 5/6 (aged 9-11 years) and their parents/carers and teachers. Questionnaires were completed by pupils at baseline and four month follow-up, and by parents at six month follow-up.

Findings

– Overall KAT was delivered with good fidelity, but two of five intervention schools withdrew from the study without completing implementation. In total, 50 per cent of eligible parents participated in the intervention, and KAT had good acceptability among pupils, parents and teachers. However, a number of “progression to effectiveness trial” criteria were not met. Intermediate outcomes on family communication (hypothesised to prevent alcohol misuse) showed insufficient evidence of an intervention effect. Difficulties were encountered in identifying age appropriate outcome measures for primary school-age children, particularly in relation to family communication processes. The study was unable to find comprehensive methodological guidance on exploratory trials.

Research limitations/implications

– It would not be appropriate to conduct an effectiveness trial as key progression criteria relating to intervention and trial feasibility were not met. There is a need for new measures of family communication which are suitable for primary school-age children, and more guidance on the design and conduct of exploratory/feasibility trials.

Originality/value

– KAT achieved high rates of parental involvement, and its theoretical framework and processes could be adapted by other interventions which experience difficulties with recruitment of parents/carers.

Relationship Satisfaction and Communication Among Urban Minority HIV-Positive and HIV-Negative Mothers: The Influence on Daughter's Alcohol Use

Family relationships influence children's beliefs and behaviors. This work examined qualities associated with communication about alcohol among 176 mothers and the influence of this communication on daughters' alcohol use. Path analyses by maternal HIV status indicated significant differences. Relationship satisfaction was associated with self-efficacy for both HIV-positive (β = 0.545, p < .001) and HIV-negative (β = 0.557, p < .001) mothers. Maternal self-efficacy was associated with communication for both HIV-positive (β = 0.364, p < .01) and HIV-negative (β = 0.310, p < .05) mothers; maternal attitudes toward alcohol use were associated with communication among HIV-negative mothers (β = 0.20, p < .05). Relationship satisfaction was indirectly related to daughter's alcohol use in HIV-positive dyads (β = 0.153, p < .05). In families with interfamilial and environmental stressors, investing in the mother-daughter relationship, in part by discussing issues related to alcohol use, is protective in nature.

Measuring Alcohol-Specific Communication with Friends: Conceptualizing and Operationalizing Communication as Multidimensional

According to primary socialization theory, adolescents develop beliefs about alcohol by interacting with peers, as well as other socialization agents. Although communication is essential to this belief-formation process, few studies have identified the specific alcohol-related messages that adolescents exchange with their peers, and more specifically friends, that lead to certain anti- and/or pro-alcohol-related beliefs. Consequently, the goal of this study was to develop a multidimensional measure of alcohol-specific communication with friends. Based on survey data from 259 high school students, the results indicated that communication with friends involving warnings against drinking alcohol, disapproval of alcohol consumption, and making fun of others for drinking alcohol was negatively related to pro-alcohol beliefs and intentions. Communication with friends involving rumors, teasing each other about drinking alcohol, intentions to drink alcohol, different types of alcohol, experiences with alcohol, and talking about how many peers drink alcohol was positively related to pro-alcohol beliefs and intentions.

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.

Mediation and moderation effects of an in-home family intervention: the "in control: no alcohol!" pilot study

The aim of this study was to examine the effect of a theory-based in-home family intervention (In control: No alcohol!) on adolescent alcohol cognitions via its putative mediators using a randomized controlled design. In the South Holland region of the Netherlands, a total of 213 children (11-12 years) and their mothers were randomly assigned to the prevention program (108 dyads) and the control condition (105 dyads). Mediation effects were analyzed using pretest and two follow-up measurements (5 and 12 months after baseline). A path model was estimated (using Mplus) to examine the effect of the intervention on the putative mediators (frequency- and quality of mother-child communication, rules about alcohol, establishing a nondrinking agreement, and parental monitoring of the child's whereabouts). Outcomes were adolescents' perceived harmfulness of drinking and intention to drink. Multigroup analyses were performed to examine potential differences across gender. The program led to an increase in frequency of alcohol-specific communication, nondrinking agreements, and parental monitoring. Moreover, adolescents in the experimental condition perceived drinking to be more harmful and had less intention to drink compared to adolescents in the control condition. The effect of the program on adolescent alcohol cognitions was significantly mediated through having more frequent conversations about alcohol, yet only among boys. Although results on actual drinking need to be added, findings indicate that this relatively inexpensive, easy-to-administer home intervention is promising.

What do high school students say when they talk to their friends about substance use? Exploring the content of substance-use-specific communication with friends

In this study, we examined the content of adolescents' conversations with their friends about substance use, adolescents' reactions to such conversations, and reasons why some adolescents did not engage in such conversations. Based on 25 semistructured interviews with high school students, we identified three themes: informational, persuasive, and relational messages. Informational messages included discussing how many peers use substances and clarifying rumors about a friend's substance use. Persuasive messages involved direct anti-substance-use messages (e.g., warning), direct pro-substance-use messages (e.g., legalizing marijuana), indirect anti-substance-use messages (e.g., disliking their substance-use experience), and indirect pro-substance-use messages (e.g., intentions to use substances). Relational messages included joking about substance use and establishing code words for use. Adolescents reacted to their conversations in several ways, such as shock and increased relational closeness. When adolescents did not talk about substance use with their friend, they offered several reasons, including low response efficacy and fear of ruining the friendship.

Talking About Antismoking Campaigns: What Do Smokers Talk About, and How Does Talk Influence Campaign Effectiveness?

Campaign-stimulated conversations have been shown to increase the effectiveness of antismoking campaigns. In order to explore why such effects occur, in the current study we coded the content of naturally occurring conversations. We also examined whether the short-term effects of talking, and of different types of talk, on quitting intentions were mediated through intrapersonal message responses. Using the Natural Exposure(SM) methodology, we exposed 411 smokers to 1 of 6 antismoking advertisements while they were watching television at home. Responses to the advertisement-conversation participation and content, emotional responses, personalized perceived effectiveness, and changes in intentions to quit-were measured within 3 days of exposure. Conversations were coded for appraisal of the advertisement (favorable, neutral, or unfavorable) and the presence of quitting talk and emotion talk. Mediation analyses indicated that the positive effects of talking on intention change were mediated through personalized perceived effectiveness and that the positive effects were driven by conversations that contained a favorable appraisal and/or quitting talk. Conversely, conversations that contained an unfavorable appraisal of the advertisement were negatively associated with campaign effectiveness. These findings highlight the importance of measuring interpersonal communication when evaluating campaigns and the need for further research to identify the message characteristics that predict when smokers talk and when they talk only in desirable ways.

When parents talk about college drinking: an examination of content, frequency, and associations with students' dangerous drinking

This project examines alcohol messages exchanged between college students and their parents, as well as how such messages associate with college students' dangerous drinking. Undergraduate students ages 18 to 25 years were recruited for the study and asked to recruit a parent. The sample included 198 students and 188 parents, all of whom completed an online survey. This study found parents tended to emphasize the negative aspects of drinking, particularly the dangers of drinking and driving and the academic consequences of too much partying. Results indicated that parent-student alcohol communication has various dimensions, including negative aspects of drinking, rules about drinking, drinking in moderation, and benefits of drinking. Parents' reports of discussing alcohol rules had a significant, negative association with students' alcohol consumption, whereas parents' reports of discussing the negative aspects of alcohol use had significant, positive associations with students' dangerous drinking.

Parental-adolescent drug use discussions: physiological responses and associated outcomes

PURPOSE

Although talking to youth about drugs is often recommended to parents, we know little about how parents actually discuss drugs with their children in the moment and how parental advice is linked to youth arousal and substance use. This study examined observed parental drug use advice and parenting behaviors during parent-adolescent drug use discussions and associations with adolescent physiological responses and substance use.

METHODS

Fifty-eight 12-17 year olds and their primary caregivers participated in a laboratory session in which parents and youth discussed the topic of alcohol and/or drug use for 10 minutes. This discussion was videotaped and coded for drug use advice (rules against drug use, information on drug use consequences, scenarios or learning advice [discussing drug use scenarios and what the child has learned about drugs]) and general parenting behaviors (parental warmth and/or support, negative and/or critical parenting). Before, during, and after the discussions, adolescents' heart rate, blood pressure (BP), and salivary cortisol levels were assessed.

RESULTS

Parental discussion of scenarios and/or learning was associated with lower adolescent BP responses to the discussions and lower likelihood of substance use. Parental discussion of rules against drug use was associated with higher heart rate and BP responses and greater likelihood of substance use. Criticism and/or negative parenting was associated with higher cortisol responses and greater likelihood of substance use at a trend level.

CONCLUSIONS

Parenting characterized by greater discussion of drug use scenarios and less stating of rules against drug use and criticism may make youth feel more comfortable and be linked to lower substance use.

Alcohol outlet density and related use in an urban Black population in Philadelphia public housing communities

Adolescent alcohol use behaviors are influenced by familial patterns and neighborhood factors. This work explored the influence of individual, family, and environment on alcohol use. Baseline data from a randomized controlled trial with Black mothers son dyads (n=382) were paired with census tract and alcohol control board data. Among mothers, younger age, along with neighborhood factors of alcohol outlet density, race, and education were significantly associated with use. Among sons, older age and alcohol outlet density in the neighborhood predicted use. Findings highlight neighborhood influence, beyond family qualities, as a significant determinant of disadvantaged Black mothers' alcohol use. Implications for public health policy are discussed.

Latino and European American early adolescents' exposure to music with substance-use references: examining parent-child communication as a moderator

This study hypothesized that frequent exposure to and attention to music with substance-use references would be indirectly related to alcohol, cigarette, or marijuana use through pro-substance-use beliefs (e.g., norms, outcome expectancies, and refusal efficacy). Parent-child communication, however, would attenuate such associations, which would differ by ethnicity. Multigroup mediation and moderation analyses were conducted, using cross-sectional survey data from 253 Latino and 308 European American 6th-8th grades students. For Latino and European American early adolescents, best-friend-injunctive norms and weak refusal efficacy were significant mediators, but not positive outcome expectancies. Descriptive norms were a significant mediator, but only for European American early adolescents. Although targeted parent-child communication and parental mediation did not moderate the associations between the music-exposure variables and the pro-substance-use beliefs variables, targeted parent-child communication attenuated the association between listening to favorite songs and alcohol consumption. Parental mediation attenuated the association between attention to music and alcohol consumption.

Do Actions Speak Louder Than Words?: Adolescent Interpretations of Parental Substance Use

Parents are powerful socialization agents for children and as children reach adolescence parental role models, among other sources of influence, become particularly salient in adolescents' decision-making regarding initiation of substance use. Open parent-adolescent communication about substances is associated with less substance use by adolescents; however, it is unclear how youth interpret anti-drug use messages from their parents, especially if the parents engage in legal and/or illicit substance use themselves. Framed by social learning theory and social constructionism, this study analyzed in-depth interviews with 108 adolescents about personal experiences with substance use, family communication about substance use, and adolescent interpretations of parental use. Emergent themes in the data include: positive parental influence, parentalcontradictions, and negative outcomes of use. Prevalence of parental use-regardless of legality, rarity of explicit communication about parental use, and various interpretations of parental use are discussed.

What are other parents saying? Perceived parental communication norms and the relationship between alcohol-specific parental communication and college student drinking

This study examined parents' normative perceptions of other college parents' alcohol-specific communication, and how parents' perceived communication norms and alcohol-specific communication relate to student drinking outcomes. A sample of 457 student-parent dyads were recruited from a midsize university. Students completed Web-based assessments of alcohol-related attitudes and behaviors. Parents completed alcohol-specific measures of communication norms and parent-child communication, including communication content (i.e., targeted communication) and frequency of communication. Results indicated that parents overestimated how much other parents talked to their college students about the frequency and quantity of alcohol use, but underestimated how often parents initiated conversations about alcohol. In a path model, perceived communication norms positively predicted both targeted communication and frequency of communication. Perceived communication norms and targeted communication negatively predicted students' attitude toward alcohol use. In contrast, more frequent communication predicted students holding more approving attitudes toward alcohol. The relationship between parents' perceived communication norms and students' drinking behaviors was mediated by the parental communication variables and student attitudes. Tests of indirect effects were undertaken to examine meditational processes. The findings underscore relations involving parental perceived communication norms and parents' own alcohol communication and their children's drinking outcomes. The complex relationships of different types of parental communication and student outcomes warrant further research.

Explicating how parent-child communication increases Latino and European American early adolescents' intentions to intervene in a friend's substance Use

This study used primary socialization theory and a focus theory of normative conduct to examine whether anti-substance-use norms mediated targeted parent-child communication against substance (alcohol, cigarette, and marijuana) use's effects on Latino and European American early adolescents' intentions to intervene in a friend's substance use. Further, this study investigated whether familism interacted with targeted parent-child communication to predict anti-substance-use norms, and whether this mediated moderation model functioned differently for Latino and European American early adolescents. Self-reported longitudinal survey data were collected from 6th-8th grade students (N = 627), attending rural IL public schools. Multigroup mediated moderation analyses revealed that as Latino and European American early adolescents engaged in targeted mother-child communication against substance use, they were more likely to develop anti-substance-use parent injunctive norms, and in turn, more likely to report anti-substance-use personal norms. Thus, they were more likely to report that if their friend used substances, they would talk to their friend, seek help from others, and end the friendship. They were, however, less likely to ignore the friend's substance use. Familism was not a significant moderator, and the hypothesized effects did not differ for Latino and European American early adolescents. The results suggest that parents of Latino and European American adolescents may discourage substance use by engaging in targeted parent-child communication, which may indirectly benefit their children's friends, as well.

Alcohol-specific parenting, adolescent alcohol use and the mediating effect of adolescent alcohol-related cognitions

OBJECTIVES

Previous research indicated that alcohol-specific parenting is an important precursor of adolescent alcohol use, but failed to define the underlying mechanism. Based on social cognitive theory, alcohol-related cognitions such as alcohol refusal self-efficacy and alcohol-related expectancies were hypothesised to mediate this link.

DESIGN

A cross-sectional survey included 1349 mothers and their sixth grade (11-12 years old) adolescent offspring. Structural equation modelling was employed to test the association between alcohol-specific parenting and adolescent alcohol use, mediated by adolescent alcohol-related cognitions.

MAIN OUTCOME MEASURES

Adolescent alcohol use, drinking refusal self-efficacy and alcohol expectancies.

RESULTS

The associations between frequency of communication, maternal alcohol use and adolescent alcohol use were mediated by negative alcohol-related expectancies. The associations between quality of communication, rules and disclosure and adolescent alcohol use were mediated by self-efficacy.

CONCLUSIONS

The present study provides a first indication that the underlying mechanism of the association between the most important alcohol-specific parenting practices and adolescent alcohol use can be contributed to the mediating effect of alcohol-refusal self-efficacy.

Does parentification place Mexican-heritage youth at risk for substance use? Identifying the intervening nature of parent-child communication about alcohol

Past research on parentification suggests that adopting adult responsibilities to the point at which the child plays a parental role places children at risk for poor mental and behavioral health outcomes. Since family relations are particularly important in Mexican culture, two hypotheses were posed to examine the indirect effects of parentification on Mexican-heritage youths' substance use via parent-child communication about alcohol, while examining the moderating effects of parent-child closeness. Mexican-heritage youth (N = 697) from 23 public middle schools in Phoenix, AZ completed surveys at three waves. Structural equation modeling results provided partial support for the hypotheses. Mexican-heritage youth experiencing problem-solving parentification were more likely to talk with a parent about alcohol and, in turn, less likely to use substances. This mediation effect, however, was not found with respect to adult parentification, and parent-child closeness was not a significant moderator. Implications for the beneficial effects of problem-solving parentification are discussed.

Examining the effects of mass media campaign exposure and interpersonal discussions on youth's drug use: the mediating role of visiting pro-drug websites

To extend past research on interpersonal communication and campaign effects, we hypothesized that anti-drug mass media campaign message exposure indirectly affects visiting anti- and pro-drug websites through targeted parent-child and friend-to-friend communication against drugs, as well as through having drug-related discussions during organized group activities. Second, we posited that engaging in anti-drug interpersonal communication indirectly affects adolescents' drug use through two intervening variables: visiting anti-drug websites and visiting pro-drug websites. Using self-reported longitudinal data from 2,749 youth, we found that as youth reported higher levels of anti-drug mass media campaign message exposure, they were more likely to talk to friends about the bad consequences of drugs, how to avoid drugs, and anti-drug ads. In turn, however, they were more likely to visit pro-drug websites, and subsequently, to smoke cigarettes.