The Effectiveness of Family Interventions in Preventing Adolescent Illicit Drug Use: A Systematic Review and Meta-analysis of Randomized Controlled Trials

In order to quantify the effectiveness of family interventions in preventing and reducing adolescent illicit drug use, we conducted a systematic review and meta-analysis of randomized controlled trials. We searched the Cochrane Database of Systematic Reviews, Educational Research Information Centre (ERIC), MEDLINE, Embase, and PsycINFO for studies published between 1995 and 2013. Results were described separately for different outcomes (marijuana vs. other illicit drugs) and intervention types (universal, selective, and indicated prevention). Meta-analyses were performed when data were sufficient (e.g., marijuana and other illicit drug initiation in universal samples), using random effect models. Otherwise, we provided narrative reviews (e.g., regarding selective and indicated prevention). Thirty-nine papers describing 22 RCTs were eligible for inclusion. Universal family interventions targeting parent-child dyads are likely to be effective in preventing (OR 0.72; 95 % CI 0.56, 0.94) and reducing adolescent marijuana use, but not in preventing other illicit drugs (OR 0.90; 95 % CI 0.60, 1.34). Among high-risk groups, there is no clear evidence for the effectiveness of family interventions in preventing and reducing illicit drug use and drug disorders. The three small RCTs among substance-(ab)using adolescents gave some indication that programs might reduce the frequency of illicit drug use. Family interventions targeting parent-child dyads are likely to be effective in preventing and reducing adolescent marijuana use in general populations, but no evidence for other illicit drug use was found. We underline the need to strengthen the evidence base with more trials, especially among at-risk populations.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Risk moderation of a parent and student preventive alcohol intervention by adolescent and family factors: a cluster randomized trial

OBJECTIVE

To examine risk moderation of an alcohol intervention targeting parents and adolescents.

DESIGN

A cluster randomized trial including 2937 Dutch early adolescents (m=12.68years, SD=0.51) and their parents randomized over four conditions: parent intervention, student intervention, combined parent-student intervention, and control group.

SETTING

152 classes of 19 high schools in The Netherlands (2006).

METHOD

Moderators at baseline (adolescent: gender, educational level and externalizing behavior; parent: educational level and heavy alcohol use) were used to examine the differential effects of the interventions on onset of (heavy) weekly drinking at 22-month follow-up.

RESULTS

The combined intervention effectively delayed the onset of weekly drinking in the general population of adolescents, and was particularly effective in delaying the onset of heavy weekly drinking in a higher-risk subsample of adolescents (i.e. those attending lower levels of education and reporting higher levels of externalizing behavior).

CONCLUSION

Present and previous results have established the combined intervention to be universally effective in postponing weekly alcohol use among Dutch adolescents, with an added effect on postponing heavy weekly drinking in high risk subgroups. Therefore, implementation of this intervention in the general population of schools in The Netherlands is advised.

TRIAL REGISTRATION

NTR649.

A cluster randomized trial on the effects of a parent and student intervention on alcohol use in adolescents four years after baseline; no evidence of catching-up behavior

OBJECTIVE

It is questioned whether the alcohol prevention program "Prevention of Alcohol use in Students" (PAS) is effective in reducing the prevalence of heavy weekend drinking and the amount of drinking among adolescents at the age at which they are allowed to buy alcohol in The Netherlands (16 years). In addition, it is questioned whether the intervention effects are attributed to a delay in onset earlier in adolescence or to the development of skills due to the PAS intervention (mediation analyses).

DESIGN

A cluster randomized trial including 3490 Dutch early adolescents (M age=12.66, SD=0.49) and their parents randomized over four conditions; 1) parent intervention, 2) student intervention, 3) combined intervention and 4) control group.

OUTCOME MEASURES

Outcome measures were prevalence of heavy drinking and amount of weekend drinking measured at age 16, 50 months after baseline.

RESULTS

Only when parents and students were targeted simultaneously could the prevalence of heavy weekend drinking (b=-.44, p=.02) and the amount of alcohol use (b=-.24, p=.02) be reduced. No significant effects of the separate parent and student interventions were found. The effect of the combined PAS intervention on heavy weekend drinking and amount of drinking can be attributed to respectively the increase in self-control and strict parenting, and a delayed alcohol initiation earlier in adolescence.

CONCLUSIONS

The current study confirms the effectiveness of the combined PAS intervention up to the legal drinking age of 16. The results underline that postponing the onset of drinking among early adolescents is not only crucial for health development in the short term, but also impacts the development of a healthier drinking pattern later on.

Developmental alcohol-specific parenting profiles in adolescence and their relationships with adolescents' alcohol use

Previous studies on general parenting have demonstrated the relevance of strict parenting within a supportive social context for a variety of adolescent behaviors, such as alcohol use. Yet, alcohol-specific parenting practices are generally examined as separate predictors of adolescents’ drinking behavior. The present study examined different developmental profiles of alcohol-specific parenting (rule-setting, quality and frequency of communication about alcohol use) and how these patterns relate to the initiation and growth of adolescents’ drinking. A longitudinal sample of 883 adolescents (47 % female) including four measurements (between ages 12 and 16) was used. Latent class growth analysis revealed that five classes of parenting could be distinguished. Communication about alcohol appeared to be fairly stable over time in all parenting classes, whereas the level of rule-setting declined in all subgroups of parents as adolescents grow older. Strict rule-setting in combination with a high quality and frequency of communication was associated with the lowest amount of drinking; parents scoring low on all these behaviors show to be related to the highest amount of drinking. This study showed that alcohol-specific rule-setting is most effective when it coincides with a good quality and frequency of communication about alcohol use. This indicates that alcohol-specific parenting behaviors should be taken into account as an alcohol-specific parenting context, rather than single parenting practices. Therefore, parent-based alcohol interventions should not only encourage strict rule setting, the way parents communicate with their child about alcohol is also of major importance.

Results of the 'in control: no alcohol!' pilot study

More than 50% of Dutch 12-year olds already started drinking. Since it is known that delaying the onset of alcohol use results in a lower risk of alcohol-related problems, the recently developed 'In control: No alcohol!' prevention program is targeted at elementary school children and their mothers. In this pilot study, the success of program implementation and impact of the program on quality of alcohol-specific communication, rules and monitoring were evaluated, using a randomized controlled design. A total of 108 children (11-12 years) and their mothers participated in the prevention program, while the control group consisted of 105 dyads. Families participating in the experimental condition showed an increase in frequency of alcohol-specific communication and 75% of the dyads reported that they took part in at least 3 of 5 magazines, suggesting implementation was successful. The program led to an increase in quality of communication but only for those dyads in which mothers' alcohol use was above average. The program led parents to set up a non-drinking contract with their children and to monitor their children more closely. Results are promising but need to be replicated in a larger longitudinal study.

Why target early adolescents and parents in alcohol prevention? The mediating effects of self-control, rules and attitudes about alcohol use

AIMS

To examine the effects of a parent and student intervention offered separately and simultaneously (PAS) on onset of weekly drinking via its putative mediators.

DESIGN

A randomized trial with four conditions; (1) parent intervention, (2) student intervention, (3) combined parent-student intervention and (4) control group.

SETTING

High schools selected randomly, located in different areas.

PARTICIPANTS

A total of 2937 early adolescents (mean age = 12.6, standard deviation = 0.49) and their parents.

MEASUREMENTS

Mediation effects were analysed using pretest data and two follow-up measurements (10 and 22 months after baseline). A path model was estimated (Mplus) to examine the effect of the interventions on adolescent-reported mediators (self-control, perceived parental rules and attitudes about alcohol) and parent-reported mediators (parental rules and attitudes about alcohol). Outcome was onset of weekly drinking.

FINDINGS

The parent intervention modified rules and attitudes about alcohol as reported by parents. An indirect effect of the parent intervention via parental rules was found. The combined intervention affected both adolescent-reported and parent-reported rules and attitudes about alcohol and adolescents' perceived self-control, yet only perceived rules and self-efficacy, as reported by adolescents, and parental attitudes mediated the association between the combined intervention and onset of weekly drinking. No significant effects were found of the separate student intervention on the mediating factors.

CONCLUSIONS

The PAS programme proved to be effective as predicted by the theoretical assumptions underlying the interventions. Interventions with parents and adolescents to prevent adolescent alcohol consumption may usefully target parental rules about alcohol and adolescents' self-confidence.

Preventing heavy alcohol use in adolescents (PAS): cluster randomized trial of a parent and student intervention offered separately and simultaneously

AIMS

To evaluate the effectiveness of two preventive interventions to reduce heavy drinking in first- and second-year high school students.

DESIGN AND SETTING

Cluster randomized controlled trial using four conditions for comparing two active interventions with a control group from 152 classes of 19 high schools in the Netherlands.

PARTICIPANTS

A total of 3490 first-year high school students (mean 12.68 years, SD=0.51) and their parents. Intervention conditions (i) Parent intervention (modelled on the Swedish Örebro Prevention Program) aimed at encouraging parental rule-setting concerning their children's alcohol consumption; (ii) student intervention consisting of four digital lessons based on the principles of the theory of planned behaviour and social cognitive theory; (iii) interventions 1 and 2 combined; and (iv) the regular curriculum as control condition. Main outcome measures Incidence of (heavy) weekly alcohol use and frequency of monthly drinking at 10 and 22 months after baseline measurement.

FINDINGS

  A total of 2937 students were eligible for analyses in this study. At first follow-up, only the combined student-parent intervention showed substantial and statistically significant effects on heavy weekly drinking, weekly drinking and frequency of drinking. At second follow-up these results were replicated, except for the effects of the combined intervention on heavy weekly drinking. These findings were consistent across intention-to-treat and completers-only analyses.

CONCLUSIONS

Results suggest that adolescents as well as their parents should be targeted in order to delay the onset of drinking, preferably prior to onset of weekly drinking.

Alcohol-specific socialization practices and alcohol use in Dutch early adolescents

The present study examined the associations of alcohol-specific socialization practices and heavy parental drinking with alcohol use in early adolescents. Cross-sectional nationwide survey data from 2599 parent-adolescent (mean age=12.16) dyads were used to conduct logistic regression analyses. Onset of alcohol use as well as infrequent and regular drinking were associated with tolerant rules and attitude as reported by adolescents, and by a tolerant attitude as reported by parents. In contrast to former studies including middle and late adolescents, parental alcohol use was not found to be associated with early adolescent alcohol use, nor did parental alcohol use influence the impact of parental rules. Restrictive alcohol-specific socialization was, independent of parental alcohol use, related to absence of (regular) early adolescent drinking. Thus, this study demonstrated that in early adolescence alcohol-specific parenting is more important for adolescent drinking than parental alcohol use.

Body mass index and body weight perception as risk factors for internalizing and externalizing problem behavior among adolescents

PURPOSE

To examine the relationship between body mass index (BMI), body weight perception (BWP), and indicators of internalizing and externalizing distress and social, attention and thought problems in a large representative sample of Dutch youth.

METHODS

A total of 1826 pupils in the eighth grade of primary education and 5730 students in the first four years of secondary education gave their height and weight to obtain an estimate of their BMI. They reported their evaluation of their body weight and completed Achenbach's Youth Self-Report (YSR) (1991), which assesses eight types of problem behavior. Data were analyzed in a multivariate framework with BMI and BWP as predictors and the YSR scores on different kinds of problem behavior as dependent variables, controlling for background characteristics.

RESULTS

Both BMI and BWP are associated with internalizing and externalizing problem behavior, and social, attention and thought problems. Multivariate tests show that BWP is more closely linked to problem behavior than BMI. Adolescents who were either underweight or overweight but considered themselves in good shape had no more problems than the group with normal BMI and BWP 'good'. The perception of being 'too thin' and particularly the perception of being 'too heavy' best predict problem behavior in both male and female adolescents. Overweight youngsters with an adequate perception of their weight have less somatic complaints than their normal-weight peers who perceive themselves as too heavy, but they show higher withdrawnness, social problems, and anxiety/depression.

CONCLUSIONS

Adolescent girls are more dissatisfied with their weight than boys; however, the relationship between weight perception and problem behavior is the same for both genders.

The relationship between health-related quality of life and two measures of alcohol consumption

OBJECTIVE

The purpose of this study was to compare two measures of alcohol consumption and their relationship with health-related quality of life and to determine whether the health status of former drinkers differs from that of abstainers.

METHOD

The study was carried out within the framework of a general population survey (4,472 persons aged 16-69 years) in two large Dutch cities. The Short Form-36 Health Survey (SF-36) was used as a measure of health-related quality of life. Measures of alcohol consumption compared were the Quantity-Frequency-Variability (QFV) method, which measures the usual frequency and number of units of alcohol during weekdays and the weekend, and the Weekly drinking Recall (WR), which measures alcohol consumption during the week prior to completion of the WR questionnaire.

RESULTS

A curvilinear relationship (inverse J shaped) was found between both measures of alcohol consumption and the subscales of the SF-36, except in the case of role problems-physical. For example, the 95% confidence interval of the odds ratios for former, light, heavy and excessive drinkers (using the QFV, with abstainers as reference group) versus the SF-36 subscale general health are, respectively, 0.55-1.39, 0.43-0.74, 0.31-0.68 and 0.38-0.99. Former drinkers have an intermediate position between drinkers and abstainers on the SF-36 subscales, except in role problems-physical (poorer health than abstainers) and mental health (better health than abstainers).

CONCLUSIONS

Both measures of alcohol consumption have a similar relationship with the subscales of the SF-36. The fact that former drinkers show a difference on two subscales (more role problems-physical but better mental health) indicates that this category may have a complex, or at least a different, relationship with aspects of health compared with abstainers and drinkers.

Estimating non-response bias in a survey on alcohol consumption: comparison of response waves

AIMS

According to 'the continuum of resistance model' late respondents can be used as a proxy for non-respondents in estimating non-response bias. In the present study, the validity of this model was explored and tested in three surveys on alcohol consumption.

METHODS

The three studies collected their data by means of mailed questionnaires on alcohol consumption whereby two studies also performed a non-response follow-up.

RESULTS

Comparisons of early respondents, late respondents and non-respondents in one study showed some support for 'the continuum of resistance model', although another study could not confirm this result. Comparison of alcohol consumption between three time response groups showed no significant linear pattern of differences between response waves.

CONCLUSIONS

The hypothesis that late respondents are more similar to non-respondents than early respondents, could not be confirmed or rejected. Repeated mailings are effective in obtaining a greater sample size, but seem ineffective in improving the representativeness of alcohol consumption surveys.