Why target early adolescents and parents in alcohol prevention? The mediating effects of self-control, rules and attitudes about alcohol use
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This entry is our analysis of a study added to the Effectiveness Bank. The original study was not published by Findings; click Title to order a copy. Free reprints may be available from the authors – click prepared e-mail. The summary conveys the findings and views expressed in the study. Below is a commentary from Drug and Alcohol Findings.

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

Koning I.M., van den Eijnden R.J.J.M., Engels R.C.M.E. et al.
Addiction: 2010, 106, p. 538–546.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Koning at i.koning@uu.nl.

In the Netherlands, allied with alcohol prevention lessons, addressing parental attitudes to and rule-setting about drinking by their adolescent children at routine parent meetings at the start of each school year led via these and other mechanisms to fewer pupils starting to drink regularly.

Summary Background In the Dutch context this study tested the impact of the Örebro intervention (developed and tested in Sweden) targeting parental rule-setting in relation to the drinking of their adolescent children. It entailed a brief presentation at the first parents' meeting at the start of each school year, after which parents of children from the same class met to agree a shared set of rules about alcohol use. Three weeks after this meeting, a summary of the presentation and the result of the classroom discussion was sent to parents' home addresses.

An earlier paper from the same study reported that relative to education as usual, Biology classes addressing the biological effects of alcohol. among 12–13-year-olds the Örebro intervention curbed the initiation of weekly drinking and heavy weekly drinking over the next two years (and reduced the frequency of drinking) only when combined with classroom-based alcohol prevention lessons. Neither these lessons on their own, nor the parenting intervention on its own, made any significant difference when the whole sample of children not yet drinking weekly at the start was included in the analysis.

The featured article investigated whether these outcomes came about because the interventions affected the following 'mediators' through which the intervention was designed to affect drinking:
• the adolescents' general self-control, their attitudes towards drinking (the degree to which they think a person of their age should be able to drink alcohol in various situations) and their perceptions of their parents' rule-setting about drinking;
• their parents' attitudes to adolescent drinking (the degree to which they find it acceptable for a 13–14-year-old to drink in various situations) and the extent to which they say they set rules about their children's drinking.

Design A randomised trial with schools allocated to four conditions; (1) parent intervention, (2) pupil intervention, (3) combined parentpupil intervention and (4) control group with neither intervention.

Setting High schools selected randomly, located in different areas.

Participants A total of 2937 early adolescents (average age 12.6 years) and their parents.

Measurements Mediation effects were analysed using pre-test data and two follow-up measurements (10 and 22 months after baseline). A path model was estimated 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) as measured at the first follow-up point. These were in turn related to how many children a year later (at the second follow-up) started drinking at least weekly.

Findings Ten months after the study started parents exposed to the Örebro parent intervention (whether or not their children had also had alcohol prevention lessons in school) were found to have developed stricter attitudes and rules about youth alcohol use compared to parents not exposed to the intervention. In turn these attitudes and rules were associated to a statistically significant degree with fewer children starting to drink on at least a weekly basis a year later, at the second-follow-up. Linking these two elements in the chain, it was found that the parent intervention on its own was related to less weekly drinking via stricter parental rule-setting. When combined with school prevention lessons, the link was via stronger parental attitudes against adolescent drinking. Rule-setting and attitudes were themselves related, stricter attitudes probably leading to stricter rule-setting. The combined intervention also affected weekly drinking via the childrens' perceptions that their parents were setting relatively strict rules about drinking and the childrens' own stronger self-control. The combined intervention also hardened the childrens' attitudes to youth drinking but this was not related to their own later weekly drinking. In contrast to the parent intervention with or without prevention lessons, the lessons on their own had no impact on parent or adolescent attitude or rule-setting variables and no impact on drinking directly or via these variables.

Conclusions The combined parent/school intervention proved to be effective in ways predicted by the underlying theoretical assumptions. The implication is that alcohol interventions targeting young adolescents should at least include components which focus on rule-setting by their parents and the development of self-control in adolescents. In this study adolescent self-control was only strengthened and affected drinking when school lessons had been combined with an intervention which led parents to be stricter about adolescent drinking. This seems to indicate that, in order to increase self-control in adolescents, parents should also be targeted. Adolescent perceptions of rule-setting were more influential than the parents' reports of the degree to which they set strict rules. The results support the potential of this type of intervention for the postponement of drinking among adolescents in the Netherlands (which has in European terms a relatively lenient drinking culture), and indicate that interventions should involve the improvement of self-control in adolescents, preceded by the encouragement of restrictive rules and attitudes in parents.

Findings logo commentary See this Findings entry for an analysis of the original Swedish version of the parent intervention tested in the featured study.

Last revised 21 March 2011

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