Drug and Alcohol Findings home page in a new window Background notes

Reducing youth alcohol drinking through a parent-targeted intervention: the Örebro Prevention Program

Methodological issues

Convincing as the study was, the Swedish programme's task was made slightly easier by the fact that parents with lenient attitudes tended more often to drop out of the study. Other methodological problems included the failure to account for the grouping of children and parents within schools; And within the small towns. not taking this in to account can lead to false findings of effectiveness. The magnitude of the effects in the featured study make this unlikely, but it is possible that this magnitude was itself an overestimate due to the failure to account for grouping. Intervention schools were selected first and then matched to comparison schools, affording scope for a biased selection process. Concern is lessened somewhat by the fact that no school refused to join the study, and that matching was largely successful. The presumption that extending parental strictness about underage drinking helped curb the growth of drunkenness in their children rests on the fact that both were enhanced by the programme. This plausible explanation would have been strengthened if the study had directly conducted a 'mediation' analysis Including whether changes in parental attitudes were actually related to their childrens' drinking, and whether once this had been accounted for, the programme schools had less of an advantage in curbing drunkenness. to test the supposed links in this mechanism. It may too have been relevant who the research project staff were who conducted the intervention and whether they and the study authors had any hand in developing it. In several social research areas (1 2 3), these and other forms of 'allegiance' have been found to favour more positive findings than fully independent research.

Other ways to take the message home

One solution to poor parental attendance at events tried in Australia is to promote parent-child communication about substance use (including family rules) by a set of 'lessons' mailed to parents (in this case of 10–11-year-olds) via the school. Feedback from parents suggested the mailings were nearly always read. Compared to parents randomly assigned to no intervention, a survey of parents about a month after the final mailing found they were around twice as likely to have talked recently to their children about alcohol and tobacco, to have done so in greater depth, and with what seemed to them greater engagement by the child. Whether such conversations actually affected the child's future substance use was unknown.

Another tactic trialled in the USA was to give children parent-child homework assignments relating to family management skills, the completion of which contributed to the pupil's school grades. Data on typical family management practices collected through these assignments was fed back to the parents in a newsletter. Further support was offered to all families and particularly to high risk families. This entire package significantly reduced the proportion of pupils who at age 14–15 admitted to having smoked or drunk alcohol in the previous month, among at-risk pupils from 42% to 36%, and among the remainder from 29% to 19%.

Voluntary self-disclosure v. parental monitoring

In the Swedish context, parents' knowledge of their children's activities outside the home has been found to derive primarily from voluntary disclosure by children who are happy to talk to their parents, rather than from active parental control or monitoring. It was this factor too – child self-disclosure – which was most closely related to lower levels of delinquency (including cannabis use and underage drinking), and not just because children who had nothing to hide were more communicative. In a society like Sweden where children would expect parents to be strict about drinking, and where youth drinking levels are low, child-to-parent communication is less likely to be threatened by parental strictures about underage drinking. In other cultures the effect could be to block this channel of communication. In Britain (see below) parental monitoring may be more important.

UK parental influence and attitudes

A national UK study found a link between lower levels of drinking among 16-year-olds and their perceptions that their parents often queried them about where they were going, with whom, and what they would be doing. There was a tendency for the child's self-disclosure of the same information also to be linked in the same way, but to a lesser and not statistically significant degree. These adolescent drinking patterns were in turn linked to later problem drinking. In another national study in England parental leniency as perceived by teenage children was strongly related to whether the child had drunk alcohol in the past four weeks. Together these studies suggest that in the UK, parental strictness about drinking, monitoring of the child's leisure time activities, and perhaps too the child's openness, may play a role in curbing adolescent drinking.

However, this package of alcohol-preventing parental and family attributes is far from universal. In the English study, fewer than half (47%) of 13-year-old pupils believed their parents were against them drinking at all; nearly all the rest said they didn't mind as long as it was not too much. In another study what leads to these attitudes was unpicked in discussions with parents. Typically they distanced themselves from the need to control their own child's drinking. The limits they felt young people should keep to were loose, embracing intoxication and (they hoped) salutary negative experiences from what was seen as an overall positive activity. As one study put it, for British parents, "excess consumption is seen as a normal part of growing up". Given this mindset, official action against underage drinking might, the researchers warned, "appear possibly draconian, possibly kill-joy, and perhaps a nice-to-have rather than an essential need for Government activity".

Dutch trial of the programme

A trial in the Netherlands of a Dutch version of the Örebro programme may be a better pointer to how it would perform in the UK. If so it suggests that it would be a worthwhile addition to alcohol use prevention lessons, but not the standalone success it was in Sweden. The study found that relative to education as usual, Biology classes addressing the biological effects of alcohol. among 12–13-year-olds the Örebro programme 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 parent programme 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 Dutch version of the Örebro programme differed in not encouraging leisure activities – unlikely to have accounted for the different results, because in Sweden it failed in this respect. More likely is that either the different drinking measures Drunkenness in Sweden, weekly (heavy) drinking in the Netherlands. used affected the apparent impact of the programme, or, as the authors believed, the relatively lenient legal and social attitude to youth drinking in the Netherlands meant parents were less well placed than in Sweden to impose strict rules.

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