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Engaging Parents in AOD Prevention : Results from Clinical Trials Examining the Efficacy of the Parent Handbook
ROB TURRISI, PhDProfessor
The Pennsylvania State University
May2019
OCI
https://sites.psu.edu/prcprohealth/
Quotes from Peer Reviews & Colleagues
- That won’t work- That might be the worst idea I have ever
heard- You have a nice career going. Are you sure
you want to do this?
Fast Forward 25+ Years
187 million hits on College Student Drinking
299 million hits on College Student Drinking Prevention(up from 35 million a few years ago)
106 million hits on Parent Based College Drinking Interventions (up from 5 million a few years ago & “0” when I started doing this work in the mid-90s)
Prevention Framework1. Epidemiology
and Etiology
2. Efficacy/Pro
of of Concept
3. Effectiveness, Targeted, and Adaptations
4. Dissemination
Turrisi et al., 2001Ary et al., 1993Abar et al., 2009Barnes, 1986Patock-Peckham & Morgan-Lopez, 2006; 2007 Reifman et al., 1998Messier et al., 2016Napper et al., 2015Turrisi et al., 2008-2018Varvil-Weld et al. 2012-2013Wood et al., 2001; 2004
Turrisi et al., 2005-2018Ichiyama et al., 2009Testa et al., 2010LaBrie et al., 2014-2016Doumas et al., 2015
I. High-Risk Drinking Drinking in Adolescents and Emerging Adults
Alcohol use is ubiquitous
II. The Role of Parents and Peers1) Peer InfluencesBaer, 1994Bergen-Cico, 2000Borsari & Carey, 2000Corbin et al., 2011Hawkins et al., 1992 LaBrie et al., 2007Neighbors et al., 2004Park et al., 2009Read et al., 2005Rulison et al. 2015Edward et al. 2016
2) Elevated Availability/Increased opportunities
Saltz et al. 1995-2008Grube et al., 2000-2008Gordon et al. 2015
3) Increased WillingnessMallett et al. 2010-2018
Why Do Students Drink?
Why Do Students Drink?4) Reduced Social ControlsAbar et al., 2007-2009Chassin et al., 2004-2008Turrisi et al., 1988-2018Patock-Peckham & Morgan-Lopez, 2007Napper et al. 2014
http://www.jumpgate.net/%7Efrank/pics/springbreak2002/padre57.jpg
Brain Development & Self-Regulatory Behavior
Picture: Paul Thompson, Ph.D. UCLA Laboratory of Neuroimaging
~Age 13 ~Age 17 ~Age 20
Less red indicates a stronger connection between lobes of cerebral cortex.
Brain Development & Self Regulation
III. Prevention Framework1. Epidemiology
and Etiology
2. Efficacy/Pro
of of Concept
3. Effectiveness, Targeted, and Adaptations
4. Dissemination
Turrisi et al., 2001Ary et al., 1993Abar et al., 2009Barnes, 1986Patock-Peckham & Morgan-Lopez, 2006; 2007 Reifman et al., 1998Messier et al., 2016Napper et al., 2015Turrisi et al., 1994-2018Varvil-Weld et al. 2012-2013Wood et al., 2001; 2004
Turrisi et al., 2009-2018Ichiyama et al., 2009Testa et al., 2010LaBrie et al., 2014-2016Doumas et al., 2015
Initial Etiology Research Questions
How do college students construe drinking and nondrinking alternatives? Turrisi (1992-1999)
What are parent and teen reactions to parental involvement in reducing drinking? Turrisi et al. (1994)
How do parents influence drinking cognitions, drinking, and consequences? Turrisi et al. (2000)
15+ Years of Clinical Trials w/Parents
Trial Type of Sample Research Question
1 multi-site, incoming freshmen Will parents implement an intervention, and will it work?
2 multi-site, incoming freshmen Will parents implement an intervention, and will it work?
3 high risk population Will PBI change culture in a high risk environment?
4 high risk population Will PBI affect transitions between drinking groups?
5 high risk population Will PBI decrease incidence of sexual consequences?
6 multi-site, high risk population Do combined interventions work for high risk groups?
7 multi-site, high risk population Do combined interventions work for high risk groups?
8 high risk population Does intervention work best implemented at certain timing/dosage?
IV. Components - Parent-Based Intervention
Brief Intervention Target Audience - Typical Families Written Handbook Motivation, Knowledge & Skills Behavioral Decision Theory
NCT01126151
NCT01126164
Parent-Based Intervention (PBI):Motivation, Knowledge & Skills
2 Versions:Components:
High School
College-Bound
Increase Parental Awareness of the Magnitude of Underage Drinking & Consequences
X X
Physical, Cognitive, Social, Emotional & Moral Development X
Parenting Strategies & Goals X
Improving Communication X X
Improving Relationships X
Developing Assertiveness & Resisting Peer Pressure X X
Talking About Alcohol X X
PBI: Talking About Alcohol
Specific Components:Parental Reluctance to Talk About Alcohol
How Alcohol Works in the Body
Physical & Psychological Effects
Setting Limits
Reasons Why Teens Drink
Reasons Why Teens Do Not Drink
Binge Drinking: Drinking to Get Drunk
Did You Drink When You Were a Teen?
Warning Signs of a Potential Problem
Riding w/a Drunk Driver
Preventing a Friend From Driving Drunk
Targeted Outcomes:Attitudes toward Drinking Activities
Attitudes toward Non-Drinking Activities
Positive Expectancies
Perceptions of Enhanced Social Behavior
Normative Peer Approval
Negative Affect
Perceptions of Risk
Protective Behaviors
Health Motivation
Assertiveness
Feedback We’re Hearing“Thank you for allowing me to participate. I found all of the material very useful and informative. Thanks for sending me a clean copy to share with a friend who has a teen who is currently facing several of these issues; I believe this handbook will help that mom a great deal.”
52 yr old father of 18 yr old female
“This information is of great value to a concerned parent. The communication techniques presented are excellent and very thorough.”
55 yr old female of 18 yr old male “The “Reacting to what you hear” section in the “Improving Communication in General” chapter was excellent. Also, the Chapter “Talking about Alcohol” is excellent for a parent who has not been talking about the effects of alcohol. Very good for parents who have a difficult time with communicating with their teen – this book helps with that (not just about issues with alcohol).”
45 yr old mother of 18 yr old female
“There were many good points in each section of the handbook. I found it easy to relate to the “parent and teen responses” section. This handbook has brought up issues that I hadn’t thought of before. Overall I found this handbook to be extremely useful.”
41 yr old mother of 18 yr old female
PresenterPresentation NotesOverwhelming support for our parent-based interventions
V. Overview Research 1) Does the intervention work?
2) Does it work by family?
3) Why does it work?
4) Does it work in high risk environments?
5) Does it work with at-risk individuals?
6) Is it effective at changing risk profiles?
Weekend Drinking (DDQ)Group F (1, 888) = 36.16 Interaction F (1, 888) = .63
(Turrisi et al. 2001 PAB)
Heavy Episodic Drinking Group F (1, 888) =17.51 Interaction F (1, 888) = .50
(Turrisi et al. 2001 PAB)
DUIGroup F (1, 903) =46.77 Interaction F (1, 903) = 1.07
(Turrisi et al. 2001 PAB)
Smoked CigarettesGroup F (1, 899) = 53.91 Interaction F (1, 899) = .82
(Turrisi et al. 2001 PAB)
Does it Work for Different Families?
Drinking
Parent Intervention:Treatment vs. Controls
Drinking Tendencies
e.g., Positive Communication Practices
Turrisi et al., 2005 ACER
Positive Communication: DDQ Saturday
b = -.769, 95% CI= -1.26 & -.29, p < .003
1.82.47
3.14
4.144.413.96
1
2
3
4
5
6
BA AVG AACommunication
Num
ber o
f Drin
ks
TreatmentControl
The worse case scenario for the Treatment is better than the best case scenario for the Controls
Monitoring: DDQ Saturdayb = .623, 95% CI= .05 & 1.52, p < .03
3.422.43
1.46
4.34 4.04 3.75
1
2
3
4
5
6
BA AVG AAMonitoring
Num
ber o
f Drin
ks
TreatmentControl
Parental Approval: DDQ Saturday b = -6.73, 95% CI= -11.23 & -2.00, p < .006
3.632.48
1.34
4.224.033.84
1
2
3
4
5
6
BA AVG AAParent Approval
Num
ber o
f Drin
ks
TreatmentControl
Why Does it Work?
Parenting Outcomes
Immediate Target Variable
(α)Program
effect
(β)Target Variable Effect
on Outcome
(αβ)DirectEffect
Turrisi et al., 2010 PAB
PBI: Taking About Alcohol
Specific Components:Parental Reluctance to Talk About Alcohol
How Alcohol Works in the Body
Physical & Psychological Effects
Setting Limits
Reasons Why Teens Drink
Reasons Why Teens Do Not Drink
Binge Drinking: Drinking to Get Drunk
Did You Drink When You Were a Teen?
Warning Signs of a Potential Problem
Riding w/a Drunk Driver
Preventing a Friend From Driving Drunk
Targeted Outcomes:Attitudes toward Drinking Activities
Attitudes toward Non-Drinking Activities
Positive Expectancies
Perceptions of Enhanced Social Behavior
Normative Peer Approval
Negative Affect
Perceptions of Risk
Protective Behaviors
Health Motivation
Assertiveness
Parenting Outcomes
(α)Program
effect
(β)Mediator Effect
on Outcome
(αβ)DirectEffect
Turrisi et al., 2010 PAB
Attitudes toward Drinking ActivitiesAttitudes toward Non-drinking AlternativesPositive TransformationsEnhance Social BehaviorsNormative ApprovalNegative AffectHealth Orientation
Why Does it Work?
Proxies for the immediate target variable and the self regulation brain change—the connection is getting stronger
Does it Work in High Risk Environments?
Study of Colorado – Boulder
High Risk Campus Riots Environmental Influence Collaboration: CU, PSU, NIAAA Efficacy & Mediation
Ray, Turrisi, & Bentley, 2006 RSA
CU Weekend Drinking (DDQ)
3.23
5.59
012345678
Fall
TreatmentControl
CU Heavy Episodic Drinking (2 Week Period)
0.87
1.9
0
1
2
3
4
Fall
TreatmentControl
Does it Work with At-Risk Individuals?
GOALS: Penn State & University of Washington
Parent Only Basics Only Parent-Basics Control
Turrisi et al., 2009
GOALS
ControlCombined
Turrisi et al., 2009
Chart1
WeekendWeekend
WeekWeek
ConsequencesConsequences
Combined
Control
5.6
6.82
7.22
8.55
2.81
3.59
Sheet1
Column1CombinedControl
Weekend5.66.82
Week7.228.55
Consequences2.813.59
Other GOALS outcomes
Authoritarian and Permissive Parent Style Students PEAK BACs were reduced the most (Mallett et al., 2010 JSAD)
At every onset age (14-18) combined was effective(Mallett et al., 2010 ACER)
High school students were least likely to transition to high-risk drinking group in college (Cleveland et al., 2011)
Project ACT: Behavior Change w/Hard to Reach Individuals
Different Profiles
Simply counting the number of drinks does not paint the whole picture
Sun Mon Tue Wed Thur Fri Sat
Sun Mon Tue Wed Thur Fri Sat
≠
(Turrisi et al., 2013; Varvil-Weld et al. 2014)
Identify Different Types of ProfilesNon-
DrinkerWeekend Non-
BingerWeekend
Binger Heavy Drinker
Past Month Drink 0.10 0.99 1.00 1.00
Past Month Drunk 0.00 0.53 0.99 1.00
2-Week Binge 0.00 0.10 0.83 0.95
BAC > 0.08 0.00 0.23 0.89 0.94
Weekday 0.00 0.05 0.08 0.30
Thursday 0.00 0.06 0.02 0.74
Weekend 0.02 0.65 0.88 0.98
Non-Drinker
Weekend Non-Binger
WeekendBinger Heavy Drinker
Past Month Drink 0.10 0.99 1.00 1.00
Past Month Drunk 0.00 0.53 0.99 1.00
2-Week Binge 0.00 0.10 0.83 0.95
BAC > 0.08 0.00 0.23 0.89 0.94
Weekday 0.00 0.05 0.08 0.30
Thursday 0.00 0.06 0.02 0.74
Weekend 0.02 0.65 0.88 0.98
Identify Different Types of Profiles
Non-Drinker
Weekend Non-Binger
WeekendBinger Heavy Drinker
Past Month Drink 0.10 0.99 1.00 1.00
Past Month Drunk 0.00 0.53 0.99 1.00
2-Week Binge 0.00 0.10 0.83 0.95
BAC > 0.08 0.00 0.23 0.89 0.94
Weekday 0.00 0.05 0.08 0.30
Thursday 0.00 0.06 0.02 0.74
Weekend 0.02 0.65 0.88 0.98
Identify Different Types of Profiles
Non-Drinker
Weekend Non-Binger
WeekendBinger Heavy Drinker
Past Month Drink 0.10 0.99 1.00 1.00
Past Month Drunk 0.00 0.53 0.99 1.00
2-Week Binge 0.00 0.10 0.83 0.95
BAC > 0.08 0.00 0.23 0.89 0.94
Weekday 0.00 0.05 0.08 0.30
Thursday 0.00 0.06 0.02 0.74
Weekend 0.02 0.65 0.88 0.98
Identify Different Types of Profiles
Is it Effective at Changing Risk Profiles?
vs.
vs.
vs.
Long term: High risk (heavy drinker) transitioned out of profile Weekend binge transitioned out of profile
Parenting and Consequences1) MRC Subgroup – 20% of drinkers experience 50% of consequences
Varvil-Weld et al. 2014
Parenting and Highest Risk Consequences
Varvil-Weld et al., 2011
1) MRC Subgroup
2) 10 indicators (each assessed separately for mothers and fathers):
MonitoringPositive CommunicationNegative CommunicationApproval of alcohol useParent drinking (quantity and frequency)
3) 15 Month Prospective Design
Parent Profiles
•High levels of mother/father monitoring and mostly positive communication
•High levels of mother/father alcohol approval and use
Positive Pro-Alc(n=140; 38%)
•High levels of mother/father monitoring and mostly positive communication
•Low levels of mother/father alcohol approval and use
Positive Anti-Alc(n=128; 35%)
•Negative communication with mother•Positive communication with father
Negative Mother(n=72; 19%)
•Negative communication with father•More father drinking
Negative Father(n=30; 8%)
Total N=370
Varvil-Weld et al. 2014
Parent Profile and High-Risk Consequence Subset
(Χ2(3)=13.87, p
Most Effective Parent Profiles
Which makes the best parent profile? Positive Pro-Alcohol? Negative Mother? Negative Father?
Positive Anti-Alcohol?
NoNoNo
YES!
Varvil-Weld et al. 2014
•Multiple well controlled trials
• Parents make a difference by influencing changes to self-regulatory behaviors
•Drinking and consequences are reduced and health outcomes increased
Summary: Early Drinking Prevention
AcknowledgementsThe PRO Health Lab at Penn State
Kimberly Mallett, Ph.D.Racheal Reavy, Ph.D.Sarah Ackerman, M.S.Nichole Sell, M.S.Brad Trager, M.S.Katja Waldron, B.S.Olivia Christman, B.S.
Undergraduate Research AssistantsLindsay Hummell, Lindsay Chandler, Katy Livezey
Former Doctoral Students Anne Ray, Ph.D. Lindsey Varvil-Weld, Ph.D. Caitlin Abar, Ph.D. Nichole Scaglione, PhD.
ColleaguesJames Jaccard, Ph.D. Michael Ichyama, Ph.D.Mary Larimer, Ph.D. Mark Wood, Ph.D.Jason Kilmer, Ph.D. Diana Doumas, Ph.D.Maria Testsa, Ph.D. Michael Cleveland, Ph.D.
www.parentteenhandbook.com
Engaging Parents in AOD Prevention : Results from Clinical Trials Examining the Efficacy of the Parent HandbookSlide Number 2Quotes from Peer Reviews & ColleaguesFast Forward 25+ YearsPrevention FrameworkI. High-Risk Drinking Drinking in Adolescents and Emerging Adults�Alcohol use is ubiquitous�Slide Number 7II. The Role of Parents and PeersSlide Number 9Why Do Students Drink?Slide Number 11Brain Development & �Self-Regulatory BehaviorBrain Development & Self RegulationIII. Prevention FrameworkInitial Etiology Research Questions15+ Years of Clinical Trials w/ParentsIV. Components - Parent-Based InterventionParent-Based Intervention (PBI):�Motivation, Knowledge & SkillsPBI: Talking About AlcoholFeedback We’re HearingV. Overview Research �1) Does the intervention work?�2) Does it work by family?�3) Why does it work?�4) Does it work in high risk environments?�5) Does it work with at-risk individuals?�6) Is it effective at changing risk profiles?���Weekend Drinking (DDQ)�Heavy Episodic Drinking �DUI �Smoked Cigarettes�Does it Work for Different Families?Positive Communication: DDQ Saturday � b = -.769, 95% CI= -1.26 & -.29, p < .003 Monitoring: DDQ Saturday�b = .623, 95% CI= .05 & 1.52, p < .03Parental Approval: DDQ Saturday � b = -6.73, 95% CI= -11.23 & -2.00, p < .006Why Does it Work?PBI: Taking About AlcoholSlide Number 32Does it Work in High Risk Environments?CU Weekend Drinking (DDQ)�CU Heavy Episodic Drinking �(2 Week Period)�Does it Work with At-Risk Individuals?GOALS Other GOALS outcomesProject ACT: Behavior Change w/Hard to Reach IndividualsIdentify Different Types of ProfilesSlide Number 41Identify Different Types of ProfilesSlide Number 43Is it Effective at Changing Risk Profiles?Slide Number 45Slide Number 46Parent ProfilesParent Profile and High-Risk Consequence SubsetMost Effective Parent ProfilesSlide Number 50Acknowledgementswww.parentteenhandbook.com