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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

Google

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


DUIGroup F (1, 903) =46.77 Interaction F (1, 903) = 1.07


Smoked CigarettesGroup F (1, 899) = 53.91 Interaction F (1, 899) = .82


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

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


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!


•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

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