Working in partnership with: South East Coast Strategic Health Authority, Kent and Medway Primary Care Trusts,

Kent and Medway NHS and Social Care Partnership Trust.

rebro Prevention Programme

Lecturer and Researcher, Centre for Developmental Research, rebro University, Sweden

Nikolaus Koutakis

Center for Developmental Research AN INTERNATIONAL CONFERENCE ON ALCOHOL AND YOUNG PEOPLE

UNIVERSITY OF REBRO

Whats the problem?

Among

adults: rapid increase in the latest decade. Consequences for public health, violence in public and private settings, traffic related incidents Authorities are concerned.

Drunkenness at least once in the last semester

100 90 80 70 60 50 40 30 20 10 0

Percentage of subjects

Boys Girls

10

11

12

13

14

15

16

17

18

Been drunk >10 times in latest semester

Common prevention strategies in European schools:

Lessons

on:

t h ar m a bo u a ti o n nform v id e i Pro

Biological / Pharmacological consequences Drug orientation Illustrative example

Implicit assumption about the cause of underage use (?)

Youth

use alcohol and drugs because they lack knowledge about the risk of using. As rational consumers of information youth will stay away from alcohol and drugs when informed about the risks of using.

Parents attitudes towards 16-year olds alcohol drinking in relation to the childrens actual drinking.
40 35 30 25

Parents attitude
Restrictive Permissive

20 15 10 5 0 Never > 10 times

Drunkenness in the latest year

PARENTAL ATTITUDE DEPENDS S ON SEVER THINGS AL

But they ar e typically subject to c hange

A child of my son or daughters age is way too young to concern him- or herself with alcohol. We think it is obvious that adolescents under 18 years should not concern themselves with alcohol.
100 90 80 70 60 50 40 30 20 10 0

13

14

15

16

Childs age

Parents are important but are they motivated? Do we need to motivate parents?
A common assumption is that parents of early adolescents are concerned about this issue and therefore highly susceptible and motivated to participate in prevention strategies.

Are parents in general concerned?

Do parents have worries that their children will get in to trouble because of alcohol drinking?

Amount of youth that believes that their parents worry about their children's alcohol consumption in relation to their parents report about their worries.
%
45 40 35 30 25 20 15 10 5 0 13 14 15 16 Youth self report Parent report

age

Parents in general do not worry to the same extent as the youths believe.

 We

expected increasing levels of parent worries as the child grows older. Parents are more likely to have caught their child drunk the older the child is. This awareness ought to make parents concerned.

seeing their child drunk but parent worries are not affected by their experiences of seeing the child drunk.
%
45 40 35 30 25 20 15 10 5 0 13 14 15 16 Parent caught the child drunk Parent worries

Childs age

 Parents

in general do not seem to

worry. If parents do not worry about underage drinking they are not motivated to engage in actions aiming to reduce it.

Prerequisites for preventing underage drinking when working through parents

Prevention programs targeting parents in order to reduce underage drinking should work through a strategy to influence and question common ideas and parental practices.

First stage: Open parents eyes

Initially,

focus on making parents aware of the problems with underage drinking, even to the extent that negative emotions are evoked. Purpose: to make parents more open to suggestions for change.

Second stage: Change parents ways of thinking about underage drinking

Tear

down parental misconceptions about youth drinking, such that most youths drink and it is not possible to change the situation. Parents should become aware that their attitudes and behavior matters.

Powerlessness

Third stage: Implement specific techniques

Parents should be taught clear and simple rules about how to prevent and handle their adolescents drinking behavior.

PP is a three stage rocket

Concern Empower Provide tools

Koutakis, N., & Stattin, H.

What if we try to maintain parents restrictive attitudes toward underage drinking; Will this have an impact on their children's alcohol drinking?

Target: Parents to 13-15 year olds. Administration: Ordinary school meetings. Dose: 15-20 minutes per semester (m=5; age 1316). Active substance: Facts and arguments. Side effects / limits: Not a cure for al. Administer in any community without any cost

Par ag enta Information on underage drinking: ree me l nt cla We, t Parent values matter ss he
of About letting the child drink ag re e rul follow dt es in g Consensus agreement. o c om chi regar mo ldr din n Having clear and restrictive en go ur house rules. ------------ Concluding letter to al- ------

Content

the

7a h

av e

pa re

nt s

----

----

----

----

----

----

----

----

-------

----

----

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Figure 1. Means for parent-reported restrictive attitudes toward underage drinking at grades 7, 8 and 9 for parents in the intervention and control groups.
4 Parents' restrictive attitudes 3,9 3,8 3,7 3,6 3,5 3,4 grade 7 grade 8 grade 9

Figure 2. Repeated measures ANOVA displaying self reported drunkenness (a) and delinquency (b) separately for youths in the intervention and control conditions.

1 0.9 0.8 Mean drunkenness 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 grade 7 grade 8 grade 9 Mean delinquency

1.35 1.3 1.25 1.2 1.15 1.1 grade 7 grade 8 grade 9

Figure 3. Repeated measures ANOVA for a subsample of early starters in drunkenness and delinquency displaying self reported drunkenness (a) and delinquency (b) separately for youths in the intervention and control conditions.

2 1,8 1,6 1,4

1.75 1.7 Mean delinquency 1.65 1.6 1.55 1.5 1.45 1.4 1.35 1.3 grade 7 grade 8 grade 9

1,2 1 0,8 0,6 0,4 0,2 0 grade 7 grade 8 grade 9

s k u r d n a e M

Effect Size
Over all ES
Repeated Post test measures, control for pre control for pre est test

Early starters ES
Repeated Post test, measures, control for pre control for pre test test

Drunkenness Antisocial behavior

.48 .42

.35 .38

.72 .46

.52 .32

Number needed to treat for one to benefit =7.7 / 7.1

Conclusions

Any effective prevention program must focus on important conditions that are realistic to alter. In order to be able to mobilize parents, it is crucial to have them motivated. Parent attitudes and parenting practices concerning underage drinking matter. The PP approach is effective in maintaining parents restrictiveness and thereby decrease underage drunkenness.

Requirements for implementing PP locally

2

day training:

Intro. Prevention science PP Theoretical explanation Professional communication Common arguments Practical simulations

Normal trajectory
More Underage drunkenness

Less

Parent restrictive attitudes

Age

13

14

15

PP results
More Parent restrictive attitudes

Underage drunkenness

Less

Age

13

14

15

nikolaus.koutakis@oru.se
Center for Developmental Research

UNIVERSITY OF REBRO