Evaluation of a Swedish parental prevention program : youth drunkenness, alcohol-specific parenting and gender differences

Background Research suggests that alcohol-specific parenting and parental prevention programs can be effective in the efforts to prevent underage drinking. The Örebro prevention program (ÖPP) is based on principles of alcohol-specific parenting and encourages parents to maintain restrictive attitudes towards underage drinking, with the aim to reduce youth drinking and drunkenness. A trial conducted in 1999-2001 when the program was recently developed has indicated that ÖPP leads to maintained restrictive attitudes and reduces youth drunkenness. Since then, ÖPP has been widely disseminated in Swedish schools. Aim The primary aim of the present thesis was to increase the knowledge about the preventive influence of alcohol-specific parenting on youth drinking and drunkenness, more specifically to study effects of ÖPP when delivered under real-world conditions. Further aims were to study parents’ use of program components and possible gender differences in alcohol-specific parenting and in the relation between alcohol-specific parenting and youth drunkenness. Method The data used in the present thesis was collected within a cluster-randomized trial of ÖPP, conducted between 2007 and 2010, comprising 40 schools in 13 Swedish counties. The participating youth and their parents answered questionnaires at three occasions, in the 7th (baseline), 8th (T2) and 9th grade (T3). The thesis comprises three papers. Paper I has a cluster-randomized design with schools randomized to ÖPP (n=20) and control group (n=20), including baseline, T2 and T3 data analysed using two-level logistic regression. Paper II has a cross-sectional design including T2 data from parent-youth dyads analysed using non-parametric tests. Paper III has a longitudinal design including baseline, T2 and T3 data analysed using two-level logistic regression. Results The results indicated no statistically significant program effects on youth drunkenness onset, frequent drunkenness or weekly drinking in the 9th grade (I). However, the program had an effect on alcohol-specific parenting, i.e. ÖPP parents reported more restrictive attitudes and fewer adolescents in the ÖPP group reported being served alcohol at home (I, II). Furthermore, parental servings of alcohol to youth at home in the 7th grade increased the likelihood of drunkenness onset for both 9th grade girls and boys, and general parental control decreased the likelihood of both drunkenness onset and frequent drunkenness for both girls and boys. Some gender differences were identified, adolescent girls were more likely to be served alcohol by parents at home while restrictive attitudes and parental warmth decreased the likelihood of frequent drunkenness among girls only (III). Discussion and conclusion The results of the present thesis suggest that ÖPP, when delivered under real-world conditions, has no effects on youth drinking or drunkenness. This is inconsistent with the first Swedish study, and the divergent results can be explained not only by that effects tend to decrease when programs are evaluated under real-world conditions, but also by methodological differences, that the evaluated programs are not identical and by a higher level of restrictive attitudes among Swedish parents in general. Furthermore, the results provide additional empirical support to the associations between alcohol-specific parenting and youth drunkenness and thus lend further support to the theoretical framework of ÖPP. Future research needs to address the family context of alcohol-specific parenting for instance by studying parental provision of alcohol to youth and the quality of the parent-youth communication about alcohol, and further to address the possible benefits of targeting both youth and parents in preventive interventions. Future preventive interventions and research would also benefit from the inclusion of a gender perspective