effekt: a parent's perspective on alcohol education

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2015-10-06 1 Engaging parents in alcohol and drug education, October 6 Birmingham Effekt: A parent’s perspective on alcohol education Dr. Nikolaus Koutakis, University of Örebro, SWEDEN Being drunk during the past 30 days by gender. 2011. (2011, ESPAD Report)

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Page 1: Effekt: A parent's perspective on alcohol education

2015-10-06

1

Engaging parents in alcohol and drug education, October 6 Birmingham

Effekt: A parent’s perspective on

alcohol education

Dr. Nikolaus Koutakis, University of Örebro, SWEDEN

Being drunk during the past 30 days by gender. 2011.

(2011, ESPAD Report)

Page 2: Effekt: A parent's perspective on alcohol education

2015-10-06

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0

10

20

30

40

50

60

70

80

90

100

10 11 12 13 14 15 16 17 18

Per

cen

tag

e o

f su

bje

cts

Boys

Girls

Percentage of youth (10-18) been drunk at least once the last semester.

Age

0

10

20

30

40

50

60

70

80

90

100

10 11 12 13 14 15 16 17 18

Per

cen

tage

Boys

Girls

Percentage of subjects at different ages been drunk more than 10 times the last semester.

Age

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2015-10-06

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OK, adolescents get drunk, so what?Alcohol related consequences age 15 & 17

0

5

10

15

20

25

30

35

40

45

50

15 17 15 17 15 17 15 17 15 17 15 17 15 17

Amount of youth that believes that their parents worry about their children's alcohol consumption in relation to their parents’ report about their worries.

%

age0

5

10

15

20

25

30

35

40

45

13 14 15 16

Youth self report

Parent report

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The percentage of youth who said they have been drunk and percentage of parents who had found their youth drunk

0

20

40

60

80

100

13 14 15 16

Youth

Parents

%

(r= .55, p < .001)

Parents get increasing experiences of seeing their child drunk but parent worries are not affected by their experiences of seeing the child drunk.

%

Childs age0

5

10

15

20

25

30

35

40

45

13 14 15 16

Parent caught the child drunk

Parent worries

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Cognitive dissonance theory:When cognitions are inconsistent�DistressRemedy: Change cognition or behavior

What does the theory have to do with underage drinking ?

Parents usually have a restrictive approach to underage drinking, especially when children are younger.

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The percentage of parents having lenient stance towards underage drinking over time (longitudinal data)

0

20

40

60

80

100

13 14 15 16

%

What happens if parents encounter their children drunk?

Longitudinal data over three years: Concentrating on the majority of parents to 13 year olds that have restrictive attitudes towards underage drinking.

Longitudinal data over three years: Concentrating on the majority of parents to 13 year olds that have restrictive attitudes towards underage drinking.

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Percentage of parents who become more lenient over time

have seen the child drunk at the age of 15?

%

”It is natural for children in your son's or daughter's age to becurious to try alcohol. We trust our son / daughter to drink responsibly.”

p < 0.001T2

N0

Yes

25

7

0

10

20

30

• A relatively small group of parents have encountered their early teens drunk, those youth are quickly increasing their frequency of drunkenness.

• This phenomenon can be explained in terms of parental cognitive dissonance.

• This group can be targeted in a universal program.

• EFFEKT is communicating clear messages about this to a universal group of parents.

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Parent’s attitudes towards 16-year olds alcohol drinking in relation to the children’s actual drinking.

0

5

10

15

20

25

30

35

40

Never > 10 times

Restrictive

Permissive

Parent’s attitude towards underage

drunkenness

Been drunk latest semester

%

Longitudinal studies on Parent Attitudes - Youth Drinking Behaviors

Abar C, Turrisi R. (2008). How important are parents during the college years? A longitudinal perspective of indirect influences parents yield on their college teens’ alcohol use. Addict Behav, 33: 1360–68

Turrisi R, Wiersma KA, Hughes KK. (2000). Binge-drinking related consequences in college students: Role of drinking beliefs and mother-teen communications. Psychol Addict Behav, 14: 342–55.

Walls TA, Fairlie AM, Wood MD. (2009). Parents do matter: a longitudinal two-part mixed model of early college alcohol participation and intensity. J Stud Alcohol Drugs, 70: 908–18.

Wood MD, Read JP, Mitchell RE, Brand NH. (2004). Do parents still matter? Parent and peer influences on alcohol involvement among recent high school graduates. Psychol Addict Behav, 18: 19–30.

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Let’s take an adolescent perspective

Certainly

not

Certainly

true

Prudential issues

To drink alcohol 19.4 55.8

To smoke or use dry tobacco 19.5 66

To go to a party where they drink

alcohol

21 45.6

To use hash or other drugs 19 77.6

How I treat my friends (about

teasing or insulting)

21.1 41.1

To spread rumors or say

something nasty

22.7 49.7

To keep my promises to others 18 46

About talking back to a teacher 20.2 47.5

About my language (e.g. cursing) 23 34.9

Average prudential issues 20.4 51.6

Personal issues

What web-pages I'm aloud to

browse

26.2 30.9

What movies or music I'm aloud

to listen to

48.4 16.2

That they decides what peers

I'm aloud to hang out with

35.4 16.8

What I do on my free time 34.1 16.6

How I use my money 36 15.7

What girls or boys I like or fall in

love with

56.3 12.3

Average personal issues 23.4 18.1

Certainly

not

Certainly

true

I think it´s OK if my parents set limits for me concerning:

Percentage of youths who accept or do not accept parents limit setting for different types of prudential and personal issues

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EFFEKT rests on the principle that parents have an important role in regulating their youth

Concept: Target: important dynamic conditions that are realistic to alter.

What if we try to maintain parents restrictive attitudes toward underage drinking;

Will this have an impact on their children's alcohol drinking?

EFFEKTTM

• Target: Parents to 13-15 year olds.• Administration: Ordinary parent-teacher conferences /

parent meetings.• Dose: 15-20 minutes biannually.• Active ingredient: Facts and arguments delivered in an

interactive format.• Administer in any community making use of existing

resources: without any cost other than training.

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Implementation

Ordinary staff e.g. teacher, school counselor, school nurse.

Content on ordinary parent-teacher conferences (20 min)

• Information on underage drinking:• Parent values matter• About letting the child drink

• Consensus agreement.• Having clear and restrictive

house rules.

• Concluding letter to al

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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.

15 av 30 15-åringar. 7 % fler pojkar än flickor.

Number of 15 year-olds who have been drunk at least once during the past year

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Number of 15 year-olds who have been drunk more than 4 times during

the past term

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 � Empowerment

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Third stage: Implement specific techniques

Parents are taught clear and simple rules about how to prevent and handle their adolescent’s drinking behavior.

•What do you and your friends think about alcohol?

•Do you know why there is an age limit for buying alcohol?

•What do you do when you are offered a drink?

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Intervention results

Koutakis, Stattin & Kerr (2008)

Tested and confirmed paths using latent growt curvemodels (Koutakis & Ozdemir, 2010)

3,4

3,5

3,6

3,7

3,8

3,9

4

grade 7 grade 8 grade 9

Pare

nts

' re

str

icti

ve a

ttit

ud

es

Mean levels for parent reported restrictive attitudes toward underage drinking at grades 7, 8 and 9 for parents in the intervention- and control groups.

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0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

1

grade 7 grade 8 grade 9

Me

an

dru

nk

en

ne

ss

control experimental

Repeated measures analysis of variance displaying self reported drunkenness for youths in the intervention and control condition at grades 7, 8 and 9.

1,1

1,15

1,2

1,25

1,3

1,35

grade 7 grade 8 grade 9

Me

an

de

lin

qu

en

cy

Repeated measures analysis of variance displaying self reported delinquency for youths in the intervention and control condition at grades 7, 8 and 9.

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0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

grade 7 grade 8 grade 9

Me

an

dru

nk

en

ne

ss

control experimental

Repeated measures analysis of variance for a sub sample of early starters in drunkenness and delinquency displaying self reported drunkenness for youths in the intervention and control condition at grades 7, 8 and 9.

1,4136

1,3

1,35

1,4

1,45

1,5

1,55

1,6

1,65

1,7

1,75

grade 7 grade 8 grade 9

Mean

delin

qu

en

cy

Repeated measures analysis of variance for a sub sample of early starters in drunkenness and delinquency displaying self reported delinquency for youths in the intervention and control condition at grades 7, 8 and 9.

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In addition

• More parents attend parent meetings

• More Communication: parent � school; school �parent.

Over all ES Early starters ESRepeated measures, control for pre test

Post test control for pre est

Repeated measures, control for pre test

Post test, control for pre test

Drunkenness .48 .35 .72 .52Antisocial behavior

.42 .38 .46 .32

Effect Size

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

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Child disclosure is related to different conditions:

Child’s personality, temperament

Parental responce

- sarkasm-penalicing-Mocking the child, make fun-Use the info. against the child -Over and over bring up issues that has been solicited in confidence

Stable traits

Tystar barnendiscourages

the child

The emotional climate encourages the child to disclose

Parental warmth

-youth are willing to disclose about their whereabouts away from home if there is

warmth in the parent – youth relations

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What do I mean with warmth?

�Praising the child unconditionally

�Show with words and gestures that they love their

youth

�More often focus on positive things in youth’s

behaviors

�Show how proud they are with their youth

�Do small things that make the child feel special

Evidence Teachers

experience

Parent and youth

demand

Evidence baced

practice

EFFEKTEFFEKTEFFEKTEFFEKT---- Evidence Evidence Evidence Evidence based?based?based?based?

Sackett, D. L., et al,. (1996). Evidence-based medicine: What it is and what it isn't. British Medical Journal, 312 , 13, 71-72.

Best avaliable

knowledge from

reliable research.

Teachers

expertice and

advice of what is

possible to

acieve.

Parent and youth

responce and

demand.

Effectively

preventing alcohol,

tobacco or illegal

substance use in a

way that suits

schools.

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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 EFFEKT approach is effective in maintaining parents restrictiveness and thereby decrease underage drunkenness.

Training: Prerequisite to

implement EFFEKT• Introduction to Prevention Science

• Theoretical and empirical background of EFFEKT

• The logic of the program

• Current knowledge about parenting research –preventive implications

• Program theory

• Importance of program fidelity

• Prerequisites for a sustainable implementation

• How to communicate professionally

• How to answer the most common (critical) questions from parents.

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For discussion

• If you had the chance to gather al or most parents to the pupils in your school, what would you like to do with them?

• What would it take to have them to come to such a gathering?

INPUTS ACTIVITIES OUTCOMES

Trained Teachers

(2d).

Access to parent-

teacher

conferences.

Less underage

drunkenness,

and antisocial

behaviors.

More parents

attending

parent-teacher

conferences.

Increased

communication

between

parents and

school & School-

parents

Logic Model for EFFEKT

Recurring

presentations at

ordinary parent –

teacher

conferences with

the purpose to

provide

arguments and

strategies for

parents’ to

uphold and

express clear and

restrictive

expectations on

underage

drinking

Parents’

restrictive

attitudes

maintained.

Letters to al

parents.

Consensus

agreements

among parents.

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2015-10-06

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less

more

Youth age13 1814 15 16 17

Normal trajectory

Intervention results

Parents having clear expectations

13 1814 15 16 17

less

more

Youth age

Page 24: Effekt: A parent's perspective on alcohol education

2015-10-06

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[email protected]

UNIVERSITY OF ÖREBRO

SWEDEN

effekt.org

Blueprints for Healthy Youth Development

http://www.blueprintsprograms.com/factSheet.php?pid=

e973a64ce098778bb7327fe57d8a607be981cbd3

Crime Solutions.gov

http://www.crimesolutions.gov/ProgramDetails.aspx?ID=

162

Institute for Fiscal Studies´s

http://www.ifs.org.uk/publications/6246

RAND Europé

www.rand.org/randeurope

Koutakis et al., 2008; Koutakis & Ozdemir, 2010; Bodin & Strandberg, 2011;

Koning et al., 2011; Ozdemir & Stattin, 2012; Ozdemir & Koutakis, 2015