Alcohol misuse in young people is a specific focus on the agenda of the World Health Organization (WHO, 2010). Alcohol use is typically initiated in adolescence (WHO, 2010) and carries high levels of risk, such as risk of dependence, physical harms and cognitive impairment (Hall et al., 2016).

Parents have been identified as vital in preventing adolescent alcohol misuse and the identification of key parenting factors is vital in the development of successful interventions.

A narrative systematic review (Ryan et al., 2010) identified a wide range of key parenting factors associated with adolescent alcohol misuse which the current study aimed to update with a comprehensive search strategy and meta-analysis of primary studies.

Methods

A total of 131 longitudinal studies were included, with 416 associations. Studies had a minimum follow-up period of one year.

Twelve parenting factors (alcohol specific factors and general factors) and two adolescent alcohol use outcomes were identified (alcohol initiation and levels of later use/misuse).

There were a diversity of methodologies and analyses across studies, meaning not all effect sizes could be extracted and only a subset could be included in the meta-analyses. Meta-analyses were conducted for specific factors when there were at least two independent studies available. Authors used r for effect size as it was most commonly reported in studies (rs were interpreted based on Cohen’s guidelines with 0.10 indicating a small effect).

To determine reliability of associations across all studies authors used Stouffer’s method of combining p-values, a technique used when there is a heterogeneity in analytical approaches.

Results

Authors categorised factors into one of three categories: factors with a sound convergent evidence base (significant effect sizes and significant Stouffer’s P), factors with a weak evidence base (a significant Stouffer’s P, but the meta-analysis of the subset was non-significant or could not be conducted) and factors with a weak evidence base (insufficient evidence to draw conclusions).

Factors with a sound convergent evidence base:

• Provision of alcohol had the largest effect size of the parenting factors, with drinking at home and having alcohol easily accessible associated with earlier initiation and higher alcohol use/misuse

• Favourable paternal attitudes towards alcohol use were associated with early initiation, and both maternal and paternal favourable attitudes were associated with increased alcohol use/misuse

• Paternal alcohol use was associated with early initiation and both maternal and paternal alcohol use were related to increased alcohol use/misuse

• High parental monitoring and parent-child relationship quality were associated with delayed alcohol initiation association and reduced alcohol use/misuse

• High maternal support was associated with delayed alcohol initiation and both high paternal and maternal support were associated with reduced alcohol use/misuse

• High parental involvement was associated with delayed alcohol initiation and reduced alcohol use/misuse.

Factors with an emerging evidence base:

• Having parental rules about alcohol use was associated with delayed alcohol initiation and lower levels of alcohol use/misuse, with clear rules having a protective effect

• Higher levels of family conflict were associated with early alcohol initiation and higher levels of alcohol use/misuse

• Maternal parental discipline was associated with delayed alcohol initiation, with appropriate discipline having a protective effect.

Factors with a weak evidence base:

• Alcohol specific communication was not significantly associated with alcohol initiation or reduced levels of alcohol use/misuse

• There were ambiguous findings for general parent-child communication and delayed alcohol initiation. A significant association was found between positive general communication between parent and child and alcohol use/misuse.

Moderation effects

Moderation effects were tested when there were at least four associations available with meta-regression analysis (follow-up interval and baseline age) and subgroup analyses (adolescent gender and outcome measure).

Follow-up interval moderated the association for five parenting factors (favourable attitudes towards alcohol use and family conflict on initiation, parental support and parental involvement on later use/misuse and parent child relationship on both initiation and use/misuse), with smaller effect sizes for longer intervals, indicating parenting can have long term influences.

Baseline age moderated the association for three parenting factors (family conflict and parent-child relationship quality on initiation and parental involvement on later use/misuse). Studies with younger children at baseline had smaller effect sizes, although authors suggest this could be an artefact of follow-up interval, as longer follow-ups are likely to recruit children at a younger age.

There was significant moderation by adolescent gender for parent-child relationship quality and parental monitoring, with girls more sensitive in terms of risk for early initiation.

There was a significant moderation by outcome measure in the associations between favourable attitudes towards alcohol and initiation and between parent-child relationship quality and both initiation and levels of later use/misuse. A stronger association was found when frequency/quantity/binge drinking measures were used, rather than onset measures.

Discussion

Authors emphasise that the heterogeneity across studies indicates the need for clearly defined and validated measures in future longitudinal research in this area. Overall effect sizes are small (rs = -0.224 to 0.263 and overall only accounting for 1-7% of variance). Authors recommend tailored online programmes to:

Support the translation of the sound evidence base on the various parenting factors examined here into prevention interventions to upskill parents.

Strengths and limitations

Strengths

• This is a comprehensive review of a wide range of specific parental factors associated with initiation and alcohol use/misuse in adolescents. Where possible, authors have conducted meta-analyses to identify associations, contributing to the literature that to date has only included narrative systematic reviews

• The division of factors into three categories based on evidence strength is particularly useful for future research and intervention design.

Limitations

• Meta-analyses could not be conducted for all parenting factors and for those that were conducted they may have been underpowered to detect associations, as some contained as little as two independent studies

• Due to the inclusion of primary studies that have not been adjusted for covariates (because of heterogeneity across studies), causality cannot be drawn from the associations

• Findings mainly relate to developed countries and may not be generalisable to other cultures and countries.

Conclusions

This study highlights a set of parental factors that have a small but significant impact on adolescent alcohol use and should be targeted in intervention efforts. Specific factor categories can provide a framework for future research design that lends to systematic analysis.

Links

Primary paper

Yap MBH, Cheong TWK, Zaravinos-Tsakos F, Lubman DI, Jorm AF. (2017) Modifiable parenting factors associated with adolescent alcohol misuse: a systematic review and meta-analysis of longitudinal studies. Addiction, doi: 10.1111/add.13785.

Other references

Hall WD, Patton G, Stockings E, Weier M, Lynskey M, Morley KI et al. (2016) Why young people’s substance use matters for global health. Lancet Psychiatry 2016; 3: 265–79.

Ryan SM, Jorm AF, Lubman DI. (2010) Parenting factors associated with reduced adolescent alcohol use: a systematic review of longitudinal studies. Aust NZ J Psychiatry 2010; 44:774–83. [PubMed abstract]

World Health Organization. (2010) Global strategy to reduce the harmful use of alcohol. Geneva: World Health Organization; 2010.

Photo credits

• Leonid Mamchenkov  CC BY 2.0
• Timothy Vollmer CC BY 2.0