www.ccsa.ca www.cclt.ca Novmbr 2014 Rapid Rviw Univrsal, Family-basd Substanc Abus Prvntion for Youth Ky Mssags Univrsal, family-basd substanc abus prvntion programs can b ffctiv for fmals, whthr dsignd for mals and fmals or just fmals. Evidnc that univrsal, family-basd substanc abus prvntion programs dsignd for mals and fmals is ffctiv for mals is mixd. Gndr is an important considration for thos dvloping, implmnting and valuating prvntion programs. Contxt A comprhnsiv stratgy for prvnting youth substanc abus includs both univrsal approachs dsignd to apply to an ntir population and targtd approachs dsignd for popl at a highr risk for substanc abus (Canadian Cntr on Substanc Abus, 2010; Wisz, Sandlr, Durlak, & Anton, 2005). Many univrsal substanc abus prvntion programs for youth focus on a spcific ag or stag of youth (.g., arly adolscnc) to rflct dvlopmntal diffrncs in th factors that influnc substanc abus (Mastn, Fadn, Zuckr, & Spar, 2008). Rcntly, som rsarchrs hav suggstd that fmal youth might b undrsrvd by univrsal substanc abus prvntion programs (Kumpfr, Smith, & Summrhays, 2008), indicating th nd for programs tailord spcifically for mals or fmals (i.., gndr-spcific). It is currntly not known whthr univrsal prvntion programs ar qually ffctiv for both mals and fmals. Thr is vidnc that univrsal prvntion programs ar mor ffctiv for mals than fmals (Kllam t al., 2008; Ostrl, Hawkins, Fagan, Abbott, & Catalano, 2010; Prry t al., 2003), but othr studis hav not found strongr ffcts for mals (O Donnll, Hawkins, Catalano, Abbott, & Day, 1995), highlighting th nd for a rviw of th vidnc. In addition to univrsal and targtd approachs, prvntion programs can b implmntd across diffrnt sttings, including community, school and family (Canadian Cntr on Substanc Abus, 2010). Studis xamining th factors that influnc youth substanc abus suggst th ffctivnss of a program might vary across ths sttings. Though ach stting is important for mals and fmals, thr is som vidnc that family factors such as parntal attachmnt and parntal monitoring might hav a strongr impact on fmal substanc abus (Fothrgill, & Ensmingr, 2006; Kumpfr, Alvarado, & Whitsid, 2003; Sals, Samrano, Springr, & Turnr, 2003), whras individual and community factors might hav a strongr impact on mal substanc abus (Klln t al., 2008; Kumpfr t al., 2003; Yin & Kaftarian, 1997). Considring th concrn that fmals might b undrsrvd by univrsal prvntion programs and that family sttings ar spcially important to fmals, this rviw focuss on th ffctivnss of univrsal, family-basd prvntion programs for fmals and mals. 1
Th rviw sought to answr th following qustion: Ar univrsal approachs to substanc abus prvntion dsignd for familis ffctiv for both mal and fmal youth? Th Issu It is unclar whthr univrsal prvntion programs ar qually ffctiv for mals and fmals. Thr is vidnc that th ffctivnss of a univrsal substanc abus prvntion program might vary across community, school, and family sttings. If thr ar gndr diffrncs in th ffctivnss of prvntion intrvntions, thn fmals or mals might b undrsrvd by xisting intrvntions and gndr-spcific approachs might b ndd. This rapid rviw xamins whthr univrsal, family-basd substanc abus prvntion programs, including programs that targt parnts alon or parnts and thir childrn, ar qually ffctiv for mals and fmals. Approach A sarch of publishd litratur was conductd to idntify randomizd controlld trials () of univrsal, family-basd substanc abus programs (Appndix A). 1 A total of 512 articls wr initially assssd for rlvanc. Basd on th scrning of titls and abstracts, 70 full-txt articls wr rviwd for rlvanc. 2 Articls wr includd if thy wr publishd in English btwn 2009 and 2014 and conductd a gndr-basd analysis on th impact of a univrsal, family-basd substanc abus prvntion program among youth (ags 10 24). 3 Th rsarchrs did not conduct a quality appraisal assssing th mthodological strngth of th individual studis includd in this rviw. Findings Of th 70 articls includd aftr titl and abstract scrning, 11 primary studis mt th inclusion critria. Ths 11 studis includ both gndr-spcific, family-basd intrvntions dsignd for fmals and mixd gndr intrvntions dsignd for both mals and fmals (s Appndix B for study dtails). Thr wr no studis of family-basd intrvntions spcifically for mals. Family-basd Prvntion Targting Fmals All svn studis of programs dsignd for fmals dmonstratd a prvntativ ffct (Fang, Schink, & Col, 2010; Fang, & Schink, 2013; O Donnll, Myint-U, Duran, & Stuv, 2010; Schink, Col, & Fang, 2009a; Schink, Fang, & Col, 2009b; Schink, Fang, & Col, 2009c; Tsta, Hoffman, Livingston, & Turrisi, 2010). Six of ths studis assssd th ffct of computr-dlivrd intrvntions for arly adolscnt fmals (about ags 10 13) and thir parnts. Fiv of ths studis cam from th sam rsarch group and two wr of th sam intrvntion at on-yar (Fang t al., 2010) and two-yar follow-ups (Fang t al., 2013). Ths programs showd positiv impacts on family factors (.g., closnss and communication), psychological bnfits to fmal youth (.g., highr slf-fficacy), and rducd substanc us in th short and mdium trm (up to two yars; Fang t al., 2010; Fang t al, 2013; O Donnll t al., 2010; Schink t al., 2009a; Schink t al., 2009b; Schink t al., 2009c). On intrvntion targting fmals xamind a parnt-basd handbook for first-yar collg studnts. This study found th intrvntion only rducd alcohol us among fmals who rportd 1 Th population, intrvntion, comparison and outcom (PICO) factors usd to formulat th rsarch qustion ar availabl upon rqust. 2 Th full list of articls is availabl upon rqust. 3 Th scrning qustions ar availabl upon rqust. 2
incrasd mothr-daughtr communication from th intrvntion. Fmals who did not hav incrasd mothr-daughtr communication from th intrvntion did not show a rduction in alcohol us (Tsta t al., 2010). Family-basd Prvntion Targting Fmals and Mals All four studis of intrvntions dsignd for mals and fmals rportd a significant prvntativ ffct for fmals (Brody, Chn, Kogan, Murry, & Brown 2010; Doumas, Turrisi, Ray, Esp, & Curtis- Schaffr, 2013; Ichiyama t al., 2009; Mason t al., 2009). Rsults for mals wr mixd with two studis rporting a significant prvntativ ffct (Brody t al., 2010; Doumas t al., 2013), on study rporting no ffct (Mason t al., 2009), and on rporting a harmful ffct (Ichiyama t al., 2009). Two of th four studis valuatd an in-prson program dsignd to nhanc family skills for familis with childrn in lat childhood or arly adolscnc. Th othr two studis valuatd th ffctivnss of a parnt handbook in rducing drinking among collg studnts. Both studis of inprson programs showd rducd substanc us among fmal participants (Brody t al., 2010; Mason t al., 2009). On study rportd rducd substanc us for mals (Brody t al., 2010), whras th othr study did not find a significant ffct (Mason t al., 2009). Th programs for collg studnts usd a similar parnt intrvntion handbook to nhanc parntal skills such as communication to rduc alcohol misus among collg frshmn (Doumas t al., 2013; Ichiyama t al., 2009). Both studis found significant ffcts for fmal collg studnts (Doumas t al., 2013; Ichiyama t al., 2009). For mal participants, on study found th intrvntion rducd both frquncy and quantity of drinking (Doumas t al., 2013), whras th othr found a harmful ffct with mals in th intrvntion rporting significantly highr wkly alcohol consumption than mals in th control group (Ichiyama t al., 2009). Discussion Basd on th 11 studis rviwd, univrsal, family-basd intrvntions can b an ffctiv mthod to rduc substanc abus among fmal youth. All includd studis of intrvntions dsignd for fmals and intrvntions dsignd for both mals and fmals dmonstratd rducd substanc us among fmals. Lss rsarch has bn conductd with mal participants and th rviw did not idntify any programs spcifically for mal youth. Rsults for mals from four studis of programs that includd both mals and fmals wr mixd: two of four studis rportd a prvntativ ffct, on study rportd no impact and on study rportd a harmful ffct. Th rviw idntifid two typs of prvntion programs: in-prson programs for parnts and thir childrn in lat childhood and arly adolscnc; and parnt handbooks for parnts with youth who ar ntring collg. Diffrncs across studis in th outcoms masurd (.g., liftim us, frquncy, quantity, substanc us problms) and follow-up tims (two months to svral yars) limit th ability to compar rsults across studis. In-prson programs for parnts and thir childrn wr ffctiv in prvnting youth substanc abus among young fmals. Parnt-basd handbooks for studnts ntring collg also had a significant impact on short-trm alcohol us for fmals; howvr, ths rsults only had short-trm follow-ups (from four to ight months) and ar spcific to alcohol us. Th impact of ths intrvntions in th longr-trm and on othr substancs is not known. 3
This rviw highlights th importanc of assssing gndr diffrncs in th ffcts of univrsal prvntion programs. Th rviw idntifid only 11 valuations of family-basd univrsal programs that xamind gndr diffrncs. That th rviw found diffrnt rsults for fmals and mals highlights th nd for furthr rsarch on this topic. Although it was not always rportd, most mixd gndr intrvntions had gratr participation from mothrs than fathrs (s Appndix B, Fmal and Mal Participants). In addition, all but on intrvntion dsignd for fmals wr dsignd for mothrs and daughtrs. As a rsult, fmals in ths programs wr mor likly to hav a sam-sx parnt participat, whras mals wr mor likly to hav an opposit-sx parnt participat. Som rsarch indicats distinct impacts of samsx vrsus opposit-sx parnts on alcohol us (Patock-Pckham, Chong, Balhorn, & Nagoshi, 2001; Patock-Pckham & Morgan-Lopz, 2007). Unfortunatly, no studis xamind whthr mothr vrsus fathr participation or sam vrsus opposit sx parnts impactd th ffctivnss of th intrvntion. In fact, no rsarch xamind whthr lmnts of th program (.g., program targts, how th program was dlivrd) impactd th ffctivnss of th program for mals or fmals. Furthr rsarch is ndd to xamin th ffctivnss of univrsal, substanc abus prvntion programs for mals and fmals and whthr aspcts of th program contnt and dlivry might impact th ffctivnss for mals and fmals. This information could b usd to hlp inform futur program dvlopmnt, particularity for young mals. This rviw focusd on univrsal, family-basd substanc abus prvntion and should not b gnralizd to community or school sttings. Similar rsarch xamining th ffctivnss of univrsal, substanc abus prvntion programs should b don in school and community sttings to assss whthr programs in ths sttings ar ffctiv for both fmals and mals. Conclusion Basd on th 11 studis rviwd, univrsal, family-basd intrvntions can b ffctiv for fmals, whthr dlivrd with mals or targtd to just fmals. Howvr vidnc of ffctivnss is mixd for mals. 4
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Appndix A: Sarch Stratgy and Scrning Qustions Rsarch Qustion Ar univrsal approachs to substanc abus prvntion dsignd for familis ffctiv for both mal and fmal youth? Databas Sarching Sarch stratgis wr dvlopd first for Ovid Mdlin basd on a numbr of xmplar articls idntifid by th authors. Indxing for th concpt of univrsal programs is inconsistnt and is not rprsntd in controlld vocabularis, so th rsarchrs dvisd a two-prongd stratgy. Th first part of th stratgy combind an addictions st (comprisd of kyword and controlld vocabulary) with th kyword univrsal. Th scond part of th stratgy combind this sam addictions st with kywords and controlld vocabulary dscribing aspcts of univrsal programs; ths rlatd trms focusd on family rlationships, parnts and at-hom tratmnt concpts. Both of ths stratgis wr rstrictd by ag hadings and school hadings (school bing a trm applicabl to scondary and lmntary ducational sttings) in th Mdlin databas. ERIC and Wb of Scinc wr sarchd using short kyword stratgis. 4 Mdlin sarchs wr limitd by using a validatd randomizd controlld trial filtr from th Cochran Handbook for Systmatic Rviws of Intrvntions (Higgins, & Grn, S., 2011). Sarchs wr conductd in Dcmbr 2013 in Ovid Mdlin, In-Procss & Othr Non-Indxd Citations and Ovid Mdlin, 1946 to Prsnt; ERIC (Education Rsourcs Information Cntr) databas via th ProQust intrfac; and Wb of Scinc Cor Collction (http://thomsonrutrs.com/wb-of-scinc-cor-collction/). Titl and Abstract Scrning English languag = ys/unclar Yar of publication = 2009 2014 Ag of population = 10 24 Purpos/aim to xamin a family-basd skills or rlationship intrvntion? = ys/unclar Dos th study masur substanc abus? = ys/unclar Is th study of a univrsal prvntion program? = ys/unclar Full Txt Scrning Ag of population=10 24 Purpos/aim to xamin a family-basd skills or rlationship intrvntion? = ys Dos th study masur substanc abus? = ys Is th study of a univrsal prvntion program = ys Is th control group consistnt with PICO? = ys Dos th study rport rsults by gndr or assss gndr diffrncs? = ys 4 Th full sarch stratgy for ach databas is availabl upon rqust. 8
Appndix B: Charactristics of Primary Studis Fmal Participants Only Study Purpos Mthod Participants Substanc Us Outcoms Fang, Schink, & Col (2010) Fang, & Schink (2013) O Donnll, Myint-U, Duran, & Stuv (2010) Schink, Col, & Fang (2009a) ffctivnss of a family-basd intrvntion dlivrd onlin for mothrs & daughtrs aimd at rducing substanc us among Asian- Amrican fmals. longr trm ffctivnss of a family-basd intrvntion dlivrd onlin for mothrs & daughtrs aimd at rducing substanc us among Asian- Amrican fmals. ffctivnss of a gndr-spcific, computr-mdiatd substanc abus prvntion intrvntion. ffctivnss of a gndr-spcific, computr-mdiatd substanc abus prvntion intrvntion to rduc undrag drinking in fmals. Random izd controlld trial () Asian- Amrican fmals agd 10-14 & thir mothrs rcruitd from th community n=108 Asian- Amrican fmals agd 10-14 & thir mothrs rcruitd from th community n=93 6 th grad studnts & thir parnts (89% mothrs; 6% fathrs; 5% othr cargivr) n=268 Fmals ags 10 13 & thir mothrs n=202 At on-yar follow up, fmals in th intrvntion rportd fwr instancs of alcohol us, marijuana us & prscription drug us in th past 30 days. At two-yar follow up, fmals in th intrvntion rportd fwr instancs of alcohol us, marijuana us & prscription drug us in th past 30 days. Girls in th intrvntion wr lss likly to us alcohol or to hav bn drunk at follow up (adjustd odds ratio = 0.38; confidnc intrval 0.15-0.97). Girls in th intrvntion wr significantly lss likly to consum alcohol in th past wk & month compard to girls in th control condition at two-month follow up. Th ffct siz of th intrvntion was vry small ( 2 =.02). Othr Rlvant Outcoms Fmals in th intrvntion rportd: Highr lvls of mothr-daughtr closnss Enhancd communication Matrnal monitoring Exprincing mor ruls against substanc us Lss dprssd mood Highr slf-fficacy Improvd rfusal skills Lowr intntion to us substancs in th futur Fmals in th intrvntion rportd: Highr lvls of mothr-daughtr closnss Enhancd communication Matrnal monitoring Exprincing mor ruls against substanc us Highr slf-fficacy Improvd rfusal skills Lowr intntion to us substancs in th futur Girls in th intrvntion rportd fwr htrosxual sxual acts Fmals in th intrvntion rportd: Highr lvls of mothr-daughtr communication Mor matrnal monitoring Exprincing mor ruls against substanc us from parnts Improvd conflict managmnt skills Lss favourabl normativ blifs about alcohol Highr slf-fficacy Improvd rfusal skills Lowr intntion to us alcohol in th futur 9
Study Purpos Mthod Participants Substanc Us Outcoms Schink, Fang, & Col (2009b) Schink, Fang, & Col (2009c) Tsta, Hoffman, Linginston, & Turrisi (2010) ffctivnss of a gndr-spcific, computr-mdiatd substanc abus prvntion intrvntion. ffctivnss of a gndr-spcific, computr-mdiatd substanc abus prvntion intrvntion. ffctivnss of a Parnt Basd Intrvntion (PBI) handbook to rduc th incidnc of alcohol us & alcohol-involvd sxual victimization among first-yar collg studnts. Fmals ags 11-13 & thir mothrs n=916 Fmals ags 11-13 & thir mothrs n=591 Fmal collg frshmn & thir mothrs n=978 Fmals in th intrvntion had fwr occasions of alcohol us, marijuana us, prscription drug misus & inhalant us ovr th past 30 days at two-yar follow up. Fmals in th intrvntion wr lss likly to us alcohol, marijuana, & prscription drugs in th last 30 days compard to thos in th control condition at on yar follow up. No diffrncs at 4- or 8-month follow ups btwn intrvntion & control groups in frquncy of havy pisodic drinking or numbr of wknd drinks. An indirct ffct was found whr th PBI incrasd gnral communication & gnral communication rsultd in lowr havy pisodic drinking. Th ffct of communication on numbr of wknd drinks was not rportd. Othr Rlvant Outcoms Fmals in th intrvntion rportd: Highr lvls of mothr-daughtr closnss Enhancd communication Incrasd matrnal monitoring Incrasd coping skills, Rducd normativ blifs about substanc us, Enhancd drug rfusal skills Exprincing mor ruls against substanc us Improvd rfusal skills Lowr intntion to us substancs in th futur Fmals in th intrvntion rportd: Highr lvls of mothr-daughtr closnss Enhancd communication Incrasd matrnal monitoring Incrasd coping skills Improvd body imag Lss dprssd mood Rducd normativ blifs about substanc us Enhancd drug rfusal skills Exprincing mor ruls against substanc us from thir parnts Improvd rfusal skills Lowr intntion to us substancs in th futur Fmals in th intrvntion rportd: Incras in gnral communication Lowr alcohol involvd sxual victimization incidnc (8% in intrvntion vrsus 12% control). 10 10
Fmal and Mal Participants Study Purpos Mthod Participants Substanc Us Outcoms Othr Rlvant Outcoms Brody, Chn, Kogan, Murry, & Brown (2010) Doumas, Turrisi, Ray, Esp, & Curtis-Schaffr (2013) Ichiyama, Fairli, Wood, Turrisi, Francis, Ray, & Stangr (2009) Mason, Kostrman, Haggrty, Hawkins, Rdmond, Spoth, Shin (2009) longtrm ffctivnss of th Strong African Amrican Familis program on youth alcohol us. ffctivnss of a PBI & a PBI with boostr sssion (PBI-B) in rducing drinking among first yar collg studnts. ffctivnss of a PBI handbook in rducing alcohol us among first-yar collg studnts. longtrm ffctivnss of a family-focusd substanc us prvntion intrvntion. African Amrican youth ag 11 (proportion of mal & fmal participation not spcifid) & thir primary cargivrs (mothr / fathr participation not spcifid). n=667 Collg frshmn (69.5% fmal) & parnts of collg frshmn (mothr / fathr participation not spcifid) n=443 Collg frshmn (proportion of mal & fmal participation not spcifid) & thir parnts (76.5% mothrs in th PBI & 77.1% in th control group) n=724 6 th grad studnts (52% fmal) & thir parnts (mothr / fathr participation not spcifid) n=429 Gndr diffrncs in program ffcts wr not found. Youth in th control group drank about twic as oftn (1.41 tims) as youth in th intrvntion (.68 tims) at th 65 month follow up. Gndr diffrncs in program ffcts wr not found. No significant diffrncs btwn PBI & controls at 4- month follow up. Th PBI-B rsultd in a mor than 65% rduction in drinking frquncy compard to controls & about 60% rduction in pak drinking quantity. Th diffrncs btwn PBI-B & control for bing drinking was not significant. At 8-month follow up, th intrvntion was ffctiv in rducing th numbr of drinks consumd pr wk for womn, but mn in th intrvntion consumd mor drinks pr wk than mn in th control. Th intrvntion had no significant impact on rducing havy pisodic drinking or alcoholrlatd problms for mn or womn. Follow-up at ag 22 found womn in th intrvntion group had significantly lowr rats of alcohol us disordrs compard to controls. Thr wr no significant ffcts for mn. No othr outcoms wr masurd. No othr outcoms wr masurd. No othr outcoms wr masurd. Girls in th intrvntion rportd highr prosocial skills & bonds. No additional outcoms for mals. Disclaimr: Rapid rviws ar producd using acclratd and stramlind systmatic rviw mthods, usually in rspons to a qustion or topic idntifid by th fild. Th information in this rapid rviw is a summary of availabl vidnc basd on a limitd litratur sarch. CCSA dos not warrant th currncy, accuracy or compltnss of this rapid rviw and dnis any rprsntation, implid or xprssd, concrning th fficacy, appropriatnss or suitability of any intrvntion or tratmnt discussd in it. ISBN 978-1-77178-218-0 Canadian Cntr on Substanc Abus 2014 Th Canadian Cntr on Substanc Abus changs livs by bringing popl and knowldg togthr to rduc th harm of alcohol and othr drugs on socity. W partnr with public, privat and non-govrnmntal organizations to improv th halth and safty of Canadians. CCSA activitis and products ar mad possibl through a financial contribution from Halth Canada. Th viws of CCSA do not ncssarily rprsnt th viws of th Govrnmnt of Canada. 11 11