Gender moderation and social developmental mediation of the effect of a family-focused substance use preventive intervention on young adult alcohol abuse
Introduction
Although declining, the rate of alcohol use among adolescents in the United States remains high (Johnston, O'Malley, Bachman, & Schulenberg, 2005). A high rate of alcohol use persists into early adulthood (Naimi et al., 2003), and alcohol abuse peaks during this developmental period (Grant et al., 2004, Guo et al., 2001). Alcohol abuse, which refers to a maladaptive pattern of drinking that results in health consequences and social problems, is a major public health concern (Grant et al., 2004). Preventing such consequences and problems by reducing risk and enhancing protection can help avoid the costs of alcohol abuse among adults (Spoth, Guyll, & Day, 2002).
Of the many risk and protective factors associated with alcohol use and abuse among youths, psychosocial factors within the family are particularly important (Barnes et al., 1995, Brook et al., 1992, Guo et al., 2001, Mason and Windle, 2001). For example, in a study of children followed from age 10 to age 21, Guo et al. (2001) found that parental monitoring, clear family rules, and parental rewards for good behavior in adolescence predicted lower risk for alcohol abuse/dependence in early adulthood. Thus, family-focused interventions that improve parenting and family interactions, and reduce teen alcohol use, may inhibit alcohol abuse among target participants as young adults.
This paper reports findings from a randomized controlled trial of Preparing for the Drug Free Years (PDFY, currently called Guiding Good Choices), a program for parents of children aged 8–14 years. The program's design was guided by the social development model (SDM, Catalano and Hawkins, 1996, Hawkins and Weis, 1985), which draws from social control theory in positing that a key protective factor against substance use is bonding to prosocial others, especially family members. Based on social learning and differential association theories, the SDM specifies the mechanisms through which bonds develop. Bonding is hypothesized to be determined by the levels of opportunities provided to the child for involvement in the family and actual prosocial involvement, the child's skills for involvement with family members, and the discipline received from parents. The model also hypothesizes that external constraints, such as monitoring, influence bonding and behavior.
Accordingly, PDFY (Hawkins & Catalano, 1988) emphasizes parenting and parent–child interactional skills for: creating opportunities for involvement and interaction in the family (e.g., in family meetings); establishing clear family rules, monitoring the behavior of children, and disciplining children; teaching children skills to resist peer influences to use drugs; and expressing positive feelings and developing bonding while reducing anger and conflict.
This paper reports young adult data from the long-term Project Family prevention trial (Spoth & Redmond, 2002), which has followed target children throughout adolescence, from age 11 through age 18, and into adulthood, at age 22. A series of prior PDFY analyses, focused primarily on the adolescent years, has demonstrated improved parenting and parent–child interactional skills (Kosterman et al., 2001, Kosterman et al., 1997, Spoth et al., 1998). PDFY also has been shown to reduce alcohol (Park et al., 2000; Spoth, Redmond, & Shin, 2001), marijuana (Spoth et al., 2001), and polysubstance use (Mason, Kosterman, Hawkins, Haggerty, & Spoth, 2003) during adolescence, with the strongest and most consistent substance-related intervention effects occurring for alcohol involvement among teens. Next steps in this long-term trial have been to examine young adult outcomes.
Another paper, currently in press, reports intervention main effects across a range of problematic substance use outcomes in early adulthood (drunkenness, alcohol-related problems, cigarette use, illicit drug use, polysubstance use), along with indirect effects via adolescent growth trajectories of substance initiation (Spoth, Trudeau, Guyll, Shin, & Redmond, in press). In addition, an earlier supplemental report examined prescription drug misuse among late adolescents and young adults, using data from this prevention trial and a separate one (Spoth, Trudeau, Shin, & Redmond, 2008). These two papers did not consider clinical diagnostic outcomes, theoretically specified mediators, or moderators. Here, previous and ongoing work is extended by testing hypothesized social developmental mediators of the long-term effect of PDFY, implemented at age 11, on the diagnostic assessment of alcohol abuse disorder among participants as young adults, at age 22. In general, and particularly with respect to the alcohol outcomes in the main effects paper, measures were selected to capture public health impact of young adult substance use, rather than clinical or diagnostic outcomes. The public health oriented alcohol measures and the alcohol abuse diagnostic measure correlate only modestly, indicating that while they are related, they by no means tap identical constructs.
Research that considers how distal intervention effects are achieved in long-term prevention trials is needed, but few direct tests of mediation have been conducted (Ennett et al., 2001, MacKinnon et al., 1991, Orlando et al., 2005), and it can be difficult to demonstrate indirect effects of an intervention over an extended period of time (Shrout & Bolger, 2002). Indeed, existing prevention studies sometimes have revealed relatively weak support for hypothesized intervention mechanisms (e.g., Ennett et al., 2001). This study examined SDM constructs and a measure of intervention-targeted family management as possible mediators of the PDFY effect on alcohol abuse. We expected that increased prosocial opportunities, involvement, skills, rewards, bonding, and family management at posttest (age 12) would mediate the effect of PDFY on alcohol abuse at age 22. We examined changes in these processes at posttest, immediately after the intervention, because this corresponds to early adolescence, during which our family-focused substance use intervention was expected to have its most direct and strongest impact.
The possible moderating influence of gender also was explored. This was not an a priori hypothesis of the prevention trial, therefore prior project analyses have not examined gender moderation of intervention effects. However, less is known about alcohol abuse among women than men (National Center on Addiction and Substance Abuse, 2006). Although the prevalence of alcohol abuse is lower among young women than young men (Grant et al., 2004), many health-related consequences of alcohol abuse are more severe for females than males (Nolen-Hoeksema, 2004). Some studies have reported that psychosocial risk and protective factors have stronger effects on alcohol abuse for females than males (Guo et al., 2001, Yeh et al., 2006). For example, Guo et al. (2001) found that family opportunities at age 10 had a stronger negative effect on a measure of alcohol abuse and dependence at age 21 for young women compared to young men. Although additional potential moderators deserve systematic attention, an emerging literature highlights gender moderation as particularly promising, suggesting that psychosocial preventive interventions may have a greater impact for females than males. Drawing on the strengths of our gender-balanced sample, the current analyses focus on testing possible gender differences in the effects of PDFY.
Section snippets
Sample
Participants were families of sixth graders enrolled in 33 rural schools in 19 counties throughout Iowa. Selection criteria for the schools included school lunch program eligibility (15% or more of district families eligible for free or reduced cost lunches) and community size (populations less than 8500). Blocked on the proportion of lower income students and school size, 11 schools each were randomly assigned to one of three conditions: a minimal-contact control condition, the PDFY condition,
Alcohol abuse disorder prevalence
Sixteen percent and 21% of PDFY group participants and control group participants, respectively, met criteria for alcohol abuse disorder in the past year. This overall difference was in the expected direction, but was not statistically significant, χ2 (1; n = 313) = .85, p = .36. Alcohol abuse was more common among men (27%) than women (11%), χ2 (1; n = 313) = 12.53, p < .01. The rate of alcohol abuse for PDFY group men (29%) was slightly higher but not significantly different from the rate for control
Discussion
PDFY had a long-term effect on young adult alcohol abuse disorder that was moderated by gender. Young women who participated in PDFY with their families in early adolescence reported a lower rate of alcohol abuse in early adulthood compared to their control group counterparts. Although men are more likely to abuse alcohol than women, the rate of alcohol abuse among young women is not trivial (Grant et al., 2004), and many adverse health-related consequences of alcohol abuse are more severe for
Acknowledgment
This research was supported by the National Institute on Alcohol Abuse and Alcoholism (part of the U.S. National Institutes of Health) Grant #9 R01 AA14702-13. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the funding agency.
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- 1
An earlier version of this paper was presented in May 2006 at the annual meeting of the Society for Prevention Research in San Antonio Texas. A portion of the work on this manuscript was completed while the first author was at the University of Washington.
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