Research report no.10 2004
Parenting influences on adolescent alcohol use
by Louise Hayes, Diana Smart, John W. Toumbourou and Ann Sanson
Executive Summary
This report is the fulfilment of a contract between the Australian Government Department of Health and Ageing and the Australian Institute of Family Studies. Alcohol use is widespread among Australian adolescents, and high risk use is a serious and growing problem. A range of individual, family, peer, school and community characteristics have been shown to be risk factors for the development of adolescent alcohol use and misuse. This report aims to review and synthesise the research and interventions concerning the impact of parenting factors on adolescent alcohol use.
To set the scene for the review, the patterns of alcohol use among Australian adolescents are described. Alcohol use is shown to be common among young Australians, with many experimenting with alcohol by the age of 14-15 years. Once adolescents begin drinking, most become regular consumers of alcohol. The evidence suggests that delaying the onset of drinking reduces long-term consumption levels into adulthood. A large proportion of Australian adolescents obtain alcohol from their parents.
Two theoretical models are used to provide a framework in which to understand the research on parenting influences on adolescent alcohol use. First, the Social Interactional model is used to describe the impact of parenting behaviours and skills such as monitoring, parental behaviour management, parent-adolescent relationship quality, and parenting norms, goals and values. Second, the Social Development model is used to understand the importance of broader environmental influences on adolescents and parents. Thus, parental consumption of alcohol, parental alcohol abuse and dependence, family structure, and family socio-economic background, the role of differing cultural norms and legal systems, and findings regarding Indigenous adolescents are examined.
Parental monitoring
Parental monitoring has been defined as parental awareness of the child's activities, and communication to the child that the parent is concerned about, and aware of, the child's activities (Dishion and McMahon 1998). The review demonstrates that adolescents who are poorly monitored begin alcohol consumption at an earlier age, tend to drink more, and are more likely to develop problematic drinking patterns. Australian parents are likely to be unaware of, or to underestimate, their adolescent's alcohol consumption and are more concerned about illicit drug use than alcohol use. Australian parents may feel pressured to accept alcohol use by adolescents as "normal". It appears that for many parents, knowing the "right age" to permit their adolescents to consume alcohol, or indeed if they should permit alcohol consumption at all, is a critical question that they feel ill equipped to answer.
Parental behaviour management
Parental behaviour management encompasses positive practices such as the use of incentives, positive reinforcement, setting limits for appropriate behaviour, providing consequences for misbehaviour, and negotiating boundaries and rules for appropriate behaviour, as well as less effective strategies such harsh and punitive discipline, high conflict, and lax, inconsistent or over-permissive approaches. Family standards and rules, rewards for good behaviour, and well developed negotiation skills were associated with lower initiation of alcohol use in early adolescence, and lower rates of alcohol abuse and dependence in early adulthood. Harsh discipline and high conflict were associated with higher rates of alcohol use. When parents were openly permissive toward adolescent alcohol use, adolescents tended to drink more.
Relationship quality
Parent-adolescent relationship quality underpins all aspects of parenting, and is the product of an ongoing interplay between parents and adolescents. For example, without a warm relationship, adolescents are more likely to resist monitoring, while authoritative parenting may contribute to and enhance strong parent-adolescent relationships. Warm and supportive parent-adolescent relationships were associated with lower levels of adolescent alcohol use, as well as lower rates of problematic use and misuse.
Parental norms
Parenting norms, values and goals reflect parents' belief systems, attitudes and conceptions concerning adolescent behaviour. Parental norms, attitudes, and beliefs with regard to adolescent alcohol use have an important influence on adolescent alcohol consumption. When parents show disapproval, their adolescents are less likely to drink, and conversely, when parents are tolerant or permissive, their adolescents are likely to drink more. Australian parents and adolescents differ in their perceptions of the appropriate age that adolescents should be permitted to consume alcohol, with studies showing that many parents believe 17 years is the appropriate age for adolescents to begin consuming alcohol at home, and many adolescents tending to believe this should occur earlier, at approximately 16 years.
Parental, family and broader environmental influences
Parents' own use of alcohol was found to increase the likelihood that adolescents would also consume alcohol. Biological links between parental alcohol dependence and adolescent alcohol use were evident. Adolescents from intact families were found to less often engage in heavy alcohol use, while adolescents from sole parent families were more often involved in heavy drinking.
In addition, social laws and norms were shown to exert a considerable influence on adolescent alcohol consumption, and parental attitudes toward adolescent alcohol use. International research has found that changes to policy or laws can influence adolescent consumption patterns.
Parenting and peer influences compared
The effect of peers was shown to mediate the influence of parenting on adolescents' alcohol use. Peer effects become particularly powerful when parent-adolescent relationships are of poorer quality. The influence of peers is thought to occur through peer modelling, peer pressure, or association with alcohol using peers. However, direct connections between parental monitoring and adolescent alcohol use remained after peer influences were taken into account.
Gaps and deficiencies in the research
There are a number of gaps and deficiencies in the literature. First, the research coverage is incomplete, Second, there is very little Australian data on this issue, and international research was relied upon to a large extent. When considering parent-adolescent relationships and parenting behaviours in general, international research reveals similar findings to Australian research. However, there are important social and cultural differences which may influence parenting behaviours and attitudes concerning adolescent alcohol use in differing countries. Third, much of the research has sought the views of adolescents only, and the findings need to be confirmed by parents and/or other informants. Fourth, while there was considerable consistency in the findings, on one important area - parental supply of alcohol - inconsistent findings were found. Finally, the possibility of gender differences has often been overlooked.
Promising intervention programs
Using randomised controlled trials as the "gold standard" for intervention programs, a small number of interventions conducted in other countries, which targeted changing parenting behaviours and parental education, have shown long term reductions in adolescent alcohol use. Several promising Australian interventions are currently underway, including PACE, Teen Triple P, and ABCD. However, Australian research using rigorous methodology and thorough evaluations is needed.
Synthesis of findings
To summarise the research reviewed, a conceptual model of parenting influences on adolescent alcohol use was developed. This model suggested that parental monitoring, parental norms for adolescent use, and parental behaviour management skills all have direct links to adolescent alcohol use. Parent-adolescent relationship quality has an overall effect on these parenting behaviours, as well as direct connections to alcohol use. Parental characteristics have an indirect effect on alcohol use, by way of their influence on the parenting behaviours described above. The parental characteristics depicted as having an indirect effect include parental alcohol use or abuse, as well as family factors, and broader cultural norms regarding alcohol use.
Conclusions
The evidence demonstrates that there is now a reasonable understanding of the processes by which parents influence adolescent alcohol use. In addition, there is also intervention evidence suggesting these principles can be translated into effective programs. Several specific conclusions are presented which highlight strategies to assist parents to more effectively guide adolescents towards responsible alcohol use.
Conclusion 1
Parents should be provided with information concerning the advantages of delaying the age at which young people begin using alcohol.
Based on the available research, there appear to be clear advantages in delaying the age at which young people begin using alcohol. Among these are the reduced likelihood of risky alcohol use and abuse in adulthood, averting the adverse impacts of alcohol on the developing adolescent body and brain, and avoiding the immediate risks to health and wellbeing conveyed by "normal" patterns of adolescent alcohol use (which are often at risky or high risk levels). It is unclear that parents are aware of this evidence, and efforts to publicise this information would appear highly worthwhile.
Conclusion 2
Parents should be provided with educative guidelines on the influence of parental attitudes and norms on adolescent alcohol use, as well as guidance in managing the social pressure they feel to allow their adolescents to consume alcohol.
Parents report feeling adverse social pressure and not having the confidence to assist children and adolescents to delay the initiation of alcohol use. However, the research evidence suggests that parental attitudes and norms can play a considerable role. Parents should be made aware of this research, and may also benefit from more information about the extent of high risk alcohol consumption among Australian adolescents, and distinctions between safe and risky levels of alcohol use. Additionally, knowledge that many Australian parents believe late adolescence to be the appropriate age at which adolescents should be introduced to alcohol might assist parents to resist pressure to permit their adolescent to commence use at an earlier age.
Conclusion 3
Once adolescents have commenced alcohol use, parents should be provided with educative guidelines which enable them to guide their adolescents in responsible alcohol use.
Once adolescents have commenced drinking, enhanced monitoring appears to be a key component of efforts to minimise harmful alcohol use. However, this first requires attention to the parent-adolescent relationship, and simply advising parents to ask more questions may have a detrimental effect in some families. Once a high quality parent-child relationship is in place, parents can then be educated on the importance of clear and consistent rules regarding alcohol use, setting age appropriate limits, and maintaining open communication about adolescents' use of free time.
Conclusion 4
Parent education and family intervention programs should be supported in Australia to assist parents to gain skills for encouraging their adolescents to delay initiation to alcohol use and to adopt less harmful patterns of use. Intervention and prevention programs should receive best practice evaluations.
Interventions that have shown promise in the North American context should be adapted, implemented and evaluated in Australia. Existing Australian interventions should also be evaluated for their potential to encourage a delayed age of first alcohol use and more moderate patterns of use. Prior to encouraging wider dissemination, evaluation funding should be provided to enable gold standard evaluations including randomised control trial designs and long-term follow-up evaluations. These best practice programs should promote the parent-adolescent relationship as a key starting point. As was demonstrated by this review, this aspect of parenting underpins the other elements shown to be important, for example monitoring and positive behavioural management techniques.
Conclusion 5
Given that broader social norms exert a considerable influence on adolescent alcohol use, strategies to reduce favourable cultural attitudes towards under-age alcohol consumption will be needed to support parental efforts.
An extensive educative effort, aimed at changing favourable societal attitudes towards adolescent alcohol use, appears necessary to assist parental efforts to delay adolescents' initiation of alcohol use and to guide responsible subsequent use. It will also be necessary to target broader adolescent attitudes regarding alcohol.
Conclusion 6
More Australian research is needed to promote understanding of the developmental processes and pathways to adolescent alcohol use. In particular, research on the development of adolescent alcohol use in Indigenous communities is seriously lacking.
At present, there is a critical lack of Australian data on the pathways to differing patterns of alcohol use, and the role that parents play. There is also a lack of Australian research evaluating promising intervention initiatives. Thus, the international research, and particularly the U.S. research, is relied upon to a large extent. Yet there are important differences, particularly relating to cultural norms and attitudes, which may dilute the transferability of the international research to the Australian context. In particular, there is almost no research on Indigenous communities on this issue. A greater investment in research in this area would appear to be vital.