Prevention and prediction of adolescent problem behavior

Background: The adolescent period is characterized by a huge leap in social, emotional, and cognitive development. For most people, it passes without major disruptions, but for a substantial number of adolescents, it does not. There is a range of social and psychological theories that aim to explain the development of problem behaviors, where some have a holistic approach and some focuses on individual features. Several strategies for preventing or decreasing problem behaviors have been developed, often by addressing identified risk factors that increase the likelihood of a negative development. Such prevention include for instance parent training programs, and a change in parenting skills has been shown to be a strong predictor for child problem behavior. Two parent training programs; ParentSteps (FöräldraStegen) and Comet for parents of adolescents aged 12-18 (ungdomsKomet) that address parents of adolescents with problem behaviors have been run since year 2004 within the regular preventive work of Swedish social services. Within this thesis, the two programs are evaluated for the first time. The aims of the three studies’ within the present thesis were to1) study the effectiveness of the two parent training programs that address parents of adolescents with at-risk behaviors with regard to the programs’ ability to decrease the adolescents’ parent- and self-rated antisocial behavior, delinquency, substance use, and psychosocial distress; 2) explore both self-rated and parent-rated short-term predictors of hazardous alcohol use (externalizing behavior, delinquency, internalizing behavior, psychosocial distress, perception of peers’ deviancy, perception of peers’ drinking) among alcohol using adolescents; 3) explore the ability of self-rated psychological risk factors to predict externalizing behavior or delinquency among female adolescents, and if perception of peers’ deviancy moderated any such effect. Methods: A naturalistic inclusion sample comprised parents and adolescents aged 12-18 years, who were assessed in a randomized controlled trial, at baseline and at a 6-month follow-up. Study 1 consisted of 243 parents and 237 adolescents, who were randomized to ParentSteps, Comet or to a wait-list control group. The parent group training was carried out in real-world settings within the regular preventive work of social services. Study 2 comprised 167 alcohol-using adolescents and their parents, and Study 3 comprised 112 female adolescents. Initially, prior to study inclusion, parents were briefly screened for eligibility with questions about their adolescent’s behaviors, and participation required informed and written consent from both parent and adolescent. Participants also had to live in on of the five collaborating municipalities in Stockholm county. Data collection was carried out between fall 2008 and spring 2010. Results: We found no significant effects from the programs over time with regard to reduction of parent- and adolescent-rated antisocial behaviors, delinquency, substance use or psychosocial distress. Of the tested predictors only perception of peers’ drinking had an effect on both females’ and males’ heavy episodic drinking and risk use of alcohol, and externalizing behaviors predicted females’ risk use. There were no significant differences in predictor slopes between females and males. Parent-rated externalizing behavior predicted males’ risk use. Among the psychological risk factors, cognitive problems emerged as a significant predictor for the females’ externalizing behaviors and delinquency. Perception of peers’ deviancy did not moderate the effect. Conclusion: With a focus on clinical applicability, it can be concluded that ParentSteps and Comet were not suitable for this population of at-risk adolescents. The included adolescents were found to have elevated, sometimes clinical, levels of several co-existing problem behaviors, suggesting that adolescents who together with their parent seek parent training should be thoroughly examined for co-existing problems so they can be assigned to proper intervention or treatment. Future research should explore both females’ and males’ ADHD symptoms as risk factors for externalizing behaviors, delinquency, illicit drug use, and hazardous alcohol use in longitudinal studies with longer follow-up periods than 6 months, preferably in larger sample

Alcohol prevention at sporting events: study protocol for a quasi-experimental control group study

Abstract Background Alcohol intoxication and overserving of alcohol at sporting events are of great concern, given the relationships between alcohol consumption, public disturbances, and violence. During recent years this matter has been on the agenda for Swedish policymakers, authorities and key stakeholders, with demands that actions be taken. There is promising potential for utilizing an environmental approach to alcohol prevention as a strategy to reduce the level of alcohol intoxication among spectators at sporting events. Examples of prevention strategies may be community mobilization, Responsible Beverage Service training, policy work, and improved controls and sanctions. This paper describes the design of a quasi-experimental control group study to examine the effects of a multi-component community-based alcohol intervention at matches in the Swedish Premier Football League. Methods A baseline assessment was conducted during 2015 and at least two follow-up assessments will be conducted in 2016 and 2017. The two largest cities in Sweden are included in the study, with Stockholm as the intervention area and Gothenburg as the control area. The setting is Licensed Premises (LP) inside and outside Swedish football arenas, in addition to arena entrances. Spectators are randomly selected and invited to participate in the study by providing a breath alcohol sample as a proxy for Blood Alcohol Concentration (BAC). Actors are hired and trained by an expert panel to act out a standardized scene of severe pseudo-intoxication. Four types of cross-sectional data are generated: (i) BAC levels among ≥ 4 200 spectators, frequency of alcohol service to pseudo-intoxicated patrons attempting to purchase alcohol at LP (ii) outside the arenas (≥200 attempts) and (iii) inside the arenas (≥ 200 attempts), and (iv) frequency of security staff interventions towards pseudo-intoxicated patrons attempting to enter the arenas (≥ 200 attempts). Discussion There is an urgent need nationally and internationally to reduce alcohol-related problems at sporting events, and it is essential to test prevention strategies to reduce intoxication levels among spectators. This project makes an important contribution not only to the research community, but also to enabling public health officials, decision-makers, authorities, the general public, and the sports community, to implement appropriate evidence-based strategies

Gender-specific predictors of at-risk adolescents’ hazardous alcohol use—a cohort study

Abstract Background Previous research has found strong associations between adolescents’ hazardous alcohol use and their perception of peer behavior, as well as own spending money and a range of antisocial behaviors. However, there is insufficient evidence of gender-specific predictors among adolescents with elevated antisocial behavior and alcohol use to design effective selective interventions. The aims of this study were to test short-term predictors of Heavy Episodic Drinking (HED) and risk-use of alcohol among 12-18-year-old females and males with elevated externalizing and delinquent behavior, and alcohol use. Methods Eighty-five females, 77 males, and their parents, originally recruited for a parent intervention, were assessed at baseline and 6 months later with several validated instruments measuring externalizing and internalizing behavior, alcohol use, psychosocial distress, and delinquency. Results The perception of peer drinking significantly predicted both genders’ HED and risk-use, and also externalizing behavior predicted female risk-use. Rule-breaking behavior and social problems predicted both HED and risk-use among males, while rule-breaking predicted female HED and social problems predicted female risk-use. The parents’ ratings of externalizing behavior predicted only their sons’ risk-use. Lastly, no differences in prediction strength were found to be statistically significant differences between genders. Conclusions Females and males shared several predictors of hazardous alcohol use, and perception of peer drinking emerged as a strong predictor. This suggests that interventions may target both genders’ hazardous use of alcohol, and should address peer-resisting skills

Alcohol intoxication at Swedish football matches: A study using biological sampling to assess blood alcohol concentration levels among spectators.

Alcohol use and alcohol-related problems, including accidents, vandalism and violence, at sporting events are of increased concern in Sweden and other countries. The relationship between alcohol use and violence has been established and can be explained by the level of intoxication. Given the occurrence of alcohol use and alcohol-related problems at sporting events, research has assessed intoxication levels measured through biological sampling among spectators. This cross-sectional study aimed to assess the level of alcohol intoxication among spectators at football matches in the Swedish Premier Football League. Spectators were randomly selected and invited to participate in the study. Alcohol intoxication was measured with a breath analyser for Blood Alcohol Concentration levels, and data on gender, age, and recent alcohol use were gathered through a face-to-face interview. Blood Alcohol Concentration samples from 4420 spectators were collected. Almost half (46.8%) had a positive Blood Alcohol Concentration level, with a mean value of 0.063%, while 8.9% had a Blood Alcohol Concentration level ≥ 0.1%, with a mean value of 0.135%. Factors that predicted a higher Blood Alcohol Concentration level included male gender (p = 0.005), lower age (p < 0.001), attending a local derby (p < 0.001), alcohol use prior to having entered the arena (p < 0.001), attending a weekend match (p < 0.001), and being a spectator at supporter sections (p < 0.001). About half of all spectators at football matches in the Swedish Premier Football League drink alcohol in conjunction with the match. Approximately one tenth have a high level of alcohol intoxication

Mean Blood Alcohol Concentration (BAC) levels in the overall sample and subsamples at each arena.

<p>Means (<i>M</i>), standard deviations (<i>SD</i>), frequencies, ranges and <i>p</i>-values for comparative statistics shown.</p

Prediction of mean Blood Alcohol Concentration (BAC) level by linear multiple regression.

<p>Unstandardized beta coefficients (B), standard errors (SE), standardized beta coefficients (β), <i>p-</i>values and 95% confidence intervals (CI) shown (<i>n</i> = 4352).</p

Participant characteristics of the overall sample and subsamples at each arena.

<p>Means (<i>M</i>), standard deviations (<i>SD</i>), frequencies, ranges and <i>p</i>-values for comparative statistics shown.</p