Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-assisted Parenting Intervention (Preprint)

BACKGROUND Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment) – a technology-assisted parenting intervention informed by extensive formative research - as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. OBJECTIVE This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors, relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. METHODS Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART + TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multi-method follow-up assessments consisting of self-report parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6-, 12-, and 24-weeks post-discharge from residential. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. RESULTS The trial was funded August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021 with recruitment beginning in February 2022. CONCLUSIONS The proposed research has the potential to advance the field by: serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. CLINICALTRIAL clinicaltrials.gov/ awaiting release (internal Brown University identifier: 2006002748) adolescent, residential, technology-assisted, substance use, parent

“Wild Years”: Rock Music, Problem Behaviors and Mental Well-being in Adolescence and Young Adulthood

Adolescent preferences for non-mainstream types of rock music can be markers of adolescent problem behaviors, but no study has ever investigated whether this relationship continues into adulthood. In a six-wave study, 900 Dutch adolescents were followed from ages 12 to 21 (Mage T1 12.4, 51.1% girls), while reporting on depressive symptoms, mental well-being, aggression and drug use. A latent class growth analysis on their preferences for specific types of rock music revealed four fan groups. When these fan groups were compared to one another, in adolescence, the all-out rock fans displayed the highest peak in depressive symptoms and the lowest dip in well-being and the rock/metal fans reported the most aggression. And for both these groups, drug use increased at the onset of adulthood. Pop fans displayed a profile characterized by low depressive symptoms and aggression, and high in mental well-being. Finally, the popular rock fans held an in-between position between pop fans, on one side, and the all-out rock fans and rock/metal fans, on the other side. Thus, music preferences can be markers of problems, not only in adolescence but also in young adulthood. Still, music can enhance mood, helps to cope with problems, and peers in fan groups can provide support. This research focuses on the relationship between music and problem behaviors, specifically among members of the all-out rock fans and rock/metal fans, but many of these young people might have had more personal problems if they had not had their music and their fan-group peers.

The Relationship Between Internet Addiction and Problem Behaviors Amongst Hong Kong Adolescents: A Three-Year Longitudinal Study

Both Internet addiction and adolescent risk behaviors are worldwide public health concerns. Unfortunately, their relationship is grossly under-researched. Adopting a longitudinal research design, this study examined the longitudinal association between Internet addiction and problem behaviors among adolescents in Hong Kong and tested whether early Internet addiction predicted later adolescent problem behaviors. A total of 2,669 junior secondary school students completed three waves of questionnaires testing their Internet addiction behavior and other problem behaviors including drug use, self-harm, suicidal behaviors, delinquency behaviors, and compensated dating. Chi-square analysis showed that Internet addicted students had a high probability to display these problem behaviors at each wave. Logistic regression analyses suggest that early Internet addiction was a precursor of later problem behaviors among adolescents. The results shed light on the relationship between Internet addiction and adolescent problem behaviors, and provide reference for prevention and intervention of these problem behaviors.

The Impact of Religion on Family Functioning in Low-Income African American Families With Adolescents

The current study explores the association between religion and family functioning. Specifically, this study examined whether two aspects of religion, social religious support (from clergy and members of the congregation) and support from God (or spirituality), were related to frequency of household routines and parenting strategies as reported by both parents and adolescents, as well as adolescent problem behaviors. The sample consisted of 115 low-income African American mother-adolescent (age 14-18 years) dyads. Families were recruited as part of a larger study on the lives of low-income African American families with adolescents. Results indicated that higher levels of social religious support and spirituality were associated with increased levels of family routine as reported by caregivers. These results highlight the important roles relationships with God and other church members may play in supporting the lives of low-income African American parents and their children.

Ecological Influences on Chinese Adolescents’ Problem Behaviors: A Multilevel Analysis

This study investigated the effects of individuals, school, and familial protective and risk factors and their interactions on adolescent problem behaviors using a stratified random sample of 2,864 (51.5% female) students from 55 classrooms in 13 schools in Shanghai, China ( Mage = 15.52 years, SD = 1.62). Results from the multilevel analyses indicate that being male, having high parent–adolescent conflict, high independent self-construal, low conformity, low grade rank, and low classroom-level and individual-level school adjustment predicted problem behaviors. Adolescent independent self-construal also interacted with parental autonomy granting to predict vandalism. For adolescents with low or moderate levels of independent self-construal, autonomy granting predicted lower odds of vandalism, but for adolescents with high levels of independent self-construal, parental autonomy granting predicted higher odds of vandalism. The findings highlight the complex effects of parenting and independent/interdependent self-construals on adolescent problem behaviors in China.