Research on Prevention in Adolescents

R. Turrisi – Current Research Preventing Drunk Driving in Adolescents

Drunk driving is a major social problem. Estimates suggest that
between 30% and 50% of all fatal crashes are alcohol related. These
estimates translate into approximately 15,000 to 25,000 deaths annually
involving the irresponsible use of alcohol. The financial costs
associated with alcohol related crashes in the United States have been
estimated in terms of billions of dollars annually in lost wages, medical
expenses, property damage, legal fees, and insurance costs. Of course,
there is no way of estimating the emotional costs to individuals who have
lost members of their families and friends in alcohol related
accidents.

It is well known that younger drivers are over-represented in driving
fatalities due to drunk driving. My research focuses on changing older
adolescent behavior with respect to drunk driving. Adolescents represent
an important target group for several reasons. First, there is evidence
indicating that the leading cause of death among young Americans is
alcohol-related traffic accidents. Second, adolescents represent new
drivers who are just embarking on a life behind the wheel of an
automobile. The establishment of safe practices and orientations
vis-a-vis drunk driving at this time is critical. Although it is the case
that high school aged adolescents are under the legal age for alcohol
consumption, estimates suggest that between 70% to 90% of all senior high
school students experiment with alcohol. Thus, the reduction of drunk
driving among this demographic group seems important.

My previous NIAAA funded research (with colleagues from the University
at Albany, SUNY) has identified empirically the kinds of information that
needs to be conveyed to teenagers in order to reduce drunk driving. Such
information potentially could be conveyed to the teen by schools, peers
(SADD), the media, parents . A review of school based treatments of drunk
driving indicates that such treatments are limited in scope. Education
about drunk driving typically occurs in mandatory health classes in which
there is tremendous competition between topics (e.g., nutrition, alcohol
consumption, drugs, sex) in terms of class coverage and class time. Drunk
driving is typically addressed only superficially and in the context of
more general lectures on alcohol. It seems unlikely that schools will
devote large amounts of class time to a specialized topic such as drunk
driving. Without special efforts on the part of schools to incorporate
the kinds of educational materials that our previous research suggests is
most effective, it is evident that other sources of information need to
be developed.

One of the lines research I have been conducting will develop
educational materials for parents of adolescents. It will teach parents
how to develop good communication patterns with their teenager. It will
teach them how to initiate communication with their adolescent about
drunk driving, even when the family history is one of minimal
parent-adolescent communication. The materials will teach parents what
information will be most effective in convincing their teenager not to
drive drunk and will teach parents the most effective ways of presenting
this information to their teen. We will then examine the impact of this
intervention on adolescent drunk driving behavior. There are several
advantages to this approach. First, it will have the general effect of
improving communication patterns between parents and teens. Second, it
will permit parents to make value judgments about the kinds of
information that their teen should be given. For example, most research
on determinants of drunk driving focuses on the act of drunk driving per
se (e.g., the increased risk of getting in a serious accident). Our
research suggests that an important set of variables that impinge on
drunk driving is how an individual construes alternative courses of
action to driving drunk as well. When faced with a situation where he or
she has consumed too much alcohol, an individual can drive drunk or
pursue some other course of action (e.g., call a taxi, stay overnight,
ask a friend for a ride home). If none of these alternatives appear
viable or desirable, the individual is more likely to drive drunk,
everything else being equal. It is possible to educate adolescents about
what alternatives to driving drunk might exist and how to most
effectively pursue these alternatives. However, our discussions with
school administrators has indicated a reluctance to incorporate such
information into school based programs. The primary objection is that by
providing effective alternatives, one might be unwittingly encouraging
adolescents to drink alcohol. This viewpoint holds that the risk to one’s
life by driving drunk is a deterrent to drinking alcohol and that by
removing this deterrent, it is more likely that the teenager will drink
alcohol, which is both illegal and undesirable. Administrators fear the
controversy that might ensue from parents of students if such an approach
is taken. With a parent based education approach, parents can be
appraised of the potential relevance of alternatives to driving drunk and
then make their own decisions about whether to address this issue and the
kinds of alternatives that are acceptable to them.

The traditional stereotype among many lay persons and social
scientists alike is that adolescence is a time when parents lose their
influence on their children and that adolescent behavior is primarily a
function of peer influences. This viewpoint is being increasingly
challenged across a wide range of research domains. In addition to my
research program on drunk driving, my colleagues at the University at
Albany, Drs. James Jaccard and Patricia Dittus, have been actively
studying parental influences on teenagers in the context of premarital
sex and unintended pregnancy. Their research efforts have clearly shown
that characterizations of minimal parental influence are based on data
that are conceptually weak and methodologically suspect and that when
approached from more compelling theoretical frameworks, parental
influence on teen behavior can be substantial.

There is a growing body of social science literature on parent
education programs in general and their effectiveness in influencing
parental behavior. Much of this research is summarized in the recent
Handbook on Parent Education. The forms of parent based interventions are
varied, including school based programs, parenting conferences, written
brochures on effective parenting, video-based programs of parenting, and
parent teacher interactions, to name a few. Programs have been aimed at
influencing such diverse child behaviors as school performance, sexual
behavior, health behaviors, and physical development, to name only a few.
It is evident from this literature that parenting education programs can
be effective, but that they are not always so. I hope to contribute to
this general body of knowledge by developing an approach to designing
parent education programs aimed at changing specific adolescent problem
behaviors. To the extent that we can show our approach produces tangible
results in an area such as drunk driving, then this will encourage
researchers to use the approach in other research domains to determine if
it can form the skeleton for programs in other domains.

Only a few published accounts of the use of parent education program
as a means of influencing drunk driving behavior in adolescence have been
published in the scientific literature. Atkin reports a parent
intervention program that led to increased concern on the part of parents
for teen drunk driving and which increased communication between parents
and teens about this topic. However, the program did not show evidence of
effects on teen drunk driving behavior. McPherson developed a program to
increase support networks for parents to discuss alcohol issues with
their teens and to convey information about drunk driving and alcohol
consumption. The results showed that parents tended to become more
assertive about talking to teens and were more likely to monitor their
teen’s behavior with regard to drunk driving. These studies suggest that
parent education programs can be effective in altering parental behavior,
but there is little evidence that these effects filter through to the
drunk driving behavior of adolescents. The focusof my research is
distinct from previous parenting interventions in several ways. First, I
have conducted extensive empirical research on our target adolescents
focusing on cognitive, attitudinal, and personality variables that are
likely to influence teen drunk driving. I have applied (and modified) a
well developed theoretical framework based on over 15 years of decision
theoretic work by Jaccard to the empirical analyses. This research has
provided a list of variables that, if changed, are likely to impact on
teen drunk driving behavior. It is these variables that will be the focus
parental education efforts. Thus, the content of the research has a
strong theoretical and empirical base that is directly tied to
determinants of drunk driving of the adolescent target population. By
contrast, past intervention efforts have not had this kind of empirical
and theoretical base. Second, the educational materials will carefully
take into account issues of adolescent development in the context of
social, emotional, cognitive, moral, and physical development. Parents
will be educated about adolescent development in each of these domains
and given specific behavioral strategies for educating their teens about
drunk driving in the context of basic adolescent development issues.

Although there are only a few studies focused on parent interventions
and adolescent drunk driving, there are numerous studies that have used
correlational paradigms to study the relationship between parental
behaviors and teen drunk driving. For example, Beck observed that parents
are more likely to attribute deviant behavior to friends of their
children rather than their children themselves and that parents generally
are not aware of the full extent of their teens’ drinking habits and
practices. Most parents admitted that they never talk to other parents
about teen drinking and driving. Beck and Lockhart reviewed factors that
can influence parent effectiveness in attempts to control adolescent
drunk driving and present a theoretical framework for analyzing parental
effectiveness. According to these authors, barriers that diminish the
impact of parents include perceptions of low levels of empowerment and
control, disaffiliation and lack of skills to communicate with their
children, low levels of awareness, a lack of social support from other
parents, and an increasing psychological distance from their children as
they grow older. Beck and Lockhart review research from other research
domains that suggest the importance of these variables. Beck, Summons,
and Matthews report the results of focus groups with parents aimed at
understanding issues related to adolescent alcohol consumption and drunk
driving. They found that parents tend to be unaware of the extent of teen
drinking, that many parents feel powerless to affect their teen’s
drinking behavior, that many parents feel a sense of isolation from other
parents dealing with similar problems, and that parents are uncommitted
to devoting large amounts of time to the problem in the context of formal
workshops. DiBlaso applied social learning theory to the analysis of
adolescent drunk driving behavior, examining the relationship between
peer variables, parental variables, and self reports of drunk driving. He
found support for a statistically significant association between
numerous parental variables (e.g., disapproval of drunk driving and
alcohol consumption, parental discipline strategies) and teen behavior.
Jessor analyzed risky driving behavior in adolescents and found that such
behavior was significantly related to parent-friend compatibility and the
number of parental models for health reinforcing behavior. Klepp and
Perry applied Problem Behavior Theory to the analysis of adolescent drunk
driving and observed little utility of parent based variables in
predicting drunk driving behavior. These studies, as well as others not
reviewed here, generally point to the potential relevance of parents in
influencing adolescent drunk driving behavior. Although there are some
negative findings and evidence to suggest that parent communications with
their teens are not frequent enough or satisfactory in quality, there
does seem to be sufficient evidence to indicate that what a parent does
and the type of relationship that a parent has with his or her teen can
and does impact on drunk driving behavior.

As noted, parent intervention programs are relatively rare in the
drunk driving domain. However, there is a much more substantial
literature on the impact of parents and parent-based interventions
focused on adolescent alcohol consumption, adolescent drug use, and
adolescent sexual behavior. There is also a substantial body of
literature on family systems approaches to the analysis of these
behaviors. Space constraints do not permit a review of these literatures
here, although overall, they affirm the promise of parent based education
efforts.

In sum, there exists sufficient empirical data both in the area of
drunk driving and related areas of adolescent problem behaviors to
suggest that parents can play an important role in influencing drunk
driving behavior. Based on data that I have collected, I believe that
parental impact will be even greater if parent-teen communication can be
encouraged and directed at the appropriate target variables identified by
our empirical and theoretical analyses. The proposed research is
significant in that it will be an important addition to the almost
non-existent literature on parent interventions aimed at reducing
adolescent drunk driving. It has the features of using a strong
theoretical base, a strong empirical base that has already been collected
and evaluated on the target populations, and it will present information
taking into consideration developmental theory on adolescence.

Last Revised: 10/10/95

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