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. 2025 Aug 27;86(5):834–841. doi: 10.15288/jsad.24-00463

Personalized Feedback in Parent-Based Interventions to Prevent or Reduce Adolescent Drinking

Mai-Ly N Steers a,,*, Sharon Lipperman-Kreda b, Kristina M Jackson c, Carolyn E Sartor c,,d, Tim Slade e, Tammy Chung c,,d
PMCID: PMC12581024  PMID: 40254562

Forty-one percent of U.S. 10th-grade and 62% of 12th-grade high school students report ever engaging in drinking (Miech et al., 2023). Furthermore, binge drinking comprises approximately 90% of all standard drinks consumed by adolescents (defined as 4+ drinks for females and 5+ drinks for males on the same occasion; Substance Abuse and Mental Health Services Administration, 2022).1 This pattern of drinking is concerning given that adolescent heavy alcohol use, particularly earlier on, is associated with a host of negative consequences (Gardner et al., 2024; Sjödin et al., 2024). These alcohol-related problems include, but are not limited to, increased susceptibility to experiencing interpersonal violence (Waterman et al., 2019) and elevated risk of developing cognitive (learning and memory) difficulties because of alcohol-related changes in the hippocampus during the peri-adolescent period (Pfefferbaum et al., 2018; Squeglia et al., 2015).

Most adolescents begin drinking in their homes or at family gatherings, pointing to the family context as a key target for intervention/prevention efforts (Islam et al., 2022; Jackson et al., 2015; Warner & White, 2003). Parents may contribute to the risk for adolescent drinking by providing their underage children with alcohol, a behavior often resulting from attitudinal (Friese et al., 2012; Jackson et al., 2012; Jones et al., 2016) and normative misperceptions (Earle & LaBrie, 2016; LaBrie et al., 2011, 2014). As such, the current article describes a conceptual model (Figure 1) to explain how three key parental misperceptions are formed, how they influence the parental provision of alcohol and family rules (or lack thereof) about their child's drinking, and how they contribute to children's perceived drinking norms, alcohol expectancies, drinking intentions, and subsequent alcohol use.

Figure 1.

Figure 1.

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Conceptual model to explain how parental misperceptions related to their children's drinking and how personalized feedback (PF) might influence these beliefs. SES = socioeconomic status.

We propose personalized feedback as a component of a multi-stage prevention/intervention effort that will enact downstream changes in alcohol use among at-risk adolescents by modifying parental misperceptions regarding parental alcohol provision to their children. Alcohol-related personalized feedback interventions provide individuals with feedback on incongruencies in personal drinking patterns (e.g., quantity) and perceptions of risk (e.g., negative consequences). A type of personalized feedback intervention known as personalized normative feedback (PNF) proffers information regarding discrepancies between perceived drinking norms (e.g., perceived peers' drinking or approval of drinking; Riper et al., 2009; Walters & Neighbors, 2005) and actual drinking.

An abundance of literature has found both personalized feedback interventions more broadly, and PNF as a standalone intervention, to be successful, low-cost methods for reducing problematic alcohol consumption among college students and general populations (Cadigan et al., 2015; Dotson et al., 2015; Miller et al., 2013; Powers et al., 2019; Pueyo-Garrigues et al., 2024; Riper et al., 2009; Saxton et al., 2021; Walters & Neighbors, 2005). However, we know of only two studies in which personalized feedback was used in parent-based interventions to target drinking reductions during students' first year of college (LaBrie et al., 2016; Napper et al., 2016). To our knowledge, no studies have explored parent-based personalized feedback as a way of curbing or preventing problematic drinking among younger adolescents—when parents might hold significant influence over their children's drinking. We intend to introduce the novel strategy of parent-based personalized feedback rather than to lay out details of an intervention or prevention approach. Instead, we hope to initiate discussion among key stakeholders (e.g., researchers, parents) on important considerations in using personalized feedback in prevention/intervention efforts with parents.

Overview of parental supply of alcohol to adolescents

Parental provision of alcohol to a minor (i.e., a person under the legal purchase age) is a relatively common behavior. A systematic review found that 11%–22% of U.S. minors indicated that their parents supplied them with alcohol (Van der Kruk et al., 2023). Similarly, in a recent survey, 47% of adolescent Australian secondary students who drank indicated that their parents provided them with alcohol (Scully et al., 2023). In addition, nearly one third of these students reported “definitely” having parental permission to drink (Scully et al., 2023). Two meta-analyses revealed that parental provision to their adolescent children was a significant predictor of early-onset non–parent-sanctioned alcohol use and eventual progression to problematic alcohol use relative to no parental supply of alcohol (Sharmin et al., 2017; Yap et al., 2017). Moreover, Yap and colleagues (2017) found that of 12 parental risk factors associated with adolescent alcohol use, parental supply had the largest effect sizes, explaining 4% of the variance in initiation of alcohol use and 7% in prospective alcohol use/abuse.

Key parental misperceptions or norms leading to supply of alcohol to their adolescents

  • (a) Parental misperceptions that sipping is harmless or not a form of consumption. A U.S.-based longitudinal study that examined children and adolescents across 7.5 years (e.g., 14 waves) found that 67% of children had sipped alcohol by age 12.5, and 96% had sipped alcohol by 18.5 years old (Donovan & Molina, 2013). Adolescent drinking frequently occurs in homes (Jongenelis et al., 2018; Vidourek et al., 2018), with parents as a common source of alcohol (Dresler et al., 2017). Initiation often begins with parents providing their children as young as 6 with first sips during family gatherings (Jackson et al., 2015). Similarly, a U.S. study found that more than one third of 8-year-olds and nearly half of 10-year-olds indicated that they had already experienced their first sip, mostly during family contexts (Donovan & Molina, 2008).

    Moreover, parents' views on adolescent drinking may be skewed, particularly regarding first sips. Some parents who allow their children to sip believe that sipping is harmless (Jackson et al., 2012) or may not even classify sips as alcohol provision (Jones et al., 2016). However, these parental misperceptions are problematic, given evidence that early sipping is predictive of early progression to other drinking milestones (e.g., a full drink) and engagement in heavy drinking later in life (Colder et al., 2018; Donovan & Molina, 2011; Jackson et al., 2015). Even after controlling for psychosocial factors commonly associated with early drinking, a U.S.-based longitudinal study found that youth who began sipping in the 6th grade were at increased odds for getting drunk and engaging in heavy episodic drinking ([HED]; i.e., three or more drinks on one occasion) by the 9th grade (Jackson et al., 2015) compared with non-sippers.

  • (b) Parental misperceptions regarding the protective effect of early alcohol exposure. Another reason parents may allow their children to sip at a young age is that they may hold the misguided perception that parental provision of first sips could mitigate the adverse effects of alcohol (Friese et al., 2012; Jackson et al., 2012). One study suggested that mothers may provide their children with first sips because they believe that if they are too restrictive, their children might desire alcohol more and perceive alcohol as the “forbidden fruit” (Van der Vorst et al., 2010). Greater endorsement of these errant assumptions (i.e., pro-sipping beliefs) was positively associated with the provision of first sips. A U.S.-based study of mother–child dyads, in which nearly 33% of 3rd graders reported having sipped alcohol, revealed that for every one unit increase in the mother's pro-sipping beliefs (e.g., children who sip alcohol at home will be more likely to resist peer pressure), children were 38% more likely to sip (Jackson et al., 2012).

    Parents may believe that by supplying alcohol in the home and hosting parties with alcohol for their children, they are providing a safe and controlled drinking environment (Friese et al., 2012; Kaynak et al., 2014). Although parents may perceive that they are teaching their children to drink responsibly, research has indicated otherwise. A study found that female college students whose mothers allowed them to drink at family meals or with friends when living at home were significantly more likely to engage in frequent HED in their first semester of college relative to those whose parents did not permit them to drink (Livingston et al., 2010). Furthermore, a longitudinal study explored the effects of adult-supervised drinking events during adolescence (i.e., ages 13–16) on drinking behaviors in young adulthood (i.e., 25–31) in the United States and Australia. Across both countries, a greater number of adult-supervised drinking events in adolescence (2002–2003) was significantly associated with a greater likelihood of adult alcohol misuse (higher Alcohol Use Disorders Identification Test [AUDIT] scores in adulthood; 2014, 2018, 2020) and greater likelihood of driving under the influence in the past year in adulthood and being a passenger in a car with an impaired driver in adulthood (Bailey et al., 2024).

  • (c) Parental perceived norms about parental provision of alcohol to adolescents. A parent's decision to supply their minor children with alcohol may be understood in part through social norms theory (Perkins, 2002; Perkins & Berkowitz, 1986), which posits that perceived norms of a given behavior often determine whether people engage in that behavior prospectively. Two psychological principles may come into play. First, parents might fall prey to the false consensus effect (Ross et al., 1977), in which they believe most parents would agree that it is appropriate and common for parents of adolescents to provide their children with alcohol or that it is inevitable that their children will begin drinking (Friese et al., 2012; Gilligan & Kypri, 2012; Mitchell et al., 2022). These parents might have engaged in early alcohol use themselves and/or may currently drink alcohol regularly, which contributes to their beliefs that such behavior is normative.

Conversely, parents who have not supplied their children with alcohol may engage in pluralistic ignorance, whereby they misjudge that they are the only ones not doing it (O'Gorman, 1986). A U.S.-based qualitative study indicated that some parents permitted their children to engage in unplanned drinking after being pressured to do so by other adults (Friese et al., 2012). Gilligan and colleagues (2012) indicated that misperceptions about the permissiveness of other parents may be driving parents' own behaviors to introduce and supply alcohol. Parents may compare themselves to perceived proximal reference groups (Festinger, 1954; Latané, 1981), such as other parents who are already providing alcohol to their children, who then socially influence them to supply their children with alcohol.

A study that examined nearly 500 Canadian and Australian parents of adolescents between 12 and 18 years old found that parents' positive attitudes toward supplying alcohol and their perceived proximal descriptive norms (i.e., beliefs that their friends were likely to supply their own adolescents with alcohol) and distal descriptive norms (i.e., beliefs that parents in general are likely to supply adolescents with alcohol) were directly associated with a greater likelihood of supplying alcohol to their children in the home (Gilligan et al., 2014). Parents' positive attitudes were found to be directly associated with a greater likelihood of unsupervised parental supply (e.g., parental provision of alcohol where the parent was not present). Furthermore, proximal descriptive and injunctive norms (i.e., perceptions that parents' friends approve of supplying alcohol to their adolescents) mediated the relationship between parents' attitudes and their unsupervised supply of alcohol (Gilligan et al., 2014). Several U.S.-based studies have also investigated perceived distal injunctive norms and found that parents significantly overestimated other parents' (whose children were attending the same university) approval of students' alcohol-related behaviors (e.g., drinking shots; Earle & LaBrie, 2016; LaBrie et al., 2011, 2014). Moreover, these misperceived distal injunctive norms were positively associated with parents' attitudes regarding their children's drinking, which, in turn, were positively and significantly associated with their children's attitudes toward drinking (LaBrie et al., 2011).

Conceptual model regarding parental perceptions in relation to their children's drinking

Drawing from the above literature, we created a conceptual model that elucidates how parental misperceptions (e.g., the provision of alcohol is benign, protective, and/or normative) relate to their children's initiation of drinking behaviors. According to our model, social-contextual factors (e.g., cultural drinking norms) inform these key parental attitudes and perceived parental norms surrounding the supply of alcohol, which in turn lead to parental supply of alcohol as well as ill-defined family rules surrounding drinking, and ultimately inform their children's perceptions of parental norms (e.g., their parents drink regularly and/or approve of alcohol use; Figure 1).

Parents may underestimate their children's drinking (Bylund et al., 2005; Guilamo-Ramos et al., 2006; LaBrie et al., 2014; Livingston et al., 2010) because they think they are teaching their children to drink responsibly. Thus, they may not feel it is necessary to explicitly discuss or enforce rules around alcohol. However, research has found that children tend to overestimate their parents' approval of their drinking (Hummer et al., 2013; Livingston et al., 2010; Van der Vorst et al., 2006). Thus, even if parents only allow sips of alcohol, adolescents may interpret their parent's supply of alcohol as parental permissiveness/approval (Aiken et al., 2020; Colder et al., 2018; Donovan & Molina, 2008).

Moreover, perceived parental approval of drinking is associated with adolescents' prospective drinking. A study found that U.S. children's perceptions of their parents' approval of sipping/tasting and parents' self-reported approval of children sipping/tasting were both predictive of their likelihood of initiation into sipping/tasting in nonreligious contexts before age 12 (Donovan & Molina, 2014). Children's perceived parental approval may also lead to an acceleration in adolescents reaching later alcohol milestones. A U.K.-based, longitudinal study that followed parents and children from infancy to 14 found that by 14, children whose parents condoned their drinking were more than twice as likely to transition within a year from drinking initiation to 5+ drinks/occasion and were also at twice the risk for engaging in frequent heavy drinking (Staff & Maggs, 2020).

In addition, parents may be modeling alcohol use by drinking in front of their child (e.g., a descriptive norm), which serves to reinforce to their adolescent children that drinking is a desirable behavior (e.g., an injunctive norm). A study that examined U.S. mothers and their 3rd-grade children found that children who were asked to bring alcohol to their parents and perceived their mother to be approving of alcohol use were more likely to sip than their abstinent peers (Jackson et al., 2013). Furthermore, a systematic review (Rossow et al., 2016) and meta-analysis (Yap et al., 2017) concluded that parental modeling of drinking was a primary factor in whether adolescent children will engage in earlyonset drinking and/or progress to later problematic drinking. Hence, the combination of parental provision of alcohol, ill-defined parental rules, and children's perceived parental norms may cause children to form positive drinking norms, positive alcohol expectancies, and drinking intentions, which subsequently lead to children's initiation of alcohol use and drinking behaviors.

Research has demonstrated that parent-based interventions may exert larger mean effect sizes on antecedents to adolescent consumption than heavy alcohol use (i.e., binge drinking; Bo et al., 2018). Thus, it may be important to modify parental factors that precede adolescent drinking (e.g., parental attitudes surrounding the supply of alcohol) with parent-based interventions. These perceptions may not only be driving parents' engagement in alcohol provision but also the transmission of these misperceptions to other parents, which may lead to cyclical increases in parental supply within their social network (Gilligan et al., 2012).

Personalized feedback parent-based interventions in relation to alcohol provision to adolescents

The existing literature demonstrates that some well-intentioned parents may be inadvertently contributing to their adolescent children's drinking behaviors, leaving the child susceptible to severe short- and possibly long-term alcohol-related consequences. For the most part, research has found parent-based interventions to successfully enact positive behavioral change among adolescents (Champion et al., 2022; Widman et al., 2019). A systematic review and meta-analysis found that parent-based interventions effectively promoted physical activity, reduced screen time, and improved certain eating habits among adolescents (Champion et al., 2022). These interventions may have been successful because they helped to redefine the family norms surrounding these behaviors to initiate change.

Conversely, systematic reviews of parent-based alcohol interventions have found some positive or mixed effects in reducing adolescent drinking, perhaps because parental communication and rules about drinking are either inconsistently enforced or are misguided (e.g., humorously discussing the harms of drinking; Bo et al., 2018; Hurley et al., 2019; Kuntsche & Kuntsche, 2016). There have been three main methods used by alcohol- or substance-use parent-based interventions. These methods include providing broad parenting strategies (e.g., tips to improve communication between adolescents and parents), informing parents about alcohol or substance use–specific approaches (e.g., ways to monitor adolescent alcohol or substance use), or a combination of both (Bo et al., 2018; Kuntsche & Kuntsche, 2016). Only one review that explored parent-based interventions (e.g., investigating behavioral change techniques such as educating parents/youth or increasing parental skills) targeting multiple risk behaviors (e.g., alcohol consumption, smoking tobacco, diet, exercise, sleep) found them to be largely ineffective in reducing adolescent drinking (Champion et al., 2022).

These inconsistent results for parent-based drinking interventions may be because previous efforts have aimed to directly modify or amplify desired parental behaviors (e.g., consistent rule setting); however, few prevention or intervention efforts have targeted changing parental attitudes and norms. Personalized feedback could be used to draw attention to parents' misperceptions regarding parental provision of alcohol to their minor children (e.g., misperceptions that providing a sip or hosting a party might be protective) by juxtaposing their beliefs with empirically based evidence and statistics highlighting the short- and long-term consequences of their decisions to provide alcohol to their minor children (Cadigan et al., 2015; Walters & Neighbors, 2005). Similarly, a type of personalized feedback known as personalized normative feedback (PNF) could be used to correct parents' normative misperceptions surrounding other parents' provision of alcohol; it operates similarly in that it would present perceived descriptive or injunctive norms regarding parental supply side-by-side with actual parental supply behavior (e.g., the prevalence of parental supply in a particular school obtained through anonymous surveys) or actual parental approval of supply (Dotson et al., 2015; Pueyo-Garrigues et al., 2024; Saxton et al., 2021).

Challenging parental permissiveness regarding supplying alcohol to adolescents through personalized feedback may be instrumental in improving efficacy in parent-based interventions (Booth et al., 2023). The feedback prompts parents to self-reflect about their role in their children's alcohol use, which, in turn, may elicit cognitive reappraisal of their attitudes and behaviors (Champion et al., 2022). Moreover, providing parents with personalized feedback and actionable strategies may serve as the impetus for parents to engage in desirable behaviors, such as enforcing clear rules and expectations surrounding alcohol (Gilligan et al., 2012). In sum, personalized feedback has the potential to shift overall family dynamics and norms surrounding alcohol.

Because of its ability to motivate individuals to action, personalized feedback interventions and PNF as a standalone intervention are some of the most robust intervention paradigms for targeting the reduction of drinking, particularly among at-risk college students (Cadigan et al., 2015; Dotson et al., 2015; Miller et al., 2013; Powers et al., 2019; Pueyo-Garrigues et al., 2024; Riper et al., 2009; Saxton et al., 2021; Walters & Neighbors, 2005). Moreover, they are brief and often computer-based (Carey et al., 2012; Dotson et al., 2015; Pueyo-Garrigues et al., 2024), providing the flexibility for the intervention to be delivered in person in real time or online, which might foster more compliance among parents than intensive in-person interventions. Parents are generally more easily engaged in interventions that are short and amenable to their schedules (Champion et al., 2022).

Thus far, only a handful of studies have used PNF in parent-based interventions; these interventions have focused on parents whose children were matriculating into or were in their first year of college (Earle & LaBrie, 2016; LaBrie et al., 2014, 2016; Napper et al., 2016). Although they provided other types of PNF feedback (e.g., parents' perceptions of other university parents' approval of their student drinking, perceptions of own students' drinking, prevalence of students' drinking at the university), these studies mainly focused on changing parents' perceptions regarding how frequently other university parents communicated with their children about alcohol as a way to motivate parents to speak to their children about alcohol since parents often underestimated how much other parents communicated with their children about alcohol (Earle & LaBrie, 2016; LaBrie et al., 2014, 2016; Napper et al., 2016). Two of the four studies only assessed parents. They found evidence that the PNF feedback was effective in changing parents' normative perceptions post-intervention and increased intentions to talk to their children about alcohol (Earle & LaBrie, 2016; LaBrie et al., 2014). One study delivered the PNF intervention in real time during college orientation and found that among those who drank, students whose parents received PNF were less likely to engage in HED and reported no alcohol-related negative consequences 1 month into college versus students who drank whose parents were in the control group. However, another study found that PNF did not predict changes in students' self-reported drinking relative to the control at 1 month versus 6 months after matriculation (e.g., no significant Time × Condition interaction; Napper et al., 2016). The authors noted that students whose parents were in the PNF condition and discussed alcohol with them were two times more likely to convey tolerant attitudes versus reprobation towards drinking. In contrast, the opposite was true for the control. This highlights that in addition to changing parents' attitudes and norms, it is crucial to enhance parents' skills for clearly communicating rules and expectations around alcohol (Napper et al., 2016).

Because parents often play an integral role in preventing heavy drinking, particularly when their children are younger and living at home, a personalized feedback parent-based prevention/intervention effort targeting parents' misperceptions holds tremendous promise. Of note, supporting research highlighting these three parental misperceptions has also been found in countries outside of the United States (e.g., Australia, Canada, and the United Kingdom), which suggests the pervasiveness of these parental attitudes and norms regarding adolescent alcohol use; additionally, this indicates personalized feedback parent-based prevention/intervention efforts may have utility in countries where cultural drinking norms play similar roles in contributing to adolescent alcohol misuse.

Conclusions

This review outlines the rationale and importance of incorporating a novel personalized feedback component into parent-based preventions/interventions to reduce adolescent problematic drinking and invites the co-development of parent-based personalized feedback efforts with key stakeholders to maximize its effectiveness. Given that a parent-based personalized feedback approach targeting parental attitudes and norms is a new direction, we offer a series of ideas and questions we encourage the field to consider:

  1. First, parents might benefit from personalized feedback in domains other than the areas outlined. Personalized feedback parent-based preventions/interventions might also include correcting misperceived norms regarding general parenting rules and expectations and the level of parental monitoring that is developmentally appropriate for parents of children from specific age groups.

  2. It is unclear what reference groups would be the basis for normative feedback. Should norms be derived from the beliefs, attitudes, and behaviors of parents from the child's school or another community, their own friends, or even the parents of their child's friends? Would parents relate to parental norms derived from nationwide surveys or feel that local or regionally derived norms better reflect their beliefs and experiences?

  3. What are the relevant social-contextual factors that might influence personalized feedback prevention/intervention efficiency (e.g., personalized feedback that incorporates parent's sex or gender identity or child's sex or gender identity; race, ethnicity, or religion; number of children in the household and their ages, etc.)? Given the power of close friends and peer influence on adolescent drinking, the combination of perceived peer approval and parental approval of drinking may reinforce or even accelerate adolescent heavy drinking trajectories over time (Brooks-Russell et al., 2014).

  4. Similar to another recent intervention targeting older youth (Byrnes et al., 2019), personalized feedback parent-based interventions might consider incorporating a component to educate parents on state-level or local social host policies; increasing parents' knowledge of the consequences of providing alcohol to minors might deter them from doing so.

  5. As demonstrated in a systematic review of parent-based programs targeting the reduction of alcohol use among adolescents (Hurley et al., 2019), parental engagement is instrumental in program efficacy. What factors and settings (e.g., school events, doctor's offices, places of worship) might foster greater parental engagement?

Footnotes

1

Calculated using past-30-day quantity and frequency of alcohol use and past-30-day frequency of binge drinking for youth ages 12–20.

Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Grant Numbers R00AA025394 and P60-AA006282 and the National Institute on Drug Abuse of the National Institutes of Health under Award Number R25DA054015. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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