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. Author manuscript; available in PMC: 2021 Aug 1.
Published in final edited form as: Addict Behav. 2020 Mar 16;107:106398. doi: 10.1016/j.addbeh.2020.106398

Examining the Associations Between Alcohol-Related Parental Communication, Alcohol Use, and Protective Behavioral Strategy Use Among Young Adults

Dana M Litt 1, Tracey A Garcia 2, Ashley Lowery 1, Cassidy LoParco 1, Annalynn M Galvin 1, Mary E Larimer 3, Melissa A Lewis 1
PMCID: PMC7186136  NIHMSID: NIHMS1580543  PMID: 32234610

Abstract

Underage alcohol use is a public health concern as it remains prevalent and problematic. Protective behavioral strategies (PBS) may prevent or reduce alcohol-related consequences, yet daily-level findings show they instead might be associated with increased drinking and consequences. While parents are a possible source of influence to their child’s decision making, it is unclear whether parental communication about alcohol affects drinking outcomes, with mixed findings noted in the literature. Furthermore, little research focuses on understanding how parental communication may impact the use of PBS. This study assessed whether alcohol specific parental communication would be associated with reduced drinking and increased use of PBS. Data from baseline and 3-month follow up were evaluated from a control group of a larger randomized controlled trial on 18- to 20-year-olds in the U.S. (N=269). Outcomes included drinks per week, peak drinks per occasion, negative consequences and use of PBS. Using negative binomial regression modeling, controlling for age, sex, and whether participants lived with parents, findings revealed that parental communication was not associated with drinks per week, peak drinks per occasion, or negative consequences reported 3 months later. However, it was positively associated with limiting/stopping drinking PBS, manner of drinking PBS, and serious harm reduction PBS reported 3 months later. Results suggest that parental communication about alcohol may be more effective in increasing the use of protective behavioral strategies rather than reduction of drinking. Research is needed to determine why parental communication may influence the use of PBS and how we can strengthen the quality or focus of communication to ultimately increase the impact on risk behaviors.

The prevalence of young adult alcohol use continues to be a public health concern with 79.7% of 18–25 year olds reporting having used alcohol in their lifetime, 55.1% using alcohol in the last month, and 38.4% reporting past month heavy episodic drinking (HED; Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). However, young adults are not homogenous in their drinking, with differences observed between those who are underage drinkers (i.e., younger than 21) versus those who can legally drink in the United States. Specifically, research indicates that underage individuals who engage in alcohol use have more frequent heavy drinking occasions than older individuals, but older individuals have more total drinks consumed per heavy drinking occasion (Esser, Clayton, Demissie, Kanny, & Brewer, 2017; Kanny, Naimi, Liu, Lu, & Brewer, 2018). Although trends indicate that there is a decline in underage alcohol use (National Institute on Drug Abuse, 2017), it still remains the most commonly used substance by adolescents and young adults (SAMHSA, 2019) and is associated with an array of negative harms (Centers for Disease Control and Prevention [CDC], 2014; SAMHSA, 2019).

Additionally, excessive alcohol use is the third leading cause of preventable death with 88,000 total deaths and 4,300 deaths among underage youth each year (Centers for Disease Control and Prevention [CDC], 2014). Not only does excessive drinking contribute to preventable deaths, but it also has societal costs. In 2010, the United States incurred $249 billion in economic costs associated with alcohol; $24 billion dollars were related to underage drinking and $191 billion related to heavy episodic drinking (CDC, 2014; Sacks, Gonzales, Bouchery, Tomedi, & Brewer, 2015). Accordingly, identifying protective factors that may ameliorate drinking-related consequences may help inform the development and refinement of effective alcohol prevention programs.

Parental Communication

Although parental influences on alcohol use are strong for those individuals who are younger (i.e. children and adolescents; Miller-Day, 2002; Miller-Day & Kam, 2010), there is a robust body of literature that indicates that parental influence still plays an important role in young adults. Specifically, parents are considered to be a salient influence on decision making in their children’s lives into young adulthood and the college years (e.g., Boyle & Boekeloo, 2009; Donaldson, Handren, & Crano, 2016; Madkour et al., 2017; Napper et al., 2014; Turrisi, Abar, Mallet, & Jaccard, 2010), even in light of research showing the large impact that peers have on adolescent and young adult drinking (D’Amico & McCarthy, 2006; Kelly et. al, 2012; Neighbors, Lee, Lewis, Fossos, & Larimer, 2007). However, a recent review shows that modifiable parental factors, including communication, only account for up to 7% of adolescent alcohol initiation and that findings are somewhat inconclusive for parental communication’s impact on various levels of alcohol use (Yap et al., 2017). In spite of these mixed findings, parent-based interventions are increasingly common in college-aged populations, indicating the utility of considering parents as important sources of alcohol-related communication in young adults (Napper, Hummer, Lac & LaBrie, 2014; Small, Morgan, Abar, & Maggs, 2011; Turrisi, Abar, Mallet & Jaccard, 2010).

Generally, research has categorized parental communication about alcohol into several different content categories, including warnings about the dangers of alcohol and communication that primarily focuses on health, safety, and legal consequences of use (Brody et al. 2005; Miller-Day & Dodd, 2004; Miller-Day, 2008). Although there are different ways in which parental communication about alcohol use can be defined, in line with previous literature (Miller-Day, 2006; Yap et al., 2017), we define parental communication about alcohol use as the frequency and/or quality of parent–child discussions about alcohol, including negative consequences of alcohol misuse, parents’ personal experiences of alcohol use, and suggestions about responsible drinking.

There have been relatively inconsistent findings regarding the impact of parental communication on reducing adolescent and young adult alcohol consumption. Some research has indicated that alcohol-specific parental communication is effective at reducing or preventing alcohol use and negative consequences among adolescent and young adult populations (Napper, Hummer, Lac & LaBrie, 2014; Small, Morgan, Abar, & Maggs, 2011; Turrisi, Abar, Mallet & Jaccard, 2010). Conversely, other studies have found that alcohol-specific communication is associated with higher frequency of use, misuse and related consequences (Chaplin et al. 2014; Friere, 2008; Van der Vorst, 2010). Possible explanations for the variation in the findings may be related to the content or focus of alcohol-specific communications (i.e. permissiveness, drinking consequences, parents’ alcohol rules) (Boyle & Boekeloo, 2009; Menegatos et al., 2016; Miller-Day, 2008) as well as issues with what type of alcohol behavior is being examined, whether it be initiation, escalation, or varying levels of misuse (see Yap et al., 2017). Finally, studies may not take into account the possible bidirectional relations between parent communication and alcohol use whereby greater parent communication may be a response to already elevated drinking among young adults. Thus, additional research examining parental communication related to alcohol use is needed in order to address gaps in the current knowledge base related to associations with varying levels of alcohol use as well as other possible alcohol-related outcomes. Given that one of the primary aims of alcohol-related parental communication is to reduce negative consequences associated with drinking (Brody et al. 2005; Miller-Day & Dodd, 2004; Miller-Day, 2008), it is important to determine whether this same type of communication is associated with specific alcohol-related strategies individuals can use to lessen the risk of negative consequences.

Protective Behavioral Strategies (PBS).

One way to prevent or reduce alcohol-related negative consequences is to promote the use of protective behavioral strategies (PBS). PBS are behaviors that individuals can engage in either before, during, or after drinking in order to limit negative alcohol-related consequences and/or reduce alcohol use (Pearson, 2013). Three types of PBS have been examined, including strategies for limiting or stopping drinking (e.g., drink water while drinking alcohol, stop drinking at a predetermined time), manner of drinking (e.g., avoid drinking games, drink slowly rather than gulp or chug), and serious harm reduction (e.g., use a designated driver; make sure that you go home with a friend) (Martens et al., 2005). Cross-sectional and longitudinal studies have shown that greater use of PBS is associated with less alcohol use and fewer alcohol-related consequences among college students (for a review, see Pearson, 2013). Increases in PBS use are not, however, always associated with reductions in alcohol use. Several daily-level studies that evaluated PBS, drinking, and consequences for specific drinking occasions found that use of limiting/stopping and serious harm reduction strategies were actually associated with greater drinking and consequences (Lewis et al., 2012, 2015; Pearson et al., 2013). Research has shown that young adults rate PBS that do not limit the use of alcohol as more preferable than those PBS that limit alcohol use. Further, young adults may prefer to use serious harm reduction PBS on heavier drinking days, thus it may be that the focus is not to reduce alcohol use, but rather negative consequences of drinking (Lewis et al., 2018).Despite these mixed findings, PBS remain a recommended component of college and young adult alcohol prevention programs and PBS are often incorporated into multi-component interventions (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2015; Turrisi et al., 2013) in the form of skills training.

PBS and parental communication.

Related to parental communication, we are aware of only one study that has explicitly looked at whether parental communication about alcohol impacts engagement in PBS use; the one study we are aware of primarily focused on PBS as part of larger parent-based interventions where parents received training on how to discuss PBS with their children. Specifically, Donovan, Wood, Frayjo, Black, and Surette (2012) delivered an online intervention over 4 weeks to both parents and their college-enrolled children aimed at improving communication about alcohol use and PBS. The college-aged participants were more likely to use PBS, specifically manner of drinking and limiting/stopping drinking, over the course of the study when compared to parents who only received an electronic newsletter (Donovan et al., 2012). Other than parental communication aimed specifically at PBS, it is unclear whether more general communication about alcohol use, and not specifically geared toward increasing PBS, may predict PBS use among adolescents and young adults. Although training parents to specifically discuss PBS with their teens is one way to encourage PBS use, it is important to determine whether the frequency of parental communication about alcohol more generally also leads to increased PBS use, as not all parents will have access to PBS-specific communication training. Therefore, based on the extant literature, we hypothesized that parental communication about alcohol at baseline would be negatively associated with drinking behavior (i.e. drinks per week, peak drinks per occasion, negative consequences) as well as positively associated with PBS use (manner of drinking, limiting/stopping, serious harm reduction) at 3-month follow-up.

Methods

Participants and Procedures

Participants for the present study included 269 young adults aged 18–20 who were assigned to a control group in a randomized controlled trial evaluating an intervention for alcohol-related risky sexual behavior. In the current study, we utilize data from the baseline and 3-month assessments, as a first step in this line of inquiry is to determine and document proximal associations between study variables. Data were collected between March 2015 and March 2018. Control participants at baseline were on average 19.15 years old (SD = 0.79) and were 56% female. Within the baseline control sample, participants self-identified as follows: 15.1% Hispanic/Latinx, 68.7% White, 12.3% Asian, 8.2% African American, 8.2% Other/More than one race, 2.2% American Indian/Alaska Native, and 0.4% Native Hawaiian/Pacific Islander. Education status at the time of the baseline assessment consisted of 78.1% attending a 4-year university, 10% not enrolled in any type of school, 9.9% attending a community college, 2.1% in high school, 0.4% attending a technical/vocational college, and 0.4% attending a graduate/professional school.

Participants for this study were recruited nationally using online recruiting (e.g., Facebook, Craigslist, Amazon Mechanical Turk), in-print advertisements, flyers, participant referrals, and in-person recruiting. Participants were asked to complete a brief, five-minute web-based screening survey to determine if they met inclusion criteria for the longitudinal study. Initial eligibility criteria included the following: reside in the U.S.; age 18–20; provide a birthdate consistent with their age; provide a phone number, first and last name, birth sex, gender, sexual desire, and valid email address; correctly answer check questions (i.e., select 2 for what is 4 minus 2, select the color blue from a list of colors); not be in a monogamous relationship, or be in a monogamous relationship for less than three months and be open to having a sexual relationship with someone other than a monogamous partner; have had sex in the past three months; and, have had an alcoholic drink at least twice a month on average over the past 3 months. A total of 17,899 participants completed the eligibility survey, with 2,690 (15%, which is in line with previous studies using similar populations and inclusion criteria) meeting eligibility criteria for the study and moving to the next step of the screening process. Additionally, to enhance the representativeness of the sample, participants were stratified by gender, education level, and other demographic variables. Participants who were in excess of a quota of one of the stratification groups, and thus would have yielded a less representative sample based on demographic information if included, were not invited to the baseline survey. Out of the 1,480 participants who met all inclusion criteria, 1,144 (77.3%) were invited to complete the baseline survey.

Upon receiving the invitation to the survey, participants were presented with a full information statement. Those who agreed to participate and indicated their consent were immediately routed to the online baseline assessment. Of the 1,144 participants invited to the baseline survey, 1,065 (93.1%) completed the survey and 269 (25.2%) were randomly assigned to the control group, from which the current data are drawn. Participants who completed the baseline and 3 month survey received $25 and $30 gift certificates, respectively. A Federal Certificate of Confidentiality was obtained to help ensure privacy of research participants. All study procedures were approved by the University’s Institutional Review Board, and no adverse events were reported.

Measures

Parental communication.

Parental communication about alcohol was assessed with 26-item modified measure (Turrisi, Wiersma & Hughes, 2000). Items had the stem “Within the past year, my mother/father/guardian talked with me about…” Responses for items were dichotomous with 1 (yes) and 0 (no). Example items include “The negative social experiences that could happen because of drinking” and “How people think they are sober when in fact they are not.” (α = .89)

Typical number of drinks per week.

The Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt, 1985) was used to assess number of typical drinks per week. Standard drinks were defined as 5 oz. of wine, 12 oz. of beer (10 oz. of microbrew), 8 oz. of malt liquor, Canadian beer or ice beer, 10 oz. of wine cooler, 1 cocktail with 1 oz of 100 proof liquor or 1 ¼ oz. of 80 proof liquor. Participants were asked to “Consider a typical week in the past month. How much alcohol, on average (measured in number of drinks), do you drink on each day of a typical week?” Weekly drinking was computed by summing the number of standard drinks for each day of the week.

Peak number of drinks.

The Quantity/Frequency assessment of alcohol use (Baer & Carney, 1993; Marlatt, Baer, & Larimer, 1995) measured participant’s peak number of drinks during the past month. Participants were asked to think about the occasion when they drank the most and to report how many drinks they had consumed on that occasion using a range from 0 – 25 or more.

Negative Consequences.

The Young Adult Alcohol Consequences Questionnaire (YAACQ; Read et al., 2006) was used to determine if any negative consequences were experienced while drinking. Participants were presented 48 items and were asked which, if any, consequences they had experienced in the past 30 days. Response options were 1 (yes) and 0 (no). A sum score was calculated to determine the total number of alcohol-related negative consequences.

Protective Behavioral Strategies Survey (PBSS).

The PBSS (Martens et al., 2005) is a 15-item measure that assesses strategies that have been shown to control alcohol use and related problems. Participants indicate how often they use each strategy within the past 3 months when drinking alcohol on a 5-point scale ranging from 1 (never) to 5 (always). This measure assesses three types of strategies, including limiting/stopping drinking (α = .74), manner of drinking (α = .73) and serious harm reduction (α = .77). Example items include “drank slowly rather than gulped or chugged” (manner of drinking); “alternated alcoholic and non-alcoholic drinks” (limiting/stopping); and “made sure that you went home with a friend” (serious harm reduction). Scores for the three subscales represent the mean of the items.

Covariates.

Age, birth sex, and whether or not participants lived with their parents were included in analyses as covariates. Baseline levels of behavior corresponding with the criterion variable of interest (i.e. baseline drinks per week included as a covariate for model examining drinks per week at 3-month follow-up; baseline peak drinks included as a covariate for model examining peak drinks at 3-month; baseline negative consequences and peak drinks included as covariates for model examining negative consequences at 3-month;) were also included in all analyses.

Data Analytic Plan

Descriptive statistics and correlations were examined for all variables of interest. Preliminary analyses revealed non-normal distributions for the alcohol outcomes (drinks per week, peak drinks per occasion, negative consequences). Because of the violation of normality assumption and the positive skew of the data, negative binomial regression was selected as the primary analysis strategy for these outcomes (Atkins, Baldwin, Zheng, Gallop, & Neighbors, 2013; Atkins & Gallop, 2007; Hilbe, 2011; Simons, Neal, & Gaher, 2006). Thus, we used the generalized linear modeling approach with the distribution specified as negative binomial (i.e. negative binomial regression) for these outcomes. Regression models for PBS subscales treated the outcome as a continuous variable with a normal distribution. Birth sex and age were included in all analyses as a covariate based on previous associations with alcohol consumption (Neighbors et al., 2007; O’Malley & Johnston, 2002). Whether or not parents and teens resided together was also included as a covariate. For all models, we also used previous behavior (i.e. behavior at baseline) as a covariate, given that many theoretical models of health behavior suggest controlling for past behavior in analyses (Fishbein & Ajzen, 1975; Gerrard et al., 2008).

Results

Correlations and Descriptive Information

Means, standard deviations (SDs), and correlations are presented in Table 1. On average, participants reported they had discussed a little fewer than half (M = 11.42, SD = 8.08) of the alcohol-related topics with their parents at baseline. The mean for total drinks per week at the 3-month follow-up was 12.21 (SD = 15.26), and the mean for peak drinks consumed on one occasion in the past month at 3-month follow-up was 8.01 (SD = 5.16) drinks. Participants also reported experiencing 7.24 (SD= 5.28) negative consequences at 3-month follow-up.

Table 1.

Correlations and Descriptive Information among the Predictors and Criterion Variables

Statistic/Measure Mean (SD) Range 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Baseline Age 19.15 (0.79) 18–20 -
2. Baseline Drinks Per Week 14.13 (11.51) 0–70 .13* -
3. Baseline Peak Drinks 9.42 (5.33) 0–25 .12 .70** -
4. Baseline Consequences 8.38 (4.94) 0–48 .05 .36** .38** -
5. Baseline Parent Communication 11.42 (8.08) 0–26 −.10 .02 .07 .15* -
6. Baseline MOD PBS 2.66 (0.76) 1–5 −.13* −.38** −.45** −.37** .10 -
7. Baseline LS PBS 2.71 (0.75) 1–5 −.19** −.16* −.20** −.26** .15* .47** -
8. Baseline SHR PBS 3.89 (0.92) 1–5 −.19** −.12* −.15* −.19** .13* .18** .33** -
9. 3-Month Drinks per Week 12.21 (15.26) 0–64 .06 .51** .38** .25** .03 −.28** −.15* −.18** -
10. 3-Month Peak Drinks 8.01 (5.16) 0–25 .10 .61** .68** .29** .11 −.35** −.21** −.14* .62** -
11. 3-Month Consequences 7.24 (5.28) 0–48 .01 .34** .34** .66** .12 −.27** −.18** −.21** .46** .50** -
12. 3-Month MOD PBS 2.76 (0.94) 1–5 −.11 −.20** −.24** −.12 .13* .41** .30** .06 −.03 −.26** −.17* -
13. 3-Month LS PBS 2.76 (0.91) 1–5 −.17* −.03 −.05 −.07 .15* .16* .50** .16* .09 −.12 −.01 0.68** -
14. 3-Month SHR PBS 3.85 (102) 1–5 −.13 −.01 −.04 −.02 .14* −.07 .10 .44** .08 .04 .02 0.36** .45**
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Note.

*

p < 0.05,

**

p < 0.01

MOD = Manner of Drinking, LS = Limiting/Stopping, SHR = Serious Harm Reduction, PBS = Protective Behavioral Strategies

Correlation analyses indicated that parental communication at baseline was not associated with drinks per week, peak drinks at baseline or 3-month follow-up. Parental communication at baseline was associated with negative consequences at baseline. Further, parental communication at baseline was not associated with manner of drinking PBS at baseline, but was associated with both limiting/stopping and serious harm reduction PBS at baseline. Results also indicated there was a positive association between baseline parental communication and all three types of PBS use (manner of drinking, limiting/stopping, serious harm reduction) at 3-month follow-up.

Parental Alcohol Communication

Drinks per week.

For the model examining drinks per week, the likelihood ratio for the full model was X2 (5) = 27.66, p < .01, which indicated that the overall model was significant. The LR test of overdispersion was significant (LR, X2 (5) = 245.44, p < .001). Results of the negative binomial regression indicated that only drinks per week at baseline was associated with greater drinks per week at 3-month follow-up, whereas age, male sex, living with parents, and parental communication were not associated with total drinks per week. See Table 2.

Table 2.

Negative Binomial Regression Results (Drinks per week, peak drink at 3-month follow-up)

Predictor B SE B z-value p-value Ratio (95% CI)
Criterion Variable: Drinks per Week (3-month)
Male sex 0.11 0.09 1.30 0.19 1.12 (0.95, 1.30)
Age −0.02 0.05 −0.04 0.67 0.98 (0.89, 1.08)
Living with Parents −0.07 0.09 −0.60 0.48 0.93 (0.78, 1.11)
Baseline Drinks per Week 0.08 0.09 9.51 <0.001 1.08 (1.07, 1.10)
Baseline Parent Communication −0.01 0.01 −0.47 0.64 0.99 (0.98, 1.01)
X2 (5) = 27.66, p < .01
Criterion Variable: Peak Drinks (3-month)
Male sex 0.31 0.06 5.91 <0.001 1.36 (1.23, 1.50)
Age −0.04 0.03 −1.25 0.21 0.96 (0.90, 1.02)
Living with Parents −0.12 0.06 −2.01 0.04 0.89 (0.78, 1.00)
Baseline Peak Drinks 0.04 0.01 6.38 <0.001 1.05 (1.02, 1.07)
Baseline Parent Communication 0.01 0.01 1.62 0.10 1.01 (0.99, 1.03)
X2 (5) = 15.30, p < .01
Criterion Variable: Negative Consequences(3-Month)
Male sex −0.03 0.06 −0.49 0.63 0.97 (0.86, 1.09)
Age −0.03 0.03 −0.84 0.40 0.97 (0.91, 1.04)
Living with Parents −0.05 0.06 −0.79 0.43 0.95 (0.84, 1.08)
Baseline Negative Consequences 0.09 0.01 14.07 <0.001 1.10 (1.08, 1.11)
Baseline Peak Drinks 0.05 0.01 6.86 <0.001 1.05 (1.04, 1.07)
Baseline Parent Communication 0.01 0.03 0.24 0.81 1.01 (0.99, 1.03)
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Note. n = 269, Ratio = negative binomial incidence rate ratios.

Sex coded 0 = female, 1 = male, living with parents coded 0 = no, 1 = yes

Peak drinks.

Similar to drinks per week, the overall model was significant with the likelihood ratio for the full model being X2 (5) = 15.30, p < .01. The LR test of overdispersion was significant (LR, X2 (6) = 173.12, p < .001). Results indicate that both male sex and baseline peak drinks were significantly associated with peak drinks at 3-month follow-up whereas age, living with parents, and baseline parent communication were not associated. See Table 2.

Negative Consequences.

The overall model was significant with the likelihood ratio for the full model being X2 (5) =14.79, p < .01). Further, the LR test of overdispersion was also significant (LR, X2 (6) = 230.15, p < .001). Results indicate that both baseline negative consequences and baseline peak drinks were associated with negative consequences at 3 months, whereas male sex, age, living with parents, and baseline levels of communication were not associated. See Table 2.

Manner of drinking PBS.

In line with our hypotheses, greater parental communication about alcohol at baseline was associated with greater use manner of drinking PBS at 3-month follow-up, such that higher levels of parental communication at baseline predicted higher levels of manner of drinking PBS use. In terms of important covariates, manner of drinking PBS use at baseline was positively associated with manner of drinking PBS at 3-month follow-up. Further, reporting fewer peak drinks at baseline was negatively associated with less manner of drinking PBS at 3-month follow-up. Neither male sex, age, nor living with parents at baseline were associated with manner of drinking PBS. See Table 3.

Table 3.

Regression Results for predictors of PBS Use at 3-Months

Predictor B SE B Beta t-value p-value
Criterion Variable: Manner of Drinking PBS (3-month)
Male sex −0.13 0.06 −0.00 −0.07 0.97
Age −0.02 0.04 −0.05 −0.05 0.96
Live with Parents at Baseline 0.06 0.07 0.03 0.75 0.45
Baseline Peak Drinks −0.03 0.01 −0.14 −4.16 <0.001
Baseline Manner of Drinking PBS 0.49 0.04 0.41 12.96 <0.001
Baseline Parent Communication 0.10 0.01 0.09 2.97 0.01
Criterion Variable: Limiting/Stopping PBS (3-month)
Male sex −0.04 0.07 −0.02 −0.66 0.51
Age −0.01 0.04 −0.01 −0.22 0.83
Live with Parents at Baseline −0.09 0.07 0.05 1.36 0.17
Baseline Peak Drinks −0.01 0.01 −0.01 −0.38 0.70
Baseline Limiting/Stopping PBS 0.59 0.04 0.52 14.37 <0.001
Baseline Parent Communication 0.01 0.01 0.09 2.45 0.01
Criterion Variable: Serious Harm Reduction PBS (3-month)
Male sex −0.25 0.07 −0.12 −3.25 0.001
Age −0.02 0.04 −0.02 −0.49 0.63
Live with Parents at Baseline 0.03 0.08 0.01 0.32 0.74
Baseline Peak Drinks 0.01 0.01 0.03 0.74 0.46
Baseline Serious Harm Reduction PBS 0.54 0.04 0.47 13.12 <0.001
Baseline Parent Communication 0.01 0.01 0.10 2.81 0.01
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Note. For all regression models, n = 269

Sex coded 0 = female, 1 = male; living with parents coded 0 = no, 1 = yes

Limiting/Stopping PBS.

Results indicated that several of the covariates (male sex, age, living with parents, and peak drinks at baseline) were not associated with limiting/stopping PBS at 3 months, whereas baseline levels of limiting/stopping PBS was associated with 3-month follow-up limiting/stopping PBS use. In terms of our main hypothesis, baseline levels of parental communication about alcohol was positively associated with limiting/stopping PBS at 3-month follow-up, such that higher levels of parental communication at baseline was associated with higher levels of limiting/stopping PBS at 3-month follow-up. See Table 3.

Serious harm reduction PBS.

Results indicated that of the covariates included in the model, being male was associated with less use of serious harm reduction PBS at 3-month follow-up. Higher serious harm reduction PBS use at baseline was associated with greater serious harm reduction PBS use at 3-month follow-up. Neither age, peak drinks, nor whether or not participants reported living with parents at baseline were associated with serious harm reduction PBS use at 3 months. However, in line with hypotheses, greater parental communication about alcohol at baseline was associated with greater use of serious harm reduction PBS at 3-month follow-up. See Table 3.

Discussion

As hypothesized, this study identified significant relationships between parental communication about alcohol and all three subtypes of PBS (manner of drinking, limiting/stopping, serious harm reduction) at 3-month follow-up. However, contrary to hypotheses, for the models predicting drinks per week, peak number of drinks, and negative consequences, parental communication was not related to drinking outcomes. Conversely, the models for each of the three PBS subgroups (manner of drinking, limiting/stopping, serious harm reduction) found that parental communication and baseline PBS use were positively associated with PBS use at 3-month follow-up. Importantly, results indicate that parental communication predicts PBS use even when controlling for whether or not participants live at home. This indicates that the associations between communication and PBS use cannot be explained by parents having more oversight, influence, and/or regulation of their child’s drinking if they live at home.

One potential reason we did not find an association between parental communication at baseline and later alcohol use or negative consequences is that the timing of parent-child communication may matter in the reduction of young adults’ alcohol use (Turrisi, et al., 2013); however, this effect has only been tested with college students. Developing a better understanding of an optimal time (Turrisi et al., 2013) or multiple times (e.g., with boosters; Doumas, Turrisi, Ray, Esp, & Curtis-Schaeffer, 2013) for parental communication to occur among underage young adults may help interventions for this age group. As the current study only assessed whether the parents had spoken to the young adult in the past year, we are unable to ascertain the timing of the communication. Furthermore, the type of communication may also be important as some research has found that parental abstinence messages may be more effective in reducing drinking compared to harm reduction messages (Abar, Morgan, Small, & Maggs, 2012), especially for light drinkers (LaBrie, Boyle, & Napper, 2015). Finally, given that the scale used to measure parental communication does not fully tap into the complexity of parental communication nor address all the ways in which it may be protective, it is possible that important characteristics of effective parental communication about alcohol are not captured. Specifically, because several of the items focus specifically on consequences, it is possible that the type of parental communication measured has more of an impact on motivating young adults to avoid consequences by using PBS, but does not directly address reasons they may want to drink less.

Clinical implications.

The current findings indicate alcohol-specific parental communication is related to increased use of all types of PBS (manner of drinking, limiting/stopping, serious harm reduction) 3 months later in a national sample of young adults. These findings support the role of parents in young adults’ decisions to use PBS even when parents are not specifically trained in how to communicate about PBS use with their youth. While these findings are encouraging, parental communication did not directly predict reduced alcohol use in this sample at 3-month follow-up, suggesting parents would still benefit from additional training (e.g. Donovan et al., 2012; Turrisi et al., 2013) regarding how and what to communicate to their young adults in order to reduce their alcohol use. Finally, given that results found that parental communication was associated with PBS use above and beyond whether or not participants live at home, parental interventions increasing communication need not be limited to those parents who still reside with their child.

Limitations.

It should be noted that this study is not without some limitations. First, although the parental communication measure adapted from Turrisi and colleagues (2000) is validated and robust, this measure does not portray the complexity of parental communication in terms of depth, accuracy, or satisfaction with parental communication. In particular, the dichotomous nature of the measure does not allow for more nuanced examinations of quality or frequency of communication. Second, data analyzed were based on self-report and retrospective, which is subject to a certain degree of recall bias. However, researchers have found self-report to be sufficiently reliable and valid (e.g., Del Boca & Darkes, 2003; Simons, Wills, Emery, & Marks, 2015). Lastly, given the select inclusion criteria of the original study to include high risk young adults age 18–20 based on both drinking and sex criteria (i.e. criteria related to being in a monogamous relationship, have had sex in the past three months; and have had an alcoholic drink at least twice a month on average over the past 3 months), the authors caution generalizing these results to those outside of these criteria.

Future directions.

In light of the current findings, future research should seek to further investigate the complexity of parental communication to determine which aspects of communication may contribute to the influence on PBS. Additionally, a deeper look into the mechanisms of parent and child relationships may provide insight into how exactly parental communications predicts use of PBS. Furthermore, researchers should seek to understand how parental communication strategies may influence PBS across adolescents and young adults with various backgrounds and experiences with alcohol use.

Young adult alcohol use is an important topic given the high rates of drinking and heavy episodic drinking among those who are underage, and the consequences that can be associated with those risky behaviors (SAMHSA, 2017). As parental communication was found be associated with specific PBS that underage drinkers may engage in, but not actual levels of alcohol consumption or negative consequences, this research suggests parental communication is important but may require additional shaping through specific parent-based intervention strategies in order to directly impact reductions in young adult alcohol use and related negative consequences.

Highlights.

  • Parent communication is not longitudinally associated with young adult drinking.

  • Parent communication is longitudinally associated with drinking strategies.

  • Research is needed to disentangle parental communication and alcohol use.

Role of Funding Source

Data collection and manuscript preparation were supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R01AA021379) awarded to Dr. Melissa A. Lewis. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health.

Footnotes

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Conflict of Interest

No conflict declared.

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