EFFEKT/Örebro/PAS - To increase parents' attitudes, norm-setting and monitoring about alcohol
At a glance
Country of origin
- Sweden
Level(s) of intervention
- Universal prevention
EFFEKT (formerly the Örebro Prevention Programme) seeks to reduce teenage alcohol use by changing the attitudes of teenagers’ parents. Parents are encouraged to communicate zero-tolerance messages about alcohol use to their children and to formulate agreed rules about alcohol and going out (by parents of children in the same class). Information is disseminated to parents at school meetings at the beginning of each term and through regular letters sent home. Parents are also sent catalogues detailing organised activities taking place in the community, so that children have constructive ways to use their time. The Dutch version (PAS) includes an additional component delivered to pupils at school.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Professor Nikolaus Koutakis,
PhD Örebro University
School of Law, Psychology and Social Work
BSR: Psychology/Centre for Developmental Research
Email: koutakis[a]effekt.org
Overview of results from the European studies
Studies overview
The programme has been evaluated in one quasi-experimental study and one cluster randomised control trial (RCT) in Sweden, one cluster RCT in Netherlands, and one cluster RCT in Estonia.
The Swedish quasi-experimental study, involving children aged 13-16 years, evaluated only the parent component of the programme and found a statistically significant effect at post-test on self-reported drunkenness and delinquency; rates of both increased for intervention and control students, but the increases were steeper in students in the control condition. Similar results were found for students who were early starters in either drinking or delinquency.
The Swedish RCT found a statistically significant positive effect on self-reported frequent drunkenness at post-test only under one of the four methods of data analysis (based on different ways of considering missing data). There was no effect on self-reported life-time drunkenness, weekly drinking or on any other outcome at follow-up (18 months after the end of the intervention). Another Swedish study (Bodin & Strandberg, 2011) revealed a statistically significant program effect for only one of three drinking outcomes under one loss-to-follow-up method, and that effect was observed at the 12-month follow-up but not at 30 months. Reanalysis of the data (Özdemir & Stattin, 2012), using frequency measures rather than dichotomized measures showed program effects for lifetime drunkenness (significant) and past-month drunkenness (marginally significant). A test of mediation showed that when the program influenced parental attitudes that all four drinking measures were reduced.
The Dutch RCT, involving children with a mean age of 12.6 years, evaluated the combined version of the programme, as well as parent-only and student-only versions. Statistically significant positive effects favouring the intervention were found for the combined version only. The number of students drinking on a weekly basis and the number of weekly heavy drinking episodes were both lower in the combined intervention; these effects were statistically significant at post-test and follow-up (50 months after baseline).
The Estonian matched-pair cluster RCT (2019), showed that programme “EFFEKT” had no impact in reducing or delaying adolescent’s alcohol use. The study had a three-year assessment period: baseline, 18 months and 30 months follow ups. It was undertaken in 2012-2015 among 985 fifth grade adolescents and 790 parents in 66 schools (34 intervention and 32 control schools). No significant changes in adolescent’s alcohol use initiation, lifetime drunkenness, alcohol use in the past year, parental alcohol supply, and adolescent’s perception of parental restrictive attitudes were identified between intervention and control school at follow-up. There were significant differences in parental attitudes only (2,05 times higher odds of having more restrictive attitudes at first follow up). The study does not describe what the control group received and participation rates were low (44% adolescents and 35% parents). The Estonian intervention differs from the Dutch and Swedish versions because programme components were modified.
The programme has been rated as Promising by Blueprints for Healthy Youth Development database based on a review of studies conducted world-wide.
Prevention of Alcohol Use in Students/Preventie Alcoholgebruik Scholieren (PAS) is the Dutch version of Orebro and refers to the study mentioned above.
Countries where evaluated
- Netherlands,
- Sweden,
- Estonia
Characteristics
Protective factor(s) addressed
- Individual and peers: refusal skills and decision making
Risk factor(s) addressed
- Family: parental attitudes favourable to alcohol/drug use
Outcomes targeted
- Alcohol use
- Use of illicit drugs
- Crime
Description of programme
EFFEKT seeks to reduce teenage alcohol use by changing the attitudes of teenagers’ parents. Parents are encouraged to communicate zero-tolerance messages about alcohol use to their children and to establish common rules about going out. Information is disseminated to parents at school meetings at the beginning of each term and through regular letters sent home. Parents are also sent catalogues detailing organised activities taking place in the community, so that children have constructive ways to use their time.
Schools hold parent information meetings at the start of each term. Project workers attend a parent meeting each term. At the first of these meetings, parents are given a 30-minute description of the programme. Programme facilitators advise parents to adopt or maintain a zero-tolerance position towards youth drinking and to communicate clear rules to their children. They suggest that parents in attendance formulate and sign agreements about their position concerning youth drinking (and other issues they deem important). These agreements are sent to all parents, including those who do not attend. Altogether, project workers attend five parent meetings: one for parents with children in grade 7 (aged 13) and two each for parents with children in grades 8 and 9 (aged 14-16). At each meeting, they emphasise the key message that strict rules are needed.
Parents receive at least three letters each term, including letters describing the parent meetings. Most letters are signed jointly by project workers and principals or teachers. These letters set out parents’ roles in reducing youth drinking and promoting leisure activities. They stress the importance of formulating and communicating family rules about alcohol and drug use, and they provide information tailored to the relevant communities about the availability of organised leisure activities.
Parents receive catalogues by mail promoting organised activities in the community. Clubs and organisations provide information about their activities, and the catalogues list contact information for organisations putting on activities in the relevant neighbourhoods. Parents are asked to read through these catalogues with their children.
The Dutch version, PAS (Prevention of Alcohol Use in Students) is a multicomponent school-based intervention for adolescents aged 12 to 15 and their parents, run over two years. As in EFFEKT (Örebro), parents attend a one-session meeting at the start of each school year and are encouraged to formulate agreed rules about alcohol and going out (by parents of children in the same class). An information leaflet, which includes a summary of the session, is sent to the parents’ homes. Additionally, students attend four initial sessions to complete a digital learning module about alcohol, with a booster session a year later. This additional module aims to increase students’ alcohol refusal and self-control skills and their knowledge about alcohol. The component is based on a specific module of the Dutch programme The Healthy School and Drugs.
Implementation Experiences
Contact details
Mariliis Tael-Öeren and Triin Sokk
mariliis.oeren[a]tai.ee
Main obstacles
With respect to individual professionals
• Trainers lacked background knowledge on the topic (alcohol, substance use, prevention).
• Trainers had poor group-management skills, as parents and teachers are difficult target groups.
• Parental attitudes and beliefs about adolescents’ alcohol use (e.g. it is OK for parents to offer alcohol to their children).
• The demands placed on trainers were significant, conditions were challenging (time required for training, training destinations were far away, short notice before meetings, etc.) and the salary was not high enough to compensate for this; therefore, trainers’ motivation was low at some points.
o Conducting training was time consuming and tiring (long drives, waiting at schools, and, at the same time, low parental participation rates).
o Negative experiences with parents (parental resistance in the beginning).
With respect to social context
• Trainers (and also the programme coordinator) encountered resistance from teachers. School directors made the decision to implement the training but in many cases did not include or even inform teachers.
• Parents were not involved in the decision-making process and often there was resistance towards the topic.
• Meetings took place after school or often late at night; the timing did not support learning (parents were tired after the working day, too much information from school as well), and a positive attitude towards the trainer and the topic was lacking.
• Class meetings were mandatory only once a year. Additional spring meetings were often cancelled or the participation rate was very low. The participation rate was very low starting from 6th grade. This is a common trend, but it affected the programme implementation.
• Social inclusion in Estonia is very low; community-based activities and communications (not only in the cities but also in smaller towns) are not very prevalent, and parents do not know how and when to work together. This was a barrier when trying to establish agreements between parents to implement the same rules.
• During the programme teachers changed, which meant that new contacts had to be made.
• In some schools the classes were mixed in 6th grade, which posed new problems; parents did not know each other and were less open to discussing difficult topics.
• Teachers were afraid of the extra workload.
• Alcohol-related attitudes among teachers varied and were not addressed in the programme. When teachers supported lenient parents, it caused a rift in the group.
• Many relevant topics (e.g. other substances, parenting skills) were not covered and there was little variation in the content.
• Parents were aware of alcohol-related consequences but lacked general parenting skills, and this made it more difficult for parents to implement new skills or knowledge acquired during the meetings.
With respect to organisational and economic context
• The costs related to programme implementation were difficult to assess in the beginning; additional time needed to train the trainers, long distances and time expenditure needed to be taken into account.
• Human resources were scarce. Much more than expected were needed to administer the programme, as the communication with schools was more time consuming than predicted.• There was no communications specialist involved to help adapt and develop attractive programme materials.
• The pool of trainers was small: interest in participating in the training itself was high, but as the training was quite demanding, interest in being involved in the programme was low.
• Most of the trainers lived in the capital, so getting to meetings outside the capital was time consuming.
• The cost-effectiveness ratio was questionable, as the number of participants was low.
• Time slots for the meetings were decided on at the last minute, as the schools were not in the habit of planning these meetings in advance. This meant that trainers were not always available and perhaps some connections were missed, as some schools got a new trainer each time.
How they overcame the obstacles
With respect to individual professionals
• A lot of emphasis was put on increasing trainers’ background knowledge and group management skills through regular meetings/extensive training.
• All topics were thoroughly discussed during trainers’ meetings, including through practising parents’ meetings, simulations and real-time feedback.
• Two outings were held twice a year to reflect on the progress made during the season and keep up the group spirit, encouraging learning as part of a group.
With respect to social context
• To overcome the fact that spring meetings were often cancelled, these meetings were planned with parents and teachers during the autumn meeting, but this did not help.
• Teachers were instructed to personally invite parents to participate, but it had little effect.
• When teachers changed, personal contact was made with new teachers, but this did not work, as the teachers were not convinced of the importance of the programme.
• In the event of unpleasant or hostile meetings, the trainer was replaced the next time. Where there was a stronger connection between the trainer and the group, the next meeting was scheduled according to the same trainer’s ability to attend.
• Meetings were designed to be active, using gamification and human-centred design principles.
• Additional parenting and risky-behaviour-related topics were added.
With respect to organisational and economic context
Feedback from the target group (parents and teachers) and from the trainers was taken into account, and materials and content for the meetings were developed accordingly.
• An additional training session was conducted to find new trainers, but interest was low.
• Trainers from outside the capital were sought, but with no luck.
Lessons learnt
With respect to individual professionals
• Thorough supporting background material from the beginning is helpful (e.g. it could be sent to potential trainers even before the initial training), for example in the form of a welcome package and workbooks.
• The initial training invitation has to be clear and requirements for trainers have to be specific (e.g. it should be possible to test if they have the crucial skills needed).
• A mentor system for trainers creates a safer and more supportive environment for practice (e.g. trainers who have more experience can mentor those with less experience).
• Feedback should be collected after meetings (to enable self-reflection), preferably online.
With respect to social context
• All meetings should take place, pauses should be avoided.
• Trainers should also attend all sessions; otherwise they might miss crucial insights from the target group.
• Face-to-face interaction with both teachers and school directors when introducing the programme to schools (i.e. the personal touch) is important.
• Thorough communication with teachers at the beginning of the programme to plan the meetings (e.g. best time and setting for the meetings, what kind of attitudes parents have towards the topic and towards the meetings in general) will hopefully increase the number of participating parents.
• It is useful to get feedback from the target group and be open to changing the content; using active learning methods and attractive materials can be effective.
• The range of topics should be wide (including parenting skills, risky behaviour, hot topics) and target groups’ needs should be taken into account.
With respect to organisational and economic context
• A communications specialist should be involved with the team from early on. This would improve communication with teachers and create more opportunities to adapt the materials and make them more attractive.
• More emphasis is required on increasing the pool of trainers from different regions.
Strengths
Long term, change in parents’ attitudes can result, active learning methods used.
Weaknesses
Meetings were cancelled, there was repetition, PowerPoint presentations meant less group learning, started too late (5th grade), communication with the developer from Sweden was minimal.
Opportunities
Increased group cohesion, insights from parents and teachers.
Threats
Low participation rate, low motivation, existing pro-alcohol social norms, high cost, time consuming for trainers.
Recommendations
With respect to individual professionals
• Extensive trainers’ training.
• Including group learning activities.
• Taking into account that parents and teachers are difficult target groups and therefore the demands on trainers are significant.
• It is very important to take into account the attitudes and beliefs of trainers and teachers in relation to substance use and risky behaviour from the beginning.
With respect to social context
• Carry out research into possible settings for meetings (e.g. school is not the only option).
• The agreement part of the programme assumes that social inclusion is relatively high, so if it is low it might be more difficult to implement the programme.
• The initial contact with teachers is crucial; it has to be personal and the teachers’ understanding of the programme’s benefits need to be clear (e.g. teachers might not see the association between delayed alcohol initiation and better academic results).
With respect to organisational and economic context
• Establish a bigger pool of trainers from different regions (shorter distances to travel to schools).
• More human resources are needed (not just a project leader), including a communications specialist.
