4.6 Article

Mediation pathways for reduced substance use among parents in South Africa: a randomized controlled trial

Journal

BMC PUBLIC HEALTH
Volume 21, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12889-021-11651-6

Keywords

Substance use; Parenting intervention; Parental depression

Funding

  1. European Research Council (ERC) under the European Union's Seventh Framework Program (FP7/2007-2013/ERC Grant) [313421]
  2. UNICEF Innocenti Office of Research
  3. UNICEF South Africa
  4. ERC under the European Union's Horizon 2020 research and innovation program [737476]
  5. UKRI GCRF through the Accelerating Achievement for Africa's Adolescents Hub [ES/S008101/1]
  6. Oak Foundation, Research England
  7. John Fell Fund
  8. Leverhulme Trust [PLP-2014-095]
  9. University of Oxford's ESRC [1311-KEA-004, 1602-KEA-189]
  10. ESRC under a Future Research Leader Award [ES/N017447/1]
  11. European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme [852787]
  12. University of Glasgow Social and Public Health Sciences Unit Complexity and Relationships in Health Improvement Programmes of the Medical Research Council MRC UK
  13. Chief Scientist Office [MC_UU_00022/1, CSO SPHSU16, MC_UU_00022/3, CSO SPHSU18]
  14. DECIPHer
  15. Wolfson Centre for Young People's Mental Health
  16. Welsh Government through Health and Care Research Wales
  17. Wolfson Foundation
  18. European Research Council (ERC) [737476] Funding Source: European Research Council (ERC)

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The study found that the effect of the parenting programme (PLH) on reducing parental substance use was primarily mediated through improving parental mental health. However, parenting stress and family poverty did not play a mediating role in the impact of the PLH intervention on parental substance use.
Background: Substance use is a major public health concern worldwide. Alcohol and drug use have increased during recent decades in many low- and middle-income countries, with South Africa, where this study was conducted, having among the highest rates in the world. Despite existing evidence on the effectiveness of family-based interventions in reducing substance use among parents and caregivers in low- and middle-income countries, little is known about the mechanism of change that contributes to the reduction. This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health [PLH]) on reducing substance use among parents and caregivers of adolescents through three potential mediators: parental depression, parenting stress and family poverty. Methods: The current study used a pragmatic cluster randomized controlled trial design. The total sample comprised 552 parent and caregiver of adolescents M = 49.37(SD = 14.69) who were recruited from 40 communities in South Africa's Eastern Cape. Participants completed a structured confidential self-report questionnaire at baseline and a follow-up test 5 to 9 months after the intervention. Structural equation modeling was conducted to investigate direct and indirect effects. Results: Analyses indicated that the effect of the PLH intervention on reducing parental substance use was mediated in one indirect pathway: improvement in parental mental health (reduction in parental depression levels). No mediation pathways from the PLH intervention on parental substance use could be associated with parenting stress or family poverty. Conclusions: The findings of the study suggest that intervention approaches targeting mental health among parents and caregivers have promise for reducing parental substance use. These findings emphasize the need to create supportive environments and systems for parents who suffer from emotional strain and mental health problems, particularly within families experiencing adversity.

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