Parenting Support: Mediation Pathways for Reduced Substance Use Among Parents and Their Children: A Randomized Controlled Trial

Abstract Background: Substance use is a major public health concern worldwide. Alcohol and drug use have risen over recent decades in many low and middle-income countries, with South Africa among the highest globally.Despite effectiveness of family-based interventions on reducing substance use among adolescents, less is known about the effectiveness of family-based programs on substance use among parents and caregivers, in particular, among families in low- and middle-income countries (LMIC).This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health -PLH) on reduction of substance use among parents and their children through three potential mediators: parental depression, parenting stress and family poverty. In addition, the study examined the correlation between parental substance use and adolescent substance use. Methods: The current study draws on a pragmatic cluster randomized controlled trial design; the total sample comprised 552 parents\caregiver and adolescent dyads (parents\caregivers M = 49.37; SD = 14.69 and adolescents M = 13.84; SD = 2.38) who were recruited from 40 communities in South Africa’s Eastern Cape. Participants completed a structured confidential self-report questionnaire, at baseline and follow-up test (5–9 months following the intervention). Structural equation modeling (SEM) was conducted to investigate direct and indirect effects. Results: Mediation analysis indicated that PLH intervention impact on parental substance use reduction among parents ran through one indirect pathway: Improvement in parental mental health (reduction in parental depression levels). There were no pathways from PLH intervention to parental substance use through parenting stress or family poverty. Furthermore, findings showed a significant positive correlation between parental substance use and adolescents' substance use. Conclusions: The findings of the study highlight the fact that PLH parenting intervention has a significant effect on secondary outcomes, including substance use and depression among parents\caregivers in LMIC. These findings emphasize the need for creating supportive environments and systems for parents who suffer from emotional strain and mental health problems, in particular among families in adversity. Supporting parental mental health as part of a parenting programme serves as a significant pathway for reducing substance use among parents and their children. Trial registration: Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. It can be found by searching for the key word ‘Sinovuyo’ on their website or via the following link:pactr.org