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Adolescent Health: Person-to-Person Interventions to Improve Caregivers' Parenting Skills


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 12 studies (search period January 1980 - August 2007). The review was conducted on behalf of the CPSTF by scientists from Research Triangle Institute, Intl., through a contract mechanism and with input from a team of specialists in systematic review methods and experts in research, practice and policy related to adolescent health.

Summary of Results

Detailed results from the systematic review are available in the CPSTF finding pdf icon [PDF - 131 kB].

Twelve studies qualified for the review.

  • Outcomes assessed include:
    • Sexual behaviors (7 studies)
    • Violence, delinquency, suicide, and self-harm (4 studies)
    • Alcohol, tobacco, and other drug use (7 studies)
    • Behaviors related to motor vehicle safety (1 study)
    • Teen pregnancy (2 studies)
  • Estimated effects for individual studies and outcomes varied substantially; most estimates of effect favored the intervention, but were not statistically significant.
  • A meta-analysis indicated that this intervention results in an approximately 20% reduction in the overall set of risk behaviors evaluated (p<.05).
    • For sexual behavior and violence, the effect estimates were RR=0.69 (95% CI 0.50, 0.94) and 0.68 (95% CI 0.49, 0.94), respectively, meaning that these risk behaviors decreased by approximately 30%.
    • The effect estimate for substance use was much smaller and was not statistically significant (RR=0.87, 95% CI 0.73, 1.04), suggesting the potential for a weaker effect or no effect on these outcomes.
    • Youth participating in these interventions also reported they had increased refusal skills and self efficacy for avoiding risky behaviors in the future.

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.


Results of this review should be applicable to diverse populations and settings (including communities, homes, and schools) provided appropriate attention is paid to adapting the intervention to the target population.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What types of person-to-person formats lead to the greatest effectiveness in adolescent health outcomes?
  • What types of caregiver behaviors, if changed, can lead to the greatest reduction or improvement in adolescent risk-taking behaviors?
  • For what types of caregiver are these interventions most effective? As noted, the caregivers in these included studies were sufficiently motivated to participate. In addition, questions remain as to whether this intervention would work consistently well across all caregiver types. Specifically, are there types of caregivers for whom caregiver interventions will have no appreciable effect overall?
  • Are certain types of caregiver-targeted interventions more effective in creating change for certain risk or protective behavior outcomes than others? Are there types of risk behaviors on which these interventions have only a minimal effect?
  • How does the “problem behavior” construct hold up in terms of behavior changes within adolescents? For example, if one risk behavior changes for an adolescent, how likely are other risk behaviors to be affected?
  • Once caregivers have received a targeted intervention, can they successfully extend the behaviors and skills to other children, so that potential benefits can be derived for those adolescents as well?
  • Is there an optimal age of the child at which, or by which, a caregiver needs to have received the intervention to achieve the desired effects?
  • What is the economic cost for these types of interventions?

Study Characteristics

  • Three elements were common to all of the interventions in the qualifying studies:
    • An education component
    • A discussion component, and
    • An opportunity for the caregiver to practice new skills
  • Specific topics covered in the educational components varied across interventions and included:
    • Information about communication strategies
    • Recommendations for parental monitoring
    • Information on more specific topics, such as teen sexual behaviors, along with guidance on how to approach the adolescent with these topics
  • Evaluated interventions targeted caregivers only, or caregivers and adolescents together or separately. These interventions were delivered via group sessions or one-on-one training with the caregiver.
  • Caregivers participating in the included studies were volunteers who were sufficiently motivated to attend.
  • The majority of studies were conducted in the United States.