Pilot Test of Parent-Focused Cannabis-Related Actions and Practices Intervention for Adolescent Marijuana Abuse

The TLFB will be used to derive a measure of percent days of marijuana and other drug use in the past 12 weeks at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed to quantify change from baseline to 3-months and change from 3-months to 6-months.

The PMHU-A measure is based on items from the National Survey of Drug Use and Health (NSDUH). Five items from the NSDUH will be used to measure the respondent's perception about the harm of using marijuana pertaining to physical harm, harm to mental health, risk for marijuana dependence, risk for injuries, and harmful social consequences. Each item has the same response option (1=no risk, 2=some risk, 3=moderate risk, 4=high risk). Items will be summed to form a total score at each assessment point (range, 5-20), with the greater the scale score the more perceived risk. The PMHU will be used to derive a measure of perception of harm at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed to quantify change from baseline to 3-months and change from 3-months to 6-months.

The Cannabis-Specific Parent Practices measure will include: self-reported medical marijuana in the presence of youth, parents' verbal discouragement of youth marijuana use, parent-adolescent communication about parent expectations for abstinence, and parent safety protocols for cannabis storage at home. Parents will be asked to rate 7 items on a 4-point Likert-type scale (1= strongly disagree; 2=disagree; 3=agree; 4=strongly agree) regarding extent of agreement with each item. The greater the item score, the more optimal the parenting practice. Each item of this measure (score range, 1-4) will be collected at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed as separate items to quantify change from baseline to 3-months and change from 3-months to 6-months.

The Report of Parent Monitoring (PRM) will be used to measure parent level of involvement in and knowledge about their son's/daughter's social activities. The parent and adolescent versions of the scale each consists of 10 items (e.g., "I knew where my son/daughter was after school" and "my parents knew who friends were"), with responses ranging from "never or almost never" to "always or almost always" on a 5-point scale. Good internal consistency reliability and validity with alphas of .87 for reported. The greater the scale score (range, 10-50), the more optimal parental acceptance and involvement. Items will be summed for the parent and youth reports to form separate total PRM scale scores at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed to quantify parent and adolescent change from baseline to 3-months and change from 3-months to 6-months.

The Family Environment Scale (FES), a widely-used and well-standardized tool, is comprised of ten subscales which measure the quality of the family functioning. Moos and colleagues report internal consistency of the subscales ranging from .61 to .78, with test-retest reliabilities from .68 to .86 at 2-month intervals. The scale effectively distinguishes normal from disturbed families. The Conflict, Cohesion, and Organization subscales, key subscales for differentiating healthy and disturbed families and detecting pre-post treatment change, will be used. Each item has a True-False response option (1=true, 2=false), and the greater the scale score the more severe the family dysfunction. Items will be summed for parent and youth reports to form separate total FES scale scores at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed to quantify parent and youth change from baseline to 3-months and change from 3-months to 6-months.

The PHMU-P is based on items from the National Survey of Drug Use and Health (NSDUH). The 5-item PHMU-A will be modified to ask parents about the level of risk of marijuana use for teenagers. Risk scores will be summed to form a total score. Parents will also be asked to respond to the 5 PHMU items pertaining to their perception of risk of their own marijuana use to aid in characterizing the study sample. Each item for PHMU-P and PHMU has the same response option (1=no risk, 2=some risk, 3=moderate risk, 4=high risk). Items will be summed to form a total score at each assessment point for each scale (range, 5-20), with the greater the scale score the more perceived risk. The PMHU-P and PMHU will be used to derive separate measures of perception of harm at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed to quantify change from baseline to 3-months and change from 3-months to 6-months.

The Behavioral Intentions Questionnaire (BIQ) is a 6-item scale designed to assess parent likelihood of applying the intervention concepts, strategies, and skills in their home environment. Behavioral intentions and expectations assess an individual's perceived likelihood of future behavior. BIQ items include parent intentions to restrict adolescent exposure to cannabis at home and parent intentions to provide messages to their adolescent that discourage underage use. Responses will be rated on 4-point Likert type scale ranging from "very likely" to "very unlikely". Ratings will be summed to provide a total BIQ score (range=6-24). The greater the scale score, the greater the perceived intention to use the resource. The BIQ will be used to derive a measure of likelihood to use the resource in the future at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed to quantify change from baseline to 3-months and change from 3-months to 6-months.

Parent efficacy and satisfaction in their own parenting will be assessed with the Parent Sense of Competence scale (PSOC), a 17-item questionnaire with items on a 4-point scale (1=strongly agree, 2=agree, 3=disagree, 4=strongly disagree). The subscales have adequate internal consistency (alpha=.82 for Satisfaction, alpha =.70 for Efficacy). Satisfactory test-retest correlations for the scales and total score were also reported. Items will be added to the PSOC to assess parents' perceptions of their self-efficacy with respect to performing the strategies and skills presented in the intervention. Ratings will be summed to provide a total PSOC score (range=17-68). The greater the scale score, the greater the perceived parenting efficacy. The PSCO will be used to derive a measure of perceived parenting at three time points (baseline, 3-months follow-up, and 6-months follow-up) and analyzed to quantify change from baseline to 3-months and change from 3-months to 6-months.

Urine toxicology screening will be conducted to verify parent report of substance use. Recent drug use will be measured using Urine Assays (UA; NIDA 12 Test Panel), using a card device with 12 finger-like prongs dipped in a urine sample will screen youth for amphetamine, barbiturates, benzodiazepines, cocaine, ecstasy, meth-amphetamine, methadone, opiates, oxycodone, phencyclidine, tricyclics, and marijuana, plus three adulterants, providing a verification of self-report. Test cups will monitor temperature to further detect tampering. Clear results for photocopy emerge within 5 minutes to simplify data collection by trained project staff. All samples will be discarded once the results have been documented. UAs, consequences and other substance use variables will be used to aid with the interpretation of study findings. Urine screen results at each time point will be compared to substance use self-report at the respective time point.

Parent cannabis use quantity and frequency will be measured using the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis-Use Inventory (DFAQ-CU; Cuttler & Spradlin, 2017). The DFAQ-CU shows pictures of various marijuana quantities to assess the quantity of cannabis used for various forms of cannabis, different methods of administration, amounts used, and typical THC levels in cannabis used. The DFAQ-CU has favorable internal reliability for the 6 factors (alpha range, .69 to .95) and favorable evidence for convergent, predictive, and discriminant validity. The range of scale scores vary across subscales, yet for each the greater the subscale score, the more use of marijuana is indicated. Subscale scores will be summed to form a total score at each time point (baseline, 3-months follow-up, and 6-months follow-up) and quantify change from baseline to 3-months and change from 3-months to 6-months.

Timeline Follow-back Interview (TLFB) will also be used to measure the parents past 12 weeks of use of other licit and illicit substances and of nonmedical and medical marijuana use. This instrument is a structured interview that yields a daily calendar-aided reconstruction of use from all drug classes (including alcohol) to facilitate recall and minimize retrospective biases. TLFB is sensitive treatment-related change, has good psychometric properties, and produces higher estimates of use than summary measures. Direct self-report measures compare favorably to collateral reports and have been validated using urine toxicology screening. Parent substance use data at baseline will be used for sample characterization and to guide interpretation of study findings (change across time).

The Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) will be used to measure the parent's perception of youth difficulties and prosocial competence. The SDQ is an internationally-validated 25-item questionnaire comprised of five subscales: emotional symptoms, conduct problems, hyperactivity-inattention, peer problems, and prosocial behavior. Each item is responded to on a 3-point ordinal scale, ranging from 0 = not true to 2 = certainly true. Subscale scores range from 0-10, and the total SDQ score ranges from 0 to 40, with higher scores indicating more problems and less competence. The SDQ has high discriminant validity and is predictive of child internalizing and externalizing behavior (Goodman, 1997; Goodman & Scott, 1999). SDQ scales at baseline will be used to characterize the study sample.