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


What the Task Force Found

About The Systematic Review

The Task Force 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 Task Force 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.


There is no information for this section.

Summary of Results

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

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

Although caregiver-targeted interventions implemented through a person-to-person format are effective for modifying adolescent risk and protective behaviors, a number of research issues still remain. The following are examples where further investigation is needed.

  • 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?

Further research is encouraged to address these and other important topics related to caregiver-targeted parenting behaviors. Where possible, rigorous research designs can help to unravel these key questions, further extend the available database, and ultimately lead to better, more cost-effective implementation of caregiver-targeted interventions.

Additional research on issues related to cost effectiveness of person-to-person parenting interventions could provide useful information for guiding future program development and decision-making.

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.