Staff with University of Iowa Health Care were part of a national research team investigating whether a family-based prevention program would keep otherwise at risk teens from becoming involved in substance abuse, as well as other risky behaviors. Robert Philibert, MD, PhD, psychiatrist with University of Iowa Health Care, also a member of the neuroscience and genetics program, and the lead of this study here in Iowa, talks about the study and its findings:

Tell us a little bit about the background of this study. What did the study look at?

I’m a parent of a 10-year-old and a 12-year-old, and I can tell you one of the things that I worry most about is the likelihood that my child might start smoking or drinking or start acting out in school. And what this study examines is a set of educational measures that involve families that we hope decrease the likelihood that a child—such as mine—might act out as a result of stresses that that student might experience; and start to initiate risk-taking behaviors such as smoking, drinking, fighting, or the whatnot.

How were participants recruited to participate in the study?

This is a randomized study in which students from rural Georgia high schools, actually middle schools, were asked to participate in the study.

What was the significance of an 11-year-old in each of the recruited families (not a younger or older sibling)?

It turns out 11 year olds are at a critical age. As parents, I always like to think that I have a great deal of control over how my child behaves, and indeed I do. But starting at about the age of 10 or 11 years old, children start to transition from that period where their parents are the most important features in their environment, to where their peers are. And this educational measure is an attempt to increase the amount of moderation that parents can have in helping their children navigate this very difficult portion of the child’s life.

What role did the genetic disposition, in some of the participants, of an increased risk linked to participation in risky behaviors play?

Like everything in life, such as high blood cholesterol or high blood pressure, we know that certain people are at higher risk as a result of genetic variation. This is true for smoking, drinking, and other forms of risk-taking behavior. What we’re attempting to see is if we can isolate certain genetic variants which place people at more risk and if we can therefore use this information to better design the educational or behavioral interventions that we are working on to make them even more effective.

What were participants of the study asked to do as part of the study?

It was a very simple, 14-hour, family-based intervention in which the parents and the children were educated about smoking, drinking, and other forms of risk-taking behavior, and we worked at increasing the communication skills in the family. It’s kind of funny to say as a board certified psychiatrist, but I often don’t talk to my children in the most productive fashion. Life is stressful. I experience stress—my children experience stress. However, the effect of the goals to intervention is to help both of us deal with that stress so we really communicate what we’re trying to say.

How long did the study last?

The educational aspect only lasted seven weeks, however, the follow-up of the study continues on even today.

At the end of the two and a half years, what did investigators of the study conclude?

We found great things. First of all, that everyone, independent of their genetic variation, all children benefited from the intervention as compared to those who did not receive intervention. Second, consistent with what we suspected previously, some people—on the basis of their genotype—were at more risk for acting out. However, the intervention worked for everybody, however, for some people it worked even more effectively.

What does the study mean with regard to the value of nurturing a child, regardless of genetic predisposition?

Well, the funny thing here is that there are all sorts of risky elements in the childhood environment, whether it be smoking, drinking, reading, writing, or even driving. What this tells us is that behavioral interventions—at least in this subset of those risks—is effective in decreasing the amount of risk and by better understanding the biology that the children have, we can more effectively create behavioral interventions to make them more productive, facile, innovative members of our society in the future.

What will the next steps be with regard to this study?

I think the next steps are to expand the study, to better understand why some children benefited more, and to see if we can continue to expand the age range in which this intervention is effective. For instance, can we do it with high school age children? Can we expand this to benefit the students in our collegiate community here which are exposed to high rates of alcohol in their environment (and many suffer from binge drinking or early alcohol abuse)? I would love it if we could get an intervention going for our college students, as well!

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