User satisfaction with antenatal care in Norway.

BACKGROUND: In Norway, antenatal care is delivered free of charge in the municipality. Satisfaction with care is considered to be an important predictor of utilization of health care. The aim of this study was to examine women's satisfaction with antenatal care, and to identify factors that predict overall satisfaction with the service. METHODS: A total of 611 women completed a survey that collected information on demographic variables, pregnancy variables, and aspects of antenatal care; it also contained one open-ended question. A hierarchical multiple regression analysis was conducted to predict Overall Satisfaction with antenatal care based on four specific scales: User Participation, Accessibility, Information, and Midwife, adjusted for demographic variables. RESULTS: Survey responses showed that 95% of women were satisfied with antenatal care in general. The expectant mother's age, having Norwegian as the native language, and the scales User Participation, Information, and Midwife were all significant predictors of Overall Satisfaction with antenatal care. The open-ended user comments underlined the important role of midwifes in antenatal care. CONCLUSIONS: The results of this study indicate that women who attended antenatal care in Norway were satisfied with the care they received. Midwives had an important role, and their relational and professional competence was highly valuated by expectant mothers. The findings also suggest that there are still opportunities to improve satisfaction with antenatal care, for example, by increasing the focus on mental health during antenatal consultations.

How do public health nurses in Norwegian school health services support siblings of children with complex care needs?

AIMS: There is a paucity of data regarding the care and support provided by Norwegian school health services to siblings of children with complex care needs. Public health nurses are an integral part of these universal services, which focus on health promotion and disease prevention in primary and secondary schools. This study aimed to explore health promotion interventions by public health nurses for siblings in Norwegian schools and to identify regional differences. METHODS: An online national questionnaire was distributed to Norwegian public health nurses and leaders of public health nursing services (N = 487). The questions were related to how the nurses support siblings of children with complex care needs. The quantitative data were analysed using descriptive statistics. An inductive thematic analysis of free-text comments was conducted. ETHICAL APPROVAL: The study was approved by the Norwegian Centre for Research Data. RESULTS: The majority of public health nursing leaders (67%) reported that the services in their municipality had no system to identify siblings or to provide them with routine care. However, 26% of public health nurses reported that routine support was provided to siblings. Regional differences were identified. STUDY LIMITATIONS: This study included responses from 487 PHNs from all four health regions in Norway. The study design is limited and gives a brief outline of the current situation. Further data are needed to provide in-depth knowledge. CONCLUSIONS: This survey provides important knowledge for health authorities and professionals working with siblings, about inadequate support and regional differences in care provided to siblings by school health services.

Beyond physical ability-predicting women's football performance from psychological factors.

Introduction: Even though there is a clear agreement among researchers that psychological factors are a vital part of a football player's performance, the topic has not been investigated thoroughly. The present study aimed to examine the predictive value of psychological factors on female football players' match performance. Methods: A sample of 156 players from the top two leagues in Norway completed the following questionnaires: Perceived Motivational Climate in Sport Questionnaire 2 (PMCSQ-2), Big Five Inventory (BFI-20), Self-Regulated Learning questionnaire, and Grit-S and Sport Mental Toughness Questionnaire (SMTQ). Match performance data were collected from the online database of the performance analysis company InStat. Results: Results from a linear mixed model analysis showed that perceived mastery climate and extraversion were the only significant predictors of performance. Other relevant indicators, such as mental toughness, self-regulated learning, and grit, did not predict performance. Discussion: These findings suggest that the team climate facilitated by coaches may be more important for predicting match performance than individual psychological factors.

A global meta-analysis of depression, anxiety, and stress before and during COVID-19.

OBJECTIVE: This meta-analysis compared negative emotions (NEs) as depression, anxiety, and stress, from before the pandemic to during the pandemic. METHOD: A total of 59 studies (19 before, 37 during-pandemic, and 3 that included both) using the Depression, Anxiety and Stress Scale (DASS) were included. A random effects model estimated the means of NEs before and during the pandemic. RESULTS: Studies from 47 countries involving 193,337 participants were included. Globally, NEs increased during the pandemic, and depression had the largest elevation. In Asia, depression and stress were elevated, whereas in Europe, only depression increased, and in America, no differences in NEs between before and during the pandemic were observed. The later time phase of the pandemic was associated with lower stress globally, and lower stress and anxiety in Europe. Being younger was associated with more stress globally, and being older was associated with higher anxiety in Asia. Students had higher anxiety globally, and higher NEs in all three aspects in Europe compared to the general population. The COVID-19 infection rate was associated with more stress globally, and stress and anxiety in Europe. During the pandemic, females reported higher levels of depression, anxiety, and stress compared to males, most pronounced in Europe. CONCLUSION: NEs increased during the pandemic, with younger and student populations, females and Asians having the highest elevations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Universal Mental Health-Promoting Mobile App for Adolescents: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: In times of increasing mental health problems among young people, strengthening efforts to improve mental health through mental health promotion and prevention becomes increasingly important. Effective measures that support young people in coping with negative thoughts, feelings, and stress are essential, not just for the individual but also for society. OBJECTIVE: The aim of this paper is to provide a description of a cluster randomized controlled trial that will be conducted to examine the effectiveness of Opp, a universal mental health-promoting mobile app for adolescents aged 13 to 19 years that provides information and exercises to better cope with stress, negative thoughts, and negative feelings. The protocol was developed in accordance with the SPIRIT checklist. METHODS: An effectiveness study will be conducted with 3 measurement points: preintervention (T1), 2 weeks after the intervention (T2), and about 1 month after the intervention (T3). Adolescents will be recruited from middle and high schools in Norway and randomly assigned to the intervention or control groups. Randomization will be conducted on the school level. Opp can be downloaded from the Google Play or App Store but is password protected with a 4-digit code, which will be removed after study completion. Participants in the intervention group will receive a text message with the code to unlock the app. The participants in the intervention group can use Opp without limits on length or time of use. Objective data on how long or how often the participants use the app will not be collected. However, the second and third questionnaires for the intervention group contain app-specific questions on, for example, the use of the app. RESULTS: Recruitment and data collection started in August and September 2022. So far, 381 adolescents have answered the first questionnaire. Data collection was expected to end in December 2022 but has had to be prolonged to approximately June 2023. The results of the study will be available in 2023 at the earliest. CONCLUSIONS: This project will contribute unique knowledge to the field, as there are few studies that have examined the effects of universal health-promoting mobile apps for adolescents. However, several limitations have to be taken into account when interpreting the results, such as randomization on the school level, the short time frame in which the study was conducted, and the lack of objective data to monitor the use of the app. TRIAL REGISTRATION: ClinicalTrials.gov NCT05211713; https://www.clinicaltrials.gov/ct2/show/NCT05211713. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42119.

General Measurement Tools for Assessing Mental Health Problems Among Children and Adolescents with an Intellectual Disability: A Systematic Review.

There is a need for more knowledge of valid and standardized measures of mental health problems among children and adolescents with intellectual disability (ID). In this study, we systematically reviewed and evaluated the psychometric properties of instruments used to assess general mental health problems in this population. Following PRISMA guidelines, we reviewed empirical research published from 1980 through February 2020 with an updated search in March 2021 in Medline, Embase, PsycINFO, Health and Psychological Instruments, CINAHL, ERIC, and Web of Science databases. Forty-nine empirical articles were included in this review. Overall, the review indicated consistently better documentation of the reliability and validity of instruments designed for the ID population compared to instruments developed for the general child population.

Under-Reporting of Self-Reported Medical Conditions in Aviation: A Cross-Sectional Survey.

BACKGROUND: The applicants' self-declaration of medical history is crucial for safety. Some evidence indicates that under-reporting of medical conditions exists. However, the magnitude in a population of aviation personnel has not been reported earlier.METHODS: A total of 9941 applicants for medical certificate/attestation for aviation-related safety functions during the last 5 yr up to December 2019 were registered at the Civil Aviation Authority Norway. E-mail addresses were known for 9027 of these applicants, who were invited to participate in a web-based survey.RESULTS: Among the 1616 respondents, 726 (45%) were commercial pilots, 457 (28%) private pilots, 272 (17%) air traffic controllers, and the remaining were cabin crew or crew in aerodrome/helicopter flight information service (AFIS or HFIS, respectively). A total of 108 were initial applicants. The age group 50+ constituted the largest proportion of respondents (53%). Aeromedical certification in general was believed to improve flight safety "to a high" or "very high extent" by 64% of the respondents. A total of 188 individuals (12%) admitted having under-reported information related to one or more categories, including mental (3%) or physical health (4%), medications (2%), and drug use, including alcohol use (5%). Among these, 21 participants believed their own under-reporting "to some" or "to a high extent" affected flight safety. In total 50% of noninitial applicants reported that they knew colleagues who had under-reported information. Analyses revealed that being a commercial pilot showed a higher risk for under-reporting compared with other classes and the perception of aeromedical examiners in a supportive or authoritative role reduced the risk.CONCLUSIONS: Under-reporting of medical conditions could be significant in aviation. Further studies should be conducted to investigate the true extent of under-reporting and its impact on flight safety and what mitigating measures might be recommended.Strand T-E, Lystrup N, Martinussen M. Under-reporting of self-reported medical conditions in aviation: a cross-sectional survey. Aerosp Med Hum Perform. 2022; 93(4):376-383.

Psychological factors and performance in women's football: A systematic review.

The amount of research conducted on female football players, compared to male players, is sparce. Even though research on female football players has increased the past decade, there is still a lack of studies of how psychological factors affect their performance. The objective of the current systematic review was therefore to summarize existing quantitative research into the relationship between psychological factors and performance in women's football. Literature was sourced from MEDLINE/PubMed, Embase, and PsychInfo. Two independent reviewers applied the selection criteria and assessed the quality of the studies. A total of 14 studies met the inclusion criteria. The total number of participants was 1449, and 15 psychological factors were examined in relation to football performance. The results revealed a tendency for higher leveled players to score higher on psychological factors like mental toughness, conscientiousness, and executive functions. They also had lower levels of anxiety. Enjoyment and a perceived mastery climate were related to increased levels of performance and perceived competence. Mood was unrelated to performance. Limitations and implications for future research are discussed.

Social and life skills in adolescents who have self-harmed: analysis of survey responses from a national sample of adolescents in Norway.

OBJECTIVE: Social and life skills (SLS) may be important in the prevention and treatment of self-harm, but few studies have described this relationship. We examined three components of SLS in adolescents who reported self-harm that was, according to themselves, diagnosed by a clinician. DESIGN: Cross-sectional. SETTING: National screening prior to military service. PARTICIPANTS: 176 284 residents of Norway born in 1999-2001 received a declaration of health. We included 171 486 individuals (84 153 (49%) women and 87 333 (51%) men) who were 17 (n=1 67 855) or 18 years of age (n=3631) when they completed the declaration. OUTCOME MEASURE: The main outcome was clinically diagnosed self-harm, defined as self-harm that the adolescents themselves stated had been diagnosed by a clinician. Components of SLS were social interactions; coping strategies; and emotional regulation/aggression. The association between SLS and self-reported clinically diagnosed self-harm was assessed in hierarchical multiple regression models controlling for sex; school absence; and feelings of emotional pain. RESULTS: Three percent (n=5507) of the adolescents reported clinically diagnosed self-harm. The three components of SLS together added little to the prediction of clinically diagnosed self-harm (∆R2=0.02). After controlling for school absence and emotional pain, emotional regulation/aggression was the only SLS-component that was independently associated with clinically diagnosed self-harm (OR 1.33, 95% CI 1.31 to 1.36). The young men who said they had been clinically diagnosed for self-harm scored slightly worse on social interactions (Hedge's g (g) = -0.13, p<0.001) and emotional regulation/aggression (g = -0.18, p<0.001) than the young women in this group. CONCLUSION: Young women and young men who reported clinically diagnosed self-harm had more problems with emotional regulation/aggression than other adolescents, but did not have worse social interactions or coping strategies.

An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial.

BACKGROUND: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. OBJECTIVE: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. METHODS: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. RESULTS: Recruitment will start in January 2022. The results from this study will be available in 2023. CONCLUSIONS: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. TRIAL REGISTRATION: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/31789.

Evaluating Delivery of a CBT-Based Group Intervention for Schoolchildren With Emotional Problems: Examining the Reliability and Applicability of a Video-Based Adherence and Competence Measure.

Adherence and competence are essential parts of program fidelity and having adequate measures to assess these constructs is important. The Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS CBT) was developed to evaluate the delivery of cognitive therapies for children with clinical anxiety. The present study is an assessment of the slightly adapted version of the CAS CBT evaluating the delivery of a Cognitive Behavioral Therapy (CBT)-based preventive group intervention: EMOTION: Kids Coping with Anxiety and Depression. This study was part of a Norwegian cluster randomized controlled trial (cRCT) investigating the effectiveness of a transdiagnostic intervention, the EMOTION program-an indicated prevention program targeting anxious and depressive symptoms. The applicability and psychometric properties of the CAS CBT were explored. Results are based on six raters evaluating 239 video-recorded sessions of the EMOTION program being delivered by 68 trained group leaders from different municipal services. Interrater reliability (intraclass correlation coefficients, ICC [3, 1]) indicated fair to good agreement between raters. Internal consistency of the instrument's key domains was calculated using the Omega coefficient which ranged between 0.70 to 0.94. There was a strong association between the two scales Adherence and Competence, and inter-item correlations were high across the items, except for the items rating the adherence to the session goals. Competence and Adherence Scale for Cognitive Behavioral Therapy is a brief measure for use in first-line services, with some promising features for easily assessing program fidelity, but some of the results indicated that the instrument should be improved. Future attention should also be made to adapt the instrument to fit better within a group setting, especially regarding evaluation of session goals. More research on how to adequately evaluate fidelity measures are also warranted. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02340637.

The psychometric properties and norm data of the Norwegian military personality inventory (NMPI).

The five-factor structure is a well-established model for personality. The five traits covary with job-performance and work-relevant outcomes. The practical administration of existing big-five measurement scales is, however, somewhat limited, in a Norwegian setting, as existing scales are impractically large or have unknown psychometric properties. Because of this, a new brief Norwegian personality assessment tool has been developed by the Norwegian Armed Forces. This study aims to uncover the psychometric properties of the 50-item Norwegian military personality inventory (NMPI-50) and establish norm data for practical use. The inventory was administered to the 2002 cohort of Norwegian 17-year olds (N = 54,355), and analyzed with factor analysis, graded response models and tests of gender invariance. The five scales of the NMPI-50 showed satisfactory internal consistency, yielded high information across a broad range of the five traits, and conformed to a bi-factor structure with one general factor and five specific factors. The general factor was positively associated with motivation for military service, indicating some measurement bias. The openness scale is less clearly psychometrically defined, compared to the other scales, and both extroversion and openness show some evidence of multidimensionality. The scales also showed scalar invariance between genders except for the openness scale. Overall, the results support the use of NMPI-50 in personnel assessment and research.

Adolescents' experiences of the information they received about the coronavirus (Covid-19) in Norway: a cross-sectional study.

BACKGROUND: In the first months of the coronavirus (Covid-19) pandemic, many countries took radical prevention measures. Authorities had to communicate with the public regularly to explain and ensure compliance with these measures and promote safety. The information given by authorities was mainly developed for adults, but children and adolescents may have different needs when it comes to information. This study examined how adolescents perceived information about Covid-19 provided by the media and other sources, and about what topics adolescents reported they lacked information during the first months of the Covid-19 pandemic. METHODS: Three hundred seventy-seven adolescents in 11th, 12th, and 13th grade in Norwegian upper secondary schools (67% girls) completed an online questionnaire. Analyses included descriptive statistics, in addition to Generalized Linear Mixed Models analyses to examine gender differences in adolescents' satisfaction with the information provided about Covid-19, to what extent the pandemic affected their everyday life, and to what extent they were concerned about becoming infected with Covid-19. RESULTS: The results showed that the majority of adolescents used the internet as the main source of information about Covid-19, followed by (online) newspapers. About half (49%) reported that they were satisfied with the information available, while 39% were neither satisfied nor dissatisfied, and 12% were dissatisfied. Adolescents wanted more information about the school situation, as well as virus- and future-related topics. A total of 21% reported that they were concerned about becoming infected with Covid-19. There was no significant gender difference in overall satisfaction with the information provided about Covid-19. Girls reported being significantly more affected by the pandemic than boys, and that they were significantly more concerned than boys about becoming infected with Covid-19. CONCLUSIONS: This survey provides important knowledge to professionals working with adolescents, as well as to authorities, about what information channels can be used to reach adolescents, and what information they lacked about the Covid-19 pandemic.

Fit for fight - self-reported health in military women: a cross-sectional study.

BACKGROUND: Substantial research has found that women assess their health as poor relative to men, but the reasons for this are not fully understood. Military women are characterised by good health and the ability to work in an archetypically male culture. Thus, studies on the gender pattern of self-reported health in military personnel could generate hypotheses for future research on the possible associations between gender and health. However, such studies are rare and limited to a few countries. The aim of this study was to examine self-reported physical and mental health in Norwegian military women. METHODS: We compared responses on self-reported health of 1068 active duty military women in Norway to those of active duty military men (n = 8100). Further, we compared the military women to civilian women working in the Norwegian Armed Forces (n = 1081). Participants were stratified into three age groups: 20-29; 30-39; and 40-60 years. We used Pearson Chi-square tests, Students t-tests and regression models to assess differences between the groups. RESULTS: The military women in our study reported physical illness and injuries equal to those of military men, but more military women used pain relieving and psychotropic drugs. More military women aged 20-29 and 30-39 years reported mental health issues than military men of the same age. In the age group 30-39 years, twice as many military women assessed their health as poor compared to military men. In the age group 40-60 years, more military women than men reported musculoskeletal pain. Military women used less smokeless tobacco than military men, but there were few differences in alcohol consumption and smoking. Military women appeared to be more physically healthy than civilian women, but we found few differences in mental health between these two groups. CONCLUSION: Most military women reported physical symptoms equal to those of military men, but there were differences between the genders in mental health and drug use. More favourable health compared to civilian women was most evident in the youngest age group and did not apply to mental health.

Confirmatory factor analysis of the behavior rating inventory of executive function in a neuro-pediatric sample and its application to mental disorders.

The construct validity of the 9-scale version of the Behavior Rating Inventory of Executive Function (BRIEF) parent form was examined in a clinical sample of children and adolescents with neurological and neurodevelopmental disorders (N = 281). Confirmatory factor analysis supported a three-factor model separating the inhibitory behavioral control dimension from the emotional control and metacognitive problem-solving dimensions. The Metacognitive factor was also related to a diagnosis of attention deficit/hyperactivity disorder (ADHD) after controlling for age, gender, IQ, adaptive functioning, and a conventional behavioral rating scale, which included inattention-hyperactivity symptoms. The Emotional Regulation factor was related to a diagnosis of oppositional defiant disorder. Correlational analyses indicated that child comorbid emotional and behavioral problems may exacerbate parental BRIEF reporting. Accordingly, when assessing executive function among children with neurological and neurodevelopmental disorders, the BRIEF should be complemented with assessments of mental health problems.

Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample.

Most research does not address the overlap between neurodevelopmental disorders when investigating concomitant mental health problems. The purpose of the present study was to examine the association of intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) with the presence of behavioural and emotional problems after controlling for other well-known correlates and risk factors. The sample included 4- to 18-year-old children who attended neuropaediatric clinics (N = 331). After controlling for adversity, age, gender, other developmental/neurological disorders, parental emotional problems, and parenting strategies, the presence of ADHD but not ASD or ID was uniquely associated with behaviour problems. Neither ADHD nor ASD nor ID was significantly associated with emotional problems after controlling for other risk factors. However, ADHD, ASD and behavioural/emotional disorders but not ID were significantly associated with functional impairment in everyday activities after controlling for other risk factors. Because children with neurodevelopmental disorders have complex needs, a holistic approach to diagnosis and interventions is highly warranted, including the assessment and treatment of behavioural and emotional disorders.

Linking interprofessional work to outcomes for employees: A meta-analysis.

The aim of this meta-analysis of studies of workers in the health and social care sector was to examine the relationship between interprofessional work and employee outcomes of job stress, autonomy, burnout, engagement, job satisfaction, turnover intention, and perceived service quality, and to examine the influence of different moderators on those relationships. A systematic literature search of the PsycInfo, Embase, Medline, and the Cumulative Index to Nursing and Allied Health Literature databases was conducted to identify relevant articles. A total of 45 articles with results for 53 independent samples was included in the meta-analysis. A random effects model was used to estimate the mean effect sizes (correlations). Most employees were nurses working in hospitals. Interprofessional work was weakly negatively associated with job stress, burnout, and turnover intention (range mean r = -.13 to -.22); and was moderately positively associated with autonomy, engagement, job satisfaction, and perceived service quality (range mean r =.33 to .46). When feasible, interprofessional work was categorized as teamwork (most intensive), collaboration, or cooperation. Teamwork, the most intense of three forms of interprofessional work, promoted lower burnout and turnover intention. The results of this meta-analysis suggest that interprofessional work is linked to better well-being for employees in health and social care.

Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being.

This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers' experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T1) and after (T2, T3) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T1 to T2. No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T3) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.

Parent participation in alcohol prevention: Evaluation of an alcohol prevention programme.

AIM: The main purpose of this study was to evaluate the effectiveness of the parental part of the Norwegian Unge & Rus (Youth and Alcohol) programme. The intervention was aimed at changing parents' rules and attitudes towards adolescent alcohol use, and their ability to talk with their adolescents about alcohol, as well as improving parents' relationships with and knowledge about their adolescents. These topics were addressed during parent meetings at school. METHOD: The effectiveness of the parent programme was tested using a longitudinal quasi-experimental control group design. Parents completed four online questionnaires N = 1166 at T1 in 2011 and N = 591 at T4 in 2013. Mixed models with observations nested in individuals were used to test the difference in rates of change between the groups. RESULTS: Parents in both groups reported strict rules and attitudes towards alcohol use. There were no significant differences in the changes between the two parent groups in terms of rules and attitudes at the three follow-up time points. The parents in the intervention did not change significantly compared to the parents in the comparison group on other alcohol-related questions. CONCLUSIONS: Parents are important facilitators for the transmission of alcohol-related attitudes and rules. However, our study did not show significant differences between changes experienced by the intervention group and those of the comparison group for the main outcome variables, such as rules, attitudes and talking about alcohol with their adolescents.