Program Profile: The Substance Use Prevention Promoted by Eating Family Meals Regularly (SUPPER) Project

This program seeks to help parents become facilitators in preventing children’s substance misuse, by encouraging them to have five or more family meals together weekly. The program is rated Promising. Intervention group parents showed a statistically significant increase in talking with children about alcohol, compared with control group parents, but there were no statistically significant differences in number of family meals per week and talking with children about marijuana and other drugs.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Substance Use Prevention Promoted by Eating family meals Regularly (SUPPER) Project is a brief preventive intervention that was designed to reduce children’s substance misuse, including increasing parent-child communication about substances and increasing eating family meals together (Skeer et al. 2016). Using a brief intervention model, the program targeted parents to help them become facilitators in preventing substance misuse among their children by encouraging them to have five or more family meals together weekly as the primary intervention strategy. During these family meals, parents are encouraged to talk to their children about the harms of substance use and other related topics. The goal is to prevent children’s misuse of substances, including alcohol, marijuana, and other drugs.

Target Population/Eligibility

To participate in the SUPPER intervention, parents had to meet the following criteria: 1) had a child in the third through sixth grade, 2) were in the same location as the child to facilitate a meal together at least 5 days per week, and 3) spoke English or Spanish fluently.

Program Components/ Key Personnel

The SUPPER program comprised of two parts: 1) an in-person session, and 2) a home-based component.

For the in-person session, parents first received a handbook (available in English and Spanish and written at an eighth-grade reading level) specific to their child’s gender that provided advice and information on the following: 1) background on adolescent substance use (such as up-to-date statistics and effects of substance use on the developing brain); 2) parent-child communication, which included the importance of open communication, monitoring, and ways to communicate effectively; 3) the importance of eating at least five meals per week with their children, including which meals parents should eat with their children, what to avoid doing during meals (such as watching TV or using phones to talk or text), and alternatives if eating meals together is not possible; 4) parent-child communication that specifically focused on the harms of substance use; and 5) a website that linked to resources for additional information, which were printed out for any parent without internet access. Parents were asked to read the entire handbook before the in-person session. Approximately 2 weeks after receiving the handbook, parents participated in a 1-hour session with a communication specialist, to review main points of the handbook that were most relevant to each parent and allow them to ask questions.

For the home-based component, which happened 2 weeks after the initial in-person session, parents had a 30-minute follow-up phone call with the same communication specialist. Text messages were sent to parents twice per week for 13 weeks, which provided reminders and tips reinforced by information in the handbook; a refrigerator magnet was also provided to reinforce the message about the importance of family meals.

Program Theory

The SUPPER program was based on the theory that a child’s family environment contains risk factors, such as family conflict and heightened family stress (Bray et al. 2001), and protective factors, such as family cohesion and effective family management (Spoth et al. 2005), both of which can impact substance use. Research suggests that family-centered approaches that focus on strengthening parent-child relationships, parental attitudes against substance use, and the monitoring of children are shown to prevent substance use among adolescents, even into young adulthood (Kumpfer et al. 2003; Skeer et al. 2016). In addition, because strengthening parent-child relationships is a principle of substance use prevention, family meals are thought to provide children with structure and stability, increase parent-child trust, and facilitate family communication (Skeer and Ballard 2013).

Study

Skeer and colleagues (2016) used a random assignment study design to examine the impact of the Substance Use Prevention Promoted by Eating family meals Regularly (SUPPER) Project. Parents were recruited between January and December 2014 from five public schools (K–8) in one school district in a large urban New England city; project staff recruited parents at school pickup, within afterschool programs, at school open houses, at parent-teacher conference events, and through posters/fliers and letters to parents. Data were collected at baseline using Computerized Assisted Survey Interview-administrated surveys that both parents and children completed. After completing the baseline survey, parents (n = 64) were randomized to either the intervention or the control group, using urn randomization to evenly distribute the number of boys and girls and the number of children in the targeted third through sixth grades across both conditions. Follow-up surveys were administered in person at 3- and 6-months post-intervention for the intervention and treatment groups (the CrimeSolutions review of this study focused on the findings at the 6-month follow up).

SUPPER intervention parents (n = 32) received the two-part intervention. Additionally, parents were asked to keep a weekly log of the number of meals they ate per week with the target child and the type of meals eaten (i.e., breakfast, lunch, dinner). The control group parents (n = 32) did not receive any additional information during the duration of the study. Of the 64 total participants, 90.6 percent of parents were female, with an average age of 37.9 years. More than half had a female child (55.1 percent). Of the parents, 56.3 percent had children in the third or fourth grade, and 43.7 percent had children in the fifth or sixth grade. About 30 percent of households were single-parent, while the remaining households had multiple caregivers. There were statistically significant differences between the intervention and control groups in age, gender, and single-parent households. Intervention group parents were slightly younger than control group parents (average age of 36.0 versus 39.6 years, respectively). The intervention group had a lower percentage of female parents, compared with the control group (82.8 percent versus 97.1 percent, respectively), and a lower percentage of single-parent households, compared with the control group (17.2 percent versus 40.0 percent, respectively). There was no indication as to whether adjustments were made for group differences at baseline.

There were four outcomes of interest: 1) parents talking to their children about drinking alcohol, 2) parents talking to their children about marijuana use, 3) parents talking to their children about other drugs, and 4) number of family meals per week.

Parents were also asked how frequently they spoke with their children about alcohol, marijuana, and other drugs. For each of these substance categories, parents were asked how many times they had ever communicated with their children about it, and how many times they communicated about it in the past 3 months. If parents responded that they spoke with their children about any of the three substance categories, they were then asked how frequently they had those conversations over the past 3 months: 1) “a lot;” or 2) “never,” “once,” or “few times” for alcohol, marijuana, and other drugs. Repeated measures log binomial regression analyses were used to evaluate differences in the percentage of parents who talked to their children “a lot” about substance at the 6-month follow up.

Family meals were defined as when the parent sat down with their children (those who participated in the study with their parents) and either the parent or child was eating, regardless of what type of food was served. Family meals were measured through self-reports that indicated the total number of meals eaten together per week. Repeated measures analyses of covariance were used to evaluate the difference in the average number of meals per week between the intervention and control groups at the 6-month follow up. The study authors did not conduct subgroup analyses.

Subgroup Analysis

Skeer and colleagues (2016) found that parents in the Substance Use Prevention Promoted by Eating family meals Regularly (SUPPER) intervention averaged eating 4 meals per week at breakfast, 2.4 meals per week at lunch, and 5.4 meals per week at dinner with their children, compared with parents in the control group who averaged eating 3.3 meals at breakfast, 2.2 meals at lunch, and 5.4 meals at dinner. There were no statistically significant differences between the intervention group and control group in the specific types of meals (breakfast, lunch, or dinner).

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Bray, James H., Gerald J. Adams, J. Greg Getz, and Teressa Stovall. 2001. “Interactive Effects of Individuation, Family Factors, and Stress on Adolescent Alcohol Use.” American Journal of Orthopsychiatry 71(4):436–49.

Kumpfer, Karol L., Rose Alvarado, and Henry O. Whiteside. 2003. “Family Based Interventions for Substance Use and Misuse Prevention.” Substance Use & Misuse 38(11–13):1759–87.

Skeer, Margie R., and Erica L. Ballard. 2013. “Are Family Meals as Good for Youth as We Think They Are? A Review of the Literature on Family Meals as They Pertain to Adolescent Risk Prevention.” Journal of Youth and Adolescence 42(7):943–63.

Spoth, Richard, G. Kevin Randall, Chungyeol Shin, and Cleve Redmond. 2005. “Randomized Study of Combined Universal Family and School Preventive Interventions: Patterns of Long-Term Effects on Initiation, Regular Use, and Weekly Drunkenness.” Psychology of Addictive Behaviors 19(4):372–81.