Underage drinking continues to be a significant public health concern in the U.S. (Centers for Disease Control and Prevention [CDC], 2022, National Institute on Alcohol Abuse and Alcoholism [NIAAA]., 2019). Results from national surveys suggest that the high school years are a critical time to intervene as this period occurs just before alcohol consumption escalates in later adolescence (ages 17–20). Parents can play a powerful role in influencing teen alcohol use during this time (Abar et al., 2011, Zehe and Colder, 2014, Kuntsche and Kuntsche, 2016, Sellers et al., 2018, Byrnes et al., 2019). A growing body of literature provides evidence for prevention of adolescent drinking associated with parent-teen communication (Abar et al., 2011, Spirito et al., 2015, Kuntsche and Kuntsche, 2016, Shin et al., 2019). However, existing evidence-based programs for parents and families of high-school students tend to require a great investment in delivery (i.e., implementer, space) and/or participation (i.e., time, number of sessions) which presents challenges with regards to wide-spread adoption (e.g., Kumpfer et al., 2007).

To address these concerns, the present study focused on adapting a brief, universal intervention, the Parent Handbook (PH), designed for parents of college students, for a high school parent audience. To our knowledge, the PH is the only evidence-based, brief parent intervention focused specifically on alcohol use that has undergone the rigor of multiple, well-controlled clinical trials, with several independent replications (Doumas et al., 2013, Ichiyama et al., 2009, Testa et al., 2010), and endorsement in the Surgeon General’s report as being efficacious (U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, 2016). It is a 35-page guide for parents derived from research on college student decision-making about alcohol and parent–child communication (e.g., Turrisi et al., 2001, Turrisi et al., 2013). The PH exists in hard copy or PDF form and provides parents with: 1) tips to improve general communication skills; 2) suggestions for how to guide teens on choosing friends, peer pressure, and decision making; and 3) a guide to discussing alcohol-specific topics.

Adaptations to the PH in the current study spanned both content and context and aimed to maximize engagement with and perceived acceptability and usability of the intervention, which is necessary to optimize program effectiveness (Greene et al., 2020, Milward et al., 2018, Perski et al., 2018) and is central to program uptake (Perski and Short, 2021, van Gemert-Pijnen et al., 2011). Context adaptations included both population and format. As noted above, the audience shifted to parents of high school students. This had the added benefit of reaching parents of non-college bound youth who represent 37% of the high school student population (NCES, 2022). The format shifted to a web-application (web-app) optimized for use on a smartphone to increase accessibility of information and ease of dissemination. From an implementation perspective, this format reduces costs associated with printing and/or mailing the handbook and increases delivery options (e.g., a link can be emailed, texted, shared via social media, etc.). While these issues could arguably be addressed by sharing a PDF version of the handbook online, this format is not optimized for display on smaller devices. Taken together, context adaptations were motivated by identified needs highlighted in the broader scientific literature including: lack of brief parent-based interventions for parents of high school students and a need for interventions that are easy to implement and disseminate.

Content adaptations were driven by the context adaptations. First, any content that referenced college student drinking (e.g., statistics about prevalence of alcohol use) was changed to reflect accurate information about high school students, in line with the new target audience. Second, although the general topics from the original handbook intervention were retained, it was necessary to reduce the amount of text consistent with the need to deliver content on a smartphone screen. The decision about what content to cut was a collaborative process between the research team and the developer of the original intervention. The focus was on retaining the key messages within each section of content, along with a few illustrative examples. For example, on the section that provided parents with suggestions for what alcohol-specific topics to discuss with their teens, the primary message that was reinforced is that communication should be ongoing, not a one-time occurrence. Then parents were presented with the list of recommended topics and sample conversation starters. To offset text, brief videos were added which provided an engaging way to deliver content that was well suited for the web-based platform.

This study is a formative assessment of the adapted PH intervention, named REAL Parenting (RP), with a nationally representative sample of parent-teen dyads who were randomized to receive the program as a part of a larger pilot study. Formative assessments are a critical step in adapting evidence-based programs (CDC, 2020).

The first aim was to describe engagement with, and acceptability and usability of RP. In past evaluations of the PH, parent engagement ranged from 62% to 85%, determined by asking parents to return materials, and in some cases, write summaries on the PH itself (; Ichiyama et al., 2009, Turrisi et al., 2009, Turrisi et al., 2013, Turrisi et al., 2001). Switching to a web-app format allowed engagement to be measured with objective program analytics (e.g., number of clicks). Acceptability and usability were assessed with self-report measures, and we explored whether baseline demographic characteristics were associated with analytic and self-report variables.

The second aim was to examine the relationship between program analytic indicators of engagement and self-report indicators of acceptability and usability with each other and with short-term outcomes for parents who used the app. Prior work suggests program analytic indicators of engagement are positively correlated with self-report indicators of acceptability and usability (Greene et al., 2020, Ray et al., 2020) but that these variables are differentially associated with outcomes (Greene et al., 2020). We expected to find similar associations in this study.