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• Critical appraisal of the article
  Mahdi Alfadhl
  Published on: 1 April 2016

• Published on: 1 April 2016

  Critical appraisal of the article

  • Mahdi Alfadhl, Masters in clinical epidemiology candidate

  I would like to submit this paper to the authors of this article for the purpose of commenting on the methods and results in the form of critical appraisal:

  This study addresses a clearly focused question in terms of population, the exposure, the outcomes, and the timeline of the study. The primary hypothesis was clearly outlined in this study as well as the secondary hypothesis. The study design chosen, prospect...

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  I would like to submit this paper to the authors of this article for the purpose of commenting on the methods and results in the form of critical appraisal:

  This study addresses a clearly focused question in terms of population, the exposure, the outcomes, and the timeline of the study. The primary hypothesis was clearly outlined in this study as well as the secondary hypothesis. The study design chosen, prospective cohort is an appropriate design for addressing the research question as the paper was attempting to study a certain exposure (parental styles) and its effect on subsequent substance use among adolescents. The cohort group may not be representative of the population, as study subjects were not randomly selected. Also, it is worth noting that this paper does not clearly state the inclusion/exclusion criteria used in recruiting the students, which may hinder the external validity of the study.

  In addition, the outcome measurements used in this paper were validated and the components of each questionnaire were clearly defined. However, given that all the outcome measures were subjective and rely heavily on self- report, the possibility of biased responses is high especially that it involves asking children about harmful behaviors as some of them would have a tendency to answer the questions based on social desirability rather than the truth. This can tremendously affect the internal validity of the results.

  Furthermore, the authors have identified and analysed several important confounding factors such as gender, parental behaviour, behaviour in school, deviant peers, delinquency, among other factors, which is important to get a genuine picture of the real effect of exposure. However, other important confounders were overlooked such as income, level of education, and whether parents are separated, which in my opinion are very important confounding factors that affect parents' attitudes towards their child's substance use habits.

  The follow up period was adequate (32 months) to determine whether baseline exposure influenced the outcome at teenage years of the students. Also, sensitivity analysis was performed to determine whether results were different for those lost to follow up. The final results of the study concluded no significant association between parenting styles and subsequent use of substance by adolescents. The paper included adjusted and non-adjusted odds ratio with 95% confidence intervals, which is very vital for interpretation of results. Nevertheless, the results may have been affected by reporting bias, and ignored confounders as mentioned earlier.

  It is interesting that results of this study are different from similar studies with larger sample sizes (1, 2). As opposed to this study, both studies reported a significant relationship between authoritative parenting style and reduction in substance use among adolescents (1, 2). Could the difference be attributed to cultural differences in parental approval of underage drinking?

  In conclusion, this study has its shares of strengths and weaknesses. A strong point in this study is its large sample size, which comes from different schools in Sweden, which raises the possibility for generalization of results. Another strong point is that the study has a long follow up time and a high response rate from adolescents and minimal dropouts, which increases the power of the study. On the other hand, weaknesses include the heavy reliance on self-report on measuring the outcomes and missing important confounding factors.

  References:

  1. Calafat A, Garcia F, Juan M, Becona E , & Fernandez-Hermida. Which parenting style is more protective against adolescent substance use? Evidence within the European context. Drug and Alcohol Dependence, 2014;138:185-192.

  2. Shakya HB, Christakis NA, & Fowler JH. Parental Influence on Substance Use in Adolescent Social Networks. Arch Pediatr Adolesc Med Archives of Pediatrics & Adolescent Medicine, 2012;166(12):1132-1139.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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