The results supported previous research suggesting carers of children with intellectual disabilities experience high parent-related stress. The results also support the buffer model of social support, as high social support was related to lower parent-related stress. Self-rated prosperity, financial pressure and relationship status were also related to lower levels of parent-related stress.

Background and Aims Impulsivity impacts adolescent alcohol use. We aimed to prospectively evaluate the cognitive mechanisms outlined in two-factor models and the protective role of coping skills. Methods Two cohorts of adolescents followed for three years were included in the study (younger cohort: N = 908, aged 10–12 years at Time 1; older cohort: N = 943, aged 12–15 years at Time 1). Constructs measured included impulsivity (reward drive, rash impulsiveness), positive social alcohol expectancies (PSAE), drinking-refusal self-efficacy (DRSE), problem-based coping skills, family and community risk factors, and alcohol use including the Alcohol Use Disorders Identification Test (AUDIT). Results Data were analysed using structural equation modelling controlling for family and community risk factors, testing mediation and moderation. Impulsivity traits predicted cognitive mechanisms and these in turn predicted alcohol use in both cohorts (χ2 = 1,139.79, df = 249, p < .001, CFI = .92, SRMR = .06, RMSEA = .04). DRSE and PSAE mediated the effects of rash impulsiveness and reward drive, respectively, on alcohol use. Problem-based coping skills moderated several pathways to drinking within each cohort, being protective even when adolescents have low DRSE, and buffering the impact of PSAE on alcohol use. Conclusions The current study details the prospective interactive influences of impulsivity and cognitive risk factors on adolescent alcohol use. The findings have direct implications for prevention and treatment programs, providing information about possible high-impact targets for intervention.

The DRSEQ-SRA is a short, 9-item, measure of adolescent drinking-refusal self-efficacy which demonstrates both reliability and validity. A significant advantage is brevity. The DRSEQ-SRA may be a valuable tool for identifying risk of adolescent drinking and prevention/treatment planning in settings where survey administration time is critical.

Public Health Significance Statements • This study supports targeting cognitive risk factors for adolescent alcohol use through Cognitive Behavioral Therapy to reduce the growth of alcohol consumption in adolescents. • The addition of Mindfulness Meditation to existing Cognitive Behavioral Therapy did not improve alcohol use outcomes when compared to an active control.

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