Parent–child connectedness and communication in relation to alcohol,tobacco and drug use in adolescence: An integrative review of the literature

Previous reviews have highlighted parent–child connectedness and communication as important protective factors against adolescent substance use. However, these reviews focus on single substances such as alcohol. An integrative review of the literature was conducted to examine which elements of parent–child connectedness and substance-use specific communication are effective across adolescent alcohol, tobacco and drug use. Forty-two English language, peer reviewed articles were reviewed. Open communication occurs within the context of high connectedness between parents and their children. Conversations about health risks are associated with lower levels of substance use while more frequent conversations, those about parents’ own use, permissive messages and consequences of use are associated with higher levels of use. There are disparities regarding conversations about use of each substance: alcohol and tobacco are easier topics of conversation while drug use is rarely discussed. Parental alcohol and tobacco use can influence the credibility of their communication with their child. Parents should be encouraged to have open, constructive, credible, two-sided conversations with their adolescents about substance use. Interventions to improve parents’ communication skills around substance use, particularly drug use, should include the types of approaches and messages highlighted in this review, and, where possible, these interventions should include all family members.     

History of marijuana use and tobacco smoking topography in tobacco-dependent adolescents

Adolescent tobacco smokers have higher rates of marijuana (MJ) use than nonsmokers. Because MJ smoking typically involves deeper inhalation and longer breathholding than tobacco smoking, we hypothesized greater puff volume, longer puff duration and puff interval, and higher puff velocity during tobacco smoking among (1) MJ-using teens; (2) teens whose onset of MJ smoking occurred before tobacco (MBT). One hundred and three tobacco-dependent adolescents presented for smoking cessation treatment (66.0% female, 71.0% European American, mean age 15.3+/-1.25 years) smoked one cigarette of their own brand in the laboratory prior to study entry. Topography and associated physiological measures among current recreational (<5 days in a 14-day period) MJ users (n=25), current heavy (>/=5 days in a 14-day period) MJ users (n=22) and current non-MJ-smoking teens (n=56) were compared. There were no differences in tobacco smoking topography or physiological measures by recent MJ-smoking history or by order of substance initiation. Significantly more African American than European American adolescent smokers reported MJ use before tobacco. Our findings in adolescent smokers are consistent with results from adult studies in which history of MJ smoking was not associated with changes in tobacco smoking topography.     

Smoking, drugs, and other behavioral health problems among multiethnic adolescents in the NHSDA

Data from the NHSDA (2000) which contained screening measures for assessing risk for DSM-IV psychiatric disorders, were used to estimate smoking prevalence and its association with these disorders, among European American, Hispanic, and African American adolescents. Prevalence estimates, odds ratios, and hazard models were used to compare ethnic subgroups. European American and Hispanic adolescents born in the U.S. had a higher prevalence of smoking and DSM-IV tobacco dependence, and girls were higher than boys. Lifetime smokers had statistically significant odds ratios for anxiety, affective, substance use, and any behavior disorder, while Current smokers had a similar risk pattern except anxiety disorder. The increased risk for substance use disorder among smokers was notably higher. A hazard analysis showed that early onset of smoking (before 12 years) was related to earlier illicit drug use initiation as contrasted with later onset (12 years +), and non-smoking sharply reduced risk and delayed initiation into drug use. African American and Hispanic immigrants had lower risk of smoking initiation and tobacco dependence, however, ethnic group adolescents who initiated smoking shared increased risk of addictive and non-addictive disorders.     

Is prenatal tobacco exposure a risk factor for early adolescent smoking? A follow-up study

Recent reports indicate a relation between prenatal tobacco exposure (PTE) and offspring smoking. Many of these reports have been retrospective or have not included important variables such as other prenatal substance exposures, maternal and child psycho-social characteristics, mother's current smoking, and friends' smoking. No prior study has examined the timing of PTE. In this prospective study of a birth cohort of 567 14-year-olds, we examined the relation between trimester-specific PTE, offspring smoking, and other correlates of adolescent smoking. Average age of the adolescents was 14.8 years (range: 13.9-16.6 years), 51% were female, 54% were African-American. Data on maternal tobacco and other substance use were collected both prenatally and postnatally, 51% of the mothers were prenatal smokers and 53% smoked when their children were 14 years. PTE in the third trimester significantly predicted offspring smoking (ever/never, smoking level, age of onset) when demographic and other prenatal substances were included in the analyses. PTE remained a significant predictor of the level of adolescent smoking when maternal and child psychological characteristics were added to the model. When more proximal measures of the child's smoking were included in the model, including mother's current smoking and friends' smoking, PTE was no longer significant. Significant predictors of adolescent smoking at age 14 were female gender, Caucasian race, child externalizing behavior, maternal anxiety, and child depressive symptoms. Although direct effects of PTE on offspring smoking behavior have previously been reported from this study and by others, by early-adolescence, this association is not significant after controlling for the more proximal covariates of adolescent smoking such as mother's current smoking and peer smoking.     

Smoking Intervention With Adolescent Substance Abusers: Initial Recommendations

Recent increases in adolescent cigarette smoking have provided an impetus for developing effective youth smoking-cessation interventions. Adolescents treated for substance abuse are a particularly important target for tobacco use intervention given the high prevalence and persistence of smoking among this subgroup of youth. The few studies to date of adolescent smoking cessation have demonstrated little success in effecting change in tobacco use. In the absence of empirical evidence, recommendations for tobacco intervention with substance-abusing adolescents are proposed based on information from several sources: studies of adolescent smoking cessation, adolescent developmental considerations, issues specific to substance abusers, motivational concerns, and adult smoking-cessation techniques. An outline is provided of components to consider for inclusion in a substance-abusing adolescent smoking intervention. It is suggested that tobacco-focused interventions be incorporated as a routine part of treatment for adolescent substance abuse.     

Parental awareness of adolescent substance use

Parental awareness of adolescent substance use was investigated in a high school sample of 985 adolescents and their parents. Only 39% of parents were aware their adolescent used tobacco, only 34% were aware of alcohol use, and only 11% were aware of illicit drug use. There were no variables that differentiated aware from unaware parents for all substances. Greater parental awareness of alcohol and tobacco use occurred with older adolescents. High adolescent ratings of family communication combined with low parental ratings of family communication were also associated with greater parental awareness of alcohol and tobacco use. Better school grades predicted greater awareness of alcohol and illicit drug use. Single parents and blended families were more aware of tobacco and illicit drug use.     

Smoking cessation during substance abuse treatment: what you need to know

Patients in substance abuse treatment frequently smoke cigarettes and often die of tobacco-related causes. Substance abuse treatment programs too often ignore tobacco use. Many patients have expressed interest in stopping smoking, although they may be ambivalent about smoking cessation during substance abuse treatment. This article provides a review of tobacco cessation literature and successful methods of intervention. Research supports two key findings: (a) smoking cessation during substance abuse treatment does not impair outcome of the presenting substance abuse problem and (b) smoking cessation may actually enhance outcome success. We will discuss how to incorporate smoking cessation.     

African–American Women’s Tobacco and Marijuana Use: The Effects of Social Context and Substance Use Perceptions

Background: Despite the status of tobacco and marijuana as two of the most commonly used substances in the U.S., both have detrimental health and social consequences for disfranchized African–Americans. Substance use may be shaped by social contextual influences from families and peers in African–American communities, and little research has examined perceptions of wrongfulness, harms, and dangers associated with daily tobacco and marijuana use among African–American women. Objectives: This study explores the effects of African–American women’s social context and substance use perceptions (wrongfulness/harmfulness/dangerousness) on daily tobacco and marijuana use. Methods: Survey data was collected in-person from 521 African–American women. Multivariate logistic models identified the significant correlates of women’s daily use of tobacco and marijuana in the past six months. Results: 52.59% of participants reported daily tobacco use and 10.56% used marijuana daily. Multivariate models indicated that women were more likely to be daily tobacco users if they had a family member with a substance use problem or perceived tobacco use to be wrong, harmful, or more dangerous than marijuana. In the models with marijuana as the dependent variable, women who lived with a person who used drugs were more likely to use marijuana daily. Perceiving marijuana use as wrong or harmful to one’s health was protective against daily marijuana use. Conclusions: Findings stress the need for prevention and intervention efforts for African–American women that highlight social context influences and promote greater awareness of the health risks associated with daily tobacco and marijuana use.     

Parental Style and Its Association With Substance Use in Argentinean Youth

Background: In Europe and the United States, family relationships and parenting behavior can influence youth substance use, but less is known about their influence in Latin American countries. Objective: To explore whether parenting behavior is associated with substance use among Latin American youth. Methods: A cross-sectional, school-based survey of middle-school youth (n = 3172) in three Argentinian cities queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Parenting behavior was assessed with previously validated items that tapped into demandingness and responsiveness, separately for mothers and fathers. Multilevel logistic regression models assessed associations between parenting behavior and substance use after adjusting for student characteristics, socioeconomic indicators, sensation seeking, and smoking amongst peers and family members. Results: Substance use prevalence was 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day binge drinking (≥5 drinks), and 8% for previous year illicit drug use (marijuana or cocaine). Greater maternal demandingness was independently associated with lower likelihood of current smoking (adjusted odds ratio [AOR] = 0.77; 95% confidence interval (CI): 0.64–0.92), current drinking (AOR = 0.81; 95% CI: 0.71–0.92), binge drinking (AOR = 0.77; 95% CI: 0.66–0.99, and drug use (AOR = 0.71; 95% CI: 0.61–0.83). No other parenting behavior were independently associated with substance use, except for paternal demandingness and binge drinking (AOR = 0.84; 95% CI: 0.74–0.97). For all outcomes, no interactions were found between parenting behavior and student gender. Conclusions: Among Argentine adolescents, maternal demandingness was the strongest and most consistent correlate of substance use, regardless of adolescent substance use behavior or gender.     

“I just use it for weed”: The modification of little cigars and cigarillos by young adult African American male users

Little cigar and cigarillo (LCC) use has received increased attention, but research on their modification is limited. Qualitative interviews with 17 young adult African American male LCC users investigated tobacco use behaviors and patterns, including LCC modification. The modification of LCCs for use as blunts emerged as a very prominent aspect of LCC users’ tobacco use. Four subthemes regarding marijuana and blunt use are explored in this article, including participants’ explanations of how blunts are made and used, concurrent use of marijuana and tobacco, perceptions and reasons for smoking marijuana and blunts, and perceptions of the risks of blunt use.     

Tobacco policies and on-premise smoking in bars and clubs that cater to young African Americans following the Maryland Clean Indoor Air Act of 2007

African American young adults ages 18–25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18–25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues—selected on the basis of youth reports of popular venues—were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.     

Personal Values as a Mediator of Relations Between Perceived Parental Support and Control and Youth Substance Use

Background: Tobacco and marijuana smoking are very popular in adolescence and there is a high rate of comorbidity between them, even in young adulthood. Parental support and control may hinder involvement in the use of these substances by promoting conventional values among adolescents. Objectives: The present study investigates the relations between family functioning (parental support and control) and psychoactive substance use (tobacco and marijuana smoking) and determines whether these relationships are mediated by personal values (in terms of disapproval of deviance and beliefs about the importance of school, health and religion). Methods: 175 Italian late adolescents (17 to 20 years old) participated in this two-wave longitudinal study. Data were collected at school through an anonymous questionnaire. Results: Greater parental control and support were directly associated with lower adolescent tobacco and marijuana use; adolescent acceptance of conventional values mediated the association between parenting and adolescent marijuana use. Conclusion: Findings emphasize the influence of family relationships throughout adolescence. The transmission of conventional values to adolescents may be a critical mechanism through which parenting protects adolescents from substance use, especially marijuana use.     

Parental substance use consequences and adolescent psychopathology

OBJECTIVE: This study examines the relationship between parental substance use consequences and adolescent psychological problems by gender of the adolescent and gender of the parent. METHOD: The data in this study were collected between 1989 and 1994 from 173 (116 proband and 57 control) families participating in the Collaborative Study on the Genetics of Alcoholism (COGA) project. All 173 adolescents (89 [51%] boys) completed the Structured Assessment Record of Alcoholic Homes (SARAH) to assess parental substance use consequences. In addition, the Semi-Structured Assessment for the Genetics of Alcoholism for Adolescents (C-SSAGA-A) was administered to all adolescents to obtain clinical psychiatric diagnoses. RESULTS: Concern about mother's substance use was significantly associated with adolescent alcohol dependence and major depressive disorder. In addition, concern about father's substance use was significantly related to adolescent alcohol dependence. Avoidance of mother when she was drinking or using drugs and maternal anger when drinking or using drugs also was significantly associated with adolescent alcohol dependence, conduct disorder and major depressive disorder. In contrast, avoidance of father and paternal anger when drinking or using drugs was not related to any of the adolescent diagnoses. CONCLUSIONS: These results suggest that maternal substance use consequences may be more closely linked to adolescent psychological adjustment than are paternal substance use consequences.     

The magnitude and impact of tobacco marketing exposure in adolescents' day-to-day lives: An ecological momentary assessment (EMA) study

PurposeResearch indicates that tobacco marketing contributes to higher pro-tobacco attitudes and behaviors among adolescents, but no studies have been able to assess the impact of real-world tobacco marketing exposures in real-time. The purpose of this study was to examine the magnitude and impact of tobacco marketing exposure on adolescents using ecological momentary assessment (EMA). Our primary hypotheses were that (1) youth would most frequently report tobacco marketing at the retail points-of-sale and (2) greater exposures to tobacco marketing would be associated with more favorable tobacco-related attitudes, use, and expectancies.MethodsParticipants were adolescent males from rural and urban Ohio (N = 176, ages 11–16). For ten days, these adolescents were prompted at two—three random times/day to complete a brief smartphone-based survey about their exposures and responses to tobacco-related advertising.ResultsAdolescents reported exposures to tobacco marketing an average of 1.9 times over the 10-day EMA period, with over 10% seeing a tobacco advertisement 5 or more times. Reports of marketing exposures occurred most frequently at the point-of-sale; exposures were higher among tobacco users and rural adolescents. Consistent with hypotheses, marketing exposure was related to more positive attitudes to the tobacco advertisements, more tobacco use, and higher expectancies to use in the future.ConclusionsOverall, these findings signal the magnitude of tobacco marketing exposures and their pernicious impact on youth. Findings underscore the importance of federal, state, and local-level tobacco regulatory policies to protect youth from the marketing that puts them at risk for a lifetime of nicotine addiction and tobacco-related diseases.     

Parent–child communication and substance use among adolescents: Do father and mother communication play a different role for sons and daughters?

The purpose of this study was to investigate gender-specific variations in the associations between communication with father and mother, cigarette smoking, alcohol drinking and marijuana use in male and female adolescents. Cross-sectional data were collected from a national sample of 1308 tenth graders who participated in the 2005/06 U.S. HBSC. Outcome variables were self-reported substances used in the past 30 days. Logistic regression analyses controlling for race/ethnicity, family structure and socioeconomic status showed that the association of mother and father communication with adolescent substance use varied by substance and gender. Among sons, father communication was protective against marijuana use and mother communication was protective against smoking. Neither father nor mother communication was protective against substance use by daughters. Research is needed to understand gender-specific differences in correlates of adolescent substance use and the implications for prevention and intervention.     

Visuospatial memory deficits emerging during nicotine withdrawal in adolescents with prenatal exposure to active maternal smoking.

Active maternal smoking during pregnancy elevates the risk of cognitive deficits and tobacco smoking among offspring. Preclinical work has shown that combined prenatal and adolescent exposure to nicotine produces more pronounced hippocampal changes and greater deficits in cholinergic activity upon nicotine withdrawal than does prenatal or adolescent exposure to nicotine alone. Few prior studies have examined the potential modifying effects of gestational exposure to active maternal smoking on cognitive or brain functional response to tobacco smoking or nicotine withdrawal in adolescents. We examined visuospatial and verbal memory in 35 adolescent tobacco smokers with prenatal exposure to active maternal smoking and 26 adolescent tobacco smokers with no prenatal exposure to maternal smoking who were similar in age, educational attainment, general intelligence, and baseline plasma cotinine. Subjects were studied during ad libitum smoking and after 24 h of abstinence from smoking. A subset of subjects from each group also underwent functional magnetic resonance imaging while performing a visuospatial encoding and recognition task. Adolescent tobacco smokers with prenatal exposure experienced greater nicotine withdrawal-related deficits in immediate and delayed visuospatial memory relative to adolescent smokers with no prenatal exposure. Among adolescent smokers with prenatal exposure, nicotine withdrawal was associated with increased activation of left parahippocampal gyrus during early recognition testing of visuospatial stimuli and increased activation of bilateral hippocampus during delayed recognition testing of visuospatial stimuli. These findings extend prior preclinical work and suggest that, in human adolescent tobacco smokers, prenatal exposure to active maternal smoking is associated with alterations in medial temporal lobe function and concomitant deficits in visuospatial memory.     

The impact of adolescent tobacco-related associative memory on smoking trajectory: an application of negative binomial regression to highly skewed longitudinal data

Tobacco use is prevalent in adolescents and understanding factors that contribute to smoking uptake remains a critical public health priority. While there is now good support for the role of implicit (preconscious) cognitive processing in accounting for changes in drug use, these models have not been applied to tobacco use. Longitudinal analysis of smoking data presents unique problems, because these data are usually highly positively skewed (with excess zeros) and render conventional statistical tools (e.g., OLS regression) largely inappropriate. This study advanced the application of implicit memory theory to adolescent smoking by adopting statistical methods that do not rely on assumptions of normality, and produce robust estimates from data with correlated observations. The study examined the longitudinal association of implicit tobacco-related memory associations (TMAs) and smoking in 114 Australian high school students. Participants completed TMA tasks and behavioural checklists designed to obscure the tobacco-related focus of the study. Results showed that the TMA-smoking association remained significant when accounting for within-subject variability, and TMAs at Time 1 were modestly associated with smoking at Time 2 after accounting for within subject variability. Students with stronger preconscious smoking-related associations appear to be at greater risk of smoking. Strategies that target implicit TMAs may be an effective early intervention or prevention tool. The statistical method will be of use in future research on adolescent smoking, and for research on other behavioural distributions that are highly positively skewed.     

School-Level Correlates of Adolescent Tobacco,Alcohol, and Marijuana Use

Background: School-level characteristics are related to students’ substance use, but little research systematically examined multiple school characteristics in relation to different types of substance use across grade levels. Objectives: This study examines multiple school-level characteristics as correlates of students’ tobacco, alcohol, marijuana, and combined substance use across three grade levels. Methods: Students (N = 23,615) from 42 urban and suburban middle schools and 24 high schools in the U.S. reported on their tobacco, alcohol, and marijuana use. Students’ mean age was 14 years; 47% were male, 53% African American, and 41% Caucasian. School-level data included poverty, racial composition, academic achievement, student-teacher ratio, absenteeism, and school size. Multilevel logistic and Poisson regressions tested associations between school-level predictors and adolescent substance use in middle school, early high school, and late high school. Results: School-level poverty, more ethnic minority students, low achievement, and higher absenteeism were related to alcohol, marijuana, and combined substance use, particularly at lower grade levels. By contrast, cigarette smoking was more prevalent in more affluent high schools with more White students. After adjusting for other school characteristics, absenteeism emerged as the most consistent predictor of student substance use. Conclusions/Importance: Interventions addressing absenteeism and truancy in middle and high schools may help prevent student substance use. Schools serving poor, urban, and mostly minority students may benefit from interventions targeting alcohol and marijuana use, whereas interventions focusing on tobacco use prevention may be more relevant for schools serving more affluent and predominantly White students.     

Psychiatric Symptoms,Parental Attachment,and Reasons for Use as Correlates of Heavy Substance Use Among Treatment-Seeking Hispanic Adolescents

In early adolescence, Hispanics self-report higher drug use rates compared to White and African American peers. Among adolescent users, heavy users have more negative behavioral and health consequences. The purpose of this cross-sectional study is to examine whether psychiatric symptoms, parental attachment, and reasons for use predict heavy alcohol and illicit drug use (more than 10 times in the past three months) among Hispanic adolescents. Methods: This study examines baseline data from a study evaluating a family based substance abuse treatment program for Hispanic adolescents. Participants were 14–17 years old (N = 156, 44% female). Adolescent reports on the Diagnostic Interview Schedule for Children Predictive Scales measured psychiatric symptoms of major depressive disorder, attention deficit hyperactivity disorder, conduct disorder, and anxiety. The Personal Experiences Inventory measured type and amount of drug use, as well as perceived social and psychological benefits of drug use. The Inventory of Parent and Peer Attachment measured trust, communication, and alienation between adolescents and their mothers. Logistic regression identified correlates of heavy alcohol use and heavy illicit drug use among Hispanic adolescents. Results: Higher social benefits were associated with increased likelihood of heavy alcohol use. Conduct disorder, higher levels of maternal attachment, lower levels of acculturation, and higher levels of psychological benefits of use were associated with an increased likelihood of heavy illicit drug use. Conclusion: These findings support the assumption that substance use treatment among Hispanic adolescents must be capable of addressing co-occurring psychiatric disorders, familial relationships, and the individual reasons/motivators to use.     

Interest in marijuana treatment programs among teenage smokers and nonsmokers

Little is known about adolescents' interest in marijuana treatment programs. This question was evaluated by telephone interview in a convenience sample of 575 adolescents responding to advertisements for tobacco research studies. Eighty-one percent of respondents endorsed the need for marijuana treatment programs for adolescents. These adolescents were younger and less likely to smoke tobacco, smoke marijuana, or use alcohol than those not endorsing such a need. Among the 192 marijuana smokers, the 58.8% who endorsed the need for marijuana treatment programs took their first puff of marijuana at a younger age than those who did not endorse the need. Those who were willing to participate in a marijuana treatment program were more likely African American and took their first marijuana puff at a younger age than those not interested in treatment. These findings suggest that most adolescent marijuana smokers endorse the need for and are willing to attend marijuana treatment programs.