National Trends in Parental Communication with their Teenage Children about the Dangers of Substance Use, 2002–2016.

Abstract

Parental engagement is critical to adolescent substance use prevention. However, our understanding of the degree to which parents are actually talking to their children about tobacco, alcohol, and drugs remains limited. The present study provides new evidence on the prevalence and trends of parental substance use communication (PSC) in the United States between 2002 and 2016. Trend analyses were conducted using 15 years of cross-sectional survey data from non-Hispanic White (n = 153,087), Black/African American, and Hispanic (n = 45,780) adolescents aged 12–17 from the National Survey on Drug Use and Health. Since the early-to-mid 2000s, the rate of past-year PSC declined significantly, even when accounting for sociodemographic factors. We observed particularly noteworthy declines among adolescents residing in households earning less than $20,000 per year, declining by 19% (in relative terms) from a high of 58% PSC in 2003 and 2008 to a low of 47% in 2016. Teens reporting PSC reported higher levels of perceived parental warmth/engagement and consistent discipline/limit setting. Findings underscore the importance of engaging parents, particularly those less likely to talk to their children about substance use, and providing caregivers instruction and encouragement to talk to teens about the very real dangers of substance use.

INTRODUCTION

Each year, millions of American adolescents use tobacco, alcohol, and illicit drugs. Recent estimates indicate that in 2016, among young people aged 12 to 17 in the United States (US), one in ten used tobacco, more than one in five used alcohol, and nearly one in six used an illicit drug (Center for Behavioral Health Statistics and Quality [CBHSQ], 2017). These figures are alarming because substance use during adolescence can place teens at risk for many adverse outcomes, including injury, arrest, and substance use disorders (Salas-Wright, Reingle Gonzalez, & Vaughn, 2016).

Prevention is a critical component of the substance use continuum of care, which includes health promotion efforts, prevention and treatment programs, and long-term recovery support (Substance Use and Mental Health Services Administration [SAMHSA], 2018). Ecodevelopmental theorists have noted that prevention efforts are most effective when targeting multiple domains of risk (e.g., school and neighborhood microsystems) and have underscored the primary importance of parenting practices and clear communication with respect to substance use risk (Pantin, Schwartz, Sullivan, Coatsworth, & Szapocznik, 2003; Szapocznik & Coatsworth, 1999). Indeed, we see that interventions specifically designed to encourage parents to speak with their children about substance use are highly effective in reducing risk of tobacco, alcohol, and illicit drug use (Dishion et al., 2002; Prado & Pantin, 2011).

Although we know that parental engagement is critical to adolescent substance use prevention, our understanding of the degree to which parents are actually talking to their children about tobacco, alcohol, and illicit drugs remains limited. In particular, we need up-to-date information on the prevalence and trends of parental engagement and information concerning the characteristics of parents who are, in fact, engaging their children in discussions about substance use. To this end, we examined national trends and correlates of parents’ communication with their teenage children about the dangers of substance use.

Methods

Data and Sample

We utilized 15 years of cross-sectional data from the National Survey on Drug Use and Health (NSDUH). Administered by SAMHSA, the NSDUH provides annual estimates for substance use risk among a nationally representative sample of civilian, noninstitutionalized individuals aged 12 and older (CBHSQ, 2017). The study’s analytic sample was limited to non-Hispanic White (hereafter, “White”; n = 153,087), non-Hispanic Black/African American (hereafter, “Black”; n = 35,216), and Hispanic (n = 45,780) young people aged 12–17. A detailed description of the NSDUH’s methodology is available elsewhere (SAMHSA, 2018).

Measures

Parental Substance Use Communication (PSC).

We measured PSC by asking: “During the past year, have you talked with at least one of your parents about the dangers of tobacco, alcohol, or drug use?” (no, yes).

Parental Behaviors.

We also examined variables related to parental warmth, engagement, discipline, and limit setting (see Table 1 for prompts). Consistent with prior research, these items were coded dichotomously (always/sometimes [yes], seldom/never [no]; Salas-Wright, Vaughn, Ugalde, & Todic, 2015; Vaughn et al., 2013).

Table 1.

Correlates of Parental Substance Use Communication

	Have you talked with at least one of your parents about the dangers of tobacco, alcohol, or drug use?
	No (n = 95,083; 41.15%)		Yes (n = 135,992; 58.85%)		Adjusted Odds Ratio
	%	(95% CI)	%	(95% CI)	AOR	95% CI
Warmth/Engagement
Parents provide help with your homework when you needed it?
No	26.56	26.18, 26.94	14.51	14.25, 14.78	--	--
Yes	73.44	73.06, 73.82	85.49	85.22, 85.75	2.131	2.070, 2.194
Parents let you know you’ve done a good job?
No	20.98	20.61, 21.35	8.69	8.50, 8.89	--	--
Yes	79.02	78.65, 79.39	91.31	91.11, 91.50	2.791	2.695, 2.891
Parents told you they were proud of you for something you had done?
No	21.40	21.05, 21.75	8.88	8.69, 9.08	--	--
Yes	78.60	78.25, 78.95	91.12	90.92, 91.31	2.806	2.715, 2.900
Discipline/Limit Setting
Parents make you do chores around the house?
No	14.57	14.28, 14.87	9.69	9.46, 9.93	--	--
Yes	85.43	85.13, 85.72	90.31	90.07, 90.54	1.639	1.580, 1.701
Parents limit the amount of time you watched TV?
No	67.93	67.50, 68.35	56.12	55.76, 56.48	--	--
Yes	32.07	31.65, 32.50	43.88	43.52, 44.24	1.673	1.632, 1.716
Parents limit the amount of time you went out with friends on school nights?
No	36.27	35.88, 36.67	26.52	26.21, 26.84	--	--
Yes	63.73	63.33, 64.12	73.48	73.16, 73.79	1.579	1.541, 1.618

Note. Adjusted odds ratios (AOR) for pooled data adjusted for age, gender, race/ethnicity, household income, father in household, urbanicity, and survey year. AORs in bold are statistically significant.

Sociodemographic Factors.

Sociodemographic variables include age, gender, race/ethnicity, household income (<$20,000, $20,000–$39,999, $40,000–$74,999, ≥$75,000), presence of a father in the household, and urbanicity (nonmetropolitan, metropolitan; based on Office of Management and Budget guidelines).

Analyses

We conducted statistical analyses in several sequential steps. First, we examined the year-by-year prevalence estimates for PSC in the full sample and across key sociodemographic subgroups (see Figure 1). Next, we tested the significance of linear trends in accordance with the Centers for Disease Control and Prevention’s (CDC, 2018) guidelines for secular trend analysis (PSC specified as dependent variable, survey year specified as continuous independent variable, sociodemographic characteristics included as control variables). This approach is consistent with recent trend studies using NSDUH data (see Salas- Wright et al., 2017; Vaughn et al., 2018). Finally, we examined the association between PSC and parental behaviors using logistic regression while controlling for sociodemographic characteristics (see Table 1).

Figure 1.

Year-by-Year Prevalence of Parental Talk About Substance Use, by Family Income and Race/Ethnicity

Results

Between 2002 and 2016, the rate of adolescents reporting PSC in the past year declined significantly, even when accounting for sociodemographic factors (AOR = 0.987, 95% CI = 0.985, 0.990). Notably, we observed this downward trend not only among teens in general, but across all demographic subgroups examined (e.g., males and females, rural and urban teens).

As shown in Figure 1, particularly noteworthy declines were observed among adolescents residing in households earning less than $20,000 per year, declining by 19% (in relative terms) from a high of 58% PSC in 2003 and 2008 to a low of 47% in 2016 (an 11 percentage point [pp] decline). During that time, rates of PSC were relatively stable among teens in families earning more than $70,000 per year (64% in 2002 and 2016), which resulted in a widening disparity in PSC between the teens in the extremes of low and higher income families (Δ in 2002 = 10 pp, Δ in 2016 = 17 pp). We also observed a gradual widening of the difference between Black and White teens (Δ in 2002 = 11 pp, Δ in 2016 = 15 pp). Supplemental analyses also revealed that rates of PSC among low-income Black adolescents declined significantly faster than those of low-income White and Hispanic adolescents.

We also found that teens reporting PSC were more likely to report consistent parental warmth and engagement (adjusted odds ratios [AORs] from 2.1–2.8) and discipline and limit setting (AORs from 1.5–1.6; see Table 1). Supplemental analyses also revealed that teens reporting PSC were more likely to report abstaining from substance use in the past year (AOR = 1.15, 95% CI = 1.13, 1.16).

Discussion

Our study provides new evidence about the prevalence and trends over time in substance use communication between parents and their adolescent children in the US. We highlight several particularly salient findings. First, we see clear evidence that, on average, the number of teens who reported talking with their parents about the dangers of tobacco, alcohol, and drug use has decreased significantly since the early 2000s.

A second point is that, upon closer inspection, we see that declines in PSC are particularly steep in two subpopulations: low-income and Black adolescents. Teens in these subgroups were substantially less likely than their higher income and White/Hispanic counterparts to have talked with their parents about substance use throughout the 2000s, and we see clear evidence that these differences have increased in recent years. These findings are disconcerting, given that prior research has made clear that rates of substance use disorders are elevated among low income and Black/African American populations (Grant et al., 2016; Hasin et al., 2015), and given that parental communication about drugs is a critical buffer against substance use during adolescence (Dishion et al., 2002; Prado & Pantin, 2011).

A third point to highlight is the finding that young people reporting having talked about (or discussed) substance use with their parents were also more likely to report that their parents regularly placed limits on their behavior. Such limit setting included regulating the amount of time young people spent watching television and being “out with friends” during the week, parental monitoring practices that we also know are related to lower risk of teen substance use and problem behavior (Salas-Wright et al., 2015). These constructs relate to parental control and self-control, suggesting that further exploration of these topics may be warranted (Vazsonyi & Jiskrova, 2018).

Fourth, we found that, in addition to greater levels of parental monitoring, teens with parents who spoke to them about substance use also reported that their parents were more likely to provide assistance with homework and express warmth and approval. This suggests that PSC is not only linked with other parenting practices related to discipline and limit setting, but is also connected with behaviors reflecting supportive parental engagement practices that we know are related to positive youth development (Mogro-Wilson, 2008).

Study Limitations

Findings from this study should be interpreted in light of several limitations. First, all data were derived from respondents’ self-reports. As such, it is certainly possible that some teens may have reported having spoken with their parents about substance use when they, in fact, did not (and vice versa). Second, we do not have specific information about the quality, quantity, or content of conversations with parents. Third, it is possible that the observed trends may be a function of shared methods variance and it is important to note that the NSDUH-based studies run the risk of being overpowered. Finally, the NSDUH does not allow us to assess changes in PSC within the same individuals over time.

Conclusions

In this study, we present cogent evidence indicating that fewer parents are talking to their teenage children about the dangers of tobacco, alcohol, and drug use today than was the case in the early to mid-2000s. Notably, we also found that low income and Black adolescents reported the lowest levels of PSC, and that the gap between these teens and their counterparts has widened over the last few years. These findings underscore the importance of engaging parents, particularly those who are less likely to talk to their children about substance use, and providing instruction and encouragement that parents should be talking to their children about the very real dangers related to such use.