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. Author manuscript; available in PMC: 2021 Mar 4.
Published in final edited form as: Youth Soc. 2018 Nov 28;52(8):1436–1458. doi: 10.1177/0044118x18815274

Parenting With a Substance Abuse History: The Moderating Role of Parenting Behaviors on Obesity and Internalizing Symptoms in Adolescence

H Isabella Lanza 1, Patricia Pittman 1, Yih-Ing Hser 2
PMCID: PMC7932061  NIHMSID: NIHMS1031637  PMID: 33678918

Abstract

Although numerous studies have shown that child obesity is associated with internalizing symptoms, relatively few studies have examined the role of parenting behaviors on this relationship. Youth meeting obesity status may be at higher risk of psychosocial maladjustment when exposed to more vulnerable parenting contexts. The current study interviewed mothers with a history of substance abuse to assess whether parenting behaviors moderated the relationship between obesity and internalizing symptoms among adolescents (N = 160; 51% girls; M = 12.76 years). Hierarchical regression analyses identified physical discipline as a moderator; girls meeting obesity status displayed higher levels of internalizing symptoms when exposed to higher versus lower levels of physical discipline. Prevention/intervention efforts targeting mothers with substance abuse histories should aim to not only improve physical and emotional health but also highlight the connections between physical and emotional health and the influence of parenting behaviors on associations.

Keywords: internalizing symptoms, obesity, parenting behaviors, physical discipline, maternal substance abuse

Childhood obesity remains one of the most significant public health concerns in the United States, with an estimated 17% of children and adolescents meeting obesity status (Ogden et al., 2016). In addition to its deleterious physical consequences, such as heightened risk of type 2 diabetes, cardiovascular problems, and hypertension (Han, Lawlor, & Kimm, 2010; Hannon, Rao, & Arslanian, 2005), obesity has been linked to psychosocial maladjustment among children and adolescents (Anderson, Cohen, Naumova, & Must, 2006; Sweeting, Wright, & Minnis, 2005; Van Vlierberghe, Braet, Goossens, & Mels, 2009; Xie, Ishibashi, Lin, Peterson, & Susman, 2013). Youth meeting obesity status are more likely than counterparts to experience internalizing symptoms reflecting anxiety and depression (Falkner et al., 2001; ter Bogt et al., 2006), and higher body mass index (BMI) irrespective of meeting obesity status has been linked to internalizing symptoms in childhood and adolescence (Bradley et al., 2008; Roberts & Duong, 2016; Russell-Mayhew, McVey, Bardick, & Ireland, 2012). The greater risk of internalizing symptoms among youth meeting obesity status is concerning as it increases vulnerability to myriad negative developmental outcomes, including school disengagement and high school dropout, career hardships, family functioning difficulties, and suicide risk (Harriger & Thompson, 2012; Harrist et al., 2016; Lanza & Huang, 2015; Nemiary, Shim, Mattox, & Holden, 2012). Consequently, identifying contextual factors that moderate the relationship between obesity and internalizing symptoms, particularly those amenable to prevention/intervention efforts, is warranted.

Most research that has sought to understand the relationship between obesity and internalizing symptoms among youth has focused on the influence of peer relationships on psychosocial adjustment. These studies indicate that youth meeting obesity status are at greater risk of experiencing internalizing symptoms due to their higher likelihood of peer victimization and poor social standing (Pearce, Boergers, & Prinstein, 2002; Strauss & Pollack, 2003; Zeller, Reiter-Putrill, & Ramey, 2008). Indeed, as social acceptance becomes a key priority in early adolescence (Fuligni, Eccles, Barber, & Clements, 2001; LaFontana & Cillessen, 2010), the social context presents a significant challenge for youth with higher weight status. Instead of gaining the social acceptance and popularity adolescents desire, adolescents meeting overweight or obesity status are often met with social stigma and exclusion (Puhl & Heuer, 2010; Puhl & King, 2013; Strauss & Pollack, 2003). Moreover, compared with adolescents of normal weight, those meeting overweight or obesity status are at higher risk of experiencing peer victimization/bullying, irrespective of gender (Hayden-Wade et al., 2005; Janssen, Katzmarzyk, & Ross, 2004; Lumeng et al., 2010; Pearce et al., 2002; van Geel, Vedder, & Tanilon, 2014). In contrast to the emphasis on peer relationships in explaining the relationship between obesity and internalizing symptoms, few empirical studies have assessed the influence of the parent–child relationship on risk of internalizing symptoms among youth meeting obesity status.

Research identifying parenting behaviors that maintain, exacerbate, or reduce youth internalizing symptoms is well established (Crawford, Cohen, Midlarsky, & Brook, 2001; Laskey & Cartwright-Hatton, 2009; Walker, 2012); for instance, numerous studies have demonstrated that low responsiveness and harsh discipline are associated with child internalizing problems (Bender et al., 2007; McKee et al., 2007; Pinquart, 2017). However, very little empirical work has evaluated the moderating role of parenting behaviors on obesity and psychosocial outcomes. Most studies focused on parenting and child obesity highlight behaviors linked to obesity risk, such as parent’s modeling and enforcing of poor health behaviors alongside low responsiveness and involvement (Gerards & Kremers, 2015; Johnson et al., 2014; Kim et al., 2008; Rhee, 2008). Morawska and West (2013) reported that parents of youth meeting obesity status versus other youth were more likely to use ineffective discipline techniques, including both coercive and permissive parenting styles. One study that examined maternal factors related to internalizing symptoms among adolescents meeting obesity status reported inconsistent discipline as a significant mediator of obesity and internalizing symptoms (Decaluwé, Braet, Moens, & Vlierberghe, 2006). The current study aimed to expand on these findings by evaluating whether risk of internalizing symptoms among adolescents meeting obesity status was moderated by key parenting behaviors, including discipline practices. Given that maladaptive parenting practices reflecting neglect, unresponsiveness, and harsh punishment are commonly presented as an explanation for an increased risk of child internalizing symptoms (Seay & Kohl, 2015; Silk et al., 2011; Stanger et al., 2002), and have even been linked to overweight/obesity status (Arredondo et al., 2006; Liang et al., 2016), the combination of obesity and problematic parenting behaviors may lead to greater risk for internalizing symptoms than the presence of either obesity or maladaptive parenting behaviors alone.

In addition to examining whether internalizing symptoms among youth meeting obesity status is exacerbated in the presence of maladaptive parenting behaviors, the current study also sought to evaluate this potential moderating relationship among mothers with a more vulnerable history. Specifically, mothers of adolescents in the current study had a history of substance abuse, which they received treatment for 10 years prior to being interviewed about their parenting behaviors. It is estimated that 1.4 million children in the United States are being raised in a single-parent household by a mother with a substance abuse disorder at any given time (Lipari & Van Horn, 2017). Children of mothers with histories of substance abuse are not only at heightened risk of internalizing symptoms (Bountress & Chassin, 2015; Fenster, 2011) but also at risk of poor physical health (Conners et al., 2004). Mothers with a history of substance abuse are more vulnerable to engaging in maladaptive parenting behaviors, such as physical discipline and lack of responsiveness, which contribute to heightened behavioral, emotional, and physical health issues in their children (Bailey, Hill, Oesterle, & Hawkins, 2009; Barnard & McKeganey, 2004; Hien & Honeyman, 2000; Solis, Shadur, Burns, & Hussong, 2012; Staton-Tindall, Sprang, Clark, Walker, & Craig, 2013). Consequently, the role of maladaptive parenting practices on obesity-internalizing symptom associations may be more salient among mothers with a history of substance abuse. Considering the robust links between maternal substance abuse history and children’s maladaptive development, examining questions related to the role of parenting behaviors on the psychosocial adjustment among youth meeting obesity status is likely to have significant implications for health efforts focused on youth identified as high risk for both physical and mental health problems.

Taking the gaps in the literature into account, the purpose of this study was to examine whether parenting behaviors moderate the relationship between obesity and internalizing symptoms among adolescents living with mothers with a history of substance abuse. Specifically, by focusing on adolescents living with mothers with more vulnerable and challenging histories, we expected that mothers’ parenting behaviors would play a key role in the psychosocial adjustment of adolescents meeting obesity status. We hypothesized that adolescents meeting obesity status would exhibit higher levels of internalizing symptoms compared with those not meeting obesity status, but more importantly, maladaptive parenting behaviors (e.g., unresponsive or harsh behaviors) would be associated with significantly higher levels of internalizing symptoms among youth meeting obesity status.

Method

Participants

Participants were recruited as part of a larger study on women admitted to substance abuse treatment. Approximately 4,500 women were recruited from 44 substance abuse treatment programs across 13 California counties during 2000–2002 as part of the California Treatment Outcome Project (CalTOP). These women were all parenting mothers (i.e., pregnant or having children below 18 years) at admission to drug treatment; thus, all mothers had children who were exposed to substance abuse either in utero or postnatally. A follow-up interview was conducted with a subset of these women (n = 713) 10 years after admission to substance abuse treatment (2010–2011). This subset of women was randomly selected from the original sample; 1,000 women were randomly selected as targets for the follow-up interview and 713 were rein-terviewed (77.2% response rate). A comparison of baseline characteristics for those completing the follow-up interview versus those that did not revealed few significant differences among demographic variables (e.g., age, ethnicity, education, public assistance), substance use frequency and severity, or psychiatric disorders. However, those not completing the follow-up interview were more likely to report their primary drug as alcohol (21.6% vs. 16.8%) or heroin (28.2% vs. 19.4%), less likely to report their primary drug as methamphetamine (33.5% vs. 43.1%) or cocaine (6.6% vs. 10.9%), and reported greater employment problems compared with the subset of women completing follow-up interviews. Of this subset of women, 396 reported having a dependent child (below age 18 years) and having spent at least the prior 6 months with the child at the time of interview. Each mother reported on her own and her children’s behavior and health (see Hser, Evans, Li, Metchik-Gaddis, & Messina, 2014; Hser et al., 2015, for other studies using this sample). The current study included children who were 10 to 16 years (early and middle adolescence) at the time of the follow-up interview and had data on obesity status, parenting behaviors, and internalizing symptoms, which included 160 out of a possible 179 children in this age range (51.0% girls; Mean age = 12.76 ± 2.08 years; 53.1% White, 21.2% Latino, 20.1% African American, 5.6% other racial/ethnic affiliations).

Procedure

Ten years after enrolling in substance abuse treatment, mothers in the current study were contacted to conduct an interview by phone. Mothers provided an assessment of their current and past substance use using the Addiction Severity Index (ASI). They also were asked questions about the child that was born closest to the time when they participated in the CalTOP substance abuse treatment program. Children selected had to be below 18 years and living with the mother for the last 6 months. When there were multiple children eligible for the study, priority was given to the child that was born closest to the time when the mother was participating in drug abuse treatment studied by CalTOP. Mothers reported on parenting behaviors, child health, and child behavioral and emotional functioning. All assessment procedures were reviewed and approved by the university’s institutional review board and the State of California Health and Human Services Agency.

Measures

Obesity status.

Mother-reported height and weight was used to measure children’s BMI. Based on responses to questions about height and weight, a BMI (kg/m2) percentile was calculated for each participant using age- and sex-specific BMI percentile distributions from the Centers for Disease Control and Prevention (CDC) 2000 growth charts (Kuczmarski et al., 2002); a child with a BMI percentile ≥95% was classified as meeting obesity status. BMI percentiles are a common method for estimating weight status in youth; they are preferred over BMI raw scores because they more accurately account for significant biological and physical development in childhood and adolescence (e.g., Huang, Lanza, Wright-Volel, & Anglin, 2013; Li, Goran, Kaur, Nollen, & Ahluwalia, 2007; Mustillo, Worthman, Erkanli, Keeler, & Angold, 2003; Xie et al., 2013).

Parenting behaviors.

Mothers reported on several dimensions of parenting behaviors using the Adolescent Adult Parenting Inventory–2 (AAPI-2; Bavolek & Keene, 1999). The AAPI-1 contains 40 questions with five response options (strongly agree to strongly disagree) designed to assess parent and child rearing attitudes and behaviors. It is a useful inventory for assessing high-risk parenting behaviors. Five subscale scores (items were reverse coded as needed) were estimated to measure the following parenting attitudes/behaviors: (a) inappropriate expectations of children (e.g., “children who are one-year-old should be able to stay away from things that could harm them”), (b) lack of empathy toward children’s needs (e.g., “children should keep their feelings to themselves”), (c) corporal punishment as a means of discipline (e.g., “spanking teaches children right from wrong”), (d) reversing parent–child role responsibilities (e.g., “in father’s absence, the son needs to become the man of the house”), and (e) limiting children’s power and independence (e.g., “children should do what they’re told to do, when they’re told to do it. It’s that simple”).

Child internalizing symptoms.

Mothers reported on child internalizing symptoms in the last 6 months with the Child Behavior Checklist, a widely used instrument to assess behavioral and emotional problems in children and adolescents from ages 6 to 18 years (Achenbach, 1991). Items were rated on a 3-point scale that included 0 (not true), 1 (sometimes or somewhat true), and 2 (very or often true). Sample items included the following: “there is very little he or she enjoys,” “cries a lot,” and “unhappy, sad, or depressed.” Standardized scores were used to create a summary scale score for internalizing symptoms, which has been shown to have good reliability and validity (Achenbach, Edelbrock, & Howell, 1987). We used the recommended T score transformations of the raw scores, which adjusted for age and sex differences in behavior found in normative samples. A T score greater than 60 on the score indicated borderline or clinically meaningful symptoms.

Planned Analyses

We conducted descriptive statistics and bivariate correlations to examine associations on major study variables, as well as independent sample t tests to assess sex differences. The primary analyses involved hierarchical linear regression analyses, for which child internalizing symptoms was the dependent variable. Given that sex differences in levels of internalizing symptoms begin in early adolescence, with girls becoming more vulnerable to depression (Ge, Conger, & Elder, 2001; McGuinness, Dyer, & Wade, 2012), separate regression analyses were conducted for boys and girls. Child’s age and mother’s BMI score were entered in the first step. The second step included child obesity status and each of the five subscales assessing parenting behaviors. The third step included the cross-product interaction terms for child obesity status and each parenting subscale. To minimize multicollinearity, before inclusion in the multiple regression analyses, the independent variables were centered (M = 0) and interaction terms were created using centered variables (Aiken & West, 1991). For significant interaction terms, we followed post hoc probing procedures outlined by Holmbeck (2002).

Results

Bivariate correlations, means, and standard deviations for study variables are presented in Table 1. Adolescent BMI percentile was positively related to mother BMI (r = .16, p < .01) and negatively related to role reversal (r = −.11, p < .05). Other significant correlations reflected associations between parenting behavior subscales. Each subscale was positively correlated with the others (e.g., higher corporal punishment associated with higher lack of empathy; r = .47, p < .001). Independent sample t tests comparing adolescents meeting obesity status to those not meeting obesity status did not find significant differences among internalizing symptoms or any of the parenting scales, but did indicate that adolescents meeting obesity status were younger, t(394) = −3.51, p < .01, and had mothers with higher BMI, t(394) = 4.16, p < .001, compared with those not meeting obesity status. In addition, independent sample t tests did not show any significant differences between boys and girls on background variables, BMI, parenting behavior subscales, or internalizing symptoms; furthermore, a chi-square test did not indicate that obesity status significantly differed between boys and girls.

Table 1.

Bivariate Correlations, Means, and Standard Deviations for Study Variables.

1 2 3 4 5 6 7 8 9
1 Internalizing symptoms (T score) —
2 Child age −.10 —
3 Mother BMI −.03 .02 —
4 Adolescent BMI percentile −.04 .06 .16** —
5 Parenting—expectations −.03 .02 −.09 −.03 —
6 Parenting—low empathy .08 −.03 .07 −.09 .45** —
7 Parenting—physical discipline .03 −.03 −.09 −.05 .46** .47* —
8 Parenting—role reversal .11 −.03 −.02 −.11* .50** .70** .45** —
9 Parenting—independence −.03 .02 −.10 .05 .27** .31** .34** .33** —
M 48.99 12.76 28.61 69.94 2.74 3.04 3.38 2.98 3.62
SD 10.19 2.08 7.42 31.09 0.48 0.38 0.42 0.50 0.46
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Note. BMI = body mass index.

*

p < .05.

**

p < .01.

Hierarchical regression analyses were conducted separately for boys and girls to examine predictors of internalizing symptoms (Table 2). Child age and mother’s BMI were entered in Step 1. Younger ages were associated with internalizing symptoms among boys (β = −.25, p < .05). Step 2 included Step 1 variables as well as obesity status and each of the five parenting behaviors (e.g., expectations, role reversal). None of the parenting behavior subscales nor obesity status alone was significantly associated with internalizing symptoms among boys or girls.

Table 2.

Summary of Hierarchical Regression Analyses for Variables Predicting Internalizing Symptoms.

Boys Girls
β R2 (f2) β R2 (f2)
Step 1 .06 .00
 Child age −.25* −.05
 Mother BMI −.06 .01
Step 2 .11 .07
 Obesity status −.03 −.07
 Inappropriate expectations .00 −.24
 Low empathy −.02 .29
 Physical discipline −.09 −.01
 Role reversal .25 −.03
 Restricts independence −.06 −.11
Step 3 .25* .21*
 Obesity × Expectations −.18 .02
 Obesity × Empathy .39* .55*
 Obesity × Discipline .11 −.49*
 Obesity × Reversal −.06 −.34
 Obesity × Independence −.23 −.01
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Note. Obesity status was coded as 0 (nonobese; BMI% < 95%) or 1 (obese; BMI% ≥ 95%), effect size = f2. BMI = body mass index.

*

p < .05.

Step 3 considered interactions between obesity status and parenting behaviors. Five interaction terms were included to account for the interaction between obesity and each type of parenting behavior (e.g., Obesity × Low Empathy, Obesity × Lack of Independence). For both boys and girls, a significant interaction between obesity and low empathy was reported (β = .39, p < .05 boys, β = .55, p < .05 girls). Also, a significant interaction between obesity and physical discipline was found among girls (β = −.49, p < .05). Following procedures described by Aiken and West (1991) and Holmbeck (2002) for probing and graphing significant interactions, each of these three interactions was further examined. We computed two new conditional moderator variables (±1 SD from the mean of each parenting behavior) and new interactions that incorporated the conditional variables. We then ran two post hoc regressions, each of which involved simultaneous entry of obesity status, one of the conditional parenting behavior variables (e.g., low empathy vs. high empathy), and the Obesity × Conditional Parenting Behavior. From these analyses, we derived unstandardized betas (slopes) and regression equations among children experiencing high (1 SD above the mean) and low (1 SD below the mean) empathy and physical discipline, respectively.

Figures 1 and 2 illustrate the significant interactions between Obesity × Empathy among boys (upper panel) and girls (lower panel), and Obesity × Physical Discipline among girls. The steepness of boys’ high (b = −6.23, SE = 4.24, p = .15) and low (b = 6.12, SE = 3.87, p = .12) empathy slopes were very similar. Although the slopes were nonsignificant, the interaction showed that boys experiencing low empathy and meeting obesity status had higher levels of internalizing symptoms that those experiencing high empathy. Girls’ high (b = −2.45, SE = 3.73, p = .51) and low (b = .48, SE = 4.75, p = .92) empathy slopes were nonsignificant and much closer to a flat than steep slope, indicating that level of empathy was not a moderator of the relationship between obesity status and internalizing symptoms. Post hoc probing of the Obesity × Physical Discipline among girls revealed a significant slope for high discipline (b = −11.44, SE = 5.44, p = .039) but not low discipline (b = 2.76, SE = 3.83, p = .47). The steeper slope representing high physical discipline indicated that among girls experiencing higher levels of physical discipline, those meeting obesity status exhibited higher levels of internalizing symptoms compared with those not meeting obesity status. The much flatter slope for low physical discipline revealed that lower levels of physical discipline were associated with similar levels of internalizing symptoms regardless of obesity status.

Figure 1.

Figure 1.

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The association between obesity and internalizing symptoms among boys (upper panel) and girls (lower panel) experiencing low (1 SD below mean) versus high (1 SD above mean) maternal empathy.

Figure 2.

Figure 2.

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The association between obesity and internalizing symptoms among girls experiencing low (1 SD below mean) versus high (1 SD above mean) physical discipline.

Discussion

A wealth of literature has shown that youth meeting obesity status are at higher risk of experiencing internalizing symptoms (Luppino et al., 2010; Reeves, Postolache, & Snitker, 2008; Van Vlierberghe et al., 2009; Xie et al., 2013), which in large part may be due to peer victimization and rejection (Pearce et al., 2002; Strauss & Pollack, 2003; Zeller et al., 2008); however, little research has assessed whether parenting behaviors moderate the relationship between obesity and internalizing symptoms. To address this gap, we evaluated whether various dimensions of parenting behaviors moderated the association between obesity status and internalizing symptoms in adolescence. Moreover, we addressed the significance of parenting behaviors within families characterized by mothers with a history of substance abuse, as past research has indicated these mothers are susceptible to relying on maladaptive parenting practices, as well as having children with co-occurring health-risks like obesity and internalizing symptoms (Solis et al., 2012; Walsh, Macmillan, & Jamieson, 2003). Although multiple facets of parenting were examined, physical discipline was unique in that it was the only parenting behavior that significantly moderated the relationship between obesity status and internalizing symptoms; in addition, physical discipline appears to be of particular concern among girls meeting obesity status. Girls meeting obesity status that were exposed to higher levels of physical discipline were reported to have significantly higher levels of internalizing symptoms compared with other girls in the study (i.e., girls meeting obesity status exposed to lower levels of physical discipline, as well as girls not meeting obesity status irrespective of exposure to physical discipline).

Given the heightened risk of internalizing symptoms and overall psychosocial maladjustment among youth meeting obesity status, identifying moderating factors that are amenable to change through interventions efforts is warranted. Identifying mother’s use of physical discipline as a parenting behavior that may exacerbate the likelihood of internalizing symptoms among girls meeting obesity status is noteworthy, as this parenting practice is amenable to change through already well-received and validated parenting interventions (Gershoff, Lee, & Durrant, 2017; Vlahovikova, Melendez-Torres, Leijten, Knerr, & Gardner, 2017). In addition to the already established positive effects of reducing physical discipline (Gershoff & Grogan-Kaylor, 2016; Turner & Muller, 2004), parenting efforts aimed at promoting more adaptive discipline strategies may have an added benefit of specifically improving psychosocial adjustment among girls meeting obesity status. Study findings suggest that mothers that forego physical discipline in favor of more adaptive and supporting strategies may provide a social buffer that could lessen the risk of internalizing symptoms among girls meeting obesity status, whose social standing with peers is likely suffering (Strauss & Pollack, 2003; van Geel et al., 2014).

Given that the few available studies (including the current study) that have assessed the role of parenting behaviors on obesity-internalizing symptoms have noted discipline strategies as a potential contributing factor (Decaluwé et al., 2006; Morawska & West, 2013), future research is warranted to understand the process by which maladaptive discipline strategies increase risk of internalizing symptoms among youth meeting versus not meeting obesity status. A wealth of literature has shown the negative effects of physical discipline on parent–child relationships (Friesen, Woodward, Horwood, & Fergusson, 2013) and internalizing symptoms among children and adolescents (Bender et al., 2007; Fergusson & Lynskey, 1997; Lansford et al., 2014); however, this research does not explain why physical discipline would be linked to higher internalizing symptoms among girls meeting obesity status but not among girls not meeting obesity status. We speculate that mother’s use of physical discipline is viewed as a form of rejection by girls meeting obesity status, who are already likely experiencing rejection or exclusion from their peers; thus, physical discipline by mothers may compound feelings of alienation and loneliness that contribute to internalizing symptoms. Girls meeting obesity status in the study may also have been more vulnerable to their mother’s use of physical discipline because girls compared with boys meeting obesity status report greater weight-related distress and dissatisfaction (ter Bogt et al., 2006; Young-Hyman et al., 2006). Furthermore, it is possible that mother’s history of substance abuse exacerbated the moderating role of physical discipline; several studies have indicated that substance abuse impacts mothers’ ability to both discipline children adaptively (Bailey et al., 2009; Hien & Honeyman, 2000) and meet child physical and mental health needs (Solis et al., 2012; Staton-Tindall et al., 2013). Past studies have also indicated mothers with a substance abuse history have difficulties engaging in warm and emotionally responsive parenting (Barnard & McKeganey, 2004; Suchman, Mayes, Conti, Slade, & Rounsaville, 2004); this may explain the post hoc finding suggesting low empathy may increase vulnerability to internalizing symptoms for boys meeting obesity status. Although the interaction between obesity and empathy did not reveal significant slopes for either boys or girls, this post hoc finding highlights the need for future studies to examine the role of maternal empathy on boys’ psychosocial adjustment, particularly among those meeting obesity status.

Limitations of this study need to be considered. First, we acknowledge that shared method variance is a weakness of this study; mothers reporting on both their own parenting behaviors and their children’s physical and mental health is not ideal, especially as children have been found to be better reporters of their own internalizing symptoms (De Los Reyes, Goodman, Kliewer, & Reid-Quiñones, 2008). In addition, although there is no specific evidence to indicate mothers with a history of substance abuse are less accurate in reporting children’s behavior compared with other mothers, it is important to acknowledge the role that substance abuse may play in altering cognitive functioning related to processing and remembering information accurately (Rogers & Robbins, 2001; Tipps, Raybuck, & Lattal, 2014). However, this was a unique opportunity to re-interview mothers that had been in substance abuse treatment 10 years prior to understand how their difficult health-risk histories may have influenced their family outcomes. Second, adolescents in the study ranged from 10 to 16 years, meaning that some children in the study were born prior to mother’s substance abuse treatment, some were in utero during mother’s treatment, and others were born shortly after mother’s treatment, making it likely mother’s substance use in utero varied across children. Unfortunately, information on prenatal substance use was not acquired for the majority of mothers. In addition, information on the onset and duration of maternal substance use varies widely in the sample, which may also influence its effects on child outcomes. Third, we relied on mother’s report of their child’s height and weight versus a direct measurement of BMI, which was not feasible as the follow-up study was conducted entirely over the phone. However, several studies have shown that reported BMI is generally consistent with BMI directly measured (Brener, Mcmanus, Galuska, Lowry, & Wechsler, 2003; Field, Aneja, & Rosner, 2007; Goodman, Hinden, & Khandelwal, 2000).

Despite these limitations, the current study highlights the importance of parenting behaviors when examining the relationship between obesity and internalizing symptoms among youth, particularly those living with mothers susceptible to maladaptive parenting behaviors as a result of substance abuse history. Mothers with a substance abuse history are faced with numerous challenges, which likely increase the use of maladaptive parenting strategies like physical discipline. Within this vulnerable context, girls meeting obesity status that are exposed to physical discipline by their mothers are at greater risk of internalizing symptoms. Prevention/intervention efforts focused on families dealing with challenges like substance abuse history should not only aim to improve the physical and emotional well-being of children but also highlight the connections between physical and emotional health as well as the influence of parenting behaviors on those associations. Adapting more adaptive discipline strategies is likely to enhance psychosocial adjustment among girls meeting obesity status; future work may show that mothers may have sufficient social capital to offset the negative social context daughters meeting obesity status are likely to experience with peers.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by grants from the National Institute on Drug Abuse (RO1DA021183 and P30DA016383) and the National Institute of General Medical Sciences (UL1GM118979 and RL5GM118978).

Biographies

H. Isabella Lanza, PhD, is assistant professor of Human Development at California State University, Long Beach (CSULB). Her research focuses on co-occurring health-risk behaviors, particularly on developmental outcomes among obese youth.

Patricia Pittman is currently a graduate student in the PhD Human Development program at The Ohio State University (OSU). She studies the role of family relationships on adolescent health outcomes.

Yih-Ing Hser, PhD, is a professor-in-Ressidence within the Psychiatry and Biobehavioral Sciences department at University of California, Los Angeles (UCLA). She has extensive experience in health services research, treatment evaluation, and long-term follow-up studies on drug addiction.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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