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. Author manuscript; available in PMC: 2022 Nov 1.
Published in final edited form as: Drug Alcohol Depend. 2021 Sep 4;228:109019. doi: 10.1016/j.drugalcdep.2021.109019

Using the Theory of Reasoned Action to examine grandparent and maternal substance use on the cannabis use of children of teen mothers

Julie A Cederbaum 1,*, Woo Jung Lee 2, Lucinda Okine 3, Lei Duan 4, Jungeun Olivia Lee 5
PMCID: PMC8713458  NIHMSID: NIHMS1764171  PMID: 34509738

Abstract

Background:

Parental cannabis use is associated with increased risks of cannabis use among offspring, yet few studies have explored the mechanisms influencing intergenerational continuity in cannabis use. To understand the mechanism by which intergenerational cannabis use is influenced, this work explores cannabis use across three generations using a family expansion of the Theory of Reasoned Action (TRA).

Methods:

Data come from the Young Women and Child Development Study which began when teen mothers were pregnant and followed mother-child dyads for 17 years (N = 240). Constructs include cannabis use of grandparents, mothers, and teens, and TRA constructs of behavioral and normative beliefs, intention, and behavior. Hypotheses were tested using Structural Equation Modeling.

Results:

Grandfather’s cannabis use was significantly linked to mother’s normative beliefs (β = .22, p = .006), but not attitudes (β = .12, p = .182). Teen mothers’ attitude was associated with intention (β = .79, p < .001); intention predicted cannabis behavior (β = .61, p < .001). Teen mothers’ cannabis use was predictive of adolescent’s attitude (β = .21, p = .002); attitude predicted intention (β = .73, p < .001) and intention predicted behavior (β = .60, p < .001).

Discussion:

Parents play an influential role in the cannabis use behaviors of adolescents. Future work should consider interventions that target both parent and adolescents, increasing knowledge and skills related to parent-child communication, parental monitoring, and positive parental role modeling to reduce intergenerational continuity of cannabis use.

Keywords: Cannabis Use, Adolescents, Intergenerational Cannabis Use, Theory of Reasoned Action, Offspring of Teen Mothers

Background

Cannabis use is prevalent and remains one of the most frequently used illicit drugs by adolescents in the United States (Scheier and Griffin, 2021) with more than one-third of high school students reporting ever having used cannabis and about one-fifth reporting current use (Kann et al., 2018). Evidence suggests that parental history of cannabis use is associated with increased risks of cannabis use among their offspring (Bailey, 2016; Kosty et al., 2015; Madras et al., 2019; Tiberio et al., 2020; Vermeulen-Smit et al., 2015) – children with mothers or fathers who reported past-year cannabis use were more likely to report current cannabis use than peers without parents who were using (O’Loughlin; 2019). While the influence of parental cannabis use on offspring’s cannabis use behaviors is established, few studies have explored the mechanisms influencing the intergenerational continuity in cannabis use. Further, only one identified study has explored the influence of grandparent cannabis use behaviors on the cannabis use behaviors of grandchildren (Bailey et al., 2016), while one other has explored adolescent protective factors (active coping, activity involvement, and academic achievement) in decreasing the likelihood of cannabis use in a three-generation sample (Rothenberg et al., 2020). Last, while there is evidence that being born to a teen mother increases the risk of cannabis use among adolescent offspring (see Cederbaum et al., 2020 for review), no three-generation study has included this vulnerable population of parents and offspring. To better understand these intergenerational processes and the mechanism by which intergenerational cannabis use is influenced, this work explores cannabis use across three generations (grandparents, teen mothers, and offspring) using a family expansion of the Theory of Reasoned Action (Hutchinson and Wood, 2007).

Cannabis use in adolescence

Nearly all cannabis use begins during adolescence (Anthony, 2016) with the number of cannabis users (adolescents 12 years or older) having steadily increased from 25.8 million (11.0%) in 2002 to 43.5 million (15.9%) in 2018 (Welty et al., 2019). Recent data from two national surveillance studies indicate that about 45% of high school seniors have used cannabis in their lifetime; 20–25% report cannabis use in the past 30 days (Johnston et al., 2019; Kann et al., 2018). The increasing potency of today’s cannabis and popularity of drugs containing synthetic cannabinoids could amplify the impact of cannabis use on the developing adolescent brain (Elsohly, 2016; Lubman, 2015). Early initiation of cannabis use among adolescents is associated with adverse outcomes later in life, including behavioral problems, impaired cognition (Broyd et al., 2016), preclinical or clinical symptoms of depression and anxiety (Gobbi et al., 2019), addiction later in life (Han et al., 2019) including cannabis use disorder, and advancement to use of other illicit drugs (Silins et al., 2014), warranting the importance of clarifying mechanisms underlying youth’s cannabis use.

Intergenerational Continuity in Substance Use

Intergenerational continuity of substance use may occur through multiple mechanisms, including genetics (Polderman et al., 2015; Dick et al., 2016), family environment, and parenting (Hill et al, 2018). The influence of parental cannabis use on offspring’s cannabis use can occur through increased visibility of cannabis use, ease of access, transmission of pro-cannabis norms, and role modeling (Kerr et al., 2015). In fact, parents’ early cannabis use as adolescents (Nadel and Thornberry, 2017; Sokol et al., 2018) and current use (Epstein, et al., 2020; Hill et al., 2018; Kosty et al., 2015; O’Laughlin et al., 2019) are both directly associated with cannabis use in adolescence and young adulthood.

Few studies examining substance use behaviors have included three generations (Bailey et al., 2016, Brook et al., 2012; Brook et al., 2015; Rothenberg et al., 2020; Steinhausen et al., 2017); only two of these works examined cannabis use specifically (Bailey et al., 2016; Rothenberg et al., 2020). Bailey and colleagues (2016) found a significant association between both parent and adolescent cannabis use and adolescent perceived norms with cannabis use; there was no significant link between grandparent and grandchild cannabis use). Rothenberg and colleagues (2020) focused on protective factors in adolescents that reduced the likelihood of cannabis use among those with parents who used cannabis. In this study, the role of grandparents’ cannabis use was not been examined. No identified studies have focused on teen mothers and their offspring within the three generation models, even though teen mothers are more likely to report cannabis use behaviors over time (DeGenna et al., 2015) and offspring of teen mothers experience increased risk for substance use (Cederbaum et al., 2020). To address these gaps, our work examines cannabis use across three generations among this specific population who is particularly vulnerable to substance use/misuse.

Theoretical Framework

The Theory of Reasoned Action (TRA) provides the foundational framework for this study. The theory suggests that behavioral intentions, previously viewed as immediate precursors to behavior, are a function of attitudes and beliefs about the probability that a behavior will lead to specific outcomes (Fishbein and Ajzen, 1975). An essential determinant of an individual’s behavior is intention, posited to be directly influenced by one’s beliefs (attitude) towards a certain behavior and their subjective norms (the notion that those important to them may disapprove/approve of the behavior; Fishbein and Ajzen, 1975). Both attitudes and norms are likely be influenced by the multifaceted system individuals are nested in (Bronfenbrenner, 1979) and family might be one of key systems shaping individuals’ beliefs and norms. Following this logic, adolescent cannabis use can be influenced by their interaction within their family systems.

Hutchinson and Wood (2007) proposed a family expansion of the Theory of Planned Behavior, applied in our study to the Theory of Reasoned Action, which has been applied in prior studies (Cederbaum et al., 2016; Cederbaum et al., 2017). The expanded model enables the researcher to conceptualize how parent’s attitudes and norms may be impacted by external influences (i.e. their own parents cannabis use behavior) and in turn, influence a parent’s intentions and behaviors; in turn, parent’s behaviors may subsequently function as external influences on adolescent cannabis use attitudes and norms, which are the predictors of an adolescents behaviors (i.e. a parent’s use of cannabis may lend to more permissive cannabis use attitudes, which in turn influence the adolescent’s intention to use cannabis and their actual cannabis use behaviors) In this work, the path model allows for the exploration of proximal and distal influences on mother’s cannabis use behaviors and in turn, the proximal and distal influences of adolescent cannabis use.

TRA to understand cannabis use behavior and intergenerational transmission

Emerging studies have attributed adolescent cannabis use to the intergenerational transmission of norms, beliefs, values, and intentions (Henry and Augustyn, 2017; Hill et al., 2018). Previous studies have demonstrated that theoretical constructs within the traditional TRA predict cannabis use behaviors in adolescence (Malmberg et al., 2012) and young adulthood (Ito et al., 2015; Wu et al., 2015). Specifically, Malmberg and colleagues (2012) found that having a positive behavioral beliefs towards cannabis use and viewing cannabis use as more normative were predictive of intention to use cannabis. This is supported by the findings of others who noted that perceived parental and peer norms are among the key drivers of these substance use behaviors (Cederbaum, 2016; Malmberg et al., 2012). Individual’s norms can come from multiple referent groups including parents, siblings, peers, and grandparents (Bailey et al., 2016; Henry and Augustyn, 2017; Hill et al., 2018).

Adolescents who have parents who currently use cannabis are more likely to report their cannabis use (Epstein et al., 2020; Henry et al., 2017; Hill et al., 2018; Knight et al., 2014; Kosty et al., 2015; Nadel and Thornberry, 2017; O’Laughlin et al., 2019; Sokol et al., 2018); this may be driven by the association of parental cannabis use and perceived parental cannabis use approval and decrease in the perceived harm of regular cannabis use among adolescents (Kosterman et al., 2016). Prior work found an association between parental substance use and adolescent perceived norms about substance use (Lochbuehler et, al., 2016; Rusby et al., 2018); youth whose parents used cannabis frequently reported fewer negative cannabis expectations, more pro-cannabis norms and lower expectations of punishment for use. Thus, the link between parental cannabis use and cannabis initiation is mediated by norms (Bailey et al., 2016). Consequently, the adolescents’ perceived parental cannabis use norms contribute to their use of cannabis (Bailey et al., 2016).

The role of grandparents provides insight into the developmental history of parents, as well as the active role grandparents play in the lives of their grandchildren (Bailey et al., 2016). While three-generation studies focusing on the influence of grandparents’ substance use on the young adult are rare, prior studies underscore how family history of substance use is an important predictor of adolescent risk behavior (Bailey et al., 2016; Brook et, al 2012; Brook et al., 2015; Rothenberg et al., 2020). Yet only two identified studies have attempted to explore intergenerational cannabis use across three generations; while both found links between parent and child cannabis used behaviors, only one included all three generations in models (Bailey et al., 2016). Given that substance use by family members other than parents can directly influence the behavioral and normative beliefs, and in turn intentions and behaviors of adolescents (Cederbaum, 2016; Hutchinson and Wood, 2007; Malmberg et al., 2012) understanding the paths from distal predictors, such as grandparent’s cannabis use, to adolescent cannabis use, will help us better understand the intergenerational links between the cannabis use of grandparents, mothers, and their offspring. Identification of these intergenerational risk factors is prerequisite to the identification of prevention and intervention targets. We also explored possible gender differences in the hypothesized paths, considering that the impact of parental substance use on youth substance use might be more prominent among same-gender parent-child dyads (Cho, 2018) particularly in mother-daughter dyads (Kosty et al., 2015). Clarifying gender variations in the intergenerational transmission of substance use between parents and offspring is important to develop effective intervention strategies and deploy resources in a more targeted way (Capaldi et al., 2016).

Methods

The Young Women and Child Development Study (YCDS) is a longitudinal study examining a comprehensive range of developmental outcomes among teen mothers and their children (Lee et al., 2017; Oxford et al., 2010). Data collection started in 1988; mother-child dyads were followed approximately every year for 17 years (N = 240). Study eligibility included: (a) being younger than 18 years old at the time of enrollment; (b) not married; (c) planning to bear and parent the child, and (d) able to speak English. The sample was racially diverse (48.8% White, 27.1% African American, 6.7% Native American, 4.6% Hispanic, 4.6% Other, 4.2% Asian/Pacific Islander, 4.2% Black/White); 40% of the children were female. At the initial interview mean age of participants was 16.1 years (SD = 1.01). Among children, 71.7% reported no prior pregnancy and 21.7% reported public assistance as their main source of income. Sample retention rates were consistently high, averaging 94.6%. Participants were compensated $15–50 per interview depending on the data collection wave. The study and data collection procedure were approved by the human subjects review committee at the affiliated universities.

Grandparents Measures

Data were collected at the first wave of the data collection (time when teen mother was pregnant). Grandfather and grandmother use of cannabis was measured by asking mothers the question “Do either of your parents (or guardians) smoke marijuana (grass, hash, pot)?” for each parent separately. The item was rated with a 3-point scale (0 = no, 1 = used to but quit, 2 = yes, sometimes, 3 = yes, often). A majority of grandfathers (N = 112; 63.3%) and grandmothers (N = 155; 69.2%) reported never having used cannabis.

Maternal Measures

Behavioral attitude toward cannabis use (at child age 11.5 years)

Behavioral attitude toward cannabis use (at child age 11.5 years) was assessed using three items. With the stem “For you, would using marijuana during the next six months be…” were anchored with a 5-point response scale (0 = very bad to 4 = very good; 0 = very unpleasant to 4 = very pleasant; and 0 = very harmful to 4 = very helpful, respectively).

Normative beliefs toward cannabis use (at child age 11.5 years)

Normative beliefs toward cannabis use (at child age 11.5 years) were measured with one question that asked, “What do most people who are important to you think about you using marijuana during the next six months?”. The item was evaluated on a 4-point response scale (0 = think I definitely should not to 3 = think it’s okay).

Intention to use cannabis (at child age 11.5 years)

Intention to use cannabis (at child age 11.5 years) was assessed with a single item that asked “How likely is it that you will use marijuana during the next six months?”. The item was rated on a 5-point response scale (0 = very unlikely to 4 = very likely).

Maternal cannabis use (at child age 15 years)

Maternal cannabis use (at child age 15 years) was measured by asking number of times mothers reported using cannabis in the past 6 months (0 = never, 1 = less than once a month, 2 = about once a month, 3 = less than once a week, 4 = about once a week, 5 = 2–5 times a week, 6 = every day, 7 = more than once a day). A majority of mothers reported never having used cannabis (N = 164; 77.0%).

Adolescent Measures (youth age 16 and 17 years)

Behavioral attitude toward cannabis use (age 16).

Three items assessed behavioral attitude. A single item “Do you think if you smoked marijuana in the next year it would be…” was anchored with a 5-point response scale (0 = very bad to 4 = very good; 0 = very foolish to 4 = very wise; and 0 = very negative to 4 = very positive).

Normative belief toward cannabis use (age 16)

Normative belief toward cannabis use (age 16) were captured with two items that asked what people who are important to youth (i.e., mother and second parent figure) would think about the youth using cannabis during the next six months. The items were evaluated on a 4-point response scale (0 = think I definitely should not to 3 = think it’s okay).

Intention to use cannabis (youth age 16)

Intention to use cannabis (youth age 16) was measured with a single item that asked, “If things went as you would like them to, how likely is it that you will smoke marijuana in the next year?”. The item was rated on a 5-point response scale (0 = very unlikely to 4 = very likely).

Cannabis use (age 17).

Cannabis use was measured by the number of times youth reported using marijuana in the past 6 months (0 = never, 1 = less than once a month, 2 = about once a month, 3 = less than once a week, 4 = about once a week, 5 = 2–5 times a week, 6 = every day, 7 = more than once a day). A majority reported having used cannabis at least once (N = 112; 60.9%).

Covariates

Covariates included child gender (male = 0; female = 1) and child race (0 = White, 1 = non-white). Youth’s internalizing (Mean = 1.96, SD = 2.01) and externalizing problems (Mean = 7.45, SD = 4.06) assessed using the Child Behavior Checklist (Achenbach, 1991) at age 4.5, the earliest assessment available, were added as covariates indicating earlier symptoms of psychopathology, which has been linked to adolescence substance use (Colder et al., 2013).

Analytic Plan

The hypotheses for the present study were tested using Structural Equation Modeling (SEM), a general linear model estimated from the covariance matrix of variables (Bollen, 1989). We performed a two-step SEM approach as recommended by Bollen (1989) and Anderson and Gerbing (1988). First, we conduct a confirmatory factor analysis (CFA) to evaluate whether latent variables reasonably represented observed variables (the measurement). Then, using the latent factors established in the CFA, we test hypothesized paths among grandparent’s cannabis use and mothers’ attitudes and normative beliefs, intention, as well as behavior toward cannabis use, which in turn influence adolescent’s attitudes and normative beliefs, intention, and then eventually adolescent cannabis use (the structure). In the final stage, a multiple group analysis approach was used to test for gender differences in the degree to which maternal cannabis use is influential on youth’s attitudes and norms. A set of fit indices, including comparative fit index (CFI ≥ .95), root mean square error of approximation (RMSEA ≤ .06), and standardized root mean squared residual (SRMR < .08), was used to estimate fit of models (Hu and Bentler, 1999). All analyses were conducted in Mplus version 8 (Muthén and Muthén, 1998–2017). Missing data were managed with full information maximum likelihood estimation (FIML), a recommended method to address missing data (Schlomer et al., 2010).

Results

Descriptive statistics for the path analysis variables are presented in Table 1 and bivariate correlations among analysis variables are shown in Table 2. Informed by the TPB model, we first estimated a CFA model with three latent constructs including maternal attitude, child behavioral attitude, and child behavioral norms. Factor loading of one indicator for each factor was fixed at 1 to scale the other indicator(s) and the factors were set to be correlated. The CFA model fits the data well—CFI = .987, RMSEA = .057, and SRMR = .055. All indicators had high factor loadings (β= .72 to .92) and were statistically significant (p < .001), empirically confirming the latent constructs. Standardized factor loadings and the intercorrelations among the factors (see Figure 1).

Table 1.

Descriptive statistics

Variable % M SD Range
Child gender
 Female 41%
 Male 59%
Child race/ethnicity (minority) 62%
Child internalizing (Age 10) 1.96 2.01 0 – 9
Child externalizing (Age 10) 7.45 4.06 0 – 19
Grandmother’s marijuana use (Pregnancy) .44 .76 0 – 3
Grandfather’s marijuana use (Pregnancy) .56 .89 0 – 3
Maternal attitude a (11.5 years postpartum)
 Bad/good .87 1.07 0 – 4
 Unpleasant/pleasant 1.06 1.25 0 – 4
 Harmful/helpful .90 1.02 0 – 4
Maternal norm (11.5 years postpartum) .67 .91 0 – 3
Maternal intention (11.5 years postpartum) .69 1.23 0 – 4
Maternal behavior (15 years postpartum) .85 1.86 0 – 7
Child attitude (Age 16)
 Bad/good 1.08 1.15 0 – 4
 Foolish/wise .83 .96 0 – 4
 Negative/positive .90 1.03 0 – 4
Child norm (Age16)
 Mother .30 .59 0 – 3
 Second parent figure .37 .71 0 – 3
Child intention (Age 16) 1.06 1.35 0 – 4
Child behavior (Age 17) 2.03 2.44 0 – 7
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Table 2.

Correlations Among Analysis Variables

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1. Child gender
2. Child race/ethnicity .07
3. Child internalizing −.09 .04
4. Child externalizing −.19* −.07 .52**
5. Grandmother marijuana use .04 .08 .08 .05
6. Grandfather marijuana use .07 .06 .05 .23** .35**
7. Maternal attitude: good/bad −.07 .18* .08 .08 .04 .09
8. Maternal attitude: pleasant/unpleasant −.05 .08 .04 .10 .07 .12 .73**
9. Maternal attitude: helpful/harmful −.19 .18* .15 .10 .06 .13 .78** .68**
10. Maternal norms −.02 .26** −.01 .06 .14* .24** .55** .46** .49**
11. Maternal intention −.06 .15* −.03 .10 .10 .10 .67** .67** .57** .38**
12. Maternal behavior −.02 .08 −.05 .05 .19** .15 .46** .50** .40** .30** .62**
13. Child attitude: good/bad .08 .12 −.00 −.04 .07 .04 .08 .17* .13 −.04 .14* .18*
14. Child attitude: wise/foolish .01 .14 −.11 −.10 .02 −.06 .04 .15* .08 −.04 .14 .20** .78**
15. Child attitude: positive/negative .03 .09 −.05 −.06 .05 −.05 .03 .14 .05 −.05 .12 .21** 79** .84**
16. Child norms: mother .01 .14 −.03 .01 .03 −.08 .19** .20** .20** .19** 21** .18* 34** 33** .28**
17. Child norms: father .08 .12 −.09 −.13 −.08 −.16 −.05 .02 .00 −.04 .00 −.01 .40** .37** 39** 57**
18. Child intention .04 .08 −.06 −.15 .03 −.09 .07 .10 .13 −.02 .07 .18* 74** .69** .69** 35**
19. Child behavior −.07 .09 .01 .03 .06 .02 .09 .05 .04 .03 .06 .12 .53** 44** 45** 27**
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Figure 1.

Figure 1.

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Confirmatory Factor Analysis of Attitude Items and Norms

Note. *** p < .001. Factor loadings are standardized.

Next, the hypothesized paths were estimated (the structural part of the model) to test the paths among grandparent, mother, and child variables. The results are presented in Figure 2. The model explained 37.5% of the variance and demonstrated a good model fit—CFI = .969, RMSEA = .039, and SRMR = .065. Grandfather’s use of cannabis was significantly linked to mother’s normative beliefs (β = .22, p = .006), but not to mother’s attitude (β = .12, p = .182). Grandmother’s use of cannabis was not significantly associated with either mother’s attitude (β = .03, p = .727) or normative belief (β = .07, p = .366). As theorized, mothers’ attitudes were associated with her intention to use cannabis (β = .79, p < .001), and in turn, intention predicted cannabis use (β = .61, p < .001). Moving through the family expansion of the Theory of Reasoned Action, mothers’ behavior was predictive of adolescent’s attitudes towards cannabis use (β = .21, p = .002), which in turn was associated with the adolescent’s intention to use cannabis (β = .73, p < .001); adolescent’s intention to use cannabis predicted cannabis use behavior (β = .60, p < .001). There were significant correlations between grandmother and grandfather cannabis use (r = .35, p < .001), mother’s behavioral and normative beliefs (r = .58, p < .001), or child’s attitude and normative beliefs (r = .51, p < .001).

Figure 2.

Figure 2.

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Path model of intergenerational model of theory of reasoned action on marijuana use

Note. *** p < .001.

Finally, a multiple group analysis was conducted to test for gender differences related to mothers’ cannabis use – mother’s cannabis use to youth’s attitude and norms. The path from maternal cannabis use to youth’s attitude was significant only for girls (β = .41, p < .001), while the path from maternal cannabis use to youth’s norm was significant only for boys (β = .25, p < .015).

Discussion

Adolescents of teen mothers are at greater risk for substance use (Cederbaum et al., 2020). While links between parental and child substance use have been previously established (Bailey et al. 2016; Madras et al, 2019; Tiberio et al., 2020; Vermeulen-Smit et al., 2015), this study is one of few (Bailey et al., 2016; Rothenberg et al., 2020) with a three-generation model to explore the cannabis use across generations and then its underlying mechanisms. Consistent with the TRA, behavioral beliefs were predictive of intention which, in turn, predicted cannabis use behavior for both mothers and youth. The findings support prior work using the family expansion of TRA (Hutchinson and Wood, 2007; Cederbaum et al., 2016; Cederbaum et al., 2017), showing that parent cannabis use behaviors (both from grandfather to mothers and mothers to adolescents) were significantly associated with cannabis use in next generation. The findings highlight the complexity of intergenerational transmission of cannabis use but establish areas for future prevention work.

Parental Influence

Parents play an influential role in the cannabis use behaviors of adolescents; role modeling of substance use behaviors is a particularly significant predictor of these same behaviors among their offspring (Rusby et al., 2018). As posited by the family expansion of the Theory or Reasoned Action (Cederbaum et al., 2016; Cederbaum et al., 2017), in this work we found that teen mother’s cannabis use behaviors were a significant predictor of adolescent permissive attitudes towards cannabis use for girls and norms for boys; these in turn were predictive of the adolescent’s intention to use cannabis, with intention predicting adolescent cannabis use. Current study findings highlight that maternal cannabis use sets the risk process in motion, although the mechanisms linking maternal cannabis use to youth’s own reasoned action process for cannabis use may differ for two genders. These findings contradict some prior studies (Kosty et al., 2015) and confirm some others (Vermeulen-Smit et al.,2015). The associations between maternal cannabis use and adolescent attitudes or norms may also be driven by direct observations and perceptions of the parental behaviors as social norms (Kerr et al., 2015; Rusby et al., 2018). Thus, problem behaviors among parents are likely to be associated with early initiation of problem behaviors for their offspring (Cho, 2018). This finding is in line with findings by Bailey and colleagues (2016) and extends this line of inquiry by testing the influence of parent cannabis use behaviors on behavioral beliefs and norms across generations.

Theorized paths underlying cannabis use across three generations

While both grandparent and parent cannabis use behaviors influenced the subsequent generation, these behaviors did not influence the same theoretical constructs. Grandparent cannabis use was predictive of mother’s perceived norms, but not their behavioral beliefs. This link may occur because social norms can be influenced by perceptions of parent substance use behaviors (Lochbuehler et al., 2016; Rusby et al., 2018); as such, grandparent behaviors influenced the perception of cannabis use norms among mothers. The influence of mothers’ behaviors on adolescents showed that maternal cannabis use behaviors were predictive of behavioral beliefs, but not norms. This finding is well supported by prior TRA work which shows a stronger link between external influence on behavioral beliefs as compared to norms (McEachan et al, 2016). For teen mothers, this relationship may have been less salient because of known relationship challenges that arise when adolescents become pregnant (Jacobs and Mollborn, 2012). As posited in TRA (Fishbein and Ajzen, 1975) and shown in relevant studies using TRA to understand cannabis use (Ito et al., 2015; Malmberg et al., 2012; Wu et al., 2015), behavioral beliefs significantly predicted intention to use cannabis; in turn, intentions to use cannabis predicted cannabis use behaviors. Taken together, our study findings support paths hypothesized in the TRA (Fishbein and Ajzen, 1975) and the family expansion (Hutchinson and Wood, 2007).

Limitations

While a theoretically grounded analysis of intergenerational cannabis use across three generations is a unique and important contribution to the literature, there are several study limitations. First, this study focuses on a specific population—teen mothers, their parents, and adolescent offspring. Because teen mothers are more likely than older mothers to live with their family of origin and/or get greater support from family after the birth of their child, intergenerational cannabis use may have a differential influence on children of teen mothers. As such, the generalization of our study findings to families with different demographic characteristics should be carried out cautiously. Second, a number of items were measured using a single item. Although the items fit each construct of the theory and use of a single-items measure is common with TRA constructs (Kavanaugh and Schwartz, 2009), more robust measures of norms and behaviors should be considered in future work. Further, all data were self-reported; it is possible that cannabis use was under-reported by teen mothers and their adolescent offspring. Last, cannabis use of fathers and paternal grandparents has not been included. Given work that shows the association of these parenting behaviors on the substance use behaviors of adolescents, this should be included in future work.

Conclusion

This study supports the prior findings connecting cannabis use across three generations (Bailey et al., 2016; Rothenberg et al., 2020) and extends the work by examining a mediational theory to explore mechanisms by which intergenerational cannabis use is influenced. The inclusion of self-reported and prospective data from grandparents, mothers, and adolescents is another strength. Using a theory-driven path model we found the grandparent cannabis use behaviors have a significant influence on mothers’ beliefs but not attitude, which in turn influence intentions and behaviors. Mothers’ behaviors set adolescents’ attitude but not their norms in motion, which in turn influence intentions and eventually adolescent cannabis use behaviors. Findings contribute to the existing literature and lend new insight into how cannabis use may be influenced or maintained across generations. The results allow for identification of prevention and intervention points for reducing cannabis use. Future work should consider interventions that target both parents and adolescents, increasing knowledge and skills related to parent-child communication (to influence attitudes and norms), parental monitoring (reduce opportunity), and positive parental role modeling (refraining from cannabis use around adolescents) to reduce intergenerational continuity of cannabis use.

Highlights:

  • Parents influence the cannabis use behaviors of their children.

  • Knowledge about mechanisms by which intergenerational cannabis use is influenced is limited

  • Interventions that target both parent and adolescents, are needed to reduce intergenerational continuity of cannabis use

Acknowledgements:

This work was funded by a grant from the National Institute of Child Health and Human Development (R03HD097379; PI: J.O. Lee).

Funding:

This work was supported by the National Institute of Child Health and Human Development (R03HD097379; PI: J.O. Lee) and National Institute of Drug Abuse (R01DA05208 PI: Gilchrist & Morrison)

Footnotes

Declarations of Interest: None

Contributor Information

Julie A. Cederbaum, University of Southern California, Suzanne Dworak-Peck School of Social Work.

Woo Jung Lee, University of Southern California, Suzanne Dworak-Peck School of Social Work.

Lucinda Okine, University of Southern California, Suzanne Dworak-Peck School of Social Work.

Lei Duan, University of Southern California, Suzanne Dworak-Peck School of Social Work.

Jungeun Olivia Lee, University of Southern California, Suzanne Dworak-Peck School of Social Work.

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