Parenting and Adolescent Substance Use: Moderation Effects of Community Engagement

# Springer Science+Business Media New York 2017

Abstract Supportive parenting practices including autonomy granting and non-parental factors including adolescents’ connections to their communities are significantly associated with adolescent substance use outcomes; however, few longitudinal studies have considered both factors concurrently in nationally representative samples. Using longitudinal data from a nationally representative sample of adolescents in grades 7–12 (n = 12,139; 51% male), results indicated that community engagement significantly moderated the association between parental autonomy granting and substance use into emerging adulthood. Results also suggested that community disadvantage was a significant risk factor for adolescents’ substance use. These results further indicated that substance use among emerging adults was also high when accounting for prior levels of community engagement and parental-autonomy, and while controlling for substance use during adolescence.

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Keywords Adolescentsubstanceuse.Parenting.Autonomygranting.Communityengagement

Parental involvement in adolescents’ daily lives is a consistent predictor of risk behavior; parental processes – including autonomy granting practices that encourage teens to develop a sense of competence in their decision making skills – are significantly associated with risk outcomes including substance use initiation and ongoing patterns of use (Abar et al. 2015; Chan and Chan 2013). Similarly, indicators of relationship dynamics that describe the bond or connection teens experience with their parents – like attachment security and perceived familial support – are protective factors against maladaptive outcomes across adolescence and through the transition to adulthood (Bell et al. 2000; Dixon et al. 2008). Recent research suggests that parenting practices that shape the socioemotional tenor of the home may act

* Beth S. Russell


Department of Human Development & Family Studies, University of Connecticut, 348 Mansfield

Road, Unit 1058, Storrs, CT 06269-1058, USA


Human Development & Family Studies Department, University of Delaware, 111 Alison Hall West, Newark, DE 19716, USA

independently from the influence of broader family functioning predictors of adolescent outcomes. For example, in a study of over 300 families, Everri et al. (2015) found that indicators of parental involvement intensified the beneficial influence of adaptive family functioning while also exerting a protective influence against the negative impact of dysfunctional family dynamics. Additionally, non-parental factors including adolescents’ connections to their communities are an important consideration in the study of substance use (Brooks et al. 2012); however, few longitudinal studies have considered both factors concurrently. This scarcity in the literature, as well as a lack of nationally representative samples, presents an opportunity to strengthen developmentally appropriate studies of adolescent risk behavior.Parenting Practices During Adolescence

Studies of parental influence on adolescent risk behavior suggest that there are specific features of parenting that are associated with substance use in adolescence. A careful examination of these features – or parenting practices – is warranted as results from the most recent National Survey on Drug Use and Health indicate over 2 million adolescents aged 12–17 were illicit drug users in 2013 (SAMHSA, Center for Behavioral Health Statistics and Quality 2014). Further, there are deeply concerning consequences from adolescent drug and alcohol use, such as impaired cognition associated with accidents, homicide, and suicide – the leading causes of morbidity and mortality for this age group (CDC 2015; Miniño 2010). The supportive tenor of the parent–child relationship serves as a crucial influence on parent–child communication about appropriate and risky behavior throughout adolescence.

Parents’ involvement in adolescents’ social lives via monitoring, or parents’ active pursuit of knowledge about child behaviors to identify and intervene against perceived inappropriate or risky behaviors, decreases over time (Abar et al. 2015). In contrast, practices that encourage independent decision making – or autonomy granting practices – increase. Parents may scale-down their monitoring practices reactively as children become more competent problem-solvers or when teens respond to their bids for information as increasingly unwanted; conversely, parents may proactively encourage more autonomous development. Developmental theories describe this as the normative process of an adolescents’ individuation from their families (parents in particular), and note a shift to an increased reliance on peers, as teens strive to build a sense of self from broader connections to their communities (Cox et al. 1999; Steinberg 2001; Steinberg and Morris 2001). In doing so, adolescents encounter an increasingly nuanced social landscape that expands to include a greater number of sources of socialization over time. These sources provide information about culturally accepted behavior and attitudes that shape individuals’ choices as they seek a sense of belonging; including whether and to what extent youth engage in risk behavior (Oetting and Donnermeyer 1998).

Reports of parents’ efforts to grant their adolescents greater autonomy and the resulting insights they may have about their child’s activities and relationships vary by source (Lippold et al. 2011; Reynolds et al. 2011). For instance, Abar and colleagues’ (2015) study of a large, longitudinal sample of 6th–8th graders indicated that while adolescents’ reports of parental monitoring were better predictors of substance use outcomes than parents’ reports, the largest discrepancies between the reports were often uniquely associated with a higher probability of alcohol use. This discordance reflects reporters’ subjective perceptions – of what and how the parent asks, and what the child is comfortable sharing – and may be influenced by reporter bias reflecting parents’ desires to appear attentive and adolescents’ desires tobeautonomous (Latendresseetal. 2009;Stattin andKerr2000).

While literature on social influences on adolescent risk behavior might place parent/family influence in opposition to that of peers and the broader community (Werner-Wilson and Arbel 2000), there is evidence that these two domains are not orthogonal, but instead are related: An adolescents’ sense of connection to the broader community context outside the home is in part dependent on the extent to which their parents support their autonomy and exploration in society (Darling and Steinberg 1993). Supportive parenting that scaffolds adolescents’ independence during the transition to adulthood reflects a degree of sensitivity and developmental awareness characteristic of a nurturing parenting style (Baumrind 1991, 2013; Darling and Steinberg 1993). While findings regarding the association between adolescent outcomes and an authoritative parenting style that balances controlling or demanding qualities against warm and nurturing ones are mixed (Koning et al. 2012; Kosterman et al. 2000), there is evidence that particular practices common to this overarching style may be more consistent predictors of risk behavior (Minaie et al. 2015).

Parental autonomy granting provides youth with significant opportunities to develop decision-making skills that promote adaptive outcomes over time and is associated with reduced risk taking behavior (Bell et al. 2000; Brenning et al. 2015; Fletcher and Jefferies 1999; Luk et al. 2015; Patock-Peckham and Morgan-Lopez 2009; Steinberg 1990). The extant literature on the possible protective influence of autonomy granting during adolescence is nuanced however, as some studies report that the greatest benefit to youth risk outcomes is only seen when autonomy granting parenting practices are coupled with parental responsivity and other features of authoritative parenting (Steinberg and Morris 2001). For example, Lanza et al. (2013) used latent class analysis with a sample of over 4,700 12–14 year olds to examine associations between parental autonomy granting and risk behavior. They reported that teens with parents who granted a high degree of autonomy but provided low levels of responsivity were more likely to take greater risks compared to all other groups. Indeed, a careful discussion about the extent to which adolescents should be granted freedom to make their own choices with regards to friends, leisure time, and risk behavior should not be uncoupled from other supportive parenting behaviors that scaffold decision making skills needed for teens’ ability to assess risk (Best and Miller 2010; Huizinga et al. 2006).

The parenting of adolescents often involves a balance between the need to support their exploration as a means of individuation, against the need to know their whereabouts and behavior. Parental monitoring is widely suggested as a protective factor against delinquency and substance use, specifically, but as Stattin and Kerr (2000) pointed out, parental monitoring is only one parenting practice for use in keeping track of youth’s behavior and associations. They posit that open communication is more beneficial than surveillance and control. In particular, their review of several studies indicated that supportive parent-adolescent relationship qualities are associated with more positive outcomes and lower risks, and that interventions to boost parents’ surveillance and control over their adolescents had no effect. Their interpretation of these findings is that parents who know more about their adolescent’s friends and how they spend their time together are likely to come by an important level of detail gained through teens’ self-disclosure; and that self-disclosure is most likely to occur in relationships characterized by open, supportive communication. In short, adolescents were more likely to share details of their lives with parents with whom they shared a supportive bond characterized by open communication.Community Connections in Adolescence

How adolescents encounter and navigate the tension between connections to family and connections to communities outside the home is a crucial consideration in predictions of adolescents’ risk behavior (Allen, and Loeb 2015; Chan and Chan 2013). Salient to the study of adolescence and emerging adulthood is an adolescent’s sense of supportive connection to their community – or lack there of – which is significantly associated with subsequent risk behavior (Brooks, et al. 2012). For example, feelings of marginalization and underrepresentation in one’s community are predictive of socioemotional struggles and increased risk behaviors, including substance use (Brenner and Wang 2015), whereas a sense of connection to positive nonfamily role models, or of belonging in one’s neighborhood community, is associated with decreased risk behavior (Scales et al. 2006). Community disorganization – physical deterioration, neighborhood crime, vagrancy, loitering, public intoxication and other forms of social disorder – is associated with negative child and adolescent health and wellbeing outcomes (Latkin and Curry 2003), whereas and community cohesion – including a sense of trust and safety in the community paired with perceived support from community members- is noted as a protective factor against substance use (Brooks et al. 2012).

Questions remain however, concerning the duration of the effect parents’ autonomy granting practices can have. For example, Fletcher and Jefferies (1999) found significant associations between autonomy granting as a feature of authoritative parenting and substance use outcomes in a sample of 8th graders, and Luk et al. (2015) found similar associations in a sample of college students. It is reasonable to ask whether this relation remains significant in longitudinal examinations of substance use over time. If so, would any longitudinal effects of parental autonomy granting on substance use be dependent on either the adolescents’ sense of connection to community or on supportive qualities of the parent–child relationship? The present study sought to fill this gap in the extant literature. We considered whether the longitudinal association between autonomy granting and substance use might be moderated by qualities of the parent-teen relationship (i.e., parental support) or by adolescents’ sense of community engagement. We hypothesized that there would be a significant association between parental autonomy granting and substance use during adolescence and emerging adulthood (H1). Further, we hypothesized that parental support and community engagement would moderate the association between parental autonomy granting and substance use during adolescence (H2), as well as during emerging adulthood (H3).Methods

This study relies on longitudinal data collected through The National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of adolescents in grades 7–12 in the United States during the 1994–95 school year. The Add Health used a multistage, stratified, school-based cluster design and the inclusion of contextual data from the U.S. census tracts (Merten 2010; Stewart and Simons 2010). Students in the selected schools responded to an in-school survey from which a nationally representative sample was selected for in-home interviews when the students were 13–17 years old (Wave 1), with a subsequent follow-up 1 year later (Wave 2). At Wave I, data collection efforts included interview questions regarding the social and demographic characteristics of the respondents, the education and occupation of their parents, household structure, risk behaviors, expectations for the future, and school-year extracurricular activities. At Wave II, data collection efforts extended to include questions relating to the adolescents’ daily activities, academics and education, their access to health care services, relations with peers, among other things (Mo and Singh 2008).Participants

Of the 20,745 Add Health respondents who completed in-home interviews at Wave 1, 17,165 (51% male) respondents from Wave 1, and 12,139 from Wave 2 were included in the current study. Of these, the majority were Caucasian (67%) and lived with both their biological parents (53%; see Table 1 for further demographic details).Measures

Substance Use (Wave 2) was measured using the same 5 items at both Waves. Items assessed the total frequency of adolescents’ use of inhalants, cocaine, marijuana, cigarettes, and alcohol in the last 30 days (e.g., BDuring the past 30 days, how many times did you use marijuana?^). Parental Autonomy Granting (Wave 1) was measured using a composite of 7 items assessing the degree to which adolescents’ reported their parents encourage autonomous decision making (including how to spend leisure time, peer selection, and daily schedule choices like bed and mealtimes, for example BDo your parents let you make your own decisions about the time you must be home on weekend nights?^). Parental Support (Wave 1) was measured by using a composite of participants’ responses to items on their perceptions of parents’ supportive and affectionate behaviors toward their adolescent (2 items for each parent, 4 total). Community Engagement (Wave 1) included 6- items assessing the level of engagement and satisfaction adolescents experienced with members of their community. Items included Bexample here^, for example.

Based on the literature, a number of covariates were included in the present study, such as, gender, race, parental education, and community disadvantage. The coding for race and ethnicity used three dummy variables, including White (reference category), African-American, and Hispanic-American. Other Race/Ethnicities represented in the Add Health dataset were not included in this study due to small group sizes and subsequent limited power to detect significant differences. The family income variable was created from the Add Health household roster and family income-toneeds ratios suggested by the federal poverty guideline for that year. Lastly, family structure was coded using three dummy variables: dual parent parent families (reference category), father-headed households, and mother-headed households. As with the Race/Ethnicity variable, other Family structures were not considered in the analyses due to small samples, and limited support for their inclusion in the extant literature.

Community-Level Disadvantage The community disadvantage variable was constructed fromAdd Health’s Wave1 contextual datafile using fivecensus-level items with stronginternal consistency (Cronbach’s alpha = 0.91). These included: (1) proportion of female headed households with children 18 years of age or younger, (2) proportion of households with public assistance income, (3) proportion of individuals with service-level or clerical jobs, (4) proportion of persons or households with income below poverty, and (5) proportion of individual’s unemployed. Scores ranged from 0 (least advantage) to 5 (highest advantage), where higher values on this scale indicated greater levels of community disadvantage.Analysis

Using the statistical software STATA, interaction terms were created for parental support and community engagement using the predictor term parental autonomy granting. Next, we tested the main effect of parental autonomy granting in adolescence and the moderating effects of parenting and community factors on later substance. In order to test our first hypothesis that parental support would moderate associations between parental autonomy granting at Wave 1 and adolescent substance use at Wave 2, we employed structural equation modeling techniques, controlling for substance use at Wave 1, gender, race, parental education, and community disadvantage. In this model, we included parental autonomy granting X parental-support as our moderating variable. A similar analytic approach was used to test our second hypothesis that community engagement wouldsignificantlymoderatethesesameassociations –againcontrollingforgender,race, parental education, community disadvantage, and substance use at Wave 1. In this model, we included parental autonomy granting X community engagement as our moderating variable. Missing data were handled using FIML procedures which assume that values are missing at random and are

Table 1 Descriptive statistics

Dependent variable Substance use (Time II)1.001.0804
Substance use (Time I)a0.031.44−2.6328.13
Parental autonomy granting5.121.5907
Parental support4.620.5715
Community engagementa0.112.80−11.815.32
RaceWhite (reference)67.2%
Other race1.3%
Gender Male51%
Community disadvantage0.700.440.953.52
Parental education Less than high school12.4%
High school (reference)32.0%
Some college21.6%
Family structureTwo-biological parents (reference)53.3%
Single mother20.4%
Single father3.1%
Other family structure6.0%

All data collected at Wave I, with the exception of Substance at Wave II a Standardized to accommodate differences in Add Health scales

appropriate for large data sets. Unlike typical Missing At-Random (MAR) procedures, however, FIML estimates a likelihood function for each individual based on the variables that are present so that all the available data are used (Graham et al. 2003).Results Descriptive Statistics

Table 1 provides the descriptive statistics for the present study. Slightly more than half the participants were male (51.0%), with just over two-thirds self-identifying as White. Most adolescents reported residing in a two-biological parent household, and over one-third of the participants’ parents had earned at least a college degree. Substance use among adolescents (Wave I) and emerging adults (Wave II) within the sample was fairly low. Scores for community disadvantage were standardized and ranged from 0.11 to 2.80. Compared with Census data in 1990 regarding population demographics, income and poverty, and community (e.g., U.S. Census Bureau, Current Population Reports, 1994; 2015), these demographics were fairly comparable to the general adolescent population (e.g., 72.5% of children living with two-biological parents in Census as compared to 74.7% in two-biological parent families and stepfamilies in the sample).Hypothesis Testing

In the present study, we investigated whether parental autonomy granting during adolescence would have an impact on adolescent substance use as well as on use over time during emerging adulthood. Further, we considered whether the aforementioned association would be moderated by qualities of the parent-teen relationship (i.e., parental support) or by adolescents’ sense of community engagement.

To test our hypotheses that there were significant associations between parental autonomy granting and substance use during adolescence and emerging adulthood (H1), we employed structural equation modeling procedures using STATA. In our first model, we included substance use at Wave 1 as our dependent variable, and parental autonomy granting as the predictor variable. Race and ethnicity, gender, parental education, family structure, and community disadvantage were included in the model as controls. Results indicated a significant positive association between parental autonomy granting and substance use during adolescence (b = .12, p < .01), suggesting that the more autonomy parents granted to their adolescent, the more inclined the adolescent was to engage in substance use. A similar pattern was found in young adulthood, as results suggested a significant positive association between parental autonomy granting and substance use in emerging adulthood (b = .06, p < .01), even after controlling for substance use during adolescence.

Next, to test the moderating effects of parental support and community engagement on the association between parental autonomy granting and substance use during adolescence (H2), we tested a model that included substance use at Wave 1 as the dependent variable, and parental autonomy granting as the predictor variable. Parental autonomy granting X parental support was included as an interaction term in one model, and parental autonomy granting X community engagement was included as an interaction term in an additional model. Race and ethnicity, gender, parental education, family structure, and community disadvantage were included as

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Fig. 1 The differential effect of parental autonomy granting on adolescents’ substance use by community engagement

controls. Results suggested that neither parental support (b = .01, p < .35) or community engagement (b = .00, p < .44) moderated the association between parental autonomy granting and substance use during adolescence.

Lastly, to test whether parental support and community engagement moderated the association between parental autonomy granting and substance use during emerging adulthood (H3), we tested a model in which substance use at Wave II was included as the dependent variable, and parental-autonomy granting as the predictor variable. Parental autonomy granting X parental support was included as an interaction term in one model, and parental autonomy granting X community engagement was included as an interaction term in a separate model. In addition to substance use at Wave I included as a control variable, race and ethnicity, gender, parental education, family structure, and community disadvantage were also included as covariates. Results suggested that although parental support (b = .01, p = .50) was not found to be a significant moderator, community engagement (b = −0.00, p = .94) significantly moderated the association between parental autonomy granting and substance use during emerging adulthood. As illustrated in Fig. 1, substance use among emerging adults is considerably greater when community engagement and parental-autonomy granting are both high, compared to when both community engagement and parental-autonomy granting are low. Results are shown in Tables 1 and 2.

Additionally, several covariates were also significantly associated with adolescents’ substance use. First, results suggested that female adolescents reported significantly less substance use than theirmalecounterparts.Interestingly,regardingraceandethnicity,whiteadolescentsreportedgreater substance use than all other race and ethnicities. Furthermore, those adolescents whose parents earned a college degree reported significantly less substance use than those whose parents only held a high school diploma. Regarding family structure, adolescents from all other family structures reported significantly greater substance use than those from two-biological parent households.

Table 2 The effects of parental support and community engagement on parental autonomy granting and adolescents’ substance use (Time I)

Parental autonomy granting0.12**0.03
Parental support−0.33**0.02
Community engagement−0.000.00
Race Hispanic−0.20**0.04
Other race−0.34**1.00
Community disadvantage−0.040.03
Parental education Less than high school0.060.03
Some college−0.040.02
Family structure Single mother0.25**0.03
Single father0.46**0.06
Other family0.49**0.06
ModerationParental autonomy granting X parental support0.010.01
Parental autonomy granting X community engagement0.000.00

White is the reference category for race and ethnicity. Male is reference category for gender. High school is the reference category for parental education. Unstandardized coefficients

**p < .01

Among emerging adults, Hispanic and black emerging adults reported significantly less substance use than Whites; similar to adolescents, emerging adults from two-biological parent households reported significantly less substance use than those from all other family structures. Also, community disadvantage was significantly associated with substance use among this sample, suggesting that those from communities experiencing greatest disadvantage were significantly more likely to engage in substance use than their peers residing in more affluent communities (Table 3).Discussion

Our results are consistent with previous findings on the tensions between family and peer influence on risk behavior that indicate parental support is more meaningful at younger ages (Aalsma et al. 2011); also, our results build on prior literature as findings suggests that adolescents who report more parental autonomy granting were more likely to report substance use in emerging adulthood when they felt a higher degree of community engagement. This suggests that the influence of the parent-teen relationship and an adolescent’s sense of connection to their community may be developmentally sensitive – in accord with developmental theories for adolescence (Darling and Steinberg 1993) – such that adolescents raised in parenting environments that support exploration and autonomy may increase their substance

Table 3 The effects of parental support and community engagement on parental autonomy granting and emerging adults’ substance use (Time 2)

Substance use (Time I)0.33**0.01
Parental autonomy granting0.06**0.01
Parental support−0.20**0.01
Community engagement−0.01*0.00
Race Hispanic0.020.03
Other race0.040.07
Gender (Reference)0.030.02
Community disadvantage−0.08**0.02
Parental education Less than high school−0.040.03
Some college0.030.02
Family structure Single mother0.16**0.02
Single father0.16**0.05
Other family0.14**0.05
ModerationParental autonomy granting X parental support0.010.01
Parental autonomy granting X community engagement−0.00**0.00

White is the reference category for race and ethnicity. Male is reference category for gender. High school is the reference category for parental education. Unstandardized coefficients

*p < .05; **p < .01

use as they transition to adulthood, particularly when they feel a strong connection to their community. These results echo those published by Brooks et al. (2012) who report that peer community factors (at participants’ schools and neighborhoods) were a more powerful predictor of risk behavior than parental monitoring and regulation of adolescents’ autonomy. The finding that increases in risk behavior may be due to adolescents’ perceived connection to individuals within the community who accept and potentially promote a degree of substance use and a Bculture of drinking^ has clear intervention implications (Ahearn et al. 2008). Specifically, substance use prevention programs for older teens may benefit from promoting positive avenues to community engagement as adolescents leave their parents’ homes and become independent members of the community. Mentorship interventions that rely on positive relationships to establish young adults’ sense of connections through building an inclusive and constructive sense of belonging to their neighborhoods and larger communities may see powerful results (Brooks, et al. 2012). Scales and colleagues (2006) note that youth development programs that bolster community connection by fostering teens relationships with nonfamily mentors creates Bmore developmentally advantageous kind of adult engagement^ (p.411) that is associated with reduced risk behavior and improved indicators of thriving. Indeed, youth program practices that create positive connections to nonfamily mentors and opportunities for adolescents to make meaningful contributions to their communities are promising (Jennings et al. 2006.

Our results suggest that racial/ethnic minority status was not a risk factor for adolescent or young adults’ substance use, but that community disadvantage was. This finding partially supports previous work on socioeconomic marginalization, which indicates the relationship between minority status and psychosocial problems is heightened among Latinos and African Americans (Galea et al. 2007; Brenner and Wang 2015). It may be the case that poverty and the marginalization families face by dint of the cumulative disadvantages associated with it (Bauman et al. 2006; Mulia et al. 2008) plays a stronger role in shaping parenting practices than those associated with race or ethnicity alone. Indeed, one may reasonably ask what aspects of social context and subsequent social capital (i.e., gender, race, ethnicity, singleparent family structure, income, education, etc.) hold sway in adolescent risk outcomes above and beyond the protective factors any particular parenting practice might afford? For this reason, reliance on race/ethnicity indicators alone is troublesome, as noted by Keyes and colleagues (2012). While race/ethnicity are subjective and dynamic concepts, and are powerfully predictive of health, they have little meaning beyond predicting social circumstances. As a result, examinations of risk behavior can avoid the concerning false dichotomies that may be introduced by relying on self-reports of discrete racial and ethnic categories alone by using a broader measure of disadvantage.

The significant associations between higher rates of substance use in White adolescents also echo previous findings which demonstrate the established racial and ethnic disparity in substance use rates at younger ages diminishes over time (Keyes et al. 2012). Family background characteristics including the parenting practices that either promote or protect against behavioral risk outcomes, represent salient endowments adolescents carry with them as they enter high school. But according to Beck and Muschkin (2012), any family disadvantage should dwindle in importance once a student enters universal public education — Bwhen differences among students are the result of their efforts rather than their family endowments^ (p. 565). They posit that school-based interventions aimed at reducing academic and behavioral struggles have likely been crucial in reducing in this component of racial disadvantage.

Moving to the gender differences, we observed a stronger association between gender and substance use for boys than girls. Although gender-differentiated associations between family dynamics and substance use may exist (i.e., a stronger association between substance use and family dynamics indicators like open communication among girls; Ohannessian et al. 2016), other studies have identified more similarities than differences between boys’ and girls’ substance use (e.g., Dornbusch et al. 2001).

A strength of using nationally representative data from longitudinal studies like Add Health is the statistical power to ask rigorous analytic questions with the potential to generalize results to a broader population – in this case, to a range of young adults from a variety of family structures and communities. A limitation that must be noted, though, is the fixed set of measures available to answer these questions, and the potential strengths future studies can adopt by considering additional assessments going forward. For example, measures of problematic substance use (i.e., diagnosis with a substance use disorder, or reports on impaired function measures like the SMAST; Selzer et al. 1975) would provide helpful insights into the extent to which young adults’ substance use outcomes impair their daily lives. Given the differential reporting between parents and their adolescent children on parenting practices including autonomy granting– additional parent-report measures would also strengthen longitudinal examinations of the influence particular family dynamics in adolescence have over time. Lastly, although the Add Health sample was nationally representative of U.S. schools during 1994–95, the sample included lower representation of racial/ethnic minority youth than found in American secondary schools today which may have affected our power to detect some possible group differences.

Compliance with Ethical Standards All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. Beth Russell and Melissa Gordon declare that they have no conflict of interest.

Conflict of Interest/Funding The authors declare that they have no conflict of interest nor funding sources to disclose.References

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