Current studies now routinely recognize that single-focused approaches to prevention must be used in coordination with programs that will increase the protective factors and reduce the risk factors surrounding the child. These factors include the child's personal, familial, and environmental background.
A large body of research findings shows that the family contributes both risk and protective factors to the lives of adolescents; it affects both vulnerability and resilience to drug abuse (NIDA Notes, May/June 1996).
The latest in a long line of studies affirming the role of parents and families in adolescents' life choices is by Resnick et al. (1997), who review adolescent risk behaviors that pose the main threat to adolescents' health. The objective of their study was to identify risk and protective factors at the family, school, and individual levels as they relate to four domains of adolescent health and morbidity: emotional health, violence, substance use, and sexuality.
Resnick and colleagues studied over 12,000 adolescents, grades 7 through 12, and interviewed them at home as part of the National Longitudinal Study of Adolescent Health. The key finding of the study, which appeared in a recent issue of JAMA and which was widely reported this past fall in the popular press and on television, was that being connected with their parents and families and with their schools helped protect teens against every health risk behavior measure that was studied, with the exception of pregnancy.
Parent-family connectedness was measured through variables such as closeness to parent, perceived caring by the parent, satisfaction with the relationship with the parent, and feelings of being loved and wanted by family members. Other measures included the number of different activities engaged in with the mother or father during the past week; the physical presence of the parent before and after school, at bedtime, or at dinner; the parent's expectations for the teen to complete high school or college; and suicide attempts and/or completions by family members in the past year. School connectedness was measured through assessing students' perceptions that teachers treated them fairly, degree of closeness to people at school and feeling part of the school; assessment of prejudice among fellow students; average daily attendance; estimated dropout rate by grade in school; type of school (public, parochial, technical, etc.); average class size; number of teachers with master's degree; proportion of students who are college bound; and percentage of parents involved with the parent/teacher association (PTA). On the individual level, the study looked at general measures of self-esteem, religious identity, same-sex attraction or behavior, perceived risk of untimely death, number of hours of paid work during the school year, perception of appearing younger or older than classmates, grades repeated, and grade point average.
Resnick and colleagues concluded that, across all domains of risk, the
role of parents and family in shaping the health of adolescents is critical.
The protective role that perceived parental expectations play regarding
adolescents' school attainment is a correlate of health and healthy behavior.
Although the physical presence of a parent in the home at key times reduces
risk (and especially substance use), of more significance is parental
connectedness (e.g., feelings of warmth, love, and caring from parents).
The home environment also helps shape health outcomes. Homes where
adolescents have easy access to guns, alcohol, tobacco, and illicit substances
contribute to the adolescent's increased risk of suicidality, involvement
in interpersonal violence, and substance use.
Parents who involve youth in their own use or misuse of alcohol, tobacco, or other drugs also increase the youth's chances of using earlier than other children. Such involvement may include giving the youth a "sip," or asking the youth to get a beer or light a cigarette (Hansen et al., 1987; Brook et al., 1990; Jackson et al., 1997).
The parent's attitude and parental permissiveness toward the youth's use is a key factor in teenage drug use, as much as or more so than peer pressure. One 1993 study conducted by the Johnson Institute in Minneapolis found that when school-age youth are allowed to drink at home, they not only are more likely to use alcohol and other drugs outside the home, but also are more likely to develop serious behavioral and health problems related to substance use. The survey indicated that most parents allow for "supervised" underage drinking, which is a bigger factor in use and abuse than peer pressure.
The influence of family siblings appears to have both a concurrent direct
effect and a delayed indirect effect on a brother or sister's risk of becoming
a heavy drinker (Conger and Rueter, 1996).
Similarly , the parent who communicates clear expectations of behaviors (Hawkins and Catalano, 1992), clear values and expectations for educational standards and goals (Felner et al., 1982), and proactive ways to manage stress and conflict in a positive manner (Werner, 1990) develops resilient behaviors in the child.
Several studies have examined the comparative value of communication from parents and perceived pressure from peers to use alcohol and other drugs (Kafka and London, 1991). One study confirms that parental support and communication from parents does appear to play a role in adolescent behavior, and openness in communication may be considered a protective measure against possible use. Communication, family management, and monitoring are important predictors of adolescent drinking, delinquency, and related problem behaviors, even after taking into account critical demographic and family factors, including socioeconomic indicators, age, gender, race of the youth, family structure, and family history of abuse (Barnes and Farrell, 1992). The authors suggest that their findings demonstrate a less frequent occurrence of overt peer pressure than commonly believed. In their study, youth did not report pressure from friends to engage in negative behaviors. However, wanting to be accepted, wanting to belong, and wanting to be noticed are powerful influences.
Other researchers cite communication and family management problems that include unclear expectations for behavior, inconsistent or harsh discipline, lack of bonding and caring, conflict between the parents or care givers (Kandel and Andrews, 1987; Baumrind, 1985; Johnson et al., 1985) and low expectation for the child's success (Wilson and Herrnstein, 1985) as contributing to the youth's risk of using substances early and becoming dependent on them.
In a study that looked at the comparative influence of family and peers
of youth aged 9 through 17, both current drug users and abstainers, Hispanic
and Anglo youth report that family communication is important to them.
For both groups of youth parental influence is more important than peer
influence on a broad array of factors (Coombs et al., 1990).
The issue of lack of monitoring has received considerable attention in recent years. One study found that latchkey youth who were home alone two or more days per week were four times more likely to have gotten drunk in the past month than those youth who had parental supervision five or more times a week (Mulhall et al., 1996). Another study found that children who had the least monitoring initiated drug use at earlier ages. The contrast in risk of initiating alcohol, tobacco, or other drug use across levels of parent monitoring was greatest when children were under 11 years old. At older ages there was no difference in risk for these drugs. However, for marijuana, cocaine, and inhalant drugs, there was a sustained risk of starting to use these drugs for youth who received low levels of monitoring in middle childhood (Chilcoat and Anthony, 1996)
Some authors have emphasized the importance of the parent's influence on the youth's choice of friends. Adolescents whose friends use drugs are very likely to use drugs themselves. And family variables may influence the choice of friends and thereby influence the risk of drug use. Adolescents who come from families where alcohol and other drugs are used are much more likely to use drugs themselves and choose friends who use drugs. And when parental monitoring is high, adolescents are much less likely to choose friends who use drugs. Thus, parents have powerful influence on their adolescents by their influence on their choice of friends and their monitoring of the peer selection process (Bahr et al., 1993).
The likelihood of youths' associating with drug-using friends is reduced by a close relationship with their parents and by knowing that their friends disapprove of drug use. Students do not use drugs if they are unwilling to jeopardize their relationship with their parents and nonusing friends. They are also less likely to use drugs if they think their parents and friends disapprove of drug use and if their friends do not use drugs themselves (Reid, 1989).
Working at least 20 hours a week during the school year is a risk;
it brings the adverse consequences of fatigue as well as excessive leisure
income. It may also lessen the parent's ability to monitor the youth's
time, choice of friends, and use of money. It is associated with higher
levels of emotional distress, substance use, and earlier age of sexual
debut.
Family factors cited in the literature that increase resiliency include the child's attachment to the parent, the parent's attachment to the child, and the parent's involvement in the child's activities (Smith et al., 1995).
Other major family factors involving family closeness are as follows: the parent is nurturing and protective and concerned for the child's safety and health (Werner, 1990; Garmezy, 1985); develops close bonds with children (Sokol-Katz et al., 1997; Bahr et al., 1995; Hawkins and Catalano, 1992); values, supports, attends and encourages educational activity (Felner, 1982); spends quality time with children (Benson, 1993); and spends time with the child as a family unit (Benson, 1993).
However, a good parent/ adolescent relationship does not always protect the child from substance use. If the parent, particularly the mother, has a good relationship with the youth, and that parent uses substances, the youth is more likely to use drugs. Female youth were more likely to imitate paternal use and nonuse of a substance if they had a good, rather than a poor, relationship with their father. Additionally, parental abstinence did not always ensure abstinence in the child. A youth with a poor relationship with a nonusing parent was as likely to use substances as a youth with a using parent (Andrews, 1994).
Research that examined the components of support from the family showed
that support was marked by more behavioral coping and academic competence,
and less tolerance for deviance and uncontrolled behavior (Wills and Cleary,
1996).
Barnes and Farrell (1992), studying parental support as predictors of adolescent drinking, also found support for peer orientation as a significant predictor of drinking behavior.
Bahr et al. (1995) examined social development and social control theories that suggest children with strong bonds to social groups with antidrug norms will be less likely to use drugs. They hypothesized that family bonds and family substance use are exogenous variables that influence choice of friends, whereas educational commitment and number of friends who use alcohol and other drugs are intervening variables with more direct influences on adolescent alcohol use. Studying a large sample of 7th- through 12th- graders in Utah schools, the authors found that the influence of family bonds on risk of alcohol use is primarily indirect, through educational commitment and choice of peers. The indirect effects of family bonding on substance use were moderate. Findings support an integrated social learning/social control model of adolescent substance use. Family bonding appears to be an important social control mechanism that could decrease the risk of adolescent alcohol use. Findings about relative strength of risk factors studied should be useful for prevention program planning.
Conger and Rueter (1996) showed that factors within the family can promote deviant peer relations. Adolescents can acquire alcohol-using friends through three distinct avenues. The behavior of other family members, including parents and siblings, is expected to increase directly the risk of choosing friends who drink. The adolescent's own drinking behavior plays a major role in determining choice of friends. Also, the role of siblings and their drinking behavior is important. The authors employed several measures in their analysis: parents' history of substance use problems, alcohol use of the target adolescent and his or her siblings, harsh and inconsistent parenting of the youth, and friends' alcohol use. Findings supported the hypothesis that frequent and problematic drinking by siblings would exacerbate the target adolescent's tendency to drink. Also, early drinking appeared to exacerbate other problems. The "flocking phenomenon," i.e., the tendency of teens who drink or use drugs to acquire friends with similar habits, was noted. Target adolescent drinking in 7th grade appears to generate more harsh and inconsistent behavior by parents. Parental history of substance abuse problems is indirectly directed to adolescent risk for later alcohol use, and a stronger effect for mothers' drinking versus fathers' drinking was noted.
The MORI Survey, carried out in 1996 by the Imperial Cancer Research Fund in Great Britain, showed that getting teens to quit smoking can be effectively done by their sweetheart, more so than by a television personality or pop star. "Love is really the key to getting youngsters to quit," says Professor Gordon McVie, director of the Cancer Research Campaign. Next on the list of influencers are parents. Celebrities influence teens in a more subtle way: by their behavior, not their preaching. Featuring celebrities who had successfully quit smoking would send a strong message to teens. Teens also report that they would be encouraged to quit if it became more difficult to buy cigarettes, or if smoking were banned in more public places, or if the price of cigarettes were raised.
Kafka and London (1991) explored the link between communication in relationships and adolescent substance use, specifically the openness in communication between youth and their parents and closest friends. Predictive value of perceived pressure from friends, friends' substance use, and parents' substance use was also analyzed. The investigators found that openness of communication is negatively associated with substance abuse in the case of parent/child communication, but not in the case of peer communication. Perceived pressure from friends was not correlated with substance use. In fact, high school students do not perceive much pressure from friends about their behavior. A possible interpretation is that overt peer pressure is less common than previously believed. Teens did not report pressure from friends to engage in negative behaviors. Perhaps the internal concerns of adolescents are at the root of their choices regarding substance use: wanting to be accepted, to belong, to be noticed.
Keefe (1994) noted that many prevention programs focus on teaching refusal skills, assuming that peers exert direct pressure on each other to influence behavior. As explained in the previously cited study, recent research has shown that adolescents rarely use explicit pressure, yet conformity to group norms does occur when one values being a member of that group. This study examined perceived social pressure among adolescents, and explored age difference in perceived social pressure. Parental and peer pressure were examined in a study of 386 7th-, 9th-, and 11th-graders. Students were asked to compare "costs" and "benefits" of using alcohol; significant differences by age were apparent, with older kids finding more benefits. Findings showed normative pressure against alcohol use from both peers and parents. The authors suggest that programs that focus on coping with negative peer pressure may not be necessary, but that peer norms and programs encouraging peer support for abstinence could be used as effective deterrents. Since older adolescents perceived more benefits to alcohol use, this suggests that programs focusing on negative consequences might be ineffective, and a better choice would be programs focusing on alternative ways to have a good time.
Ried (1989) investigated differential social control theory, which proposes that delinquent behavior becomes more probable as an adolescent's bond to society weakens. The bond, which includes attachment to parents and close supervision, communication, and affectionate ties with parents, is inversely related to delinquency. Another aspect of the bond is attachment to peers; delinquents do not form attachments to conventional peers nor to one another. The third aspect of the bond relates to school: School is not seen as by delinquent adolescents as a source of conventional norms and influences. Ried discusses differential association-reinforcement theory: the adolescent symbolically interacts with many primary groups (parents, peers, school). These groups have verbalized normative expectations for adolescents' behavior. The adolescents are rewarded for the desired response, or punished for failing to make the response, depending on the group's expectations.
This study of 5th- through 8th-grade students showed that none of the above three attachment variables had significant, direct effects on drug use. Instead, the drug use of this sample of students was shown to be directly affected by 1) their perception of whether their friends think they should use drugs or not; 2) their peers' own drug use; and 3) their attitude towards drugs.
Schneider and Perney (1993), surveying adolescents' major concerns and perceived resources, collected information on 42 concerns (e.g., divorce, war, grades, salary, peer drug and alcohol use, family finances, appearance, sexual behavior, etc.). Drug use was in the top 11 percent. Concerns were grouped in various contexts: family, peers, school, etc. Peers were viewed by adolescents as their major source of support, followed by parents, counselors, and self. The peer context included two concerns. Peer drug and alcohol use was seen as less of a concern to Hispanics and Asians, more for African Americans, and most of all to whites. The other major concern, sexual behavior, was significantly more important to rural than to suburban students.
Lifrak et al. (1996) studied the relationship between perceived self-competence and social support, gender, and substance abuse in middle schoolers. In girls, social support was unrelated to substance abuse except for support from classmates, which was associated with more cigarette and marijuana use. In girls with low scholastic competence, more support from peers was consistently associated with more substance abuse.
Ianotti et al. (1996) examined the relationship between adolescent substance
abuse and the adolescents' perceptions of their friends' substance use.
The study involved 4th- and 5th-grade students who were surveyed and tracked
for 4 years. The sample included nearly 2000 students, most of whom
were African American. Self-reported substance use of friends and
classmates was also assessed. Perceived substance use of friends
had stronger association with prior substance use than friends' self-reported
substance use. Perceived family use and classmates' self-reported
use were also contributors. Perceived friends' use is more likely
to be a product of an adolescent's previous substance use than a precursor
of subsequent substance use.
For example, a study by Newsweek magazine (1993) examined the influences on youth aged 11 through 17. The youth were asked a series of questions, among them, Who has a very important influence on you? The responses: parents (86%), grandparents( 56%), place of worship (55%), teachers (50%), peers ( 41%), community (23%), and television, movies, music (22%).
A study examining support networks (Benson, 1993) asked youth aged 12 through 17 where they get their support. Most respondents reported their support came from mother (75%), father (50%), adult sibling (25%), doctor/nurse (20%), aunt (14%), grandmother (13%), and uncle (8%).
Of youth aged 9 through 13 who say they have a hero (60%), here are the top five categories of their heroes: relatives/friends (52.9%), athletes (31.5%), religious figures (13.6%), fictional characters (11.3%), and political-historical figures (8.7%) (USA Today, October 23, 1997).
Research on adolescent development not particularly focusing on substance abuse has indicated that a relationship with at least one caring adult, not necessarily a parent, is perhaps the single most important element in protecting young people who have multiple risks in their lives (Carnegie Council on Adolescent Development, 1992; National Commission on Children, 1991; Wynn et al., 1994).
A review of the literature of the influence of extended family members shows that although parents are the most important adults in the lives of adolescents, nonparental adults may play important roles in the healthy development of young people. Extended family members may be the most important nonparent adults for young adolescents, especially low-income adolescents of color. Although unrelated adults, such as teachers, neighbors, clergy, and youth workers, may comprise a relatively small percentage of the significant adults young adolescents identify as being helpful, they are seen probably more frequently than are adults in the extended family and may assume more importance for specific kinds of communication. Their importance becomes more marked for some youth the older they get ( Scales and Gibbons, 1996).
Extended family members are the most common non-parent source of adult support for adolescents; strong relationships with nonfamily members may be correlates with strong relationships with parents (Scales and Gibbons, 1996). Family members encourage youth to have supportive relationships with caring adults beyond the immediate family, such as a teacher, scout leader, or mentor (Benson,1993).
From these studies, it can be stated that youth are strongly influenced
and supported by their family members, and recognize and value that
support and influence.
Rhodes, Ebert and Fisher (1992) found that young women with natural
mentors had lower rates of depression than those without this support.
Williams and Kornblum (1985) found that one of the key differences between
successful and unsuccessful youth from lower-income urban communities is
that the successful ones had mentors. Also, Lefkowitz (1986) and
Anderson (1991) found supportive adults to be a vital protective influence
on at-risk youth. Other studies have pointed out the importance of
the presence of extra-familial sources of support, including identification
of mentors and models (Masten and Garmezy, 1985; Werner,1990).
Implications for Prevention Programming
Parent, family, and extended family are recognized by research to have a very significant impact on the adolescent's intention to use and actual use of drugs. Young adolescents recognize the family as a very powerful influence on their lives. If family is this powerful an influence, then it follows that our messages directed to youth most certainly need to come from the source that they are most influenced by—their family. Many parents are unaware of how their parenting styles or their drug-taking behaviors influence their youth.
Prevention programming must send the family, including the youth, a
message that has four important components:
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