1. Nonmedical prescription opioids (NMPO) use in parents is an independent risk factor for use in their adolescent children, even after controlling for other substance use and sociodemographic factors.
2. Additional parental risk factors for adolescent NMPO use were parental smoking, low levels of monitoring, and high levels of parent-adolescent conflict.
Evidence Rating Level: 4 (Below Average)
Study Rundown: Parental use of tobacco, alcohol, marijuana, and other substances has been shown to be an independent risk factor for adolescent substance use. Despite these prior findings, potential intergenerational NMPO use between parents and children has not yet been examined, even though many adolescents identify family members as a source of NMPOs. In this cross-sectional study, researchers used survey data from the National Survey on Drug Use and Health (NSDUH) of parent-adolescent dyads to examine the association between parental and adolescent NMPO use. After controlling for other drug use and sociodemographic characteristics, parental, specifically maternal, NMPO was significantly associated with adolescent use. Additional parental risk factors for adolescent NMPO use were parental smoking, low levels of monitoring, and high levels of parent-adolescent conflict. Adolescent risk factors for NMPO use included cigarette or marijuana use, being depressed, and perceiving that most schoolmates used drugs; protective factors were believing that drug use was risky and high religiosity.
These findings are limited by the focus on lifetime use, rather than more specific use patterns. Furthermore, the data were cross-sectional and used only parent-adolescent dyads, not triads. Nonetheless, the study is strengthened by its large, nationally-representative sample and novel exploration of a previously unexamined association. For physicians, these findings highlight the importance of addressing parental NMPO use as a risk factor for adolescent use, potentially by screening for affected adolescents and parents and offering interventions for both.
In-Depth [cross-sectional study]: Researchers used cross-sectional survey data from the 2004-2012 NSDUH to identify 35 000 parent-adolescent dyads with an adolescent aged 12 to 17 years. The study estimated the association between parent and adolescent self-reported lifetime NMPO use while controlling for parent and adolescent other drug use, attitudes about drug use, and sociodemographic characteristics.
There was a significant association between parent and adolescent NMPO use; 13.9% of adolescents whose parents had used an NMPO also did so, compared with 8.1% when a parent had not used (adjusted odds ratio [aOR] 1.30; 95% CI 1.09-1.56). Only maternal, and not paternal, NMPO use was significantly associated with adolescent NMPO use (aOR 1.62; 95% CI 1.28-2.05) and did not differ by child sex or parent-adolescent race. When controlling for parental use of other drugs, lifetime smoking retained a positive association with adolescent NMPO use (aOR 1.24; 95% CI 1.02-1.51). Adolescent risk factors included cigarette or marijuana use before NMPO, being depressed (aOR 1.62; 95% CI 1.37-1.93), and perceiving that most schoolmates used drugs (aOR 1.71; 95% CI 1.44-2.04). Adolescent protective factors for NMPO use were believing that drug use was risky (aOR 0.77; 95% CI 0.72-0.82) and high religiosity (aOR 0.92; 95% CI 0.86-0.99).
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