Research report no.10 2004
Parenting influences on adolescent alcohol use
by Louise Hayes, Diana Smart, John W. Toumbourou and Ann Sanson
5. Parental, family, and broader environmental factors
In addition to parenting behaviours, there are other ways in which parents may influence their adolescent's alcohol use. The aspects to be reviewed here range from individual parental characteristics (such as parental alcohol use) to broader contextual and cultural influences. As made clear by ecological models of development (for example, Bronfenbrenner 1992) and more specific approaches such as the Social Developmental Model, it is important to consider the broader social context in which families are embedded, including cultural norms and values, laws concerning adolescent alcohol use, and the applicability of the findings to particular communities and sub-groups.
This review thus now turns to an examination of the research on parental and family characteristics and their relationship with adolescent alcohol use. The following sections examine parental consumption of alcohol, risky parental alcohol use and alcohol dependence, followed by family structure, and family socio-economic background, the role of differing cultural norms and legal systems, and findings regarding Indigenous adolescents.
Parental factors
Regular parental alcohol consumption
Parents' own use of alcohol is related to adolescents' alcohol consumption. An Australian cross-sectional study (Quine and Stephenson 1990), with 2336 primary school children in Grades 5 and 6, found that even young children were significantly more likely than other children to have the intention to drink, or to have drunk a glass of alcohol, if their parents drank at least weekly. They were also more likely than other children to accept a glass of alcohol from a friend if their parents drank at least weekly.
With regard to drinking behaviour, as opposed to intentions, the importance of parents and peers was shown in a sub-sample of these children. From the sample of 2336 children, there were 720 children classified as either occasional or morefrequent drinkers. These children were significantly more likely to drink frequently if a close friend also drank, more likely to drink if a sibling drank, and the significance of parental drinking was third in importance (Quine and Stephenson 1990). Thus in this study the intention to drink appeared to be primarily influenced by parental behaviour, but for actual drinking behaviour (as opposed to intentions) parental influence was ranked third, after the influence of peers and siblings.
An analysis within the Australian Temperament Project (Prior et al. 2000) found that while the most significant predictor of substance use at age 15-16 years was antisocial behaviour at 13-14 years; substance use was also associated with maternal smoking and drinking, as well as poorer attachment to parents, and other child characteristics such as thrill seeking.
Some research suggests that when parents use alcohol frequently, their adolescents have an increased likelihood of being exposed to alcohol-related risk behaviours. In a survey of 658 Victorian students aged 16-17 years, Bonomo et al. (2001) found adolescents who had experienced an alcohol-related injury were 1.8 times more likely than other adolescents to have parents who drank alcohol daily. (There was also a significant relationship with sexual risk taking behaviour, with adolescents who reported sexual risk taking behaviours being 3.1 times more likely than other adolescents to report that their parents drank daily).
Further analysis of data from the Australian Temperament Project for the present review also revealed significant associations between maternal and paternal drinking patterns (as reported by the mother), and the level of alcohol use reported by the adolescent. Adolescents who reported that they did not drink were more likely to have parents who reported that they were occasional or non-drinkers, while adolescents who drank at very high levels were more likely to have parents who reported that they were occasional or frequent drinkers. There was also a significant association between parental alcohol use and allowing adolescents to take alcohol to parties, with those parents who were non-drinkers less likely to give permission for their adolescent to take alcohol to parties.
It is possible that frequent parental alcohol use might affect the parenting behaviours that were shown previously in this review to be most proximal to adolescent alcohol use. In international research, an important longitudinal body of work by Dishion et al. (1999) has found that parental substance use does not show unique influence, after controlling for parenting practices or peer influence, and these authors argue that it is parenting skills and behaviour management that have the most direct influence on adolescent behaviour. Using the parenting framework of Dishion and McMahon (1998) to interpret these findings, it could be inferred that a range of parental behaviours might change as a result of frequent parental alcohol use. For example, it may be that parents who drink alcohol daily may be less likely to monitor their adolescents' free time, or to have beliefs supporting young people's early alcohol initiation, or they may have poorer relationships with their adolescents. These are areas that warrant further investigation.
Alternatively, research has suggested that there may be an educative modelling role in responsible parental drinking. For example, Johnson and Johnson (2000) suggest that controlled parental alcohol use may have a buffering effect when used within ritualised family practices. There may also be different associations between the use of alcohol by mothers and fathers. For example, Chassin and colleagues (1993) found that there was a direct relationship between mother's current use and adolescent alcohol use, but not father's current use. To understand these issues it is necessary to identify the impact of specific parental drinking patterns on adolescent drinking, and the influence of parental alcohol use on parenting behaviours in general, and parent-adolescent relationships in particular.
Parental alcohol abuse
With regard to parental alcohol abuse, the research has taken two directions, and has examined either the biological propensity for abuse, or the social and behavioural learning links. Each of these will be reviewed in turn.
Research has demonstrated significant biological links between parental alcohol abuse and the alcohol use of their children. In a summary of the key research on these biological associations, Hawkins et al. (1992) reported that research has demonstrated some genetic differences in alcohol responses in the children of adults who are dependent upon alcohol. Twin studies have shown that male children of such individuals have a greater likelihood of alcohol abuse (discussed in Hawkins et al. 1992). Adoption studies, too, have shown consistent evidence for the genetic transmission of alcohol dependence to male children, with rates of dependence of 18 per cent to 27 per cent among male offspring (Hawkins et al. 1992). However, as Hawkins and colleagues (1992) point out, approximately half the adults hospitalised for alcohol dependence do not have a history of family alcohol abuse, suggesting that biological linkages are not pervasive.
However, parenting behaviours and skills that have been discussed previously may have a greater impact on adolescent alcohol use than biological propensities. The greatest effect of parental alcohol abuse is likely to come from disrupted parent-adolescent relationships. For example, in a matched sample comparing families with at least one biological parent who was dependent on alcohol to a control group with no dependence, the biological effect on adolescent alcohol use was mediated by the child's stress level (Chassin et al. 1993). This study showed that parental alcohol dependence increases the child's stress, and this stress is directly related to negative affect, associations with deviant peers, and increased use of alcohol.
Similarly, the longitudinal modelling of Barnes and Farrell (1992) (using latent growth modelling) revealed that parental alcohol abuse had an indirect effect on adolescent alcohol use, and was mediated through parental support and parental monitoring. They also reported that adolescent orientation to peers had a significant impact. The peer orientation factor measured whether adolescents were more likely to choose the views of their peers, rather than their parents. In this study, when adolescents had a familial history of alcohol abuse plus a high regard for peers, the adolescent was more likely to develop regular drinking patterns.
Other researchers have investigated adolescents' internalised cognitions toward alcohol, and have found that parental consumption is associated with adolescents having positive attitudes towards alcohol, even when the parents abused alcohol. For example, in a sample of 97 adolescents aged 12-18 years, Brown and colleagues (1999) found that adolescents who were exposed to familial alcohol dependence tended to have positive attitudes toward alcohol in general, and positive expectancies for the effects of alcohol on social behaviour, sexual enhancement, relaxation, and tension reduction. Surprisingly, exposure to parental alcohol dependence did not predict negative alcohol expectancies in these adolescents. The findings from this study highlight the importance of learning and modelling processes in the expectancies adolescents develop about alcohol consumption. They also showed that adolescents from alcohol abusing families did not develop more negative attitudes towards alcohol use.
Summary
The research reviewed reveals that parents' own use of alcohol increases the likelihood that adolescents will also consume alcohol. Australian research has shown that parental alcohol use is also associated with greater alcohol-related risk behaviours in adolescents. Other research suggests that parental alcohol use impacts indirectly, by changing parental management skills. Although limited, some alternative research suggests that controlled parental alcohol use may have a buffering effect when used within ritualised family practices.
Biological links between parental alcohol dependence and adolescent alcohol use have been found. Additionally, other research indicates that parental alcohol dependence has indirect effects on adolescent alcohol use, through the changes it exerts on parenting behaviours and socialisation patterns. Exposure to parental alcohol abuse has been shown to influence adolescent attitudes toward alcohol, and appears to result in positive, rather than negative, attitudes. The studies reviewed have examined adolescent levels of use, risky use and abuse, with connections between parental alcohol use or alcoholism and adolescents' initiation of alcohol use under-studied at present.
Broader family factors
Family structure
The association between family composition and adolescent alcohol use has not been widely investigated. One very large well-designed European study was located that investigated this issue amongst 34,001 adolescents aged 15-16 years (Bjarnason et al. 2002). This cross-cultural study over 11 European countries used random sampling to select schools and classes, and all students present on the day completed the questionnaire (86-92 per cent response rate). A significant positive effect was found for adolescents who lived with both biological parents (intact families). These adolescents had reduced frequency of heavy drinking, when compared with single mother, single father, or blended families. Interestingly, the positive effect of belonging to an intact family was stronger in the societies where adolescent culture favoured heavy drinking.
In the New Zealand Christchurch cohort, early family breakdown was associated with heavier alcohol use at age 14 and this effect was maintained after adjusting for age 8 conduct problems and earlier age of first alcohol use (Fergusson et al. 1995). Although no Australian studies on family composition were found, previous longitudinal research has linked family breakdown as an independent risk factor for the development of youth substance use (Coffey, Lynskey, Wolfe et al. 2000).
Family socio-economic background
While family socio-economic status has been consistently associated with antisocial behaviour, the relationship between socio-economic status and adolescent drinking is equivocal. Class or socio-economic status does not generally appear a strong predictor of youth drug use in Australian follow-up research (Coffey et al. 2000; Williams, Sanson, Toumbourou and Smart 2000).
There are scattered United States findings suggesting that parental occupation and parental prestige are positively related to adolescent drinking (discussed in Hawkins et al. 1992), indicating that alcohol use is higher among adolescents whose parents are of higher socio-economic status. In relation to the impact of low family socio-economic status on adolescent alcohol use, Hawkins et al. (1992) argue that adolescent alcohol use increases only when poverty is extreme, but notes that at this extreme level most adolescent risk factors and problem behaviours also increase.
Community influences on parenting
In disadvantaged communities the impacts of poverty, neighbourhood safety, and social supports on parenting are important factors. Disadvantage in communities has been associated with poorer relationships between parents and their children (FACS Parenting Information Project review 2004). While the effect of poverty alone is not clear, poor families experience greater stress through inadequate housing, economic insecurity, and job loss (FACS Parenting Information Project review 2004). The Parenting Information Project reports that neighbourhood effects are only small to moderate when family factors are controlled for; however, it is not clear how parenting might change to counter the effects of dangerous neighbourhoods. According to a review by Garbarino and Kostelny (1993), parents living in dangerous neighbourhoods respond by being more restrictive with their children. For the purposes of this review, this could mean that parenting norms concerning adolescent alcohol use might be tightened as a response to social disadvantage within communities, but this remains unknown as yet.
Summary
Several broader family characteristics have been shown to be related to adolescent alcohol use. Adolescents from intact families were found to engage less often in heavy alcohol use, while adolescents from sole-parent families were more often involved in heavy drinking. While there are scattered United States findings suggesting connections between higher family socio-economic background and greater adolescent alcohol use, these trends were not evident in the Australian studies reviewed. Relationships between socio-economic status, community disadvantage, and adolescent alcohol use have not been clearly demonstrated as yet.
Broader cultural influences and norms
The theoretical frameworks provided by the Parenting Model and the ecological emphasis of the Social Development Model highlight the fact that parental and adolescent behaviour are influenced at many levels and in many arenas. Therefore a multi-component approach is required to change adolescent drinking behaviour (Catalano, Kosterman, Hawkins, Newcomb and Abbott 1996). That is, there would need to be not only parenting interventions, but also changes within schools, peers, communites, social norms, and laws.
Prevailing cultural norms regarding adolescent alcohol use are thought to exert a powerful influence. Bjarnason and colleagues (2002) found that in countries where there was a tolerant or permissive attitude towards youth alcohol use, rates of heavy alcohol use among young people were higher than in countries where the social climate towards youth alcohol use was less favourable. Distinct differences between Australia and the United States were found in the relationship between norms concerning adolescent substance use and patterns of use, as shown by Beyers Toumbourou, Catalano, Arthur and Hawkins (2004). These authors present findings from three large, representative student samples recruited in Victoria, Australia and in the American states of Maine and Oregon. In each study, a variant of the Communities That Care youth survey was used (Arthur, Hawkins, Pollard, Catalano and Baglioni 2002).
While there were many similarities across the two countries, the factors which were more powerfully associated with risk for substance use among Australian youth reflected more tolerant attitudes and norms, while the risk factors identified for youth in the United States were more reflective of social alienation, measured by individual factors such as rebelliousness, academic failure and low social skills.
Findings were interpreted according to the policy differences in the two countries (Beyers et al. 2004), with Australian harm minimisation policies associated with greater acceptance of experimentation with drug use and American abstinence policies associated with punishment of use. The authors note that although these comparisons are important, methodological differences may limit their validity, including the fact that the studies were cross-sectional and the samples were not prospectively matched. It is likely that other factors also contributed to these across-country differences - for example, norms concerning adolescent alcohol use and different socialisation practices surrounding alcohol.
Summary
Prevailing cultural norms regarding adolescent alcohol use appear to exert a powerful influence. In countries where there is a tolerant or permissive attitude towards youth alcohol use, youth patterns of risky use tend to be higher than in countries where the climate is less favourable towards youth alcohol use.
Young Australians perceive there to be considerable acceptance among parents and the broader community of youth alcohol use, and there appears to be powerful normative pressure toward youth alcohol use.
Laws regarding adolescent alcohol use
Hawkins and colleagues (1992) have proposed that laws affect social norms, and that alcohol use is a function of these social norms. Laws also impact on availability, and when availability increases, so does the prevalence of adolescent drinking (Hawkins et al. 1992). Studies examining the relationship between minimum legal drinking age and adolescent drinking have shown that lower legal age limits are associated with increases in adolescent drinking and adolescent traffic accidents (Hawkins et al. 1992). The previously discussed large cross-cultural study (Bjarnason et al. 2002) across 11 European countries with 34,001 students found that the adolescent drinking culture had a significant overall direct effect on heavy drinking across these countries.
There is strong evidence from both the United Sates (Wagenaar and Toomey 2002), and Canada and some other countries (Shults, Elder, Sleet et al. 2001) that increasing the legal age for youth purchase and use of alcohol can reduce youth alcohol use and related harm. This evidence comes from research studies that have monitored trends in state data concerning alcohol consumption, and alcohol-related mortality and morbidity before and after modifications to state minimum drinking age laws.
The evidence supports the view that increasing the legal age for alcohol purchase and use is associated with reductions in levels of adolescent alcohol consumption and related harm. One flow-on effect of changing the laws concerning access to alcohol among adolescents and young adults is that parents seem to adopt less favourable attitudes to youth alcohol use (Yu and Shacket 1998). There is also evidence from one community trial demonstrating that action to enforce minimum alcohol purchase age laws can reduce associated harms (Grube 1997). It is possible that an increased focus on the enforcement of under-age drinking laws in Australia might influence prevailing attitudes regarding youth alcohol use as well as supporting and reinforcing parental efforts to delay the age of adolescent alcohol initiation and to guide subsequent moderate, responsible patterns of use.
Summary
Laws concerning adolescent alcohol use can exert considerable influence on adolescent consumption and parental attitudes toward adolescent alcohol use. Studies conducted in the United States examining the relationship between minimum legal drinking age and adolescent drinking have shown that lower legal age limits are associated with increases in adolescent drinking and adolescent traffic accidents. Conversely, increasing the legal age for youth purchase and use of alcohol has been associated with reductions in youth alcohol use and related harm. One effect of changing the laws concerning adolescent access to alcohol is that parents seem to adopt less favourable attitudes to youth alcohol use. As yet, the applicability of these findings to the Australian context is unknown.
Indigenous adolescents
One goal of the present project was to review relevant Australian research with Indigenous adolescents. There is little information regarding patterns of drug use among young Indigenous people. Dunne, Yeo, Keane and Elkins (2000) report findings from a primary school student survey completed with a small convenience sample of schools in Brisbane and the Torres Strait Islands. They found no significant association between Indigenous/non-Indigenous background and risk of smoking tobacco or marijuana, while Indigenous children were less likely than non-Indigenous children to report experience with alcohol. Their conclusion was that that the excessive uptake of drug use among Indigenous Australian young people occurs in the early stages of secondary school, arguing for preventive education in primary schools. The Indigenous and non-Indigenous children living in Brisbane had slightly higher smoking rates than those in the Torres Strait Islands. Conclusions from this study should be accepted very cautiously as the small, non-representative sample may not have reflected broader trends.
Gray and colleagues were invited by the local Indigenous community to complete a study in the Albany region of Western Australia. All 110 Indigenous Australians aged 8-17 years living in the region were identified. and 105 surveyed. There were high rates of solvent use and poly drug use, rising sharply from age 15. The overall frequency of alcohol consumption was lower in this survey by comparison with younger Western Australian secondary school students (Gray, Morfitt, Williams, Ryan and Coyne 1996). Findings from the above study were in line with those reported earlier for Dunne and colleagues (2000) in demonstrating that excessive substance use for young Indigenous people around Albany emerged most strongly in the early high school years.
In their consultations in Victoria, Rowland and Toumbourou (2004) reported that the family was considered within the Indigenous community to play an important role in Indigenous youth alcohol and drug use. In this review, interventions to assist Indigenous families through the early years and also with the parenting of adolescents were both indicated. The report noted the recent development in Victoria of a Koori ABCD Parenting Program seeking to assist Indigenous families with culturally specific parenting practices.
Using the NDSHS 1994 Indigenous supplement data, Hennessy and Williams (2001) reported that proportionately fewer Indigenous young people consume alcohol than non-Indigenous people; however, the Indigenous young people who drink do so at more risky levels. This finding was replicated in the recent NDSHS survey, which revealed that more than one-quarter of Indigenous young people aged 18-24 years drank at levels that are considered to be high risk over the long term, compared with 14 per cent of other Australian young people (AIHW 2003a).
A New South Wales survey has compared alcohol use amongst Aboriginal and Torres Strait Islanders (ATSI) school students and non-Aboriginal students (Forero, Bauman, Chen, and Flaherty 1999). This study reported on data collected across several administrations of a large-scale survey, and included data collected in 1996 from 346 ATSI students (from a total sample of 10,026 students), and also on pooled data collected in 1992 and 1989 from 224 ATSI students (from a total sample of 7,614 students). Prevalence comparisons revealed that ATSI students were not significantly more likely to drink alcohol on a weekly basis than other students, but they were 2.1 times more likely to drink at risky levels (Forero et al. 1999).
The Forero et al. (1999) study measured relatively few parenting-related variables, but some differences were shown between the Indigenous and non- Indigenous students. Comparisons revealed that Indigenous students were 1.6 times more likely than non-Indigenous students to be unmonitored in the evening and had higher amounts of spending money each week. They were also 2.0 times more likely not to be living with both parents (Forero et al. 1999).
In the Albany study reported above (Gray et al. 1996), 60 per cent of the parents identified alcohol use as a major problem, and the parents also thought there was a need for more education and support. This study also reported that 89 per cent of the parents wanted more information about alcohol for their children, and 76 per cent wanted more information for themselves (Gray et al. 1996). Clearly, the issue of parenting influences of adolescent alcohol use in the Indigenous context is under-researched at present. It is likely that the recently completed study of Indigenous children and families - the Western Australian Aboriginal Child Health Survey (Zubrick, Lawrence, Silburn, Blair, Milburn, Wilkes et al. 2004) - will provide relevant data in its forthcoming reports. One major aim of the study was to report on the levels of problem behaviours, including alcohol use, among child and adolescent participants, and the family and environmental influences on these behaviours.
While there is lack of information at present, it is probable that many aspects of the parenting behaviours and parental characteristics discussed in this review will generalise to Indigenous adolescents and families. To the extent that aspects of parenting and their effects on child and adolescent development are universal, the broader findings and conclusions described here may be applicable to Indigenous parents, and prove of benefit to them.
Summary
The studies reviewed suggest that the pattern of Indigenous adolescent alcohol consumption differs from that of non- Indigenous adolescents. Those Indigenous adolescents who drink appear to consume alcohol at more risky levels. Unfortunately, these conclusions are based on few studies, and further investigation is needed. No specific research was located concerning the influence of parenting on alcohol use among Indigenous adolescents.