The Underlying Effects of the Caregiver-Child Relationship Quality on Adolescent Substance Use in at-Risk Youth

Background and Purpose:
Adolescent substance use is a growing social problem that serves as a catalyst for later substance dependence and other risk-taking behaviors. A significant body of research has reported that substance use is a common and serious issue among child maltreatment victims. However, the effects of child neglect on adolescent substance use remain largely unexplored as studies over-focus on physical and sexual abuse. Gaps in knowledge also remain with respect to the mechanisms through which child neglect affects adolescent substance use. This study seeks to improve our understanding of substance use among neglected adolescents by answering the following research questions: 1) Does child neglect predict adolescent substance use? 2) Does the caregiver-child relationship mediate the effects of neglect on substance use?

Methods:
This study used data from Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), which include five pooled cohort samples that represent children at risk of maltreatment (e.g., children with out-of-home placement history). A total of 883 adolescents (age 12 years at baseline) were included in the analysis. Child neglect at age 11 was measured using the revised version of the youth-reported Neglect Scale that assessed caregivers’ neglectful behaviors (e.g., not give enough food, not take care of the sick child) during the past 12 months. The caregiver-child relationship was measured at age 12 by youth self-report, using a 6-item scale (level of closeness, understanding, trust) that assessed adolescents’ perceptions of the quality of the relationship with their caregivers. Substance use was assessed at age 16, using adolescent self-report of tobacco, alcohol and marijuana use during the past 12 months. Substance use was specified as a latent variable with these three substances. Covariates included child race, gender, parental substance use, and household income. Structural equation modeling was used to examine the direct and indirect (via the quality of the caregiver-child relationship) effects of child neglect on adolescent substance use.

Results:
The proposed mediation path model showed a good fit for the data, indicated by the CFI of .997, RMSEA of .02 and WRMR of .40. Child neglect had no direct effect on adolescents’ alcohol, tobacco, or marijuana use (β = .04, p = .340, 95% CI [-.15, .02]) but had a significant indirect effect on substance use via the quality of the caregiver-child relationship (β = .07, p < .001, 95% CI [.04, .09). Child neglect was associated with poor quality of caregiver-child relationships (β = -.25, p < .001, 95% CI [-.31, -.22]), which in turn, were related to adolescent substance use (β = -.26, p < .001, 95% CI [-.35, -.16]).

Conclusions and Implications:
The present study expands the current literature on adolescent substance use among maltreatment victims by focusing on neglect, the most common, yet under-recognized, form of maltreatment. Further, this study identified the quality of the caregiver-child relationship as a significant underlying mechanism of adolescent substance use in neglected children. Strengthening positive caregiver-child relationships through family-based interventions may be helpful in preventing substance use in neglected youth.