Positive Parenting and Substance Use Intentions Among U.S. Rural Adolescents: The Mediating Role of Immediate Substance Use Determinants

Background and Purpose: Rural youth report higher rates of substance use (i.e., alcohol, tobacco) and more severe substance use-related consequences than their urban and suburban counterparts. Positive parenting is consistently found to deter adolescent substance use through various mechanisms such as increasing resistance self-efficacy and decreasing affiliation with substance-using peers. However, previous research on this topic has failed to examine (1) these mediational relationships among U.S. rural adolescents, an understudied group in the U.S.; (2) parental disapproval of substance use as a mediator; and (3) substance use intentions as a target outcome, a more relevant outcome for prevention targeting early adolescents. This study fills these gaps by examining the pathways of parental monitoring and parent-child relationship to substance use intentions through five immediate substance use determinants among rural adolescents.

Methods: The sample consisted of 228 rural adolescents (7^th and 8^th graders) in North Carolina. Over half of the participants identified as female (57.6%), 52.4% identified as Black, 18.5% as Latinx, 17.2% as White, and 11.9% as Mixed Race or Other. Participants filled out a 30–45-minute-long online survey at two time points (4 months apart). This study used the data for all eight key variables from both time points, including parental monitoring and parent-child relationship as focal independent variables, five mediators (i.e., perceived peer substance use, perceived peer and parental disapproval of substance use, substance resistance self-efficacy [refuse, explain, avoid, and leave], and would say no if offered substances), and substance use intentions as the target outcome (i.e., intent to use alcohol/vape/tobacco/marijuana in the next two months). Composite scores were used for all multi-item variables. Structural equation modeling (SEM) in Mplus 8 was used to test the hypothesized mediation paths that include autoregressive, lagged, and contemporaneous effects. All models controlled for sex, grade, and race/ethnicity. Significance tests for the mediated effects were tested based on the bias-corrected bootstrapped confidence intervals.

Results: Perceived peer disapproval of substance use was not a significant mediator between parenting and substance use intentions and was dropped from the final model. The final model had a satisfactory model fit. Parental monitoring and parent-child relationship at time 1 had a statistically significant indirect influence on concurrent and future substance use intentions. The other four immediate substance use determinants mediated the relationships. When holding time 1 variables constant, parental monitoring at time 2 still had a statistically significant indirect influence on time 2 substance use intentions through the mediation of substance resistance self-efficacy, whereas parent-child relationship at time 2 did not have a statistically significant influence on time 2 substance use intentions over and above time 1 parent-child relationship.

Conclusions and Implications: Parental monitoring and positive parent-child relationship decrease substance use intentions among U.S. rural adolescents by influencing immediate substance use determinants. While parental monitoring has an immediate and sustaining protective influence on substance use intentions, the protective effect of a positive parent-child relationship on substance use intentions might take time to evolve. The findings of this longitudinal study have implications for substance use prevention efforts for rural adolescents.