Adolescent Substance Use in Mexico: Does Health Literacy Moderate Known Predictors?

Overview: This study aimed to assess the moderating effects of adolescent health literacy on the connection between parent-child relationship and adolescent substance use. We find a strong relationship between parent-child relationship and adolescent substance use, which supports previous research, and has important policy implications for parents and youth in Mexico.Proposal text: Background and

Purpose: According to the National Institute on Drug Abuse, 61.5% of United States twelfth graders have used alcohol, 46.6% have used illicit drugs, 43.7% have used marijuana, and 24.0% have used cigarettes in their lifetime. It is known that the quality of the parent-child relationship is associated with adolescent substance use; however, there are – to our knowledge - no studies on whether health literacy (HL) can moderate and help explain the connection between parent-child relationship and adolescent substance use. Information about the potential moderating effects of adolescent HL on this relationship could be a valuable addition to our understanding of how to assist with and prevent substance use among youth.

Method: Surveys were sent to households in Mexico where there was a parent/guardian and a 14-17-year-old youth. Participants were solicited from every state in Mexico, with sampling initially focused on rural states. Interested parent-youth dyads were provided a link with consent forms and the survey. Once the survey data was collected, various checks were used to ensure high quality data, including: 1) Flagging responses that were completed faster than the median time; 2) Screening out duplicate internet protocol (IP) addresses to prevent “ballot box stuffing”; and 3) Checking for straight-lining and copy/paste open-ended responses. The final sample consisted of data from 373 parent-child dyads (total N = 746), with data coming from participants living in each Mexican state. Demographic measures, parent-child relationship measures, and measures assessing participant health, health behaviors, HL, health access, and health knowledge were administered.

Results: T-tests looking at parent-child relationship and substance use indicated that youth who had ever used alcohol, tobacco, marijuana, or hard drugs reported a poorer relationship with their parents than youth who had never used any of those substances (t = -1.99, p < .05). Logistic regression analyses predicting lifetime use of the substances listed found that lower parent-child relationship scores predicted higher lifetime drug use when controlling for adolescent age, gender, and parent’s highest level of education (OR = 1.26; p < .05). Moderation analyses suggested that adolescent HL did not influence the connection between parent-child relationship and substance use.

Discussion: Our results support previous research on the connection between parent-child relationships and substance use outcomes, with poorer parent-child relationships associated with increased drug use. However, the findings show that adolescent HL does not moderate this connection. These results may be partially understood through mixed findings of previous research looking at adolescent HL and health behavior. Some research has found that adolescent HL is associated with higher rates of substance use, unlike findings among adults where increased HL is regularly associated with positive health outcomes. This could be due to youth with higher HL believing they can use substances in a safer manner, or the fact that individuals do not always make decisions based on their knowledge and values. Further research is needed to see how or whether HL may be helpful in preventing or lowering rates of adolescent substance use.