Associations of Parental Marijuana Use With Offspring Marijuana, Tobacco, and Alcohol Use and Opioid Misuse, Bertha K. Madras et al., 2019

Associations of Parental Marijuana Use With Offspring Marijuana, Tobacco, and Alcohol Use and Opioid Misuse

Bertha K. Madras, Beth Han, Wilson M. Compton, Christopher M. Jones, Elizabeth I. Lopez, Elinore F. McCance-Katz

JAMA Network Open, 2019, 2, (11), e1916015.

doi : 10.1001/jamanetworkopen.2019.16015

Abstract

IMPORTANCE : Marijuana use is increasing among adults and often co-occurs with other substance use; therefore, it is important to examine whether parental marijuana use is associated with elevated risk of substance use among offspring living in the same household.

OBJECTIVE : To examine associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse.

DESIGN, SETTING, AND PARTICIPANTS : This cross-sectional study used survey data from the 2015 through 2018 National Surveys on Drug Use and Health (NSDUH), which provide nationally representative data on adolescents or young adults living with a parent (the mother or the father). Annual average percentages were based on survey sampling weights. Final analyses were conducted September 21 through 23, 2019.

EXPOSURES : Parental marijuana use status.

MAIN OUTCOMES AND MEASURES : Offspring self-reported use of marijuana, tobacco, or alcohol or misuse of opioids.

RESULTS : Survey respondents included 24 900 father-offspring or mother-offspring dyads sampled
from the same household. Among mothers living with adolescent offspring, 8.2%(95%CI, 7.3%-9.2%) had past-year marijuana use, while 7.6%(95%CI, 6.2%-9.2%) of mothers living with young adult offspring had past-year marijuana use. Among fathers living with adolescent offspring, 9.6%(95%CI, 8.5%-10.8%) had past-year marijuana use, and 9.0%(95%CI, 7.4%-10.9%) of fathers living with young adult offspring had past-year marijuana use. Compared with adolescents whose mothers never used marijuana, adjusted relative risk (ARR) of past-year marijuana usewas higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.3; 95%CI, 1.1-1.6; P = .007), less than 52 days of past-year marijuana use (ARR, 1.7; 95%CI, 1.1-2.7; P = .02), or 52 days or more of past-year marijuana use (ARR, 1.5; 95%CI, 1.1-2.2; P = .02). Compared with young adults whose mothers never used marijuana, adjusted risk of past-year marijuana usewas higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.4; 95%CI, 1.1-1.7; P = .001), less than 52 days of pastyear marijuana use (ARR, 1.5; 95%CI, 1.0-2.3; P = .049), or 52 days or more of past-year marijuana use (ARR, 1.8; 95%CI, 1.3-2.5; P = .002). Compared with adolescents whose fathers never used marijuana, adolescents whose fathers had less than 52 days of past-year marijuana use were more likely to use marijuana (ARR, 1.8; 95%CI, 1.2-2.7; P = .006). Compared with young adults whose fathers never used marijuana, young adults whose fathers had 52 days or more of past-year marijuana usewere more likely to use marijuana (ARR, 2.1; 95%CI, 1.6-2.9; P < .001). Compared with their peers whose parents never used marijuana and after adjusting for covariates, the adjusted risk of past-year tobacco usewas higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.3; 95%CI, 1.0-1.6; P = .03), less than 52 days of past-year marijuana use (ARR, 1.5; 95%CI, 1.0-2.1; P = .04), or 52 days or more of pastyear marijuana use (ARR, 1.6; 95%CI, 1.1-2.3; P = .03); adolescents whose fathers had lifetime marijuana use (ARR, 1.5; 95%CI, 1.1-1.9; P = .004) or 52 days or more of past-year marijuana use (ARR, 1.8; 95%CI, 1.2-2.7; P = .006); young adults whose mothers had lifetime marijuana use (ARR, 1.2; 95%CI, 1.0-1.4; P = .04); and young adults whose fathers had 52 days or more of past-year marijuana use (ARR, 1.4; 95% CI, 1.0-1.9; P = .046). Compared with their peers whose parents had no past marijuana use and after adjusting for covariates, risk of past-year alcohol usewas higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.2; 95%CI, 1.1-1.4; P = .004), less than 52 days of past-year marijuana use (ARR, 1.5; 95%CI, 1.2-1.9; P = .002), or 52 days or more of past-year marijuana use (ARR, 1.3; 95%CI, 1.0-1.7; P = .04). After adjusting for covariates, parental marijuana usewas not associated with opioid misuse by offspring.

CONCLUSIONS AND RELEVANCE : In this cross-sectional study, parental marijuana use was associated with increased risk of substance use among adolescent and young adult offspring living in the same household. Screening household members for substance use and counseling parents on risks posed by current and past marijuana use are warranted.

Introduction

The shifting legal environment for marijuana in the United States is traceable to a 1996 California ballot initiative that approved use of marijuana for various medical conditions. Thereafter, medicalization proliferated in other states and spawned a derivativemovement to legalize nonmedical use of marijuana. With legal status and social acceptability of marijuana ascendant, the marijuana industry has created products to enhance palatability and potency1 and expand modes of delivery.2 One outcome of this shift in marijuana status is an overall increase in past-year marijuana use from 25.8 million people (11.0%) in 2002 to 43.5 million (15.9%) in 2018 among US people aged 12 years or older, with noteworthy increases in young adults.3

Paralleling these trends is increasing apprehension of the health consequences of marijuana, especially among adolescents.4 Early marijuana initiation is associated with higher rates of addiction,5 impaired cognition,6,7 preclinical or clinical symptoms of psychosis, schizophrenia, depression, suicidality,8-11 and reduced educational achievement12 and employment status.13 Peer influence, genetics, family environment, family interactions, and quality of parenting are among the risk factors and protective modulators of children’s substance use.14-17

With peak marijuana use occurring among adults of childbearing and childrearing ages, parental marijuana use conceivably poses a direct environmental risk of normalizing marijuana use and enabling access to marijuana for their offspring. Adolescent marijuana use is highest among those with parents and peers who use marijuana compared with nonusing counterparts,18 whereas peer influence on youth substance use can be neutralized by parents who do not use substances.19 In general, living with a parent who uses substances or has substance use disorder is a risk factor for use of substances among young offspring.20,21 Yet, fewstudies have directly examined whether parental marijuana use increases the risk of opioid misuse among adolescent and young adult offspring living in the same household, a critical gap in view of the current opioid crisis.22 Most importantly, none of the existing epidemiological studies simultaneously examined associations between parental marijuana use at detailed frequency levels and adolescent and young adult offspring’s marijuana, tobacco, and alcohol use, and opioid misuse, to our knowledge.

To address this gap, this study examined potential intergenerational associations within specific substances and across substances. Specifically,we examined whether parental marijuana usewas associated with offspring marijuana, tobacco, or alcohol use or opioid misuse. Adolescents and young adults have distinct developmental stages, so separate analyseswere conducted among adolescent and young adult offspring. Our results could help to inform clinicians, parents, and policy makers regarding substance use prevention.

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