Parenting Behaviors and Their Relationship With

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Institute of Psychiatry Ramón de la Fuente Muñiz. [NIPRFM] ..... .84. Emotional warmth. 15. 2, 6, 14, 18, 24, 26, 28, 32, 40, 42, 48, 54, 58, 62, 66 .90. Rejection. 8.
JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2018, VOL. 27, NO. 4, 227–237 https://doi.org/10.1080/1067828X.2018.1455612

Parenting Behaviors and Their Relationship With Alcohol Involvement in Mexican Teenagers and Young Adults Miguel Villegas-Pantoja !pez-Garc!ıab and Karla Lo

a

, Francisco Guzm!an-Facundob, Maria Alonso-Castillob, Jos!e Moral de la Rubiac,

a School of Nursing, Universidad Aut!onoma de Tamaulipas, Nuevo Laredo, Mexico; bSchool of Nursing, Universidad Aut! onoma de Nuevo Le!on, Monterrey, Mexico; cSchool of Psychology, Universidad Aut!onoma de Nuevo Le!on, Monterrey, Mexico

ABSTRACT

KEYWORDS

This study aimed to identify relationships between perceived parenting behaviors and alcohol involvement in Mexican teenagers and young adults. Egna Minnen Betr€affande Uppfostran (EMBU-I) and Alcohol Use Disorders Identification Test (AUDIT) questionnaires were administered to 276 students from technical schools. Lifetime prevalence of alcohol use was 76.1%. Findings revealed that higher perception of parenting behaviors (rejection and overprotection) was significantly related to higher involvement with alcohol. Those results were consistent in men. Results suggest that parental rejection and overprotection, as well as sex of the offspring, are key elements that must be studied extensively among youths in order to justify preventive strategies toward reducing alcohol use in Mexico.

adolescent; alcohol-related disorders; Mexico; parenting; young adult

Use of alcohol is a highly prevalent behavior (National Institute of Psychiatry Ram!on de la Fuente Mu~ niz [NIPRFM], National Institute of Public Health [NIPH], National Council Against Addictions [NCAA], & Secretariat of Health, 2017) that increases risks for many physical, psychological, emotional, and social disturbances (Monteiro, 2007). In fact, alcohol is the most widely used addictive substance around the world, and is credited with 5.9% of all deaths (World Health Organization [WHO], 2014). In Mexico, it is estimated that some of the leading causes of healthy life-years lost—such as diabetes mellitus, major depression, cerebrovascular diseases, traffic accidents, homicides, and cirrhosis—are related to alcohol use (Lozano et al., 2013). Alcohol use may contribute to a detriment of population health; however, alcohol intake by teenagers and young adults may pose higher risks (Monteiro, 2007). It is known that during early stages of life alcoholic beverages can produce negative effects on neurological development, and may involve significant collateral risks produced under alcoholic intoxication, such as violence and accidents (Monteiro, 2007). As an example, in 2016 there were 2,124 minors (18 years). Their participation was anonymous and voluntary, and their information confidential. The researchers did not collect personal information that could relate the participant with the data. Likewise, data sets were encrypted and stored in a secure computer. The students were distributed in blocks of 10 participants. Only those who gave their signed consent forms could participate (19 participants [6.88%] did not hand in the consent form or refused to participate and were replaced by other students). Academic authorities gave us permission to use specially equipped classrooms next to the library. Those classrooms were quieter, and only the researchers and participants had access. Once the participants were assigned to the computers, the researchers provided the instructions to complete the instrument. To facilitate answering, every laptop had a

Cronbach’s a .91 .94 .85 .81 .84 .90 .77 .70 .88 .93 .81 .74

wired mouse and the software flashed a notification in case the participant had left a question unanswered. The participants could change their responses in case of mistake by clicking the “Back” button (which remained available five seconds after the next question). This feature was included since pressing the space bar or enter key by accident could select a wrong response. The software saved all data automatically and, once a questionnaire was completed, the next instrument was provided. The time for completing the instruments (including instructions) was 27.6 minutes (SD D 3.05). Completion rate was 97.4%. Seven participants did not finish the survey due to academic activities and new participants randomly selected replaced those who suspended the survey. There were no missing data. Data analysis Data analyses were performed with the statistical package IBM SPSS v. 20.0 for Mac OSX! . Descriptive statistical analysis included percentages, central tendency measures, and frequency distributions. The selection of inferential statistics was based on the Kolmogorov-Smirnov test (with Lilliefors correction). As data were not evenly distributed, the Spearman rank correlation coefficient was best suited to answer the study aims. Coefficients’ intensity was interpreted according to Ellis (2010), who proposes that correlation coefficients lower than .100 indicate that the strength of association between two variables is trivial, that from .101 to .299 is small, from .300 to .499 is moderate, from .500 to .699 is high, from .700 to .899 is very high, and any value over .900 is unitary.

Results Sample characteristics Approximately one in 10 participants did not wish to participate. However, we did not ask about the reason

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for not participating. The final sample was 276 randomly selected participants (160 men and 116 women). Descriptive analysis showed that most participants were men (58%), and the average age of the sample was 16.7 years (SD D 1.6). Nearly half of the participants were first-year technical school students (47.8%) and the rest (52.2%) were second-year students. A higher percentage of students reported that they lived with both of their parents (76.1%), followed by those living in a single-parent home (10.9%), with a biological father and stepfather/stepmother (6.5%), and with friends and other relatives (6.5%). Use of alcohol More than half of the sample had drunk alcohol at least once in their life (76.1%), and in the past year (63.8%). Age at first alcohol use was 14.9 years (SD D 1.97). Table 2 shows an average total score of 4.78 points (SD D 4.81) in the AUDIT among those who have drunk alcohol at some point in their life. When compared by sex, male respondents scored significantly higher than females in the domains of Hazardous Alcohol Use (U D 4296.00, Mean rank D p D .019), Dependence Symptoms (U D 4485.00, p D .026), and in AUDIT overall score (U D 4310.50, p D .022). The open-ended question helped to identify that, after alcohol, the most commonly used substances (once in life) were tobacco (52.9%), marijuana (17%), inhalants (7.6%), cocaine (2.9%), and methamphetamine (2.2%). Relationship between perceived parenting behaviors and alcohol use indicators Table 3 displays Spearman’s rank correlation coefficients between parenting behaviors and AUDIT scores. In the overall sample parental emotional warmth was not significantly related to any alcohol use indicator, so there was no empirical support for Hypothesis 2. However, there were significant small correlations between parental rejection subscale and AUDIT overall score (rs D .179, p D .009), Hazardous Alcohol Use domain (rs D .172, p D .012), and Harmful Alcohol Use

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Table 3. Spearman Rank Correlation Matrix for EMBU-I and AUDIT Scores. Variable

1

1. Emotional warmth 2. Rejection 3. Overprotection 4. AUDIT Total Score 5. Hazardous Alcohol Use 6. Dependence Symptoms 7. Harmful Alcohol Use

1 –.367** .465** –.058 –.073 .070 –.096

2 1

.279** .179** .172* .119y .162*

3

4

5

6

7

1 .066 1 .016 .918** 1 .170* .683** .507** 1 .045 .721** .473** .519** 1

Note. N D 276. y p < .10. ! p < .05. !! p < .01.

domain (rs D .162, p D .019). These results indicate that perception of parental rejection is related to higher alcohol use indicators among participants, confirming Hypothesis 1. Concerning the subscale of overprotection, it was correlated to the Dependence Symptoms domain (rs D .170, p D .014), suggesting that when participants perceive more parental excessive control, they score higher on the alcohol Dependence Symptoms domain. The last coefficient also supports Hypothesis 1.

Relationship between perceived parenting behaviors and alcohol use indicators according to sex In general, significant coefficients between parenting behaviors and AUDIT scores were more consistent in teenage men (Table 4) than in teenage women (Table 5). Interestingly, there were no statistically significant relationships between parental warmth and involvement with alcoholic beverages, neither in men nor in women. Only one coefficient approached the borderline of significance in teenage women. The negative relationship between parental emotional warmth and the Hazardous Alcohol Use domain (rs D –.196, p D .074) may suggest a possible inverse association, where higher perception of parental warmth is related to lower alcohol consumption. Although the direction of the coefficient is as expected, the lack of significance does not support Hypothesis 2. As for parental rejection, in men it was positively correlated with AUDIT overall score (rs D .208, p D .019),

Table 2. AUDIT Descriptive Data. Total Sample

Men

Women

Domains

Mean

SD

Max

Mean

Mean Rank

SD

Mean

Mean Rank

SD

Hazardous Alcohol Use Dependence Symptoms Harmful Alcohol Use Total Score

2.89 0.69 1.19 4.78

2.49 1.30 2.07 4.81

10 7 12 28

3.26 0.85 1.42 5.54

113.40 111.90 108.65 113.29

2.67 1.42 2.35 5.42

2.33 0.45 0.84 3.63

93.64 95.89 100.77 93.82

2.09 1.04 1.50 3.45

Note. Minimum score was 0 in all domains.

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Table 4. Spearman Rank Correlation Matrix for EMBU-I and AUDIT Scores in Men. Variable 1. Emotional warmth 2. Rejection 3. Overprotection 4. AUDIT Total Score 5. Hazardous Alcohol Use 6. Dependence Symptoms 7. Harmful Alcohol Use

1

2

1 –.307** .501** –.002 –.016 .111 –.088

1 .317** .208* .211* .153y .182*

3

4

5

6

7

1 .183* 1 .124 .914** 1 .259** .715** .535** 1 .101 .739** .500** .535** 1

Note. N D 160. y p < .10. ! p < .05. !! p < .01.

Hazardous Alcohol Use (rs D .211, p D .018), and Harmful Alcohol Use domains (rs D .182, p D .041). Only a possible trend of significance was found in women (rs D .182, p D .097). These small and positive coefficients indicate that, the more parental rejection men perceive, the higher AUDIT points they score. The significant correlations coincide and support Hypothesis 1. Regarding perception of parental overprotection, there were two significant coefficients in teenage men: the first points out a relationship between overprotection and AUDIT overall score (rs D .183, p D .040); the second between overprotection and the Dependence Symptoms domain (rs D .259, p D .003). Both coefficients suggested that greater parental excessive control perceived by teenage men was correlated with higher scores of alcohol dependence symptoms. No significant coefficients were detected in women. The positive relationship between teenage males’ involvement with alcohol and perceived parental overprotection also confirms Hypothesis 1.

Discussion This study identified relationships between perceived parenting behaviors and involvement with alcohol in Mexican teenagers and young adults. Findings support Hypothesis 1 (higher parental rejection and/or Table 5. Spearman Rank Correlation Matrix for EMBU-I and AUDIT Scores in Women. Variable 1. Emotional warmth 2. Rejection 3. Overprotection 4. AUDIT Total Score 5. Hazardous Alcohol Use 6. Dependence Symptoms 7. Harmful Alcohol Use Note. N D 116. y p < .10. ! p < .05. !! p < .01.

1 1 –.457** .408** –.177 –.196y –.030 –.115

2

3

4

5

6

7

1 .232* 1 1 .182y –.121 .161 –.160 .918** 1 1 .109 .028 .620** .436** .159 .039 .705** .432** .496** 1

overprotection will relate positively to alcohol involvement) and are consistent with studies that indicate that parental behaviors may constitute risk factors for psychopathology in offspring (Matejevic et al., 2014; Perris, 1988). Regarding parental emotional warmth, which comprised practices that include affection (e.g., Does your mother show you that she loves you by hugging you or giving you a cuddle?), support (If things are not going right for you, does your father try to comfort or help you?), and understanding (Does your mother try to help you and to be understanding when you feel unhappy?), we note that in the overall sample it was unrelated to alcohol involvement, giving no support to the second hypothesis. Evidence suggests that higher parental warmth is associated with lower initial levels of alcohol use and with social skills that may prevent alcohol use initiation, while its role may be relatively limited in more problematic alcohol use patterns (Woo & Roemer, 2008). In this regard, it is important to note that the AUDIT score reflects the extent of alcohol involvement along a broad continuum of severity, which may give an approximation of individuals’ current alcohol consumption, but not exclusively in the initiation stage (Babor et al., 2001). Perhaps, this may explain our findings. According to the additional analyses stratified by sex, the lack of significant coefficients between perception of parental warmth and alcohol involvement in teenage men is similar to what was identified by Choquet, Hassler, Morin, Falissard, and Chau (2008) in French adolescents. The same authors reported that lower emotional support was associated with high-risk use of alcohol in girls, which resembles the negative close-tosignificant relationship that we found in women. Some conditions and characteristics of the Mexican population may explain our findings. For example, the reports of emotional warmth by men may be biased by sociocultural traits like machismo, which has been tied to the Mexican population (Ch!avezAyala et al., 2013). Since strength and fortitude are key characteristics of the macho stereotype (Ram!ırez, 2008), it is possible that teenage men were not willing to openly reveal the affection they perceive or receive from their parents. Also, during adolescence there may be a decrease in displays of affection because teenagers want to be treated as adults (Steinberg & Silk, 2002), resulting in less perceived parental warmth. On the other hand, fear of reprisals and marianismo are reasons that may explain findings in women. Subordinate groups—like minors and students—may feel intimidated by their superiors when answering questions about alcohol and drug use, even with the protection of confidentiality and anonymity offered by researchers

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(Burns & Grove, 2009). This may be particularly important for Mexican teenage woman, who are exposed to higher parental monitoring (Strunin et al., 2013). In fact, in this study some women noted their concern regarding receiving punishment by schools’ authorities or their parents when answering questions. Furthermore, marianismo values may also discourage alcohol consumption reports, as this unhealthy behavior is not part of the sociocultural premises of the Mexican women. In this regard, recent studies have showed that Mexican women are more motivated to indicate less alcohol use to differentiate from men (Ch!avez-Ayala et al., 2013). The aforementioned conditions that may compromise reliability of information, far from discouraging the study of parental rearing behaviors and addictions, urge researchers to look for new data-collection methods that may help in increasing participants’ confidence and data quality. An option to reduce interviewer-related bias when collecting information about sensitive topics may be online and electronic surveys, where participants believe that their responses are more secure and anonymous (Rhodes, Bowie & Hergenrather, 2003). This strategy was selected for the present study. However, due to structural limitations (no Internet connection in most schools), on-site electronic surveys through an application were used instead. Regarding the perceived parental rejection, our findings indicate that the higher the perception of negative behaviors such as hostility (e.g., Do you think that your father is stingy and unkind to you?) or punishment (Does your mother hit you for no reason?), the greater the participants’ involvement with alcohol. In fact, parental rejection was correlated with three indicators of the AUDIT (overall score, Hazardous Alcohol Use, and Harmful Alcohol Use domains). These findings are consistent with other studies that have pointed out relationships between alcohol use and parental practices inherent to the rejection dimension, such as punishment (Shin et al., 2009) and neglect (Cheng & Lo, 2010). It is found in literature that parental rejection is associated with general deficits in self-regulation, and high physical pleasure seeking in children (Baker & Hoerger, 2012), so alcohol use could be a response against undesirable parenting practices. That is, youths may turn to unhealthy ways to cope with both external factors and parental behaviors. However, these results should be interpreted carefully because the design of this study does not identify causal relationships. Although higher perceived parental rejection may trigger use of alcohol or other addictive substances (Shin et al., 2009), it is also possible that adolescents who drink more frequently—and in higher quantity—could selfexpose to more parental practices of rejection (Smith,

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2010). This can explain why most significant coefficients were identified only among men, but sex of the individual may underlie these findings as well. In this sense, some studies indicate that men perceive parenting as more rejecting than women (Markus, Lindhout, Boer, Hoogendijk, & Arrindell, 2003; Someya, Uehara, Kadowaki, Tang, & Takahashi, 2000). Given that parents’ behaviors effects may be indirect—through the mental representation of their offspring (Main et al., 1985)—it was expected that teenage men who perceived more rejection from their parents would show more externalized behaviors, such as alcohol use. The fact that most significant coefficients have been identified in men does not diminish the importance of parental rejection for women, especially when considering the recent high rates of alcohol use registered in Mexican teenage women (NIPRFM et al., 2017). It cannot be ignored that regardless of whether women’s alcohol use becomes higher, they may also be subject to more punitive parenting practices, which may lead them to eventually become more involved with alcohol. In such scenarios, it would be necessary to deepen the study of beneficial Mexican cultural characteristics. As suggested by other researchers (Becerra & Castillo, 2011; Strunin et al., 2013), adherence to traditional values like parental closeness, monitoring, and marianismo could protect teenagers from alcohol use and misuse. Researchers and health specialists still need to thoroughly study the behaviors of Mexican families, in particular those that protect women against alcohol use. With regard to the perception of overprotection, this dimension includes parental behaviors that imply excessive protection (e.g., Does your father forbid you from doing things that your classmates are allowed to do because he is afraid of something happening to you?), anxiety about the child’s safety (Is your mother concerned about what you do after school hours, or when you go with a friend?), privacy intrusion (When you have a secret, does your father want to know it too?), and emotional blackmail (Does your mother sometimes say things like “It would make me really unhappy if you did that”?) (M!arquez-Caraveo et al., 2007). In this study, overprotection was positively related to more alcohol dependence symptoms and supported Hypothesis 1. Our conclusions are consistent with evidence (Patock-Peckman & Morgan-L!opez, 2009; Visser et al., 2012) that suggests that parental overprotection is associated with increased alcohol use. One explanation may be that adolescents receive overprotection when their parents suspect—or know—that they drink alcohol excessively or drink in a non-responsible manner, signs that may suggest a possible alcohol use disorder (AUD). Previously classified as alcohol

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dependence and alcohol abuse, AUD is the medical diagnosis given to problem drinking that becomes severe (American Psychiatric Association [APA], 2013). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), anyone who meets two of 11 established criteria during a 12-month period (for example, spend a lot of time drinking or give up activities that were important or interesting, in order to drink) might receive a diagnosis of AUD (APA, 2013). In the AUDIT, items concerning the domain of Dependence Symptoms are directed to identify conditions that typically develop after repeated alcohol use, such as impaired control over drinking, increased salience of drinking, and morning drinking (Babor et al., 2001). Usually, these conditions are present in people who meet the criteria of AUD, so it is reasonable to think that if teenagers showed any of these signs of severe drinking, it would certainly worry their parents, and they would probably decide to exert more control over them. However, although this may be plausible, due the cross-sectional design it is not possible to identify whether parental overprotection is the cause of symptoms of dependence or, conversely, the symptoms of dependence could trigger certain control practices by their parents (Visser et al., 2012). Moreover, we highlight the positive coefficients found only in men, which also could be attributed to the men’s higher scores in alcohol involvement (fewer women obtained scores higher than zero in the domain of Dependence Symptoms). In this regard, as explained before, it is known that behaviors that consist of demonstration of strength and belligerence are part of Mexican male identity, and alcohol use may be part of that ideal (V!azquez & Castro, 2009). On the other hand, Mexican women are raised under higher levels of parental control (D!ıaz-Loving et al., 2015; Strunin et al., 2013; Voisine, Parsai, Marsiglia, Kulis, & Nieri, 2008), which may protect them from more problematic patterns of alcohol use. Limitations The results of this research study add to the understanding of parental behaviors and youths’ involvement with alcohol, a topic that has been partially studied in Mexico and which may be useful in the future when designing preventive strategies against addictions. However, the researchers recognize several limitations. For example, parenting behaviors were only measured from the perception of their offspring, and there is evidence suggesting that homogeneity of some parenting dimensions may be improved when using multiple informants, including parents (B€ogels & Van Melick, 2004). On the other hand, quality of responses on self-answered questionnaires may depend on factors such as participant’s

habit of relying on typical pattern or heuristics—rather than true memories of the events (Patrick & Lee, 2010)—, and time and length of the instruments (Galesic & Bosnjak, 2009). Regarding the latter, the average 26.7 minutes of this study may suggest some sort of bias and fatigue. This could have an impact on internal validity of the study. Another limitation may be that the sample did not include non-matriculated students or individuals who could not provide an evaluation of both of their parents. This restricts the generalizability of the results to other adolescents and young adults, such as those who were born and raised in single-parent families. The numbers of single-parent families have increased in Mexico in recent years and must be of interest in future studies (National Institute of Statistics and Geography, 2011). We also recommend replicating this type of study with youths from areas like North (area with the best socioeconomic conditions), Center (middle socioeconomic status), and South (most unfavorable socioeconomic situation), who may be exposed to other parenting practices due to geographic and socioeconomic differences with Northeastern Mexico. Likewise, parenting behaviors according to the parent’s sex is a variable that may have specific functions during the socialization of their children (Sol!ıs-C!amara, Fung, & Fox, 2014) and must be studied in-depth.

Conclusion The findings of this research study indicate that the perceptions of higher parental rejection and overprotection are positively correlated to adolescents and young adults’ involvement with alcohol. These correlations—although of low intensity—were more consistent among men, which was the group that displayed higher alcohol consumption. Also, a negative correlation with trends of significance was found in women, suggesting that lower perceived emotional warmth is related to higher scores of Hazardous Alcohol Use. These results suggest that parental behaviors may have an important role in offspring’s involvement with alcohol. Since the effect size of the alleged relationships is not trivial, it is important to determine whether the findings are generalizable to adolescents and young adults who live in other geographical areas and not only Northeastern Mexico (Coahuila, Nuevo Leon, and Tamaulipas states). In order to confirm the generalizability of this study it is necessary to conduct new research in other regions of the country. This is crucial in order to justify preventive strategies for reducing alcohol consumption in adolescents focused on parental rearing because Mexico is a heterogeneous country in terms of geographic,

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social, and cultural characteristics (D!ıaz-Loving et al., 2015). Also, we recommend conducting studies that include additional important variables and different methodological approaches in order to achieve better understanding of parental behaviors. For example, aspects such as the effect of parents’ sex, the role of gender (with two independent factors: masculinity and femininity), and the composition of the family (biparental, uniparental women, uniparental men) as a between-subject factor can enrich the understanding of parental behaviors. Qualitative approaches may help to further understand parents’ parenting beliefs as well (D!ıaz & McClelland, 2017). The identified scarcity of studies on this topic exhorts health researchers to continue evaluating parental behaviors so that in the future they may be included as a key element of culture-adapted strategies for preventing alcohol use in Mexican youths.

ORCID Miguel Villegas-Pantoja 8439

http://orcid.org/0000-0001-9917-

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