Perceptions of Peer and Parental Attitudes toward Substance Use and Actual Adolescent Substance Use: The Impact of Adolescent-Confidant Relationships

Objective: While peer influence is a well-documented risk factor for adolescent substance use, it remains unclear whether peer or parental attitudes have greater impact, and if this relationship is moderated by having a confidant and the relationship between adolescents and their confidant. Method: Pooled (2015–2018) National Survey on Drug Use and Health (NSDUH) data on adolescents (12–17 years) were used. Perceived peer and parental disapproval of tobacco, alcohol, and marijuana use were dichotomized. We assessed associations between disapproval and past-month tobacco (N = 51,352), alcohol (N = 51,407), and marijuana use (N = 51,355) using separate multivariable logistic regression models. We explored effect modification by the presence of a confidant, parental vs. non-parental disapproval, and peer vs. non-peer confidant relationship. Results: Peer and parental disapproval, presence of any confidant, and identifying a parental confidant were consistently protective against substance use; identifying a peer confidant increased odds of use across substances. For marijuana use, peer disapproval (adjusted odds ratio [aOR]: 0.07, 95% confidence interval [CI]: 0.06, 0.08) was more protective than parental disapproval (aOR: 0.13, 95% CI: 0.12, 0.15). The joint presence of peer/parental disapproval and any confidant decreased the odds of substance use beyond the individual effects of peer/parental disapproval and having a confidant. However, having a peer confidant attenuated the protective association between peer/parental disapproval and tobacco, alcohol, and marijuana use. Conclusions: Both peer and parental relationships are salient when considering the social context of adolescent substance use and should be considered when studying the effects of perceived disapproval.