title: A prospective study of familial conflict, psychological stress, and the development of substance use disorders in adolescence.
abstract: BACKGROUND
  Exposure to adverse family environments in childhood can influence the risk trajectory for developing substance use disorders in adolescence. Evidence for this is largely based on cross-sectional studies which have been unable to establish the temporality of this association and investigate underlying pathways.
  
  
  METHODS
  The sample consisted of 1421 adolescents from the Project on Human Development in Chicago Neighborhoods, a three wave longitudinal study conducted between 1994 and 2001 that followed children from ages 10 to 22. Logistic regression analyses with multiple imputation were conducted to examine the relation between familial conflict in childhood and substance use disorders in late adolescence and emerging adulthood. We conducted mediational analyses to determine if internalizing and externalizing problems explain this relationship, and we investigated whether external social support mitigates the adverse effects of familial conflict on the development of substance use disorders.
  
  
  RESULTS
  Familial conflict was significantly associated with the risk of substance use disorders during adolescence (odds ratio: 1.23; 95% CI: 1.02-1.47), and 30% of this effect was due to higher levels of externalizing problems (but not internalizing problems). External social support in childhood did not buffer the effects of familial conflict on substance use disorders during adolescence.
  
  
  CONCLUSIONS
  Exposure to familial conflict early in life increases the risk of substance use disorders during late adolescence and emerging adulthood, due partly to higher levels of externalizing problems, but not internalizing problems. Future research is needed to identify additional pathways underlying this association, and the extent to which these pathways are modifiable.
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. mskeer@hsph.harvard.edu
authors.forename: Margie
authors.initials: M
authors.lastname: Skeer
authors.forename: Marie C
authors.initials: MC
authors.lastname: McCormick
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Buka
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Gilman
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010290:Parents / Q000523:psychology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012306:Risk; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome