Gender Differences in the Association between Maternal Depressed Mood and Child Depressive Phenomena from Grade 3 through Grade 10

Midlife Children's and Older Mothers' Depressive Symptoms: Empathic Mother-Child Relationships as a Key Moderator

OBJECTIVE

This study aimed to evaluate the link between midlife children's and older mothers' depressive symptoms, whether this link is exacerbated in highly empathic mother-child relationships (i.e., shared strong feelings of being loved, cared for, and understood in the mother-child tie), and whether these associations vary by children's gender.

BACKGROUND

Empathic mother-child relationships in later life may intensify the link between midlife children's and older mothers' depressive symptoms. Yet little is known about the emotional implications of the mother-child tie for midlife daughters and sons.

METHOD

The sample included 234 midlife children (M = 49.75 years) and their mothers (M = 75.27 years) from Wave 1 of the Family Exchanges Study. Linear regressions were estimated to determine the link between midlife children's and older mothers' depressive symptoms and the potential moderating role of highly empathic mother-child relationships.

RESULTS

Midlife children had greater depressive symptoms when their mothers had greater depressive symptoms in the context of highly empathic mother-child relationships. This association was not moderated by children's gender.

CONCLUSION

These findings underscore the enduring emotional salience of the mother-child tie and emphasize the importance of relationship characteristics that may heighten the link between midlife children's and their mothers' depressive symptoms.

IMPLICATIONS

Interventions to prevent or treat depressive symptoms among midlife adults may benefit from accounting for the role that their mothers' depressive symptoms might play in maintaining these symptoms, particularly when mother-child ties are highly empathic.

The Association Between Parental Depression and Child Psychosocial Intervention Outcomes: Directions for Future Research

Recent studies suggest that parental depressive symptoms may affect a child's ability to benefit from interventions for anxiety and depression. This article reviews the current literature, suggesting that, when parents experience current depressive symptoms, children are less likely to benefit from psychosocial interventions for anxiety and depression. Opportunities for future research are discussed, including moderators and mechanisms of the association between parental depressive symptoms and child intervention outcomes.

Disentangling the effects of intergenerational transmission of depression from adolescence to adulthood: the protective role of self-esteem

This study aimed to disentangle time-stable and time-varying effects of maternal and paternal depression on trajectories of adolescent depression from ages 13 to 23 and examined whether self-esteem moderates the examined associations. Sex differences in the direct effects of parental depression and its interacted effects with self-esteem were further explored. Data were collected from a sample of 2502 adolescents and their parents participating in a panel study spanning from the year 2000 to 2009 in northern Taiwan. Multilevel modeling was conducted to disentangle the time-stable and time-varying effects of parental depression on adolescent depression. The moderating role of self-esteem and the potential sex differences in the transmission process were tested by adding two- and three-way interactions among parental depression, self-esteem, and sex of adolescents in the models. As predicted, significant time-stable intergenerational transmission of depression was found, indicating that adolescents of parents with higher levels of depression were at increased risks for depression. Self-esteem was further found to buffer the negative effects of maternal depression on development of depression in offspring. No sex-specific intergenerational transmission of depression was observed. In sum, both maternal and paternal depression contributed to elevated levels of adolescent depression. The effects of maternal depression, however, may not be uniform, but depend on levels of self-esteem. Intervention and prevention strategies that enhance self-esteem may help participants withstand the negative effects of maternal depression.

Indirect effect of parental depression on school victimization through adolescent depression

BACKGROUND

While a link between parental depression and adolescent school victimization is frequently hypothesized, studies on this association have shown mixed results. In addition, adolescent depression has been considered a potential psychosocial mechanism underlying the link between parental depression and adolescent school victimization. However, studies to support this proposition are lacking. This paper examines the direct effect of parental depression on adolescent victimization by peers and teachers in school as well as indirect effect through adolescent depression in an Asian context (Taiwan) and further examines differences in the interrelationships of parental depression, adolescent depression, and school victimization by peers and teachers across gender and school age groups.

METHODS

Data were obtained from a random sample of 2,419 students (grades 7-12) and their parents in one of the largest metropolitan areas in Taiwan.

RESULTS

Parental depression did not have a significant direct association with either type of school victimization. However, parental depression showed a significant indirect association with both types of school victimization through adolescent depression. These findings applied to both males and females and both junior and senior high school students.

LIMITATION

The study utilized cross-sectional data, and the findings cannot be used to build causal relationships.

CONCLUSION

Our findings provide empirical support that parental depression has indirect associations with school victimization by peers and teachers through adolescent depression. The results support the importance of including family-based approaches for depression targeting parents and adolescents in future victim intervention/prevention school programs.

Parental psychopathology and offspring attention-deficit/hyperactivity disorder in a nationwide sample

OBJECTIVE

To study the associations between a wide range of parental psychiatric disorders and offspring attention-deficit/hyperactivity disorder (ADHD).

METHOD

This study is based on a nested case-control design. The association between parental registered psychiatric diagnoses and offspring ADHD was examined adjusting for socioeconomic and prenatal factors. Data was linked from Finnish nationwide registers. The cases (n = 10,409) were all the children born between years 1991 and 2005 in Finland and diagnosed with ADHD by the end of 2011. Four controls without ADHD (n = 39,124) were matched for every case by sex, age and place of birth. Main outcomes were adjusted odds ratio (aOR) for parental diagnosis of cases vs controls. Analyses were further stratified by sex. Disorders diagnosed before and after birth were analyzed separately.

RESULTS

The odds ratio for ADHD increased when only mother (aOR 2.2, 95% CI 2.0-2.3), only father (aOR 1.7, 95% CI 1.6-1.8) and both parents (aOR 3.6, 95% CI 3.3-4.0) were diagnosed. Maternal diagnosis showed stronger association than paternal. The weight of association between several parental disorders and offspring ADHD were similar. Maternal psychopathology overall showed stronger associations with girls than boys with ADHD. The diagnoses registered after birth did not show stronger association than the diagnoses registered before.

CONCLUSIONS

Maternal psychopathology showing stronger association than paternal implies that environmental factors or their interaction with genetic factors partly mediates the risk of parental psychopathology. Similar associations between several maternal psychiatric disorders and offspring ADHD points towards the need for investigating some common mother-related risk factors.

Maternal psychopathology and offspring clinical outcome: a four-year follow-up of boys with ADHD

Previous cross-sectional research has shown that parents of children with attention deficit hyperactivity disorder (ADHD) have high rates of psychopathology, especially ADHD and depression. However, it is not clear whether different types of parent psychopathology contribute to the course and persistence of ADHD in the child over time. The aim of this two wave study was to investigate if mother self-reported ADHD and depression influence persistence of offspring ADHD and conduct disorder symptom severity in adolescents diagnosed with ADHD in childhood. A sample of 143 males with a confirmed diagnosis of ADHD participated in this study. ADHD and conduct disorder symptoms were assessed at baseline and reassessed 4 years later. The boys in this sample had a mean age of 10.7 years at Time 1 (SD 2.14, range 6-15 years) and 13.73 years at Time 2 (SD 1.74, range 10-17 years). Questionnaire measures were used to assess ADHD and depression symptoms in mothers at Time 1. Mother self-reported ADHD was not associated with a change in child ADHD or conduct symptom severity over time. Mother self-reported depression was found to predict an increase in child conduct disorder symptoms, but did not contribute to ADHD symptom levels. This study provides the first evidence that concurrent depression in mothers may be a predictor of worsening conduct disorder symptoms in adolescents with ADHD. It may, therefore, be important to screen for depression in mothers of children with ADHD in clinical practice to tailor interventions accordingly.

Gender Moderation of the Intergenerational Transmission and Stability of Depressive Symptoms from Early Adolescence to Early Adulthood

Factors that might exacerbate or mitigate the transmission of depressive symptoms from parents to adolescents and the continuity of depressive symptoms into early adulthood are poorly understood. This study tested the hypothesis that the intergenerational transmission and stability of depressive symptoms would be stronger for girls than boys over adolescence and into early adulthood, while considering the possibility that the pattern of gender moderation might vary depending on parent gender and developmental timing. The participants were 667 rural Midwestern adolescents (52 % female) and their parents. Survey data on maternal and paternal depressive symptoms (at youth age 11) and on adolescent and young adult depressive symptoms (at youth ages 11, 18, and 21) were analyzed via multiple group structural equation modeling. Maternal depressive symptoms predicted increased late adolescent depressive symptoms for girls but not boys, and adolescent depressive symptoms were more stable in girls. Paternal depressive symptoms predicted increased late adolescent depressive symptoms for all youth. The findings suggest the need for early, tailored interventions.

Family process and youth internalizing problems: A triadic model of etiology and intervention

Despite major advances in the development of interventions for youth anxiety and depression, approximately 30% of youths with anxiety do not respond to cognitive behavioral treatment, and youth depression treatments yield modest symptom decreases overall. Identifying networks of modifiable risk and maintenance factors that contribute to both youth anxiety and depression (i.e., internalizing problems) may enhance and broaden treatment benefits by informing the development of mechanism-targeted interventions. A particularly powerful network is the rich array of family processes linked to internalizing problems (e.g., parenting styles, parental mental health problems, and sibling relationships). Here, we propose a new theoretical model, the triadic modelof family process, to organize theory and evidence around modifiable, transdiagnostic family factors that may contribute to youth internalizing problems. We describe the model's implications for intervention, and we propose strategies for testing the model in future research. The model provides a framework for studying associations among family processes, their relation to youth internalizing problems, and family-based strategies for strengthening prevention and treatment.

Escolares que Convivem com a Depressão Materna Recorrente: Diferenças entre os Sexos

Resumo Há divergências na literatura quanto às diferenças entre os sexos na associação entre depressão materna e desenvolvimento infantil. Neste estudo, compararam-se diferenças entre os sexos relativas ao comportamento e desempenho escolar de crianças que conviviam com a depressão materna, correlacionando tais desfechos. Participaram 40 díades mãe-criança, tendo as mães diagnóstico de Transtorno Depressivo Recorrente. As crianças, de sete a 12 anos, foram divididas em grupos por sexo. Foi realizada aplicação de entrevista diagnóstica, do Questionário de Capacidades e Dificuldades e do Teste de Desempenho Escolar. As meninas apresentaram mais sintomas emocionais comparadas aos meninos. Constataram-se associações significativas entre comportamento e desempenho escolar apenas para as meninas, sinalizando maior vulnerabilidade destas meninas.

Practitioner review: Dysphoria and its regulation in child and adolescent depression

BACKGROUND

By emphasizing the importance of emotions, the 'affect revolution' in how human behavior is conceptualized has inspired a new generation of studies on dysphoric experience and its regulation in clinical depression, and novel efforts to characterize the precursors of affective disorders in juveniles at familial risk for depression.

METHOD

We review clinical, behavioral, and functional neuroimaging studies of dysphoric experience and its regulation in depressed children and adolescents, and in juvenile offspring of parents with histories of clinical depression. We discuss the implication of the literature in the context of maternal depression.

RESULTS

Findings confirm the high rate of clinically significant dysphoria in depressed children and adolescents and reveal notable affective lability in daily life as a function of context and activity. Findings also show that depressed youngsters have problems in attenuating dysphoria. Similarly, never-depressed offspring at familial risk for depression display problems in mood repair and impaired mood repair mechanisms. Brain neuroimaging findings indicate that, overall, depressed, and high-risk youngsters differ from never depressed controls in neural functioning (activation, connectivity) both at rest and in response to emotion triggers.

CONCLUSION

The evaluation of depressed youngsters should include questions about reactivity of dysphoric mood to the changing contexts of daily life and about how they manage (respond to) their own sadness and distress. The resultant information may help the clinician to restructure a young patient's day for the better and identify helpful mood repair responses. Evidence of impaired mood repair mechanisms in youngsters at high-risk for depression suggests the need for early intervention. But interventions must consider that many depressed and high-risk children have depressed mothers, who may be constrained in their ability to help offspring's emotion regulation efforts. To optimize treatment response of offspring, mothers of depressed children should therefore be routinely screened for depression and treated, as warranted.

Parental and late adolescent psychopathology: mothers may provide support when needed most

Research links negative parenting and parental psychopathology to poorer outcomes among youth. Less research examines these effects simultaneously during late adolescence. The current study examines parenting, parental psychopathology, and late adolescent psychopathology as reported by late adolescents (N = 328) with the use of structural equation modeling. Results of measurement models indicate that parental psychopathology and parenting are related to late adolescent psychopathology. However, results of structural models indicate that the effect of parenting on late adolescent psychopathology becomes non-significant in the paternal model and reverses in the maternal model. Interestingly, maternal parenting is associated with higher levels of late adolescent psychopathology, suggesting that mothers provide their late adolescents with more supportive parenting when it is needed most. Overall, results suggest the importance of examining parenting characteristics simultaneously in the context of gender and other variables.

The younger siblings of childbearing adolescents: parenting influences on their academic and social-emotional adjustment

The younger siblings of childbearing adolescents have poorer school outcomes and exhibit more internalizing and externalizing problems compared to their peers without a childbearing sister. We test a model where living with an adolescent childbearing sister constitutes a major family stressor that disrupts mothers' parenting and well-being, and through which, adversely affect youths' adjustment. Data came from 243 Latino younger siblings (62% female, M age 13.7 years) and their mothers, 121 of whom lived with a childbearing adolescent sister and 122 of whom did not. Individual fixed-effects models controlled for earlier measures of each respective model construct, thereby reducing omitted variable bias from pre-existing group differences. Results show that, for boys, the relationship between living with a childbearing adolescent sister and youth outcomes was sequentially mediated through mothers' stress and parenting (i.e., monitoring and nurturance). For girls, however, the relationship was mediated through mothers' monitoring only. Findings elucidate the within-family processes that contribute to the problematic outcomes of youth living with childbearing adolescent older sisters.

Mothers with depression, school-age children with depression? A systematic review

PURPOSE

To carry out a systematic review of the association between maternal and school-age children depression and covariate factors.

DESIGN AND METHODS

The key words maternal depression, depressed children, and school-age key words were searched in Medline, Lilacs, Scielo, IndexPsi, and PsycInfo (2004-2010). Clinical and community cross-sectional and longitudinal studies were included. A qualitative checklist was used.

FINDINGS

Thirty studies were included (21.926 dyads). The results supported the association, showing several modulators: family environment, marital adjustment, social support, depression symptoms, and children-related variables. Limitations were nonrandom samples, single informants, and nondepression diagnosis.

PRACTICE IMPLICATIONS

  Identifying mothers with depression may be useful for prevention and early detection of school-age children's depression.

Offspring of parents with recurrent depression: which features of parent depression index risk for offspring psychopathology?

BACKGROUND

Parental depression is associated with an increased risk of psychiatric disorder in offspring, although outcomes vary. At present relatively little is known about how differences in episode timing, severity, and course of recurrent depression relate to risk in children. The aim of this study was to consider the offspring of parents with recurrent depression and examine whether a recent episode of parental depression indexes risk for offspring psychopathology over and above these other parental depression features.

METHODS

Three hundred and thirty seven recurrently depressed parents and their offspring (aged 9-17) were interviewed as part of an ongoing study, the 'Early Prediction of Adolescent Depression Study'. The Child and Adolescent Psychiatric Assessment was used to assess two child outcomes; presence of a DSM-IV psychiatric disorder and number of DSM-IV child-rated depression symptoms.

RESULTS

Children whose parents had experienced a recent episode of depression reported significantly more depression symptoms, and odds of child psychiatric disorder were doubled relative to children whose parents had not experienced a recent episode of depression. Past severity of parental depression was also significantly associated with child depression symptoms.

LIMITATIONS

Statistical analyses preclude causal conclusions pertaining to parental depression influences on offspring psychopathology; several features of parental depression were recalled retrospectively.

CONCLUSIONS

This study suggests that particular features of parental depression, specifically past depression severity and presence of a recent episode, may be important indicators of risk for child psychiatric disorder and depressive symptoms.

Psychological and educational interventions for preventing depression in children and adolescents

BACKGROUND

Depression is common in young people, has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health.  

OBJECTIVES

To determine whether psychological or educational interventions, or both, are effective in preventing the onset of depressive disorder in children and adolescents.

SEARCH METHODS

The Cochrane Depression, Anxiety and Neurosis Review Group's trials registers (CCDANCTR) were searched at the editorial base in July 2010. Update searches of MEDLINE, EMBASE, PsycINFO and ERIC were conducted by the authors in September 2009. Conference abstracts, reference lists of included studies and reviews were searched and experts in the field contacted.

SELECTION CRITERIA

Randomised controlled trials of psychological or educational prevention programmes, or both, compared with placebo, any comparison intervention, or no intervention for young people aged 5 to 19 years-old, who did not currently meet diagnostic criteria for depression or who were below the clinical range on standardised, validated, and reliable rating scales of depression, or both, were included.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed studies for inclusion and rated their quality. Sample sizes were adjusted to take account of cluster designs and multiple comparisons. We contacted study authors for additional information where needed. 

MAIN RESULTS

Fifty-three studies including 14,406 participants were included in the analysis. There were only six studies with clear allocation concealment, participants and assessors were mostly not blind to the intervention or blinding was unclear so that the overall risk of bias was moderately high. Sixteen studies including 3240 participants reported outcomes on depressive diagnosis. The risk of having a depressive disorder post-intervention was reduced immediately compared with no intervention (15 studies; 3115 participants risk difference (RD) -0.09; 95% confidence interval (CI) -0.14 to -0.05; P<0.0003), at three to nine months (14 studies; 1842 participants; RD -0.11; 95% CI -0.16 to -0.06) and at 12 months (10 studies; 1750 participants; RD -0.06; 95% CI -0.11 to -0.01). There was no evidence for continued efficacy at 24 months (eight studies; 2084 participant; RD -0.01; 95% CI -0.04 to 0.03) but limited evidence of efficacy at 36 months (two studies; 464 participants; RD -0.10; 95% CI -0.19 to -0.02). There was significant heterogeneity in all these findings. There was no evidence of efficacy in the few studies that compared intervention with placebo or attention controls.

AUTHORS' CONCLUSIONS

There is some evidence from this review that targeted and universal depression prevention programmes may prevent the onset of depressive disorders compared with no intervention. However, allocation concealment is unclear in most studies, and there is heterogeneity in the findings. The persistence of findings suggests that this is real and not a placebo effect. 

Maternal depression and child and adolescent depression symptoms: an exploratory test for moderation by CRHR1, FKBP5 and NR3C1 gene variants

This study investigated moderation of the association between recurrent maternal depression and offspring depression symptoms by a selection of biologically relevant gene variants. 271 children/adolescents (aged 9.00 to 16.00 years) whose mothers had experienced at least two episodes of DSM-IV major depression and 165 controls (aged 12.25 to 16.67 years) drawn from a population-based twin register were used. Seven single nucleotide polymorphisms (SNPs) from three genes were genotyped in children. The genes were the Corticotropin Receptor Type 1 gene (CRHR1), the gene coding for the FK506 binding protein 5 (FKBP5) and the Glucocorticoid receptor gene (NR3c1) along with a haplotype formed by the SNPs in CRHR1. A significant association was found between recurrent maternal depression and depression symptoms in offspring. None of the SNPs were associated with offspring depression symptoms and associations did not differ according to the presence of recurrent maternal depression. However, caution is required due to a relatively small sample size.

Investigating environmental links between parent depression and child depressive/anxiety symptoms using an assisted conception design

OBJECTIVE

Links between maternal and offspring depression symptoms could arise from inherited factors, direct environmental exposure, or shared adversity. A novel genetically sensitive design was used to test the extent of environmental links between maternal depression symptoms and child depression/anxiety symptoms, accounting for inherited effects, shared adversity, and child age and gender.

METHOD

Eight hundred fifty-two families with a child born by assisted conception provided questionnaire data. Mothers and fathers were genetically related or unrelated to the child depending on conception method. Parental depression symptoms were assessed using the Hospital Anxiety and Depression Scale. Child depression/anxiety symptoms were assessed using the Short Mood and Feelings questionnaire and six items tapping generalized anxiety disorder symptoms. Associations between maternal and child symptoms were examined separately for genetically unrelated and related mother-child pairs, adjusting for three measurements of shared adversity: negative life events, family income, and socioeconomic status. Analyses were then run separately for boys and girls and for children and adolescents, and the role of paternal depression symptoms was also examined.

RESULTS

Significant associations between parent and child symptoms were found for genetically unrelated mother-child (r = 0.32, p < .001) and father-child (r = 0.17, p < .05) pairs and genetically related mother-child (r = 0.31, p < .001) and father-child (r = 0.23, p < .001) pairs and were not explained by the shared adversity measurements. Environmental links were present for children and adolescents and were stronger for girls.

CONCLUSIONS

The transmission of depression symptoms is due in part to environmental processes independent of inherited effects and is not accounted for by shared adversity measurements. Girls may be more sensitive to the negative effects of maternal depression symptoms than boys through environmental processes.

Dynamic associations between maternal depressive symptoms and adolescents' depressive and externalizing symptoms

The current prospective study investigated transactional relations between maternal depressive symptoms and children's depressive and externalizing symptoms. Participants included 240 children (M age = 11.86 years, SD = 0.56; 53.9% female) and their mothers who were part of a 6-year longitudinal study. Measures of maternal depression (Beck Depression Inventory), child depression (Children's Depression Inventory), and children's externalizing symptoms (Youth Self-Report Form) were assessed annually. Data analyses using dynamic latent difference score structural equation models indicated that the observed relations between mothers' and adolescents' symptoms were stable across the 6 years. Higher levels of maternal depressive symptoms predicted subsequent elevations in children's depressive symptoms and in their externalizing problems over time. Among mothers with high initial levels of depression, children's depressive symptoms predicted subsequent declines in mothers' depressive symptoms. Children's externalizing problems were not related to subsequent change in maternal symptoms.

Parental depressive feelings, parental support, and the serotonin transporter gene as predictors of adolescent depressive feelings: a latent growth curve analysis

Parental support and parental depressive feelings are found to be associated with depressive feelings in adolescent boys and girls, but results are inconsistent. In addition, the 5-HTTLPR genotype has been found to interact with environmental stressors in predicting adolescents' depressive feelings, but this has not been examined longitudinally. Therefore, the present study examined the relationships between parental support, parental depressive feelings, and adolescent depressive feelings. In addition, the relationships between the 5-HTTLPR genotype and adolescent depressive feelings were explored, as well as gene-environment interactions. Adolescents (N = 306; Girls = 53.3%; M (age T1) = 13.4) filled out questionnaires at five annual waves and provided saliva samples for DNA. Latent growth curve modelling (LGCM) was used to examine the baseline level and the change in depressive feelings over time. Maternal support was related to baseline levels of depressive feelings in girls, whereas paternal support was related to baseline levels in boys. Paternal depressive feelings were only related to boys' depressive feelings at baseline, and maternal depressive feelings were not related to any outcome measures. Furthermore, no associations were found between 5-HTTLPR genotype and adolescent depressive feelings, and no gene-environment interactions emerged. Limitations of the study and implications of the findings are discussed.

Identifying trajectories of adolescents' depressive phenomena: an examination of early risk factors

Few studies have examined risk factors of childhood and early adolescent depressive symptomatology trajectories. This study examined self-report depressive symptomatology across a 6-year time period from 2nd to 8th grade to identify latent groups of individuals with similar patterns of depressive phenomena in a sample of 951 children (440 girls, 511 boys). Analyses, using semiparametric group modeling (SGM), identified 5 trajectory groups for girls and boys: low depressed stables, low depressed risers, mildly depressed stables, moderately depressed changers, and moderately depressed risers. Individual risk factors, with the exception of shy/withdrawn behavior, were significantly different across trajectory group membership for boys and girls, as was low-income status for boys. Boys in the low depressed and mildly depressed stable trajectory groups had significantly higher levels of antisocial behavior, attention problems, and lower social competency compared to girls in similar groups. These results suggest that universal prevention programs implemented in early elementary school that target selected risk factors may be helpful in reducing future adolescent mental health problems, specifically depressive symptomatology.

Risk Factors Linking Maternal Depressed Mood to Growth in Adolescent Substance Use

Maternal depression has been implicated in the development of adolescent substance use. Conceptualizing depression as a continuum, the aims of this study were to (a) understand the relationship between maternal depressed mood and risk factors associated with adolescent substance use; (b) understand the relationship between maternal depressed mood and level and growth in adolescent alcohol, cigarette, and marijuana use assessed at multiple time points during adolescence; and (c) examine the unique and relative contribution of maternal depressed mood after taking into account contextual risk factors related to adolescent substance use. Participants were 792 children and their mothers. Latent growth modeling was used with adolescent alcohol, cigarette, and marijuana use treated as ordinal variables. Child depressive phenomena and child antisocial behavior partially explained the relationship between maternal depressed mood and adolescent alcohol and cigarette use. Mothers' own substance use did not contribute to level or change in adolescent substance use after other risk factors were considered.