The Importance of Family Dinners VI



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The Importance of Family Dinners VI September 2010 Conducted by: QEV Analytics, Ltd. Knowledge Networks * The National Center on Addiction and Substance Abuse at Columbia University is neither affiliated with, nor sponsored by, the National Court Appointed Special Advocate Association (also known as "CASA ) or any of its member organizations, or any other organizations with the name of "CASA".

Board of Directors Lee C. Bollinger President, Columbia University Ursula M. Burns Chairman and CEO, Xerox Corporation Columba Bush Former First Lady of Florida Joseph A. Califano, Jr. Founder and Chairman, CASA Kenneth I. Chenault Chairman and CEO, American Express Company Peter R. Dolan William H. Foster, Ph.D. President and CEO, CASA Victor F. Ganzi Chairman of the Board PGA Tour David A. Kessler, M.D. Alan I. Leshner, Ph.D. CEO, Executive Publisher, Science, American Association for the Advancement of Science Rev. Edward A. Malloy, CSC President Emeritus, University of Notre Dame Doug Morris Chairman and Co-CEO, Universal Music Group Bruce E. Mosler Chairman and CEO, Cushman & Wakefield, Inc. Manuel T. Pacheco, Ph.D. President Emeritus, University of Arizona and University of Missouri System Joseph J. Plumeri Chairman and CEO, Willis Group Holdings Public Limited Company Jim Ramstad Member of Congress (1991 2009) Shari E. Redstone President, National Amusements, Inc. E. John Rosenwald, Jr. Vice Chairman Emeritus, J.P.Morgan Michael I. Roth Chairman and CEO, The Interpublic Group of Companies, Inc. Michael P. Schulhof Chairman, GTI Group LLC Louis W. Sullivan, M.D. President Emeritus, Morehouse School of Medicine John J. Sweeney Clyde C. Tuggle Senior Vice President, Global Public Affairs & Communications, The Coca-Cola Company Directors Emeritus James E. Burke (1992-1997) Jamie Lee Curtis (2001-2009) Jamie Dimon (1995-2009) Mary Fisher (1996-2005) Betty Ford (1992-1998) Douglas A. Fraser (1992-2003) Barbara C. Jordan (1992-1996) Leo-Arthur Kelmenson (1998-2006) Donald R. Keough (1992-2010) LaSalle D. Leffall, Jr., M.D., F.A.C.S. (1992-2001) Nancy Reagan (1995-2000) Linda Johnson Rice (1992-1996) George Rupp, Ph.D. (1993-2002) Michael I. Sovern (1992-1993) Frank G. Wells (1992-1994) Michael A. Wiener (1997-2009) Copyright 2010. All rights reserved. May not be used or reproduced without the express written permission of The National Center on Addiction and Substance Abuse at Columbia University.

Table of Contents Accompanying Statement... i Chapter I: The Importance of Family Dinners...1 Frequency of Family Dinners...1 Dinner: A Time to Talk About What s Going on in Teens Lives...1 Why Aren t Family Dinners More Frequent?...2 Teens Want More Family Dinners...2 Teens Think Family Dinners Are Important...3 How Teens Help with Dinner...3 Family Dinners and Academic Performance...4 Chapter II: The Relationship Between Family Dinners and Teen Substance Use and Availability of Substances...5 Frequency of Dinner and Teen Substance Use...5 Communicating at the Table and Teen Substance Use...6 Reasons Teens Don t Drink or Use Marijuana...6 Family Dinners and Having Friends Who Use Substances...7 The Relationship between Family Dinners and the Likelihood of Future Substance Use...8 Family Dinners and Teens Access to Marijuana and Prescription Drugs...8 Chapter III: Family Dinners and Family Relationships...11 Strength of Family Ties Associated with Teen Substance Use...11 Family Dinners and the Quality of Teens Relationships with Mom and Dad...12 Family Dinners and How Good Parents Are at Really Listening to Teen...13 Other than Dinner, Occasions When Parents and Teens Talk About What s Going on in Teens Lives...13 Family Dinners and Attending Religious Services...14 Appendix A: Survey Methodology...15

Accompanying Statement by Joseph A. Califano, Jr., Founder and Chairman Over the past 16 years, The National Center on Addiction and Substance Abuse (CASA) at Columbia University has surveyed thousands of American teens and their parents to identify factors that increase or decrease the likelihood of teen substance abuse. We have learned that a child who gets through age 21 without smoking, using illegal drugs or abusing alcohol is virtually certain never to do so. And, we ve learned that parents have the greatest influence on whether their teens will choose to use. Our surveys have consistently found that the more often children have dinners with their parents, the less likely they are to smoke, drink or use drugs, and that parental engagement fostered around the dinner table is one of the most potent tools to help parents raise healthy, drug-free children. Simply put: frequent family dinners make a difference. In this report, The Importance of Family Dinners VI, we examine the link between the frequency of family dinners and teens substance use, their access to substances, and the quality of teens relationships with their parents. We also explore what teens think about family dinners. Compared to teens who have frequent family dinners (five to seven per week), those who have infrequent family dinners (fewer than three per week) are: Twice as likely to use tobacco; Nearly twice as likely to use alcohol; and One and a half times likelier to use marijuana. There is also a connection between the frequency of family dinners and a teen s access to drugs. Compared to teens who have frequent family dinners, those who have infrequent

family dinners are twice as likely to say they can get marijuana or prescription drugs (to get high) in an hour or less. This year s study demonstrates that the magic that happens at family dinners isn t the food on the table, but the conversations around it. Three in four teens report that they talk to their parents about what s going on in their lives during dinner; and eight in 10 parents agree that by having family dinner they learn more about what s going on in their teens lives. These conversations are key: Teens who say that they talk to their parents about what s going in on their lives over dinner are less likely to smoke, drink and use marijuana than teens who don t have such talks with their parents. Our The National Survey of American Attitudes on Substance Abuse XV: Teens and Parents examined whether Family Ties, the strength of the bond between parents and teens, is related to the risk that a teen will smoke, drink or use drugs. We found that compared to teens in families with strong Family Ties, teens in families with weak Family Ties are: Four times likelier to have tried tobacco; Four times likelier to have tried marijuana; and Almost three times likelier to have tried alcohol. Family dinner is an ideal opportunity to strengthen Family Ties. Teens who have frequent family dinners are almost three times as likely to say they have an excellent relationship with their mother and three times likelier to say they have an excellent relationship with their father; they are also more than twice as likely to report that their parents are very good at listening to them. Teens themselves understand the value of family dinners: nearly three-quarters of teens think that eating dinner together with their parents is important. Most teens (60 percent) who have dinner with their parents fewer than five nights a week wish they could eat dinner with their parents more often. Compared to teens who don t talk to their parents about what s going on in their lives at dinner, those who do are more likely to think frequent family dinners are important and to want to have them more often. Dinner isn t the only time when parents can engage with their children. Parents who aren t able to make it to the dinner table can take advantage of other opportunities for conversation. Among the families we surveyed, those other opportunities for conversation occur most frequently on the weekends and driving to and from school or other activities. Wherever these conversations occur, it s important for parents to make talking to teens about what s going on in their lives routine. Our research findings on the importance of family dinners inspired us in 2001 to create an annual, national day of celebration, CASA Family Day A Day to Eat Dinner with Your Children. Family Day is celebrated every year on the fourth Monday in September, as a reminder to parents of the importance of family dinners. In 2010, Family Day will be celebrated on September 27 th, its 10 th anniversary. The president, the governors of all the states, and more than a thousand cities and counties all across America recognize the importance of family dinners by proclaiming and supporting Family Day. Hundreds of community organizations, churches, schools, and social centers celebrate Family Day. For more information about Family Day, and for ideas about how to make dinner together fun, visit our website, www.casafamilyday.org. The findings presented in this report come from The National Survey of American Attitudes on Substance Abuse XV: Teens and Parents, which CASA released on August 19, 2010. This year we surveyed 1,055 teenagers ages 12 to 17 (540 males, 515 females), and 456 parents of these teens via the Internet. We also conducted our usual telephone survey of 1,000 teens ages 12 to 17 (511 boys and 489 girls) in order to continue tracking trends from prior years. The methodology for CASA s 2010 annual survey is described in Appendix A. -ii-

A Word of Appreciation I want to express CASA s appreciation to Steve Wagner, President of QEV Analytics, Ltd., for administering the telephone survey and especially for his insightful work in analyzing the data, and to the staff at Knowledge Networks, including Jordon Peugh and Sergei Rodkin, for their administration of the Internetbased survey. On CASA s staff, Emily Feinstein managed this complex undertaking and wrote the report. Sarah Tsai conducted the data analysis. Kathleen Ferrigno, CASA s Director of Marketing, and Lauren Duran, CASA s Director of Communications, reviewed and edited the report. Roger Vaughan, DrPH, head of CASA s Substance Abuse and Data Analysis Center (SADAC SM ), Professor of Clinical Biostatistics, Department of Biostatistics, Mailman School of Public Health at Columbia University and associate editor for statistics and evaluation for the American Journal of Public Health, reviewed the analysis. Jane Carlson efficiently handled the administrative aspects. -iii-

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Chapter I The Importance of Family Dinners Frequency of Family Dinners In this year s trend survey, * 60 percent of teens report having dinner with their families at least five times a week, a proportion that has remained consistent over the past decade. (Figure 1.A) Figure 1.A Percent Teens Having Frequent Family Dinners, 1999-2010 51 57 61 61 59 58 58 59 58 59 60 1999 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Data not available for 2000. Dinner: A Time to Talk About What s Going on in Teens Lives Three-quarters of teens (75 percent) say they talk to their parents about what s going on in their lives at dinner. Nearly eight in 10 parents (79 percent) agree that by having dinner together they learn more about what s going on in their teens lives. * This year we conducted two nationally representative surveys--for the first time, we surveyed 1,055 teens and 456 of their parents over the Internet, and, as we have done in all past years, we surveyed 1,000 teens by telephone. In the telephone survey we asked teens questions that we have used to measure trends over time.

Teens who have five to seven family dinners per week are more likely to report that they talk to their parents about what s going on in their lives during dinner than teens who have fewer than three family dinners per week. (Figure 1.B) Figure 1.B At Dinner, I Talk to My Parents About What's Going on in My Life 81 44 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week Why Aren t Family Dinners More Frequent? We asked teens and parents who have fewer than five family dinners per week, What are some of the reasons you and your family do not have dinner together more often? A comparison of the responses given by teens and parents appears in Table 1.1. Table 1.1 Percent Teens/Parents Who Say Dinner Not More Frequent Because Teens Parents Too busy/different activities 25% 28% At work/late shifts 38% 19% Family members not home/out 2% 3% Involved in sports 5% 8% With friends/girlfriend/boyfriend 5% 6% Everyone wants to do their own thing 9% 5% Other 13% 8% Teens Want More Family Dinners Don t Know 2% 25% Among teens who report having fewer than five family dinners per week, 60 percent say they would like to have dinner with their parents more often. -2-

Teens Think Family Dinners Are Important Nearly three-quarters of teens (72 percent) think that eating dinner frequently with their parents is very or fairly important. Figure 1.C Teens who talk to their parents about what s going on in their lives at dinner are more likely to think frequent family dinners are important than teens who don t talk to their parents about what s going on in their lives during dinner. (Figure 1.C) Percent Teens Who Think Eating Dinner Frequently with Their Parents is Very or Fairly Important 79 49 Talk at Dinner About Life Do Not Talk at Dinner About Life How Teens Help with Dinner Most teens say that they help with at least one aspect of family dinner: two-thirds report that they help clean up afterwards, half say they help set the table, and more than a third of teens report that they help prepare the meal. (Table 1.2) Table 1.2 Do you help with dinner in any of the following ways? (Multiple responses accepted) Cleaning up afterwards 66% Deciding what to eat Setting the table Preparing the meal Other Refused 57% 49% 39% 8% 3% -3-

Family Dinners and Academic Performance Teens who report typically receiving mostly C s or lower grades in school are likelier to smoke, drink and use drugs compared to teens who typically receive all A s or A s and B s in school. Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are nearly twice as likely to report receiving mostly C s or lower grades in school. (Figure 1.D) 52 Figure 1.D Family Dinners and Academic Performance 64 Mostly A/B or Higher 22 12 Mostly C or Less 0 to 2 5 to 7-4-

Chapter II The Relationship Between Family Dinners and Teen Substance Use and Availability of Substances Frequency of Dinner and Teen Substance Use Over the past 16 years, CASA s national survey of teens and parents has consistently found a relationship between the frequency of family dinner and teen drinking, smoking and drug use. Compared to teens who have frequent family dinners (five to seven per week), those who have infrequent family dinners (fewer than three per week) are twice as likely to have used tobacco, nearly twice as likely to have used alcohol, and one and a half times likelier to have used marijuana. (Figure 2.A) Figure 2.A Percent Teens Who Have Used Substance by Frequency of Family Dinners 36 18 19 15 9 10 Tobacco Alcohol Marijuana 0 to 2 5 to 7-5-

Communication at the Table and Teen Substance Use Teens who talk to their parents about what s going on in their lives at dinner are less likely to smoke, drink and use drugs. Figure 2.B At Dinner, Do You Talk to Your Parents About What's Going on in Your Life? Compared to teens who talk to their parents about what s going in their lives at dinner, teens who don t are: (Figure 2.B) Nearly twice as likely to have used tobacco; 9 17 20 28 10 15 One and a half times likelier to have used marijuana; and Almost one and a half times likelier to have used alcohol. * Used Tobacco Used Alcohol Used Marijuana Talk About Life at Dinner Don't Talk About Life at Dinner Reasons Teens Don t Drink or Use Marijuana Among teens who don t drink or use marijuana, those who have five to seven family dinners per week are more likely to cite their parents as the reason why than teens who have fewer than three family dinners per week. (Figure 2.C) 57 Figure 2.C Percent Teens Who Say They Don't Use Substances Because Their Parents Would Be Upset 70 70 52 Alcohol Marijuana * Using regression methods, we adjusted the relationship between teens' talking to parents at dinner and teens' use of tobacco, alcohol and marijuana to account for the effect of the frequency of family dinners. For tobacco and marijuana use, there was slight attenuation of the magnitude of the association, and significance of the associations were maintained. For teen's use of alcohol, the odds ratio was reduced from 1.5 to 1.3, and significance level went from.01 to.17, indicating that the frequency of family dinners accounts for some of the statistical relationship between teens' talking to parents at dinner and teens' alcohol use. 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week -6-

Family Dinners and Having Friends Who Use Substances Teens who have frequent family dinners are less likely to report having friends who use substances. Figure 2.D Percent Teens Who Have Friends Who Drink Regularly or Use Marijuana Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are more than one and a half times likelier to have friends who drink regularly and use marijuana. (Figure 2.D) 52 33 39 24 Drink Regularly Use Marijuana 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are more likely to have friends who abuse prescription drugs (to get high) and use illegal drugs like acid, ecstasy, cocaine, methamphetamine and heroin. (Figure 2.E) Figure 2.E Family Dinners and Percent Teens With Friends/Classmates Who... 31 25 21 14 Use Illegal Drugs like Acid, Ecstasy, Cocaine, Meth, Heroin Abuse Prescription Drugs Without a Prescription to Get High 0 to 2 5 to 7-7-

The Relationship between Family Dinners and the Likelihood of Future Substance Use Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are more than twice as likely to say they expect to try drugs in the future. (Figure 2.F) Figure 2.F Percent Teens Who Say They are Very or Somewhat Likely to Try Drugs in the Future 12 5 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week Family Dinners and Teens Access to Marijuana and Prescription Drugs Teens who have infrequent family dinners are likelier to say they have ready access to marijuana and prescription drugs (to get high) compared to teens who have frequent family dinners; whereas, teens who have frequent family dinners are more likely to report having no access to such drugs. Figure 2.G Percent Teens Who Could Get Marijuana or Prescription Drugs to Get High Within an Hour Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are twice as likely to say they could get marijuana or prescription drugs (to get high) in an hour or less. (Figure 2.G) 16 8 Prescription Drugs 17 Marijuana 7 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week -8-

Teens who have five to seven family dinners per week are nearly twice as likely to report that they could not get marijuana or prescription drugs (to get high) if they wanted to, compared to teens who have fewer than three family dinners per week. (Figure 2.H) Figure 2.H Percent Teens Unable to Get Marijuana or Prescription Drugs to Get High 26 25 14 13 Prescription Drugs Marijuana 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week -9-

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Chapter III Family Dinners and Family Relationships Strength of Family Ties Associated with Teen Substance Use This year, for the first time, we assembled characteristics related to the bond between parents and teens (Family Ties) in order to identify the relationship of that bond to the risk that a teen will smoke, drink or use drugs. To measure Family Ties, we used a statistical method called factor analysis. Based on the teen s response to six survey questions, including the frequency of family dinners, we scored each teen on the strength of his or her Family Ties, which allowed us to place each teen in a Family Ties category: Strong, Average or Weak. (Table 3.1) Table 3.1 What it Means For a Teen to Have Strong/Average/Weak Family Ties Characteristics of Teens Strong Ties Average Ties Weak Ties (Percent of teens in category) (34% of teens) (33% of teens) (33% of teens) Has excellent relationship with biological/step mother 93% 33% 7% Has excellent relationship with biological/step father 84% 19% 3% Their parents hardly ever argue with each other 60% 45% 17% Believe parents are very good at listening to them 66% 33% 5% Attend religious services at least once a month 75% 64% 55% Has dinner with their parents 5 or more nights a week 82% 67% 41% -11-

The stronger the Family Ties, the less likely teens are to have used tobacco, alcohol or marijuana. (Figure 3.A) Compared to teens in families with strong Family Ties, teens in families with weak Family Ties are: Figure 3.A Percent Teens Who Have Tried Tobacco, Alcohol or Marijuana 35 Four times likelier to have tried tobacco; Almost three times likelier to have tried alcohol; and 5 7 20 12 19 5 8 20 Four times likelier to have tried marijuana. Tobacco Alcohol Marijuana Strong Family Ties Average Family Ties Weak Family Ties Family Dinners and the Quality of Teens Relationships with Mom and Dad Figure 3.B Teens who report having excellent relationships with their parents are less likely to use substances. Percent Teens on Relationship with Mom 49 Teens who have five to seven family dinners per week are almost three times likelier to say they have an excellent relationship with their mother and three times likelier to say they have an excellent relationship with their father compared to teens who have fewer than three family dinners per week. (Figures 3.B and 3.C) 18 10 3 Excellent Fair/Poor 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are three times likelier to say they have a fair or poor relationship with their mother, and almost three times likelier to say they have a fair or poor relationship with their father. (Figures 3.B and 3.C) 12 Figure 3.C Percent Teens on Relationship with Dad 36 16 6 Excellent Fair/Poor 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week -12-

Family Dinners and How Good Parents Are at Really Listening to Teen Teens who have five to seven family dinners per week are more than twice as likely to report that their parents are very good at listening to them, compared to teens who have fewer than three family dinners per week. (Figure 3.D) Figure 3.D How Good Are Your Parents at Really Listening to You? 39 16 23 8 Very Good Not Very Good/Not Good at All 0 to 2 Family Dinners/Week 5 to 7 Family Dinners/Week Other than Dinner, Occasions When Parents and Teens Talk About What s Going on in Teens Lives Because sitting down to dinner together isn t always an option, we asked parents and teens when, other than dinner, they talk to one another about what s going on in the teen s life, and allowed them to select multiple responses. The most common occasions when teens and parents talk are on the weekends and driving to and from school or activities. (Table 3.2) Table 3.2 Other Than Dinner, When Do Parents and Teens Talk About What s Going On in Teen s Life? (multiple responses accepted) Teens Parents On the weekends 71% 80% Driving to/from school or activities 71% 74% While eating other meals together 39% 46% On vacations 32% 36% While helping teen with homework 25% 34% On the phone 21% 23% Other 16% 19% -13-

Family Dinners and Attending Religious Services Regular religious service attendance is associated with lower rates of smoking, drinking and drug use. Teens who have frequent family dinners are more likely to attend religious services weekly (four or more times a month) compared to teens who have infrequent family dinners. (Figure 3.E) 47 Figure 3.E Family Dinners and Religious Service Attendance 46 32 30 Never Attends Attends 4+/Month 0 to 2 5 to 7 Compared to teens who attend religious services at least four times a month, those who never attend services are twice as likely to have tried cigarettes, nearly twice as likely to have tried alcohol, and two and a half times likelier to have tried marijuana. (Figure 3.F) Figure 3.F Percent Teens Who Have Tried Substances by Frequency of Religious Service Attendance 27 15 15 16 7 6 Tobacco Alcohol Marijuana Attends 4+/Month Never Attends -14-

Appendix A Survey Methodology The questionnaire for this survey was designed by the staffs of CASA at Columbia University (CASA) and QEV Analytics, Ltd. (QEV), a public opinion research firm located in Washington, DC. QEV has extensive experience conducting surveys and other forms of qualitative and quantitative research with adolescents and adults. Questions and themes were pre-tested by conducting two focus groups in Nashville, Tennessee, at a commercial focus group facility. The first focus group consisted of current high school juniors and seniors (16- and 17-year olds). The second focus group consisted of recent high school graduates (18- to 20-year olds). The data in this report were derived from two surveys: (1) a telephone survey of 1,000 teenagers ages 12 to 17 conducted by QEV using the same random digit dial (RDD) technique used in previous years; and (2) an Internet-based survey of 1,055 teenagers ages 12 to 17 and 456 of their parents conducted by Knowledge Networks using a new methodology the combines RDD and address-based sampling (ABS). QEV Analytics, Ltd. Survey In order to track trends from previous survey years, we contracted with QEV Analytics, Ltd. (QEV) to conduct a telephone survey of children ages 12 to 17. As we have done in the past 14 surveys, this survey was conducted by telephone, utilizing a random household selection procedure called random digit dialing (RDD), in which a pool of telephone numbers was assembled by a commercial survey sample vendor utilizing extensive information concerning telephone number assignments across the country. Telephone numbers in this initial pool represented all 48 continental states in proportion to their population. The sample frame does not include cell phone-only households. -15-

Households were qualified for participation in the survey by determining that a teen between the ages of 12 and 17 lived in the household. At least six call back attempts were made to each telephone number before the telephone number was rejected. Once a household was qualified as the residence of an eligible teenager ages 12 to 17, permission for survey participation by the teen was sought from the teen s parent or guardian. After permission was obtained, if the potential teen participant was available, the teen interview was conducted. If the potential teen participant was not available at the time of the initial contact with the parent or guardian, then a call back was scheduled for the teen interview. The surveys were conducted in English only. The scripts designed to solicit parental consent for the teen participation in this survey were available in English and Spanish. In total, 1,000 teenagers (511 males, 489 females) were interviewed between April 6 and April 27, 2010. The margin of sampling error for the telephone survey is ±3.1 percent at a 95 percent confidence level. The data collection process for this survey was supervised by Steven Wagner, President of QEV Analytics, Ltd. Knowledge Networks Survey Knowledge Networks administered the survey through adult members of its online, nationally representative research panel and their children. The panel was created by randomly selecting households using two methodologies: randomdigit dial (RDD) and addressed-based sampling (ABS). ABS involves probability-based sampling of addresses from the U.S. Postal Service s Delivery Sequence File. Randomly selected addresses are invited, through a series of mailings and, in some cases, follow up calls, to join the Knowledge Networks panel. ABS reaches households that are outside the RDD frame or are hard to reach through RDD, including cell-phone only households, households on do not call lists, and household with caller-id systems; 98 percent of households are covered using ABS. Knowledge Network also utilizes list-assisted RDD sampling techniques based on a sample frame of the U.S. residential landline telephone universe, with an oversampling of telephone exchanges that have high concentrations of African-American and Hispanic households based on Census data. The 30 percent of numbers for which a valid postal address can not be matched to the number are under-sampled. Advance letters are sent to households for which a valid address is available; subsequently, all of the randomly selected numbers are called and invited to participate in the Knowledge Networks panel. Numbers are called for 90 days, with at least 14 attempts made for non-answers and numbers known to be associated with a household. In order to assure that the research panel is nationally representative, individuals are selected independently of Internet access and computer ownership, and individuals who attempt to self-select or volunteer to join the panel are excluded. Individuals who are randomly selected and agree to become members of the research panel are provided with a laptop computer and free Internet access if they don t already have a personal computer and Internet access in their home. Knowledge Networks administers a profile survey to each new panel member to collect basic demographic information (including the ages of all other individuals living in the member s household) which is used for eligibility and weighting purposes, and is attached to future survey results. Once the profile is complete the member is considered activated. Once a week, activated members are invited, based on eligibility, to participate in a Knowledge Networks client survey. Participation is completely voluntary and panel members are free to participate (or not) in any given survey; however, if a member does not participate in a number of consecutive surveys, Knowledge Networks may remove that individual from the panel. Panel members are offered incentives to serve on the panel: those without a computer and Internet connection are provided with a laptop and free Internet access, -16-

while those who have their own computer and Internet access earn reward points for participation that can be converted into cash (approximately $4 - $6 per month). Knowledge Networks invited 1,648 men and 1,648 women (3,296) ages 25 and older with a child between the ages of 12 and 17 living in their home to participate in our survey. The panelists were asked to complete a screening which: (1) confirmed that they were the parent or guardian of child ages 12 to 17 who lives with them, (2) if more than one eligible child lived in the home, randomly selected one child to participate, and (3) obtained the parents consent for the child s participation in the teen survey. After competing the screening, the parent was instructed to invite the child to come to the computer and take the survey; the parent was also instructed to give the child privacy while doing so. Before the survey appeared on the screen, each teen was asked to provide consent for their own participation. While taking the survey, respondents were free to pause, to skip questions and to go back and change previous answers. The surveys were conducted in English only. be calculated for a probability sample (which a panel is not), the margin of sampling error for a survey of 456, which is the size of the parent/guardian sample, is ±4.6 percent (at the 95 percent confidence level). The data collection process for the Knowledge Networks surveys was conducted by Jordon Peugh, Sergei Rodkin, Mike Dennis and Charles DiSorga at Knowledge Networks. The data analysis for this report was accomplished by Steven Wagner, President of QEV Analytics, Ltd., and Roger Vaughan, DrPH and Sarah Tsai of CASA; this report was written by Emily Feinstein of CASA. Knowledge Networks administered the surveys between April 8, 2010 and April 27, 2010. In total, 1,055 teenagers ages 12 to 17 (540 males, 515 females) completed the teen survey. While technically sampling error can only be calculated for a probability sample (which a panel is not), the margin of sampling error for a survey of 1,055 teens is ±3.1 percent at a 95 percent confidence level. Five hundred sixty-nine parents of teens who completed the teen survey were randomly selected and invited to participate in the parent survey. In total, 456 parents (170 fathers, 238 mothers, 28 stepfathers, 12 stepmothers and 8 guardians) completed the survey. All of the parents interviewed reside in two-interview households, meaning that a teen was also interviewed from the same household; we only interview parents in households with a teen respondent because the principal utility of the parental data is in its relationship with the teen data. While technically sampling error can only -17-