Family functioning and adolescent risk perception of opioid misuse: A cross-sectional study

Adolescents with better family functioning and higher opioid risk perception are at lower risk for opioid misuse. However, studies examining the association between family functioning and opioid risk perception are lacking. We conducted an exploratory cross-sectional analysis of baseline data from a randomized controlled trial with adolescents aged 16-19 (n = 262) in high schools in Connecticut from 2022 to 2024. Bivariate and multivariable logistic regression models tested the association between family functioning and opioid misuse risk perception. Using principal component analysis, a family functioning score was derived from eight variables: cohesion, conflict, open and problematic communication, connectedness, parental monitoring, parenting practices, and family support. Higher scores indicated better family functioning. Perception of risk of harm from opioid misuse was assessed using eight items. Seventeen percent (44/262) of adolescents reported great risk from opioid misuse. The median family functioning score among adolescents perceiving great risk was 1.07 (interquartile range = 2.75), while the median score among those not perceiving great risk was 0.11 (interquartile range = 2.62; χ² = 7.27, p < .01). After adjusting for covariates, adolescents had 35% higher odds of reporting great risk of harm from opioids for every 0.5-unit increase in the family functioning score (adjusted odds ratio = 1.35, 95% CI [1.09, 1.67]). Adolescents in the top tertile of family functioning had more than 300% higher odds of reporting great risk compared to those in the lowest tertile (adjusted odds ratio = 4.26, 95% CI [1.53, 11.92]). Findings suggest that family functioning is associated with perceiving great risk of harm from opioids. Future studies are needed to uncover potential mediating/moderating factors that explain this association. (PsycInfo Database Record (c) 2026 APA, all rights reserved).