Youth Tobacco Use: Associations with Household Rules and Parental Awareness

Objectives: With recent public health concerns about the increasing popularity of non-cigarette tobacco products, it is important to reexamine parents’ roles in youth tobacco prevention. This study examined: (1) parental awareness of their children’s tobacco use, (2) household tobacco-free rules and youth initiation, (3) variations in awareness and initiation by tobacco product type.
Methods: Data came from youth (ages 12-17) who completed Waves 1-3 (collected 2013-2016) of the Population Assessment of Tobacco and Health Study, a nationally representative (USA) longitudinal household survey of tobacco use and health. Youth tobacco use was categorized as: cigarette only, e-cigarette only, smokeless tobacco only, non-cigarette combustible only, and poly-use. Pseudo cross-sectional time-series analysis (N=17,787) examined parent report of whether they know/strongly suspect their child uses tobacco. Longitudinal analysis among Wave 1 never-users examined two potential predictors of tobacco initiation: household rules barring burned or non-burned tobacco use inside the home and whether parents talked with youth about not using tobacco. Survey-weighted logistic and multinomial logistic regression models adjusted for child and parent sociodemographic variables and other tobacco use risk factors. Multiple imputation accounted for missing covariate observations.

Results: Compared to youth cigarette use, parental awareness was lower for e-cigarettes (OR: 0.22), non-cigarette combustibles (OR: 0.18), and smokeless products (OR: 0.33, all p<0.001) among past 30-day users across Waves 1-3. Youth tobacco initiation by Wave 3 was lower when rules prohibited tobacco use throughout the home (OR: 0.78, 95%CI: 0.66, 0.93) compared to more permissive household rules. Parents’ advising youth against tobacco use was not associated with less initiation (OR: 1.14, 95%CI: 0.98, 1.33). Evidence did not strongly indicate household rules specifically about burned products more effectively prevented combustible tobacco initiation.
Conclusions: Many parents overlook their children’s non-cigarette tobacco use. Tobacco-free household environments appear more effective at preventing youth tobacco initiation than parents advising children not to use tobacco.