Strict household rules the best way to prevent child tobacco use

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Most parents know or suspect when their child smokes, but they are much more likely to be in the dark if the child vapes or uses other tobacco products, according to a large national study by researchers at the University of California, San Francisco. The researchers found that setting strict household rules is the best way to prevent child tobacco use.

The study – published on 5 October in the Pediatrics, a journal of the American Academy of Pediatrics – a tracked more than 23,000 participants aged 12 to 17 years old,

It found that parents or guardians were substantially less likely to report knowing or suspecting that their child had used tobacco if the child used only e-cigarettes, non-cigarette combustible products or smokeless tobacco, compared to smoking cigarettes or using multiple tobacco products, UC San Francisco reports.

The researchers also discovered that when parents set strong household rules about not using tobacco – applying to all residents – their children were less likely to start tobacco use. Just talking to kids about not smoking was far less effective.

“We know that tobacco-free homes are a key tool to help prevent smoking by kids,” said corresponding and senior author Benjamin Chaffee, an associate professor at the UC San Francisco School of Dentistry.

“What studies haven’t examined is how tobacco-free homes stack up against other approaches and how much tobacco-free home rules might help with other tobacco products beyond smoking. “Tobacco use by children is troubling, and dentists, like all healthcare providers, should be concerned about preventing youth tobacco use,” Chaffee said.

Changed smoking landscape

Over the last decade, the smoking landscape has dramatically changed, especially among youth, for whom cigarette smoking has declined while use of electronic cigarettes has soared. Last year, the Centers for Disease Control and Prevention reported that more than one in four high school students was vaping.

The study used data from the Population Assessment of Tobacco and Health (PATH) Study to investigate parental awareness of youth tobacco use and the role of household tobacco rules in preventing smoking.

In addition to cigarettes and e-cigarettes, the study looked at non-cigarette combustible products (including cigars, pipes, hookahs and bidis), and smokeless tobacco (including snuff, chewing tobacco, snus and dissolvable tobacco).

It found that parents were more likely to know or suspect that their child was using a tobacco or nicotine product if the child was older, male, identified as white, and lived with a tobacco user, as well as if the parents were less educated. Mothers were singled out as more aware than fathers.

The researchers also found that teens and tweens living in homes with the strictest rules prohibiting tobacco use were 20% to 26% less likely to start using tobacco, compared to youth living in the most permissive homes. The investigators suggest that parents:

  • Don’t smoke.
  • Create tobacco-free home environments that include all parts of the home.
  • Establish strict rules against all tobacco use that apply to all members of the household.
  • Have high quality, clear communication with youth about not using tobacco.

“Low parental awareness of e-cigarette use belies rising public attention to youth vaping,” said co-author Tsu-Shuan Wu, a student at the UCSF School of Dentistry. “Youth tobacco use is a considerable public health concern, regardless of the tobacco product used, and parents play a very important role in tobacco prevention.

“Creating tobacco-free home environments is one approach parents can use to set norms and expectations about tobacco use,” she said. “And for healthcare providers, raising parental awareness should be part of overall guidance and tobacco-prevention support.”

 

Parental Awareness of Youth Tobacco Use and the Role of Household Tobacco Rules in Use Prevention

In Pediatrics, a journal of the American Academy of Pediatrics. Published on 5 October 2020.

Authors

Tsu-Shuan Wu and Benjamin W. Chaffee

University of California, San Francisco, San Francisco.

Abstract

Non-cigarette tobacco use is increasing. In this study, we reexamined (1) parental knowledge or suspicion of their children’s tobacco use and (2) associations of household tobacco-free rules with youth initiation.

Methods

Participants were youth (aged 12–17) in waves 1 to 4 (2013–2018) of the Population Assessment of Tobacco and Health Study. A pseudo cross-sectional time-series analysis (N = 23 170) was used to examine parent or guardian knowledge or suspicion of their child’s tobacco use according to youth-reported use categories: cigarette only, electronic cigarette only, smokeless tobacco only, noncigarette combustible only, and poly use.

A longitudinal analysis among wave 1 never users (n = 8994) was used to examine rules barring tobacco inside the home and whether parents talked with youth about not using tobacco as predictors of youth tobacco initiation after 1 to 3 years. Survey-weighted multivariable models were adjusted for tobacco use risk factors.

Results

In all waves, parents or guardians much less often knew or suspected that their children used tobacco if youth only reported use of electronic cigarettes, noncigarette combustible products, or smokeless tobacco compared with cigarettes.

Youth tobacco initiation was lower when youth and parents agreed that rules prohibited all tobacco use throughout the home (1-year adjusted odds ratio: 0.74; 95% confidence interval: 0.59–0.94) but not when parents talked with youth about tobacco (adjusted odds ratio: 1.08; 95% confidence interval: 0.94–1.23).

Conclusions

Many parents are unaware of their children’s noncigarette tobacco use. Setting expectations for tobacco-free environments appears more effective at preventing youth tobacco initiation than parents advising children not to use tobacco.

 

Parents Less Aware When Their Kids Vape Than When They Smoke

 

Parental Awareness of Youth Tobacco Use and the Role of Household Tobacco Rules in Use Prevention

 


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