Family-centered Intervention Research Articles

Satisfaction and Quality of Life of Families Participating in Two Different Early Intervention Models in the Same Context: A Mixed Methods Study.

Early intervention is developed following different types of service organization, which in turn require different professional and family roles. The aim of this study was to compare the perceived satisfaction and family quality of life amongst families receiving early intervention developed at centers in comparison to those receiving the routines-based early intervention in families’ homes, that is a family centered intervention in ecological environments. Under a transformative paradigm, a mixed methods design was used, using the Consumer Report Effectiveness Scale (CRES-4) and the Beach Center Family Quality of Life Scale (FQOLS) and two focus groups as data collection instruments. The sample comprised 166 parents in the quantitative phase and 16 parents in the qualitative phase. Results showed that families receiving routines-based early intervention had greater satisfaction with the service although both groups showed similar scores for family quality of life in most of the analyzed domains. Three dimensions were identified throughout the qualitative phase: problem solving, professional team and service organization. Both the models analyzed have an impact on family quality of life and parents are in general satisfied. Strengths and weaknesses were found related to the problem-solving process, the role of the professional team, family empowerment and the service’s organization. The areas requiring further development are the effective training of professionals focused on family practices, the exchange of information with the family and a more participatory organization that takes parent’s perspectives into consideration. The value given to a combined model is another aspect highlighted in this study, as well as the need for a more agile assessment period to avoid unnecessary delays.

Growth and identity of music therapy in the NICU: Pioneering perspectives

This duoethnographic exploration expounds on the journeys of two women who pioneered music therapy in the NICUs in their respective countries. The dialogue uses their practice wisdom and research to illuminate core issues that have served the development of music as process and intervention for infants, families and those in the context of the NICU. They conclude with recommendations for the future.Monika Nöcker-Ribaupierre (MNR): I was a musician and I worked in the theatre. The premature birth of my daughter in the 1970s, experiencing my own helplessness and that of my family and friends, all of this led my life in an unexpected new direction: to music therapy in the NICU. My overall goal was to promote both the infant’s development in connection with support of the mother’s resilience – because there is no development without bonding. Next step was to open NICUs in my country to music therapy, also to strengthen our NICU music therapists and helping to develop an international network. Throughout all these years Helen Shoemark has been my most important and valuable colleague.Helen Shoemark (HS): I was a music therapist working in special education and early intervention for 15 years before. I started the program in the NICU at the Royal Children’s Hospital in 1994, and grew the role of music therapy in the pediatric NICU/ Newborn Surgical Unit through my research. Because of my experience in family-centered early intervention, my focus in the NICU is on supporting the expressive capacities of both infant and parents. My other focus is in supporting clinicians develop programs that are ecologically situated, theoretically- informed, and pragmatically realistic. Monika Nöcker-Ribaupierre was one of my earliest mentors, and I have always been inspired by the strength of her commitment, understanding, and support for the experience of the mothers in the NICU.

Needs assessment in unmet healthcare and family support services: A survey of caregivers of children and youth with autism spectrum disorder in Delaware.

The study aimed to collect data from families of children and youth with Autism Spectrum Disorder (ASD) in the state of Delaware, USA to understand their ongoing needs and challenges in accessing child healthcare and family support services. We analyzed responses from 263 caregivers of children and youth with ASD from 3 to 24 years using a statewide needs assessment survey. Over 50% caregivers indicated having unmet needs relative to both child/youth healthcare services and family support services. Between 24 and 38% caregivers expressed unmet needs for healthcare services such as social skills training, speech-language therapy, behavioral intervention, and occupational therapy for their child and 20-24% expressed needs for family support services such as respite care, parent/sibling support groups, counseling, and babysitting support. Additionally, number of prior early interventions received, limitations in accessing healthcare services, and unmet needs for family support services significantly predicted child/youth unmet healthcare needs. Greater ASD severity and difficulties accessing child/youth healthcare services predicted participant's functional dependence on caregivers for activities of daily living. Together, these findings call for designing holistic, family-centered interventions that address needs of both children and youth with ASD and their families. LAY SUMMARY: A statewide needs assessment survey of caregivers of children and youth with ASD revealed that 50% responders had unmet needs relative to both child/youth healthcare services and family support services. Number of prior services received, limitations in accessing healthcare, and unmet needs for family support are linked to child/youth unmet healthcare needs. Severity of autism and difficulties accessing child/youth healthcare are associated with participant's functional dependence. Together, these findings call for placing the family at the heart of the service system in ASD.

The effectiveness of a family-centred intervention after traumatic brain injury: A pragmatic randomised controlled trial

Objectives: To determine the effectiveness of a family-centred intervention for patients with traumatic brain injury and family members. Design: Open-labelled, two-armed randomised controlled trial. Settings: Outpatient clinic and family residences. Participants: Sixty-one patients (33 women) with traumatic brain injury, with mean (SD) age 43.8 (12.2), and 63 family members (33 women), with mean (SD) age 42.6 (11.3), were assign to intervention (n = 30 families) and control group (n = 31 families). Intervention: An eight-session single-family intervention to improve individual and family functioning. Outcome measures: Self-reported questionnaires at start-of-treatment, median (IQR) 11.4 (8.4, 15.9) months post-injury, and at two follow-ups, 2.7 (2.3, 3.8) and 9.2 (8.2, 9.9) months after start-of-treatment. Primary outcome measures were the SF-36 Mental Component Summary (MCS) and Caregiver Burden Scale (CGB). Secondary outcome measures were the Family Adaptability and Cohesion Evaluation Scale (FACES) and Quality of Life after Brain Injury Questionnaire (QOLIBRI). Group differences were analysed with linear mixed-model analysis for repeated measurements. Results: No significant between-group differences were found. The intervention group significantly improved on the MCS, the CGB and FACES in the treatment period, whereas the controls did not. The mean (SD) MCS change in the treatment period was 2.4 (1.1) points P = 0.028 in the intervention group. Mean (SE) MCS scores were 47.9 (1.26) and 47.3 (1.27) in the intervention and control group at last follow-up. Conclusions: Receiving an eight-session family intervention, in addition to specialised rehabilitation for the patients, was not superior to rehabilitation at a specialised traumatic brain injury outpatient clinic.

Working with Families Using a Family-Centered Approach for Improved Development Outcomes in High-Risk Children

Introduction: Around the world, almost half of all deaths in children under five occur in the newborn period. Ninety-nine percent of newborn deaths are in low- and middle-income countries and prematurity, intrapartumrelated neonatal deaths (‘birth asphyxia’), sepsis and meningitis account for 75% of these1. Developmental disability is a diverse group of chronic conditions that are due to mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in “language, mobility, learning, self-help, and independent living”2. Aim of Study: To analyze the impact of family centered-approach on child’s development outcomes. To quantify and validate the advantages of family-centered- approach for parents and children. Method: A low-cost, family-centered intervention programme to promote child and family wellbeing is provided at an Early Intervention Centre in Latika Roy Foundation, Dehradun, India. It follows a familycentered approach of empowering families through respect, collaboration, information, training and support. The effectiveness of this methodology is evaluated in this study. Discussion: This study evaluates the effectiveness of this family-centred interventions programme, provided by early intervention Centre, for improving development outcomes of high-risk infants. This study explores, for the first time in a resource limited country, the relationship between the reduction of family stress achieved through a family empowerment programme and improvement in development outcomes of high-risk children. Families of High-risk infants enrolled at the Centre during January 2015 through July 2017, who were in NICU for 5 or >5 days are partners in the study. Conclusion: The importance of family-centred care cannot be over-emphasized. Early intervention services and support to families can significantly improve quality of life of high-risk children. Intervention studies for children with disability state that the best way of improving children’s outcomes is by empowering parents through a structured learning programme. Given the scope and potential of such programs, this study quantifies and validates the advantages of the family-centred approach.

Role of older generations in the family's adjustment to Huntington disease.

Genetic diseases are a family matter, requiring adjustment and management from the family system, particularly when the diagnosis is recent. Literature has evidenced the importance of the role of older relatives in families dealing with some genetic diseases; however, knowledge is scarce regarding rare incurable genetic disorders, such as Huntington disease. Therefore, this exploratory qualitative study aims at describing how adjustment to Huntington disease occurs, from a family perspective, considering the roles performed by older generations, in the Portuguese context. It adopts the critical incidents technique, administered based on semi-structured interviews, and comprises 10 participants, aged 28 to 72 years (8 females), from seven families. Participants reported 130 critical incidents. The interviews were audiotaped, transcribed, and submitted to thematic analysis. Findings portray participants and their families as "beginners" in understanding and incorporating Huntington disease in their lives, due to recent diagnosis. In addition, data suggest that older relatives play two relevant roles in the creation of family narratives: (1) "shaping awareness about HD" (68 critical incidents) and (2) "influencing HD management" (62 critical incidents). Genetic counseling and family-centered interventions aimed at supporting families with a history of hereditary genetic diseases, should consider a narrative approach involving older relatives, since they have a great influence in sustaining family stories.

Telehealth Delivery of a Behavioral Parent Training Program to Spanish-Speaking Latinx Parents of Young Children With Developmental Delay: Applying an Implementation Framework Approach

Families play an important role in supporting children’s learning and behavioral health. School psychologists are ideally situated to promote family–school partnerships, home–school collaboration, and enhance positive parenting practices on behalf of students. When American schools closed due to the COVID-19 pandemic in March 2020, many families experienced increased stress and caregiving burden associated with supporting their children at home. We delivered a behavioral parent training program via telehealth to 42 Spanish-speaking Latinx parents of preschool children with developmental delay (DD) and elevated behavior problems during the pandemic. We used an implementation framework to examine acceptability, adoption, appropriateness, feasibility, fidelity, and implementation cost of the telehealth approach for this sample. Our findings suggest overall positive implementation outcomes for Latinx parents of children with DD. We discuss key implementation issues that are relevant to school psychologists delivering consultation and family-centered interventions to support families and students from diverse backgrounds. Impact Statement Parents of children with disabilities experience heightened stress and caregiving burden, likely exacerbated by the school closures associated with the COVID-19 pandemic. We delivered a behavioral parent training program via telehealth during the pandemic to Spanish-speaking parents of preschool children with developmental delay to support parenting at home. Study findings suggest strong support for the implementation outcomes investigated.

Family perspectives on the acceptability and usefulness of the FAB Positive Behaviour Support program: A pilot study

ABSTRACT Purpose: This pilot feasibility study aimed to gain preliminary insight into the acceptability and usefulness of the FAB-PBS program for providing behavior support to families following acquired brain injury (ABI) in community settings. The FAB-PBS program is based on a Positive Behavior Support (PBS) framework and principles of Family-Centered Care and Family-Directed Intervention. It consists of an education phase followed by individualized sessions during which the family is supported to develop and implement a PBS plan. Methods: A mixed-methods design was utilized, with feedback obtained from family members via short questionnaires and semi-structured interviews post education phase and individualized sessions, and at three-month follow up. Results: Two family members completed the full FAB-PBS program and reported high satisfaction with the program and increased confidence in providing behavior support. Findings also suggested an increase in desired behaviors and a decrease in challenging behaviors presented by family members with ABI. Conclusions: The FAB-PBS program may be an acceptable and feasible approach to increasing the capability of family caregivers in providing behavior support following ABI. Further pilot testing is required to inform the development of a larger feasibility study.

Race and Ethnicity and Exclusive Breastfeeding Success.

Introduction: Breast milk is the ideal food for infants. However, at 6 months of age, <25% of infants in the United States are exclusively breastfed. While racial disparities in breastfeeding have been documented, questions remain about the contributions of paternal race and ethnicity to breastfeeding. Materials and Methods: This single-site, prospective study investigated the association of parental characteristics and exclusive breastfeeding (EBF). EBF and non-EBF (N-EBF) infants who were >35 weeks gestational age were compared at nursery discharge and ∼30 days of age. Results: At nursery discharge (n = 499), mean birth weight (±standard deviation [SD]) was greater in the EBF versus N-EBF cohort (3.4 ± 0.4 versus 3.3 ± 0.5 kg, p = 0.01). When compared to the N-EBF cohort, infants in the EBF cohort were significantly more likely to have the following characteristics: (1) vaginal birth; (2) non-Hispanic parents; (3) parents with higher socioeconomic status, and (4) parents who are English-speaking (p < 0.01 for all). Similar findings persisted at 30 days. Non-Hispanic parents were 2 (95% confidence interval [CI]: 1.4-3.3) and 3.5 (95% CI: 1.5-7.9) times more likely to exclusively breastfeed than Hispanic parents at nursery discharge and 30 days, respectively. At nursery discharge, families with a Hispanic mother and non-Hispanic father were more likely to EBF than families with a Hispanic mother and father (odds ratio 2.9, 95% CI: 1.1-7.6). In multivariate model, parental ethnicity was associated with EBF at discharge (p = 0.03) and 30 days (p = 0.02). Conclusion: Paternal ethnicity may influence EBF. Addressing disparities in EBF may warrant investigations into culturally inclusive and family-centered interventions.

Effect of family-centered care interventions on motor and neurobehavior development of very preterm infants: a protocol for systematic review

BackgroundGlobally, very preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born very preterm, family-centered care (FCC) might promote developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on the motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect infant development.MethodsSystematic review will be carried out by including (a) quasi-randomized controlled trials and randomized controlled trials (b) of very preterm born infants (born < 32 weeks of gestation), and their primary caregivers will be included in the review (c) who received FCC-based interventions such as collaborative interaction between a healthcare professional and a parent, home program, home visits, and parent education, and (d) measure motor and neurobehavioral function. Electronic databases such as Scopus, PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database-specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, a meta-analysis will be undertaken to assess the effect of the FCC on the motor and neurobehavior of premature infants.ConclusionThe review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings.Systematic review registrationProtocol has been registered in PROSPERO on August 26, 2020.

A Feasibility Trial of an Online-Only, Family-Centered Preventive Intervention for Hispanics: e-Familias Unidas.

We piloted the preventive intervention e-Familias Unidas, delivered exclusively through the Internet to maximize reach and sustainability. This program is an adaptation of an evidence-based, family-centered intervention that aims to prevent Hispanic adolescent drug use and risky sexual behavior through improving family functioning. The purpose of this feasibility trial was to: (1) explore the use of Facebook and a trusted community champion in the online recruitment of Hispanic parents of adolescents, (2) test an online-only assessment and randomization protocol, (3) pilot intervention delivery via e-familiasunidas.com, and (4) assess pre-post changes in family functioning. We tracked participant recruitment and enrollment via Facebook analytics and REDCap. Intervention completion was tracked via our website. We conducted an ANCOVA to test for between group (e-Familias Unidas vs. control) differences post-intervention. Recruitment lasted for a total of 10weeks and was divided into three phases, with each phase systematically assessing which strategies maximized recruitment and enrollment. Overall, 93 Hispanic parents enrolled in the study. Of those randomized to the intervention group (n = 46), 70% were engaged and watched an average of 5.4 out of the 12 online videos. We found that participants recruited through a community champion, versus Facebook advertisements, had higher rates of enrollment and intervention completion. There was a significant improvement in parent-adolescent communication for parents who received e-Familias Unidas compared to those in the control group (n = 47). This pilot trial demonstrated it is feasible to recruit, assess, and deliver e-Familias Unidas to Hispanic parents through an online-only platform. Our findings highlight the promise of an online platform to optimize the reach of preventive interventions for underserved populations, to more effectively target participants, and to disseminate sustainable evidence-based interventions. We discuss lessons learned and recommendations for future research.

Empirical evaluation of the association between daily living skills of adults with autism and parental caregiver burden.

Despite the joy of parenting, the burden of daily caregiving for children with autism spectrum disorders (ASD) can be overwhelming and constant. Parents can expect to provide enduring care for their children with ASD. Given that the majority of individuals with autism spectrum disorders (ASD) remain in their family homes well into adulthood, often the need for assistance with activities of daily living (ADLs) is placed on parents. Providing ongoing support to adult children who have difficulty with completing ADLs can increase parental caregiving demands. Therefore, the purpose of this study was to examine the relationship between the ability of adults with ASD to perform ADLs with parental perceptions of caregiver burden. Quantitative analysis of cross-sectional multi-state data gathered electronically using Qualtrics from 320 aging parents of adults with ASD was conducted. Regression models were fit to examine the association of ADL challenges with total caregiver burden and its four domains (emotional, financial, time dependence, and developmental). Parental perceptions of caregiver burden decreased, particularly time dependence and developmental burden, when adult children were less dependent in ADLs, even after adjusting for parental health and behavioral challenges. Findings support the need for family-centered interventions to improve the capacity of adults with ASD to perform ADLs independently.

Assessing Caregiver Stress and Coping at Time of Autism Spectrum Disorder Diagnosis

Research and practice emphasize the importance of family involvement in early intervention for children with autism spectrum disorder (ASD). However, in order to address the unique and diverse challenges of families, support and resources may need to be prescribed on a case-by-case basis. This article suggests ways early intervention programs can assess parent stress, self-efficacy and disability specific knowledge at time of ASD diagnosis to inform family centered intervention programs with attention to individualized support for children with ASD and their families. A variety of assessment tools are provided with rationale for their use of results to inform program intervention and service plans for families of young children with ASD.

Stress, anxiety, depression and basic hope in family members of patients hospitalised in intensive care units - preliminary report.

The family response to intensive care unit (ICU) hospitalisation includes development of adverse psychological outcomes such as stress, anxiety or depression. These complications from exposure to critical care are termed post-intensive care syndrome-family (PICS-f). Psychological repercussions of critical illness affect the family member's ability to perform care functions after hospitalisation. Atotal of 37 family members of patients hospitalised in an ICU were included. To evaluate the level stress, anxiety, depression and basic hope the standardized questionnaires the Perceived Stress Scale (PSS-10), the Hospital Anxiety and Depression Scale (HADS) and the Basic Hope Inventory (BHI-12) respectively were used. In 33 respondents (89.19%) ahigh level of stress was identified, and 14 (37.84%) and 12 (32.43%) respondents had severe anxiety and depression, respectively. Higher levels of stress, anxiety and depression were found in spouses and family members living with the patient. Female subjects had ahigher level of basic hope (P = 0.026). It was found that perceived stress correlated with anxiety (r = 0.456, P = 0.005) and depression (r = 0.481, P = 0.003). Most relatives of the patients reported stress, anxiety, depression and low basic hope. Preventive family-centred interventions are needed to minimize the risk of adverse psychological repercussions, including post-intensive care syndrome family.

Caregivers' perceptions of the relationship among weight, health status, and asthma in their children.

Asthma and obesity are the two most common childhood illnesses and are physiologically interrelated. Few studies have assessed parental perceptions and beliefs about this relationship to better target education and therapy. This study aimed to determine caregiver beliefs and perceptions regarding weight, health status, and asthma diagnoses. Data from a survey of caregivers to children aged 4-11years are merged with corresponding anthropometric and medical data from the electronic medical record. Caregivers of children with asthma completed a supplemental questionnaire. Univariable and multivariable logistic regressions were used to evaluate associations between perception of health problem, asthma, and weight status. Increased weight status was ≥ 85th body mass index percentile per Centers for Disease Control classifications. Compared to caregivers of healthy children and those of children with healthy weight and asthma, caregivers of dual diagnosis children were more likely to identify weight as a health problem (OR = 3.89, 95% confidence interval [1.48, 10.21]). Nevertheless, only 31% of caregivers of children with dual diagnosis believed weight contributed to the severity of their child's asthma. Less than one third of caregivers of dual diagnosis children believed that these diagnoses are interrelated. Addressing this gap in understanding is a critical next step to developing family-centered interventions.

INTERVENÇÃO MUSICOTERÁPICA PARA MÃE-BEBÊ PRÉ-TERMO - IMUSP:

O presente artigo descreve o protocolo da Intervenção Musicoterápica para Mãe-Bebê Pré-termo – IMUSP, desenvolvido para aplicação em Unidades de Terapia Intensiva Neonatal (UTI Neo). Trata-se de uma intervenção precoce, individualizada e centrada na família, que busca sensibilizar e apoiar o canto materno com o bebê pré-termo. Após estudos iniciais, a intervenção foi estendida e implementada em um hospital público de Porto Alegre com 16 mães-bebês pré-termo. A IMUSP envolve seis encontros individuais com mãe-bebê na UTI Neo, utilizando três técnicas: o canto de músicas familiares, o canto dirigido ao bebê e a composição de uma música para o bebê. Resultados revelam que a IMUSP contribui para melhorar a saúde mental materna, favorecer a estabilização e a ativação emocional dos bebês, e promover a sincronia interacional mãe-bebê. Discute-se sua aplicação em contextos clínicos e sua adequação para diferentes demandas e características culturais das famílias, bem como para as especificidades da UTI Neo.

Pediatric Primary Care and Partnerships Across Sectors to Promote Early Child Development.

Poverty remains a critical predictor of children's school readiness, health and longer term outcomes. Early relational health (ERH) (ie, parenting practices and relationship quality) mediates the impact of poverty on child development, and thus has been the focus of many parenting interventions. Despite the documented efficacy of parenting interventions at reducing poverty-related disparities in child health and development, several key barriers prevent achieving population-level reach to families with young children. In the current paper we highlight several of these barriers including gaining population-level access to young children and families, reaching families only through single points of access, addressing the significant heterogeneity of risk that exists among families living in poverty, as well as addressing each of these barriers in combination. We suggest that understanding and confronting these barriers will allow family-centered interventions to more effectively address issues related to ERH at a population level, which in turn will reduce poverty-related disparities in child development.

Measuring Impact and Sustainability of Evidence-Based Dementia Care Treatment in the Community

Through a collaborative agreement with the Administration for Community Living, Memory Care Home Solutions translated the evidence-based program (EBP) Care of Persons with Dementia in their Environments (COPE) into community practice as a covered benefit through Medicare and commercial health insurance for people living with dementia. While many studies have demonstrated the efficacy of family-centered behavioral interventions for this population, few of these interventions have been translated from academic studies into successful community practice. This session will describe the process of translating an EBP into community practice utilizing social work and occupational therapy interventionists with a diverse population of people living in both urban and rural areas of Missouri and Illinois, including modifications required and lessons learned in rural service delivery. Attendees will gain an understanding of the translation process, differential treatment outcomes for people living with dementia and care partners and Medicare billing mechanisms for sustainability.

Attitude Toward Family Involvement in End-of-Life Care Among Older Chinese Americans

Family involvement is critical to end-of-life (EOL) care of older adults. Attitude toward family involvement in EOL care can be influenced by family relationship. Yet, mechanisms explaining such influence have not been examined among older Chinese Americans. This study aims to examine the association between family relationship and older Chinese Americans’ attitude toward family involvement in EOL care and explore pathways of this association. Potential mediators include self-efficacy, perceived benefits, and perceived barriers of discussing EOL care with family members. Data were collected from 276 Chinese Americans aged 55+ in two metropolitan areas in 2018. Participants’ average age was 74 years (SD=9.6). Approximately 64% of the sample were female. Most participants (57%) held positive attitudes toward family involvement in EOL care. Using the Structural Equation Modeling method, we found that family relationship had a significant positive total effect on positive attitude toward family involvement in EOL care (z=5.57, p<0.001). Indirect direct of family relationship on attitude toward family involvement in EOL care through both self-efficacy (z=3.13, p<0.01) and perceived barriers (z=2.30, p<0.05) of discussing EOL care with family members was significant. Results suggest that improving family relationship may increase elder’s self-efficacy and reduce barriers of discussing EOL with family members, which is associated with more positive attitude toward family involvement in EOL care. Findings provide empirical evidence of how family relationship affects older Chinese Americans’ attitude toward family involvement in EOL care and underline the need for family-centered interventions for older Chinese Americans.

Nicotine-naïve adolescents who live with tobacco products users, 2018 Florida Youth Tobacco Survey

Objective We assessed the prevalence and factors associated with living with tobacco/nicotine product users among nicotine-naïve adolescents. Methods Data were from the 2018 Florida Youth Tobacco Survey that included 34,183 adolescents who were never-tobacco product users and provided information about living with tobacco/nicotine users. Results More than a quarter of adolescents lived with a tobacco/nicotine user. Girls were more likely than boys and middle-schoolers were more likely than high-schoolers to live with someone who uses cigarettes, cigars, and poly-tobacco. Compared to non-Hispanic Whites, Hispanics were less likely to live with someone who uses cigarettes, electronic nicotine delivery systems, cigars, and poly-tobacco. Adolescents who reported currently having asthma were more likely to report living with someone who smokes cigarettes, hookah, and poly tobacco. Conclusions To reduce and ideally eliminate exposure to smoke/aerosol emitted from tobacco products in nicotine-naïve adolescents, individual and family-centered interventions, coupled with state-wide tobacco prevention strategies are warranted.