Parental Tobacco Use Research Articles

Cannabis and tobacco use prior to pregnancy and subsequent offspring birth outcomes: a 20-year intergenerational prospective cohort study

There is increasing evidence that the life-course origins of health and development begin before conception. We examined associations between timing and frequency of preconception cannabis and tobacco use and next generation preterm birth (PTB), low birth weight (LBW) and small for gestational age. 665 participants in a general population cohort were repeatedly assessed on tobacco and cannabis use between ages 14–29 years, before pregnancy. Associations were estimated using logistic regression. Preconception parent (either maternal or paternal) daily cannabis use age 15–17 was associated with sixfold increases in the odds of offspring PTB (aOR 6.65, 95% CI 1.92, 23.09), and offspring LBW (aOR 5.84, 95% CI 1.70–20.08), after adjusting for baseline sociodemographic factors, parent sex, offspring sex, family socioeconomic status, parent mental health at baseline, and concurrent tobacco use. There was little evidence of associations with preconception parental cannabis use at other ages or preconception parental tobacco use. Findings support the hypothesis that the early life origins of growth begin before conception and provide a compelling rationale for prevention of frequent use during adolescence. This is pertinent given liberalisation of cannabis policy.

Parental tobacco and indoor secondhand smoking exposure and the risk of offspring under-five mortality in low- and middle-income countries.

Children are vulnerable to exposure of secondhand smoking (SHS) which is a major preventable cause of disease and death. This study aimed to investigate the association between parental tobacco use or SHS exposure, respectively, and under-five mortality. Data were obtained from the nationally representative and population-based Demographic and Health Surveys in low- and middle-income countries (LMICs) between 2000 and 2018. Cox proportional hazard regression models with complex survey design were conducted to examine the adjusted associations between parental smoking and SHS exposure and child under-five mortality. In the pooled analysis of parental smoking, 437322 children were included. Compared with children whose parents are not smoking, those whose father or both parents smoked any form of tobacco had higher risks of mortality (hazard ratio [HR]=1.08, 95% confidence interval [CI]=1.03-1.13; HR=1.18, 95% CI=1.06-1.32, respectively). In addition, parental using smokeless tobacco, smoking tobacco, and using smokeless tobacco and smoking tobacco simultaneously was significantly associated with child under-five mortality (HR=1.07, 95% CI=1.01-1.12; HR=1.12, 95%CI=1.04-1.21; and HR=1.17, 95%CI=1.06-1.30, respectively). In the pooled analysis of SHS exposure, 605442 children were included, and weekly and daily SHS exposure were significantly associated with child under-five mortality (HR=1.11, 95% CI=1.03-1.20, and HR=1.10, 95% CI=1.06-1.15, respectively). The results were robust in most stratification analyses and sensitivity analyses. Parental tobacco use and indoor SHS exposure were associated with increased risk of under-five mortality in LMICs. Comprehensive tobacco control programs should be considered by policymakers in LMICs to promote smoke-free environments for children.

Parental cannabis and tobacco use during pregnancy and childhood hair cortisol concentrations

BackgroundFetal exposure to cannabis and tobacco during pregnancy leads to adverse fetal and childhood outcomes. We hypothesized that fetal exposure to cannabis and tobacco have persistent programming effects on hypothalamic pituitary adrenal (HPA) axis functioning in childhood. Therefore, we examined the associations of parental cannabis and tobacco use during pregnancy with childhood hair cortisol and cortisone concentrations at 6 years, as biomarkers of long-term HPA-axis functioning. MethodIn a population-based prospective birth cohort among 2577 mothers and their children, information of parental cannabis and tobacco use was collected by questionnaires, and maternal urine samples were additionally analyzed to detect cannabis metabolite concentrations. Cortisol and cortisone were measured in hair samples at 6 years. Linear regression analysis with adjustment for several confounders was used to test our hypothesis. ResultsAs compared to non-exposed children, offspring exposed to cannabis during pregnancy (in combination with tobacco) had higher childhood cortisol concentrations (log-10 transformed difference 0.16, 95 % Confidence Interval 0.04 to 0.28). This association was not mediated by birth weight. No differences in cortisone concentrations among cannabis-exposed children were observed. Maternal tobacco use during pregnancy was not associated with childhood cortisol or cortisone concentrations. Further, paternal cannabis or tobacco use was not associated with childhood cortisol or cortisone concentrations. ConclusionsOur findings suggest that maternal cannabis use, combined with tobacco, during pregnancy is associated with alterations in offspring HPA-axis functioning. Further studies need to replicate these findings, and assess the causality and long-term consequences of these associations.

An examination of social and environmental determinants of secondhand smoke exposure among non-smoking adolescents

INTRODUCTIONAdolescents are at increased risk of secondhand smoke exposure (SHS) due to the limited control that they have over social and physical environments. Yet, knowledge regarding determinants of SHS among non-smoking adolescents is limited. This study identifies social and environmental factors associated with SHS among non-smoking adolescents.METHODSTo be included, parents and adolescents (aged 11–17 years) of the Adolescents, Place, and Behavior Study had to have completed surveys between March 2019 and May 2020. Adolescents had to have not reported smoking within the past 30 days and provided a saliva sample assayed for cotinine (≤3 ng/mL). A series of stepwise linear regression models were fit to the data to identify social and environmental determinants of SHS, using log-transformed salivary cotinine.RESULTSOf the 105 adolescent and parent dyads included, 90.3% were African American, 26.9% of parents reported smoking, 33.3% resided in multi-unit housing, and 67.7% lived in homes where smoking was not permitted. Significant associations were found between parent tobacco use (β=2.56, SE=0.98, p=0.0082) and residing in multi-unit housing (β=1.72, SE=0.86, p=0.0460) with increased log-transformed cotinine levels among non-smoking adolescents. Adolescent age, gender, and race/ ethnicity, parental education, peer tobacco use, the number of adults and children in the home, average number of days of self-reported SHS within public spaces outside of the home, and home smoking policies were not significantly associated with cotinine.CONCLUSIONSResults emphasize the importance of reducing secondhand smoke exposure by reducing parental smoking and altering exposures within social and home environments. Parental tobacco use and residential setting should be considered when developing interventions to reduce secondhand smoke exposure among non-smoking adolescents.

Smoking Behaviors Among Tobacco-Using Parents of Hospitalized Children and Association With Child Cotinine Level.

Understanding patterns of parental tobacco use and their association with child exposure can help us target interventions more appropriately. We aimed to examine the association between parental smoking practices and cotinine levels of hospitalized children. This is a secondary analysis of data collected from parents of hospitalized children, recruited for a cessation intervention randomized controlled trial. Smoking parents were identified by using a medical record screening question. Parent-reported demographics and smoking habits were compared to child urine cotinine by using geometric means and log-transformed cotinine levels in multivariable linear regression analyses. A total of 213 patients had complete baseline parent-interview and urine cotinine data. The median age was 4 (interquartile range: 1-9); 57% were boys; 56% were white, 12% were Black, and 23% were multiracial; 36% identified as Hispanic. Most families (54%) had 1 smoker in the home; 36% had 2, and 9% had ≥3. Many (77%) reported having a ban on smoking in the home, and 86% reported smoking only outside. The geometric mean cotinine level of the cohort was 0.98 ng/mL. Higher cotinine levels were associated with more smokers in the home (ratio of 2.99) and smoking inside the house (ratio of 4.11). Having more smokers in the home and parents who smoke inside are associated with increased smoke exposure; however, even children whose families who smoke only outside the home have significant levels of cotinine, a marker for toxin exposure.

Single and Multiple Suicide Attempts: Prevalence and Correlates in School-Going Adolescents in Liberia in 2017.

BackgroundThis investigation aimed to estimate the prevalence and correlates of single and multiple suicide attempts among adolescents in Liberia.MethodsCross-sectional nationally representative data were analysed from 2744 adolescents (18 years of median age) who participated in the “2017 Liberia Global School-Based Student Health Survey (GSHS)”.ResultsResults indicate that 33.7% of students had made a suicide attempt in the past 12 months (16.5% single and 17.2% multiple suicide attempts). In adjusted multinomial logistic regression analysis, having no close friends, loneliness, having been frequently physically attacked, ever used amphetamine and fast food intake were associated with multiple suicide attempts in the past 12 months. In addition, having been frequently in a physical fight and current tobacco use were associated with single suicide attempt. In sex stratified analyses, in addition, among boys frequent bullying victimization and among girls, parental tobacco use and parents never or rarely check on home work were associated with multiple suicide attempts. Multiple psychosocial distressors, multiple social-environmental factors, and multiple health risk behaviours were associated with single and multiple suicide attempts.ConclusionOne in three students had made suicide attempt in the past 12 months (one in six students multiple suicide attempts) and several associated variables were detected which can aid in designing intervention strategies.

Predictors of electronic cigarette use among Swedish teenagers: a population-based cohort study

ObjectivesThe aim was to identify predictors of electronic cigarette (e-cigarette) use among teenagers.Design and settingA prospective population-based cohort study of schoolchildren in northern Sweden.ParticipantsIn 2006, a cohort study about asthma...

Barriers and incentives for Italian paediatricians to become smoking cessation promoters: a GARD-Italy Demonstration Project.

BackgroundPaediatricians rarely devote any time to screening and treatment for parental tobacco use. The present project is part of a Global Alliance against Chronic Respiratory Diseases (GARD)-Italy Demonstration Project, aimed to increase the skills of primary care physicians and paediatricians as “promoter of smoking cessation”. The aims of this study were: (I) to identify latent classes of barriers and incentives for smoking cessation counseling among paediatricians using latent class analysis (LCA); (II) to investigate risk factors for inclusion into the identified classes.MethodsIn 2018, 1,500 Italian paediatricians were invited to complete an online survey on passive smoke exposure in children. LCA was used to discover underlying response patterns, and to identify respondent groups with similar attitudes toward passive smoke exposure in children. Multinomial logistic regression helped investigate which explanatory variables influenced inclusion into a class. A P value <0.05 was considered significant.ResultsThe overall response rate was 71% (n=1,071/1,500). Three classes were identified: Class 1 “passive” (n=226, 21.10%); Class 2 “unmotivated” (n=124, 11.58%); and Class 3 “proactive” (n=721, 67.32%). Assuming Class 3 as reference, ever having been a smoker was borderline associated (P=0.052) with increased probability of inclusion into Class 1 (OR =1.43, 95% CI, 1.00–2.06). Having 6–15 or ≥15 years of work experience versus having less than five years was associated with decreased probability of being in the “passive” class (OR =0.46, 95% CI, 0.22–0.96 and OR =0.49, 95% CI, 0.27–0.87, respectively), as was discussing parents’ addiction to alcohol/drugs (OR =0.50, 95% CI, 0.33–0.76).ConclusionsWe identified three profiles among Italian paediatricians related to barriers and incentives for smoking cessation promotion. Tailored educational interventions for paediatricians are required to promote smoking cessation programs.

Parental Optimism and Perceived Control over Children's Initiation of Tobacco, Cannabis, and Opioid Use.

Families play an important role in helping teenagers avoid using tobacco, cannabis, and opioids, but some parents may underestimate the risk of their children using those substances. This study aimed to determine parents’ perceived likelihood of their child initiating tobacco, cannabis, and opioid use, as well as the control they have in preventing their child from using those substances. We surveyed 427 parents of children aged 0–18 years old using the online Amazon Mechanical Turk platform in the spring of 2019. We measured participants’ perceived likelihood of their child initiating tobacco, cannabis, or opioid use before the age of 18 compared to other children, using a five-point Likert scale. This perceived likelihood was dichotomized between optimistic (less likely than average) and non-optimistic (average or more likely than average). Independent variables included parental tobacco use, perceived parental control, and perceived severity of the behavior. Participants with missing data and participants with children who had already initiated substance use were excluded from statistical analyses. Mean age of participants was 38.1 years (Standard Deviation 8.4); 67% were female. Level of parental optimism was 59% for cannabis, 77% for tobacco, and 82% for opioids. Perceived severity was significantly lower for cannabis use (71/100) than tobacco (90/100) and opioid use (92/100) (p < 0.001). Current smokers were less likely than never smokers to be optimistic about their child’s risk of initiating using tobacco (Adjusted Odds Ratio (AOR): 0.18 [95% Confidence Interval (CI) 0.10–0.34]) or cannabis (AOR: 0.21 [95% CI 0.12–0.38]). Parental perceived likelihood of a child initiating substance use represents an understudied and potential target for substance use prevention.

A translational science approach to community-based participatory research using methodological triangulation

To advance the science of translational research and triangulation through a case study of community-based participatory research (CBPR) study on children’s exposure to environmental tobacco smoke (ETS). A total of 130 African American parents and children were recruited to participate in 13 parent advisory board key informant interviews (n = 6), parent tobacco use and behavior survey (n = 63), children’s (aged 6 months to 5 years) salivary assays (n = 43), and three member check focus groups (n = 18). Data were collected and analyzed separately, and overall findings were evaluated for consistency, inconsistency, divergent data, and data saturation using a data matrix table aligned with the social ecological model. Out of 43 children, 39.5% had levels of cotinine, suggesting high ETS exposure. The findings demonstrated that extremely low knowledge on how to protect children from exposure as well as low education and poverty increase the likelihood that parents do not believe in the harms of ETS. Custodial parents cannot control noncustodial parents smoking around children and 28% of children live in homes with no or partial smoking restrictions. Children’s healthcare providers are inconsistently inquiring about ETS exposure. Children living in attached homes had a greater likelihood of being exposed to ETS by another adult outside the home. CBPR is an effective strategy for translating science into promising community-informed interventions that meet the cultural and social needs of medically underserved populations. Integrated diverse data sets were utilized in the formation of a parental intervention targeting factors identified in the matrix.

To Determine Tobacco Usage and Associated Risk Factors among Adolescents- A Survey

Aim: To determine tobacco usage and associated factors among adolescents. Material &amp; Method: The present study was conducted on 1350 students age ranged 12- 17 years of age. Parameters such as type of school, type of tobacco use, type of family, grade, father occupation, mother occupation, monthly pocket money, history of parental use of tobacco and type of family was recorded. Results: Age group 12-14 years had 780 and 15-17 years had 570 subjects. Subjects were from private school in 890 and government in 460. Grade was 7th in 110, 8th in 230, 9th in 450and 10th in 560 subjects. Family of subjects was nuclear in 960 and joint in 390. Father occupation was service in 362, farmer in 290, business in 446 and laborer in 252, mother occupation was housewife in 440 and working in 910, parental tobacco usage habit was present in 830 subjects. The difference was significant (P&lt; 0.05). Conclusion: Authors found that later age, male gender, nuclear family, monthly income &gt;5000 per month, parental use and private school was predictor and risk factor of tobacco usage among school children.

Intergenerational Transfer of Tobacco Use Behaviour from Parent to Child: A Case Control Study.

Background:Parental influence may be a strong modifiable risk factor in the initiation of Tobacco habits among young adults. Parenting style may modify the risk of initiation of Tobacco use.Objective:To examine the intergenerational transfer of Tobacco habits amongst the urban and tribal populations in Kerala. Methodology:A hospital based unmatched case control study was undertaken in urban and tribal health centres in Kerala, India. 239 cases (19-30 years of age using any form of Tobacco, 64.10% males) and 256 controls (35.90% males) were enrolled. Parental Tobacco exposure ascertainment was done by conducting in depth interviews using a validated structured questionnaire, parent bonding instrument and life grid technique. Multiple logistic regressions were performed.Results:The odds of a case initiating the habit of Tobacco use was nearly four times more when the parent was a Tobacco user [adjusted OR 4.26 (95% CI 2.39 – 7.58)] as opposed to controls. Among other covariates examined, low parental bonding with subject (especially father- warmth/care) was a strong risk factor for Tobacco usage [OR 2.17 (95% 1.11 – 4.23)]. The cases had nearly four times the probability of Tobacco uptake compared to controls if the mothers had no formal schooling [adjusted OR of 3.93 (95% CI, 2.12 – 7.26)]. Conclusion:Parental use of Tobacco influences the uptake of Tobacco habits in their children, with the father’s parenting (low paternal warmth) being a strong risk factor.

Physical fitness in Catalan children in relation to parental tobacco use and other associated factors

IntroductionPhysical fitness level in children and adolescents is determined, partly, by the specific social and cultural context of each country. There is a lack of information about physical fitness level of Catalan children and its relation with parental socioeconomic and education level and anthropometric parameters. The aim of this study is to assess the physical fitness level of Catalan children and to examine the association with family environment and parental anthropometric characteristics and smoking. Methods and MaterialsThis is an observational, cross-sectional, descriptive and analytic study of 8- and 9-year-old schoolchildren. Physical fitness level was assessed with “ALPHA-FITNESS battery” and familiar environment and progenitors’ characteristics with ALADINO family questionnaire. Differences between group means were assessed using Student’s t test and analysis of variance (ANOVA) and relation between variables by Pearson correlation coefficient. Results269 children participated, 146 male (54.2%). Higher parental education level is associated to a better cardiorespiratory condition in their offspring. Those children whose fathers have higher education have a lower waist perimeter and lower body mass index. Children whose parents are not regular smokers have a better physical fitness. A positive correlation between body mass indexes of parents and children is observed, while a negative correlation between the maternal body mass index and both the musculoskeletal and cardiorespiratory conditions of the children is found. ConclusionChildren’s physical fitness is related with education level, body mass index and smoking pattern of their parents.

Correctly Identifying Hospitalized Pediatric Patients With Tobacco Smoke Exposure: The First Step in Addressing Parental Tobacco Use.

In their study in this issue of Hospital Pediatrics , Mahabee-Gittens et al1 compared tobacco smoke exposure (TSE) based on parental self-report in a convenience sample of pediatric patients who were hospitalized with TSE based on biochemical confirmation with levels of child salivary cotinine, a biomarker of nicotine. The study revealed poor sensitivity and specificity of parental self-report of TSE (reported in the electronic health record [EHR]), compared with measured cotinine levels. Only 67% of patients with positive cotinine levels were identified as having TSE by parental self-report, as documented in the EHR. In contrast, 77% of children with parental report of TSE who were hospitalized had positive cotinine levels. The authors concluded that almost 40% of children were misclassified in the EHR as not …

Treating Parents for Tobacco Use in the Pediatric Setting

Despite the availability of free and effective treatment, few pediatric practices identify and treat parental tobacco use. To determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention can be implemented and sustained in pediatric practices and test whether implementing CEASE led to changes in practice-level prevalence of smoking among parents over 2 years. This cluster randomized clinical trial was conducted from April 2015 to October 2017. Ten pediatric practices in 5 states were randomized to either implement the CEASE protocol or maintain usual care (as a control group). All parents who screened positive for tobacco use by exit survey after their child's clinical visit 2 weeks (from April to October 2015) and 2 years after intervention implementation (April to October 2017) were eligible to participate. Data analysis occurred from January 2018 to March 2019. The CEASE intervention is a practice-change intervention designed to facilitate both routine screening in pediatric settings of families for tobacco use and delivery of tobacco cessation treatment to individuals in screened households who use tobacco. The primary outcome was delivery of meaningful tobacco treatment, defined as the prescription of nicotine replacement therapy or quit line enrollment. Furthermore, changes in practice-level smoking prevalence and cotinine-confirmed quit rates over the 2 years of intervention implementation were assessed. Of the 8184 parents screened after their child's visit 2 weeks after intervention implementation, 961 (27.1%) were identified as currently smoking in intervention practices; 1103 parents (23.9%) were currently smoking in control practices. Among the 822 and 701 eligible parents who completed the survey in intervention and control practices, respectively 364 in the intervention practices (44.3%) vs 1 in a control practice (0.1%) received meaningful treatment at that visit (risk difference, 44.0% [95% CI, 9.8%-84.8%]). Two years later, of the 9794 parents screened, 1261 (24.4%) in intervention practices and 1149 (25.0%) in control practices were identified as currently smoking. Among the 804 and 727 eligible parents completing the survey in intervention and control practices, respectively, 113 in the intervention practices (14.1%) vs 2 in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8% [95% CI, 3.3%-37.8%]). Change in smoking prevalence over the 2 years of intervention implementation favored the intervention (-2.7% vs 1.1%; difference -3.7% [95% CI, -6.3% to -1.2%]), as did the cotinine-confirmed quit rate (2.4% vs -3.2%; difference, 5.5% [95% CI, 1.4%-9.6%]). In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care. ClinicalTrials.gov identifier: NCT01882348.

Tobacco‐21 laws and young adult smoking: quasi‐experimental evidence

To estimate the impact of tobacco-21 laws on smoking among young adults who are likely to smoke, and consider potential social multiplier effects. Design Quasi-experimental, observational study using new 2016-17 survey data. United States. A total of 1869 18-22-year-olds who have tried a combustible or electronic cigarette. Tobacco-21 laws raise the minimum legal sales age of cigarettes to 21years. Logistic regressions compared the association between tobacco-21 laws and smoking among 18-20-year-olds with that for 21-22-year-olds. The older age group served as a comparison group that was not bound by these restrictions, but could have been affected by correlated factors. Age 16 peer and parental tobacco use were considered as potential moderators. Self-reported recent smoking (past 30-day smoking) and current established smoking (recent smoking and life-time consumption of at least 100 cigarettes). Exposure to tobacco-21 laws yielded a 39% reduction in the odds of both recent smoking [odds ratio (OR)=0.61; 95% confidence interval (CI)=0.42, 0.89] and current established smoking (OR=0.61; 95% CI=0.39, 0.97) among 18-20-year-olds who had ever tried cigarettes. This association exceeded the policy's relationship with smoking among 21-22-year-olds. For current established smoking, the tobacco-21 reduction was amplified among those whose closest friends at age 16 used cigarettes (OR=0.50; 95% CI=0.29, 0.87), consistent with peer effects moderating the policy's impact on young adult smoking. Tobacco-21 laws appear to reduce smoking among 18-20-year-olds who have ever tried cigarettes.

The Enduring Effects of Parental Alcohol, Tobacco, and Drug Use on Child Well-being: A Multilevel Meta-Analysis.

The effects of psychoactive substance abuse are not limited to the user, but extend to the entire family system, with children of substance abusers being particularly at risk. This meta-analysis attempted to quantify the longitudinal relationship between parental alcohol, tobacco, and drug use and child well-being, investigating variation across a range of substance and well-being indices and other potential moderators. We performed a literature search of peer-reviewed, English language, longitudinal observational studies that reported outcomes for children aged 0 to 18 years. In total, 56 studies, yielding 220 dependent effect sizes, met inclusion criteria. A multilevel random-effects model revealed a statistically significant, small detriment to child well-being for parental substance abuse over time (r = .15). Moderator analyses demonstrated that the effect was more pronounced for parental drug use (r = .25), compared with alcohol use (r = .13), tobacco use (r = .13), and alcohol use disorder (r = .14). Results highlight a need for future studies that better capture the effect of parental psychoactive substance abuse on the full breadth of childhood well-being outcomes and to integrate substance abuse into models that specify the precise conditions under which parental behavior determines child well-being.Registration: PROSPERO CRD42017076088.

Alcohol Use and Misuse Among School-Going Adolescents in Thailand: Results of a National Survey in 2015.

The aim of this study was to assess the prevalence of alcohol use and misuse, and to identify its associated factors among in-school adolescents in the 2015 Thailand Global School-based Student Health Survey (GSHS). The sample included 5994 school-going adolescents (mean age 14.5 years, SD = 1.7) from Thailand that responded to the 2015 GSHS. Overall, 22.2% were current alcohol users, 24.3% had ever been drunk, 12.1% had drunk two or more alcoholic drinks in a day in the past 30 days and 10.8% had gotten into trouble because of drinking alcohol. In adjusted Poisson regression analysis, older age, psychological distress, current tobacco use, the consumption of one or more soft drinks a day, school truancy, having been in a physical fight in the past 12 months, and having been seriously injured in the past 12 months were associated with current alcohol use. Older age, psychological distress, current tobacco use and injury also increased the odds for lifetime drunkenness, having two or more drinks in a day and trouble resulting from drinking. Soft drink consumption and having been in a physical fight also increased the odds for lifetime drunkenness and having two or more drinks in a day and school truancy also increased the odds for lifetime drunkenness and trouble resulting from drinking. In addition. Parental tobacco use was associated with lifetime drunkenness and trouble resulting from drinking, cannabis use with trouble resulting from drinking, and parental support was protective from trouble resulting from drinking. There were no significant sex differences regarding any of the four alcohol use indicators. More than one in five school-going adolescents in Thailand use and misuse alcohol, and strategies to prevent alcohol misuse, including a cluster of risk behaviours, are needed.

Tobacco-Related Counseling and Documentation in Adolescent Primary Care Practice: Challenges and Opportunities.

Primary care visits present an opportunity to reduce tobacco use and tobacco smoke exposure (TSE) among adolescents. To date, few studies have examined tobacco-related electronic health record (EHR) documentation in adolescent visits. The purpose of this study was to (1) describe tobacco-related EHR documentation practices in adolescent care clinics, including whether alternative tobacco products, parental use, and TSE were addressed; and (2) identify aspects of adolescent tobacco use that may inform EHR updates and counseling and documentation practices. Following a convergent mixed-methods design, we conducted an EHR review of 508 adolescent well-child visits, performed focus groups with pediatric providers and staff, and conducted in-depth interviews with adolescent patients. Record review data and interview transcripts were analyzed and interpreted concurrently. In the EHR review, cigarette screening was documented in 92.3% of visits, smokeless tobacco screening in 51.4%, parental tobacco use in 23.2%, and home TSE in 33.1% of visits. Smoking status options were not mutually exclusive and did not include noncigarette products. No records documented assessment of e-cigarette use, despite nearly half of adolescent interview respondents citing these as the most popular products among adolescents. In interviews, adolescents discussed their experiences with alternative tobacco/nicotine products more than cigarettes. Tobacco use status prompts should be revised for clarity and include noncigarette tobacco products and TSE. Provider education on noncigarette products and TSE assessment is needed. Improvements in EHR systems, resources, and tools can lead to better tobacco screening, prevention, and treatment practices among primary care providers. Clinical guidelines call for pediatricians to assess and treat adolescent and parental tobacco use during primary care visits. The use of electronic health records (EHRs) can improve screening and counseling practices; however, few studies have examined tobacco-related EHR documentation practices in adolescent care settings. This mixed-methods study found low rates of EHR documentation related to noncigarette nicotine/tobacco products, parental tobacco use, and tobacco smoke exposure. These results demonstrate the need for increased provider training and EHR modifications to facilitate comprehensive tobacco control efforts in the adolescent population.

Tobacco Abstinence Motives in Young Adult College Students: Scale Development and Validation.

Objectives: Our objective was to develop a scale to assess motives for abstaining from tobacco use among young adults. Methods: We analyzed 2016 survey data from 2094 US college students (ages 18-25) who reported no past-4-month tobacco use. We developed a 10-item scale and examined its reliability and validity, specifically in relationship to future use intentions; perceived addictiveness, health risks, and social acceptability of tobacco use; and tobacco product use at 4-month follow-up. Results: Factor analysis identified 2 factors: Social Concerns and Instrumental Concerns. Bivariate analyses regarding convergent and discriminant validity indicated that both subscales were associated with lower future tobacco use intentions; greater perceived addictiveness and harm to health; and lower likelihood of follow-up use across products (ps < .05). Social Concerns scores were associated with all psychosocial factors; Instrumental Concerns scores were not associated with perceived social acceptability or parental tobacco use. Multivariable logistic regression indicated that lower Social Concerns scores predicted any follow-up tobacco use (p = .027); lower Instrumental Concerns scores predicted follow-up e-cigarette use (p = .037). Additionally, Tobacco Abstinence Motives scores contributed significantly to each model. Conclusions: This scale demonstrated good psychometric properties and identi- fied social and instrumental concerns as potential intervention targets to promote young adult abstinence.