Parental Dual Use of e-Cigarettes and Traditional Cigarettes

Types of Tobacco Products Used by Caregivers of Newborns in the Primary Care Setting

This study determined the types of tobacco products used by caregivers who presented to infant well-child visits (WCVs), tobacco product use by other household members, and caregivers' readiness to quit. The Ohio Chapter of the American Academy of Pediatrics conducted a 10-month quality improvement collaborative to improve providers' tobacco screening and cessation counseling practices. A sub-analysis of the initial screenings was performed to determine types of tobacco products used and caregivers' readiness to quit. Fourteen practices (60 providers) participated, and 3972 initial screens were analyzed; 320 (8.1%) caregivers and 490 (12.4%) household members used tobacco products. Most smoking caregivers and household members exclusively used cigarettes (79% and 72%, respectively). There was no difference in caregiver intention to quit by tobacco type, yet 53% of smoking caregivers were ready to quit. Providers should provide screening and cessation counseling to caregivers of infants at WCVs since many are ready to quit.

Changes in childhood experimentation with, and exposure to, tobacco and e-cigarettes and perceived smoking norms: a repeated cross-sectional study of 10-11 year olds' in Wales

BACKGROUND

Today's primary school children have grown up in a climate of strong smoking restrictions, decreasing tobacco use, and the emergence of e-cigarettes. Children's exposure to tobacco declined substantially in years following the introduction of smoke-free legislation, with smoking uptake and perceived smoking norms declining. There is debate regarding whether emergence of e-cigarettes may interrupt trends in children's smoking perceptions, or offer a means for adults to limit children's exposure to tobacco. This study examines change in children's tobacco and e-cigarettes experimentation (ever use), exposure to secondhand smoking and vaping, and perceived smoking norms.

METHODS

Data from four, repeat cross-sectional surveys of Year 6 primary school pupils (age 10-11 years) in Wales in 2007, 2008, 2014 and 2019 (n = 6741) were combined. E-cigarette use and perceptions were included in 2014 and 2019 surveys. Analyses used binary logistic regression analyses, adjusted for school-level clustering.

RESULTS

Child tobacco experimentation and most indicators of exposure to tobacco smoke indicated a graded decreasing trend over time from 2007 to 2019. Exposure to e-cigarettes increased from 2014 to 2019, as did pupil awareness of e-cigarettes (OR = 2.56, 95%CI = 2.12-3.10), and parental use (OR = 1.26, 95%CI = 1.00-1.57). A decrease in child e-cigarette experimentation was not significant (OR = 0.80, 95%CI = 0.57-1.13). Children's normative perceptions for smoking by adults and children indicated a graded decrease over time (OR = 0.66, 95%CI = 0.54-0.80; OR = 0.69, 95%CI = 0.55-0.86; respectively from 2014 to 2019). However, fewer reported disapproval of people smoking around them in 2019 relative to 2014 (OR = 0.68, 95%CI = 0.53-0.88). Higher exposure to tobacco cigarettes and e-cigarettes in public places, cars and households were associated with favourable normative perceptions for tobacco smoking; however in models adjusted for exposure to both associations of e-cigarette exposure were attenuated.

CONCLUSION

Children's experimentation with and exposure to tobacco, and their perceptions of smoking as a normative behaviour, have continued to decline alongside growth in exposure to e-cigarettes. Although a large majority of pupils reported they minded people smoking around them, there was some evidence of diminishing disapproval of secondhand smoke since 2007. Further research is needed to understand whether use of e-cigarettes in cars and homes is displacing prior smoking or being introduced into environments where smoking had been eliminated.

Smoking Cessation Treatment for Parents Who Dual Use E-Cigarettes and Traditional Cigarettes

INTRODUCTION

An increasing number of parents use both e-cigarettes and cigarettes (dual users). Previous studies have shown that dual users may have higher rates of contemplating smoking cessation than parents who only smoke cigarettes. This study was aimed to assess the delivery of tobacco cessation treatment (prescription for nicotine replacement therapy and referral to the quitline) among parents who report being dual users vs. cigarette-only smokers.

METHODS

A secondary analysis of parent survey data collected between April and October 2017 at 10 pediatric primary care practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was conducted. Parents were considered to be dual users of cigarettes and e-cigarettes if they reported smoking a cigarette, even a puff, in the past seven days and using an e-cigarette within the past 30 days. Parents were asked if they received a prescription for nicotine replacement therapy and referral to the quitline to help them quit from their child's clinician. Multivariable logistic regression examined factors (dual use, insurance status, relationship to the child, race, and education status of the parent) associated with delivery of smoking cessation treatment (receiving prescriptions and/or enrollment in quitline) to smoking parents. Further, we compared the rates of tobacco cessation treatment delivery to dual users in the usual-care control practices vs. intervention practices.

RESULTS

Of 1007 smokers or recent quitters surveyed in the five intervention practices, 722 parents reported current use of cigarettes-only and 111 used e-cigarettes. Of these 111 parents, 82 (73.9%) reported smoking cigarettes. Parents were more likely to report receiving any treatment if they were dual users vs. cigarette-only smokers (OR 2.43, 95% CI 1.38, 4.29). Child's insurance status, parents' sex, education, and race were not associated with parental receipt of tobacco cessation treatment in the model. No dual users in the usual-care control practices reported receiving treatment. Discussion. Dual users who visited CEASE intervention practices were more likely to receive treatment than cigarette-only smokers when treatments were discussed. An increased uptake of tobacco cessation treatments among dual users reinforces the importance of discussing treatment options with this group, while also recognizing that cigarette-only smokers may require additional intervention to increase the acceptance rate of cessation assistance. This trial is registered with ClinicalTrials.gov, Identifier: NCT01882348.

Investigating the role of familial and peer-related factors on electronic nicotine delivery systems (ENDS) use among U.S. adolescents

INTRODUCTION

Tobacco use is a public health concern, and adolescents are at an increased risk of starting and continuing to use tobacco relative to other age groups. Parent involvement and other social environmental factors may influence the development and persistence of tobacco use behaviors in adolescence. This study used the nationally representative Population Assessment of Tobacco and Health (PATH) study data set, and responses from 7025 adolescent participants were analyzed to illustrate the longitudinal relationship between social environment influences and use of adolescent electronic nicotine delivery systems (i.e., ENDS).

METHODS

Social environmental factors were assessed at Wave 3 and then compared to electronic nicotine delivery systems (ENDS) status transitions (i.e., initiation, expansion, persistence) at follow-up. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI).

RESULTS

Initiation and persistence of ENDS use were associated with tobacco availability in the house, perception of having no adverse parent reaction to discovering ENDS use and having a best friend who uses ENDS. Initiation of ENDS use was further associated with having biological relatives who have ever been diagnosed with a substance use disorder (SUD) and persistence of ENDS use was also positively associated with lack of in-house rules. Parents talking about ENDS use with adolescents had no association across all three outcomes.

CONCLUSIONS

Findings suggest that parental and environmental factors alter the risk of initiation and persistence of ENDS and tobacco use in adolescents, and these should be considered when working with this at-risk population.

Smoking Cessation Treatment for Parents Who Are Light or Very Light Smokers in the Pediatric Setting

BACKGROUND

The percentage of US smokers who smoke <10 cigarettes per day has increased, yet it is not known how often light parental smokers are offered and accept cessation assistance in pediatric offices.

METHODS

A secondary analysis of parent interview data collected April to October 2017 at 10 pediatric practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention.

RESULTS

Forty percent of 725 usual care control (UCC) group smokers smoked lightly (<10 cigarettes per day); of these 58% smoked very lightly (<5 per day). Compared to heavier smokers in UCC practices, light and very light smokers in UCC practices were more likely to have made a recent quit attempt (P < .001), yet less likely to have used cessation medication (P = .001). In intervention practices, compared to heavier smokers, light (P = .04) and very light (P < .01) smokers were less likely to be asked if they smoke and very light smokers were less likely to be advised to quit (P = .02) and to receive a nicotine replacement therapy (NRT) prescription (P < .01). However, light smokers (P < .001), very light smokers (P < .001), and light smokers who use e-cigarettes (P = .01) were more likely to receive assistance (NRT or quitline enrollment) in intervention versus UCC practices.

CONCLUSIONS

The CEASE intervention increased assistance to light and very light smokers, yet heavier smokers received more assistance than light smokers. Improving cessation interventions for light and very light smokers is warranted.