P1054 - Tobacco-Free Home Rules and Association with Adolescent Smoking Initiation

Background
Promoting smoke-free home policies have been a key public health strategy credited with declining rates of cigarette initiation. Awareness of risk for initiation of new products such as e-cigarettes, nicotine dependence, and serious health consequences has led legislators, clinicians, and parents to discuss how best to protect adolescents from using. Parental monitoring and enforcement of rules has been shown to influence adolescent health behaviors.

Methods
This is a secondary analysis of the Population Assessment of Tobacco and Health (PATH) Study, a longitudinal household survey representative of US adult and youth tobacco use. We assessed the relationship between parent-child agreement on rules for tobacco use in the home and adolescent tobacco use in the Youth Sample (n=11,059) from Wave 1 to Wave 4 (Sept 2013-Jan 2018). Youth sample was 48.7% female, 51.2% male. Parent-child agreement on rules for tobacco product use within the home were classified as: a) agree the home is tobacco-free (reference group); b) agree the home is not tobacco-free; c) youth believe rules are more lenient; and d) youth believe rules are more restrictive. We used logistic regression to assess initiation of any tobacco use among Wave 1 never users at Wave 4. Models included planned covariates for parental education, marital status, a tobacco user in the household, sociodemographic characteristics of the youth, and youth mental health status.

Results
At Wave 1, prevalence of Wave 1 youth tobacco use was 20.7±0.5%, and 76±0.7% of parent-child dyads agreed their home was tobacco-free. Youth in homes with parent-child agreement that tobacco use is allowed in the home (AOR =1.7; 95%CI=1.4-2.1) or where youth believe tobacco rules are lenient (AOR =1.9; 95%CI=1.5-2.4) were significantly (p<0.01) more likely to have used tobacco than youth in homes where there was agreement that the home is tobacco-free. Among Wave 1 never users, initiation of tobacco use by Wave 4 was significantly (p<0.03) higher in homes where the youth reported lenient (AOR = 1.2; 95%CI=1.03-1.5) or more restrictive (AOR = 1.3; 95%CI=1.1-1.6) tobacco use rules compared to youth in homes where parents and youth agreed the home was tobacco-free.

Conclusion
Agreement about tobacco-free home rules was significantly associated with lower rates of youth tobacco use as well as tobacco initiation. These results suggest the importance of promoting tobacco-free home policies and helping parents clarify home rules for tobacco use.