The proliferation of new smoking devices such as e-cigarettes and of tobacco products such as dissolvable tobacco is making it harder for parents to police children's tobacco use, according to a survey using national data from the ongoing Population Assessment of Tobacco and Health Study to determine the extent to which parents are in the dark.

Prior to 2016, when e-cigarette popularity surged, traditional cigarettes were the most common form of tobacco used by youths. The distinctive odor of cigarette smoke, and its residue in clothing, hair, and breath, made detection by parents and guardians easier than with e-cigarettes, which often employ flavored liquids that conceal tobacco odors. Analyzing data from 2013 to 2018, the researchers found that some 62% to 72% (depending on the year surveyed) of parents knew their children were smoking cigarettes but only 35% to 42% were aware of e-cigarette use.

Another question explored by the researchers was the effect of parental expectations on children's tobacco use. They found that children in households with strict rules against tobacco use had "20% to 26% lower odds of tobacco initiation compared with children in the most permissive households." These rules applied to adults in the household and to visitors as well. By contrast, in households where parents or guardians talked to children about the hazards of tobacco use, but where one or more adults might be smokers, there was no restraining effect on youth initiation of tobacco use.

The researchers' findings, published in Pediatrics last November, come against a backdrop of steady decline in youth tobacco use since the late 1990s. The emergence of e-cigarettes has not significantly altered that trajectory. One influential factor not measured by the study is the impact of a widely publicized 2019 outbreak of serious lung damage in young people who used certain e-cigarette or "vaping" liquids. As a result, parents today may be far more alert to e-cigarette use and its dangers.

Nevertheless, the study authors note that ever-changing e-cigarette device designs, their easily concealed size, and the confusing terminology surrounding tobacco products (hookah, bidi, kretek, snus, and others) continue to pose challenges for parents trying to safeguard their children. It suggests a role for nurses and other health professionals to inform parents about the appearance, forms, and harm of noncigarette tobacco products.-Joan Zolot, PA