Familial Influences on Adolescent E-Cigarette and Cannabis Use: A Qualitative Analysis.

Family factors influencing adolescent cigarette smoking are well described, but specific family influences of e-cigarettes and cannabis behaviors are underexamined. The objective of this study was to explore the role of family in adolescent e-cigarette, other tobacco, and cannabis use. Semi-structured interviews with 47 California adolescents, aged 13-17, who had ever used tobacco products were conducted between May 2020 and December 2021. Thematic analysis techniques identified unifying themes related to family factors and adolescent e-cigarette and cannabis use behaviors. Family members often played a role in initiating or facilitating access to substances. Some participants perceived that their parents displayed permissive attitudes toward e-cigarettes and cannabis, often setting weaker boundaries and allowing exceptions to otherwise stricter rules for combustible tobacco. Others expressed fear of being caught using tobacco by their family and used more easily concealed products (e.g., small, odorless devices) and other strategies to hide use from parents and family. For some, experiencing parental punishment or observing addiction in the family only partly deterred e-cigarette and cannabis use. Future research and education initiatives should focus on developing strategies that reduce youth access to e-cigarettes and cannabis by addressing and leveraging the nuanced role family plays in adolescent substance use behaviors.