title: Associations of Adolescents' Cigarette, Waterpipe, and Dual Tobacco Use With Parental Tobacco Use.
abstract: BACKGROUND
  Previous studies have demonstrated the influence of parental (both mother and father) cigarette smoking on adolescents' cigarette smoking. Little is known, however, about how parental tobacco use is related to waterpipe and dual waterpipe/cigarette use, which is increasing dramatically in the Arab countries.
  
  
  METHODS
  Study data (n = 34 788, N = 6 109 572) were obtained from nationally representative Global Youth Tobacco Surveys in 17 Arab countries. Study outcome was adolescents' tobacco use categorized into none, cigarette smoking only, waterpipe smoking (WPS) only, and dual use. Primary exposure included parental tobacco use categorized into 10 groups-maternal (mother) cigarette smoking only, maternal WPS only, maternal dual use, paternal (father) cigarette smoking only, paternal WPS only, paternal dual use, parental (both mother and father) cigarette smoking only, parental WPS only, parental dual use, and none. Weighted multinomial regression models were conducted to assess the relationships.
  
  
  RESULTS
  Adolescents reported smoking WPS only (5.7%), cigarettes only (2.9%), and dual use (3.5%). Compared to adolescent with no exposure to parental tobacco use, adolescent exposure to parental dual use was associated with significant increase in WPS only (OR = 6.08, 95% CI = 2.38-15.51) and dual use (OR = 3.86, 95% CI = 1.43-10.43). Effect modification of the relationship by adolescents' sex was observed.
  
  
  CONCLUSIONS
  This is the first study to examine adolescent cigarette, waterpipe, and dual use with parental tobacco use. Study findings may help development of cessation interventions targeting parental tobacco use to prevent the rising waterpipe and dual use strain of the global tobacco epidemic.
  
  
  CONCLUSIONS
  (1) Influence of parents' cigarette smoking on adolescents' smoking has been demonstrated in earlier studies, however, little is known about how tobacco use behaviors of mother and father influences an adolescent's cigarette, waterpipe and dual cigarette/waterpipe use. (2) Associations of parental (both mother and father) tobacco use with adolescents' tobacco use differed significantly if the adolescent is a waterpipe smoker or dual user compared to an adolescent cigarette smoker. (3) Adolescents' exposed to their mothers' WPS or dual use were more likely to be a waterpipe smoker or dual user. High likelihood of adolescents' cigarette, waterpipe and dual use is found in homes where parental tobacco use is rampant with both parents smoking either cigarette, waterpipe or both.
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX; spveeran@utmb.edu.
authors.forename: Sreenivas P
authors.initials: SP
authors.lastname: Veeranki
authors.affiliation: Department of Community and Mental Health, Faculty of Nursing, Hashemite University, Zarqa, Jordan;
authors.forename: Sukaina
authors.initials: S
authors.lastname: Alzyoud
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX;
authors.forename: Leah
authors.initials: L
authors.lastname: Dierking
authors.affiliation: Deparment of Public Health, Jordan University of Science and Technology, Irbed, Jordan;
authors.forename: Khalid
authors.initials: K
authors.lastname: Kheriallah
authors.affiliation: Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN;
authors.forename: Fawaz
authors.initials: F
authors.lastname: Mzayek
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA;
authors.forename: Lori
authors.initials: L
authors.lastname: Pbert
authors.affiliation: Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN; Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D006801:Humans; D010290:Parents; D012907:Smoking / Q000453:epidemiology*; D062789:Tobacco Products