Beyond contextual smoking norms: The importance of family-level nicotine use risk factors among rural and nonrural youth living in Arkansas

Objective This study identified the associations between home-based nicotine use risk factors (sibling nicotine use; permissive home/car smoking rules; and parental approval of youth nicotine use) and nicotine use among Arkansas youth, a rural state overburdened by tobacco, after accounting for county-level adult smoking rates. Methods Data were from the 2021 Arkansas Prevention Needs Assessment, a state-wide, school-based survey ( N = 41,707) of 6th, 8th, 10th, and 12th graders. Youth self-reported on lifetime and past-month nicotine use and independent variables [home/car smoking rules, sibling nicotine use, parental approval of child nicotine use]. Models were executed on the full sample and stratified by rurality. Results In the full and nonrural models, higher county-level adult smoking rates were associated with youth nicotine use. In all models, after adjusting for county-level adult smoking, youth with permissive smoke-free home/car rules, perceived parental approval of child nicotine use, and sibling nicotine use were more likely to report lifetime and past-month nicotine use. Conclusions Addressing home-based nicotine use risk factors may reduce nicotine use among rural and nonrural youth, regardless of the prevalence of adult smoking in their communities. Multi-level interventions are needed to reduce youth exposure to smoking in their communities and home-based nicotine use risk factors.