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

Couch E.; Lieuw K.; Castillo C.; Halpern-Felsher B.; Chaffee B.; Hoeft K. · Journal of child & adolescent substance use · 2026

**Background & Methods** This qualitative study examined family influences on adolescent e-cigarette, tobacco, and cannabis use through semi-structured interviews with 47 California adolescents aged 13-17 who had ever used tobacco products. Interviews were conducted between May 2020 and December 2021, with thematic analysis techniques used to identify unifying themes related to family factors and substance use behaviors. **Key Findings** - Family members frequently played active roles in initiating or facilitating adolescent access to e-cigarettes and cannabis, either directly or indirectly through enabling behaviors and reduced supervision. - Adolescents perceived differential parental attitudes toward various nicotine/cannabis products, with many parents displaying more permissive attitudes toward e-cigarettes and cannabis compared to combustible tobacco, resulting in weaker boundaries and exceptions to established rules. - Fear of parental detection motivated adolescents to use more easily concealed products (small, odorless devices) and employ strategies to hide use from family members, suggesting parental awareness and monitoring remained influential deterrents despite permissive attitudes toward certain substances. - Parental punishment and exposure to family addiction demonstrated only partial deterrent effects on e-cigarette and cannabis use, indicating these negative consequences were insufficient to prevent adolescent substance use behaviors. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This qualitative study represents a lower level of evidence (Level IV) with significant limitations. The sample was limited to 47 California adolescents with prior tobacco exposure, restricting generalizability to broader adolescent populations or those without tobacco use history. The cross-sectional design precludes establishment of causal relationships between family factors and substance use. Selection bias is likely, as participants willing to discuss substance use may differ systematically from non-participants. The semi-structured interview approach is subject to recall bias and social desirability bias regarding family dynamics and substance use behaviors. No inter-rater reliability or validation procedures were reported for thematic analysis. While the study provides valuable qualitative insights into family influences on adolescent substance use, these findings require validation through larger, more representative samples and longitudinal designs to establish causal mechanisms and predictive relationships.

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