Parenting practices and tobacco use in middle school students in low- and middle-income countries.

BACKGROUND: Parenting practices have been shown to have a strong influence on adolescent tobacco use in high-income countries. This study examined whether parenting practices also were associated with tobacco use by middle school students (approximately ages 13-15) in low- and middle-income countries. METHODS: A secondary analysis was performed on data from 106,041 middle school students in 27 countries who participated in the Global School-Based Health Survey conducted between 2003 and 2007. RESULTS: In nearly all countries, boys and older students were significantly more likely to use tobacco than girls and younger students. In most countries, students who reported a high level of parental understanding or a high level of parental awareness of their children's activities were significantly less likely to use tobacco than other students. The children of parents who used tobacco were significantly more likely to use tobacco than children of non-users. After adjustment for age, sex, and parental tobacco use, the associations between parental understanding and awareness were statistically significant in 16 and 24 countries, respectively, of the 26 countries with parental tobacco use data. CONCLUSION: This multivariate analysis shows that positive parenting practices are significantly associated with decreased tobacco use among adolescents in low- and middle-income countries, which matches previous findings from high-income countries. Educating parents on the importance of their parenting practices may be an effective component of school-based programs aimed at reducing adolescent tobacco use.