Introduction
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Many factors influence why kids do and don’t use alcohol and tobacco. As parents, we can’t control all of them. However, there are many things we do that can make a major difference. These ideas and activities focus on tapping into—and building on—your family’s strengths in order to prevent alcohol and tobacco use in teenagers and young people. Keep Connected focuses on building relationships and strengths to prevent alcohol or tobacco use among young people. Abuse of and addiction to alcohol or tobacco are serious health and family issues that require professional support, intervention, and treatment.

Ideas for Starting Conversations about Alcohol or Tobacco Use
  • Look for openings. Don’t wait for your children to bring up the topic. Use advertisements, news stories, or personal incidents to raise the issue before it becomes a problem. If your daughter asks for permission to go to a party on Friday night, talk about the situations she might encounter and how she can deal with them. If your son mentions the rules his high school coach has set down for a team, discuss some of the health reasons for those rules.
  • State your own values clearly. Talk about how adults in your family are responsible about drinking and don’t drive or become overly intoxicated. Younger children may respond well to simple rules, such as “In this family we don’t smoke. I don’t want you to smoke.” As your child grows older, she may be more concerned with fitting in with peers. But she is still listening closely to what you have to say—even if it doesn’t feel that way at times.
  • Emphasize what matters to your child. You know your child better than anyone. That puts you in a great position to know which messages about not using tobacco may make the biggest impression.
  • Focus on short-term consequences. As adults, we know that tobacco can lead to life-threatening illnesses such as heart disease, emphysema, and lung cancer. But most kids don’t worry about long-term risks. They can’t imagine what it’s like to be older or to be sick. Make sure you also focus on the immediate consequences of smoking. Kids don’t like bad breath, smelly clothes, yellow teeth, or poor performance in sports, which can all be caused by using tobacco.
  • Run a reality check. Kids tend to overestimate the number of children their age and older who engage in all sorts of risky behaviors, including smoking, using drugs, and drinking alcohol. Make sure your child knows that the large majority of high school students don’t smoke.1
  • Talk about peer influence. Point out how friends influence your child. (It’s easier to say no to a stranger who asks you to drink alcohol instead of a friend.) Acknowledge some of the tough situations your child may face, and suggest positive ways of dealing with them. Remember, too, that positive peer pressure can help keep your child away from tobacco, alcohol, and other drugs. Talk about classmates and friends your child admires who don’t engage in these behaviors.
  • Point out the costs. Figure out together how much it would cost each year to smoke and how many hours it would take, at typical teen wages, to earn that. Then talk about what else your kids might do with that money.
  • Set the rules. Tell your child the consequences for using tobacco in your family. If you discover your child is using tobacco, make sure you follow through on the consequences you set.
If You Drink Alcohol

The choices we make as parents about alcohol use not only affect us, but also our kids. Here are some ways we can be positive role models for our kids regarding alcohol use.

  • If you choose to drink, do so responsibly. The National Institute on Alcohol Abuse and Alcoholism identifies two parts of responsible alcohol use2:
    1. Consistent low-risk drinking, which means …
      • For men: No more than 4 drinks in a day AND no more than 14 drinks total in a week.
      • For women: No more than 3 drinks in a day AND no more than 7 drinks total in a week.
    2. Not consuming any alcohol when you …
      • Plan to drive a vehicle or operate machinery;
      • Are taking medications that interact with alcohol;
      • Have a medical condition that can be made worse by drinking; or
      • Are pregnant or trying to become pregnant.
  • If you have trouble drinking responsibly or if you need help in changing your patterns of alcohol use, visit Rethinking Drinking, which provides a variety of resources to help you with different choices you can make.
  • Avoid making alcohol seem essential for relaxing or having a good time. Don’t laugh at or glorify the people who have had too much to drink, whether it is in your community, in the news, or on television.
  • Be prepared to answer when your kids ask why they can’t drink when you can. Keep your answer simple, such as “Alcohol isn’t good for growing bodies and minds.” Or: “Consuming alcohol well requires first developing adult skills and showing responsibility in many different areas of life.”
  • If you consumed alcohol as a teenager, be honest with your children if they ask about it. Tell them about the consequences you faced.
  • Always offer plenty of nonalcoholic drink options when you entertain in your home to show your kids that grown-ups don’t need alcohol to have fun together.
  • Set a good example for your children when attending parties. Just because it’s New Year’s Eve or the Fourth of July doesn’t mean you should drink excessively.
If You Use Tobacco

If you smoke or use other tobacco products, it is hard to model abstinence to your kids. Adding to the challenge, young people are more likely to use tobacco if a parent or other family member uses them.3

Quitting—the best option

Quitting use of tobacco products is the best health option for you and your family. The earlier you stop, the less likely your kids will start using. Smokefree.gov is a free resource to help people quit smoking that provides information, a telephone quitline, and other resources. If a child is already using tobacco, consider this: Youth are twice as likely to quit if a parent quits.4 Taking this step together can help both of you become tobacco free.

When you use: Some guidelines

  • Be direct and honest about your tobacco use. Explain why you don’t want your child to start smoking or using other tobacco products. Don’t be afraid to admit it if you wish you hadn’t started using.
  • Share your story with your child. Talk about why you started using tobacco. Did your friends smoke or use smokeless tobacco? Did your parents? Talk about your addiction to tobacco and the effect that it has had on your health.
  • If you’ve tried to quit, make sure your child knows how hard it is. This will reinforce that starting the use of tobacco is not worth it.
  • Don’t allow smoking by anyone inside your home, including yourself. Even a partial ban on smoking and other tobacco use at home relays negative attitudes toward tobacco. It may decrease the chances that your child will start using.5
  • Spell out the reasons why your child shouldn’t use tobacco. Keep in mind that teens are more likely to respond to the short-term effects, such as the cost.

Be alert to signs of use by your kids

Because teens are much more likely to use tobacco when a parent uses tobacco, be careful to reduce the chances that will happen.

  • Many teen tobacco users take cigarettes or other tobacco products from their parents. Make sure to keep your tobacco products where your children can’t easily get them
  • Often, young children who complained about their parents’ smoking or other tobacco use grow into teens who are silent on the matter. Just because your child says nothing about tobacco does not mean he or she will not try it. Be sure to keep talking: “I notice that you haven’t complained about my smoking lately. Why is that?”
  • As a smoker, you may be less attuned to the smell of smoke in your home. Watch for other warning signs, such as burn holes in your child’s clothes, excuses to go outside often, or lighters or matches in your child’s belongings. If your child avoids questions about these things, she may be trying to cover up tobacco use.
If the Problem Is Already Serious

Keep Connected focuses on building relationships and strengths to prevent alcohol or tobacco use among young people. Abuse of and addiction to alcohol or tobacco are serious health and family issues that require professional support, intervention, and treatment.

If your family is experiencing serious issues with alcohol or tobacco abuse or addiction:

  • Find resources in your own community that specialize in substance abuse treatment.
  • Get help from Rethinking Drinking or Smoke Free.
  • Contact the 24-hour National Helpline, 1-800-662-HELP (4357), is a confidential, free, information service, in English and Spanish, for individuals and family members facing mental health and/or substance use disorders.

If you are concerned that you or another family member may have a problem with alcohol abuse, consider taking this self-assessment from the National Council on Alcoholism and Drug Dependence. More Resources on Trouble with Alcohol

More Resources on Trouble with Tobacco

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Check It

Take a quick quiz to reflect on how you prevent alcohol and tobacco use in your family. Use the results to explore how you might tackle this sometimes-challenging topic together.

Parents Do you already have a Family Quiz Code? Click here. Click here to take the quiz and get a Family Quiz Code to share with your family (optional).
Youth* Click here if your family has a Family Quiz Code. Ask a parent to set up a Family Quiz Code.

* The quiz is designed for youth ages 10 to 18.

ABOUT THE QUIZ

What’s the quiz for? This quiz is for your own reflection and discussion as a family. It is not a formal assessment.

How does it work? The first adult who takes a quiz is assigned a random number, which we call your Family Quiz Code. They then share that code with everyone else in the family. Each person just enters this Family Quiz Code when they start a quiz, and all your results are automatically combined so you can talk about them together.

Why do you need a Family Quiz Code? This anonymous code lets you see the results from everyone in your family combined.

Who will see the results? No one else will ever know your responses, unless you share them. The Family Quiz Code cannot be used to find or identify you or your family.

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Talk About It

Getting Comfortable with a Tough Topic


Seven out of 10 parents of 10 to 15 year olds say they are “very comfortable” talking with their kids about alcohol, tobacco, and other drugs. However, only 38 percent of youth in the same families say they are “very comfortable” talking with their parents about these issues.1 Use these discussion starters to help you get a bit more comfortable. The keep the conversation going!

Discussion Starters for Parents and Youth Together

  1. What are some of your early memories of seeing others use alcohol or tobacco? What do you remember about those? How did you react at the time?
  2. Where have our family’s attitudes about alcohol and tobacco come from? Are those influences positive or negative, in your view?
  3. Think about your best friends. Do they use alcohol? Tobacco? When, where, and how much? In what ways does what your friends do influence what you do?
  4. If you could change one law related to alcohol or tobacco, what would you change? Why?

Discussion Starters for Other Parenting Adults*

  1. What are our biggest concerns regarding alcohol or tobacco use?
  2. What’s hardest in addressing youth alcohol or tobacco use in our community? What has worked?
  3. What are great resources in our community to help with keeping kids substance free? What groups or places in the community are problematic or make it harder?
  4. How have our own experiences growing up affected how we think about alcohol and tobacco use? If those attitudes are harmful, how do we begin to change the patterns for our own kids?
  5. Where do we agree and differ in our expectations for youth alcohol or tobacco use? How do we resolve those issues so that we have a consistent approach?

*These parenting adults may include your spouse or partner, extended family members, friends who are parents, or a parent group or class.

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Try It


Ideas for Parents: Preventing Youth Alcohol and Tobacco Use

Practice Having the Tough Conversations (3 Activities)

Bringing up alcohol and tobacco with our kids can be tough, particularly if they’re not comfortable talking about it. These activities offer some simple ways to bring up the topic.

Look Around for Messages 15min

Family members keep track for one day of the messages about alcohol and tobacco they encounter in everyday life.

  1. For one day, have all family members keep track of all the times they encounter alcohol and tobacco or messages about them. This could include at school, with friends, in the community, in the media. Everyone can jot them down or take photos of situations with cell phones.
  2. Then get together to compare notes and pictures. Who noticed the most examples? (He or she might deserve a prize!) Where were there the most? The fewest? Then discuss these questions:
    • What direct or indirect messages did you see in these different places? (For example, if you saw ads on billboards, in a magazine, on television, or on a website, how were the people and product portrayed?)
    • Were they realistic? Did they glorify substance use? Did they use scare tactics?
    • Which messages really made sense to you?
    • Where do we each learn the most about alcohol or tobacco use and its effects? How accurate or reliable are those sources? What might be other trustworthy sources? (For some ideas, see the other resources section.)
    • What, if anything, did you notice about the place of alcohol and tobacco in your community or society? What did your observations tell you about yourself and your family?

Media Scorecard 20min

Analyze the messages about alcohol and tobacco that family members encounter when they view different media sources. Media can play a big role in shaping our attitudes about alcohol and tobacco. Download and print this Media Message Analysis sheet. Give each person a copy, and decide which people are going to focus on which form of media. When everyone has finished viewing their media, come together and look at all the analysis sheets:

  • What patterns do you see? In which forms of media did you see the most and the least alcohol and tobacco? What kinds did you see?
  • Where were there more examples of alcohol being displayed in a positive versus negative light? What seems to be the difference?
  • In what ways do different media reflect reality or distort reality when it comes to alcohol and tobacco?
  • How were the messages you saw similar to and different from how you think about alcohol and tobacco in your family?

After the discussion, decide if you want to try it again with different media, on different days, or at different times of the day. Do those differences change what you see? Note: You can use these same questions to trigger more conversations in the future when something happens in the media.

Events with Alcohol and Tobacco: If…Then 25min

  1. Together as a family, create a list of some of the major events in the course of your year when family members (adults and youth) will have to make choices about alcohol or tobacco use. These could include parties, holiday celebrations, vacations, or just hanging out with friends who drink or use tobacco.
  2. Decide on two or three of these that can be particularly challenging. Write each of these down at the top of a sheet of paper. Then create a series of if-then statements about what you’ll do in those circumstances. For example:
    • If youth are invited to a party where there will be lots of drinking and smoking, then they will…
      • choose a different activity; or
      • make a pact with each other to stay substance free; or
      • _____________
    • If a parent is at an office party and has too much to drink, then he or she will…
      • Leave immediately; or
      • _____________
    • If you go to a party where a good friend urges you to try an e-cigarette to help you relax, then you will…
      • Politely say, “No thank you” or
      • _____________

The goal is to think through several scenarios that help young people both think about their values and priorities and learn how to be proactive in making good decisions. This can be a great activity to do together as your kids grow up and face new experiences.

The Power of Consistent Expectations (2 Activities)

Clear and consistent messages about the importance of not consuming alcohol or tobacco while a teenager play a major role in whether young people use. These activities give your family a way to talk about your expectations together.

Mythbusters 15min

A true-false quiz triggers conversations in your family about whether “everybody (really) does it.” Our expectations about underage alcohol and tobacco use are shaped by the beliefs and knowledge we have about these substances and their use. Too often, an “everyone’s doing it” belief can make youth think they need to drink alcohol or use tobacco if they want to fit in.

  1. Print out this Mythbusters Quiz (PDF) for each family member.
  2. Individually decide whether each statement is true or false.
  3. When everyone is done, download the Mythbusters Key. See who got which answers right.
  4. Talk about how these facts change or reinforce your expectations about use of alcohol or tobacco.

“Because I Said So” Isn’t Enough 20min

Use a simple tic-tac-toe game to talk about the reasons behind parents’ expectations about alcohol and tobacco use. As our kids grow up, most need to understand more of the “why” behind “what” parents expect. This tic-tac-toe game is a chance for your kids to ask you any questions they have about your family’s expectations about alcohol and tobacco use. By turning these serious questions into a game, it makes it less awkward for kids to ask. How to play:

  1. On three separate sheets of paper, parents write three different expectations or rules they have about alcohol and tobacco use. Write one expectation on each sheet of paper. These may include expectations about when, if ever, it’s okay for young people to consume, what you expect if kids are at parties with alcohol and tobacco, and what to do if kids get into trouble in some way related to substance use.
  2. Parents read their expectations aloud, then tape the sheets with their expectations to a wall side by side, with space underneath each of them.
  3. In private, kids work together to come up with questions they want to ask parents about each expectation—one question per sheet of paper. They’ll need a total of three questions per expectation, so there will be nine questions total. (If there’s just one child playing, he or she can come up with these alone.) Don’t show the parents! If they have trouble coming up with questions, here are some suggestions:
    • Why is this important to you?
    • Why did you pick this as a rule?
    • Did you follow this expectation when you were my age?
  4. Kids turn their questions upside down (so they’re hidden), then tape them underneath the parents’ expectations that are on the wall, forming a tic-tac-toe shape like this:
  5. If there are two parenting adults: Take turns picking one of the questions—with a goal of getting a tic-tac-toe—three in a row. Read the question aloud, then answer it. If the parent answers it, then he or she can claim that square. If the parent can’t or won’t answer it, the other parent gets a turn. Go back and forth until someone gets three in a row. Or just keep going until all the questions are answered.
    If there is one parenting adult: The parent picks a question and answers it. Then kids pick a question to “freeze” so that the parent doesn’t answer it—with a goal of blocking three in a row. When the parent gets three in a row or there’s a stalemate, you can then answer the blocked questions.
Role Models—Do as I Do? (3 Activities)

Some of our greatest influence on each other is how we live our lives and the choices we make. These three activities invite your family to reflect together about how family members model healthy (and unhealthy) choices.

What Would Our “Heroes” Do? 20min

Unpack the “messages” about alcohol and tobacco you get from people you admire.

  1. As a family, brainstorm a list of people or characters that different family members admire or pay attention to. These may be celebrities, athletes, national leaders, online personalities, TV, cartoon or video game characters, or others.
  2. Pick three or four to focus on for this activity, including some that generally have a more positive influence and some that have a more negative influence.
  3. Based on what you know or assume about these people or characters, imagine what they would do in the following situations…
    • If they were offered a beer when they were not yet 21.
    • If teenagers asked them for a cigarette.
    • If they had a chance to try an e-cigarette.
    • If they had been drinking and needed to get across town quickly.
    • If they had a child who asked to try alcohol or tobacco.
  4. After you’ve discussed all the people or characters, talk together about what we learn from these people.
    • How do they reinforce positive behaviors about alcohol and tobacco?
    • When do they encourage unhealthy behaviors about alcohol and/or tobacco?
    • How do we deal with liking celebrities who do things we don’t agree with?

    In the future, you can use these same kinds of questions to trigger conversations about new role models or celebrities who family members pay attention to.

What’s Consistent? What’s Not? 25min

Complete a simple worksheet to prompt conversations about messages that are or are not consistent with your values about alcohol or tobacco. Sometimes our actions don’t reflect what we say or what we believe. We may say (and truly believe) that we want to lose weight, but we still take an extra cookie—because they’re so good! The same thing can happen with alcohol and tobacco: What we say and what we do don’t always match up. This can undermine our credibility as role models for each other. This activity encourages you to reflect about the messages we give each other about alcohol and tobacco. By highlighting them together, we can be intentional about being more consistent.

  1. Download and print the Mixed Messages worksheet to complete together as a family. One page focuses on alcohol use; the other focuses on tobacco use. Pick the one that’s most relevant for your family—or do both.
  2. When you’ve completed the worksheet, pick one thing you’ll focus on being more consistent and intentional about in your family.

Who’s Watching Us? 20min

Map who’s paying attention to how your family members deal with alcohol and tobacco. Is what they see consistent with what you believe? We live in a time when there’s a lot of concern about who has access to our online data, which can track so many things about us. In this activity, your family will imagine together what others would see if they were tracking your family’s attitudes and actions regarding alcohol and tobacco use. What do they see?

    1. Give each family member a sheet of paper and something to write with. Draw a series of concentric circles (like a bullseye) on the paper. Have each person fill in the sheet like this:
  1. After everyone has completed their own diagram, focus on the circle of “people you are close to.” These close friends and family may not be able to track all your online data, but they do see a great deal about you. What they see can influence their own actions, since they care about you and you influence them.
  2. Do they see you modeling (either positively or negatively) when it comes to alcohol and/or tobacco use? What do you see others in our family do? Either just talk about it together, or write down key ideas in the circle.
  3. When everyone is done, move to the outer circle: other people you know. What do they see? How might it be influencing them?
  4. Finally, talk together about whether the ways you’re “modeling” attitudes and behaviors about alcohol and tobacco are consistent with your family’s beliefs and values:
    • If so, talk about how you’ll maintain this positive influence?
    • If not, talk about ways you want to adjust to be sure that your influence is consistent with your values?
Influencing Other Influencers (4 Activities)

What are the “hot spots” in your community that push people to use alcohol or tobacco? What are the resources that help people stay substance free? These activities will help you reflect on how peers, parents in the community, places, and policies either help or hurt efforts to keep kids from using alcohol or tobacco.

Peers: Positive or Negative Influences? 25min

Think about the ways our friends are positive and negative influences on us when it comes to alcohol and tobacco use. Friends play important roles in either encouraging or discouraging alcohol or tobacco use. This activity helps everyone in a family think through the ways their friends are positive or negative influences—and how to boost the positive influence. (This activity is designed for both parents and youth to do together to think about their own friends. Parents model how to think about friendships by how they reflect on their own friends.)

  1. Have family members each pick two or three friends who they will focus on. (Don’t use their names.) Find an object in your home that you’ll use to “represent” that friend. Use something simple (even scraps of paper with names on each) or something that captures their spirit (a ball for a friend who’s an athlete).
  2. Sit together at a table. Label one end of the table: “Just like my friend.” Label the other end of the table: “Not at all like my friend.”
  3. Read each of the following statements. After each statement, pause to have family members each place the objects representing their friends somewhere between the two ends based on what they know about that friend. After each statement, also talk about why you each placed your friend where you did. Here are the statements:This friend is someone who…
    • I really trust
    • Respects what I believe about alcohol and tobacco
    • Likes to push to the limits in taking risks
    • Has a lot of fun without relying on alcohol or tobacco
    • Challenges me to be my best
  4. When you’ve thought about all the friends based on these statements, reflect on what you learned through this activity. Discuss these questions:
    • In what ways do our friends encourage us to make positive choices about alcohol and/or tobacco?
    • In what ways do our friends push us to make negative or unhealthy choices about alcohol and/or tobacco?
    • What are good ways to respond to negative pressure from friends regarding alcohol and tobacco use? How can other family members help?
    • How can we thank those friends who are positive supporters and influencers?

    If negative peer pressure is a major issue for your family, consider developing an action plan that focuses on how you’ll work together to reduce negative influence and increase positive influence.

Other Parents: Getting on the Same Page 15min

Identify ways that families can reinforce each others’ efforts to prevent youth alcohol and tobacco use. Other parents and families in your community—particularly the parents of kids’ friends—can be important allies in preventing underage alcohol or tobacco use. Or they can be part of the problem. For example, young people who use alcohol are more likely to say they get it at someone else’s home (56 percent) than their own (29 percent).6 As a family, brainstorm a list of ways other parents and families either support or undermine efforts to prevent youth alcohol or tobacco use. These can be based on things either parents have seen or kids have experienced when they’re in other people’s homes. If you need some ideas, think about whether the following occur:

Helpful Not Helpful
  • Check signals with other families about expectations regarding alcohol and tobacco.
  • Ensure that at least one responsible adult is around when there’s a party in the home.
  • Have a specific plan to be proactive to keep kids safe if problems occur (such as giving them a ride home if they consume alcohol).
  • Reinforce or advocate school and community policies that prevent underage alcohol or tobacco use.
  • Easy access to alcohol or tobacco in their home (such as packs of cigarettes lying around).
  • Adults purchase or provide alcohol or tobacco for underage youth.
  • Host parties for youth where alcohol is served.
  • Modeling irresponsible use of alcohol or tobacco as an adult.7

After you’ve completed your list, talk about ways you can reinforce the helpful things that other families do. Consider talking with other families about these issues, potentially even completing a “family pact” for how you’ll support each other in efforts to prevent youth alcohol and tobacco use.

Places: Safe Zones, Danger Zones 30min

Map the places in your community that reinforce or undermine your family’s values regarding alcohol and tobacco use. The places we spend time can shape how we think about and use alcohol or tobacco. In some places, use is normal, even expected. In other places, it may be frowned upon or banned.

  1. Find or create a map of your community. (If you want and know how, you can use an online mapping service, such as Google Maps, for this activity.) If you don’t have a map handy, you can draw a rough map or diagram.
  2. Highlight all the places where family members spend time during a typical week. These may include:
    • Your home (or more than one, if family members live in two or more places)
    • School
    • Workplaces
    • Grocery store
    • Park or recreation area
    • Athletic facility or health club
    • Sports field
    • Place of worship
    • Library
    • Hangouts in your neighborhood
    • Coffee shops, bars, or restaurants
    • A shopping area or mall
    • After-school program
    • Community organization, such as a community center, Boys & Girls Club, YMCA, YWCA
    • Organizations where family members volunteer
    • Friends’ apartments or houses
  3. Now, next to the places you marked, add GREEN marks for safe zones—those where underage use is neither promoted nor accepted (and where no adult use or only responsible adult use is condoned). If family members disagree, discuss it and decide together.
  4. Add RED marks for danger zones—places where alcohol and tobacco use are normal, encouraged, and celebrated.
  5. When you’ve completed the map, talk about what you see:
    • Are there more “red” or “green” places? Does that fit your experience?
    • How can family members deal with the “red zones” (This could include avoiding them, visiting them with someone who reinforces your values, developing skills to resist the pressure, or working with others to influence the place so it’s a better place for young people.)
    • Who can be an ally or resource in helping us address these issues?

    If this is an important issue to your family, create a plan for how you can work together with other families and leaders to influence some part of your community so that it becomes a safer and more supportive place for young people.

Policies: What’s on—and What Should Be on—the Books?60min (plus some prep time)

Find policies on underage alcohol and tobacco use, then contact leaders to thank them for strong policies—or to encourage them to strengthen their policies. Clear, enforced, and consistent policies that regulate the marketing, sale, distribution, and use of alcohol and tobacco are key to preventing underage use8 in schools, organizations, cities, states, and across the nation. Knowing the policies allows you to reinforce them at home—or take action as citizens to strengthen policies. In this activity, your family learns about current regulations, then writes a letter to an appropriate leader or decision maker, thanking him or her for setting and enforcing strong policies—or encouraging her or him to strengthen either policy or enforcement.

  1. Assign family members each to investigate an area of policy regarding underage alcohol and tobacco use that interests them. This could include:
    • Your school or organization’s policies
    • Local businesses, retailers, and advertisers
    • Restaurants, entertainment, or sports facilities
    • City, state, or national policies.
  2. You can do a web search or call the organization or school. For information on federal or state policies, these sites may get you started:
  3. For each policy that seeks to prevent underage tobacco or alcohol use, try to identify the following elements:
    • Purpose—What it is trying to accomplish
    • Rules—What is or isn’t allowed under the policy
    • Consequences—What happens if rules are broken
    • Accountability—Who is held responsible (youth, parent, retailer, etc.)
  4. Once you’ve gathered information from places of interest to you, compare notes in the family. Which policies are most aligned with your perspective and values? Where do you see gaps? What surprised you?
  5. Identify one of the places you investigated that your family believes is either doing a really good job or has some major gaps to address. Together, draft a letter or email to a leader of the organization to express your perspective.
  6. In coming weeks, pay attention to the places you go to see whether and how they enforce policies, such as
    • Where people can (or cannot) smoke or use tobacco
    • Carding underage youth before selling alcohol or tobacco
    • Appealing to young people in advertising and marketing campaigns
Getting Back on Track (3 Activities)

If someone in your family has trouble with alcohol or tobacco, how do you tap your strengths to help you address the issues and get back on track? If the issue has become serious, your first task is to get appropriate help. Use these activities to tap your family’s relationships as resources in the midst of these challenges.

A Tough, But Important, Conversation60min (or more)

A conversation guide to help you talk with your child if you suspect alcohol or tobacco use. Do you have concerns as a parent about whether a young person is experimenting with or using alcohol or tobacco? (Review some warning signs.) If so, you may need to have a difficult conversation with your child. This may either lessen or confirm your worries. But it also sets the stage for taking next steps, if needed. This activity offers a conversation guide that can help you think through how you’ll bring up your concern, listen to your child’s perspective, and identify some next steps to follow up on what you’ve learned. However, because each situation is different, and because your child may react in many different ways, you’ll need to adapt it to fit. OPTION: If alcohol or tobacco use isn’t an issue for you now, you may still use this activity to practice tough conversations. Sometimes it is easier to talk about tough issues when they’re not as close to home. These may include situations in the news, with people you know, or with friends. Through these conversations, your family gets to practice dealing with differences of opinions and conflicts without all the emotional baggage that comes when you are dealing with a pressing, emotional issue.

  1. Find the right time and place to bring up the issue. Address the issue as early as possible, but not when you’re so upset or angry that you can’t have a good conversation. Here are some recommended do’s and don’ts:
    • DO give yourself time to cool down if you’re really upset or angry. If you can’t have a good conversation when the issue first comes up, acknowledge the issue and say something like: “I’m pretty upset by this right now. We’ll talk about this later.” (You can even give a specific time.) This way, your child knows you take the issue (and her or him) seriously.
    • DON’T use meal times or other regular family times for this conversation. If you use these other times to confront issues or resolve conflicts, family members won’t look forward to those times in the future.
    • DO find a time and place where you can talk without distractions, interruptions, or being rushed.
  2. State what you know clearly. Describe what signs you’ve seen: “I’ve noticed your jacket smells like smoke” or “When I was putting away laundry, I noticed an empty beer bottle in a drawer.” Then express your concern briefly: “I’m worried that you might be drinking or smoking.”
  3. Ask for your child’s perspective. You might say: “What’s going on?” or “What happened last night?” Your teen could respond in several ways. Some sample responses follow.
    Their Explanation How You Might Respond
    Admit using, and regret it. Thank your child for her or his honesty. Use the incident as an opportunity to help them learn from mistakes and make better decisions in the future. Reinforce your expectations about not using alcohol or tobacco as teens, and the reasons for those expectations. If your child is open to it, work together to come up with other ways to deal with the situation that led to the use. (Or you can save that for another time.)
    Admit using, but don’t see it as a big deal Thank your child for her or his honesty. Ask her or him to tell you more about why he or she uses, how often, how much, and how it started. This may open up strategies for prevent future use. It may also give you a better sense of whether you need to intervene. Challenge the “it’s no big deal” attitude. Express the reasons behind your concern. You probably won’t see an immediate change in attitude, but your message may still be getting through. In this case, your teen may be regularly using. Consider whether you need to get more help in intervening.
    Deny using, and have a believable explanation for your concerns Perhaps their explanation makes sense, is consistent with your past experience with them. Thank them for clarifying, but say that you will continue to keep tabs because it’s an important issue. If he or she was in a difficult situation, talk about how he or she might avoid or deal with similar situations in the future. Talk about what you might do in your family to avoid raising suspicions with each other.
    Deny using, but you don’t believe their explanation. Restate your evidence, but keep focused on the issue at hand. Don’t bring up a lot of other issues that will only escalate the situation and makes it harder to resolve. Focus on the use, not on what you think is a lie. Say something like: “Maybe you didn’t smoke. But I want to talk about tobacco anyway.” Reinforce your concerns, your expectations, and consequences. If the conflict becomes heated, take a break. Bring up the issue again, perhaps taking a different approach, if you think it might work better.
    Refuse to talk about it (shut down, storm out, etc.). Find another time to talk when you and he or she have both had a chance to calm down and get some perspective. Then bring it up again, potentially trying some different approaches.
  4. Unpack the motivations. Young people may be motivated to use alcohol or tobacco for many different reasons. For example, researchers have found that youth may drink alcohol for social reasons (to fit in with friends or to be sociable), for enjoyment reasons (like the taste, to get a buzz, or for excitement), or to escape or cope with negative experiences or feelings (self-medication).9 Understanding the motives for why he or she has used can help to focus on actions that best get at the underlying issue.
  5. Build a plan for moving forward together. Instead of dwelling on the past problems and who is to blame, focus on future planning, problem solving, and rebuilding the trust and affection that may have been undermined. The next activities focus on these areas.
  6. No matter what happens, offer an expression of love and commitment. In whatever way your family shows affection and expresses care, let your child know that your relationship with her or him is most important to you. Whether you say, “I love you,” give a hug, or leave a note of care on her or his bed, do something that reinforces your love and commitment.

Our Family, Only Better20min

Use this activity to think together about what your family would be like if you developed healthy habits to prevent youth alcohol and tobacco use.  Imagine your family after you’ve addressed the issue of underage alcohol or tobacco use. What would you hope your family be like once you’ve put in place expectations and good habits that help everyone make better choices?

  1. Give family members each a sheet of paper to complete the following sentences on their own. When our family becomes strong and resilient in preventing alcohol or tobacco use, we will
    • Pay more attention to…
    • Spend more time…
    • And less time…
    • We will __________ when someone makes a mistake.
    • Regularly tell each other…
    • Tell others that the best thing about our family is…
  2. Once people have each completed their own sentences, come together as a family and decide how you might combine your responses to have one shared answer for each statement.
  3. Then talk together about little things you can do in the next week to help you bring one of those ideas to life in your family now.

Refocus on Your Family’s Strengths and Relationship30min

Focus on rebuilding the relationships your family values, even as you work through challenges. Your family’s strengths and relationships are important resources for your family when you’re working through and recovering from challenges, such as dealing with a young person’s alcohol or tobacco use. Many aspects of your relationships are the foundation of family resilience, which is a family’s ability to survive, self-repair and grow stronger, even in the midst of major challenges and stress.10 When we’re in the midst of a challenging situation, we can neglect things that we really value about our family. This activity encourages you to be intentional in cultivating key strengths that you not only appreciate, but that can help you through hard times.

  1. Download a copy of the Developmental Relationships Framework and give a copy to each family member.
  2. Have each person pick two or three of these relationship strengths that they appreciate the most about your family, but that you might have paid less attention to lately. Think about examples of when that strength has really helped the family in the past.
  3. Ask each person to say what relationship strengths they picked, as well as their story of how that strength has helped the family in the past.
  4. After everyone has shared their examples, brainstorm what you might do in your family to focus on these strengths to help your family get back on track, even while you’re dealing with the challenges you’ve faced.
  5. Pick two or three things you will do together in the next week. Write them down, post them where everyone can see them, and revisit them in future conversations.
  6. For certain areas of family relationships (such as expressing care, sharing power), consider completing the quiz for that strategy, and then try the activities offered in each area.

Learn About It Icon

Learn About It

The Importance of Preventing Underage Use


Using alcohol and tobacco is unhealthy—and illegal—for young people. The younger kids begin using these substances, the more likely they are to become addicted and face other risks.1 Alcohol and tobacco are “gateways” to other unhealthy or illegal activities. These risks include early sex and use of illegal drugs.2 Families (along with others) can play important roles in preventing these high-risk behaviors.

Dangers of Underage Alcohol Use

The legal drinking age in the United States is 21. However, most adults (95 percent) who become dependent on or abuse alcohol begin drinking before that age.3

Young people who drink alcohol are more likely to experience the following risks:

  • Brain and other neurological impairment
  • Missed school and lower grades
  • Hangovers and other problems, including death from alcohol poisoning
  • Sexual intercourse, pregnancy, sexually transmitted diseases, or being involved in sexual assault
  • Greater suicide and homicide risk
  • Injuries or death from car crashes (driving drunk or riding with someone who is under the influence), burns, falls, and drowning
  • Abuse of tobacco or other drugs4

Many of these risks are more likely for youth who binge drink. Binge drinking is having five or more drinks in a row.

Dangers of Underage Tobacco Use

Smoking is the leading cause of premature, preventable death and disease in the United States.5

Short-term Effects

Some of the short-term effects of smoking include:

  • Addiction to nicotine and exposure to dangerous chemicals
  • More breathing problems
  • Shortness of breath, phlegm, and a coarse cough
  • Impaired lung growth and function
  • Bad breath, yellow teeth, and stained fingers
  • Foul-smelling clothes and hair6

Long-term Risks

Additional long-term risks of smoking include:

  • Addiction to nicotine and exposure to dangerous chemicals
  • Lung, mouth, throat, kidney, and stomach cancers
  • Heart disease
  • Impaired immune systems
  • Emphysema and other chronic diseases
  • Shorter lifespan (up to 20 years shorter)7

Other Risks from Smokeless Tobacco Use

Health risks of smokeless tobacco use include:

  • Oral cancer and gum recession
  • Gum disease
  • Tooth decay
  • Nicotine addiction
  • Increased likelihood of becoming a smoker.8
Beyond Cigarettes: Other Tobacco and Nicotine Products

Cigarettes are the most common form of tobacco used by teens. Teens use other forms of tobacco also, and e-cigarette use is growing among teens.

Teens sometimes think other forms of tobacco have lower health risks. Or they think they have a lower chance of becoming addicted. However, other tobacco products contain nicotine and other chemicals. They are not “safer” than smoking cigarettes.9

Most teens who use e-cigarettes and other tobacco products also smoke regular cigarettes.10

Electronic Cigarettes or E-Cigarettes

E-cigarettes are battery-powered devices that turn nicotine into a vapor to inhale. E-cigarettes may look like regular cigarettes but produce no smoke. They contain nicotine and other chemicals.

Other forms of tobacco use have declined among teens, but e-cigarette use is growing.11 E-cigarettes can easily be bought online and are mistakenly thought to be safe.

Smokeless Tobacco, Including Chewing Tobacco, Snuff, and Snus

Smokeless tobacco is placed in the user’s cheek or between the gum and cheek. Then the user spits out the product. Snus are small pouches of tobacco that are placed between the gum and lip but are usually not spit out.

Bidis (“bee-dees”) and Kreteks

Bidis are small, hand-rolled cigarettes. They may be flavored (such as chocolate, mango, or strawberry). Kreteks are also called clove cigarettes, because they include cloves (along with tobacco and other additives). These products contain more nicotine, tar, and carbon monoxide than regular U.S. cigarettes.

Cigars, Cigarillos, Little Cigars, and Blunts

Most cigars include tobacco that is cured to give it a different taste and smell. Regular cigars are larger than cigarettes. Little cigars or cigarillos look like cigarettes, but are filled with pipe tobacco. They may be flavored (chocolate, apple, etc.). Blunts are wide, stubby cigars. All of these products contain more nicotine than cigarettes.

Pipes

Pipes use loose tobacco in a bowl, which is inhaled through a mouthpiece.

Hookah or Water Pipe

Hookahs or water pipes are originally from India and the Middle East. They use tobacco and fruits or vegetables (called Shisha) that is heated and filtered through water.

Dissolvable Tobacco

Dissolvable tobacco is used on strips, sticks, orbs, or lozenges. They can look like a breath mint or candy. They contain nicotine and other chemicals.

For more information on different tobacco products, visit Be Tobacco Free.

How Much Do Teens Use Alcohol and Tobacco?

Current alcohol and tobacco use by U.S. high school students from a survey in 2017

Levels of Youth Alcohol and Tobacco Use

Below are the percentages of U.S. high school students (grades 9 to 12) who report any or current alcohol and tobacco use (as of 2013, the most recent figures available). Current use is defined as having used at least once in the past 30 days.

Overall Declines in Use

Overall levels of youth smoking and alcohol use have declined between 1991 and 2017.12,13 For example:

1991 2017
Ever had a drink of alcohol 82% 60%
Ever tried smoking cigarettes 70% 29%

E-Cigarette Use Is Increasing

Although smoking cigarettes has declined significantly among teens, use of e-cigarettes continues to rise. In 2016, 12 out of every 100 high school students reported using electronic cigarettes in the past 30 days. That’s an increase from 1.5% in 2011.14

Prevent Youth Alcohol Use

Risk and Protective Factors

Young people use alcohol for many reasons. Many factors come into play.15 Families cannot do much about some factors—like how laws are enforced, pricing, advertising, or community norms. Parent can, however, support good policies and laws.16 Families play big roles in reducing risks and enhancing protective factors. Protective factors are strengths that a family already has.

Risk Factors for Youth Alcohol Use 17

Young people are MORE likely to drink when …

  • Family members drink.
  • Parents think it is okay for teens to drink at home. Some parents mistakenly believe supervised drinking will help kids be responsible with alcohol.
  • Friends drink or use other drugs.
  • The youth is impulsive, likes to take risks, or has a high tolerance for alcohol.
  • The youth thinks alcohol has benefits, such as helping a person relax.
  • Family history includes alcoholism, violence, or depression.
  • The youth has been maltreated or neglected.
  • The young person’s mother drank while pregnant.
  • The youth smokes or uses other drugs.

Protective Factors for Youth Alcohol Use 18

Young people are LESS likely to drink when …

  • Parents disapprove of underage drinking, especially early use.
  • Friends are substance free.
  • Youth can manage their emotions and behaviors.
  • Youth focus on the bad results of drinking.
  • Youth have many developmental assets, or key strengths and supports in their lives.19
  • Parents show a balance of expressing care, providing support, and challenging growth.
  • The family is fairly free of conflict.
  • Youth does well in school and other activities.
Preventing Youth Tobacco Use

Risk and Protective Factors

Many factors affect kids’ use or abuse of tobacco.20 These include social and policy issues, such as how laws are enforced. Pricing, advertising, and community norms also play a part. Parents can’t do anything about these things, but they can support good policies and regulations. In addition, families play important roles. We can make a difference by reducing risks and enhancing key protective factors, or strengths.

Risk Factors for Youth Tobacco Use21

Young people are MORE likely to use tobacco products when …

  • Prices are low, tobacco is easy to get, and social norms encourage tobacco use.
  • Parents or other family members smoke or use other nicotine products.
  • There is a family history of tobacco use (genetics).
  • Their friends smoke.
  • Youth think “all” their friends use tobacco.
  • They use alcohol or other drugs.
  • Youth believe using tobacco has benefits (like relaxing) and is safe.

Protective Factors for Tobacco Use22

Young people are LESS likely to use tobacco products when …

  • They do well in school and are involved in other activities.
  • Parents disapprove of tobacco use.
  • Relationships with parents include a balance of expressing care, providing support, and challenging growth.
  • Friends are substance free.
  • Youth have internal self-control and strengths to resist peer pressure.
Other Reliable Information on Underage Alcohol and Tobacco Use

For Parents

For Youth

  • The Real Cost aims to reduce the number of teens who try smoking and become lifelong tobacco users.
  • Smokefree Teens helps teens understand the decisions they make—especially the decision to quit smoking.

General

Takeaways

  • Alcohol use by teenagers is dangerous.
  • All tobacco products are dangerous.
  • Overall teen use of alcohol and tobacco have declined in recent years. But not e-cigarettes.
  • There are many things families and others can do to prevent underage use of alcohol and tobacco.
Research Sources

Learn About It

  1. Office of Applied Studies (2004, updated 2008). The NSDUH Report: Alcohol dependence or abuse and age of first use. Rockville, MD: Substance Abuse and Mental Health Services Administration; and U.S. Department of Health and Human Services (2012). ). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  2. Office of Applied Studies (2004, updated 2008). The NSDUH Report: Alcohol dependence or abuse and age of first use. Rockville, MD: Substance Abuse and Mental Health Services Administration; and U.S. Department of Health and Human Services (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  3. Office of Applied Studies (2004, updated 2008). The NSDUH Report: Alcohol dependence or abuse and age of first use. Rockville, MD: Substance Abuse and Mental Health Services Administration; and U.S. Department of Health and Human Services (2012).
  4. Office of Juvenile Justice and Delinquency Prevention (2012, September). Effects and consequences of underage drinking. Juvenile Justice Bulletin (NCJ 237145), 1-11. Also see: U.S. Department of Health and Human Services (2014). Report to Congress on the prevention and reduction of underage drinking 2013. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
  5. U.S. Department of Health and Human Services (2014). The health consequences of smoking—50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  6. U.S. Department of Health and Human Services (2012).Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  7. U.S. Department of Health and Human Services (2014). The health consequences of smoking—50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  8. National Institute on Drug Abuse (2014). Electronic cigarettes (e-cigarettes). Drug Facts. Washington, DC: U. S. Department of Health and Human Services, National Institutes of Health.
  9. Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-cigarettes: A scientific review. Circulation, 129, 1972-1986. doi:10.1161/CIRCULATIONAHA.114.007667; Callahan-Lyon, P. (2014). Electronic cigarettes: Human health effects. Tobacco Control, 23, 36-40. doi:10.1136/tobaccocontrol-2013-051470; and World Health Organization (2007). Smokeless tobacco and some tobacco-specific N-Nitrosamines. International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans Vol. 89. Lyon, France: World Health Organization.
  10. National Institute on Drug Abuse (2014). Electronic cigarettes (e-cigarettes). Drug Facts. Washington, DC: U. S. Department of Health and Human Services, National Institutes of Health.
  11. National Institute on Drug Abuse (2014). Electronic cigarettes (e-cigarettes). Drug Facts. Washington, DC: U. S. Department of Health and Human Services, National Institutes of Health.
  12. Youth Risk Behavior Surveillance System (2013). Trends in the prevalence of alcohol use—National YRBS: 1991—2013. Atlanta, GA: Centers for Disease Control and Prevention; and Youth Risk Behavior Surveillance System (2013). Trends in the prevalence of tobacco use—National YRBS: 1991—2013. Atlanta, GA: Centers for Disease Control and Prevention.
  13. Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R., Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y, Leon, M., Brener, N. & Ethier, K. A. (2018). Youth risk behavior surveillance—United States, 2017. Morbidity and Mortality Weekly Report, 67(8), 1-114.
  14. Wang, T. W., Gentzke, A., Sharapova, S., Cullen, K. A., Ambrose, B. K. &, Jamal, A. (2018). Tobacco product use among middle and high school students — United States, 2011–2017. Morbidity and Mortality Weekly Report, 67(22), 629-633.
  15. Centers for Disease Control (2014, August 25). More than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013 (news release).
  16. U.S. Department of Health and Human Services (2014). Report to Congress on the prevention and reduction of underage drinking 2013. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
  17. Bonnie, R. J., & O’Connell, M. E. (Eds.). (2004). Reducing underage drinking: A collective responsibility. Washington, DC: National Academies Press.
  18. U.S. Department of Health and Human Services (2014). Report to Congress on the prevention and reduction of underage drinking 2013. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services; and Bonnie, R. J., & O’Connell, M. E. (Eds.). (2004). Reducing underage drinking: A collective responsibility. Washington, DC: National Academies Press.
  19. U.S. Department of Health and Human Services (2014). Report to Congress on the prevention and reduction of underage drinking 2013. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services; and Bonnie, R. J., & O’Connell, M. E. (Eds.). (2004). Reducing underage drinking: A collective responsibility. Washington, DC: National Academies Press.
  20. Benson, P. L., Roehlkepartain, E. C., & Sesma, A., Jr. (2004, March). Tapping the power of community: The potential of asset building to strengthen substance abuse prevention efforts. Search Institute Insights & Evidence 2(1), 1-14.
  21. U.S. Department of Health and Human Services (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  22. U.S. Department of Health and Human Services (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  23. U.S. Department of Health and Human Services (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

Talk About It

  1. Syvertsen, A. K., Roehlkepartain, E. C., & Scales, P. C. (2012). The American family assets study. Minneapolis, MN: Search Institute.

Try It

  1. U.S. Department of Health and Human Services (2014). Report to Congress on the prevention and reduction of underage drinking 2013. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services
  2. National Institute on Alcohol Abuse and Alcoholism (2010). Rethinking drinking: Alcohol and your health (NIH Pub. No. 13-3770). Washington, DC: National Institutes of Health, U. S. Department of Health and Human Services.
  3. Mays, D., Gilman, S. E., Rende, R., Luta, G., Tercyak, K. P., & Niaura, R. S. (2014). Parental smoking exposure and adolescent smoking trajectories. Pediatrics, 133(6), 983-991. doi:10.1542/peds.2013-3003
  4. Bricker, J. B., Otten, R., Liu, J., & Peterson, A. V. Jr. (2009). Parents who quit smoking and their adult children’s smoking cessation: A 20-year follow-up study, Addiction, 104(6), 1036–1042. doi:10.1111/j.1360-0443.2009.02547.x
  5. Muilenburg, J. L., Latham, T., Annang, L., Johnson, W. D., Burdell, A. C., West, S. J., & Clayton, D. L. (2009). The home smoking environment: Influence on behaviors and attitudes in a racially diverse adolescent population. Health Education and Behavior 36 (4): 777-793. doi:10.1177/1090198109339461.
  6. Office of Juvenile Justice and Delinquency Prevention (2012, September). Effects and consequences of underage drinking. Juvenile Justice Bulletin (NCJ 237145), 1-11. Also see: U.S. Department of Health and Human Services (2014). Report to Congress on the prevention and reduction of underage drinking 2013. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
  7. The National Institute on Alcohol Abuse and Alcoholism offers specific guidance for responsible alcohol use by adults. See: National Institute on Alcohol Abuse and Alcoholism (2010). Rethinking drinking: Alcohol and your health (NIH Pub. No. 13-3770). Washington, DC: National Institutes of Health, U. S. Department of Health and Human Services.
  8. U.S. Department of Health and Human Services (2014). Report to Congress on the prevention and reduction of underage drinking 2013. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services; and U.S. Department of Health and Human Services (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  9. Kuntsche, E., Ronald Knibbe, R., Gmel, G., & Engels, R. (2005). Why do young people drink? A review of drinking motives. Clinical Psychology Review, 25, 841–861. doi:10.1016/j.cpr.2005.06.002
  10. Walsh, F. (2004). The concept of family resilience: Crisis and challenge. Family Processes, 35(3), 261–281. doi:10.1111/j.1545-5300.1996.00261.x/full
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