The Association Between Parental Migration and Tobacco Use Among Adolescents in Western China: The Moderation Role of Tobacco Sales Near Schools and Mediation Role of Loneliness.

Background: Tobacco use among adolescents remains an important public health issue. This study investigated the association between parental migration and adolescents' tobacco use among adolescents in western China, including its mediating and moderating mechanism.

Method: This study was conducted in Qinghai Province, China, from April 1 to May 31, 2023. The participants were recruited via stratified random sampling. A total of 2811 adolescents were involved. Univariate logistic regressions were conducted to examine the associated factors of adolescents' tobacco use, including cigarette and electronic cigarette (e-cigarette) use. Pathway analysis was used to examine the moderation effect of tobacco sales exposure and mediation effect of loneliness in the relationship between parental migration and tobacco use.

Results: The study found that the proportion of adolescents who had ever used cigarette and e-cigarette in the sample were 19.5% and 12.2%, respectively. Among adolescents who were exposed to tobacco sales, parental migration was directly associated with cigarette use (standardized b = 0.18, 95%CI 0.04, 0.32) and e-cigarette use (standardized b = 0.24, 95%CI 0.09, 0.38). Meanwhile, loneliness served as a mediator in the association between parental migration and both the use of cigarette (standardized b = 0.014, 95%CI 0.01, 0.02) and e-cigarette (standardized b = 0.02, 95%CI 0.01, 0.03) among adolescents who were not exposed to tobacco sales.

Conclusion: The tobacco control strategies and surveillance should be strengthened in school neighborhood. Health education and interventions are warranted for adolescents, especially those with parental migration in underdeveloped areas in China.