Master flea and tick prevention for dogs with expert-approved methods, product reviews, and natural alternatives. Protect your dog year-round with proven strategies that work.
Table of Contents
1.Understanding Fleas and Ticks
2.Health Risks and Disease Transmission
3.Seasonal Prevention Strategies
4.Top Prescription Prevention Products
5.Natural and Alternative Methods
6.Environmental Control Measures
8.Breed and Age Considerations
Introduction
Flea and tick prevention represents one of the most critical aspects of canine health management, with these parasites posing significant threats not only to your dog’s comfort and well-being but also to the health of your entire family. Modern veterinary medicine has developed highly effective prevention strategies that, when properly implemented, can provide year-round protection against these persistent and potentially dangerous parasites.
The landscape of flea and tick prevention has evolved dramatically over the past decade, with new products offering longer-lasting protection, broader spectrum coverage, and improved safety profiles. Understanding the various options available, their mechanisms of action, and appropriate application strategies enables pet owners to make informed decisions that provide optimal protection while minimizing risks and costs.
Climate change and increased travel with pets have expanded the geographic range and seasonal activity of many flea and tick species, making year-round prevention increasingly important even in regions that previously experienced seasonal respite from these parasites. The emergence of new tick-borne diseases and the increasing prevalence of existing conditions underscore the importance of comprehensive prevention strategies that address both immediate comfort and long-term health protection.
This comprehensive guide examines the latest developments in flea and tick prevention, provides detailed analysis of available products and methods, and offers expert guidance on developing effective prevention strategies tailored to individual dogs and their specific risk factors. Our recommendations are based on current veterinary research, real-world effectiveness data, and safety considerations that ensure optimal protection for dogs of all ages and health status.
Understanding Fleas and Ticks {#understanding-parasites}
Fleas and ticks represent two distinct groups of parasites that pose unique challenges for prevention and control, each with specific life cycles, behaviors, and environmental requirements that influence effective prevention strategies.
Fleas are wingless insects that complete their life cycle through four distinct stages: egg, larva, pupa, and adult. Understanding this life cycle is crucial for effective prevention, as adult fleas represent only about 5% of the total flea population at any given time, with the remaining 95% consisting of eggs, larvae, and pupae in the environment. This means that seeing adult fleas on your dog indicates a much larger population developing in your home and yard.
The flea life cycle can be completed in as little as 14 days under optimal conditions of warmth and humidity, but can extend to several months in cooler or drier conditions. Female fleas can lay up to 50 eggs per day, which fall off the host animal and develop in carpets, upholstery, cracks in flooring, and outdoor areas where pets spend time. This reproductive capacity means that small flea populations can quickly explode into major infestations without proper prevention.
Ticks are arachnids (related to spiders) that undergo three life stages: larva, nymph, and adult. Each stage requires a blood meal to progress to the next stage, and ticks can survive for months or even years between meals. This longevity and their ability to detect hosts from considerable distances make ticks particularly challenging to control through environmental management alone.
Different tick species have varying host preferences, activity patterns, and disease transmission capabilities. Hard ticks, which include most medically important species, attach firmly to hosts and feed for several days, while soft ticks typically feed for shorter periods. The duration of attachment is important for disease transmission, as many tick-borne pathogens require 24-48 hours of attachment before transmission occurs.
Seasonal activity patterns vary significantly between flea and tick species and are influenced by geographic location, climate conditions, and local environmental factors. Fleas are generally most active in warm, humid conditions and may be active year-round in heated indoor environments. Ticks show more variable seasonal patterns, with some species most active in spring and fall, while others peak during summer months.
Host-seeking behaviors differ between fleas and ticks, influencing prevention strategies. Fleas are excellent jumpers that can leap onto hosts from the environment, while ticks typically climb onto vegetation and wait for hosts to brush against them in a behavior called “questing.” Understanding these behaviors helps inform both prevention and environmental control strategies.
Geographic distribution of flea and tick species continues to expand due to climate change, increased travel, and wildlife movement patterns. Species that were once limited to specific regions are now found in new areas, making it important to understand local parasite populations and their associated disease risks.
Health Risks and Disease Transmission {#health-risks}
The health risks associated with flea and tick infestations extend far beyond simple irritation and discomfort, encompassing serious diseases that can affect both dogs and humans, making prevention a critical public health concern as well as a pet health issue.
Flea-borne diseases include several conditions that can significantly impact canine health. Flea allergy dermatitis represents the most common flea-related health problem, causing intense itching, skin inflammation, and secondary bacterial infections that can persist long after fleas are eliminated. Some dogs develop such severe allergic reactions that even a single flea bite can trigger widespread skin problems.
Bartonellosis, caused by Bartonella bacteria transmitted by fleas, can cause fever, lethargy, and various other symptoms in dogs. This condition can also affect humans, making flea control important for family health as well as pet health. The bacteria can persist in the bloodstream for months, causing chronic health problems if not properly treated.
Tapeworm infections commonly result from dogs ingesting fleas during grooming, as fleas serve as intermediate hosts for certain tapeworm species. While rarely life-threatening, tapeworm infections can cause digestive upset, weight loss, and nutritional deficiencies, particularly in young or debilitated dogs.
Tick-borne diseases represent some of the most serious health threats associated with external parasites, with new diseases continuing to emerge as tick populations expand and new pathogens are identified. Lyme disease, caused by Borrelia burgdorferi, can cause lameness, fever, kidney problems, and neurological symptoms in dogs. Early detection and treatment are crucial for preventing chronic complications.
Rocky Mountain spotted fever, transmitted by several tick species, causes fever, lethargy, and can progress to serious complications including bleeding disorders and organ failure if not treated promptly. This disease can also affect humans, making tick prevention important for family protection.
Ehrlichiosis and anaplasmosis are bacterial infections transmitted by ticks that can cause fever, lethargy, bleeding disorders, and immune system suppression. These diseases can become chronic if not properly treated and may require extended antibiotic therapy for resolution.
Babesiosis, caused by protozoan parasites transmitted by ticks, destroys red blood cells and can cause severe anemia, fever, and organ failure. Some forms of babesiosis are particularly severe and may require intensive treatment including blood transfusions.
Tick paralysis, caused by neurotoxins in tick saliva, can cause progressive paralysis that begins in the hind legs and progresses forward. This condition is typically reversible with tick removal but can be fatal if the tick is not found and removed promptly.
The concept of co-infections, where dogs are infected with multiple tick-borne pathogens simultaneously, is increasingly recognized as a significant health concern. Co-infections can cause more severe symptoms and may be more difficult to diagnose and treat than single infections.
Zoonotic transmission, where diseases can spread from dogs to humans, makes flea and tick prevention a family health issue. Many flea and tick-borne diseases can affect humans, either through direct transmission from infected pets or through exposure to the same parasites in the environment.
Geographic disease distribution varies significantly, with different regions having different risk profiles for various flea and tick-borne diseases. Understanding local disease risks helps inform prevention strategies and enables early recognition of symptoms that might indicate exposure to regional pathogens.
The economic impact of flea and tick-borne diseases includes not only treatment costs but also lost productivity, chronic health management expenses, and potential long-term complications that can affect quality of life for both pets and their families.
Seasonal Prevention Strategies {#seasonal-strategies}
Effective flea and tick prevention requires understanding seasonal activity patterns and adjusting prevention strategies accordingly to provide optimal protection while managing costs and minimizing unnecessary chemical exposure.
Spring prevention strategies should begin before parasite activity peaks, as many tick species become active when temperatures consistently reach 40-45°F (4-7°C). Early spring application of preventive products ensures protection is in place before exposure occurs. This timing is particularly important for tick prevention, as spring-active species like deer ticks can transmit Lyme disease and other serious conditions.
Summer intensification often requires enhanced prevention measures as both flea and tick activity typically peaks during warm months. Higher temperatures and humidity create optimal conditions for flea reproduction, while many tick species are most active during summer. Dogs spending more time outdoors during summer months face increased exposure risks that may require more frequent application of preventive products or combination approaches.
Fall continuation of prevention is crucial in many regions, as some tick species show peak activity during fall months when temperatures begin to cool. The misconception that parasite activity ends with the first frost can lead to gaps in protection during periods of continued risk. Many tick species remain active until sustained freezing temperatures occur.
Winter considerations vary significantly by geographic location and housing conditions. In warmer climates or heated indoor environments, flea populations may remain active year-round, requiring continued prevention. Even in colder climates, indoor flea populations can persist and develop, making year-round prevention increasingly recommended by veterinarians.
Geographic variations in seasonal patterns require understanding local parasite populations and their specific activity cycles. Consulting with local veterinarians and monitoring regional parasite surveillance data helps inform appropriate seasonal prevention strategies for specific areas.
Climate change impacts are altering traditional seasonal patterns, with many regions experiencing extended parasite seasons and year-round activity of species that previously showed distinct seasonal patterns. These changes make flexible prevention strategies and ongoing monitoring increasingly important.
Travel considerations require adjusting prevention strategies when dogs travel to areas with different parasite populations or seasonal patterns. Dogs traveling from low-risk to high-risk areas may need enhanced protection, while those traveling during typically low-risk seasons may encounter unexpected parasite activity.
Top Prescription Prevention Products {#prescription-products}
Prescription flea and tick prevention products represent the most effective and reliable options available, offering superior efficacy, longer duration of action, and comprehensive protection against multiple parasite species.
Oral Preventives
Bravecto (Fluralaner) Rating: 9.8/10
Bravecto provides 12 weeks of protection against fleas and ticks with a single oral dose, offering the longest duration of any currently available product. The active ingredient fluralaner is absorbed systemically and provides consistent protection throughout the dosing interval. Clinical studies demonstrate >95% efficacy against fleas and >90% efficacy against most tick species.
The extended dosing interval improves compliance and reduces the risk of gaps in protection that can occur with monthly products. The systemic action means that fleas and ticks must bite the dog to be exposed to the active ingredient, providing rapid kill times that interrupt disease transmission cycles.
Pros: Longest duration (12 weeks), excellent efficacy, improved compliance, broad spectrum Cons: Higher upfront cost, systemic exposure, not suitable for dogs under 6 months
NexGard (Afoxolaner) Rating: 9.5/10
NexGard provides monthly protection against fleas and ticks through a palatable chewable tablet that most dogs readily accept. The active ingredient afoxolaner provides rapid kill times for both fleas and ticks, with studies showing flea kill within 8 hours and tick kill within 48 hours of administration.
The monthly dosing schedule allows for flexible timing and easier integration into routine care schedules. The product has an excellent safety profile and is approved for use in puppies as young as 8 weeks of age.
Pros: Monthly dosing, excellent palatability, rapid kill times, safe for young puppies Cons: Monthly compliance required, higher cost than some alternatives
Simparica (Sarolaner) Rating: 9.3/10
Simparica offers monthly flea and tick protection with rapid kill times and excellent efficacy against a broad spectrum of parasites. The chewable formulation is highly palatable and provides consistent protection throughout the monthly dosing interval.
Clinical studies demonstrate superior speed of kill compared to some competing products, with flea kill within 3 hours and tick kill within 8 hours. The product also provides protection against sarcoptic mange mites.
Pros: Rapid kill times, broad spectrum protection, monthly dosing, excellent efficacy Cons: Monthly compliance required, premium pricing
Topical Preventives
Frontline Plus Rating: 8.5/10
Frontline Plus combines fipronil and methoprene to provide both adult flea and tick kill and flea reproduction control. The product is applied monthly to the skin between the shoulder blades and spreads through the skin’s oil layer to provide whole-body protection.
The addition of methoprene provides insect growth regulator activity that prevents flea eggs and larvae from developing, helping to break the flea life cycle. The product is waterproof after 24 hours and maintains efficacy even with regular bathing or swimming.
Pros: Proven efficacy, waterproof, includes growth regulator, widely available Cons: Monthly application required, potential for application site reactions, slower kill times than newer products
Advantage II Rating: 8.2/10
Advantage II focuses primarily on flea control, combining imidacloprid for adult flea kill with pyriproxyfen for flea development control. The product provides rapid flea kill within 12 hours and continues killing fleas for 30 days.
The formulation is particularly effective for flea control in multi-pet households, as it kills fleas before they can lay eggs, helping to reduce environmental flea populations. The product is available without prescription in many areas.
Pros: Rapid flea kill, effective in multi-pet households, available over-the-counter Cons: Limited tick efficacy, monthly application required, potential for skin reactions
Collar Products
Seresto Collar Rating: 9.0/10
Seresto collars provide 8 months of continuous flea and tick protection through slow release of imidacloprid and flumethrin. The collar design ensures consistent delivery of active ingredients while remaining comfortable for daily wear.
The extended duration reduces compliance issues and provides cost-effective protection over the collar’s lifespan. The collar is water-resistant and maintains efficacy even with regular exposure to water.
Pros: 8-month duration, water-resistant, cost-effective, continuous protection Cons: Collar must be worn continuously, potential for collar-related injuries, not suitable for all dogs
Combination Products
Simparica Trio Rating: 9.7/10
Simparica Trio combines flea and tick prevention with heartworm prevention in a single monthly chewable, providing comprehensive parasite protection. The combination of sarolaner, moxidectin, and pyrantel provides broad-spectrum protection against fleas, ticks, heartworms, and intestinal parasites.
The convenience of combination protection improves compliance and reduces the complexity of parasite prevention protocols. The product maintains the rapid kill times and excellent efficacy of Simparica while adding essential heartworm protection.
Pros: Comprehensive protection, monthly dosing, excellent efficacy, convenient combination Cons: Higher cost, monthly compliance required, not suitable for dogs with heartworm infections
Product Comparison Table
| Product | Duration | Fleas | Ticks | Additional Benefits | Age Minimum |
| Bravecto | 12 weeks | ✓✓✓ | ✓✓✓ | Long duration | 6 months |
| NexGard | 1 month | ✓✓✓ | ✓✓✓ | Rapid kill | 8 weeks |
| Simparica | 1 month | ✓✓✓ | ✓✓✓ | Mange mites | 6 months |
| Frontline Plus | 1 month | ✓✓ | ✓✓ | Growth regulator | 8 weeks |
| Seresto | 8 months | ✓✓ | ✓✓ | Long duration | 7 weeks |
| Simparica Trio | 1 month | ✓✓✓ | ✓✓✓ | Heartworm, intestinal | 8 weeks |
Veterinary Guidance
Prescription products require veterinary oversight that ensures appropriate product selection based on individual dog needs, local parasite populations, and potential drug interactions or contraindications. This professional guidance helps optimize protection while minimizing risks and costs.
Regular monitoring through veterinary checkups allows for assessment of product effectiveness and adjustment of prevention strategies based on changing risk factors or product performance. Veterinarians can also provide guidance on managing side effects or addressing breakthrough infestations.
Natural and Alternative Methods {#natural-methods}
While prescription products provide the most reliable protection, natural and alternative methods can serve as supplementary measures or options for dogs that cannot tolerate conventional products, though their efficacy is generally lower and more variable than prescription alternatives.
Essential oil-based repellents using oils such as cedarwood, eucalyptus, and lemongrass may provide some deterrent effect against fleas and ticks, but their efficacy is limited and duration of action is short. These products require frequent reapplication and should be used with caution, as some essential oils can be toxic to dogs in concentrated forms.
Diatomaceous earth (food grade) can help control flea populations in the environment by damaging the exoskeletons of adult fleas, but it has no effect on flea eggs, larvae, or pupae. The product must be applied regularly and can cause respiratory irritation if inhaled by pets or humans.
Beneficial nematodes represent a biological control method for flea larvae in outdoor environments. These microscopic worms consume flea larvae in soil and can help reduce environmental flea populations, but they require specific environmental conditions to survive and establish.
Regular grooming with fine-toothed flea combs can help detect and remove adult fleas before they establish large populations, but this method is labor-intensive and only addresses adult fleas already on the pet. Grooming should be combined with other prevention methods for optimal effectiveness.
Herbal repellents including garlic, brewer’s yeast, and various plant extracts are often promoted for flea and tick prevention, but scientific evidence for their effectiveness is limited. Some of these products, particularly garlic, can be toxic to dogs and should be avoided.
Environmental management through regular vacuuming, washing pet bedding in hot water, and maintaining low humidity levels can help control flea populations but requires consistent effort and may not be sufficient for heavy infestations or high-risk environments.
Predator encouragement by supporting populations of natural flea and tick predators such as spiders, ants, and certain birds can provide some environmental control, but this approach is not reliable as a primary prevention method.
Environmental Control Measures {#environmental-control}
Comprehensive flea and tick prevention requires addressing environmental sources of infestation, as these parasites spend significant portions of their life cycles in the environment rather than on host animals.
Indoor environmental control focuses primarily on flea management, as ticks rarely complete their life cycles indoors. Regular vacuuming of carpets, upholstery, and cracks in flooring removes flea eggs, larvae, and pupae while stimulating adult flea emergence from cocoons. Vacuum bags should be disposed of immediately or vacuum canisters emptied and cleaned to prevent flea development.
Washing pet bedding, toys, and removable fabric items in hot water (140°F or higher) kills all life stages of fleas and should be performed weekly during active infestations. Items that cannot be washed can be placed in the dryer on high heat for 30-40 minutes to achieve similar results.
Humidity control through dehumidifiers or air conditioning can help reduce flea reproduction, as flea eggs and larvae require humidity levels above 50% for optimal development. Maintaining indoor humidity below 50% can significantly slow flea population growth.
Professional pest control services may be necessary for severe indoor flea infestations that don’t respond to other control measures. Professional treatments can provide more comprehensive coverage and longer-lasting results than consumer products.
Outdoor environmental control presents greater challenges due to the larger areas involved and environmental factors beyond homeowner control. Focus should be on areas where pets spend the most time, such as yards, patios, and favorite resting spots.
Lawn maintenance including regular mowing, removal of debris, and elimination of standing water reduces habitat for both fleas and ticks. Tall grass and leaf litter provide ideal environments for tick development and should be minimized in areas where pets spend time.
Barrier treatments using appropriate pesticides can create protective zones around homes and in high-use areas. These treatments should be applied by professionals or according to label directions to ensure safety and effectiveness.
Wildlife management to reduce populations of animals that serve as hosts for fleas and ticks can help reduce environmental parasite loads. This may include securing garbage, removing food sources, and using exclusion methods to prevent wildlife access to pet areas.
Treatment vs. Prevention {#treatment-vs-prevention}
Understanding the distinction between treatment and prevention approaches is crucial for developing effective parasite management strategies that provide optimal protection while managing costs and minimizing chemical exposure.
Prevention strategies focus on stopping infestations before they become established, using products and methods that kill parasites before they can reproduce or transmit diseases. Prevention is generally more cost-effective and less stressful than treating established infestations.
Treatment approaches address existing infestations and typically require more intensive interventions, including environmental treatment, multiple product applications, and often professional pest control services. Treatment costs typically exceed prevention costs by 3-5 times when environmental control measures are included.
The prevention mindset emphasizes consistent, year-round protection that maintains parasite-free status rather than responding to problems after they develop. This approach provides better health protection and reduces the risk of disease transmission.
Early intervention at the first signs of parasite activity can prevent minor problems from becoming major infestations. Regular monitoring and prompt response to early warning signs can often prevent the need for intensive treatment protocols.
Integrated pest management combines multiple prevention and control strategies to provide comprehensive protection while minimizing reliance on any single approach. This strategy typically provides more robust and sustainable protection than single-method approaches.
Breed and Age Considerations {#breed-age-considerations}
Different dog breeds and age groups have varying susceptibility to flea and tick problems and may require modified prevention approaches based on their specific characteristics and risk factors.
Puppies under 8-12 weeks of age have limited options for flea and tick prevention due to safety concerns with many products. Gentle methods such as frequent bathing, flea combing, and environmental control may be necessary until puppies are old enough for conventional preventives.
Senior dogs may have compromised immune systems or underlying health conditions that affect their ability to tolerate parasite infestations or certain prevention products. Gentle, effective prevention becomes particularly important for maintaining health and comfort in older dogs.
Breeds with thick, double coats such as Golden Retrievers and German Shepherds may harbor larger flea and tick populations and may require more frequent grooming and monitoring. The dense coat can make parasite detection more difficult and may require specialized grooming tools.
Small breed dogs may be more susceptible to the effects of flea infestations due to their smaller blood volume and may require more aggressive prevention measures. Careful attention to product dosing is essential to ensure safety while providing adequate protection.
Outdoor working breeds and hunting dogs face higher exposure risks and may require enhanced prevention protocols, including more frequent product applications or combination approaches during high-risk activities.
Geographic Risk Factors {#geographic-factors}
Geographic location significantly influences flea and tick risk levels and determines which species are likely to be encountered, affecting prevention strategy selection and timing.
Regional disease patterns vary significantly across different geographic areas, with some regions having high risks for specific tick-borne diseases while others may have minimal risk. Understanding local disease prevalence helps inform prevention decisions and enables early recognition of symptoms.
Climate considerations affect parasite activity patterns and survival rates, with warmer, more humid climates generally supporting higher parasite populations and longer activity seasons. Cold, dry climates may have shorter parasite seasons but can still support significant populations during favorable periods.
Elevation effects can influence parasite populations, with higher elevations typically having lower parasite pressure due to temperature and humidity factors. However, climate change is expanding parasite ranges to higher elevations in many areas.
Urban versus rural environments present different risk profiles, with rural areas typically having higher tick populations due to wildlife hosts and natural habitats, while urban areas may have higher flea populations due to higher pet densities and favorable indoor environments.
Travel risks require consideration when dogs travel to areas with different parasite populations or disease risks. Dogs traveling from low-risk to high-risk areas may need enhanced protection, while those traveling internationally may face entirely different parasite species and diseases.
Emergency Response Plans {#emergency-response}
Having a plan for responding to parasite emergencies helps ensure prompt, appropriate action that minimizes health risks and prevents minor problems from becoming major infestations.
Immediate response protocols for discovering fleas or ticks on pets should include safe removal techniques, documentation of findings, and assessment of the need for veterinary consultation. Prompt action can often prevent establishment of infestations or disease transmission.
Veterinary consultation guidelines help determine when professional evaluation is necessary versus when home management may be appropriate. Factors such as the number of parasites found, the dog’s health status, and local disease risks influence these decisions.
Product failure protocols address situations where prevention products don’t provide expected protection, including assessment of application technique, product storage, and potential resistance issues. Consultation with veterinarians can help identify causes and alternative approaches.
Infestation management plans outline steps for addressing established flea or tick infestations, including environmental treatment, enhanced prevention measures, and monitoring for resolution. These plans help ensure comprehensive approaches that address all aspects of infestation control.
Frequently Asked Questions {#faq}
Q: How often should I check my dog for fleas and ticks? A: Daily checks are ideal, especially during peak season or after outdoor activities. Focus on areas where parasites commonly attach, including the head, neck, ears, and between toes.
Q: Can I use human insect repellent on my dog? A: No, human insect repellents often contain DEET or other ingredients that can be toxic to dogs. Only use products specifically designed and approved for canine use.
Q: How long does it take for flea prevention to work? A: Most modern flea preventives begin killing fleas within hours of application, but it may take several weeks to eliminate existing environmental populations. Consistent use is essential for optimal results.
Q: Are natural flea and tick preventives as effective as prescription products? A: Natural products generally provide lower and more variable efficacy compared to prescription preventives. They may serve as supplementary measures but shouldn’t be relied upon as primary protection in high-risk situations.
Q: Can indoor dogs get fleas and ticks? A: Yes, fleas can be brought indoors on clothing or other pets, while ticks can attach to dogs during brief outdoor excursions. Indoor dogs in flea-infested environments may need prevention.
Q: What should I do if I find a tick on my dog? A: Remove the tick promptly using fine-tipped tweezers, grasping close to the skin and pulling straight out. Clean the area and monitor for signs of illness. Save the tick for identification if symptoms develop.
Conclusion
Effective flea and tick prevention requires a comprehensive approach that combines appropriate product selection, consistent application, environmental management, and ongoing monitoring. The investment in quality prevention products and strategies pays dividends in terms of pet health, family safety, and overall quality of life.
The evolution of flea and tick prevention products has provided pet owners with highly effective options that offer superior protection with improved safety profiles. Understanding the various options available and their appropriate applications enables informed decision-making that provides optimal protection for individual dogs and their specific risk factors.
Climate change and expanding parasite ranges make year-round prevention increasingly important, even in regions that previously experienced seasonal respite from these parasites. Staying informed about local parasite populations and disease risks helps ensure that prevention strategies remain appropriate and effective.
The partnership between pet owners and veterinarians is essential for developing and maintaining effective prevention strategies. Regular consultation and monitoring help ensure that prevention approaches remain current and effective while addressing any changes in risk factors or product performance.
Remember that flea and tick prevention is an investment in your dog’s health and your family’s well-being. The diseases transmitted by these parasites can have serious long-term consequences that far exceed the cost of prevention. Consistent, appropriate prevention provides peace of mind and protection that enhances the quality of life for both pets and their families.
References
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