Do as I say: parent smoking, antismoking socialization, and smoking onset among children

Household smoking restrictions and adolescent smoking

PURPOSE

To examine the association between household smoking restrictions and adolescent smoking, controlling for parental smoking, peer smoking, and tobacco marketing.

DESIGN

Cross-sectional analysis of 1999 data from the Growing Up Today Study, a longitudinal cohort of adolescents.

SETTING

Self-report questionnaire.

SUBJECTS

10,593 adolescents aged 12 to 18 years.

MEASURES

The dependent variable was established smoking (smoking > or = 100 cigarettes). Variables of interest were household smoking restrictions, parental smoking, peer smoking, and tobacco promotional item (TPI) possession.

RESULTS

Four percent of participants reported that their households permitted smoking. Parental smoking, peer smoking, and TPI possession were significantly associated with established smoking In logistic regression models adjusted for age, gender, peer smoking, and TPI possession, adolescent smoking was inversely related to the presence of a restrictive household policy (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48-0.93); however, when parental smoking was added to this model, the association was attenuated (OR = 0.94, CI = 0.65-1.35). When only one parent in the household smoked, smoking restrictions were more common when this parent was the father.

CONCLUSIONS

Although household smoking restrictions offer health benefits, they do not appear to be associated with adolescent smoking after accounting for other factors. Prior studies did not include parental smoking, peer smoking, and marketing influences. This analytic difference may explain apparent contradictions in the literature.

A qualitative study of how families decide to adopt household smoking restrictions

Household smoking bans reduce exposure to secondhand smoke in adult nonsmokers and children. To explore the process families go through in adopting voluntary household smoking restrictions, qualitative interviews were conducted with rural African American and White adults in 102 households. The study investigated how families decide to restrict smoking in the home, who has significant influence in the decision-making process, the kinds of disagreements families have about household smoking restrictions, and reasons some families never consider household smoking policies. These findings have implications for designing intervention strategies and messages to promote household smoking bans and help family members negotiate smoke-free homes.

Susceptibility to nicotine dependence: the Development and Assessment of Nicotine Dependence in Youth 2 study

OBJECTIVES

The purpose of this work was to identify characteristics that predict progression from the first inhalation of a cigarette to dependence. We studied a cohort of 1246 public school 6th-graders in 6 Massachusetts communities (mean age at baseline: 12.2 years).

METHODS

We conducted a 4-year prospective study using 11 interviews. We assessed 45 risk factors and measured diminished autonomy over tobacco with the Hooked on Nicotine Checklist and evaluated tobacco dependence according to the International Classification of Diseases, 10th Revision. Cox proportional-hazards models were used.

RESULTS

Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette and depressed mood. Tobacco dependence was predicted by feeling relaxed, familiarity with Joe Camel, novelty seeking, and depressed mood.

CONCLUSIONS

Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence or loss of autonomy. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or any of the other measured psychosocial factors. These results are discussed in relation to the theory that the process of dependence is initiated by the first dose of nicotine.

The role of smoking-cessation-specific parenting in adolescent smoking-specific cognitions and readiness to quit

BACKGROUND

An instrument assessing smoking-cessation-specific parenting was developed and tested in relation to a) the pros of smoking and quitting and self-efficacy to resist smoking, and b) adolescent readiness to quit.

METHODS

Cross-sectional survey data from 998 Dutch adolescents who smoked regularly were used to perform structural equation analyses.

RESULTS

Adolescents who perceived relatively few advantages of smoking and many benefits of quitting reported a high readiness to quit. Self-efficacy was not related to readiness to quit. Smoking-cessation-specific parenting was both directly related to a high readiness to quit, and indirectly through the perceived pros of quitting. Also, if one or both parents were smokers, adolescents reported experiencing less smoking-cessation-specific parenting and a lower readiness to quit. However, in general, differences in paths were not found between adolescents with two parents who did not smoke and adolescents with one or two parents who smoked.

CONCLUSIONS

Given that anti-smoking socialisation has not yet been operationalised in terms of smoking-cessation-specific parenting, the present results will warrant further research into smoking-cessation-specific parenting in relation to adolescent smoking cessation. Further, parental smoking should not discourage parents from engaging in smoking-cessation-specific parenting as its relations with smoking cognitions and readiness to quit were highly similar in both the group with two parents who did not smoke and the group with one or two parents who smoked.

Parental Smoking and Adolescent Smoking Stages: The Role of Parents’ Current and Former Smoking, and Family Structure

This study examined the role of parents' current and former smoking in predicting adolescent smoking acquisition stages. Participants were 7,426 students from 33 schools in the Netherlands. Participants' survey data were gathered at baseline and at two-year follow-up. Logistic regression models showed that parental smoking status was not only predictive of transitions from never smoking to trying smoking, monthly smoking, or daily smoking, but also of the progression from trying smoking to daily smoking. Further, although parental former smoking was weaker associated with progressive adolescent smoking transitions than current parental smoking, however absence of parental smoking history was most preventive. Compared to the situation in which both parents had never smoked, cessation of parental smoking after the child was born was associated with an increased risk for children to smoke. Adolescents living in a single-parent family were at greater risk of smoking than adolescents living in an intact family with both mother and father. In sum, the role of parental smoking is not restricted to smoking onset and is present throughout different phases of the acquisition process. Results support the delayed modeling hypothesis that parental smoking affects the likelihood for children to smoke even when parents quit many years before. Children living in single-parent families are only exposed to the behaviour of one parent; in two-parent families the behaviour from one parent may magnify or buffer the behaviour of the other parent.

Correlates of home smoking restrictions among rural smokers

The prevalence of smoking is greater and smoking restrictions are less common in rural areas in comparison to urban areas. Consequently, rural smokers and their families are at increased risk for adverse health consequences from smoking. The presence of home smoking restrictions (i.e., limiting or banning cigarette smoking in the home) can be a mediator for smoking cessation and can reduce health risks for those who live with smokers. The purpose of the present study was to identify correlates of home smoking restrictions among rural smokers. We surveyed 472 smokers from 40 rural Kansas primary care practices who were enrolled in a smoking cessation intervention study. We assessed the prevalence of home smoking restrictions and examined the relationship between such restrictions, demographic variables, comorbid diagnoses, and psychosocial measures of smoking abstinence self-efficacy and motivation to quit. Complete home smoking restrictions were found among 25.4% of rural smokers with an additional 28.3% reporting some restrictions. Restrictions were associated with younger age, higher controlled motivation to quit (i.e., motivation from external pressure), the presence of children under age 6 years living in the home, fewer friends who smoke, and a partner who does not smoke. Smokers with a comorbid diagnosis of high cholesterol, chronic lung disease, or heart disease were less likely to have restrictions. Most smokers in rural primary care practices do not have home smoking restrictions, particularly those without children or a nonsmoking partner and those with significant risk factors for smoking-related illnesses. These patients may be critical targets for broaching issues of home smoking restrictions.

Cigarette smoking among Greek adolescents: behavior, attitudes, risk, and preventive factors

This study was produced in the context of the first author's thesis at Athens University and was a collaboration between the Department of Clinical Care Medicine, Athens University, and Attiki Child Psychiatric Hospital. It was supported by a project grant from the THORAX Foundation, Greece.

OBJECTIVE

To study the smoking behavior, attitudes, and beliefs of Greek adolescents, as well as the risk and preventive factors for the onset of smoking and to obtain data to serve in the planning of comprehensive antismoking campaigns tailored to the Greek adolescent's specific profile.

SAMPLE AND METHOD

A stratified, nationwide, representative, school-based sample of 3827 Greek adolescents was surveyed during the academic year 2001-2002, using a questionnaire on smoking and Achenbach's Youth Self-Report.

RESULTS

Cigarette smoking is a serious problem among Greek youth. Family and peers play a primary role in shaping smoking attitudes and habits. Adolescents who smoke regularly have increased rates of psychopathology as indicated by higher scores on the Externalising and Attention Problem scales of Achenbach's Youth Self-Report, compared to adolescents who are non-smokers. The data obtained can indeed guide smoking prevention strategies in Greece.

Using classification trees to profile adolescent smoking behaviors

The purpose of this study was to explore the interactive nature of various predictor variables in profiling adolescent smoking behaviors characterized by intention to smoke, current, situational, and established smoking using classification trees. The data (n = 3610) were obtained from cross-sectional telephone surveys of the Florida Anti-Tobacco Media Evaluation Program. Three classification trees were constructed, namely, intention versus no intention to smoke among non-smokers, current smokers versus non-smokers, and established versus situational smokers. The tree model for the intention model revealed that social and health risks are important in the context of peer smoking. Certain variables such as peer smoking and alcohol consumption retained their relative importance across the tree classifiers demonstrating that smoking intention may be predictable using some of the same variables as in current or more dependent smoking.

The joint influence of parental modeling and positive parental concern on cigarette smoking in middle and high school students

The purpose of the study was to examine the interaction between parental smoking status and parental attitudes, as measured by positive parental concern, on the risk of adolescent cigarette smoking. Parental smoking and parental concern about smoking were measured in a cross-sectional study of 37,244 students, a random sample of Maryland middle and high school students, who were current or never smokers. Parental concern was classified into 3 levels: strict, moderate, and minimal. The likelihood of youths being current smokers was positively associated with both parental smoking (both versus neither parent smokes: odds ratio [OR] 3.4, 95% confidence interval [CI] 3.1-3.7) and parental concern about smoking (minimal versus strict concern: OR 2.3, 95% CI 2.1-2.4). Youths with parents who did not smoke and with strict concern had the lowest likelihood of smoking. In comparison to this group, after adjustment for other social influences the likelihood of being a current smoker was more than 5 times greater among boys (OR 5.8, 95% CI 4.5-7.4) and girls (OR 5.2, 95% CI 4.1-6.5) whose parents both smoked and were minimally concerned about smoking. Current smoking in youths was independently associated with both parental smoking and less parental concern. When these 2 factors were jointly considered, the prevalence of current smoking in youths increased both with exposure to parental modeling and reduced parental concern about smoking. The results indicate that minimal parental concern about smoking worsens the risk due to parental modeling. Parental modeling and parental attitudes act synergistically to exacerbate the likelihood of smoking.

Correspondence between proxy and self-reports on smoking in a full family study

OBJECTIVES

The present study investigated the reliability of proxy reports obtained from family members with self-reports on adolescent and parental lifetime and current smoking status.

METHODS

Data were assessed from 416 families, consisting of both biological parents and two adolescent siblings aged 13-17 years. These families were assessed at baseline and 1 year later. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to test whether proxy reports corresponded with self-reports.

RESULTS

Mothers scored higher than fathers on most measures on lifetime and current smoking status of both children. The sensitivity was low for parental reports, but moderate to high for children's reports. Specificity and positive predictive value were high in all proxy reports. The negative predictive value was moderate (parents as proxy reporters) to low (children as proxy reporters) on lifetime smoking, but high on current smoking.

CONCLUSIONS

Adolescents, aged 13-17 years, can be used as a reliable source to assess the smoking status of their mothers and fathers. Parents, however, appeared to accurately identify the smoking status of their adolescent children less reliably.

Challenges to the peer influence paradigm: results for 12-13 year olds from six European countries from the European Smoking Prevention Framework Approach study

OBJECTIVE

To examine whether smoking onset in young adolescents is predicted by peer or parental smoking.

DESIGN

Longitudinal design with one pretest and one follow-up at 12 months.

SETTING

Schools in Finland, Denmark, the Netherlands, the United Kingdom, Spain and Portugal.

PARTICIPANTS

7102 randomly selected adolescents from six countries. Mean age was 12.78 years.

MAIN OUTCOME MEASURES

Smoking behaviour of adolescents, peers and parents.

RESULTS

No support was found for peer smoking as an important predictor of smoking onset in most countries. Support was found for the selection paradigm, implying that adolescents choose friends with similar smoking behaviour. Support for the impact of parents on adolescent behaviour and the choice of friends was also found.

CONCLUSIONS

Smoking uptake in this age cohort may be more strongly influenced by personal and parental influences than initially believed. Hence, social inoculation programmes teaching youngsters to resist the pressures to smoke may be less appropriate if youngsters have a positive attitude towards smoking, associate smoking with various advantages and look for peers with similar values. For this group attitudes towards smoking may thus guide future friend selection.

Personal, interpersonal, and cultural predictors of stages of cigarette smoking among adolescents in Johannesburg, South Africa

OBJECTIVE

This study examined the personal, parental, peer, and cultural predictors of stage of smoking among South African urban adolescents.

DESIGN

A cross-sectional design was employed. A stratified random approach based on census data was used to obtain the sample. Analyses were conducted using logistic regression.

SETTING

The study took place in communities in and around Johannesburg, South Africa.

SUBJECTS

Participants consisted of 731 adolescents in the age range of 12-17 years old. The sample was 47% male and 53% female, and contained four ethnic classifications: white, black, Indian, and "coloured" (a South African term for mixed ancestry).

METHODS

A structured, in-person interview was administered to each participant in private by a trained interviewer, after obtaining consent.

MAIN OUTCOME MEASURES

The dependent variables consisted of three stages of smoking: non-smoking, experimental smoking, and regular smoking. The independent measures were drawn from four domains: personal attributes, parental, peer, and cultural influences.

RESULTS

Factors in all four domains significantly predicted three different stages of smoking. Personal attributes (internalising and externalising) distinguished among the three stages. Parental factors (for example, affection) reduced the odds of being a regular smoker compared with an experimental smoker or non-smoker, but did not differentiate experimental smokers from non-smokers. Findings from the peer domain (for example, peer substance use) predicted an increase in the risk of being a regular smoker compared with an experimental smoker or non-smoker. In the cultural domain, ethnic identification predicted a decrease in the risk of being a regular smoker compared with an experimental smoker, whereas discrimination and victimisation predicted an increase in the risk of being an experimental smoker compared with a non-smoker.

CONCLUSIONS

All the domains were important for all four ethnic groups. Four psychosocial domains are important in distinguishing among the three stages of smoking studied. Some predictors differentiated all stages of smoking, others between some of the stages of smoking. Therefore, intervention and prevention programmes which are culturally and linguistically sensitive and appropriate should consider the individual's stage of smoking.

The association between adolescent smokers' desire and intentions to quit smoking and their views of parents' attitudes and opinions about smoking

OBJECTIVE

To explore whether an association exists between adolescent smokers' attitudes toward quitting and their beliefs about whether their parents know they smoke, their perceptions of whether their parents disapprove of smoking, their recollection of their parents' expressed disapproval of smoking, and the importance they place on their parents' opinions.

METHODS

This cross sectional study of US high school students included 17,287 respondents. Only those who had smoked in the past 30 days (4593 [26.6%]) were included in the analysis. "Have you ever seriously thought about quitting smoking?" was asked of all adolescent smokers. Those who had seriously thought about quitting were then asked about past attempts and how recent their last attempt was, while those who had not seriously thought about quitting were asked if they thought they would ever want to quit.

RESULTS

Regardless of whether their parents smoked, adolescents who placed value on their parents' opinions were more likely to think seriously about quitting and to have tried to quit in the past 6 months. Recalling parents' expressed desire that their child not smoke was associated with significant increases in the likelihood of seriously thinking about quitting even among those whose parents smoked. Agreeing with the statement, "When I'm older, my parents won't mind that I smoke" was significantly associated with decreased odds of seriously thinking about quitting and recently attempting to quit.

CONCLUSIONS

Parents, both those who smoke and those who do not, may have a significant role in influencing young smokers' desire to quit smoking.

Understanding the Association Between Authoritative Parenting and Adolescent Smoking

BACKGROUND

Research on adolescent cigarette smoking has attempted to measure the role of parents in preventing smoking experimentation and uptake. However, aspects of parental influence have often been limited to parental smoking behavior or antismoking socialization. Only a limited number of studies considered the hypothesis that the influence of parenting on adolescent current cigarette smoking may extend beyond parental behavior and antismoking socialization to consider broader measures of the parent-child relationship, such as parenting style.

METHODS

The sample was nationally representative and included 17,287 high school students nationwide. Data were used to categorize the parenting style--authoritative, permissive, autocratic, and unengaged--experienced by each respondent. Logistic regression analysis was used to assess the association between parenting style and adolescent current cigarette smoking.

RESULTS

Authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking (OR: 0.74, 99% CI: 0.58, 0.95). When authoritative parenting is simultaneously considered with believing parents' opinions about smoking are important, authoritative parenting was no longer a significant correlate of adolescent current cigarette smoking, while believing parents' opinions about smoking are important was associated with a 45% (99% CI: 0.48, 0.64) reduction in the odds of adolescent current cigarette smoking. Authoritative parenting was associated with a more than three-fold increase (OR: 3.65, 99% CI: 2.87, 4.66) in the odds of believing parents' opinions about smoking are important.

DISCUSSION

Interventions may want to educate parents about authoritative parenting, which includes the importance of having appropriate and routine conversations with their children, requiring chores, and implementing general rules and boundaries.

Association between personality and adolescent smoking

The present study examined the association between adolescents' personality traits and smoking, and tested whether this association was moderated by birth order or gender. Participants were 832 Dutch siblings aged 13 to 17 years participating at baseline assessment (T1) and at follow-up 12 months later (T2). Personality was assessed by applying a variable-centered approach including five personality dimensions (Extraversion, Agreeableness, Conscientiousness, Emotional Stability and Openness to Experience), and a person-oriented approach using three personality types (i.e., Resilients, Overcontrollers and Undercontrollers). Cross-sectional findings indicated that Extraversion (at T1 and T2), Agreeableness (at T2), Conscientiousness (at T2), and Emotional Stability (at T2) were related to adolescent smoking. Longitudinal findings indicated that only Extraversion and Emotional Stability were related to onset of adolescent smoking. Using a person-oriented approach, Overcontrollers and Undercontrollers did not differ from Resilients on smoking onset. No indication was found for a moderating effect of birth order on the association between personality and smoking. Additional findings showed that gender moderated the effect of Agreeableness on adolescents' smoking onset. Implications for prevention are also addressed.

Are anti-smoking parenting practices related to adolescent smoking cognitions and behavior?

The aim of this study was to explain the effects of anti-smoking parenting practices on adolescent smoking cognitions and behavior by showing the mediating effects of cognitions. Data were gathered among Dutch high school students in the control condition of the European Smoking prevention Framework Approach (ESFA). Anti-smoking parenting practices were measured by parental reactions to smoking, house rules, and frequency and content of communication about smoking. Attitudes, perceived social influences and self-efficacy made up for smoking cognitions. Additionally, intention to smoke was measured. Relations between practices and cognitions were mostly significant. While some practices were associated with less smoking (communication about health risks of smoking, health risks of breathing in smoke, addictive qualities of smoking and attention for smoking in school), others were related to increased chances of smoking (rewards for not smoking, frequency of communication about smoking, communication about being allowed to smoke, price of cigarettes and friends smoking). The effects of parenting hardly varied by parental smoking status or adolescent gender. Several practices operated through cognitions, which was more pronounced in older adolescents. Counter-productive effects of practices and the few effects in the longitudinal analyses indicate that the order in which parents and adolescents influence each other should be examined more closely.

Parental anti-smoking socialization. associations between parental anti-smoking socialization practices and early adolescent smoking initiation

This longitudinal study of 600 families concentrates on the influence of parental anti-smoking socialization by examining both (a) the effects of eight indicators of anti-smoking socialization on adolescent smoking and (b) the influence of parental smoking on the effectiveness of their anti-smoking socialization. Robust differences between smoking and non-smoking parents demonstrated that both kinds of families hold different norms and attitudes about adolescent smoking and how to deal with it. In terms of effective anti-smoking socialization, it appeared that parental involvement on a more abstract level, such as feeling confident one has influence on the smoking behaviour of one's child and having knowledge whether one's child and his or her friends smoke, seemed important in preventing early adolescent smoking, while concrete communication or house rules about smoking were not.

Smoking Initiation Prevention Among Youths: Implications for Community Health Nursing Practice

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions.

The effect of immigrant generation on smoking

Immigrants to the US are not only an increasingly significant demographic group but overall they also have lower socioeconomic status (SES) than the native-born. It is known that tobacco use is a major health risk for groups that have low SES. However, there is some evidence that tobacco use among certain immigrant groups is lower than among the respective native-born ethnic group, and that immigrant assimilation is positively related to tobacco use. We investigated the relationship between immigrant generation and daily smoking, using the Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 1995-96, a national data set representative of the US general and immigrant populations. Our multivariate logistic regression analysis of the relationship between immigrant generation and daily smoker status (n = 221,798) showed that after controlling for age, gender, race/ethnicity, SES variables (i.e. equivalized household income, education, occupation), and central-city residence, the odds of being a daily smoker were highest among US-born individuals of US-born parents (reference group) and lowest among foreign-born individuals (95% CI: 0.54-0.62). Being a second-generation immigrant (i.e. US born) with two immigrant parents also conferred a protective effective from smoking (95% CI: 0.64-0.77). However, having only one foreign-born parent was not protective against smoking. Testing for interaction effects, we also found that being foreign born and being second generation with two immigrant parents were especially protective against smoking among females (vis-à-vis males); racial/ethnic minorities (vis-à-vis whites); and low-income individuals (vis-à-vis high-income individuals). We discuss possible mechanisms that may explain the protective effect against smoking of being foreign born and being second generation with two immigrant parents, including differences in the stage of the tobacco epidemic between immigrants' countries of origin and the US, the "healthy immigrant effect", and anti-smoking socialization in immigrant families.

Household smoking bans and adolescents' perceived prevalence of smoking and social acceptability of smoking

OBJECTIVES

Household smoking bans might decrease the visibility of cigarette smoking and communicate nonsmoking social norms and parental attitudes to youths, which may serve as mediators to reduce smoking initiation. Whether they have these effects even if parents smoke or do not otherwise communicate strong disapproval of smoking to their children is not clear. We tested these hypotheses in multi-level analyses.

METHODS

A telephone survey of a random sample of 3831 Massachusetts adolescents (12-17 years) assessed respondents' perceptions of smoking prevalence and attitudes about the social acceptability of smoking in their community. The association of these outcomes with the presence of a smoking ban in the youths' home was tested in multivariate analyses that adjusted for town-level clustering and individual and environmental characteristics.

RESULTS

A household smoking ban was reported by 71% of all youths and 49% of youths who lived with smokers. In multivariate models, youths who had a household smoking ban were more likely to perceive a lower adult smoking prevalence (OR 2.1; 95% CI 1.7-2.5; P < 0.001), greater adult disapproval of adult smoking (OR 2.0; 1.5-2.6; P < 0.001) and of teen smoking (OR 1.5; 95% CI 1.2-1.9; P = 0.001).

CONCLUSIONS

Among adolescents, a household smoking ban was associated with a lower perceived prevalence of adult smoking in their communities and more negative attitudes about the social acceptability of smoking, two factors that affect the likelihood of smoking initiation. Household smoking bans had these effects even in the presence of two parental factors known to encourage adolescent smoking initiation (parental smoking and lack of perceived parental disapproval of youth tobacco use). This provides an additional rationale for promoting household smoking bans to parents.

Parental smoking cessation and children's smoking: Mediation by antismoking actions

The present study investigated whether parents' antismoking actions mediated the prospective relationship between parental smoking cessation and children's smoking. Smoking status of parents (predictor) was assessed when their children were in 3rd grade, parental antismoking actions (mediators) were assessed when their children were in 11th grade, and children's smoking status (outcome) was assessed when they were in 12th grade. In 20 Washington state school districts, data were collected from 1,600 children (49% female, 91% White) and from their parents. Results showed that children's odds of daily smoking were reduced by 39% (95% CI = 24%-51%) for those whose parents had quit smoking, compared with those whose parents were current smokers. Asking to sit in nonsmoking sections of public establishments was a significant (p<.01) mediator that explained 64% of the association between parental smoking cessation and children's smoking. However, not allowing smoking in the home and asking others not to smoke around them were not significant mediators (p = .10, and p = .06, respectively). In conclusion, asking to sit in a nonsmoking section of a public establishment substantially mediates the relationship between parental smoking cessation and children's smoking.

The impact of parenting on risk cognitions and risk behavior: a study of mediation and moderation in a panel of African American adolescents

Hypotheses concerning the extent to which adolescents' cognitions mediate the relation between parenting behaviors and adolescent substance use were examined in a panel of African American adolescents (N = 714, M age at Time 1 = 10.51 years) and their primary caregivers. A nested-model approach indicated that effective parenting (i.e., monitoring of the child's activities, communication about substances, and parental warmth) was related to adolescent substance use more than 5 years later. The parenting behaviors protected the adolescent from subsequent alcohol, tobacco, and marijuana use through associations with two cognitive elements from the prototype/willingness model: favorable risk images (prototypes) and behavioral willingness. Additional analyses indicated that these protective effects were strongest among families residing in high-risk neighborhoods.

Parental rules and communication: their association with adolescent smoking

AIMS

To examine the association between parental rules and communication (also referred to as antismoking socialization) and adolescents' smoking.

DESIGN AND PARTICIPANTS

A cross-sectional study including 428 Dutch two-parent families with at least two adolescent children (aged 13-17 years).

MEASUREMENTS

Parents' and adolescents' reports on an agreement regarding smoking by adolescents, smoking house rules, parental confidence in preventing their child from smoking, frequency and quality of communication about smoking, and parent's reactions to smoking experimentation.

FINDINGS

Compared with fathers and adolescents, mothers reported being more involved in antismoking socialization. There were robust differences in antismoking socialization efforts between smoking and non-smoking parents. Perceived parental influence and frequency and quality of communication about smoking were associated with adolescents' smoking. The association between antismoking socialization practices and adolescents' smoking was not moderated by birth order, parents' smoking or gender of the adolescent.

CONCLUSIONS

Encouraging parents, whether or not they themselves smoke, to discuss smoking-related issues with their children in a constructive and respectful manner is worth exploring as an intervention strategy to prevent young people taking up smoking.

Does parental smoking cessation encourage their young adult children to quit smoking? A prospective study

AIMS

To investigate the extent to which parental early and late smoking cessation predicts their young adult children's smoking cessation.

DESIGN

Parental early smoking cessation status was assessed when children were in 3rd grade, parental late smoking cessation was assessed when children were in 11th grade, and young adult children's smoking cessation was assessed 2 years after high school.

SETTING

Forty Washington State school districts participated in the Hutchinson Smoking Prevention Project.

PARTICIPANTS AND MEASUREMENTS

Participants were the 1553 families in which parents were ever regular smokers who had a young adult child smoking at least weekly at 12th grade who also reported their smoking status 2 years later. Questionnaire data were gathered on parents and their young adult children (49% female and 91% Caucasian) in a cohort with a 94% retention rate.

FINDINGS

Parents who quit early had children with 1.8 (OR = 1.80; 95% CI = 1.22, 2.64) times higher odds of quitting smoking for at least 1 month in young adulthood compared to those whose parents did not quit early. In contrast, there was no association (OR = 0.84; 95% CI = 0.47, 1.51) between parents quitting late and their young adult children's smoking cessation.

CONCLUSIONS

Parental early smoking cessation is associated with increased odds of their young adult children's smoking cessation. Parents who smoke should be encouraged to quit when their children are young.

Ethnic variation in socioenvironmental factors that influence adolescent smoking

PURPOSE

To compare black, Hispanic and white adolescent smokers on socioenvironmental factors associated with smoking.

METHODS

The study uses a cross-sectional design. A needs assessment of 1305 current, former and never adolescent smokers from four ethnically and geographically diverse sites in the United States was conducted in 1999. Two sites were selected because they represented urban cities in the Northeast and Midwest with a high proportion of black and Hispanic residents. Two additional sites were selected to recruit rural and suburban adolescents. From this larger sample, 181 subjects from three focal ethnic groups (white n = 138; black n = 24; Hispanic n = 19) who had smoked at least 100 cigarettes in their lifetime and were current smokers (smoked in the past 30 days) were included. The three ethnic groups were compared on the following variables of interest: peer and family influences on smoking, situational factors associated with smoking, places that were likely sites for smoking and perceptions of friends and family as potential support persons for quitting smoking. All data were analyzed with Chi-square analysis.

RESULTS

Almost all (96%) of the black adolescents lived with another smoker compared to 68% of Hispanic and 60% of whites (p = .004). Black teens were more likely to smoke with family members (50%) than Hispanics (5%) or whites (25%) (p = .003). In addition, 50% of black teens compared to 5% of Hispanics and 12% of white teens, reported smoking to fit in (p < .0001). Black teens in this study emphasized the familial and social pressures of smoking. Higher rates of acceptance of smoking by family members, role modeling by household members, more prevalent beliefs that smoking is a way to achieve belonging, and lack of perceived support for quitting by friends appear to influence cigarette smoking more for black than white or Hispanic youth.

CONCLUSIONS

These preliminary results indicate that familial and household norms play a critical role in influencing cigarette smoking among black teens.

State-of-the-art interventions for office-based parental tobacco control

Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A's framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.

Images of smokers and willingness to smoke among African American pre-adolescents: an application of the prototype/willingness model of adolescent health risk behavior to smoking initiation

OBJECTIVE

This study used the prototype/willingness model of adolescent health risk behavior to examine factors related to onset of smoking.

METHODS

Two waves of data were collected from a panel of 742 African American children (mean age=10.5 at Wave 1) and their primary caregivers. Measures included cognitions outlined by the prototype model as well as self-reports of smoking by the parent and child.

RESULTS

Structural equation modeling revealed a pattern consistent with expectations generated by the prototype model. The relation between contextual, familial, and dispositional factors-including neighborhood risk, parental smoking, and children's academic orientation-and the initiation of smoking at Wave 2, two years later, was mediated by the children's cognitions. Primary among these cognitions were the children's images of smokers and children's willingness to smoke.

CONCLUSIONS

Smoking cognitions mediate the impact of important distal factors (such as context, family environment, and disposition) on the onset of smoking in children. Perhaps more important, it is possible to predict onset of smoking in African American children as young as age 10 by assessing the cognitive factors suggested by the prototype model.

Parenting Style and Smoking-Specific Parenting Practices as Predictors of Adolescent Smoking Onset

OBJECTIVE

To test whether parenting style and smoking-specific parenting practices prospectively predicted adolescent smoking.

METHODS

Three hundred eighty-two adolescents (age 10-17 years, initial nonsmokers, 98% non-Hispanic whites) and their parents were interviewed, with smoking also assessed 1-2 years later.

RESULTS

Adolescents from disengaged families (low acceptance and low behavioral control) were most likely to initiate smoking. Adolescents' reports of parents' smoking-related discussion was related to lowered smoking risk for adolescents with nonsmoking parents, but unrelated to smoking onset for adolescents with smoking parents. Smoking-specific parenting practices did not account for the effects of general parenting styles.

CONCLUSIONS

Both parenting style and smoking-specific parenting practices have unique effects on adolescent smoking, although effects were largely confined to adolescents' reports; and for smoking-specific parenting practices, effects were confined to families with nonsmoking parents. Interventions that focus only on smoking-specific parenting practices may be insufficient to deter adolescent smoking.

Smoking in adolescence: what a clinician can do to help

Approximately 4400 adolescents try their first cigarette every day in the United States. Trying a few cigarettes or using tobacco more regularly as an adolescent significantly increases the risk of smoking in adulthood. Adolescents can develop nicotine dependency after smoking relatively few cigarettes. This article points out the prevalence and unique aspects of teenage tobacco use. In addition, current recommendations for treating nicotine dependence in adolescents are reviewed.

Influence and selection processes in friendships and adolescent smoking behaviour: the role of parental smoking

Concerning the role of parental smoking on development of adolescent smoking, most studies have exclusively focused on the direct effects of parents' smoking on youths' smoking. However, parental smoking may also play an indirect role by affecting youths' susceptibility to peer influences and by affecting friendship selection. Data were from a three-wave short-term longitudinal study of 1595 adolescents. Findings showed high similarities in smoking between reciprocal friends. Additionally, friend's smoking and parents' smoking were moderately related to adolescent smoking onset, but parents' smoking did not moderate the prospective association between best friend's smoking and adolescent smoking. Finally, parental smoking seemed to affect the selection of new friends: In particular, adolescents with smoking parents were most likely to become affiliated with smoking friends. There was no evidence that parental smoking affected termination of friendships.

The health-promoting family: a conceptual framework for future research

There has so far only been little research attention given to how families actively engage in promoting their health in everyday life. In this paper a theoretical framework is proposed for studies of the 'health-promoting family' with particular focus on children's health and well-being. This paper sets out a conceptual model for understanding how the family can play a part in promoting both the health of children and children's capacities as health-promoting actors. It draws on contemporary social science approaches to health, the family and children, suggesting a new emphasis on the family's ecocultural pathway, family practices and the child as a health-promoting actor.

Individual and Contextual Influences on Adolescent Smoking

Cigarette smoking among adolescents remains one of the most important public health challenges. Despite much attention to research on the etiology of smoking, notably the examination of factors that differentiate adolescent smokers from never smokers, much less is known about factors that predict the development of dependence once an adolescent tries smoking. This paper reviews individual and contextual influences on the progression of smoking among adolescents. Highlights include a consideration of multiple levels of influence, from intra-individual factors, such as genetics, demographics, temperament and comorbidities, to social influences, such as families and peers, to the more macro, societal/cultural levels of influence, including advertising and tobacco-related policies. More recent work examining microcontextual influences through the use of Ecological Momentary Assessments is also discussed. Finally, the need to consider both developmental and transdisciplinary approaches to understanding the development of nicotine dependence in adolescents is emphasized.

Beyond modeling: parenting practices, parental smoking history, and adolescent cigarette smoking

This study explored parental beliefs and behaviors designed to convey an antismoking message across levels of self-reported parent and adolescent smoking behavior. Parental self-efficacy, beliefs about smoking, the family relationship, antismoking messages, reactions to smoking, and household smoking rules were explored. Participants were 345 6th, 8th, and 10th graders (50% female; 93% White) and their parents (86% mothers). Beliefs about smoking, parental efficacy, and rules varied across levels of both parental and adolescent smoking. Parents with a history of smoking and parents of adolescents who had tried smoking were less efficacious, held weaker antismoking beliefs, and less often reported household smoking rules. Overall, examining parental behavior across levels of both parent and youth smoking is important. Similarly, parental efficacy, not previously studied in relation to parenting about smoking, may be important to target in future interventions.

Public education campaign heightens awareness that youth model authorities' tobacco use

To evaluate whether people changed their views about acceptability of authority figures smoking after an anti-tobacco initiative, randomly selected southeastern U.S. voters (801 in 2001; 806 in 2002) responded to a 20-minute telephone interview. Acceptability attitudes held steady: most (80.8%) said that any authority figures' smoking in front of youth is unacceptable, with women, minorities, and never-smokers even surer than their counterparts. However, there was a change in 2002, with respondents more strongly recognizing that youth model adults' tobacco behaviors and attitudes. An implication is that media campaigns may benefit from emphasizing that youth model adults' tobacco use.

Lifetime parental smoking history and cessation and early adolescent smoking behavior

BACKGROUND

Associations are examined between parental smoking and smoking onset by their children. Smoking parents are more likely to have children who start smoking in their teenage years; however, less is known about whether parental quitting is related to adolescent smoking.

METHODS

A cross-sectional national sample of 2,206 adolescents, ages 10-14 years, living in two-parent households were interviewed for the DEFACTO annual report on Dutch youth smoking behavior. Adolescent smokers reported that they have tried smoking, even one puff. Respondents indicated whether their parents were never, former, or current smokers, and provided, in the case a parent had quit, their age at that time.

RESULTS

Logistic regression analyses revealed that likelihood increased gradually: adolescents with both parents being current smokers were four times more likely to be a smoker compared to adolescents with parents who had never smoked. Additionally, within the group of adolescents whose parents quit smoking, the findings demonstrated that the earlier the parents stopped smoking in the life of their offspring, the less likely their children were to start smoking in adolescence.

CONCLUSIONS

Parental smoking history is associated with smoking initiation in early adolescence. Parental cessation at an early age of their offspring reduces the likelihood of adolescent smoking initiation. Preventive efforts, therefore, should focus on the benefits of parental cessation as early as possible.

Delay and probability discounting as related to different stages of adolescent smoking and non-smoking

This study examined relations between different patterns of adolescent cigarette smoking and discounting of monetary rewards due to delay (delay discounting) and probabilistic uncertainty (probability discounting). The study also examined the relation between smoking and the number of peer friends who smoke and level of parent education. Participants were 55 adolescents (28 females) between 14 and 16 years of age who were categorized according to the following patterns of smoking behavior: "never smokers" (n=19; 10 females) who had not tried even one cigarette; "triers" (n=17; 9 females) who had recently tried cigarettes for the first time; and "current smokers" (n=19; 9 females) who smoked a minimum of one cigarette every week for at least 6 months prior to data collection. It was hypothesized that current smokers would discount more than those who had never smoked. No specific hypotheses were made for participants only trying cigarettes. Unexpectedly, results indicated no differences in discounting between the current smokers and never smokers. However, the trier group discounted probabilistic rewards significantly more than the never- and current-smoker groups. Also, triers and current smokers both reported having more friends who smoked than never smokers, and fathers of never smokers had significantly more education than fathers of either triers or current smokers. These results suggest that impulsive discounting may be more related to adolescents trying cigarettes than to their becoming regular smokers, whereas number of peer friends who smoke and parent level of education seem to differentiate between those who have smoked to some extent (triers and current smokers) and those who have not even tried cigarettes (never smokers).

Adolescent smoking behavior: measures of social norms

BACKGROUND

Relatively little research has focused on the social norms of teen smoking. This study examined social norms regarding adolescent smoking and their relationship with smoking behavior.

METHODS

Data were collected in 1998 as part of the follow-up for a randomized trial in 14 rural Minnesota communities. Four aspects of perceived social norms of smoking were measured, and students were classified as nonsmokers, daily smokers, past-week smokers, or past-month smokers. Social norms were compared across four levels of smoking behavior, and multivariate models controlled for personal characteristics and family and peer smoking.

RESULTS

The sample comprised a total of 3128 girls and 3146 boys in grades 8 to 10. For all four measures, nonsmokers had the most antismoking perceptions of social norms around smoking (p <0.001). In multivariate models, noticing other teens smoking and the perception that adults care about and disapprove of teen smoking remained significantly related to past-month smoking. Using more frequent smoking as the dependent variable, noticing smoking remained significantly associated with smoking in the anticipated direction. Perceived prevalence of smoking did not perform consistently across models.

CONCLUSIONS

Noticing teens smoking is associated with smoking behavior across three different levels of smoking frequency. The perception that adults care about and disapprove of teen smoking was associated with past-month and past-week smoking. Although perceived prevalence is often used to measure social norms of teen smoking, this measure may have limited utility. Strategies for health promotion and intervention on the issue of youth smoking are discussed.

Maternal smoking and smoking in adolescents: a prospective community study of adolescents and their mothers

The associations between maternal smoking and nicotine dependence and patterns of smoking and nicotine dependence in offspring were examined in a large community-based sample of adolescents. Data were derived from baseline and 4-year follow-up assessments of 938 respondents aged 14-17 years at the outset of the Early Developmental Stages of Psychopathology (EDSP) study, a prospective-longitudinal community study of adolescents and young adults and their parents respectively. Smoking and nicotine dependence in respondents were assessed using the Munich Composite International Diagnostic Interview (DSM-IV algorithms). Diagnostic information about smoking behavior in mothers was collected by independent direct diagnostic interviews with the mothers. In comparison to children of non- or occasionally smoking mothers, children of regularly smoking and nicotine-dependent mothers had higher probabilities of using tobacco as well as of developing nicotine dependence. For all ages under consideration, survival analyses revealed a higher cumulative lifetime risk of regular smoking and nicotine dependence among these children. Maternal smoking during pregnancy seems to represent an additional risk for these outcomes in children, specifically with regard to the risk of developing nicotine dependence. Associations were comparable for sons and daughters. Our findings show that maternal smoking predicts escalation of smoking, development of nicotine dependence, and stability of smoking behavior in children. Implications for specific intervention and prevention efforts are discussed.

Teen penalties for tobacco possession, use, and purchase: evidence and issues

A handful of empirical studies have related changes in youth smoking to popular laws that penalise tobacco possession, use, and purchase (PUP). In this paper, we review the literature and outline reasons why PUP laws may be unlikely to reduce youth smoking significantly at the population level. In theoretical terms, we argue that PUP laws lack important features required for punishment to be effective in changing behaviour. In practical terms, PUP transgressions seem difficult to detect. Conceptually, there is potential for PUP laws to undermine conventional avenues of discipline, such as the parent-child relationship and the school environment. Strategically, PUP laws may divert policy attention from effective tobacco control strategies, relieve the tobacco industry of responsibility for its marketing practices, and reinforce the tobacco industry's espoused position that smoking is for adults only. To assist further debate and discussion, we identify research issues requiring attention.

Familial influences on adolescent smoking

The family unit is the primary source of transmission of basic social, cultural, genetic, and biological factors that may underlie individual differences in smoking. Existing information on the role of familial factors in tobacco use is characterized by two separate, but somewhat overlapping, lines of research: genetic epidemiological studies and risk-factor research. The present paper summarizes and evaluates studies assessing the association between adolescent smoking and parent and sibling smoking behaviors. A review of 87 studies reveals that methods are limited by a lack of standardized instruments, failure to measure important confounding and mediating factors, reliance on cross-sectional designs and the use of inconsistent definitions of tobacco-related behavior and assessment procedures. Moreover, there are no systematic family studies of the acquisition and continuation of smoking that have employed contemporary methodological standards for examining familial aggregation of tobacco behaviors among adolescents. Findings across studies show weak and inconsistent associations between parent and adolescent smoking; inconsistent findings may be attributed to methodological issues or associated factors that may complicate the relation between parent and adolescent smoking. Sibling and peer smoking show greater associations with adolescent smoking. Suggestions for future research include contemporary family studies that delineate meaningful phenotypes of tobacco use and prospective work on the later stages of tobacco use and the timing of the influence and valence of parent and family factors. Integration of the risk factor approach within the family study design may enrich both approaches to elucidate familial influences on smoking.

Parental, family, and home characteristics associated with cigarette smoking among adolescents

PURPOSE

This study examines the relationship between smoking-related parental, family, and home factors with adolescents' cigarette use.

DESIGN

Cross-sectional surveys of adolescents, via a self-administered questionnaire in classrooms, and their parents, via a telephone interview, were conducted.

SETTING

Fifteen suburban and rural communities within Minnesota.

SUBJECTS

The study sample included 8th, 9th, and 10th grade public school students and their parents.

MEASURES

The dependent variable was monthly tobacco use among students. The independent measures were parental, family, and home smoking-related characteristics. There were 1343 parent-child dyads with completed surveys.

RESULTS

The final, multivariate logistic regression model found the following variables to be independently related to higher smoking rates among adolescents: child's grade (odds ratio [OR] = 3.03 for 10th vs. 8th), parents' permissiveness of adult smoking (OR = 1.80), parents' having higher normative estimates of how many people smoke (OR = 1.70), parents' decreased likelihood of punishing their teenager for smoking (OR = 1.65), smoking by an adult living in the home (OR = 1.99), and sibling smoking (OR = 8.95). Lack of communication about consequences for breaking family smoking rules was associated with lower smoking rates among adolescents (OR = .49).

CONCLUSION

The results of this study highlight the importance of parental smoking norms and attitudes and smoking role models in the home. It is important that smoking prevention strategies target and include the entire family. Limitations of the study are its cross-sectional design and that the sample was primarily white.

Theory, measurement, and methods in the study of family influences on adolescent smoking

This paper discusses three dilemmas faced by researchers interested in family influences in substance use: the transitional nature of adolescent smoking, the complexity and multi-dimensionality of family forms and influences, and the inter-relationship of family influences with other key developmental contexts. Methodological and conceptual issues stemming from these dilemmas are discussed with regard to understanding why previous reviews have found the correlations between family predictors and adolescent smoking to be relatively low. In particular, the importance of understanding time, the transitional nature of the phenomenon, and within- and between- family processes are emphasized. More appropriate conceptual and statistical models for analyzing family influences are suggested, including both mixed models and person-centered approaches.

Smoking visibility, perceived acceptability, and frequency in various locations among youth and adults

OBJECTIVES

This study tests whether there is an association between high visibility of smoking, perceived acceptability of smoking, and where youth smoke.

METHODS

Surveys of 9,762 students in grades 8-10 and 1,586 parents in 15 Minnesota communities asked about the frequency of and opinions of adult and youth smoking in various indoor and outdoor public places. Chi-square analysis and ANOVAs compared smokers and nonsmokers.

RESULTS

More smoking than nonsmoking youth reported often seeing adults and teens smoking in all locations. Forty-two percent of students often noticed adults and 35% often noticed teens smoking outdoors, also the most frequent location where teens report smoking. Students perceived adult and teen smoking as more acceptable in restaurants, recreation centers, and outdoor gathering places. More student smokers than nonsmokers believe that smoking is acceptable for both adults and teens. Of the parent sample, 52% often observed adults and 36% often observed youth smoking outdoors. Nonsmoking parents observed adult and teen smoking more often than parents who smoke.

CONCLUSIONS

The data support an association between the frequency that youth observe smoking in various locations and the perception that smoking is socially acceptable by smoking status. Policies that restrict smoking in various locations will reduce both visibility and perceived acceptability of smoking in those locations.

Media campaign influences parents' opinions about their children and tobacco

The study assessed the effectiveness of a media campaign in convincing parents that children are targeted by the tobacco industry and that children should be banned from tobacco use. An 800-parent sample survey was conducted prior to a statewide anti-tobacco campaign, and another survey sample of 790 parents was conducted afterward.

THE RESULTS

Though parents who smoked in high school and those who did not agreed that children are targeted and should be banned from tobacco use, parents who did not smoke in high school believed it more strongly. Parents who had a history of smoking changed more on the issue of banning, perhaps because they had more room to change. The study concluded that media campaigns can change parents' attitudes.

Missed opportunities for prevention: failure to identify smoking in the parents of adolescent patients

Smoking is an addiction that often begins in childhood or adolescence. Factors associated with early smoking initiation include parental smoking and socialization about smoking with their children. Previous studies evaluating the history obtained during routine pediatric appointments have not focused on parental smoking history and counseling. In this study, seventy-three (73) adolescents (mean age: 15.2 years; 77% female; 64% African-American) seen for medical care in a primary care clinic and their accompanying parent(s) (mean age: 43.5 years; 91% female) were surveyed about smoking followed by a review of each chart measuring documentation of adolescent and parent smoking history and counseling. Although the majority of adolescents were questioned about smoking (92%), parents were rarely questioned (1%) (p < 0.05). Adolescents were counseled about smoking (7%) and other risk-taking behaviors (44%); however, no parents were counseled about smoking or smoking socialization. Physicians frequently overlook an important factor in the prevention of smoking initiation at a young age, parental smoking history and counseling.

Smoking restrictions in the home and car among rural Native American and white families with young children

BACKGROUND

This paper examines the prevalence of household and car smoking restrictions, factors associated with these restrictions, and children's exposure to secondhand smoke in homes with varying levels of household smoking restrictions in rural Native American and White families.

METHODS

In-person interviews were conducted with 380 rural, low-income Native American and White parents or guardians who were the primary caregivers of children aged 1-6 in northeastern Oklahoma.

RESULTS

Prevalence of complete smoking bans was 49.1% in Native American homes and 42.7% in White homes. Car smoking bans were less common, with 34.9% of Native American and 39.6% of White caregivers reporting complete bans. Among nonsmoking households, the proportion of friends who smoked was associated with both car and home smoking bans. Race and education of the caregivers were also associated with car smoking bans in homes with no adult smokers. Among smokers, cigarettes smoked per day, quit attempts within the past year, and the strong belief that secondhand smoke harmed children and babies were related to household smoking bans, whereas cigarettes smoked per day and the proportion of friends who smoked were related to car smoking bans.

CONCLUSIONS

Despite the relatively low prevalence of smoking bans in our population, factors associated with household and car smoking bans were similar to those found in the general population.

An exploration of family influences on smoking among ethnically diverse adolescents

In an attempt to better understand mechanisms through which families might influence adolescent smoking, focus group data collected as part of a larger study of ethnic and gender differences in teen smoking were analyzed for family-related themes. Across six sites, 132 focus groups were conducted with African American, American Indian, Hispanic, Asian/Pacific Islander, and White youth. Similarities across race/ethnicity were evident in the content of antismoking messages and the feeling among youth that they would get in trouble with their parents if caught smoking. African American and Asian/Pacific Islander youth appeared more concerned about their parents thinking less of them if they smoked than were youth from other racial/ethnic groups. White and American Indian youth were more likely to discuss that their parents felt it was their own decision as to whether or not to smoke than were the other groups.

Smoking, getting drunk, and engaging in bulimic behaviors: in which order are the behaviors adopted?

OBJECTIVE

To assess the relation between beginning to binge-eat or purge, beginning to smoke, and getting drunk for the first time.

METHOD

Prospective study of 11,358 girls and boys, 10 to 15 years of age, in an ongoing cohort study who completed questionnaires in 1997 and 1998. The outcome measures were beginning to engage in bulimic behaviors, beginning to smoke, and getting drunk for the first time between 1997 and 1998.

RESULTS

During 1 year, 4.3% of girls and 3.8% of boys started smoking, 5.3% of girls and 4.8% of boys started getting drunk, and 2.4% of girls and 0.8% of boys started engaging in bulimic behaviors. Among the girls, weight concerns in 1997 were predictive of beginning to smoke (odds ratio [OR] = 2.2), get drunk (OR = 1.7), purge (OR = 3.8), and binge-eat (OR = 2.6). Adolescents who reported smoking in 1997 were more likely than nonsmokers to get drunk for the first time (girls: OR = 5.7; boys: OR = 7.1). The reverse association, getting drunk as a predictor of starting to smoke, was of lesser magnitude (OR = 2.3-2.6).

CONCLUSIONS

The three unhealthy behaviors were associated prospectively with each other. The results suggest that prevention efforts should target weight concerns and multiple risk behaviors.

Ethnicity, gender and risk factors for smoking initiation: an overview

Although the prevalence of cigarette smoking has increased dramatically among youth over the past several years, there are significant ethnic and gender differences in prevalence rates. This paper presents highlights of the research literature on ethnic and gender differences in risk factors for smoking. The effects of peer and family influences may vary by both ethnicity and gender. White youth, especially females, may be more susceptible to the negative influence of friends' smoking than are African-American youth. Although the evidence about the relative importance of parent smoking among ethnic groups is contradictory, recent data suggest that African-American parents provide stronger anti-smoking messages than do white parents. The subgroups also vary in their perceptions of the negative consequences of smoking, with Asian-American and African-American females perceiving stronger negative consequences. Cultural expectations may place white females at increased risk for smoking. The link between depressed mood and smoking also varies by subgroup. Finally, popular media figures may influence the appeal of smoking and be differentially relevant to youth subgroups. We need: (1) specific examinations of ethnic and gender effects with attention paid to identifying protective factors among certain ethnic/gender subgroups; (2) to know more about how family influences may vary by the ethnic/gender subgroups and over the developmental course of smoking; (3) to know more about how youth cope with negative moods and the role of smoking in coping; and (4) to investigate whether the factors that protect youth in some subgroups can be diffused to others.