While parental smoking is a well-established risk factor of smoking initiation in adolescents, our study further showed that adolescents who had a smoking father but rejected the father’s smoking might have a lower chance to become smokers than those with a non-smoking father. Specifically, we found that compared with adolescents without paternal smoking, those with paternal smoking were 1.4 times as likely to be current smokers, but those with paternal smoking but rejected it were half as likely to be current smokers.
Such findings are in line with emerging studies showing that parental smoking causes perennial health concerns and negative experiences in adolescents. Therefore, these adolescents may be particularly anti-smoking and even less likely to smoke than those who have no smoking parents and experienced no unpleasantness of parental smoking. We also found that compared with adolescents without maternal smoking, those with maternal smoking were 3.9 times as likely to be current smokers, but those with maternal smoking but rejected it were only 2.1 times as likely to be current smokers.
Why are the findings significant?
Tobacco smoking is one of the leading causes of preventable death. It is estimated that each year, smoking and passive smoking cause over 7 million deaths and are responsible for an economic cost of US$1436 billion (PMID: 28138063). Extensive research has been conducted to explore the factors that would lead to smoking. One of the most widely assessed and well-established risk factors is parental smoking, indicating that smoking can be transmitted across generations, thus perpetuating the tobacco epidemic. An understanding of the mechanisms of such transmission, especially when smoking has become more denormalized recently, should be useful for designing smoking prevention programmes, but such studies are limited.
Our study showed that adolescents’ cognition played an important role in the link between parental smoking and their own smoking behaviors, stimulating new ideas in the intervention design for smoking prevention. Potential targets of the interventions may include normative beliefs around smoking, a comprehensive understanding of the harms, and knowledge of the tobacco industry’s deceitful and manipulative practices, all of which may potentially shape how adolescents perceive their parents’ smoking behaviors.
How was the study conducted?
The study used data from a survey of 61080 Secondary 1-6 (equivalent to US Grade 7-12) students in Hong Kong, which has the lowest adult smoking prevalence (about 11% in 2010) in the developed world. The survey was conducted in 2010/11 and used a random sample of 79 schools stratified by the 18 districts in Hong Kong. The sample had a mean age of 14.6 years, and 50.5% were boys. Paternal smoking and maternal smoking were reported by 31.0% and 5.9%, respectively. Among the adolescents with paternal smoking, 51.3% rejected it; the corresponding proportion for maternal smoking was 49.2%. About 5.8% of the students were smokers, defined as any smoking in the past 30 days
We used logistic regression models to estimate the relative odds of smoking in relation to different groups (eg, “those with paternal smoking” vs “those without”).The factors that might potentially confound the associations of interest were adjusted in the regression models (eg, age, sex, perceived family affluence, and co-residing smokers other than parents).
These findings are described in the article Parental smoking, rejection of parental smoking and smoking susceptibility and behaviours in Hong Kong adolescents, recently published in the journal Addictive Behaviors. This work was conducted by Jianjiu Chen, Sai Yin Ho, Man Ping Wang, and Tai Hing Lam from the University of Hong Kong.