Anti-tobacco socialization in homes of African-American and white parents,and smoking and nonsmoking parents

Purpose: To examine parental perceptions and behaviors with regard to teen smoking, comparing African-American and white parents, and those who did and did not smoke.Methods: Focus groups consisting of African-American and white parents who smoked provided initial in-depth information. A computer-assisted telephone survey of a biracial sample of 311 parents of children ages 8 to 17 years provided more generalizable information regarding parental beliefs and behaviors.Results: Nearly 50% of households either allowed teen smoking, had no ground rules, or had set restrictive rules but never communicated them to the children. Compared to white parents, African-American parents felt more empowered to affect their children’s behaviors and were more likely to actively participate in anti-tobacco socialization within the home (all p values < 0.01). Among the African-American parents, 98% reported 18 years or older to be an appropriate age for teens to make up their own minds about using tobacco, whereas 26% of white parents thought 16 years to be an appropriate age (p < 0.001). Parents who smoked reported more frequent rule-making than those who did not smoke (p = 0.02), but were more likely to believe that childhood tobacco use is inevitable (p = 0.01).Conclusions: Many parents are not engaged in anti-tobacco socialization in the home. Differences in the degree of parental participation may contribute to the variance in smoking prevalence between African-American and white children.     

Cigarette smoking and its risk factors among elementary school students in Beijing.

OBJECTIVES. This study investigated patterns of and risk factors for smoking among elementary school children in Beijing, China. METHODS. In 1988, anonymous questionnaires were administered to a multistage stratified cluster sample of 16996 students, aged mostly 10 to 12, in 479 fourth- to sixth-grade classes from 122 Beijing elementary schools. RESULTS. Approximately 28% of boys and 3% of girls had smoked cigarettes. The most frequently cited reasons for smoking initiation were "to imitate others'' behavior" and "to see what it was like." Girls were more likely to get cigarettes from home than to purchase their own. Having close friends who smoked and being encouraged by close friends to smoke were strong risk factors for smoking. Smoking was also associated with lower parental socioeconomic status; having parents, siblings, or teachers who smoked; buying cigarettes for parents; performing poorly in school; and not believing that smoking is harmful to health. CONCLUSIONS. Gender differences in smoking prevalence among adolescents in China are larger than those among US teenagers, whereas the proximal risk factors for smoking are similar. Major efforts are needed to monitor and prevent smoking initiation among Chinese adolescents, particularly girls.     

Urinary cotinine as a marker for passive tobacco smoking

To provide an objective measure of the hazard smoking parents represent to their children's health, continue concentration in urine was measured by the colorimetric method using barbituric acid (DBA). A total of 205 children, aged 10-12, were examined. The results of laboratory tests were correlated with the data collected by interview. A significant difference in the average value of cotinine concentration was demonstrated between the children whose parents did not smoke (3.2 mumol/L) and those whose one parent smoked (5.8 mumol/L). An even larger concentration was recorded when both parents smoked (7.8 mumol/L). The largest cotinine concentration was determined in the urine of children--passive smokers whose both parents smoked and who did not have a room of their own (9.2 mumol/L). The difference in cotinine concentration between girls and boys was not statistically significant.     

Blood lead levels in Japanese children: Effects of passive smoking

Blood lead levels (BLLs) of 188 pediatric patients were measured and their parents were queried as to the smoking style in their home. Their mean BLL was 3.16 μg/dl, which was among the lowest levels in the world, and none of them had levels of over 10 μ g/dl. Preschool children ( 1 to 6 years of age) with parents who smoked in the same room had a significantly higher BLL (mean; 4.15 μ g/dl) than those with parents who never smoked (mean; 3.06 μ g/dl) (P<0.01). However, the mean BLL of school children (6 to 15 years of age) with parents who smoked in the same room was not significantly different from that of school children with parents who never smoked. Passive smoking caused an increase of the BLL only in preschool children in Japan. This is probably because preschool infants spend much more time with their parents and have much more contact with passive smoking than school children and, additionally young infants have a limited ability to excrete lead from the body.     

Exposure to environmental tobacco smoke in the household and urinary cotinine excretion, heavy metals retention, and lung function.

The relationship between urinary levels of cotinine (U-cotinine) and arsenic (U-As), blood levels of cadmium (B-Cd), blood levels of lead (B-Pb), lung function, and questionnaire data on smoking habits were studied in 107 parents and their 46 children (7-10 y of age). There was a statistically significant relationship between the reported amount of tobacco smoked and U-cotinine levels. Nonsmokers who were married to persons who smoked had three times higher U-cotinine levels than nonsmokers whose spouses did not smoke. There was a significant association between the number of parents who smoked in the family and the U-cotinine levels of children. If only one parent smoked, maternal smoking was of greater importance than paternal smoking. There was also an association between U-cotinine and B-Cd. A study of lung function in the children revealed that vital capacity and functional residual capacity (corrected for sex, age, and height) increased as the number of parents who smoked increased. Therefore, the present study showed that (1) U-cotinine was a useful index of active smoking and environmental tobacco smoke exposure in adults and children, (2) U-cotinine was associated with the blood concentration of cadmium, and (3) environmental tobacco smoke exposure was associated with changes in lung function of children.     

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.     

Do Dutch 11-12 years olds who never smoke,smoke experimentally or smoke regularly have different demographic backgrounds and perceptions of smoking?

BACKGROUND: Most adolescent smokers start smoking before the age of twelve. Little is known about the behavioural smoking determinants of Dutch primary school children. METHODS: A cross-sectional study was carried out on a sample of students from the final year of 143 Dutch primary schools. A total of 3700 students (mean age = 11.6 years) completed a questionnaire based on the ASE model, measuring the attitude, social influences and self-efficacy expectations concerning smoking. RESULTS: Students were categorized as never smokers (64.3%), experimental smokers (28.0%), and regular smokers (7.8%). Multinomial logistic regression analyses showed that never smokers were younger, and were more often female, religious and from two-parent families than experimental smokers. Never smokers perceived more disadvantages, long-term physical consequences, more negative social norms and less pressure regarding smoking, higher self-efficacy expectations towards non-smoking, and had fewer parents, siblings or best friends who smoked. Looking at differences between experimental and regular smokers showed that experimental smokers received less pocket money. They also perceived more disadvantages, fewer advantages, more negative social norms and less pressure towards smoking, higher self-efficacy expectations towards non-smoking, and were less likely to be surrounded by friends, peers, family or teachers who smoked. Generally, the low scores for physical consequences and risk perception regarding addiction were striking. CONCLUSIONS: Smoking prevention aimed at primary schoolchildren should consider the different smoking categories, with their specific motives and influences. For instance, the influences on smoking initiation of parents, siblings and best friends suggest more comprehensive programmes aimed at the entire family. Youngsters' ignorance of addiction needs more attention.     

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.     

Effect of parental cigarette smoking on the pulmonary function of children.

The authors have investigated the effects of parental smoking patterns on the pulmonary function of children in East Boston, Massachusetts. A crude inverse dose-response relationship was observed between the level of FEF25--75% predicted of children who never smoked and the number of smoking parents in the household. Compared to children with two non-smoking parents, the level of FEF25--75% predicted was 0.156 and 0.355 standard deviation units lower for children with one and two currently smoking parents, respectively. An additional decline in level of FEF25--75% predicted was observed for children who themselves had smoked. Smoking children with two smoking parents had an average FEF25--75% predicted level which was 0.355 standard deviation units lower than non-smoking children with two smoking parents. These data not only confirm that cigarette smoking by young children and teenagers has direct measurable effects on their pulmonary function, but also show that cigarette smoking by parents has a measurable effect on the pulmonary function of their children which is independent of any direct use of cigarettes by the children.     

Relation between lead and cadmium in blood and the involuntary smoking of children

The blood lead (PbB) and blood cadmium (CdB) levels, as well as the parental smoking habits, of 133 children aged 4 to 11 years were studied. The children were from a town with a lead smeltery and a surrounding rural area. There was a significant association between the higher PbB levels of the children and involuntary (parental) smoking in the home. The CdB levels of the children were not affected by parental smoking habits. The children whose parents did not smoke at home had lower PbB values than those with one smoking parent. These children, in turn, had lower levels than children with two smoking parents. Mothers who smoked had a greater impact than fathers who smoked. There was also a dose-response relationship between the amount of tobacco smoked by the mother and the PbB level of the child. The PbB value was higher for the children living near industrial lead emissions than for children from the rural area. The association between PbB level and involuntary smoking is probably not due to inhalation of lead originating from tobacco smoke. A small airways disease affecting the absorption of inhaled lead particles is proposed as an explanation.     

Does parental smoking cessation discourage adolescent smoking?

BACKGROUND: We examined the relationship of smoking cessation in parents to smoking and uptake and cessation by their adolescent children. METHODS: We analyzed a cross-sectional sample of 4,502 adolescents, ages 15-17 years, who lived in two-parent households that were interviewed as part of the 1992-1993 Tobacco Supplement of the Current Population Survey, which questioned householders 15 years of age and older about their smoking history. Ever smokers reported smoking at least 100 cigarettes in their lifetime. Former smokers were ever smokers who had quit. RESULTS: Multivariate analyses, adjusted for demographic characteristics of adolescents, as well as father's age, education, and family income, found that adolescents whose parents had quit smoking were almost one-third less likely to be ever smokers than those with a parent who still smoked. Furthermore, adolescent ever smokers whose parents quit smoking were twice as likely to quit as those who had a parent who still smoked. Parental quitting is most effective in reducing initiation if it occurs before the child reaches 9 years of age. CONCLUSION: Encouraging parents to quit may be an effective method for reducing adolescent smoking, through decreased uptake and increased cessation. The earlier parents quit, the less likely their children will become smokers.     

Cigarette smoking behavioral distinctions between experimental nonadopters and adopters in children and adolescents--a consideration of transitional smoking experience: the Bogalusa Heart Study

A cigarette-smoking questionnaire to examine behavior, attitudes, and beliefs related to cigarette use was administered to children, ages 8-17, in a biracial community. Children who experimented with cigarettes but did not adopt the habit (experimental nonadopters) and children who continued to smoke (adopters) were identified and characterized. Follow-up behavior was examined 2 years later. Adopters were more likely to have smokers as friends and family members, more likely to have purchased their first cigarettes, more likely to believe smoking to be pleasurable for themselves and others, and less likely to consider smoking harmful. Adopters who maintained smoking behavior 2 years later had, during the initial survey, reported having more friends who also smoked and were more likely to believe smoking to be enjoyable. Experimental nonadopters were more likely to try the first cigarette alone, reported having fewer friends and family members who smoked, and believed greater health risks to be associated with cigarette use. Experimental nonadopters who maintained nonsmoking behavior 2 years later, especially in the older cohort, exhibited higher agreement with the negative consequences of cigarette smoking (health beliefs) and theories concerning smoking behavior of others.     

Exposure to cigarette smoking and children's growth

An analysis of data from 5903 children from a study of primary schools in England and Scotland in 1982 showed that the number of cigarettes smoked by the parents at home was significantly associated with the attained height of their children. This relation was statistically significant after allowing for parents' height, child's birthweight, mother's smoking during pregnancy, overcrowding and number of older siblings. Number of cigarettes smoked at home was more strongly related to height than number of cigarettes smoked by the mother during pregnancy. The results suggest that passive smoking may have an effect on the height of a child independent of genetic factors, the social environment and mother's smoking in pregnancy. Whether this is a direct effect of parents' smoking on the child's growth remains unclear.     

Sex differences in prevalence rates and predictors of cigarette smoking among in-school adolescents in Kilimanjaro, Tanzania

An analysis of the Global Youth Tobacco Survey for Kilimanjaro, Tanzania was carried out to assess sex differences in the prevalence rates and predictors of current cigarette smoking among in-school adolescents. A total of 2323 adolescents participated in the study of whom 53% were females and 47% males. The prevalence of current cigarette smoking was 3.0% and 1.4% among males and females, respectively. The common factors that were significantly positively associated with cigarette smoking between sexes were: having more pocket money, closest friend smoked cigarettes, seeing actors smoke on TV, videos or movies, and seeing advertisements for cigarettes at social gatherings. Seeing anti-smoking messages at social gatherings were negatively associated with smoking among both sexes. While having had something such as a t-shirt or pen with a cigarette brand logo on it was positively associated with cigarette smoking among males, it was negatively associated with cigarette smoking among females. Male adolescents older than 15 years, those in their 9th year of schooling, and those who had seen cigarette brand names on TV were more likely to smoke. Meanwhile, male respondents who were in their 8th year of schooling, had seen anti-smoking media messages, and advertisements for cigarettes in newspapers or magazines were less likely to smoke. Among female adolescents, those who had parents who smoked, and surprisingly those who perceived that cigarette smoking as harmful were more likely to smoke. Interestingly, seeing advertisement for cigarettes on billboards was negatively associated with smoking among female adolescents. Interventions aimed to reduce adolescent smoking need to be designed and implemented with due consideration of sex differences in these associated factors.     

Anti-smoking socialization beliefs among rural Native American and White parents of young children

This study assesses similarities and differences in anti-smoking socialization beliefs of White and Native American parents in a low-income, rural population in northeastern Oklahoma. Data are from a population-based, cross-sectional children's environmental health study in which in-home interviews were conducted with 356 parents (56.2% White, 43.8% Native American), primarily mothers, of young children. Approximately 65% of the participants had a high school education or less and over 50% smoked. The Native American participants represented numerous tribes and did not live on reservations. Multivariate logistic regression models were used to examine associations between race/ethnicity, education, smoking status and six anti-smoking socialization beliefs. Results showed that White and Native American parents in this study were very similar in their anti-smoking socialization beliefs, with the one exception that Native American parents were less likely to believe that schools are better than parents in teaching children about the dangers of cigarette smoking. Parental education was significantly associated with the beliefs that all children will try smoking and that forbidding children to smoke will only make them want to smoke more, with less-educated parents more likely to share these beliefs. Findings suggest that interventions to promote anti-smoking socialization beliefs among parents with high school education or less may be important in low-income, rural communities with high smoking rates.     

Characteristics of pregnant adolescents receiving prenatal care at school-based or hospital-based clinics

This study examines characteristics of adolescent females in prenatal care in a hospital-based teen clinic compared to a school-based teen clinic. Interviews were conducted during 1991-92 among 189 pregnant adolescents, whose mean age was 16.22 years. 48% were African American, 42% were Hispanic, and 2% were Asian or other. 75% of adolescents were single or without a spouse. 30% lived with siblings, 21% lived with their husband, 9% lived with their boyfriend, 10% lived with in-laws, 4% lived with a friend, and the rest lived with their mothers. 48% of adolescents' mothers helped with child care. 27% did not have any help. 57% were enrolled in school, 41% dropped out, and 4% graduated. 63% planned to continue their education. 75% had a parent who served as a mentor. Over 50% lived with someone who smoked cigarettes or drank alcohol. 75% had friends or relatives who smoked. Almost 25% had a sexual partner who sold drugs, and 25% had a sexual partner who had been in trouble with the law. 14% had a partner who used drugs. 62% of adolescents who had smoked before their pregnancy quit smoking. 79% of adolescents who had consumed alcohol before their pregnancy stopped consuming alcohol. Adolescents in both clinics showed no significant differences in family welfare status, initiation of prenatal care, parity, and number of living children. There were differences by clinic type for adolescent ethnic patterns of clinic use, educational status, financial and social support, and family setting. Hispanics and Whites and school dropouts were more likely to use hospital-based care. The school-based adolescents were more likely to be single; to receive support from parents, relatives, and a job; and to have higher exposure to alcohol and substance abuse. Hospital-based adolescents were more likely to live with relatives, not to have help, and to be Spanish speakers. It is recommended that services match the characteristics and needs of clients in each local setting.     

Continued smoking and smoking cessation among urban young adult women: findings from the Reach for Health longitudinal study

We examined smoking and smoking cessation among 538 young inner-city women who had been followed from early adolescence to young adulthood. Results showed that 14.3% of these young women had smoked in middle school, 26.4% had smoked in high school, and 21.9% had smoked at age 19 or 20 years, when many were rearing children, pregnant, or considering pregnancy. Young women who were raising children were more likely than those who were not to currently smoke or to have smoked in the past. Partner violence victimization was an independent risk factor for continued smoking. If improvements in smoking cessation rates are to be achieved, public health efforts must address factors underlying early and continued smoking.     

Breastfeeding duration and perinatal cigarette smoking in a population-based cohort

OBJECTIVES: We examined the association between breastfeeding duration and maternal smoking before, during, and after pregnancy. METHODS: Data from the 2000-2001 Oregon Pregnancy Risk Assessment Monitoring System were used. Early weaning was defined as not breastfeeding at 10 weeks postpartum. RESULTS: At 10 weeks after pregnancy, 25.7% of mothers who initiated breastfeeding no longer breastfed. After controlling for confounders, quitters (mothers who quit smoking during pregnancy and maintained quit status after pregnancy) and postpartum relapsers (mothers who quit smoking during pregnancy and resumed smoking after delivery) did not have significantly higher risk for early weaning than nonsmokers. However, persistent smokers (mothers who smoked before, during, and after pregnancy) were 2.18 times more likely not to breastfeed at 10 weeks (95% confidence interval=1.52, 2.97). Women who smoked 10 or more cigarettes per day postpartum (i.e., heavy postpartum relapsers and heavy persistent smokers) were 2.3-2.4 times more likely to wean their infants before 10 weeks than were nonsmokers. CONCLUSIONS: Maternal smoking is associated with early weaning. Stopping smoking during pregnancy and decreasing the number of cigarettes smoked postpartum may increase breastfeeding duration.     

Saturation of tobacco smoking models and risk of alcohol and tobacco use among adolescents.

PURPOSE: To examine how saturation of an adolescent's environment with models of cigarette smoking (e.g., parents, siblings, friends) affects the probability of tobacco and alcohol use among junior high and high school students. METHODS: The Health and Smoking Questionnaire was administered to 806 adolescents (182 smokers and 624 nonsmokers; 57.2% female) average age of 15.1 years (SD = 1.6) in a mid-size Midwestern town. The questionnaire contains standardized items in five domains: demographics, smoking status and history, perceptions of risk and risk reduction, risk factors for tobacco use, and parenting style. RESULTS: Risk for smoking or using alcohol increased dramatically as the number of models who smoke increased in an adolescent's environment. For instance, adolescents with one significant other who smoked were nearly four times (OR = 3.76, p <.001) more likely to smoke than someone with no significant others who smoked. However, if an adolescent had four significant others who smoked, they were over 160 times more likely to smoke (OR = 161.25, p <.001). Similar results were found for alcohol use; adolescents who had one significant other who smoked were more than 2.5 (OR = 2.66, p <.001) times more likely to drink than those without smoking models. Adolescents who had four significant other smoking models were 13 times (OR = 13.08, p <.001) more likely to drink. CONCLUSIONS: As the number of cigarette smokers in an adolescent's environment increases, risk of tobacco and alcohol use increases substantially. These data suggest that multiple models of tobacco use will substantially increase risk for substance use in adolescents.     

Children's health in families with cigarette smokers.

Recent studies have indicated higher rates of certain respiratory conditions among children who live in households with adults who smoke cigarettes. This paper analyzes data from the 1970 National Health Interview Survey. Children in families with no smokers had an average of 1.1 fewer restricted-activity days and 0.8 fewer bed-disability days per year than did children in families with two smokers. Children in families with one smoker were in between. Acute respiratory illness accounted for the difference in disability days among children in families with different smoking characteristics. Family smoking was also measured by the combined number of cigarettes smoked by adults; children in families which smoked 45 or more cigarettes a day had 1.9 more restricted activity days and 0.9 more bed-disability days due to acute respiratory conditions than did children in families who did not smoke cigarettes. The age of the child, the number of adults in the family, the education of the family head, and the family income were all controlled and did not eliminate the relationship between children's health and family smoking.