Intergenerational Patterns of Smoking and Nicotine Dependence Among US Adolescents

Objectives. We examined associations between parental and adolescent smoking and nicotine dependence in the United States.Methods. We used data from the 2004 to 2012 National Survey on Drug Use and Health, which ascertained smoking behaviors of 1 parent and 1 adolescent aged 12 to 17 years in 35 000 dyads. We estimated associations between parental and adolescent smoking behaviors, adjusted for covariates.Results. Parental current dependence was strongly associated with adolescents’ lifetime smoking (adjusted odds ratio AOR] = 2.96; 95% confidence interval CI] = 2.47, 3.55), whereas parental current nondependent smoking (AOR = 2.26; 95% CI = 1.92, 2.67) and former smoking (AOR = 1.51; 95% CI = 1.31, 1.75) were less strongly associated. Only parental nicotine dependence was associated with adolescent nicotine dependence (AOR = 1.66; 95% CI = 1.00, 2.74). Associations between parental and adolescent smoking did not differ by race/ethnicity. Parents’ education, marital status, and parenting and adolescents'' mental health, beliefs about smoking, perception of schoolmates’ smoking, and other substance use predicted adolescent smoking and dependence.Conclusions. Reducing parental smoking would reduce adolescent smoking. Prevention efforts should encourage parental smoking cessation, improve parenting, address adolescent mental health, and reinforce adolescents'' negative beliefs about smoking.Of the models developed to account for the etiology of substance use and dependence, familial transmission represents an important class.1,2 This is especially the case for tobacco, because most onset begins and ends in adolescence, a period of intense socialization by parents and peers. Parental smoking is an important risk factor for adolescent smoking.3–7Studies of familial influences on adolescent smoking have 2 major limitations, regarding informants and constructs. Parental smoking behaviors are ascertained mostly from offspring; nicotine dependence (ND) is rarely assessed.8 Over the past decade, however, parental self-reports have been used to examine the associations of parental smoking and ND with adolescent smoking5–7,9–19 and dependence.20–29 Parental smoking is associated with smoking by offspring in a dose–response relationship: more extensive parental smoking is associated with more extensive adolescent smoking. Parental current, persistent, and dependent smoking is associated with current, heavy, and dependent smoking by adolescents.5,10,21,22,24 Although some studies have shown specific effects of parental ND on adolescent smoking and ND,22,24–26 others have not.11,23 Former parental smoking is also associated with a slightly increased risk of adolescent lifetime and current smoking in some studies,6,15,19 but not others.10,11Associations between parental and offspring smoking differ by gender and race/ethnicity: associations are stronger for mothers than fathers7,10,13,28,30 and for daughters than sons,4,30 although stronger paternal associations with sons than daughters,11 and no parental or adolescent gender effects,12 have also been reported. Although the prevalence of smoking and ND are consistently higher among Whites than minorities,16,29,31–33 findings for associations between parental and adolescent smoking across racial/ethnic groups vary. Stronger parental influence in White than African American families16,34 and similar influences across racial/ethnic groups have been observed.17,18,35We examined intergenerational associations for cigarette smoking and ND in 9 surveys (2004–2012) of large, nationally representative samples in the National Survey on Drug Use and Health (NSDUH). The sampling of respondent pairs within the same household provides national samples of related family members. The measurement of dependence among parents and adolescents permitted analysis of familial influences on tobacco use that focused on addiction and not only use. Covariates of parental and adolescent smoking and ND4,13–18,20,22,34–48 could be controlled to estimate the unique contribution of parental smoking on offspring. Aggregating multiple surveys permitted analyses in subgroups cross-classified by parental and adolescent gender, and race/ethnicity. No other national data set contains dyadic data on ND.We addressed 3 questions: (1) What is the association between patterns of parental smoking and adolescent lifetime smoking and ND? (2) What are the unique effects of parental smoking and dependence, after adjustment for other risk factors for adolescent smoking? (3) Do the effects of parental smoking and dependence vary by parental and adolescent gender and race/ethnicity?