Sunday, August 10, 2008

Parental Influence on Adolescent Smoking

Condensed version: Most smokers start as a teenagers and if they become addicted, they become lifelong smokers and have a high risk of dying from smoking. The teen doesn't become addicted with the first cigarette but follows a path that can lead to addiction. The first step is thinking about trying a cigarette, then experimentation, a cigarette every now and then, which progresses to a regular pattern of usage, whether one every day after school, one every Saturday or one every time with a friend that smokes. Once this pattern is set, addiction is already being conditioned for structural brain changes that lead to addiction. Parents can influence whether their child will progress from one step to the next, those teens who are at greatest risk of continuing to smoke have parents that are uninvolved with the teens life, have friends or older siblings that smoke. Unfortunately a large number of teens that smoke are at risk for mental disorders such as depression, conduct disorder, ADHD, schizophrenia and future substance abuse.

For the full text reading:
Parental Influence on Adolescent Smoking

Smoking is one of the most preventable causes of death in the United States. Every day approximately 6000 adolescents will try smoking a cigarette for the first time, half will become a habitual smoker as an adult (U.S. Department of Health and Human Services, 2000; cited in Abroms, Haynie 2004). Over one quarter will die from the effects of their habitual smoking. (Orleans & Slade, 1993). Almost ninety percent of adult smokers started before they reached the age of 18, with 30% (Flay 1993) to 71% (U.S. Department of Health and Human Services, 2000) being habitual smokers before they were legally able to purchase cigarettes. The U.S. Department of Health and Human Services, (2000) estimates that only 7% of adult smokers who try to quit are still smoke free after one year.

It would be unethical to conduct experiments with adolescents and nicotine to assess exactly how long it takes to become addicted to nicotine after the adolescent is exposed to nicotine for the first time or exactly the changes that smoking has on the developing brain of a adolescent, however it is clear that adolescents do smoke and a large percentage will become addicted and this will decrease their life expectancy. This is the reason why it is important to look at adolescent smoking to develop strategies to prevent youth from becoming a smoker in the first place and to develop effective intervention techniques to stop the escalation into habitual adult smoking. Understanding who will quit as an adolescent and who will become an adult smoker is also important in developing these prevention and intervention strategies.

There are many reasons why an adolescent may start smoking such as peer pressure and marketing techniques of the tobacco industry. The purpose of this paper is to present a limited number of peer reviewed articles that discuss the influence of parents on adolescent smoking.

Differences have been identified as to how an adolescent relates to cigarettes and stages have been identified as to the progression of smoking which is called a tobacco trajectory.A tobacco trajectory is identified as the several stages or sequences of events that lead to the adoption of smoking by adolescents (cited in Flay, 1993, Avenevili & Merikangas, 2003): Preparatory, initiation, experimentation, regular use and nicotine dependence.The preparation stage happens when an adolescent or child begins to think about cigarettes and what meaning the cigarettes have for this child. Influences can be marketing by the tobacco companies, information about the health effects and the smoking status of parents, peers and siblings.The first one or two attempts at smoking are the initiation stage. Often there are unfavorable physical sensations such as coughing and dizziness. The next stage is experimentation, which can last for many years. It is the use of tobacco on an irregular basis. Maybe a few times a month or only with certain peers but no regular habit has been established.Regular use is the repeated use of tobacco on a regular basis whether by day, week, on weekends or just after school but with a predictable pattern.

It is important to study if parental influence is different at these different stages and to determine what truly is effective.Avenevoli & Merikangas (2003) did a literature search of published studies to see if whether parents who smoked had an influence on whether their children would smoke. They reviewed articles written after 1980 and which were mainly written in the United States. The age range was from six years old to college age, and were mainly school-based studies with predominately Caucasian subjects.The results they received are inconsistent as to whether the smoking status of a parent influences their adolescent. Several reasons were cited such as lack of standardized definitions, and the absence of adolescent that are not in school. Adolescents who drop out of school may have a higher smoking rate than those who complete high school. They did find that parents of European and Asian decent who smoke, may have an effect of their children. Significant findings were found with mothers who smoked a pack a day of cigarettes, influencing their daughters especially. More consistently they found that having an older brother or sister who smoked was predictive of both current and lifetime smoking. Having friends who smoked was an even greater predictive factor across all stages of the smoking trajectory than either having parents who smoked or older siblings whereas parental smoking was predictive in the regular use stage.

A genetic influence from twin studies (cited in Avenevoli, 2003) may lead to nicotine addiction but was not predictive for initiation.Many of the studies that Avenevoli et al (2003) reviewed did not use the stages of the tobacco trajectory so it is not known whether the effect of parental smoking may be different at different stages or whether the adult had been a former smoker or a current smoker. However, Adalbjarnardottir & Hafsteinsson (2001) did find that parental smoking was predictive of whether an adolescent became a daily smoker.Adalbjarnardottir etal (2001) looked at four different parenting styles and their influence on adolescent smoking. The four styles studied were authoritative, authoritarian, indulgent and neglectful. Theirs was a longitudinal study of 347 adolescents that they followed from age 14 to 17 in Iceland. Their results showed that adolescents whose parents were authoritative, authoritarian or indulgent were less likely to experiment with smoking at age 14 than adolescents who parents were labeled neglectful. By age 17 though, the influence on parenting styles had no effect on whether the adolescent was a daily smoker. They did exclude the daily smokers at age 14 from this progression. With cultural and attitudinal differences between the United States and Iceland it may be difficult to generalize from this study.Miller & Volk (2002) also found significant predictors among parenting styles. They used data from the National Youth Survey, which was a national longitudinal study over seven years with adolescents aged 11 to 17 with the initial information from 1976 with four subsequent follow ups. Miller et al (2202) did find that family relations were more predictive of daily use than for either the earlier stages of initiation or experimentation. Unlike Adalbjarnardottir, Miller et al (2002) did not find any significant findings when looking at how a parent disciplined their child nor their level of honesty.

The activities that Miller et al (2002) found predictive of daily smoking by the age of seventeen were: “Negative labeling of the child by the parent, perceived lack of value towards parental relationship, perceived importance of family activities, lack of time spent with one’s family, average number of weekday evenings spent with the parent and frequency of participation in family activities in the last year”. They also found that having an older sibling who smoked increased the chance of becoming a daily smoker and there was more experimentation with smoking. Miller et al (2002) also concluded that positive family relationships may reduce the risk that the adolescent becomes a daily smoker even if they have passed initiation and experimentation on the tobacco trajectory. However, the data for Miller’s study are from the late 1970’s through mid 1980. Social norm changes towards smoking and current laws against smoking may render these data outdated.In a more recent study, Simons-Miller, Chen, Abroms & Haynie (2004) also concluded that parental relations continue to influence both directly and indirectly whether an adolescent moves along the tobacco trajectory to become a daily smoker.Simon-Miller et al (2004) used data from 1996 from 1320 students in one Maryland school district with racial break down of 66% Caucasian, 25% black and 9% other for subjects. The aspects they studied were peer affiliation, parental influences and smoking stage progression. (Simons-Morton et al, 2004).They found that parental involvement, monitoring and expectations decreased the chance of child progressing forward on the tobacco trajectory but that these traits needed to be sustained over a period of time and not just exhibited at the initiation stage to be protective. They also found that parental influence had an indirect effect in protection against stage progression.

Simons-Morton et al (2004) found that adolescents that start out higher on the tobacco trajectory at earlier ages, tend to have more friends who smoke and the number increases over time. Adolescents who smoke are more likely to want to associate with other adolescents who smoke. Parents who place limits on the friendships formed with these new adolescent friends that smoke indirectly influence their adolescent’s progression . This may be limited to early adolescence since at this age many do not smoke and as the adolescent ages exposure to others who do smoke either on a regular basis or through experimentation increases. Stanton, Flay, Colder and Meta (2004) hypothesized that the escalation of smoking along the tobacco trajectory may be different than just at the initiation stage. They identified six stages: early rapid escalators, late rapid escalators, late moderate escalators, late slow escalators-smokers, stable puffers, and late slow escalators-puffers. The different stages depending on the age the adolescent started smoking and if the smoking increased quickly or over a longer period of time.The data used was from a longitudinal study from the Dunedin Multidisciplinary Health and Development Study in New Zealand. The subjects were interviewed at ages 9, 11, 13, 15, and 18 for a total of 306 subjects with 96% being Caucasian.Early predictors of future smoking at ages 11-13 included attention deficit and conduct disorders. At age 15, behavioral problems, depression scores and change of address were predictors. By age 18, poor school performance, not belonging to organized clubs and attachment to friends were predictors of smoking behavior. Intention to smoke or preparatory stage was indicated for future puffers at age 9 but not leading into rapid escalation of smoking behavior. However, the mother’s psychological symptoms when the child was 9, were an early predictor of smoking behavior. However, all of the factors mentioned may not be related to smoking specifically but may be indicative of underlying problems in the family unit.

The purpose of this paper was to investigate whether parents have an influence on whether their adolescent smokes or not. Although some parental factors do influence their adolescent no pattern was observed and it is not apparent which factors have the greatest influence.It is evident that there are inherent problems with studies in this area, due to lack of standardized definitions and inability to conduct double blind studies due to ethical reasons. Even the studies mentioned suffered from attrition of subjects, which may under estimate actual smoking rates and behaviors because most data are collected from schools. This eliminates those adolescents who do not attend school or who were absent when the initial testing was done. Adolescents who have dropped out of school, have frequent address changes or absenteeism may have higher smoking rates than students that are able to be followed for longitudinal studies. It may be that students who are stable enough to be followed, may have a more stable family life also which may influence smoking behavior.Further studies could be structured to show gender, racial and social-economic differences. Of further interest is the reason why smoking mothers influence their daughters but not their sons (Avenevoli et al 2003).Another avenue for research could look at these different factors along with social norm changes that have happened with smoking over the past decade and whether these changes affect adolescent smoking. Another area could be whether a parent has been a never-smoker or a ex-smoker or a current smoker struggling to quit, how this may influence the preparatory stage.This area of study is important in understanding how an adolescent moves from one stage of the tobacco trajectory to the next and what influences the progression and how parental influences changes with the different stages. This can lead to better prevention and intervention techniques, which over a life time will reduce the death toll from smoking.
Adalbjarnardottir, S. & Hafsteinsson, L. G. (2001). Adolescents’ Perceived Parenting Styles and Their Substance Use: Concurrent and Longitudinal Analyses. Journal of Research on Adolescence, 11 (4), 401-423.Avenevoli, S. & Merikangas, K. R. (2003). Familial Influences on Adolescent Smoking. Addiction, 98 (Suppl 1), 1-20.Flay, B. R. (1993). Youth Tobacco Use: Risks, Patterns, and Control. In C. T. Orleans & J. Slade (Eds.), Nicotine Addiction, Principles and Management, (pp 365 – 384). New York: Oxford University Press.Miller, T. Q. & Volk, R. J. (2002). Family Relationships and Adolescent Cigarette Smoking: Results form a National Longitudinal Survey. Journal of Drug Issues 0022-0426/02/03, 945-972.Simons-Morton, B., Chen, R., Abroms, L. & Hanyie, D. L. (2004) Latent Growth Curve Analyses of Peer and Parent Influences on Smoking Progression Among Early Adolescents. Health Psychology, 23 (6), 612-621.Stanton, W. R. Flay, B. R., Colder, C. R. & Mahta, P. (2004). Identifying and Predicting Adolesecent Smokers’ developmental trajectories. Nicotine & Tobacco Research 6 (5), 843-852.U.S. Department of Health and Human Services. (2000). Clinical Practice Guideline: Treating Tobacco Use and Dependence. Public Health Service.


Mz Diva said...

VJ I love your blog but what does this one say in real time English? I needed the abridged version...

VJ Sleight, Queen of Quitting said...

Thanks for the feedback Diva, I was in a hurry and someone I know had asked for information on this subject, so I just copied a paper I had written on the subject. I will post a condensed, reader friendly version, as soon as google unblocks my blog.

Mz Diva said...

I am happy to oblige. I am college graduste and I was like, "Say what?"

VJ Sleight, Queen of Quitting said...

I have posted a condensed version of this post and I left the longer version for the psychology student that had asked orginally about it. Thanks for your feedback Mz Diva!! have a blessed day. VJ