Journal of Pediatric Psychology, Vol. 27, No. 6, 2002, pp. 485-496
© 2002 Society of Pediatric Psychology
Parental Smoking Cessation and Adolescent Smoking
1 Arizona State University, 2 Indiana University
All correspondence should be sent to Laurie Chassin, Psychology Department, Box 871104, Arizona State University, Tempe, Arizona 85287-1104. E-mail: laurie.chassin{at}asu.edu.
 |
Abstract |
|---|
 Top Abstract IntroductionMethodResultsDiscussionReferences |
|---|
Objective: To examine the relation of parent smoking cessation to adolescent smoking and test its potential mediators.
Method: Participants were 446 adolescents and their parents who completed a computerized measure of implicit attitudes toward smoking and questionnaires assessing smoking, parenting, and explicit attitudes.
Results: Parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked. In general, ex-smoking parents showed more antismoking socialization than did smoking parents. However, in children's reports, these effects were negated if the other parent (particularly the mother) smoked. Children's reports of parents' antismoking behavior partially mediated the relation between parental smoking and adolescent smoking. Although children's implicit and explicit attitudes were unrelated to parental smoking, mothers' implicit attitudes were related to both their own smoking and their child's smoking.
Conclusions: Parental smoking cessation may help lower risk for adolescent smoking. However, this benefit may be realized only if the other parent does not currently smoke. Antismoking parenting might be a useful focus in cessation interventions.
Key words: parent smoking cessation; parenting; adolescent smoking.
|
Introduction |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionReferences |
|---|
The role of parent smoking in adolescent smoking has been somewhat controversial, with some researchers viewing it as relatively unimportant and others finding it a robust predictor (Conrad, Flay, & Hill, 1992
). The inconsistency may stem from differing definitions of
parent smoking (i.e., current vs. lifetime smoking;
Bauman, Foshee, Linzer, & Koch,
1990), child smoking (e.g., experimental smoking vs. persistent
smoking), and differing demographics (e.g., parental smoking may be more
influential for non-Hispanic Caucasians than for others,
U.S. Department of Health and Human
Services [USDHH], 1994). Despite inconsistent findings, there are
several reasons to focus on the role of parent smoking. First, parent smoking
is related to the persistence of adolescent smoking (Flay, Hu, &
Richardson, 2000) and to smoking trajectories that are particularly
problematic because they show early onset, rapid escalation, and long-term
persistence (Chassin, Presson, Pitts, &
Sherman, 2000). Second, because tobacco dependence shows
significant heritability, parental smoking may reflect important genetic
influence (Heath & Madden,
1995).
Psychosocial research has often conceptualized the role of parent smoking
in terms of social learning theory, hypothesizing that modeling and access to
cigarettes raise adolescents' risk to smoke (Flay, Petratis, & Hu, 1999;
USDHHS, 1994). These theories
focus on the deleterious effects of adolescents' exposure to parents' current
smoking, and parents who have quit are simply viewed as nonsmokers.
Conversely, behavioral genetic theories are more likely to consider parents'
lifetime smoking, because those who have ever been regular smokers might
transmit a genetic predisposition that raises their offspring's risk to smoke
(e.g., Boomsma, Koopmanns, van Doornen,
& Orlebeke, 1994). However, neither of these approaches
focuses on the potential importance of parental cessation.
A few studies have found that parent smoking cessation is associated with
less adolescent smoking. Jackson and Henricksen (1997) reported that children
of two ex-smokers had less smoking onset than did children of two current
smokers, but higher onset rates than children of two nonsmokers. Farkas,
Distefan, Choi, Gilpin, and Pierce
(1999) found that parental
smoking cessation had the strongest effect if it occurred when the child was
younger than nine years old. Most important, Bricker et al.
(2001) found that parent
smoking cessation (when the child was in third grade) prospectively predicted
lowered risk of adolescent smoking 9 years later. However, none of these
studies examined mediating mechanisms for these effects (although Bailey,
Ennett, and Ringwalt [1993]
found that general parenting styles did not explain parental smoking cessation
effects). This study is the first to examine smoking-specific parenting and
attitudes that might mediate the relation between parent smoking cessation and
adolescent smoking.
Theoretically, parent smoking cessation might influence adolescent smoking
by several mechanisms. Social learning theory suggests that home environments
without adult smoking models will produce lower risk for adolescent smoking.
In addition, parents who have quit smoking might provide particularly strong
antismoking socialization to their children. They may be less likely to
tolerate smoking by their adolescents (perhaps to even a greater degree than
nonsmokers, given their own struggles to quit). A large literature has shown
that adolescents who view their parents as particularly intolerant of their
smoking are less likely to smoke (e.g.,
Chassin, Presson, Sherman, Corty, &
Olshavksy, 1984; see Flay et
al., 1999, for a review). Moreover, parents who have quit smoking
may be particularly motivated (even more so than nonsmokers) to protect their
children from smoking initiation. Thus, their parenting behaviors may include
punishing smoking and discussing smoking with their children. These behaviors
are associated with lowered likelihood of adolescent smoking
(Chassin, Presson, Todd, Rose, &
Sherman, 1998; Jackson & Henricksen, 1997).
However, in other ways, parental smoking cessation might actually elevate
the likelihood of adolescent smoking compared to parents who never smoked.
Ex-smoking parents may not perceive themselves as having legitimate authority
to regulate their child's smoking behavior because they do not feel
comfortable demanding that their children behave in ways that they themselves
did not. In turn, their children may not perceive them as having the
legitimate authority to regulate their smoking. Research on parenting suggests
that such a perceived lack of legitimacy reduces parents' efforts to engage in
socialization practices and also undermines the success of their efforts
(Grusec & Goodnow,
1994).
In addition to parenting factors, attitudes toward smoking might also
explain the effects of parent smoking cessation. For example, because of their
struggles to quit, parents who have stopped smoking may have particularly
negative attitudes toward smoking, and they might communicate these negative
attitudes to their children. A large literature suggests that negative
attitudes toward smoking prospectively predict low rates of smoking behavior
(see Flay et al., 1999, for a
review). However, attitudes toward smoking may also be associated with
heightened risk for adolescents with ex-smoking parents. The fact that parents
did smoke at some time might inadvertently communicate to their children that
smoking has some positive benefits. If there were no positive effects of
smoking, why would a parent have been a smoker for any length of time? Thus,
children of ex-smoking parents may view smoking as relatively positive
compared to children whose parents have never smoked, and this could increase
their risk for smoking.
Previous studies that have examined the relations between attitudes and
smoking behavior have relied on explicit (pencil and paper) measures of
attitudes, which are under conscious control and are influenced by social
desirability. Although these explicit measures are good predictors of smoking
behavior, they may be limited in their ability to predict the subtle messages
that parents transmit to their children, because these messages are likely to
be beyond the parents' awareness. In fact, explicit attitudes toward smoking
have not shown transmission from parent to adolescent
(Chassin, Presson, Rose, & Sherman,
1998). Research in social psychology suggests that explicit
measures are good predictors of behavior that is under conscious control but
not behavior that is beyond awareness
(Greenwald, McGhee, & Schwartz,
1998), which may be better predicted by implicit measures. Thus,
in predicting adolescents' smoking behavior from their parents' attitudes, the
parents' implicit attitudes rather than their explicit attitudes may be the
better predictors. This study is the first to examine the relations among
parents' implicit attitudes about smoking, parental smoking cessation, and
adolescent smoking.
The above discussion illustrates the potential importance of studying parental smoking cessation and its correlates in order to understand the processes underlying adolescents' smoking behavior. However, there are also practical implications for intervention. Treatment programs might use parental influence on children as a source of motivation to support parents' cessation efforts. These programs might also help parents discuss their own smoking cessation with their children in ways that foster the children's non-smoking. Thus, for both theoretical and practical reasons, it is important for researchers to ask whether parental smoking cessation is associated with a lowered likelihood of adolescent smoking and, if so, whether smoking-specific parenting behaviors and attitudes might mediate this effect. These are the goals of this study.
|
Method |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionReferences |
|---|
Participants
Participants were adolescents ages 10 to 17 and their parents, at least one of whom was also in our longitudinal smoking survey (Chassin et al., 1984
,
2000). All 1999 survey
respondents who reported that they had a child between ages 10 and 18 were
invited to participate in this family study (N = 861), and 556 (65%)
accepted. Parents who refused were more likely to be smokers (45.0% of
refusers vs. 32.7% of participants) and less likely to have attended college
(21.8% of refusers vs. 38.8% of participants, ps < .05),
suggesting some caution in generalization. Some families with a child over the
age of 18 were recruited for another study. Informed parental consent and
child assent were obtained at the time of the study, and the protocol was
approved by the Indiana University Institutional Review Board. Families were excluded if the child was 18 years old or older (n = 14), parental smoking cessation occurred within the past 6 months so that it might be unstable (n = 23), or the child did not live at least part time with two custodial parents (n = 73, final n for analysis = 446). (We did not consider legal custody, but were interested in environmental exposure to parental figures. Adolescents who lived full time with a single parent and had no contact with another parent figure [either because the other parent had died or had no contact] had to be eliminated because we could not consider the impact of their custodial mothers' and fathers' smoking status [and their interactions] on adolescent smoking.) In this final sample, 51% of the adolescents were female, 55% lived full time with two biological parents, and their average age was 12.8 years. Custodial parents' age averaged 34.0 for mothers and 36.1 years for fathers. Because the sample was 98% non-Hispanic Caucasian, ethnic differences were not examined.
Procedure
Families living in the vicinity attended a laboratory session, and the
others were interviewed in their homes by an interviewer from a nearby
university. For both parents and adolescents (independently), the laboratory
session began with a bioassay to validate self-reported smoking (using a
MicroCO to measure carbon monoxide in expired air). Then, both parents and
adolescents (independently) did a computer task (described below) to measure
implicit attitudes toward smoking. Finally, parents completed a questionnaire
(in separate rooms). In a different room, an interviewer read the
questionnaire items aloud to the child, who responded on his or her own copy.
All participants were assured of confidentiality.
Measures
Smoking Status. Adolescents reported whether they had ever smoked
and their current smoking frequency from less than monthly to daily. Parents
indicated their lifetime smoking status as follows: "never smoked, not
even a single puff," "smoked one or two, `just to try', but not in
the past month," "no longer smoke, but used to be a regular
smoker," "smoke, but no more than once a month,"
"smoke, but no more than once a week," "smoke, but no more
than once a day," and "smoke more than once a day." Parents
and adolescents also reported the time since their last cigarette from within
the past hour to more than 5 years ago. Eighty percent of ex-smoking parents
reported smoking their last cigarette at least 2 years ago.
The bioassay supported the validity of these self-reports. Those who did
and did not self-report smoking in the past 4 hours were compared in their
bioassay readings as a smoker (i.e., CO levels greater than 10 parts per
million; cf. Wald, Idle, Boreham, &
Bailey, 1981). The resulting kappas ranged from .73 for
adolescents to .91 for mothers (all ps<.0001).
When a parent was not interviewed (4% of custodial mothers; 27% of the custodial fathers), that parent's smoking was assessed by spousal reports. Parents were categorized as either nonsmokers (never smokers or triers), ex-smokers (used to smoke regularly but had not smoked for at least 6 months), or current smokers (smoke at least monthly).
Given the young age of the adolescents, we used their lifetime smoking
(dichotomized) as the outcome. Its prevalence was slightly lower than national
levels for middle school participants (21.7% here vs. 29.3% nationally), but
comparable to national levels for high school age participants (63.6% in this
sample vs. 63.5% nationally; Centers for
Disease Control and Prevention [CDC], 2000).
Smoking-Specific Parenting: Normative Beliefs, Legitimacy to Regulate
Adolescent Smoking, and Antismoking Behaviors. Parents reported their
normative beliefs about their adolescents' smoking, and adolescents reported
their perceptions of their mothers' and fathers' beliefs. There were three
items (e.g., parent's value on the adolescent's nonsmoking) with higher values
indicating more antismoking normative beliefs. There was good internal
consistency for adolescent report (
= .77 and .81 for perceptions of
their mothers and fathers) but less for parental self-report ( = .54
and .60 for mothers and fathers).
Parents and adolescents reported their perceptions of parental legitimacy
to regulate the adolescent's smoking (six items: e.g., "My mom
experimented with smoking as a teenager, so she doesn't have the right to try
to stop me from smoking," "It's part of my personal choice whether
or not to smoke, rather than something that my mom [dad] ought to
control," scored with higher values indicating greater legitimacy).
Because this construct has never been tested, the items were created for this
study. However, they showed good internal consistency ( = .85 for
fathers, .86 for mothers, and .89 and .82 for adolescents' ratings of their
fathers and mothers).
Finally, parents and adolescents reported the extent to which parents would
react to the adolescent's smoking with antismoking behavior (eight items:
e.g., "take away privileges," with higher values indicating more
antismoking behaviors). These items predicted adolescent smoking in an earlier
study (Chassin et al., 1998,
Chassin et al., 1998) and
showed good internal consistency in the current data ( = .83 for both
mother and father-self-report, and .88 and .90 for adolescent report of mother
and father).
For all variables, parent self-report and children's reports were significantly but modestly correlated (rs from .15 for father's legitimacy to .32 for mother's normative beliefs, all ps<.05).
Attitudes About Smoking: Implicit and Explicit Attitudes
Parents' and adolescents' implicit attitudes were measured using Greenwald
et al.'s (1998) Implicit
Association Test (IAT) procedure. The IAT uses a dual categorization task in
which one of the categorizations involves a discrimination between positive
and negative words, and the other involves a discrimination between two
stimuli (here, smoking-related pictures vs. neutral shapes). In one case, the
attitude object (e.g., cigarette) shares a response key with positive words,
while the other (e.g., shapes) shares a response key with negative words. In
the other case, these pairings are reversed. The difference in latency to
respond indicates attitudes toward cigarettes. That is, if it is more
difficult to use the same response key for cigarette images and positive
words, then implicit attitudes toward cigarettes are negative.
There were five phases, with on-screen instructions and a short practice before each one. In the first phase, positive and negative adjectives were shown. Participants responded as quickly as possible by using their right hand to press the "5" key on the number pad (if the word was good) or their left hand to press the "a" key (if the word was bad). The word remained on the screen until the participant responded. There were 16 trials with an intertrial interval of 250 ms.
The second phase asked participants to categorize pictures as either a smoking stimulus or a shape, and the pictures remained on the screen until the participant responded. There were 32 trials with an intertrial interval of 250 ms. The third phase was a random presentation of both the words and the pictures. Participants categorized each picture and responded to each word with the same response keys they had practiced earlier. The stimulus remained on the screen until the participant responded. There were 33 trials with an intertrial interval of 250 ms. The fourth phase was identical to phase two (categorizing only pictures) except that the right and left hand responses were reversed. The fifth phase was another combination task that was identical to phase three except that the right and left hand responses were reversed for categorizing the pictures.
The measure of implicit attitudes was a difference score calculated by
subtracting the mean latency score for compatible trials (i.e., trials in
which the smoking pictures and "bad" adjectives shared the same
response key) from the mean latency score for incompatible trials (i.e.,
trials in which the categorization of smoking pictures and "good"
adjectives shared the same response key). Thus, higher scores reflect more
negative implicit attitudes toward smoking. Following Greenwald et al.'s
(1998) recommendations, we
dropped the first two trials of each task from scoring to allow for adaptation
to the task, and extreme latencies (under 300 ms and over 3,000) were recoded
to equal 300 and 3,000 ms respectively. Participants with average error rates
greater than 25% were eliminated (n = 18 adolescents and 7 parents).
Children's implicit attitudes were significantly (although weakly) correlated
with mother's (r = .15, p <.05) but not father's
(r = .06) implicit attitudes.
There is now substantial evidence for the IAT's reliability, as well as
convergent and discriminant validity
(Cunningham, Preacher, & Banaji,
2001; Greenwald & Nosek,
in press). Test retest reliability has averaged above .6, and
split-half reliabilities are about .90
(Bosson, Swann, & Pennebaker,
2000; Greenwald & Farnham,
2000). Construct validity has been demonstrated by showing that
the IAT correlates in expected ways both with other implicit measures of
similar constructs (Cunningham et al.,
2001) and with group membership classification and measures of
individual differences (Greenwald et al.,
1998).
Explicit global attitudes toward smoking were measured with five items
asking if smoking was "nice," "pleasant,"
"fun," and "good" along with a rating of attitude from
"very negative" to "very positive," all with higher
values indicating more positive attitudes
(Ajzen & Fishbein, 1980).
These items prospectively predicted adolescent smoking
(Chassin et al., 1984) and had
high internal consistency in this study ( = .89 for children and
fathers and .91 for mothers). Children's and parent's explicit attitudes were
significantly (although modestly) correlated (rs = .12 for fathers
and .21 for mothers, both ps < .05).
|
Results |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionReferences |
|---|
Relations Between Parental Smoking and Adolescent Smoking
We tested whether parental smoking cessation was associated with lowered rates of child smoking using hierarchical logistic regression to predict adolescent smoking (dichotomized) from mothers' and fathers' smoking (non/ex/current; two dummy-coded variables for each) and the interaction between mothers' and fathers' smoking (four variables). Child age, family structure (child living full time with two biological parents vs. any other), and parent education were entered in the first block as covariates. In preliminary analyses, we also tested the effects of gender, but because it was unrelated to parent smoking status and to adolescent smoking, we did not pursue its effects.
All covariates had significant effects such that older children, those with
less educated parents, and those who did not live full time with two
biological parents were more likely to have smoked (Wald 
2s
from 15.6 to 61.2, all ps < .001). The block of two maternal
smoking variables added significant explained variance above and beyond the
covariates, (2[2] = 8.32, p < .02, as did the
paternal smoking variables (2[2] = 9.64, p <
.008). Finally, the block of variables representing the interaction between
maternal and paternal smoking was marginally significant above and beyond both
the covariates and main effects of parent smoking (2[4] =
7.97, p < .09). The main effects of maternal and paternal smoking
and their interaction produced a 6% change in the Negelkerke
R2 over and above the covariates.
Table I presents the
prevalence of child smoking for the combinations of maternal and paternal
smoking of interest (i.e., families with one currently smoking and one never
smoking parent are omitted). We compared the prevalence within each cell to
the most low-risk (two nonsmoking parents) and the most high-risk (two smoking
parents) combinations above and beyond the effects of the covariates. Compared
to those with two nonsmoking parents, children with two smoking parents were
significantly more likely to smoke (Wald 2[1] = 15.01,
p < .001, odds ratio [OR] = 4.19), and those with a smoking mother
and an ex-smoking father (Wald 2[1] = 3.57, p <
.06, OR = 4.21) were marginally more likely to smoke. We next compared each
cell to those with two smoking parents. Those with two smoking parents were
significantly more likely to smoke than were those with a nonsmoking mother
and an ex-smoking father (Wald 2[1] = 7.42, p <
.01, OR = 3.33) and were marginally more likely to smoke than were those with
either two ex-smoking parents or an ex-smoking mother and a smoking father
(Wald 2s[1] = 3.06 and 2.78, respectively, both ps
< .10, ORs of 3.85 and 2.63, respectively). Note that those with a smoking
mother and ex-smoking father did not differ from those with two smoking
parents.
|
Relations Between Parental Smoking and Hypothesized Mediators
We tested whether parental smoking was related to the hypothesized
mediators using a series of 3 (mothers' smoking: non/ex/current) by 3
(fathers' smoking: non/ex/current) analyses of covariance (ANCOVAs with child
age, family structure, and parent education as covariates). The sample sizes
in these analyses varied because we had fewer participating fathers than
mothers and a smaller sample in the laboratory that completed the implicit
attitude task. Thus, the power to detect a small interaction effect in these
analyses was not optimal and varied from .65 to .41. Accordingly, we probed
all of the interactions that were conventionally significant (p <
.05) or that accounted for at least 1.5% of unique variance (above and beyond
the covariates and the main effects of maternal and paternal smoking). Results
of these ANCOVAs are shown in Table
II, and means and pairwise comparisons for the interactions that
were probed are shown in Table
I. Moreover, for each interaction that was probed, we performed
three additional planned contrasts to test the impact of parent cessation when
the other parent still smoked (aggregating across some of the cells in
Table I). We compared those
with one ex-smoking parent and one smoking parent to (1) those with two
nonsmoking parents, (2) those with two smoking parents, and (3) those with one
ex-smoking parent and one non-smoking parent (with significant contrasts
described in the text).
|
Mothers' Parenting. For child reports of mothers' normative
beliefs, there was an interaction of maternal and paternal smoking (see Tables
I and
II). Children with two smoking
parents perceived their mothers as most accepting their smoking, and this
group significantly differed from all others except from children with a
smoking mother and an ex-smoking father. None of the additional planned
contrasts was significant. For child reports of mothers' legitimacy, there was
a marginally significant interaction of maternal and paternal smoking that
accounted for 1.8% of unique variance (see Tables
I and
II). Children with a smoking
mother and an ex-smoking father viewed their mothers as having the least
legitimacy to regulate their smoking, and this group differed from children of
two nonsmoking parents. Moreover, children with one ex-smoking and one smoking
parent viewed their mothers as having significantly less legitimacy than did
those with two nonsmoking parents (p < .01, 
2 =
.016) and those with an ex-smoking and a nonsmoking parent (p <
.02, 2 = .014), and they did not differ from those with two
smoking parents. Finally, for children's reports of their mothers' antismoking
behaviors, there was an interaction of maternal and paternal smoking that
accounted for 1.7% of unique variance (see Tables
I and
II). Children of two ex-smoking
parents and two-nonsmoking parents saw their parents as most antismoking,
significantly more so than did children of two smoking parents. However, those
with one ex-smoking and one smoking parent did not significantly differ from
those with two smoking parents. No additional planned contrasts were
significant.
When mothers' self-reports were considered, there was a significant effect of mothers' smoking for all three variables. In each case, smoking mothers were the most distinct, and most permissive of smoking (Madj = 4.61 for normative beliefs, 4.02 for perceived legitimacy, and 3.83 for antismoking behaviors) compared to ex-smoking and nonsmoking mothers (Madj = 4.94 and 4.98 for normative beliefs, 4.31 and 4.28 for legitimacy, and 4.18 and 4.21 for antismoking parenting behaviors).
For mother-reported legitimacy, there was also a marginally significant
interaction of maternal and paternal smoking that accounted for 1.9% of unique
variance (see Tables I and
II). Smoking mothers in
families with ex-smoking fathers self-reported the least legitimacy
(paralleling the child's perceptions). Moreover, mothers in families with one
ex-smoking parent and one smoking parent reported significantly less
legitimacy than did mothers in families with: two nonsmoking parents
(p < .05, 2 = .01) and b) one ex-smoking and one
nonsmoking parent (p < .04, 2 = .01), and they did
not differ from families with two smoking parents.
Father's Parenting. For children's reports, there were
interactions between mothers' and fathers' smoking for each of the three
variables accounting for between 2% and 3.5% of unique variance (see Tables
I and
II). For normative beliefs,
children with one smoking parent and one ex-smoking parent viewed their
fathers as more tolerant than did children in families with two nonsmoking
parents (p < .002, 2 = .02) and one ex-smoking and
one non-smoking parent (p < .02, 2 = .015) and as
tolerant as children with two smoking parents.
Legitimacy showed a similar pattern. Children with an ex-smoking father and
a smoking mother perceived their fathers as having the least legitimacy to
regulate their smoking. Finally, children in families with smoking fathers and
ex-smoking mothers viewed their fathers as showing the least antismoking
behavior. Children in families with one ex-smoking parent and one smoking
parent viewed their fathers as less antismoking than did children with two
nonsmoking parents (p < .001, 2 = .02), and they
did not significantly differ from those with two smoking parents.
Fathers' self-reports produced a marginally significant interaction for
antismoking behaviors that accounted for 2.2% of unique variance (see Tables
I and
II). Fathers in families with
one ex-smoking parent and one smoking parent self-reported the least
antismoking parenting behavior (paralleling the child's perceptions). These
fathers were less antismoking than were fathers in families with two
nonsmoking parents (p < .02, 2 = .017) and one
ex-smoking and one nonsmoking parent (p < .006, 2
= .02), and they were only marginally different from those with two smoking
parents (p < .09, 2 < .01).
Implicit Attitudes Towards Smoking. Children's implicit attitudes showed no significant unique relations to parental smoking. However, smoking mothers had more positive implicit attitudes (Madj = 226.98) than did either nonsmoking mothers (Madj = 298.50) or ex-smoking mothers (Madj 292.50). Fathers' implicit attitudes showed a significant interaction between mothers' and fathers' smoking (see Tables I and II). Fathers in families with two smoking parents had the most positive implicit attitudes, and they significantly differed from all other groups except those with ex-smoking mothers and nonsmoking fathers. Thus, even if the father smoked, when the mother was an ex-smoker, his implicit attitudes were more negative than when the mother was a current smoker.
Explicit Attitudes Toward Smoking. Children's explicit attitudes
showed no significant unique relations to parent smoking. Mothers' explicit
attitudes showed a main effect of maternal smoking such that smoking mothers
had the most positive attitudes (Madj = 2.51), compared to
nonsmoking mothers (Madj = 1.18) and ex-smoking mothers
(Madj = 1.32). Finally, fathers' explicit attitudes showed an
interaction between maternal and paternal smoking that explained 1.5% of
unique variance. Fathers in families with two smoking parents were the most
positive and differed from all groups except those with smoking fathers and
ex-smoking mothers (see Table
I). Fathers in families with one ex-smoking and one smoking parent
were more positive toward smoking than were fathers in families with two
nonsmoking parents (2 = .115, p < .001), more
positive than those with one ex-smoking parent and one nonsmoking parent
(2 = .118, p < .001), but more negative than
fathers in families with two smoking parents (2 = .025,
p < .003).
Relations Between the Hypothesized Mediators and Adolescent
Smoking
Relations between the hypothesized mediators and adolescent smoking were
tested in 10 logistic regression models (all including child age, family
structure, parental education, maternal smoking, paternal smoking, and the
interaction of maternal and paternal smoking). As noted earlier, older
adolescents, those who did not live full time with two biological parents, and
those who had less educated parents were more likely to have smoked (all
ps < .05). Moreover, significant parent smoking effects were never
entirely eliminated by adding the mediators.
The hypothesized mediators were entered in blocks in separate models as follows: parenting models (normative beliefs, perceived legitimacy, and antismoking behaviors; separate models for child report about mother, mother's self-report, child report about father, and father's self-report), implicit attitudes (separate models for child, mother, and father), and explicit global attitudes (separate models for child, mother, and father). Standardized scores for the mediators were used so that their associated ORs could be interpreted, as the increased odds of adolescent smoking given a one standard deviation change in the mediator.
Mothers' Parenting. Child reports of mothers' anti-smoking
behaviors (but not normative beliefs or legitimacy) had a unique effect on
adolescent smoking (Wald 2[1] = 13.94, p < .001,
OR = 2.15, such that those who viewed their mothers' parenting behaviors as
less antismoking were more likely to have smoked. When the model was estimated
with mothers' self-reports, there was a significant effect of normative
beliefs, but not legitimacy or behaviors (Wald 2[1] = 4.89,
p < .03, OR = 1.37), such that mothers who reported less negative
beliefs about their child's smoking were more likely to have a child who had
smoked.
Fathers' Parenting. For child reports of fathers' parenting, there
was a significant effect of antismoking behaviors, but not legitimacy or
normative beliefs (Wald 2[1] = 15.57, p < .001, OR
= 2.33), such that adolescents who viewed their fathers' parenting behaviors
as less antismoking were more likely to have smoked. Considering fathers'
self-reports, there were no significant unique effects of the parenting
mediators.
Implicit Attitudes About Smoking. Neither children's nor fathers'
implicit attitudes had unique effects on adolescent smoking. Mothers with more
positive implicit attitudes had children who were more likely to have smoked
(Wald 2[1] = 4.95, p < .03, OR = 1.41).
Explicit Attitudes About Smoking. Children's attitudes had a
significant unique relation to their smoking (Wald 2[1] =
29.35, p < .001, OR = 2.67), such that those with more positive
attitudes were more likely to have smoked. Mothers' and fathers' self-reported
explicit attitudes did not uniquely predict adolescent smoking.
Tests of Mediated Effects
Four variables met Baron and Kenny's
(1986) preconditions for
mediation (i.e., significant relations with parent smoking and significant
unique relations with child smoking over and above parent smoking). For these
variables (child reports of mothers' and fathers' antismoking parenting
behaviors, mothers' implicit attitudes, and mothers' self-reported normative
beliefs), we used MPLUS software (Muthen
& Muthen, 1998) to obtain the relevant path estimates for
mediated effects. Multinomial predictors were entered using weighted contrast
coding. The standard error of the mediated effect was calculated by extending
the multivariate delta method proposed by MacKinnon
(2000; MacKinnon, personal
communication). In these models, the tests of the mediated effects represent
the combined main effects of maternal and paternal smoking and their
interactions.1 There
was no significant mediated effect for mothers' normative beliefs. However,
there was a marginally significant mediated effect for mother's implicit
attitude (path estimate/standard error = 1.88, p < .10) and
significant effects for the child's reports of parenting behavior (path
estimate/standard error = -34.34 for mother's and -50.22 for father's
parenting, both ps < .001).
|
Discussion |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionReferences |
|---|
This study asked whether parental smoking cessation was associated with lowered levels of adolescent smoking and whether smoking-specific parenting behaviors and attitudes (both implicit and explicit) were plausible candidates to mediate such effects. Results showed that parent smoking status had a moderate-sized effect on adolescent smoking. Moreover, this effect was found above and beyond both the effects of child age and of demographic risk factors, thus representing a stringent test of parent smoking influences. Moreover, parent smoking cessation was indeed associated with reduced prevalence of adolescent smoking. Adolescents with an ex-smoking parent had lowered prevalence of smoking except when their other custodial parent (particularly the mother) was a current smoker. Although causal relations cannot be identified with our correlational design, attempts to manipulate parental smoking (i.e., in cessation interventions) could test the impact of parents' successful quitting on their adolescent children to determine whether parental smoking treatment can function as a form of preventive intervention for the next generation.
Interestingly, the beneficial effect of parental smoking cessation was largely negated if the other parent continued to smoke, particularly if that smoking parent was the mother. Smoking cessation programs already recognize that the presence of a smoking spouse raises risk for an individual's relapse after quitting. Our data suggest that the presence of a currently smoking spouse also threatens the potential benefits for the next generation.
We also asked whether smoking-specific parenting behaviors could mediate this effect. We found that parent smoking cessation was related to smoking-specific parenting variables that have been shown in other studies to reduce the risk of adolescent smoking. Namely, ex-smoking mothers viewed themselves as quite intolerant of their child's smoking, and both ex-smoking mothers and fathers viewed themselves as antismoking in their parenting (except for ex-smoking fathers in families with a currently smoking mother). However, the extent to which the children perceived such parental intolerance of their smoking and these antismoking parenting behaviors was undermined for children of ex-smoking parents when the other parent continued to smoke. Parents in these circumstances may find it difficult to frame credible antismoking messages for their children without somehow implying criticism of the other parent. A lack of consistency between parents' behaviors and their messages (and between the two parents) may create a mixed signal for these adolescents that undermines the benefits of parental cessation. These findings are consistent with the principles of social learning theory in that consistent models should be the most powerful agents of social learning, whereas inconsistent models (such as one smoking parent and one ex-smoking parent) should be less effective in transmitting parental messages.
These findings highlight the importance of children's perceptions of their
parents' antismoking behaviors because these variables were not only related
to parent smoking but also showed unique relations to adolescent smoking
(above and beyond parental smoking). In fact, our analyses showed that
children's perceptions of their parents' antismoking behaviors partially
mediated the effects of parent smoking on adolescent smoking. This finding
replicates and extends earlier work that simply compared smoking and
nonsmoking parents without considering the effects of parental smoking
cessation (e.g., Chassin et al.,
1998, Chassin et al.,
1998).
Parents' perceived legitimacy to regulate smoking was also related to
parent smoking. Contrary to prediction, ex-smoking parents did not necessarily
view themselves as having less legitimate authority to regulate their child's
smoking just because they themselves had smoked in the past. However,
adolescents in families with one ex-smoking parent and one current smoking
parent did view their parents as having this lowered legitimacy, particularly
when the mother smoked, (paralleling findings for parental normative beliefs
and antismoking behaviors already described). Perceived legitimacy has not
been studied in the context of adolescent smoking, and it did not uniquely
relate to adolescent smoking in these data. However, lowered parental
legitimacy is still of concern because adolescents should be less likely to
internalize and comply with parental directives that they view as not based in
legitimate authority (Grusec &
Goodnow, 1994). Thus, this variable warrants further study.
The importance of attitudinal variables in our data was less clear because children's attitudes (both implicit and explicit) were unrelated to parental smoking. Thus, although (as typically found) children's explicit attitudes to smoking were correlated with their smoking behavior, the children's attitudes do not appear to be shaped uniquely by their parents' smoking. Interestingly, however, parents' implicit attitudes toward smoking were related to parental smoking and (for mothers) uniquely related to the adolescent's smoking as well. This study is the first to demonstrate that mothers' implicit attitudes toward smoking relate to their child's smoking and, in fact, may be better predictors than are explicit measures of mothers' attitudes. In fact, mothers' implicit attitudes showed a marginally significant mediational pathway from parent smoking to child smoking. Although beyond the scope of this study, implicit attitudes may reflect affective messages that can interact with parenting strategies that are under more conscious control. In any case, the unique relation of mothers' implicit attitudes to adolescent smoking is a novel and potentially important finding that warrants further study.
In relating parenting and attitudes to the adolescent's smoking behavior,
many of the child-reported variables, fewer of the mother-reported variables,
and none of the father-reported variables were unique predictors (above and
beyond child age, family structure, parent education, and parent smoking).
This may reflect meaningful and important reporter effects. That is, parents'
attitudes or their beliefs that they provide antismoking parenting might be
ineffective unless their adolescents also internalize these perceptions
(Grusec & Goodnow, 1994),
and our modest correlations between parents' and adolescents' perceptions
suggest less than strong transmission from parent to child. Thus, adolescents'
perceptions might be the most important in influencing their smoking
decisions. However, methodological considerations limit the certainty with
which we can interpret any lack of relation between the hypothesized mediators
and adolescent smoking. Because this young sample has not passed through the
age of risk for smoking initiation, we cannot distinguish true nonsmokers from
those who will initiate smoking in the future. Stronger effects of
parent-reported variables might be found in predictions of longerterm
outcomes.
Although this study extended previous research by examining potential mediators of parent cessation effects, by including both implicit and explicit attitudes and both parent and adolescent reports, and by validating self-reported smoking status, it does have limitations. The young age of the subjects and the cross-sectional design dictate caution in drawing conclusions about the influence of attitudinal and parenting variables on adolescent smoking. Moreover, althought the sample size was relatively large for a laboratory-based family study, our statistical power to detect small effects (particularly pairwise differences between family types) was not optimal. It would be particularly interesting to examine larger samples of families with one ex-smoking and one currently smoking parent. Finally, our data do not allow us to examine genetic mechanisms underlying parent smoking effects.
In short, these findings suggest that parental smoking cessation may have potential benefits for adolescents in terms of a lower prevalence of smoking, but that these benefits may be undermined when one of the parents (particularly the mother) continues to smoke. The relation between parental smoking and adolescent smoking may be partly due to adolescents' perceptions of their parents' antismoking behaviors, and inconsistencies between the two parents in their smoking behavior may undermine parents' abilities to frame credible messages. Future studies of the role of parents' implicit attitudes toward smoking and of parents' perceived legitimacy to regulate adolescent smoking are also warranted, particularly with larger samples of ex-smoking parents and longitudinal designs.
|
Acknowledgments |
|---|
This research was supported by Grants DA13555 and K05DA00492 from the National Institute on Drug Abuse and HD13449 from the National Institute of Child Health and Human Development. We thank Alma Taubensee and William Rodawalt for coordinating data collection and David MacKinnon, Antonio Morgan-Lopez, and Linda Muthen for consultation on testing mediated effects. Portions of these data were presented at the 11th World Congress on Tobacco OR Health, Chicago, June 2000, in a symposium sponsored by GlaxoSmithKline and Pharmacia, and those analyses were partially supported by an unrestricted grant from GlaxoSmithKline.
|
Notes |
|---|
1 Weighted contrast coding was necessary because the available formula for the standard error does not account for indirect paths passing through correlations between coded variables. Weighted contrast coding forced all indirect effects to be accounted for in the direct paths between the coded variables and the mediators and the path from the mediator to the outcome, thus providing an appropriate estimate of the total mediated effect. However, the weighted contrast coding accounts for both the interaction and main effect terms, so that tests for the mediated effect combine both the main effects of maternal and paternal smoking and their interaction. Further research is required to develop a method for decomposing this total mediated effect into the mediated effect from the main effects and from the interaction term.
Received December 21, 2000; revision received May 30, 2001; accepted August 15, 2001
|
References |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionReferences |
|---|
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.
Bailey, S. L., Ennett, S. T., & Ringwalt, C. L. (1993). Potential mediators, moderators, or independent effects in the relationship between parents' former and current cigarette use and their children's cigarette use. Addictive Behaviors, 18, 601-621.[ISI][Medline]
Baron, R., & Kenny, D. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.[ISI][Medline]
Bauman, K. E., Foshee, V. A., Linzer, M. A., & Koch, G. G. (1990). Effect of parental smoking classification on the association between parental and adolescent smoking. Addictive Behaviors, 9, 413-422.
Boomsma, D., Koopmanns, J., van Doornen, L., & Orlebeke, J. (1994). Genetic and social influences on starting to smoke: A study of Dutch adolescent twins and their parents. Addiction, 89, 219-226.[ISI][Medline]
Bosson, J. K., Swann, W. B., & Pennebaker, J. W. (2000). Stalking the perfect measure of self-esteem: The blind men and the elephant revisited. Journal of Personality and Social Psychology, 79, 631-643.[ISI][Medline]
Bricker, J., Leroux, B., Peterson, A., Kealey, K., Sarason, I., Anderson, M. R., & Marek, P. (2001). A nine-year prospective analysis of the relationship between parent smoking cessation and children's daily smoking. Presented at the Annual Meeting of the Society for Behavioral Medicine, April, Seattle, WA.
Centers for Disease Control and Prevention (2000). Youth tobacco surveillance—United States, 1998-1999. Morbidity and Mortality Weekly Reports, 49(SS10), 1-93.
Chassin, L., Presson, C. C., Pitts, S. C., & Sherman, S. J. (2000). The natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: Multiple trajectories and their psychosocial correlates. Health Psychology, 19, 223-231.[ISI][Medline]
Chassin, L., Presson, C. C., Rose, J., & Sherman, S. J. (1998). The inter-generational transmission of beliefs about smoking and adolescent smoking. Psychology of Addictive Behaviors, 12, 206-213.
Chassin, L., Presson, C. C., Sherman, S. J., Corty, E., & Olshavsky, R. W. (1984). Predicting the onset of cigarette smoking in adolescents: A longitudinal study. Journal of Applied Social Psychology, 14, 224-243.
Chassin, L., Presson, C. C., Todd, M., Rose, J., & Sherman, S. J. (1998). Maternal socialization of adolescent smoking: The intergenerational transmission of parenting and smoking. Developmental Psychology, 34, 1189-1201.[ISI][Medline]
Conrad, K., Flay, B., & Hill, D. (1992). Why children start smoking cigarettes: Predictors of onset. British Journal of Addiction, 87, 1711-1724.[ISI][Medline]
Cunningham, W. A., Preacher, K. J., & Banaji, M. R. (2001). Implicit attitude measures: Consistency, stability, and convergent validity. Psychological Science, 12, 163-170.[ISI][Medline]
Farkas, A., Distefan, J., Choi, W., Gilpin, E., & Pierce, J. (1999). Does parental smoking cessation discourage adolescent smoking? Preventive Medicine, 28, 213-218.[ISI][Medline]
Flay, B. R., Hu, F., & Richardson, J. (1998). Psychosocial predictors of different stages of cigarette smoking among high school students. Preventive Medicine, 27, 9-18.
Flay, B. R., Petraitis, J., & Hu, F. (1999). Psychosocial risk and protective factors for adolescent tobacco use. Nicotine and Tobacco Research, 1(Suppl.), 59-66.
Greenwald, A. G., & Farnham, S. D. (2000). Using the Implicit Association Test to measure self-esteem and self-concept. Journal of Personality and Social Psychology, 79, 1022-1038.[ISI][Medline]
Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The Implicit Association Test. Journal of Personality and Social Psychology, 74, 1464-1480.[ISI][Medline]
Greenwald, A. G., & Nosek, B. A. (in press). Health of the Implicit Association Test at age 3. Zeitschrift fur Experimentelle Psychologie.
Grusec, J. E., & Goodnow, J. J. (1994). Impact of parental discipline methods on the child's internalization of values: A reconceptualization of the current points of view. Developmental Psychology, 30, 4-19.[ISI]
Heath, A., & Madden, P. (1995). Genetic influences on smoking behavior. In J. R. Turner, L. Cardon, & J. K. Hewitt (Eds.), Behavioral genetic approaches to behavioral medicine (pp. 45-65). New York: Plenum.
Jackson, C., & Henriksen, L. (1997). Do as I say: Parent smoking, antismoking socialization, and smoking onset among children. Addictive Behaviors, 22, 107-114.[ISI][Medline]
MacKinnon, D. P. (2000). Contrasts in multiple mediator models. In J. Rose, L. Chassin, C. C. Presson, & S. J. Sherman (Eds.), Multivariate applications in substance use research: New methods for new questions (pp. 141-160). Mahweh, NJ: Lawrence Erlbaum.
Muthén, L. K., & Muthén, B. (1998). Mplus user's guide. Los Angeles, CA: Muthén & Muthén.
U.S. Department of Health and Human Services. (1994). Preventing tobacco use among young people: A report of the Surgeon General. Washington, DC: U.S. Government Printing Office.
Wald, N. J., Idle, M., Boreham, J., & Bailey, A. (1981). Carbon monoxide in breath in relation to smoking and carboxyhaemoglobin levels. Thorax, 36, 366-369.[Abstract]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. P. Winickoff, E. R. Park, B. J. Hipple, A. Berkowitz, C. Vieira, J. Friebely, E. A. Healey, and N. A. Rigotti Clinical Effort Against Secondhand Smoke Exposure: Development of Framework and Intervention Pediatrics, August 1, 2008; 122(2): e363 - e375. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Foster, D. J. Jones, A. L. Olson, R. Forehand, C. A. Gaffney, M. S. Zens, and J.J. Bau Family Socialization of Adolescent's Self-Reported Cigarette Use: The Role of Parents' History of Regular Smoking and Parenting Style J. Pediatr. Psychol., May 1, 2007; 32(4): 481 - 493. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Greaves and N. Jategaonkar Tobacco policies and vulnerable girls and women: toward a framework for gender sensitive policy development J. Epidemiol. Community Health, September 1, 2006; 60(suppl_2): ii57 - ii65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Winickoff, S. E. Tanski, R. C. McMillen, B. J. Hipple, J. Friebely, and E. A. Healey A National Survey of the Acceptability of Quitlines to Help Parents Quit Smoking Pediatrics, April 1, 2006; 117(4): e695 - e700. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Chassin, C. C. Presson, J. Rose, S. J. Sherman, M. J. Davis, and J. L. Gonzalez Parenting Style and Smoking-Specific Parenting Practices as Predictors of Adolescent Smoking Onset J. Pediatr. Psychol., June 1, 2005; 30(4): 333 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. G. Molina, M. P. Marshal, W. E. Pelham Jr., and R. J. Wirth Coping Skills and Parent Support Mediate the Association Between Childhood Attention-Deficit/Hyperactivity Disorder and Adolescent Cigarette Use J. Pediatr. Psychol., June 1, 2005; 30(4): 345 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Winickoff, S. E. Tanski, R. C. McMillen, J. D. Klein, N. A. Rigotti, and M. Weitzman Child Health Care Clinicians' Use of Medications to Help Parents Quit Smoking: A National Parent Survey Pediatrics, April 1, 2005; 115(4): 1013 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Winickoff, A. B. Berkowitz, K. Brooks, S. E. Tanski, A. Geller, C. Thomson, H. A. Lando, S. Curry, M. Muramoto, A. V. Prokhorov, et al. State-of-the-Art Interventions for Office-Based Parental Tobacco Control Pediatrics, March 1, 2005; 115(3): 750 - 760. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||