LEBANON, NH—Think there is little or nothing parents can do to keep their children from smoking? Think again, says James D. Sargent, MD.

Dr. Sargent was lead investigator in a recent study of cigarette use among students in grades 4 through 12. His main finding: The chances that a child will become an established smoker are significantly decreased if the child’s parents make it clear that they strongly disapprove.[1] The effect of parental disapproval was greatest when both parents opposed smoking. Combined disapproval made the students less apt to smoke, even in the face of negative influences, such as peers, a sibling, or a parent who smoked.

The study was conducted by Dr. Sargent, an Associate Professor of Pediatrics and of Community and Family Medicine at the Dartmouth Medical School in Lebanon, NH, and his colleague Madeline Dalton, PhD. They asked students to complete three surveys, each about a year apart, on smoking status and perceptions about parents’ reactions to the possibility of the student smoking. The results were used in two types of analysis: cross-sectional and longitudinal.

In the cross-sectional analysis, the association between parental disapproval and current smoking among students was separately assessed for each of the three survey populations (which contained 663, 760, and 732 students, respectively). The longitudinal analysis evaluated the relationship between parental disapproval and the odds that a student would become an established smoker by the third survey. It included 372 children who had never smoked at baseline.

MORE PARENTING NEEDED

In all three surveys, more than half of the students—about 60%—reported that they had never used cigarettes, were not planning to in the near future, and would not smoke even if offered a cigarette by a best friend. Only about 10% were established smokers.

n the cross-sectional analysis, students who perceived both parents as strongly disapproving were less than half as likely as those who felt neither parent disapproved to report high levels of smoking, either currently or in the past. Disapproval by one parent also reduced the likelihood of high smoking levels, but not significantly.

The longitudinal analysis revealed that about 14% of the students had become established smokers by the third survey.

The chances of this occurring, though, were more than 50% lower for the students who thought both parents disapproved than for those who lacked that perception. Interestingly, smoking by parents or siblings did not significantly affect the odds that a student would become an established smoker, but the belief that parents were becoming more lenient about smoking markedly increased the risk that the child would start smoking regularly.

This study shows the positive role parents can play in combating childhood smoking. “Tobacco prevention efforts have focused a lot on school-based programs, which have had mixed or weak results, and not enough on parenting,” Dr. Sargent said. Physicians should focus more on counseling parents about the need to enforce rules against their children smoking, he added.

—Timothy Begany