Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence

Abstract

The objectives of this longitudinal study were to determine the prevalence of smoking among primary school children in Liverpool, and to identify the predictors of experimentation with cigarettes during pre-adolescence.

A cohort of children (n=270) completed questionnaires that elicited patterns of child smoking behaviour and children's experiences of smoking in their families and communities each year between the ages of 9 and 11 years. Parents also completed questionnaires. Children's first trials with cigarettes and repeated smoking were reported. The independent variables measured were socio-economic status, familial and peer smoking, and intentions to smoke. By age 11, 27% of children had tried smoking, 12% had smoked repeatedly and 3% were smoking regularly. Variables measured at age 9 predicting experimentation with cigarettes by age 11 were male gender (P=0.041), paternal smoking (P=0.001), fraternal smoking (P=0.017), a best friend who smoked (P=0.026) and knowing someone with a smoking-related disease (P=0.006). Intentions to smoke at age 9 did not predict smoking at age 11 (P>0.05). In univariate analyses, child smoking was also associated with maternal smoking (P=0.002 at age 11), living in a low-income household (P<0.001 at age 10) and living in a deprived area (P=0.025 at age 11).

Early smoking presents a considerable challenge to health promoters, not least because it is socially patterned. The interventions required must tackle the structural and social pressures that shape smoking behaviour during childhood.

Introduction

Adult smoking rates in the UK have been falling for some time,¹ but smoking prevalence rates among children have remained relatively stable over the past two decades.2., 3. Four hundred and fifty British children take up smoking every day,⁴ and a recent national survey found that 10% of young people aged 11–15 years were regular smokers.² Most smokers begin to smoke regularly during their teenage years, and it is relatively unusual to take up smoking during adulthood. By the age of 16 years (the minimum legal age to purchase tobacco in the UK), seven in 10 children have tried smoking. Tobacco use by children is of particular public health concern because the earlier a child begins to smoke, the less likely they are to quit the habit as an adult, and the more likely it is that they will die prematurely from a smoking-related disease.5., 6., 7., 8., 9., 10. Smoking by children is also of concern for policy makers because ‘gateway theory’ suggests that early use of tobacco predicts illegal drug taking during adolescence and adulthood.11., 12. Smoking among adults is inversely correlated with occupational class, with higher smoking rates among people in manual than in non-manual occupations.13., 14. Thus, smoking is associated with social inequalities and, as a major cause of disease and premature death, smoking serves to create and deepen inequalities in health.

Although it is unusual for regular smoking patterns to be established before the teenage years, regular smoking is preceded by experimentation with cigarettes, and this may occur at primary school or even before children start school.15., 16., 17., 18., 19. Rates of smoking experimentation peak between the ages of 9 and 12 years for boys and 10 and 13 years for girls, therefore pre-adolescence is a key period during which to study smoking uptake.⁴

Although many children try smoking for the first time during pre-adolescence, little longitudinal research has been carried out with this age group. Instead, studies of young people and tobacco have tended to focus on adolescence, and have concentrated on measuring prevalence rates. Although numerous cross-sectional studies have examined the factors that are associated with smoking uptake among young people, few longitudinal studies have explored why some children experiment with cigarettes. As becoming a smoker is part of a process, longitudinal studies can explain sequences of events and examine the ways in which different variables operate over time. To date, no longitudinal research of this kind into smoking onset has been carried out in the UK. However, some prospective longitudinal research has been carried out with pre-adolescents in New Zealand and the USA. These studies found that smoking during pre-adolescence was predicted by early experimentation,²⁰ low academic achievement,²¹ positive perceptions of smokers,²² and parental and peer smoking.23., 24.

This article presents data from the pre-adolescent phase (age 9 in 1999 to age 11 in 2001) of the Liverpool Longitudinal Study of Smoking (LLSS). This unique, prospective longitudinal study has tracked a cohort of children throughout their years at primary school, from reception class (age 5) through to Year 6 (age 11), and has used a variety of quantitative and qualitative methods to explore children's experiences of smoking in their homes and communities.25., 26., 27., 28. This article presents quantitative analysis of the associations between socio-economic variables and early smoking. We identified which factors at age 9 predicted smoking at age 11.