Individual and social environment influences on smoking in children and adolescents

doi:10.1016/j.puhe.2007.12.011

Public Health

Volume 122, Issue 12, December 2008, Pages 1324-1330

https://doi.org/10.1016/j.puhe.2007.12.011 Get rights and content

Summary

Objectives

A precise knowledge of the risk factors for childhood and adolescent smoking is crucial for the development of appropriate preventive measures. This study investigated current smoking prevalence and the social and regional correlates for smoking among minors (children and adolescents aged 12–17 years) in Germany.

Methods

Bivariate data analysis was performed on the basis of a representative national cross-sectional study performed in 2004, and multivariable logistic regression models were calculated separately for boys and girls. All correlates identified as significant in the bivariate model were used in the multivariable analysis.

Study design

The database used in this research was from the study ‘Drug Affinity of Young People in the Federal Republic of Germany 2004’, with approximately 1298 children and adolescents aged 12–17 years.

Results

Twelve percent of male and 9% of female adolescents in Germany reported that they are habitual smokers, and 12% of male and 13% of female adolescents reported that they are occasional smokers. Multivariable data analysis shows that living in a large city is protective for adolescents in terms of local disparities. The educational level of the respondents also correlates significantly with smoking behaviour. The percentage of adolescent smokers is lowest among those with a high level of education. The presence of smokers in the household is associated with a significantly higher prevalence of smoking among adolescents compared with those growing up in a non-smoking household.

Conclusion

Smoking is a major public health problem among German children and adolescents. Control measures must tackle the structural and social pressures that shape smoking behaviour during childhood.

Introduction

The tobacco epidemic is a global challenge.¹ Approximately 1.1 billion people in the world today are smokers, and this figure is expected to rise to more than 1.6 billion by 2025.² Smoking is also the most common preventable cause of disease, disability and death,3, 4, 5 and the health hazards of smoking are well documented. Smoking increases the risk for myocardial infarction, stroke, arteriosclerosis, hypertension, pneumonia, chronic bronchitis, and malignancy of the lungs, oral cavity, pharynx and gastrointestinal tract.⁶ Early initiation of smoking is associated with an even higher risk to health because of the long-term impairment of organ development.⁶ Virtually all smokers start smoking in their youth.⁷ People who start smoking at a young age are more likely to become heavy smokers, and are more likely to die of smoking-related illnesses later in life.²

A knowledge of the risk factors for childhood and adolescent smoking is crucial for the development of appropriate preventive measures. Therefore, this study investigated current smoking prevalence and the social and regional correlates for smoking among minors (i.e. children and adolescents aged 12–17 years) in Germany.

Section snippets

Sample design

The database used in this research was from the study ‘Drug Affinity of Young People in the Federal Republic of Germany 2004’. This study was undertaken by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung), which aims to prevent health risks and support health-promoting life styles.⁸ It conducts a representative cross-sectional survey of drug affinity of children, adolescents and young adults in Germany at regular intervals every 2 years. The survey data

Results

The age groups 12–14 years and 15–17 years were investigated separately. Smoking prevalence was found to rise continuously during adolescence (Fig. 1); 9.8% of boys and 11.4% of girls aged 12–14 years were habitual or occasional smokers, and the figures rise to 37.9% and 33.4%, respectively, in 15–17 year olds.

Discussion

These results confirm that smoking is widespread among German children and adolescents, and that prevalence increases with age. These results are supported by other national and international studies.14, 15 Smoking prevalence is now equally high in both genders, which is generally attributed to a change in the gender role of the female.¹⁶

Childhood and adolescent smoking is a multifactorial phenomenon influenced by both local and social factors. The respective influences seem to be of greater or

Acknowledgements

The authors wish to thank the Federal Centre for Health Education in Cologne, Germany for providing the data sets, and Dr. Martina Pötschke-Langer (German Cancer Research Centre) for her helpful review of earlier drafts of this paper.

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Despite noticeable decline in trends of global tobacco smoking since 2000 (WHO, 2019), progress in meeting the worldwide goal set by countries and territories to cut tobacco smoking by 30 % by 2025 remains off track (WHO, 2011). Although the precise underlying causes of tobacco smoking/dependence are not well understood, evidence from epidemiological studies suggests that a combination of individual socioeconomic factors such as age, education, occupation and income (Pust, Mohnen et al. 2008; Kim, Ko et al. 2012; Fernando, Wimaladasa et al. 2019), parents' and friends' tobacco smoking status (de Vries et al., 2003), adverse childhood experiences (Alcalá, von Ehrenstein et al. 2016) and environmental tobacco smoke exposure(Leonardi-Bee, Jere et al. 2011) can significantly contribute to tobacco smoking initiation/dependence. Further, it has been proposed that influences and parental behaviours during the prenatal period may also result in adverse outcomes in offspring via in-utero programming of the developing brain (Kim, Bale et al. 2015).
There is some compelling, though not comprehensive, epidemiological evidence which suggests an association between prenatal tobacco exposure and tobacco smoking/dependence in offspring. We conducted a systematic review and meta-analysis to identify the magnitude and consistency of associations reported between prenatal tobacco exposure and subsequent tobacco smoking/dependence in offspring.
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Twenty-six cohort and one case-control study were included in the final meta-analysis. We found elevated pooled risks of tobacco smoking initiation [RR = 2.08, (95 % CI: 1.18–3.68)], ever tobacco smoking [RR = 1.21, (95 % CI: 1.05–1.38)], current tobacco smoking [RR = 1.70, (95 % CI: 1.48–1.95)] and tobacco dependence [RR = 1.50, (95 % CI: 1.31–1.73)] in offspring exposed to maternal prenatal tobacco use compared to non-exposed. We also noted higher risk estimate of current tobacco smoking in offspring exposed to heavy prenatal tobacco smoking [RR = 1.68, (95 % CI: 1.26–2.23)] when compared to prenatal exposure to lighter tobacco use [RR = 1.39, (95 % CI: 1.09–1.78)]. There was no association observed between paternal smoking during pregnancy and tobacco smoking in offspring.
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It is crucially important therefore to prevent exposure of young people to factors that increase their risk of smoking uptake. Various risk factors have been shown to be associated with tobacco use in adolescents,4 ranging from individual to social and community and societal factors—including age, sex and socio-economic status;5 parental separation6 or family conflict;7 and smoking among peer groups,8–10 in feature films11 and, perhaps most importantly, among family members.4 Smoking in the home is a recognised and entirely avoidable health hazard for children both before and after birth through passive exposure to smoke, however the influence of family smoking on the risk of smoking uptake and consequent future health of the individual is an aspect that to date has not be systematically reviewed and quantified.
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58 studies were included in the meta-analyses. The relative odds of uptake of smoking in children were increased significantly if at least one parent smoked (OR 1.72, 95% CI 1.59 to 1.86), more so by smoking by the mother (OR 2.19, 95% CI 1.73 to 2.79) than the father (OR 1.66, 95% CI 1.42 to 1.94), and if both parents smoked (OR 2.73, 95% CI 2.28 to 3.28). Smoking by a sibling increased the odds of smoking uptake by 2.30 (95% CI 1.85 to 2.86) and smoking by any household member by 1.92 (95% CI 1.70 to 2.16). After adjusting for overestimation of RRs it is estimated that, in England and Wales, around 17 000 young people take up smoking by the age of 15 each year as a consequence of exposure to household smoking.
Parental and sibling smoking is a strong and significant determinant of the risk of smoking uptake by children and young people and, as such, is a major and entirely avoidable health risk. Children should be protected from exposure to smoking behaviour, especially by family members.
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Original ResearchIndividual and social environment influences on smoking in children and adolescents

Summary

Objectives

Methods

Study design

Results

Conclusion

Introduction

Section snippets

Sample design

Results

Discussion

Acknowledgements

Lancet

Building blocks for tobacco control: a handbook

Curbing the epidemic – governments and the economics of tobacco control

Mortality in relation to smoking: 50 years' observations on male British doctors

BMJ

Mortality from cancer in relation to smoking: 50 years observations on British doctors

Br J Cancer

The health consequences of smoking: a report of the Surgeon General

Epidemiology of tobacco use among US adolescents

Nicotine Tob Res

The drug affinity of young people in the Federal Republic of Germany 2004

Guidelines for controlling and monitoring the tobacco epidemic

The classification of city regions and entwined areas in the Federal Republic of Germany

Original Research
Individual and social environment influences on smoking in children and adolescents