Health Education Research, Vol. 18, No. 5, 627-636,
October 2003
© 2003 Oxford University Press
Parents’ and friends’ smoking status as predictors of smoking onset: findings from six European countries
Department of Health Education and Promotion, Maastricht University, PO Box 616, 6200 MD Maastricht, and 1 Department of Child and Adolescent Studies, Utrecht University, 3508 TC Utrecht, The Netherlands E–mail: hein.devries{at}gvo.unimaas.nl
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Abstract |
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This study assessed the relationship between the smoking behavior of adolescents and the smoking status of their parents and friends among adolescents from six European countries. A longitudinal study collected data from 15 705 adolescents on their own smoking status, and that of their parents, best friend and friends in general. Cross-sectional regression analysis showed that adolescent smoking was most strongly associated with friends’ smoking and best friend’s smoking, explaining 38% of the variance in the total sample. Longitudinal regression analysis, however, showed that the ß coefficients of the smoking status of the best friend and friends in general were comparable to that of parental smoking. Parental smoking behavior was found to be as predictive of smoking onset after 1 year as friends’ smoking status.
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Introduction |
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Smoking prevention projects yield mixed results, and the long-term effectiveness of smoking prevention programmes is modest (Hansen, 1992
; Reid et al., 1995; Peterson et al., 2000; Lantz et al., 2000; Tobler et al., 2000; Thomas, 2003). One explanation for these modest effects may be the fact that smoking prevention programmes are based on the social influence paradigm. Evans’ seminal work on peer pressure suggested that peer pressure to smoke constituted the most important factor in smoking uptake among adolescents (Evans et al., 1988). This assumption resulted in the development of many smoking prevention programmes based on the ‘social influence approach’.
However, a focus on peer pressure as the sole explanation for the onset of risky behaviors such as smoking and alcohol use has rightly been criticized (Ennett and Bauman, 1993, 1994; Bauman and Ennett, 1996). Some studies suggested that indirect peer pressures might be just as relevant to the explanation of smoking onset as direct pressures (De Vries and Kok, 1986; Graham et al., 1991; De Vries et al., 1995). Other criticisms concern the direction of adolescent peer influences. An alternative to peer pressure as an explanation for similarities between adolescent and peer smoking is the selection of smoking friends by an (smoking) adolescent. The selection paradigm implies that an adolescent decides to take up smoking and than chooses like-minded friends (Kandel, 1978; Cohen et al., 1994; Ennett and Bauman, 1994; De Vries, 1999).
A variety of studies have analyzed elements of the selection paradigm with regard to adolescent health behavior (Kandel, 1978; Billy et al., 1985; Fisher and Bauman, 1988; Baumrind, 1991; Brown et al., 1993; Ennett and Bauman, 1993, 1994; Cohen et al., 1994; Aseltine, 1995; Berndt and Keefe, 1995; Engels et al., 1997, 1999a; Urberg et al., 1997; Norton et al., 1998). However, Engels et al. (Engels et al., 1997) found more evidence for the influence of parents than for that of (best) friends. They also found an important effect of the smoking status of friends from cross-sectional data, but a much lower impact on adolescent smoking behavior 5 years later. The effects of peers and parents were found to be comparable in their power to explain future smoking onset. Wang et al. (Wang et al., 1999) showed that although both peer influence and selection occurred, selection might play a greater role in the commencement of smoking in adolescents.
The present study used data from two waves of adolescents in six European countries to analyze the impact of parents’ and friends’ smoking status on smoking onset among adolescents. The goal of the study was to analyze the process of relationships between the smoking status of (best) friends and parents, on the one hand, and the smoking behavior of adolescents, on the other. We hypothesized that at Time 1 (T1), adolescents’ smoking behavior is closely related to the behavior of their best friend and friends in general, and moderately related to parental smoking behavior (hypothesis 1). According to the social influence paradigm, the smoking behavior of their best friend and friends in general, as measured at T1, would accurately predict adolescents’ smoking behavior measured at Time 2 (T2). However, on the basis of the selection paradigm we hypothesized a much lower impact of their best friend and friends in general on adolescent smoking behavior at T2 (hypothesis 2). We furthermore hypothesized that the relationship between the smoking behavior of adolescents and that of their parents would be fairly stable, which would imply that the impact of parental smoking on adolescent smoking behavior at T1 should be similar to that at T2 (hypothesis 3). Finally, we examined differences between the six countries.
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Method |
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Participants
Six states of the European Community—Denmark, Finland, The Netherlands, Portugal, Spain and the UK—took part in this study, which was part of the European Smoking prevention Framework Approach study described in the previous paper (De Vries et al., 2003
). The study included 7823 (= 49.8%) male and 7876 (= 50.1%) female adolescents who participated in the first and second measurements (N = 15 705). The mean age was 13.6 years (SD = 0.58).
Procedure
Questionnaires were distributed to schools in the autumn of 1999 and 2000. Students were invited to participate and to read the introductory letter. Before the questionnaires were distributed, the teacher explained the procedure. Students were told that researchers at Maastricht University would treat their questionnaires confidentially and that they could refuse to participate. Each school pupil put their questionnaire in an envelope and sealed it. The teacher put all the questionnaires of the class into a larger envelope and sealed this one in front of the class. The same procedure was used 1 year later.
Questionnaire
The questionnaire was based on a review of the literature and earlier work regarding adolescent smoking behavior over the last 15 years (De Vries and Kok, 1986; De Vries et al., 1988, 1994, 1999), and has been described in more detail elsewhere (Kremers et al., 2001a,b).
Adolescent smoking behavior was measured on the basis of a model of adolescent smoking initiation (Kremers et al., 2001a,b), resulting in a categorization of the adolescents as: (1) never smokers (never having smoked, not even a single puff), (2) tried, but not regular smokers (having tried smoking at least once in the past but not more than 100 cigarettes in their lifetime and currently not smoking regularly), and (3) regular smokers (smoking at least once a week). Self-reports could not be validated because of logistical and financial constraints. Moreover, experimental and weekly smoking is difficult to detect. Self-reports were cross-validated by means of four items in the adolescents’ responses to questions about current smoking and lifetime smoking. In cases of incongruent answers, the respondents were allocated to the most unfavorable response. For instance, respondents who claimed to be experimental smokers in answer to the first question, but indicated having smoked more than 100 cigarettes in their lives, were classified as regular smokers (De Vries et al., 1994; US Department of Health and Human Services, 1994; Kremers et al., 2001a,b).
Parental smoking behavior was assessed by means of two questions measuring the smoking behavior of the father and the mother, using a two-point scale for each item (De Vries et al., 1995).
Friends’ smoking behavior was assessed for the best friend on a three-point scale (yes, maybe, no) and for friends in general on a five-point scale (all, more than half, half, less than half, hardly anybody) (De Vries et al., 1995).
Analysis
Multiple regression analysis was used to analyze predictors of smoking. Cross-sectional regression analyses were conducted to evaluate the correlations between the smoking status of friends, best friends and parents, on the one hand, and the adolescents’ smoking behavior at T1, on the other hand. The longitudinal effects of the predictors were analyzed in two ways. (1) The effects of the T1 predictor variables on T2 smoking were examined for the total sample, including smokers and non-smokers. (2) T1 non-regular smokers were selected in order to analyze which T1 predictors would explain the transition to regular smoking. Only the main effects were examined, since previous research found no evidence for interaction effects (De Vries et al., 1995; Engels et al., 1999b).
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Results |
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Changes in smoking behavior
Table I shows that at the time of the first measurement (T1), 4.8% of the 15 604 adolescents were weekly smokers. The highest percentage, 8.3%, was found in Finland, while the lowest percentage of regular smokers was found in Barcelona, Spain. One year later (T2), the percentage of smokers was 13.1% of the total sample of 15 541 adolescents. The highest percentage of smokers was again found in Finland (20.3%), while Portuguese adolescents reported the lowest percentage (6.1%). When looking at the percentage point increases, it can be noted that the greatest increase in regular smoking was found in Finland (12.0%) followed by Denmark (11.3%), the UK (8.6%), The Netherlands (7.9%), Spain (7.1%) and Portugal (3.2%). When looking at the increase in the smoking proportion of the sample (thus looking at the increase of numbers of smokers), the largest increase was observed in Spain (from 44 to 161; 266.0%), followed by the UK (from 199 to 575; 188.9%), Denmark (from 79 to 222; 179.7%), The Netherlands (from 157 to 435; 177.1%), Finland (from 207 to 510; 146%) and Portugal (from 63 to 133; 111.1%).
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The percentage of never smokers in the total sample dropped by 16.8%, from 63.9 to 47.1%. At T1 the largest subsample was found in Portugal, with 76.2% respondents indicating that they had never smoked a cigarette, while the lowest percentage of never smokers was found in Denmark (55.7%). A similar pattern was found 1 year later, with the highest percentage of never smokers (59.3%) in Portugal and the lowest percentage in Denmark (39%). The greatest drop in the percentage of never smokers occurred in Spain (19.7%) followed by Finland (18.1), the UK (17.4%), Portugal (16.9%), Denmark (16.7%) and The Netherlands (13.7%).
Cross-sectional associations between the smoking behavior of adolescents and that of parents and friends
Table II shows the regression coefficients and the estimates of explained variance of the multiple regression analyses. The adolescents’ smoking behavior was most strongly associated with that of friends (ß = 0.36) and that of their best friend (ß = 0.25). The ß coefficient depicting the impact of the parents was significant, but much lower. The efficacy of the model in explaining smoking behavior was 0.30; this value varied greatly between the countries (R2adj values between 0.19 and 0.37).
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Longitudinal predictors of adolescent smoking behavior
Table III shows that, over a period of 1 year, the model’s variables explained 37% of the variance in smoking behavior. The results also show that, on the whole, adolescents’ smoking behavior at T2 was best predicted by their smoking behavior at T1 (ß = 0.53). The ß coefficients of the smoking behavior of the best friend at T1 (ß = 0.04) and that of friends in general at T1 (ß = 0.08) were found to be comparable to those of the fathers’ smoking behavior at T1 (ß = 0.04) and the mother’s smoking behavior at T1 (ß = 0.06). The results suggest a slightly greater impact of the mother’s smoking behavior than that of the father, the difference being most marked in Portugal and Denmark. In Denmark, the impact of parental smoking behavior seemed to be more important than that of peer behavior. In Helsinki and Barcelona, the most important predictor besides the adolescents’ own smoking status at T1 was the smoking behavior of friends.
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Longitudinal predictors of smoking initiation among adolescents
Table IV lists the findings of the regression analyses assessing the effects of the T1 predictor variables on smoking at T2 for the category of non-smokers at T1. For the total sample, it was found that smoking initiation was best predicted by the T1 smoking behavior of friends (ß = 0.08), of the mother (ß = 0.07), of the father (ß = 0.04) and of the best friend (ß = 0.03). This model explained only 2% of the variance in smoking onset. Separate regression analyses for the six countries showed that smoking initiation was only predicted by the mother’s smoking behavior in Portugal and Denmark. In Barcelona, smoking initiation was only predicted by friends’ smoking behavior, while an almost identical pattern was found in Helsinki.
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Discussion |
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This paper analyses the predictive impact of peer and parental smoking behavior using data on 15 604 adolescents in six European countries. After 1 year, regular smoking in general was found to have increased by 8.3%, from 4.8% at the pre-test stage to 13.1% 1 year later. The overall decrease in the percentage of never smokers was 16.8%, dropping from 63.9% at the pre-test to 47.1% 1 year later.
Much research suggesting the importance of peer influence on smoking onset is based on cross-sectional research. Our cross-sectional findings also confirmed this hypothesis, suggesting that adolescent smoking behavior is most closely related to the behavior of the best friend and friends in general, and moderately related to parental smoking behavior. However, our longitudinal results showed a much smaller role of the best friend and friends in general in predicting smoking behavior 1 year later. The impact was found to be comparable to that of parental behavior, which supports our second hypothesis. We also found that the strength of the relationship between the smoking behavior of adolescents and that of their parents was similar at T1 and T2 (hypothesis 3). The last two hypotheses were also supported by the specific results for the group of T1 non-smokers. In conclusion, our data suggests that the impact of peer influences in the process of smoking onset may have been overestimated, while the impact of parental influences may have been underestimated. Our first longitudinal comparison included adolescent behavior at T1, which was the strongest predictor of future behavior. Our second longitudinal comparison included only non-smokers and showed that smoking uptake was hardly predicted by either peer or parental behavior, since only 2% of the variance in the behavioral changes among non-smoking adolescents was explained. Future research should include other factors that have been shown to be important, e.g. the adolescents’ attitudes, self-efficacy expectations and levels of self-esteem, as well as parenting styles (Conrad et al., 1992; US Department of Health and Human Services, 1994; Chassin et al., 1998).
Some interesting differences between the countries can be noted, but the interpretation of these differences is complicated by the fact that the data for Finland and Spain only comprise the results of two cities, Helsinki and Barcelona. The greatest increase in regular smoking was found in Finland (12.0%), followed by Denmark (11.3%), the UK (8.6%), The Netherlands (7.9%), Spain (7.1%) and Portugal (3.2%). The greatest drop in the percentage of never smokers occurred in Spain (19.7%), followed by Finland (18.1), the UK (17.4%), Portugal (16.9%), Denmark (16.7%) and The Netherlands (13.7%). All countries showed a pattern suggesting a more important influence by the mother than by the father. Moreover, the behavior of friends in general appeared to be a stronger predictor than that of an adolescent’s best friend. The latter can be explained by the fact that best friends may change over a period of 1 year, but that it is less likely that a whole group of friends will change. In Helsinki and Barcelona, smoking uptake within the sample of non-smokers was best predicted by peer behavior. Since these two samples only comprised adolescents from cities, it is possible that peer pressure is stronger in cities than in rural areas. More research on this topic is needed to allow firm conclusions to be drawn. In Denmark, smoking onset among the sample of non-smokers was hardly predicted by peer or parental influences. This also illustrates the need for further research on the selection paradigm to analyze the role of other factors as determinants of smoking onset. Interestingly, smoking onset among never smokers in Portugal was mainly predicted by their mother’s behavior.
Our study is subject to some limitations. (1) The self-reported smoking behavior was not validated by biochemical measures. However, self-reports have been shown to be reliable and in good agreement with biological indicators when measurements are carried out under optimized measurement conditions, ensuring anonymity (Murray et al., 1987; Hansen, 1992; Dolcini et al., 1996). Moreover, experimental and weekly smoking would have been difficult to detect anyway. We optimized measurement conditions by assuring respondents that their responses would be treated strictly confidentially. (2) The reports on parental and friends’ smoking were based on the adolescents’ own reports. However, studies in which independent reports were obtained have shown that adolescents appear to be well aware of their parents’ and friends’ risk behavior (Wilks et al., 1989). (3) Friendships may change rapidly during adolescence. This means that a strategy is needed in which we ask respondents to list the names of their current friends and to check reciprocity in peer relationships; we recommend such a strategy for future studies. (4) Methodological differences in measuring predictor variables and dependent variables, sample characteristics, attrition rates, analytic strategies, time intervals between the measurements, and countries hamper comparisons between different longitudinal studies (Conrad et al., 1992), which means that comparable findings by others (Biglan et al., 1995; Engels et al., 1997; Siddiqui et al., 1999) may have been subject to these differences as well.
Despite these limitations, the similarity between the findings among the adolescents in the six European countries in the present study suggests that parental influences and peer influences may both be important factors in the process of smoking onset, but that the impact of friends may have been overestimated and that parents as well as friends may influence adolescents, not directly but through their attitudes and self-efficacy expectations (Kandel, 1978; Biddle et al., 1980; Billy et al., 1985; Fisher and Bauman, 1988; Brown et al., 1993; Ennett and Bauman, 1993, 1994; Cohen et al., 1994; Engels et al., 1997; Urberg et al., 1997; Norton et al., 1998; Mott et al., 1999; Unger and Chen, 1999). More research on the predictors of smoking onset is needed, which should also analyze whether similar patterns are to be found among different age groups. Furthermore, it is conceivable that once friendships have been formed, the peer group may become an active reinforcing factor for smoking behavior. Consequently, peer pressure may be a very potent factor impeding smoking cessation by adolescents in a group where the majority smokes.
Our results do not provide much support for the peer pressure paradigm as an explanation of smoking onset. An alternative explanation suggests the impact of peer selection processes. This implies that an adolescent decides to take up smoking and then chooses like-minded friends (Kandel, 1978; Cohen et al., 1994; Bauman and Ennett, 1996; De Vries, 1999). Wang et al. (Wang et al., 1999) suggested that, while teaching adolescents to resist peer pressure may be necessary, it may be more important to identify factors that influence adolescents’ decisions in choosing friends who smoke. Hence, more research is needed to analyze the nature of this decision-making process, whether it is influenced by a positive attitude among adolescents towards smoking and/or by positive perceptions among adolescents of a smoking peer group, and how parental behavior influences this process (De Vries, 1999; Engels et al., 1999a). Furthermore, parental influences may not operate solely through their smoking behavior. Several studies suggest the impact of parenting styles as determinants of smoking onset, which may also have been erroneously neglected in prevention programmes (Cohen et al., 1994; Jackson and Henriksen, 1997; Chassin et al., 1998; Henriksen and Jackson, 1998; Kerr et al., 1999). Further exploration is needed to take account of how parental influences operate and how they can be included in prevention programmes to improve the latter’s effectiveness (Albert et al., 1983; Andrews and Hearne, 1984; Glynn, 1989; Biglan et al., 1996; Bogenschneider et al., 1998; Ary et al., 1999; Beyers and Goossens, 1999; Simons Morton et al., 1999; Stanton et al., 2000; Wakefield et al., 2000).
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Acknowledgements |
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The ESFA project is financed by a grant from the European Commission (The Tobacco Research and Information Fund; 96/IT/13-B96 Soc96201157). We would like to thank the national project managers in the participating countries (Carles Ariza, Paulo Duarte Vitória, Klavs Holm, Karin Jansen, Riku Lehtuvuori, Max Muqual and Lourdes Fresnillo) for their help in collecting the data. We also thank the co-contractors of the ESFA project (Anne Charlton, Errki Vartiainen, Goof Buijs, Pais Clemente, Hans Storm, Andrez González Navarro, Manel Nebot, Trudy Prins and António Romeiro), as well as all the teachers, health intermediaries and others involved in the ESFA project.
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Received on July 31, 2002; accepted on January 31, 2003
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