The dynamic role of parental influences in preventing adolescent smoking initiation

Background: As adolescents grow, protective parental influences become less important and peer influences take precedence in adolescent's initiation of smoking. It is unknown how and when this occurs. We sought to: prospectively estimate incidence rates of smoking initiation from late childhood through mid-adolescence, identify important risk and protective parental influences on smoking initiation, and examine their dynamic nature in order to identify key ages.

Methods: Longitudinal data from the National Survey of Parents and Youth of 8 nationally representative age cohorts (9-16 years) of never smokers in the U.S. were used (N=5705 dyads at baseline). Analysis involved a series of lagged logistic regression models using a cohort-sequential design.

Results: The mean sample cumulative incidence rates of tobacco use increased from 1.8% to 22.5% between the 9 and 16 years old age cohorts. Among risk factors, peer smoking was the most important across all ages; 11-15 year-olds who spent time with peers who smoked had 2 to 6.5 times higher odds of initiating smoking. Parent-youth connectedness significantly decreased the odds of smoking initiation by 14-37% in 11-14 year-olds; parental monitoring and punishment for smoking decreased the odds of smoking initiation risk by 36-59% in 10-15 year-olds, and by 15-28% in 12-14 year-olds, respectively.

Conclusions: Parental influences are important in protecting against smoking initiation across adolescence. At the same time, association with peers who smoke is a very strong risk factor. Our findings provide empirical evidence to suggest that in order to prevent youth from initiating smoking, parents should be actively involved in their adolescents' lives and guard them against association with peers who smoke.