A telephone survey of 1,308 adolescents by Elpidoforos Soteriades, M.D., M.Sc.,
and Joseph DiFranza, M.D., appears in the July issue of the American
Journal of Public Health.
Some previous studies had tied low socioeconomic status with increased teen
smoking, but others found no association. Soteriades and DiFranza say that
their study is the first in the United States to connect parental income and
education to adolescent smoking, even after adjusting for age, sex, race/ethnicity
and other factors.
They divided parents’ incomes into four categories — those
earning $20,000 or under; $20,000 to 30,000; $30,000 to $50,000; and more
than $50,000.
Each drop on the income scale meant a 30 percent increased risk of smoking
by the teenager.
Parental education levels were categorized as less than
high school; high school diploma; some college; and college graduate. Each
step down the parents’ education
ladder meant a 28 percent increase in the risk of adolescent smoking.
A third important contributing factor was whether or not
the teen’s
parents smoked.
“Parental smoking status is a known strong predictor of adolescent smoking
and we know smoking is more prevalent among low socioeconomic status parents,” said
Soteriades and DiFranza.
Mothers set a particularly powerful example: Teens whose mothers smoked had
an 85 percent increased risk of becoming smokers themselves.
The role of parents’ smoking status suggests that
tailoring smoking cessation programs for adults with low incomes or educational
levels may
be one way of preventing their kids from smoking.
Soteriades and DiFranza originally thought that more personal
or psychological factors, like depressive symptoms or adolescent rebelliousness,
might have
an effect on smoking rates, but those turned out not to affect the role of
the parents’ socioeconomic status.
However, the amount of a teen’s spending money did seem to magnify the
effects of their parents’ income or education on the teen’s decision
to smoke or not. Teens who were receiving a weekly allowance or had earned
money from a job were more likely to be smokers, the researchers said.
Knowing that parental income and education can influence
a child’s
chances of smoking may be a starting point for preventive measures, say Soteriades
and DiFranza, but they may reflect other associations as well.
For instance, low socioeconomic status has been tied to
eschewing preventive measures like wearing seatbelts. It may also reflect
community factors such
as the quality of health education in local schools and how well smoking
bans are enforced there, or the availability of tobacco in the neighborhood.
Kids
from low socioeconomic backgrounds may also feel that life is stacked against
them or don’t care about their future health, so they may be less concerned
in the present about the long-term consequences of smoking.
“Without an understanding of why parental socioeconomic status so strongly
predicts adolescent smoking,” say Soteriades and DiFranza, “it
is not clear how that knowledge can be used for prevention except to provide
grounds for simply targeting low-socioeconomic status populations with general
preventive measures.”
More research is needed to better understand the connection between low parental
income and education and adolescent smoking, the researchers say.
This study was funded by an educational grant from the Robert Wood Johnson
Foundation and the Massachusetts Department of Public Health (Health Protection
Fund).
