- Email: [email protected]
Family life and smoking in adolescence
Pergamon
Soc. Sci. Med. Vol. 44, No. 1, pp. 93-101, 1997
S0277-9536(96)00238-9
Copyright© 1997Elsevier ScienceLtd Printed in Great Britain. All fights reserved 0277-9536/97$17.00+ 0.00
FAMILY LIFE A N D SMOKING IN ADOLESCENCE A N T H O N Y G L E N D I N N I N G , JANET SHUCKSMITH and LEO H E N D R Y Department of Education, King's College, University of Aberdeen, Aberdeen AB9 2UB, U.K. Almtract--The paper examines the relationship between perceptions of family life and smoking behaviour, using questionnaire survey data from a Scottish longitudinal study of adolescent socialization and lifestyles. Recent research has established links between adolescent health behaviours and family life, where the home environment is characterized in terms of young people's perceptions of parental support and control. The present study extends this approach, and also takes account of other important aspects of the home environment, including socio-economic circumstances and make up of the family. Perceptions of family support were found to be inversely related to smoking, with an "unsupportive" home environment associated with increased likelihood of smoking. In addition, smoking prevalences were raised where perceptions of poor support were combined with reports of fewer controls (i.e. "neglectful" parenting). More detailed multivariate analysis showed that the effects of perceived family life on smoking were felt independently of the socio-economic circumstances of the family, as characterized by neighbourhood deprivation and parents' social class. The picture was different for family structure, however, with smoking prevalences uniformly raised among adolescents from loneparent or reconstituted households, irrespective of perceptions of parenting practices. The paper concludes by discussing the potential significance of associations between family life and health behaviours for the production of class based health inequalities in youth through processes of indirect social selection. Copyright © 1997 Elsevier Science Ltd Key words--smoking, adolescence, family fife, indirect selection
INTRODUCTION In this paper we examine the possible influences of family life and the home environment on smoking behaviour in adolescence. Recent work by Foxcroft and Lowe (1995) has suggested that young people's self-perceptions of family life and relationships with parents may be important for the socialization of health behaviours. Our purpose here is to extend these findings for adolescent smoking behaviour. We are particularly concerned to locate such family influences on young people's smoking within the broader context of the young person's family circumstances, including the socio-economic position and structure of the family household. One reason for considering the broader family context, including the socio-economic circumstances of the family, is that recent research by Sweeting and West (1995) has highlighted the potential importance of family life for the patterning of class based differences in health between social groups at this stage of the life course. In particular, they have shown that aspects of family life in middle adolescence are linked to health status in later adolescence, independently of the material circumstances of the young person's family. One of the alms of the present study is to assess the extent to which associations between family life and smoking behaviour also operate independently of the socioeconomic circumstances of the young person's family.
It is well known that family based factors are associated with young people's smoking behaviour. Lynn Michell (1990), in a survey of Scottish 14 year-olds, found that nearly fives times as many young people who admitted smoking regularly came from households where a family member smoked than came from families where nobody smoked. To broaden this picture of family influences, Conrad et al. (1992) in a review of the findings of 27 prospective studies from different countries of factors affecting the onset of cigarette smoking in youth found that, for example: family socio-economic status, family "bonding", and parents' smoking were
typically identifiedas significant.However, it should be noted that in their review a whole range of indicators are grouped under the heading of socio-economic status, including, the make up of the family household, parents' occupations and parents' education. In Britain clear links have certainly been found between family structure and adolescent smoking behaviour, with young people from loneparent families, for example, being more likely to smoke (Goddard, 1990). Findings from the Exeter Family Study confirm this picture for British house-
holds; for example, children from "re-ordered" families were more likely to have tried cigarettes (Cocker and Tripp, 1994). The picture is less clear cut for parents' occupations, however, with social class differences reported in some studies and few differences reported in other studies (McNeill et al., 1988; Green et al., 1991; Rudat et al., 1992; Currie 93
94
Anthony Glendinning et al.
and Todd, 1993; Glendinning et ai., 1994). For this reason we have been careful to include a range of measures of the family's social position in the present study. Turning to factors which are related to family "bonding", and particularly relationships with parents, Foxcroft and Lowe (1991) have also conducted a meta-analysis of research on family socialization and drinking behaviour in adolescence. In line with theoretical models of parent-child relafionships, they concluded that two dimensions of family life were important for the socialization of drinking behaviour, namely, "family support" and "family control". An unsupportive home environment was associated with raised prevalences of alcohol use, whilst a supportive family environment was associated with lowered prevalences, and more moderate drinking behaviour. Links between family controls and adolescent drinking were less clear cut; and it was suggested that this was because it was at the extremes of parental control where significant effects occurred. In other words, both high and low levels of control resulted in raised prevalences and possible problem drinking. Interestingly, Foxcroft and Lowe identified "family structure" as a third influence, with adolescents from "non-intact" families tending to drink more. They also noted that these three components of the home environment (i.e. family structure, support and control) may be interrelated, with the make up of the family household affecting parent-child interactions, and so finks between family life and adolescent health behaviours are potentially complex. For this reason alone, it is necessary to take careful account of the wider family context when assessing the importance of parent-child interactions for the socialization of health behaviours. More recently Foxcroft and Lowe (1995) have examined associations between young people's perceptions of family life and self-reported health behaviours, including alcohol use and cigarette smoking, using self-completion questionnaire survey data drawn from a sample of more than 1000 12-16 year-olds. In this study adolescents were assigned by the researchers to one of four types of family enviroument on the basis of participants' own reports of levels of support and control in the family. These four types were identified with "warm-directive" families (i.e. high support and high control), "indulgent" families (i.e. high support but low control), "authoritarian" families (i.e. low support but high control) and "neglecting" families (i.e. low support and low control). No allowance was made in this categorization for families where there were more moderate levels of parental support or parental control, and more importantly no account was taken of how associations between family life and health behaviours might be affected by the wider family context. Nevertheless, the findings from the study indicated that perceived family life was associ-
ated with a range of behaviours, for example, with generally raised drinking and smoking prevalences among young people from "authoritarian" and "neglecting" families, Hence, at least from the young person's perspecfive, recent research suggests that parenting and parent-child relationships are linked to cigarette smoking. Our aim is to extend these findings using longitudinal self-report data from a representative sample of Scottish young people. We use a finer grain categorization of young people's perceptions of family life, which makes allowance for more moderate levels of perceived parental support and control. We also take account of other important aspects of the home environment, such as the make up and socio-economic circumstances of the household, when we examine associations between percepfions of family life and smoking behaviour in adolescence. Finally, we highlight the potential significance of our findings for the patterning of social class differences in health at this stage of the life course.
METHODS
Survey sample Our analysis is based on longitudinal survey data from two age cohorts of young people. An initial survey was conducted in 1987 with 13114 year-olds and with 15116 year-olds. These young people were drawn from two school year groups in each of 10 randomly selected secondary schools spread throughout Scotland. A follow up survey of the same two cohorts of young people was conducted in 1989 (at 15/16 years of age and 17/18 years of age, respectively). The initial questionnaire was completed at school under the guidance of a fieldworker, whereas the follow up questionnaire was sent by post to the respondents home address. Fifty-three percent of the original sample of 13/14 year-olds (339 out of 627) and 50% of 15/16 yearolds (296 out of 595) returned a completed postal questionnaire in 1989.
Measures of smoking A number of questionnaire items in the fofiow up survey related to smoking behaviour. Here, we focused on serf-reports of current cigarette use and reports of parents' smoking. Respondents were asked to describe their present smoking status and also to indicate how many cigarettes they currently smoked. Responses to these two closed questions were cross-checked and then used to group respondents into one of four categories of cigarette use: "none (non- or ex-smoker)', "less than once a week", "once a week or more", and "once a day or more". Respondents were considered to be "regular" smokers if they currently smoked at least one cigarette per day. Parents were characterized as
Family life and smoking "non-smokers" at follow up if the respondent reported that neither parent smoked, and otherwise as smokers.
Family circumstances
95
were identified, where the first (28% of the variance) correlated highly with items (ii), (v) and (vi), whilst the second (22% of the variance) correlated highly with items (i), (iii) and (iv). The first factor was therefore interpreted as representing perceived levels of parental support, and the second factor as representing perceived levels of parental control. These interpretations tie in well with theoretical perspectives on family socialization and health behaviours, where models of parent-child interactions typically emphasize a family support (or acceptance) dimension, and a further family control dimension.
The baseline survey was used to provide information on family circumstances. Here, we looked at family socio-economic status and family structure. Family status at baseline was characterized in terms of residential neighbourhood, parental occupations and parental education. A measure of deprivation in the young person's local neighbourhood was derived from the family's postal address, where this was linked to Census enumeration district, and so A model of parenting to small area statistics. Census data were then used It may be that different combinations of parental to define a neighbourhood deprivation index follow- support and control represent the key factor for ing the work of Duguid and Grant (1984). The adolescent socialization. This view is consistent with sample was separated into two broad groupings on that of Maccoby and Martin (1983) who proposed the basis of deprivation scores: "most deprived a fourfold classification of parent-child interactions upper quartile" and "other family households". in terms of different combinations of parental supYoung people's reports of parental occupations port and control, following on from the important were used to derive a twofold characterization of early work of Baumrind (1971, 1978). Baumrind social class of head of household (HoH) in terms of (1989) has remarked that much of the original the Registrar General's classification into: "non- research in this area was based on in-depth observamanual" and "manual" households. Another tional and interview studies, but later research by measure of socio-economic status was derived from Lamborn et al. (1991) using a large-scale questionyoung people's reports of their parents' educational naire survey approach with young people has led to experiences beyond secondary schooling, namely: a similar characterization of parent-child inter"neither parent continued education" and "one or actions. In order to develop such a characterization both parents continued education". The final vari- for the present study standardized factor scores on able relating to earlier family circumstances was the the support dimension were used to subdivide the make up of the family household, where this was sample into three groups of equal size, where these derived from questionnaire items relating to house- were intended to represent families where there were hold composition at baseline. Families were relatively low, moderate, or high levels of perceived grouped into three types of household in terms of parental support. Factor scores on the control family structure: "lone-parent families", dimension were used to subdivide the sample in "reconstituted families, with a step-parent present", terms of perceived levels of parental control in a similar way. The three support and control catand "intact two parent families". egories were then combined to produce five distinct Perceptions of parental support and control types of family. There were four types of family Young people's assessments of relationships with where there were extremes of both parental support parents at the time of the baseline survey were used and parental control, at least, from the young perto derive characterizations of "perceived family son's perspective. These were identified with life". Here, the young person's perceptions of the "authoritative" (i.e. high support and control), home environment was derived from six Likert type "permissive" (i.e. high support but low control), questionnaire items, rated on a four point scale "authoritarian" (i.e. low support but high control), from "strongly disagree" to "strongly agree". and "neglectful" (i.e. low support and control) Responses to these items reflected level of agreement families. The fifth family type represented the with each of the following statements: (i) My "other" families in the sample where levels of either parent/s have strong views about my appearance, parental support or control (or both) were viewed (ii) I do not get on well with my parent/s, (iii) My by young people as more moderate. parent/s disapprove of some of my friends, (iv) My parent/s want to know where I go in the evenings, Sample characteristics A complete set of responses to the study variables (v) My parent/s expect too much of me and, lastly, (vi) My parent/s are disappointed in me. These six relating to smoking behaviour, age, gender, parental family relationship items were entered into a princi- education, family structure, and perceptions of pal components analysis (the results indicated that family life was provided by 604 out of the 635 this was an appropriate technique to use, respondents to the follow up postal survey. Our KMO ffi 0.68). Once the factor solution had been analysis is therefore based on a sample of 604 rotated, two empirically independent dimensions young people, where this represents 49.5% of the
96
Anthony Glendinning et al.
original baseline sample. In addition, 98 of these 604 respondents (i.e. 16%) were not classified with respect to the social class of head of household, for example, because the appropriate parent figure was unemployed or non-employed at the time of the baseline survey. Interestingly, two national surveys of young people's health behaviours (one carried out in England in 1989 and the other in Scotland in 1990) where a self-completion questionnaire format was used report similar percentages of respondents as not classified with respect to social class (Rudat et al., 1992; Currie and Todd, 1993). This "unclassified" group of respondents was included in our analysis since it is likely to contain some of the most materially disadvantaged families in the sample, for example, unemployed single mothers. Finally, 45 of the 604 respondents (i.e. 7.5%) were not classified with respect to our measure of neighbourhood deprivation. This "unclassified" group was included in the analysis since it contains young people who are resident in more remote rural areas of Scotland, where a definition of the local neighbourhood in terms of small area Census statistics is not possible. We conclude the methods section by considering the effects of non-response on the composition of the follow up postal sample. Non-response to the postal survey was cross-tabulated against gender (male:female = 51:49% in 1987, and male:female = 49:51% in 1989) and against age group (13/ 14 year-olds:lS/16 year-olds = 51:49% in 1987, and 15/16 year-olds:17/18 year-olds = 53:47% in 1989). Chi-square tests indicated that the follow up postal sample was not significantly different from the baseline sample with respect to these characteristics. Non-response was also cross-tabulated against the social class of head of household at baseline for those respondents where social class was defined (non-manual:manual--47:53% in 1987, and nonmanual:manual = 49:51% in 1989). Non-response was found to be independent of social class. Lastly, non-response was cross-tabulated against family structure and was found to unrelated to the make up of the young person's family (e.g. lone-parent families = 13% in 1987, and lone-parent families = 12% in 1989). Comparisons were then made with national statistics in order to assess the representativeness of the survey sample. For families with dependent children under 16 years of age, and where social class of head of household was defined, the 1987 General Household Survey reported the proportion of nonmanual to manual households in Britain to be 46:54%, whilst the proportion of lone-parent households with dependent children under 16 years of age was at 14% (OPCS, 1989). Hence, the profile of families provided by our baseline sample in 1987 would appear to be in line with the national picture at that time, and the follow up postal sample in 1989 was similar in composition to the baseline
sample in 1987, at least for the key variables of social class and family structure.
FINDINGS
Age, gender and parents" smoking Cigarette use was clearly related to age [22(3) -- 12.98, P < 0.005; see Table 1 (a)] with less than one in six 15/16 year-olds reporting that they smoked regularly, whilst this proportion was one in four among 17/18 year-olds. Frequency of dgarette use was not related to gender in our sample, although a greater proportion of males compared to females described themselves as currently non-smokers (male:female = 62:54%). Associations with parents' smoking behaviour have been consistently reported in the literature (Charlton, 1992) and our data indicated that young people from smoking backgrounds were at least twice as likely to be regular smokers themselves [22(3)= 17.35, P < 0.001; see Table 1 (b)].
Family circumstances The results for parents' occupations and education suggested that smoking was not associated with the socio-economic status of the family [see Table 1 (d)]. These findings are consistent with the relatively complex picture for social class reported in other contemporary British studies, for example: a national survey of English schoolchildren in 1989 (funded by the Health Education Authority) found that there was no relationship between socio-economic group and regular smoking, but that young people from non-manual home backgrounds on average smoked fewer cigarettes per week (Rudat et aL, 1992), whilst a national survey of Scottish schoolchildren in 1990 (funded by the Health Education Board for Scotland) found that the relationship between smoking and socio-economic background was "complex" and dependent on age, with no social class differences found for the older age-group of 15 year-olds in this study (Cuttle and Todd, 1993). To further emphasize the point, in the present study residential neighbourhood provided a significant pattern of differences [Z2(3)= 9.06, P < 0.05; see Table 1 (c)], with young people who were living in deprived areas more likely to smoke regularly at follow up two years later. Turning to the make up of the family household, smoking was strongly associated with family structure [/2(6) = 24.77, P < 0.001; see Table 1 (e)], with raised prevalences among young people from both reconstituted and lone-parent families. Thus, some aspects of the young person's earlier home circumstances (i.e. local neighbourhood and the make up of the family) were associated with smoking, whilst other aspects (i.e. parents' social class) appeared to have little direct relationship to smoking.
Family life and smoking
97
Table 1. Respondent's smoking behaviour at follow up by (a) age and gender, (b) parents' smoking bchavionr, (e) location of family household, (d) family socioeconomic status and (e) family structure Self-reported frequency of cur~nt cigarette use None
(%)
Lessthanon~ On~ a week or On~ a d a y o r a w~k more more
(%)
Total
(%)
(%)
(%)
7 7
15 27
100 100
(a) Age and gender Cohort** 15/16 year-olds 17/18 year-olds Sex of respondent (NS) Female Male
(n = 313) (n = 291)
59 56
19 12
(n = 311) (n = 293)
54 17 62 16 (b) Parents'smokingbehaviour
8 5
21 17
100 100
Parents' described as smokers*** Yes (one or both parents) No
(n = 309) (n = 295)
53 12 64 19 (c) Location of family household
9 5
26 12
100 100
Neighbourhood deprivation index* Deprived (upper quartile) All other households t
(n = 149) (n = 455)
49 17 60 16 (d) Family socio-economie status
6 7
28 17
100
18 13 16
6 7 9
17 20 27
100 100 100
61 16 55 17 (e) Family structure
6 7
17 21
100 100
6 4 13
16 35 31
100 100 100
Parents' social class (HoH) (NS) Non-manual Manual Unclassified Parents' education post-school (NS) Yes (one or both parents) No Type of household*** Intact two-parent Reconstituted Lone-parent
(n = 251) (n = 255) (n = 98) (n = 246) (n = 358)
(n = 479) (n = 46) (n = 79)
59 60
48
62 46 40
16 15 16
100
~Includes 45 unclassified households. NS = not significant, *P < 0.05, **P < 0.005, ***P < 0.001.
Perceived parental support and control
A loglinear analysis was conducted by fitting logit models to the data presented in Table 2, with prevalence of regular smoking as the dependent variable and perceived parental support and control as explanatory variables. Neither the main effect for parental control nor the two-way interaction effect between parental support and control were found to be significant at the a = 0.05 level. By contrast, a main effect for perceived parental support was found [X2(2) = 13.86, P < 0.001], with perceptions of an unsupportive home environment associated with raised prevalences of regular smoking, whilst perceptions of supportive family relationships were associated with lowered prevalences. However, although the logit model with the main effect for parental support provided an adequate fit to the data [X2(6) = 9.52, P = 0.15], a significant residual remained to be explained for the low support/low control cell in Table 2 (Norusis, 1988). We interpreted these results to mean that there was a negative relationship between smoking and perceived levels of parental support, but, in addition, smoking prevalences were raised where poorer perceptions of parental support were combined with less parental control (i.e. a "neglectful" home environment). Multivariate analysis
Thus far, we have examined the associations between a range of family based factors and adolescent smoking, where each area of influence has been
considered in isolation (i.e. parents' smoking, neighbourhood, socio-economic status, family structure, and perceived family relationships). We next adopted a multivariate approach in which we examined the collective effects of such factors when they were considered together. In particular, we assessed the importance of more extreme types of family relationships, once the effects of other family circumstances had been controlled for. This was done by conducting a logistic regression analysis with regular smoking at follow up as the dependent variable, and a range of dichotomous "dummy" variables entered into the analysis as explanatory factors. Blocks of independent variables were forced into the logistic regression in a series of four steps, as follows: (a) age, gender and parents' smoking, (b) neighbourhood deprivation, parents' occupations and parents' education, (c) family structure, as represented by reconstituted and lone-parent households and, finally, (d) the four types of family relationship, as represented by the extremes of support and control found within authoritative, permissive, authoritarian and neglectful families. The results of the logistic regression analysis are presented in Table 3. The findings of the logistic regression [see Table 3 (d)] indicated that age, parents' smoking, family neighbourhood, family structure, and perceived type of family relationship were all associated with smoking at follow up, whilst gender and parents' social class were not. Perhaps the key finding for
98
Anthony Glendinning e t
al.
Table 2. Respondent's smoking behaviour at follow up (proportion currently smoking one or more cigarettes per day) by perceived parental support and control Self-reported prevalenceof regular smoking(%) Low (n Perceivedparental control Low (n = 208) Moderate (n ffi 195) High (n ffi 201)
'Neglectful' 34 16 'Authoritarian' 25
16 15
26
All respondents
All respondents
Perceivedparental support Moderate (n = 209)
= 199)
High (n
ffi 196)
(n = 604)
21 15
15
'Permissive' 12 14 'Authoritative' 12
16
12
19
the present study is that even when the combined effects of earlier family circumstances were controlled for (i.e. neighbourhood, socio-economic status and make up o f household) perceptions of family relationships were still associated with subsequent smoking behaviour. Thus, from the young person's perspective, a n unsupportive home environment combined with lower levels of control (i.e. "neglectful" parenting) was associated with raised smoking prevalences. (In addition, although not significantly different from 1.00 at the a = 0.05 level, odds ratios were reduced among young people from more supportive home environments.) Logistic regression also allowed for further testing for interaction effects between perceived family life and other aspects o f the young person's home circumstances. Interactive terms did not attain statistical significance, however, with the notable exception of family structure. I n order to examine this issue in more depth the data presented in Table 4 were tested for interaction effects between perceived family life and family circumstances by conducting five s e p a r a t e loglinear analysis, one for each of the other family factors included in the logistic regression. Logit models were fitted to the data in Table 4 (a)-(e), with regular smoking at follow up as the dependent variable and type of family relationship
18
and one of the other family factors as explanatory variables. N o evidence was found for a significant interaction effect between young people's smoking, parents' smoking and perceived type o f family relationship [see Table 4 (a)]. Similarly, no interaction effects were found for residential neighbourhood [see Table 4 (b)] or parents' social class [see Table 4 (c) and (d)]. Thus, associations between perceptions of family life and adolescent smoking were found to operate independently of these other family factors and, in particular, the socio-economic circumstances of the family. By contrast, a significant interaction effect was found for family structure LT2(4) = 9.56, P < 0.05; see Table 4 (e)], with smoking prevalences uniformly raised among adolescents from loneparent and reconstituted families, irrespective of the young person's perceptions o f relationships with parents. Thus, within single-parent households and households with a step-parent present, it would appear that this set of circumstances was of significance for young people's smoking behaviour, whatever type of parent-child relationship might also exist.
DISCUSSION
The profile of associations between family factors and smoking behaviour found in the present study
Table 3. Losistic regressionof respondent'ssmokingbehaviour at follow up (currentlysmokingone or more cisarettes per day) against a range of explanatory factors (n = 604) where these were entered in blocks, as follows: (a) age, gender and patents' smoking behaviour, (b) location and socioeconomic status of family household, (c) structure of family homehold and (d) perceivedtype of family relationship Explanatory variables
Xolder Xfemale
Xparents' smoke Xdeprived area
Xmanual household Xleu education XJtep.parent
Xlone-parent Xanthoritative Xpermiuive Xauthoritarian Xp~glecffttl
(a) Enter age, gender and (b) Enter familylocale (c) Enter family parents' smoking and socio-economic structure status Odds ratio P Odds ratio P Odds ratio P (n ~ (n = (n: (n ~ (n =
291) 311) 309) 149) 255)
1.90 1.09 2.12 ---
<0.01 >0.50 <0.01 ---
(n ~ 358) (n ffi 46) (n ffi 79) (n : 68)
-. .
--
(n = 67)
. .
. .
( n - 71) (n ffi 70)
. .
. .
. .
. .
Odds ratio
P
1.99 1.08 2.00 1.70 1.01
<0.01 >0.50 <0.01 0.03 > 0.50
2.04 1.09 1.93 1.66 0.99
<0.01 >0.50 <0.01 0.04 > 0.50
2.04 1.15 !.88 1.63 0.98
<0,01 >0.50 0.01 0.05 > 0.50
1.37
0.16
1.39 2.95 2.15
0.15 <0.01 0.01
i.41 2.71 2.00 0.51 0.46 i.56 1.98
0.14 0.01 0.03 0.09 0.09 0.13 0.03
. .
. . . .
(d) Enter type of family relationship
. . . .
. . . .
. . . .
Family life and smoking
99
Table 4. Perceived type of family relationship and respondent's smoking bchaviour at follow up (proportion ~ t l y smoking one or more cigarettes per day) controlling, in turn, for each of: (a) parents' smoking bchaviour, Co) location of family household, (c) parents' social class, (d) parents' education and (e) family structure Perceived type of family relationship S¢lf-re~rtcd prevalence of regular smoking (%)
Authoritative
No (non-smokers) Yes (one or both parents)
(n = 295) (n ~ 309)
Deprived areas All other areas
(n = 149) (n = 455)
Non-manual households Manual households Unclassified
(n = 251) (n = 255) (n ~ 98)
Yes (one or both parents) No
(n = 246) (n = 358)
Intact two-parent families Step- or lone-parent families
(n = 479) (n = 125)
Permissive
Authoriation
(a) Parents' smoking (NS) 8 8 17 18 CO)Local ndghbourhood (NS) 16 17 9 9 (c) Parents' social class (Hell) (NS) 12 12 13 14 20 22 (d) Parents' education post-school (NS) 8 13 14 15 (e) Family structure* 12 12 29 30
Negl~fful
Other families
21 30
32 36
12 21
36 20
41 32
18 13
24 23 31
35 34 40
15 14 23
23 24
27 42
15 16
24 32
34 34
12 33
Two-way interaction with type of family relationship: NS = not significant, *P < 0.05.
is, in general, consistent with that reported in the our sample were older, and so smoking prevalences research literature. Parents' smoking, neighbour- were correspondingly raised, and smoking habits hood deprivation, family structure and family more firmly established. Two main conclusions can "bonding" were all found to have a significant be drawn from our findings here. Perceived levels of effect on the likelihood of the young person smok- parental support are inversely related to smoking, ing regularly at follow up, but family social class with high support linked to reduced prevalences and did not, suggesting a relatively complex relationship low support linked to raised prevalences. Secondly, between socio-cconomic status and smoking in prevalences would appear to be particularly raised youth. In addition, our findings indicated that an where parents are seen as both unsupportive and unsupportive home environment with fewer controls providing fewer controls (i.e. a "'neglectful" home (i.e. where parents were seen as "neglectful") was environment). We now discuss some of the potential limitations related to raised smoking prevalences. This association between smoking and perceptions of parenting of our work. It must be acknowledged that our conwas still evident even after the combined effects of clusions are based on the young person's self-perparents' smoking, neighbourhood deprivation, ceptions. Such perceptions may or may not reflect socio-economic status and family structure were the "reality" of family life, but ultimately the young included in a multivariate analysis. Closer examin- person's subjective assessments and internalized feelation also indicated that associations between per- ings of support, acceptance and controls within the ceptions of parenting and smoking were felt family may be of considerable importance to the independently of the socio-economic circumstances adoption of health related behaviours. A further of the family. caveat is that the model of parent-child interactions Our findings for perceptions of parental support which is used in our analysis assumes a generally and control extend the results of Foxcroft and consistent approach to issues of support and control Lowe (1995) to a longitudinal sample of older ado- on the part of parents, and it may be that it is lescents, using a less extreme characterization of exactly where there is an inconsistent approach "perceived family life" although it must be noted within a more chaotic home environment that that our measures of smoking behaviour, and of young people are potentially at greatest risk. family support and control, are based on a less Additionally, there is the difficulty of making indetailed set of questionnaire items. Nevertheless, in terpretations which attempt to link cause and effect, our study there was a more marked pattern of despite the longitudinal nature of our data (e.g. the differences in smoking prevalences across family problem of reverse causation). Parent-child retypes (i.e. "warm-directive", "indulgent", lationships reflect complex family processes, and "authoritarian" and "neglecting" families), perhaps parenting practices may in part repre,scnt responses exactly because young people from such families to the young person's earlier behaviours, including were by definition in the minority in our sample, smoking behaviour. A prospective study of the and so more genuinely represented extremes of uptake of smoking with a younger age group of family life. (Fifty-four percent of respondents were adolescents would help to address this difficulty. Conrad et aL (1992) in their review of prospective categorized as coming from families where levels of support or control were seen as more moderate.) A studies identified intra-personal factors as an imfurther explanation may be that the adolescents in portant further area of explanation for the onset of
100
Anthony Glendinning et al.
smoking in youth. This is of relevance to the present study, since parenting may have consequences for the young person's self-esteem and psychological functioning at an earlier stage of development, and this in turn may help to explain associations between perceived family life and adolescent health behaviours. The point is well made by Sweeting and West (1995). Using longitudinal data from the youngest cohort of the West of Scotland Twenty-07 Study, they examined the links between family life and adolescent health status, whilst controlling for the intervening effects of the young person's self esteem. It was found that a "poorer relationship and conflict with parent(s)" was associated with poorer assessments of health, and that these associations between family life and health status were mediated by perceptions of self-esteem. Our own research in this area has also shown that perceptions of parenting practices are linked to psychological well-being in adolescence (Shucksmith eta[., 1995). Thus, a complex interplay of psychological factors may be responsible for the associations between perceived family life and adolescent health behaviours observed in the present study. At the outset we stated that one of our aims was to examine parent-adolescent relationships within the broader context of the young person's family circumstances. Our findings suggest that associations between perceived family life and adolescent smoking may operate independently of the socioeconomic status of the family, at least as characterized by neighbourhood deprivation and social class. However, the results for family structure paint a different picture. Our results indicate that within reconstituted and lone-parent families smoking was largely unaffected by perceptions of parental support and control. Interestingly, in their meta-analysis of research on family socialization and alcohol use Foxcroft and Lowe (1991) remark that associations between adolescent health behaviours, family structure, family support and family control may well be complex, and our findings would appear to confirm this conjecture in the case of adolescent smoking behaviour. We conclude by discussing the relevance of our study for the "health inequalities debate" in youth (Townsend and Davidson, 1982; Davey Smith et aL, 1990; Macintyre and West, 1991; Glendinning et al., 1992). As we have argued in detail elsewhere, smoking may well act as a marker for the production of health inequalities between social groups in later adolescence and early adulthood (Glendinning et al., 1994). The suggestion is that "indirect health selection" (West, 1991; Blane et al., 1993) on the basis of factors which are also hound up with young people's health behaviour may offer one explanation for the patterning of health by social class which is observed in adolescence and early adulthood (West, in press). In other words, adolescents' educational and employment trajectories may be
affected by a range of factors, where these factors are also linked to adolescent health behaviours, and so to adult health status. In this way, for example, adolescent smoking hehaviour may provide a marker of both social mobility and future health status. This still leaves the question of exactly how such processes of indirect social selection would operate in youth. As part of the answer, it is much easier to see possible consequences of earlier experiences of family lifeand parenting practices(e.g.lowered selfesteem and social competence, poorer psychological well-being, and "problem" bchaviour at school) as being tied to processes of social selectionand social mobility in adolescence, as well as to health bchaviours and future health outcomes. Support for such a view comes from the recent research by Sweeting and West (1995). In their work explanations for the patterning of health inequalitiesin later adolescence and early adulthood are linked to "cultural" factors operating within the family in childhood and adolescence, where these factors are seen to cut across social class boundaries. They found that various aspects of family lifein mid-adolescence were related to the young person's labour market position in late adolescence, and that these effects of family life on social position were felt independently of the material circumstances of the family. They also found that family lifewas related to subsequent health status, once again, independently of the material circumstances of the family. These findings for family lifeand adolescent health parallel the findings reported in the present study for family life and adolescent smoking. There are some differences of detail, however, with Sweeting and West (1995) reporting few associationsbetween family "centredness', parental "strictness" and health, but a significant pattern of associations between family "conflict", quality of "relationship with parent(s)" and subsequent health status. Nevertheless, for both studies the general conclusion is the same, earlierexperiences of family lifewould appear to be related to adolescent health and to adolescent health behaviours independently of the socio-economic circumstances of the family. Family life may therefore have a significantrole to play in explaining the production of social class differences in health in youth through a process of indirect selection.
REFERENCES
Baumrind, D. (1971) Current patterns of parental authority. Developments in Psychology Monographs 4, 1-102. Baumrind, D. (1978) Authoritarian versus authoritative parents control. Adolescence 3, 255-272. Baumrind, D. (1989) Rearing competent children. In Child Development Today and Tomorrow, ed. W. Damon.
Jossey Bass, San Francisco.
Family life and smoking Blane, D., Davey Smith, G. and Bartley, M. (1993) Social selection: what does it contribute to social class differences in health7 Sociology of Health & Illness 15, 1-15. Charlton, A. (1992) Children and tobacco. British Journal of Cancer 66, 1-4. Cockett, M. and Tripp, J. (1994) The Exeter Family Study: Family Breakdown and its Impact on Children. Exeter University Press, Exeter. Conrad, K. M., Flay, B. R. and Hill, D. (1992) Why children start smoking cigarettes: predictors of onset. British Journal of Addiction 87, 1711-1724. Currie, C. and Todd, J. (1993) Health Behaviours of Scottish Schoolchildren." Family, Peer, School and Socioeconomic Influences. Research Unit in Health and Behavioural Change, University of Edinburgh, Edinburgh. Davey Smith, G., Bartley, M. and Blanc, D. (1990) The Black report on socioeconomic inequalities in health 10 years on. British Medical Journal 301, 373-377. Duguid, G. and Grant, R. (1984) Areas of Special Need in Scotland. HMSO, Edinburgh. Foxcroft, D. R. and Lowe, G. (1991) Adolescent drinking behaviour and family socialisation factors: a meta-analysis. Journal of Adolescence 14, 255-273. Foxcroft, D. R. and Lowe, G. (1995) Adolescent drinking, smoking and other substance use involvement: links with perceived family life. Journal of Adolescence 18, 159-177. Glendinning, A., Love, J., Hendry, L. and Shucksmith, J. (1992) Adolescence and health inequalities: extensions to Macintyre and West. Social Science & Medicine 35, 679687. Glendinning, A., Shucksmith, J. and Hendry, L. (1994) Social class and adolescent smoking behaviour. Social Science & Medicine 38, 1449-1460. Green, G., Macintyre, S., West, P. and Ecob, R. (1991) Like parent like child? Associations between drinking and smoking behaviour of parents and their children. British Journal of Addiction 86, 745-758. Goddard, E. (1990) Why Children Start Smoking. HMSO, London.
101
Lamborn, S. D., Mounts, N., Steinberg, L. and Dornbusch, S. (1991) Patterns of competence and adjustment among adolescents from authoritative, authoritarian, indulgent and neglectful families. Child Development 62, 1049-1065. Maccoby, E. and Martin, J. (1983) Socialisation in the context of the family: parent-child interaction. In Handbook of Child Psychology, ed. P. H. Mussen. Wiley, New York. Macintyre, S. and West, P. (1991) Lack of class variation in health in adolescence: an artefact of an occupational measure of social class. Social Science & Medicine 32, 395-402. McNeill, A. D., Jarvis, M. J., Stapleton, J. A., Russell, M. A. H., Eiser, J. R., Gammage, P. and Gray, E. M. (1988) Prospective study of factors predicting uptake of smoking in adolescents. Journal of Epidemiology and Community Health 43, 72-78. MicheU, L. (1990) Growing up in Smoke. Pluto, London. Norusis, M. J. (1988) SPPS-X Advanced Statistics Guide. SPSS Inc., Chicago. Office of Population Censuses and Surveys (OPCS) (1989) General Household Survey, 1987. HMSO, London. Rudat, K., Speed, M. and Ryan, H. (1992) Tomorrow's Young Adults: 9-15 year-olds look at alcohol, drugs, exercise and smoking. Health Education Authority, London. Shucksmith, J., Hendry, L. and Glendinning, A. (1995) Models of parenting: implications for adolescent wellbeing within different types of family contexts. Journal of Adolescence 18, 253-270. Sweeting, H. and West, P. (1995) Family life and health in adolescence: a role for culture in the health inequalities debate? Social Science & Medicine 40, 163-175. Townsend, P. and Davidson, N. (1982) Inequalities in Health: The Black Report. Penguin, Harmondsworth. West, P. (1991) Rethinking the health selection explanation for health inequalities. Social Science & Medicine 35, 373-384. West, P. (in press) Health inequalities in the early years: is there equalisation in youth? Social Science & Medicine.
Soc. Sci. Med. Vol. 44, No. 1, pp. 93-101, 1997
S0277-9536(96)00238-9
Copyright© 1997Elsevier ScienceLtd Printed in Great Britain. All fights reserved 0277-9536/97$17.00+ 0.00
FAMILY LIFE A N D SMOKING IN ADOLESCENCE A N T H O N Y G L E N D I N N I N G , JANET SHUCKSMITH and LEO H E N D R Y Department of Education, King's College, University of Aberdeen, Aberdeen AB9 2UB, U.K. Almtract--The paper examines the relationship between perceptions of family life and smoking behaviour, using questionnaire survey data from a Scottish longitudinal study of adolescent socialization and lifestyles. Recent research has established links between adolescent health behaviours and family life, where the home environment is characterized in terms of young people's perceptions of parental support and control. The present study extends this approach, and also takes account of other important aspects of the home environment, including socio-economic circumstances and make up of the family. Perceptions of family support were found to be inversely related to smoking, with an "unsupportive" home environment associated with increased likelihood of smoking. In addition, smoking prevalences were raised where perceptions of poor support were combined with reports of fewer controls (i.e. "neglectful" parenting). More detailed multivariate analysis showed that the effects of perceived family life on smoking were felt independently of the socio-economic circumstances of the family, as characterized by neighbourhood deprivation and parents' social class. The picture was different for family structure, however, with smoking prevalences uniformly raised among adolescents from loneparent or reconstituted households, irrespective of perceptions of parenting practices. The paper concludes by discussing the potential significance of associations between family life and health behaviours for the production of class based health inequalities in youth through processes of indirect social selection. Copyright © 1997 Elsevier Science Ltd Key words--smoking, adolescence, family fife, indirect selection
INTRODUCTION In this paper we examine the possible influences of family life and the home environment on smoking behaviour in adolescence. Recent work by Foxcroft and Lowe (1995) has suggested that young people's self-perceptions of family life and relationships with parents may be important for the socialization of health behaviours. Our purpose here is to extend these findings for adolescent smoking behaviour. We are particularly concerned to locate such family influences on young people's smoking within the broader context of the young person's family circumstances, including the socio-economic position and structure of the family household. One reason for considering the broader family context, including the socio-economic circumstances of the family, is that recent research by Sweeting and West (1995) has highlighted the potential importance of family life for the patterning of class based differences in health between social groups at this stage of the life course. In particular, they have shown that aspects of family life in middle adolescence are linked to health status in later adolescence, independently of the material circumstances of the young person's family. One of the alms of the present study is to assess the extent to which associations between family life and smoking behaviour also operate independently of the socioeconomic circumstances of the young person's family.
It is well known that family based factors are associated with young people's smoking behaviour. Lynn Michell (1990), in a survey of Scottish 14 year-olds, found that nearly fives times as many young people who admitted smoking regularly came from households where a family member smoked than came from families where nobody smoked. To broaden this picture of family influences, Conrad et al. (1992) in a review of the findings of 27 prospective studies from different countries of factors affecting the onset of cigarette smoking in youth found that, for example: family socio-economic status, family "bonding", and parents' smoking were
typically identifiedas significant.However, it should be noted that in their review a whole range of indicators are grouped under the heading of socio-economic status, including, the make up of the family household, parents' occupations and parents' education. In Britain clear links have certainly been found between family structure and adolescent smoking behaviour, with young people from loneparent families, for example, being more likely to smoke (Goddard, 1990). Findings from the Exeter Family Study confirm this picture for British house-
holds; for example, children from "re-ordered" families were more likely to have tried cigarettes (Cocker and Tripp, 1994). The picture is less clear cut for parents' occupations, however, with social class differences reported in some studies and few differences reported in other studies (McNeill et al., 1988; Green et al., 1991; Rudat et al., 1992; Currie 93
94
Anthony Glendinning et al.
and Todd, 1993; Glendinning et ai., 1994). For this reason we have been careful to include a range of measures of the family's social position in the present study. Turning to factors which are related to family "bonding", and particularly relationships with parents, Foxcroft and Lowe (1991) have also conducted a meta-analysis of research on family socialization and drinking behaviour in adolescence. In line with theoretical models of parent-child relafionships, they concluded that two dimensions of family life were important for the socialization of drinking behaviour, namely, "family support" and "family control". An unsupportive home environment was associated with raised prevalences of alcohol use, whilst a supportive family environment was associated with lowered prevalences, and more moderate drinking behaviour. Links between family controls and adolescent drinking were less clear cut; and it was suggested that this was because it was at the extremes of parental control where significant effects occurred. In other words, both high and low levels of control resulted in raised prevalences and possible problem drinking. Interestingly, Foxcroft and Lowe identified "family structure" as a third influence, with adolescents from "non-intact" families tending to drink more. They also noted that these three components of the home environment (i.e. family structure, support and control) may be interrelated, with the make up of the family household affecting parent-child interactions, and so finks between family life and adolescent health behaviours are potentially complex. For this reason alone, it is necessary to take careful account of the wider family context when assessing the importance of parent-child interactions for the socialization of health behaviours. More recently Foxcroft and Lowe (1995) have examined associations between young people's perceptions of family life and self-reported health behaviours, including alcohol use and cigarette smoking, using self-completion questionnaire survey data drawn from a sample of more than 1000 12-16 year-olds. In this study adolescents were assigned by the researchers to one of four types of family enviroument on the basis of participants' own reports of levels of support and control in the family. These four types were identified with "warm-directive" families (i.e. high support and high control), "indulgent" families (i.e. high support but low control), "authoritarian" families (i.e. low support but high control) and "neglecting" families (i.e. low support and low control). No allowance was made in this categorization for families where there were more moderate levels of parental support or parental control, and more importantly no account was taken of how associations between family life and health behaviours might be affected by the wider family context. Nevertheless, the findings from the study indicated that perceived family life was associ-
ated with a range of behaviours, for example, with generally raised drinking and smoking prevalences among young people from "authoritarian" and "neglecting" families, Hence, at least from the young person's perspecfive, recent research suggests that parenting and parent-child relationships are linked to cigarette smoking. Our aim is to extend these findings using longitudinal self-report data from a representative sample of Scottish young people. We use a finer grain categorization of young people's perceptions of family life, which makes allowance for more moderate levels of perceived parental support and control. We also take account of other important aspects of the home environment, such as the make up and socio-economic circumstances of the household, when we examine associations between percepfions of family life and smoking behaviour in adolescence. Finally, we highlight the potential significance of our findings for the patterning of social class differences in health at this stage of the life course.
METHODS
Survey sample Our analysis is based on longitudinal survey data from two age cohorts of young people. An initial survey was conducted in 1987 with 13114 year-olds and with 15116 year-olds. These young people were drawn from two school year groups in each of 10 randomly selected secondary schools spread throughout Scotland. A follow up survey of the same two cohorts of young people was conducted in 1989 (at 15/16 years of age and 17/18 years of age, respectively). The initial questionnaire was completed at school under the guidance of a fieldworker, whereas the follow up questionnaire was sent by post to the respondents home address. Fifty-three percent of the original sample of 13/14 year-olds (339 out of 627) and 50% of 15/16 yearolds (296 out of 595) returned a completed postal questionnaire in 1989.
Measures of smoking A number of questionnaire items in the fofiow up survey related to smoking behaviour. Here, we focused on serf-reports of current cigarette use and reports of parents' smoking. Respondents were asked to describe their present smoking status and also to indicate how many cigarettes they currently smoked. Responses to these two closed questions were cross-checked and then used to group respondents into one of four categories of cigarette use: "none (non- or ex-smoker)', "less than once a week", "once a week or more", and "once a day or more". Respondents were considered to be "regular" smokers if they currently smoked at least one cigarette per day. Parents were characterized as
Family life and smoking "non-smokers" at follow up if the respondent reported that neither parent smoked, and otherwise as smokers.
Family circumstances
95
were identified, where the first (28% of the variance) correlated highly with items (ii), (v) and (vi), whilst the second (22% of the variance) correlated highly with items (i), (iii) and (iv). The first factor was therefore interpreted as representing perceived levels of parental support, and the second factor as representing perceived levels of parental control. These interpretations tie in well with theoretical perspectives on family socialization and health behaviours, where models of parent-child interactions typically emphasize a family support (or acceptance) dimension, and a further family control dimension.
The baseline survey was used to provide information on family circumstances. Here, we looked at family socio-economic status and family structure. Family status at baseline was characterized in terms of residential neighbourhood, parental occupations and parental education. A measure of deprivation in the young person's local neighbourhood was derived from the family's postal address, where this was linked to Census enumeration district, and so A model of parenting to small area statistics. Census data were then used It may be that different combinations of parental to define a neighbourhood deprivation index follow- support and control represent the key factor for ing the work of Duguid and Grant (1984). The adolescent socialization. This view is consistent with sample was separated into two broad groupings on that of Maccoby and Martin (1983) who proposed the basis of deprivation scores: "most deprived a fourfold classification of parent-child interactions upper quartile" and "other family households". in terms of different combinations of parental supYoung people's reports of parental occupations port and control, following on from the important were used to derive a twofold characterization of early work of Baumrind (1971, 1978). Baumrind social class of head of household (HoH) in terms of (1989) has remarked that much of the original the Registrar General's classification into: "non- research in this area was based on in-depth observamanual" and "manual" households. Another tional and interview studies, but later research by measure of socio-economic status was derived from Lamborn et al. (1991) using a large-scale questionyoung people's reports of their parents' educational naire survey approach with young people has led to experiences beyond secondary schooling, namely: a similar characterization of parent-child inter"neither parent continued education" and "one or actions. In order to develop such a characterization both parents continued education". The final vari- for the present study standardized factor scores on able relating to earlier family circumstances was the the support dimension were used to subdivide the make up of the family household, where this was sample into three groups of equal size, where these derived from questionnaire items relating to house- were intended to represent families where there were hold composition at baseline. Families were relatively low, moderate, or high levels of perceived grouped into three types of household in terms of parental support. Factor scores on the control family structure: "lone-parent families", dimension were used to subdivide the sample in "reconstituted families, with a step-parent present", terms of perceived levels of parental control in a similar way. The three support and control catand "intact two parent families". egories were then combined to produce five distinct Perceptions of parental support and control types of family. There were four types of family Young people's assessments of relationships with where there were extremes of both parental support parents at the time of the baseline survey were used and parental control, at least, from the young perto derive characterizations of "perceived family son's perspective. These were identified with life". Here, the young person's perceptions of the "authoritative" (i.e. high support and control), home environment was derived from six Likert type "permissive" (i.e. high support but low control), questionnaire items, rated on a four point scale "authoritarian" (i.e. low support but high control), from "strongly disagree" to "strongly agree". and "neglectful" (i.e. low support and control) Responses to these items reflected level of agreement families. The fifth family type represented the with each of the following statements: (i) My "other" families in the sample where levels of either parent/s have strong views about my appearance, parental support or control (or both) were viewed (ii) I do not get on well with my parent/s, (iii) My by young people as more moderate. parent/s disapprove of some of my friends, (iv) My parent/s want to know where I go in the evenings, Sample characteristics A complete set of responses to the study variables (v) My parent/s expect too much of me and, lastly, (vi) My parent/s are disappointed in me. These six relating to smoking behaviour, age, gender, parental family relationship items were entered into a princi- education, family structure, and perceptions of pal components analysis (the results indicated that family life was provided by 604 out of the 635 this was an appropriate technique to use, respondents to the follow up postal survey. Our KMO ffi 0.68). Once the factor solution had been analysis is therefore based on a sample of 604 rotated, two empirically independent dimensions young people, where this represents 49.5% of the
96
Anthony Glendinning et al.
original baseline sample. In addition, 98 of these 604 respondents (i.e. 16%) were not classified with respect to the social class of head of household, for example, because the appropriate parent figure was unemployed or non-employed at the time of the baseline survey. Interestingly, two national surveys of young people's health behaviours (one carried out in England in 1989 and the other in Scotland in 1990) where a self-completion questionnaire format was used report similar percentages of respondents as not classified with respect to social class (Rudat et al., 1992; Currie and Todd, 1993). This "unclassified" group of respondents was included in our analysis since it is likely to contain some of the most materially disadvantaged families in the sample, for example, unemployed single mothers. Finally, 45 of the 604 respondents (i.e. 7.5%) were not classified with respect to our measure of neighbourhood deprivation. This "unclassified" group was included in the analysis since it contains young people who are resident in more remote rural areas of Scotland, where a definition of the local neighbourhood in terms of small area Census statistics is not possible. We conclude the methods section by considering the effects of non-response on the composition of the follow up postal sample. Non-response to the postal survey was cross-tabulated against gender (male:female = 51:49% in 1987, and male:female = 49:51% in 1989) and against age group (13/ 14 year-olds:lS/16 year-olds = 51:49% in 1987, and 15/16 year-olds:17/18 year-olds = 53:47% in 1989). Chi-square tests indicated that the follow up postal sample was not significantly different from the baseline sample with respect to these characteristics. Non-response was also cross-tabulated against the social class of head of household at baseline for those respondents where social class was defined (non-manual:manual--47:53% in 1987, and nonmanual:manual = 49:51% in 1989). Non-response was found to be independent of social class. Lastly, non-response was cross-tabulated against family structure and was found to unrelated to the make up of the young person's family (e.g. lone-parent families = 13% in 1987, and lone-parent families = 12% in 1989). Comparisons were then made with national statistics in order to assess the representativeness of the survey sample. For families with dependent children under 16 years of age, and where social class of head of household was defined, the 1987 General Household Survey reported the proportion of nonmanual to manual households in Britain to be 46:54%, whilst the proportion of lone-parent households with dependent children under 16 years of age was at 14% (OPCS, 1989). Hence, the profile of families provided by our baseline sample in 1987 would appear to be in line with the national picture at that time, and the follow up postal sample in 1989 was similar in composition to the baseline
sample in 1987, at least for the key variables of social class and family structure.
FINDINGS
Age, gender and parents" smoking Cigarette use was clearly related to age [22(3) -- 12.98, P < 0.005; see Table 1 (a)] with less than one in six 15/16 year-olds reporting that they smoked regularly, whilst this proportion was one in four among 17/18 year-olds. Frequency of dgarette use was not related to gender in our sample, although a greater proportion of males compared to females described themselves as currently non-smokers (male:female = 62:54%). Associations with parents' smoking behaviour have been consistently reported in the literature (Charlton, 1992) and our data indicated that young people from smoking backgrounds were at least twice as likely to be regular smokers themselves [22(3)= 17.35, P < 0.001; see Table 1 (b)].
Family circumstances The results for parents' occupations and education suggested that smoking was not associated with the socio-economic status of the family [see Table 1 (d)]. These findings are consistent with the relatively complex picture for social class reported in other contemporary British studies, for example: a national survey of English schoolchildren in 1989 (funded by the Health Education Authority) found that there was no relationship between socio-economic group and regular smoking, but that young people from non-manual home backgrounds on average smoked fewer cigarettes per week (Rudat et aL, 1992), whilst a national survey of Scottish schoolchildren in 1990 (funded by the Health Education Board for Scotland) found that the relationship between smoking and socio-economic background was "complex" and dependent on age, with no social class differences found for the older age-group of 15 year-olds in this study (Cuttle and Todd, 1993). To further emphasize the point, in the present study residential neighbourhood provided a significant pattern of differences [Z2(3)= 9.06, P < 0.05; see Table 1 (c)], with young people who were living in deprived areas more likely to smoke regularly at follow up two years later. Turning to the make up of the family household, smoking was strongly associated with family structure [/2(6) = 24.77, P < 0.001; see Table 1 (e)], with raised prevalences among young people from both reconstituted and lone-parent families. Thus, some aspects of the young person's earlier home circumstances (i.e. local neighbourhood and the make up of the family) were associated with smoking, whilst other aspects (i.e. parents' social class) appeared to have little direct relationship to smoking.
Family life and smoking
97
Table 1. Respondent's smoking behaviour at follow up by (a) age and gender, (b) parents' smoking bchavionr, (e) location of family household, (d) family socioeconomic status and (e) family structure Self-reported frequency of cur~nt cigarette use None
(%)
Lessthanon~ On~ a week or On~ a d a y o r a w~k more more
(%)
Total
(%)
(%)
(%)
7 7
15 27
100 100
(a) Age and gender Cohort** 15/16 year-olds 17/18 year-olds Sex of respondent (NS) Female Male
(n = 313) (n = 291)
59 56
19 12
(n = 311) (n = 293)
54 17 62 16 (b) Parents'smokingbehaviour
8 5
21 17
100 100
Parents' described as smokers*** Yes (one or both parents) No
(n = 309) (n = 295)
53 12 64 19 (c) Location of family household
9 5
26 12
100 100
Neighbourhood deprivation index* Deprived (upper quartile) All other households t
(n = 149) (n = 455)
49 17 60 16 (d) Family socio-economie status
6 7
28 17
100
18 13 16
6 7 9
17 20 27
100 100 100
61 16 55 17 (e) Family structure
6 7
17 21
100 100
6 4 13
16 35 31
100 100 100
Parents' social class (HoH) (NS) Non-manual Manual Unclassified Parents' education post-school (NS) Yes (one or both parents) No Type of household*** Intact two-parent Reconstituted Lone-parent
(n = 251) (n = 255) (n = 98) (n = 246) (n = 358)
(n = 479) (n = 46) (n = 79)
59 60
48
62 46 40
16 15 16
100
~Includes 45 unclassified households. NS = not significant, *P < 0.05, **P < 0.005, ***P < 0.001.
Perceived parental support and control
A loglinear analysis was conducted by fitting logit models to the data presented in Table 2, with prevalence of regular smoking as the dependent variable and perceived parental support and control as explanatory variables. Neither the main effect for parental control nor the two-way interaction effect between parental support and control were found to be significant at the a = 0.05 level. By contrast, a main effect for perceived parental support was found [X2(2) = 13.86, P < 0.001], with perceptions of an unsupportive home environment associated with raised prevalences of regular smoking, whilst perceptions of supportive family relationships were associated with lowered prevalences. However, although the logit model with the main effect for parental support provided an adequate fit to the data [X2(6) = 9.52, P = 0.15], a significant residual remained to be explained for the low support/low control cell in Table 2 (Norusis, 1988). We interpreted these results to mean that there was a negative relationship between smoking and perceived levels of parental support, but, in addition, smoking prevalences were raised where poorer perceptions of parental support were combined with less parental control (i.e. a "neglectful" home environment). Multivariate analysis
Thus far, we have examined the associations between a range of family based factors and adolescent smoking, where each area of influence has been
considered in isolation (i.e. parents' smoking, neighbourhood, socio-economic status, family structure, and perceived family relationships). We next adopted a multivariate approach in which we examined the collective effects of such factors when they were considered together. In particular, we assessed the importance of more extreme types of family relationships, once the effects of other family circumstances had been controlled for. This was done by conducting a logistic regression analysis with regular smoking at follow up as the dependent variable, and a range of dichotomous "dummy" variables entered into the analysis as explanatory factors. Blocks of independent variables were forced into the logistic regression in a series of four steps, as follows: (a) age, gender and parents' smoking, (b) neighbourhood deprivation, parents' occupations and parents' education, (c) family structure, as represented by reconstituted and lone-parent households and, finally, (d) the four types of family relationship, as represented by the extremes of support and control found within authoritative, permissive, authoritarian and neglectful families. The results of the logistic regression analysis are presented in Table 3. The findings of the logistic regression [see Table 3 (d)] indicated that age, parents' smoking, family neighbourhood, family structure, and perceived type of family relationship were all associated with smoking at follow up, whilst gender and parents' social class were not. Perhaps the key finding for
98
Anthony Glendinning e t
al.
Table 2. Respondent's smoking behaviour at follow up (proportion currently smoking one or more cigarettes per day) by perceived parental support and control Self-reported prevalenceof regular smoking(%) Low (n Perceivedparental control Low (n = 208) Moderate (n ffi 195) High (n ffi 201)
'Neglectful' 34 16 'Authoritarian' 25
16 15
26
All respondents
All respondents
Perceivedparental support Moderate (n = 209)
= 199)
High (n
ffi 196)
(n = 604)
21 15
15
'Permissive' 12 14 'Authoritative' 12
16
12
19
the present study is that even when the combined effects of earlier family circumstances were controlled for (i.e. neighbourhood, socio-economic status and make up o f household) perceptions of family relationships were still associated with subsequent smoking behaviour. Thus, from the young person's perspective, a n unsupportive home environment combined with lower levels of control (i.e. "neglectful" parenting) was associated with raised smoking prevalences. (In addition, although not significantly different from 1.00 at the a = 0.05 level, odds ratios were reduced among young people from more supportive home environments.) Logistic regression also allowed for further testing for interaction effects between perceived family life and other aspects o f the young person's home circumstances. Interactive terms did not attain statistical significance, however, with the notable exception of family structure. I n order to examine this issue in more depth the data presented in Table 4 were tested for interaction effects between perceived family life and family circumstances by conducting five s e p a r a t e loglinear analysis, one for each of the other family factors included in the logistic regression. Logit models were fitted to the data in Table 4 (a)-(e), with regular smoking at follow up as the dependent variable and type of family relationship
18
and one of the other family factors as explanatory variables. N o evidence was found for a significant interaction effect between young people's smoking, parents' smoking and perceived type o f family relationship [see Table 4 (a)]. Similarly, no interaction effects were found for residential neighbourhood [see Table 4 (b)] or parents' social class [see Table 4 (c) and (d)]. Thus, associations between perceptions of family life and adolescent smoking were found to operate independently of these other family factors and, in particular, the socio-economic circumstances of the family. By contrast, a significant interaction effect was found for family structure LT2(4) = 9.56, P < 0.05; see Table 4 (e)], with smoking prevalences uniformly raised among adolescents from loneparent and reconstituted families, irrespective of the young person's perceptions o f relationships with parents. Thus, within single-parent households and households with a step-parent present, it would appear that this set of circumstances was of significance for young people's smoking behaviour, whatever type of parent-child relationship might also exist.
DISCUSSION
The profile of associations between family factors and smoking behaviour found in the present study
Table 3. Losistic regressionof respondent'ssmokingbehaviour at follow up (currentlysmokingone or more cisarettes per day) against a range of explanatory factors (n = 604) where these were entered in blocks, as follows: (a) age, gender and patents' smoking behaviour, (b) location and socioeconomic status of family household, (c) structure of family homehold and (d) perceivedtype of family relationship Explanatory variables
Xolder Xfemale
Xparents' smoke Xdeprived area
Xmanual household Xleu education XJtep.parent
Xlone-parent Xanthoritative Xpermiuive Xauthoritarian Xp~glecffttl
(a) Enter age, gender and (b) Enter familylocale (c) Enter family parents' smoking and socio-economic structure status Odds ratio P Odds ratio P Odds ratio P (n ~ (n = (n: (n ~ (n =
291) 311) 309) 149) 255)
1.90 1.09 2.12 ---
<0.01 >0.50 <0.01 ---
(n ~ 358) (n ffi 46) (n ffi 79) (n : 68)
-. .
--
(n = 67)
. .
. .
( n - 71) (n ffi 70)
. .
. .
. .
. .
Odds ratio
P
1.99 1.08 2.00 1.70 1.01
<0.01 >0.50 <0.01 0.03 > 0.50
2.04 1.09 1.93 1.66 0.99
<0.01 >0.50 <0.01 0.04 > 0.50
2.04 1.15 !.88 1.63 0.98
<0,01 >0.50 0.01 0.05 > 0.50
1.37
0.16
1.39 2.95 2.15
0.15 <0.01 0.01
i.41 2.71 2.00 0.51 0.46 i.56 1.98
0.14 0.01 0.03 0.09 0.09 0.13 0.03
. .
. . . .
(d) Enter type of family relationship
. . . .
. . . .
. . . .
Family life and smoking
99
Table 4. Perceived type of family relationship and respondent's smoking bchaviour at follow up (proportion ~ t l y smoking one or more cigarettes per day) controlling, in turn, for each of: (a) parents' smoking bchaviour, Co) location of family household, (c) parents' social class, (d) parents' education and (e) family structure Perceived type of family relationship S¢lf-re~rtcd prevalence of regular smoking (%)
Authoritative
No (non-smokers) Yes (one or both parents)
(n = 295) (n ~ 309)
Deprived areas All other areas
(n = 149) (n = 455)
Non-manual households Manual households Unclassified
(n = 251) (n = 255) (n ~ 98)
Yes (one or both parents) No
(n = 246) (n = 358)
Intact two-parent families Step- or lone-parent families
(n = 479) (n = 125)
Permissive
Authoriation
(a) Parents' smoking (NS) 8 8 17 18 CO)Local ndghbourhood (NS) 16 17 9 9 (c) Parents' social class (Hell) (NS) 12 12 13 14 20 22 (d) Parents' education post-school (NS) 8 13 14 15 (e) Family structure* 12 12 29 30
Negl~fful
Other families
21 30
32 36
12 21
36 20
41 32
18 13
24 23 31
35 34 40
15 14 23
23 24
27 42
15 16
24 32
34 34
12 33
Two-way interaction with type of family relationship: NS = not significant, *P < 0.05.
is, in general, consistent with that reported in the our sample were older, and so smoking prevalences research literature. Parents' smoking, neighbour- were correspondingly raised, and smoking habits hood deprivation, family structure and family more firmly established. Two main conclusions can "bonding" were all found to have a significant be drawn from our findings here. Perceived levels of effect on the likelihood of the young person smok- parental support are inversely related to smoking, ing regularly at follow up, but family social class with high support linked to reduced prevalences and did not, suggesting a relatively complex relationship low support linked to raised prevalences. Secondly, between socio-cconomic status and smoking in prevalences would appear to be particularly raised youth. In addition, our findings indicated that an where parents are seen as both unsupportive and unsupportive home environment with fewer controls providing fewer controls (i.e. a "'neglectful" home (i.e. where parents were seen as "neglectful") was environment). We now discuss some of the potential limitations related to raised smoking prevalences. This association between smoking and perceptions of parenting of our work. It must be acknowledged that our conwas still evident even after the combined effects of clusions are based on the young person's self-perparents' smoking, neighbourhood deprivation, ceptions. Such perceptions may or may not reflect socio-economic status and family structure were the "reality" of family life, but ultimately the young included in a multivariate analysis. Closer examin- person's subjective assessments and internalized feelation also indicated that associations between per- ings of support, acceptance and controls within the ceptions of parenting and smoking were felt family may be of considerable importance to the independently of the socio-economic circumstances adoption of health related behaviours. A further of the family. caveat is that the model of parent-child interactions Our findings for perceptions of parental support which is used in our analysis assumes a generally and control extend the results of Foxcroft and consistent approach to issues of support and control Lowe (1995) to a longitudinal sample of older ado- on the part of parents, and it may be that it is lescents, using a less extreme characterization of exactly where there is an inconsistent approach "perceived family life" although it must be noted within a more chaotic home environment that that our measures of smoking behaviour, and of young people are potentially at greatest risk. family support and control, are based on a less Additionally, there is the difficulty of making indetailed set of questionnaire items. Nevertheless, in terpretations which attempt to link cause and effect, our study there was a more marked pattern of despite the longitudinal nature of our data (e.g. the differences in smoking prevalences across family problem of reverse causation). Parent-child retypes (i.e. "warm-directive", "indulgent", lationships reflect complex family processes, and "authoritarian" and "neglecting" families), perhaps parenting practices may in part repre,scnt responses exactly because young people from such families to the young person's earlier behaviours, including were by definition in the minority in our sample, smoking behaviour. A prospective study of the and so more genuinely represented extremes of uptake of smoking with a younger age group of family life. (Fifty-four percent of respondents were adolescents would help to address this difficulty. Conrad et aL (1992) in their review of prospective categorized as coming from families where levels of support or control were seen as more moderate.) A studies identified intra-personal factors as an imfurther explanation may be that the adolescents in portant further area of explanation for the onset of
100
Anthony Glendinning et al.
smoking in youth. This is of relevance to the present study, since parenting may have consequences for the young person's self-esteem and psychological functioning at an earlier stage of development, and this in turn may help to explain associations between perceived family life and adolescent health behaviours. The point is well made by Sweeting and West (1995). Using longitudinal data from the youngest cohort of the West of Scotland Twenty-07 Study, they examined the links between family life and adolescent health status, whilst controlling for the intervening effects of the young person's self esteem. It was found that a "poorer relationship and conflict with parent(s)" was associated with poorer assessments of health, and that these associations between family life and health status were mediated by perceptions of self-esteem. Our own research in this area has also shown that perceptions of parenting practices are linked to psychological well-being in adolescence (Shucksmith eta[., 1995). Thus, a complex interplay of psychological factors may be responsible for the associations between perceived family life and adolescent health behaviours observed in the present study. At the outset we stated that one of our aims was to examine parent-adolescent relationships within the broader context of the young person's family circumstances. Our findings suggest that associations between perceived family life and adolescent smoking may operate independently of the socioeconomic status of the family, at least as characterized by neighbourhood deprivation and social class. However, the results for family structure paint a different picture. Our results indicate that within reconstituted and lone-parent families smoking was largely unaffected by perceptions of parental support and control. Interestingly, in their meta-analysis of research on family socialization and alcohol use Foxcroft and Lowe (1991) remark that associations between adolescent health behaviours, family structure, family support and family control may well be complex, and our findings would appear to confirm this conjecture in the case of adolescent smoking behaviour. We conclude by discussing the relevance of our study for the "health inequalities debate" in youth (Townsend and Davidson, 1982; Davey Smith et aL, 1990; Macintyre and West, 1991; Glendinning et al., 1992). As we have argued in detail elsewhere, smoking may well act as a marker for the production of health inequalities between social groups in later adolescence and early adulthood (Glendinning et al., 1994). The suggestion is that "indirect health selection" (West, 1991; Blane et al., 1993) on the basis of factors which are also hound up with young people's health behaviour may offer one explanation for the patterning of health by social class which is observed in adolescence and early adulthood (West, in press). In other words, adolescents' educational and employment trajectories may be
affected by a range of factors, where these factors are also linked to adolescent health behaviours, and so to adult health status. In this way, for example, adolescent smoking hehaviour may provide a marker of both social mobility and future health status. This still leaves the question of exactly how such processes of indirect social selection would operate in youth. As part of the answer, it is much easier to see possible consequences of earlier experiences of family lifeand parenting practices(e.g.lowered selfesteem and social competence, poorer psychological well-being, and "problem" bchaviour at school) as being tied to processes of social selectionand social mobility in adolescence, as well as to health bchaviours and future health outcomes. Support for such a view comes from the recent research by Sweeting and West (1995). In their work explanations for the patterning of health inequalitiesin later adolescence and early adulthood are linked to "cultural" factors operating within the family in childhood and adolescence, where these factors are seen to cut across social class boundaries. They found that various aspects of family lifein mid-adolescence were related to the young person's labour market position in late adolescence, and that these effects of family life on social position were felt independently of the material circumstances of the family. They also found that family lifewas related to subsequent health status, once again, independently of the material circumstances of the family. These findings for family lifeand adolescent health parallel the findings reported in the present study for family life and adolescent smoking. There are some differences of detail, however, with Sweeting and West (1995) reporting few associationsbetween family "centredness', parental "strictness" and health, but a significant pattern of associations between family "conflict", quality of "relationship with parent(s)" and subsequent health status. Nevertheless, for both studies the general conclusion is the same, earlierexperiences of family lifewould appear to be related to adolescent health and to adolescent health behaviours independently of the socio-economic circumstances of the family. Family life may therefore have a significantrole to play in explaining the production of social class differences in health in youth through a process of indirect selection.
REFERENCES
Baumrind, D. (1971) Current patterns of parental authority. Developments in Psychology Monographs 4, 1-102. Baumrind, D. (1978) Authoritarian versus authoritative parents control. Adolescence 3, 255-272. Baumrind, D. (1989) Rearing competent children. In Child Development Today and Tomorrow, ed. W. Damon.
Jossey Bass, San Francisco.
Family life and smoking Blane, D., Davey Smith, G. and Bartley, M. (1993) Social selection: what does it contribute to social class differences in health7 Sociology of Health & Illness 15, 1-15. Charlton, A. (1992) Children and tobacco. British Journal of Cancer 66, 1-4. Cockett, M. and Tripp, J. (1994) The Exeter Family Study: Family Breakdown and its Impact on Children. Exeter University Press, Exeter. Conrad, K. M., Flay, B. R. and Hill, D. (1992) Why children start smoking cigarettes: predictors of onset. British Journal of Addiction 87, 1711-1724. Currie, C. and Todd, J. (1993) Health Behaviours of Scottish Schoolchildren." Family, Peer, School and Socioeconomic Influences. Research Unit in Health and Behavioural Change, University of Edinburgh, Edinburgh. Davey Smith, G., Bartley, M. and Blanc, D. (1990) The Black report on socioeconomic inequalities in health 10 years on. British Medical Journal 301, 373-377. Duguid, G. and Grant, R. (1984) Areas of Special Need in Scotland. HMSO, Edinburgh. Foxcroft, D. R. and Lowe, G. (1991) Adolescent drinking behaviour and family socialisation factors: a meta-analysis. Journal of Adolescence 14, 255-273. Foxcroft, D. R. and Lowe, G. (1995) Adolescent drinking, smoking and other substance use involvement: links with perceived family life. Journal of Adolescence 18, 159-177. Glendinning, A., Love, J., Hendry, L. and Shucksmith, J. (1992) Adolescence and health inequalities: extensions to Macintyre and West. Social Science & Medicine 35, 679687. Glendinning, A., Shucksmith, J. and Hendry, L. (1994) Social class and adolescent smoking behaviour. Social Science & Medicine 38, 1449-1460. Green, G., Macintyre, S., West, P. and Ecob, R. (1991) Like parent like child? Associations between drinking and smoking behaviour of parents and their children. British Journal of Addiction 86, 745-758. Goddard, E. (1990) Why Children Start Smoking. HMSO, London.
101
Lamborn, S. D., Mounts, N., Steinberg, L. and Dornbusch, S. (1991) Patterns of competence and adjustment among adolescents from authoritative, authoritarian, indulgent and neglectful families. Child Development 62, 1049-1065. Maccoby, E. and Martin, J. (1983) Socialisation in the context of the family: parent-child interaction. In Handbook of Child Psychology, ed. P. H. Mussen. Wiley, New York. Macintyre, S. and West, P. (1991) Lack of class variation in health in adolescence: an artefact of an occupational measure of social class. Social Science & Medicine 32, 395-402. McNeill, A. D., Jarvis, M. J., Stapleton, J. A., Russell, M. A. H., Eiser, J. R., Gammage, P. and Gray, E. M. (1988) Prospective study of factors predicting uptake of smoking in adolescents. Journal of Epidemiology and Community Health 43, 72-78. MicheU, L. (1990) Growing up in Smoke. Pluto, London. Norusis, M. J. (1988) SPPS-X Advanced Statistics Guide. SPSS Inc., Chicago. Office of Population Censuses and Surveys (OPCS) (1989) General Household Survey, 1987. HMSO, London. Rudat, K., Speed, M. and Ryan, H. (1992) Tomorrow's Young Adults: 9-15 year-olds look at alcohol, drugs, exercise and smoking. Health Education Authority, London. Shucksmith, J., Hendry, L. and Glendinning, A. (1995) Models of parenting: implications for adolescent wellbeing within different types of family contexts. Journal of Adolescence 18, 253-270. Sweeting, H. and West, P. (1995) Family life and health in adolescence: a role for culture in the health inequalities debate? Social Science & Medicine 40, 163-175. Townsend, P. and Davidson, N. (1982) Inequalities in Health: The Black Report. Penguin, Harmondsworth. West, P. (1991) Rethinking the health selection explanation for health inequalities. Social Science & Medicine 35, 373-384. West, P. (in press) Health inequalities in the early years: is there equalisation in youth? Social Science & Medicine.