Adolescent smoking and family structure in Europe
Introduction
During the 1990s there was little decline in smoking rates among young people in Europe. Recent figures have shown that in several countries smoking prevalence among young people increased among both boys and girls (Roberts, Currie, & François, 1999). Indeed in some countries, the rates of smoking among 15-year-old girls doubled over this period (Wold, Holstein, Griesbach, & Currie, 2000). The reasons for the lack of decline in adolescent smoking, at a time when adult smoking continued to decrease, are not fully understood. However these are likely to involve a combination of factors operating at several levels from the continued marketing of cigarettes to young people by the tobacco industry (Amos, Bostock, & Bostock, 1998; Hastings & MacFadyen, 2000) to the lack of effective school health education programmes on smoking (Reid, 1996; Stead, Hastings, & Tudor-Smith, 1996; NHS CRD, 1999). What has been given less consideration is the influence that wider social and cultural trends may have had on young people's decisions to start, and then to continue to smoke.
One of the most significant social changes that has occurred in many countries in the European Union over the last few decades has been the increase in numbers of children living in single-parent families or stepfamilies (Eurostat (1995), Eurostat (1996)). This reflects an increase in the rates of divorce and re-marriage as well as more children being born into lone-parent families, particularly in Northern European countries (Drew, Emerek, & Mahon, 1995). For example, in Great Britain while the majority of children still grow up in a family headed by a couple, the proportion living in lone-parent families has increased significantly. In 1998 more than double the number of 11- to 15-year-olds experienced divorce in their family compared with 1978 (Summerfield & Matheson, 2000). In the European Union the divorce rate tripled between 1960 and 1992, and the percentage of births outside marriage increased from 8.8% in 1980 to 20% in 1992 (Eurostat, 1995).
It has been argued that young people in lone-parent households or stepfamilies may suffer more disadvantage than those from intact families. A recent report by Eurostat for the European Commission found that single-parent households in EU countries were three times more likely to live on low incomes than the rest of the population (Eurostat, 2000). Research, mainly in the US and UK, has also focused on the many negative life chances and lifestyles that are associated in adolescence with coming from a stepfamily or a lone-parent family. Sweeting and colleagues, in their review of the literature (Sweeting, West, & Richards, 1998), found that adolescents from non-intact families were at greater risk of poor educational progress such as higher rates of truancy and leaving school at an early age, “deviant” or problem behaviours such as criminal activity and running away from home, as well as higher rates of “risky” health-related behaviours including smoking. Several studies have found that these young people have higher rates of smoking cigarettes (Bachman, Johnson, & O’Malley, 1981; Goddard, 1990; Green, MacIntyre, & West, 1990; Isohanni, Moilanen, & Rantakallio, 1991; Goddard & Higgins, 1999; Tyas & Pederson, 1998), regular drinking (Foxcroft & Lowe, 1991; Shucksmith, Glendinning, & Hendry, 1997) and drug use (Bachman et al., 1981; Sweeting et al., 1998). It has been argued that these negative “outcomes” may arise from differences in the home environments of adolescents in intact and non-intact families, in particular the quality of family relationships measured in terms of parental support and control, and family attachment. For example, a study of 12- to 16-year-olds found that those who perceived that their parents were authoritarian (low support and high control) or neglecting (low support and control) were more likely to smoke and drink than adolescents whose parents were indulgent (high support and low control) or warm-directive (high support and control) (Foxcroft & Lowe, 1991). Dornbusch and colleagues have suggested that the high rates of smoking in adolescents from lone mother households might be due to lower levels of parental surveillance or social support (Dornbusch et al., 1985). Similarly, a study of 11- to 14-year-olds found that family structure had an indirect effect on adolescent smoking behaviour, being mediated by family attachment which was found to have a direct effect on cigarette use (Sokol-Katz, Dunham, & Zimmerman, 1997).
However, while several studies that have investigated the relationship between family structure and health-related behaviours, it is not clear in many of these studies to what extent such outcomes may be a direct result of family structure and/or processes rather than the poorer socio-economic circumstances of lone-parent families and stepfamilies compared to intact two-parent families (Sweeting et al., 1998). Also studies have often failed to differentiate, on the one hand, between reconstituted two-parent families (i.e., stepfamilies) and intact two-parent families, or on the other hand, between stepfamilies and lone-parent families. In addition few, if any, studies have included other key familial factors such as the smoking status of parents and siblings which may be higher in these families, and individual factors such as personal disposable income, which are known to influence smoking rates in young people (Conrad, Flay, & Hill, 1992; Tyas & Pederson, 1998; Goddard & Higgins, 1999).
Two recent Scottish studies have started to address some of these issues by including measures of household deprivation and socio-economic status (Glendinning, Shucksmith, & Hendry, 1997; Sweeting et al., 1998). Both studies found that while there were considerable differences in material factors according to family structure, these did not explain the higher smoking rates found among young people from lone-parent families or stepfamilies compared to those living in intact two-parent families. However neither study included in their analyses measures of parental/sibling smoking or of the adolescents’ own disposable income.
Given the trends in smoking among young people in Europe, this paper will address two questions:
- 1.
Is the association between family structure and adolescent smoking that has been found in studies in the US and UK common to other countries in Northern Europe?
- 2.
To what extent are associations between family structure and adolescent smoking in these countries independent of other factors i.e., gender, smoking status of parents and other family members, material circumstances (family and personal)?
Section snippets
Data collection
The research described here was carried out as part of the Health Behaviour in School-aged Children (HBSC) study, a WHO cross-national study of health behaviours, health and its social context in children and adolescents in European and North America. Cross-sectional surveys of 11-, 13- and 15-year-old children are undertaken by HBSC every four years based on an internationally agreed protocol (Currie, 1998). Survey data are collected through the use of a aself-completion questionnaire
Results
Table 1 shows the sample sizes and smoking prevalences of 15-year-olds in each country by gender. The prevalence of daily smoking ranged from 18.1% in Denmark to 23.6% in Germany. In all countries, more girls than boys were occasional or daily smokers and this was statistically significant in all countries. Austria, Denmark, Scotland and Wales had the greatest difference in prevalence between girls and boys, with 5–6% more girls than boys smoking daily.
The other characteristics of the samples
Discussion
The main aim of this analysis was to determine whether there was an association between family structure and daily smoking among 15-year-olds in seven countries of northern Europe. The results from the univariate analysis showed that several family and personal factors increased the likelihood of smoking among adolescents in all countries. Adolescent smokers were more likely to be female, have higher than average personal income, live in a stepfamily, have a parent that smoked, and live with
Acknowledgements
The authors acknowledge the significant role played by Dr. Bente Wold at the University of Bergen and the Norwegian Social Science Data Services in making available cross-national data from the HBSC study.
We would also like to thank Jo Inchley, Gillian Small and Joanna Todd for their comments on earlier drafts of this paper, and suggestions regarding statistical analysis.
The HBSC study is funded in Austria by the Federal Ministry for Social Security and Generations and the Federal Ministry for
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