Does parental disapproval of smoking prevent adolescents from becoming established smokers?

OBJECTIVE To evaluate the hypothesis that adolescents are less likely to smoke if their parents voice strong disapproval of smoking. DESIGN AND SETTING Three-wave school-based cohort study of rural Vermont adolescents attending 3 K-12 schools. We evaluate cross-sectional and longitudinal associations between perceived parental disapproval of smoking and the adoption of smoking behavior. OUTCOME MEASURES Students' perceptions of their parents' reaction to their own smoking was ascertained by asking the following question for mothers and fathers: "How do you think your mother (father) would react if you were smoking cigarettes and she (he) knew about it? " A response of "S/he would tell me to stop and be very upset" was considered to indicate strong parental disapproval. Outcome measures include a 6-level smoking index for cross-sectional analyses and, for a longitudinal analysis of 372 never smokers at baseline, being an established smoker (smoked > or =100 cigarettes lifetime and within the past 30 days) by survey 3. RESULTS The study samples for the cross-sectional analyses were 662 (baseline), 758 (year 2), and 730 (year 3). Students were equally distributed across grade (4th-11th grades) and gender. At baseline, most (65.9%) adolescents perceived both parents as disapproving of smoking, with 110 (16.6) perceiving 1 parent as disapproving, and 116 (17.5%) perceiving neither parent as disapproving. Perceived disapproval of smoking was inversely associated with adolescent smoking, grade in school, parental and sibling smoking, friend smoking, and ownership of tobacco promotional items. After controlling for confounding influences, adolescents who perceived strong parental disapproval of their smoking were less than half as likely to have higher smoking index levels compared with those who did not perceive strong parental disapproval. In the longitudinal sample of baseline never smokers, those who perceived strong disapproval in both parents at baseline were less than half as likely to become established smokers (adjusted odds ratio 0.4 [0.1, 1.0]). Those who perceived their parents becoming more lenient over time were significantly more likely to progress to established smokers. In all analyses, the effect of parental disapproval of smoking was stronger and more robust than the effect of parent smoking. In addition, the effect of parent disapproval was as strong for parents who smoked as it was for nonsmoking parents. An interaction analysis suggests that the peer smoking effect is attenuated when both parents strongly disapprove of smoking, suggesting that parent disapproval makes adolescents more resistant to the influence of peer smoking. CONCLUSIONS These findings contrast with the widespread notion that there is little parents can do to prevent their adolescents from becoming smokers. Instead, adolescents who perceive that both parents would respond negatively and be upset by their smoking are less likely to smoke. Interventions that enhance parental self-efficacy in conveying and enforcing no-smoking policies for their children could reduce adolescent smoking.