Learning Objective #1: Identify the numerous influences that impact tobacco initiation in children

Learning Objective #2: Identify how the family may be a potentially protective factor in preventing tobacco initiation in children

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Purpose: Tobacco use remains the most preventable cause of disease and disability in the world and has its origins in childhood. Many begin smoking in response to social influences with parent/guardian smoking being a key predictor of a child's initiation. Based theoretically on the concept of reciprocal determinism, the purpose of this study was to examine the interaction effects of a school-based tobacco prevention program offered concurrently with a family cessation program.

Methods: A pre-test, post-test design was used with children and their parents/guardians representing 23 school systems in disparate areas. Paired t-tests examined whether differences between pre-test and post-test scores were statistically significant for child and parent scales. To examine parental smoking status affects and interactions, repeated measures of ANOVA models were used (alpha = 0.05). Post hoc differences using a Bonferroni adjustment were also analyzed.

Findings: 521 6th and 7th grade children and parents/guardians (total N=1042) participated. Twenty-six percent of parents/guardians smoked an average of 1.2 packs per day (SD=0.4). Significant changes from pre-test to post-test in children variables included: drug refusal skills (p=0.0012); saying “no” to offers to smoke (p=0.0044); assertiveness (p=0.0015); and anxiety-reduction skills (p=0.0065). Children whose parents smoked had significantly higher drug use intention and drug use behavior scores at both pre-test (p=0.0005) and post-test (p=0.0001) than children whose parents did not smoke. Of parents/guardians who smoked, 87% indicated they read the cessation information provided to them; 49% indicated they were motivated to quit; and 13% reported success with cessation.

Implications: The child program was effective on essential variables for preventing tobacco initiation, having less impact on children from homes with parent smokers. The cessation program motivated parents to want to quit and produced modest actual quit rates. Further research incorporating a more robust family cessation component and biochemical validation of tobacco use is needed.