Modeling a smoke-free life

Sitting in nonsmoking sections and banning smoking at home are powerful tactics for preventing teen smoking
Dr. Robyn Andersen
Dr. Robyn Andersen and Public Health Sciences Division colleagues found that parents — even if they are smokers — who request seating in nonsmoking sections of restaurants can reduce their children's risk of becoming a smoker. Photo by Todd McNaught

The simple act of requesting to sit in a non-smoking section may have profound benefits beyond avoiding second-hand smoke, according to findings by researchers at Fred Hutchinson published in the April issue of The Archives of Pediatrics and Adolescent Medicine.

Parents who routinely engage in such anti-smoking behaviors in front of their adolescent children — particularly parents who themselves smoke — appear to significantly reduce their offspring's chances of becoming a smoker by their senior year in high school, reports Dr. M. Robyn Andersen, an associate member of the center's Public Health Sciences Division. PHS researchers Drs. Brian Leroux, Jonathan Bricker, Kumar Bharat Rajan and Art Peterson contributed to the study.

Adolescent children of parents who smoke were 13 percent less likely to become smokers by 12th grade if their parents reported routinely asking to sit in designated smoke-free areas of public establishments compared to adolescent children whose smoking parents chose to sit in smoking sections, Andersen said.

Specifically, when parents reported that they did not usually use nonsmoking sections, about 42 percent of their adolescent children became daily smokers. When parents usually asked to sit in nonsmoking sections, the daily smoking rate among their adolescent children was 27 percent.

"I was surprised by the size of the effects. In particular, I didn't expect them to be so large in the families where there was at least one smoking parent. This was a happy surprise, because most smoking parents don't want their kids to smoke," Andersen said.

Effective anti-smoking statement

The study, funded by the National Cancer Institute and a gift from the Northern Life Insurance Company of Minneapolis, is the first study of its kind to assess the impact of nonsmoking sections on smoking behavior in adolescents, Andersen said.

"Since Americans tend to go out to eat quite a bit, asking to be seated in a nonsmoking section may be a particularly effective way to communicate because it's a way to make an anti-smoking statement on a regular basis. It's a chance to bring it up," said Andersen, also a clinical assistant professor in the Department of Health Services at the University of Washington School of Public Health and Community Medicine.

The study also looked at parents' reports of other anti-smoking actions such as banning smoking in the home and asking others not to smoke in their presence, both of which also had a significant impact on preventing daily teen smoking. (Adolescent children of smoking parents who banned smoking in the home and asked people not to smoke in their presence were 15 percent and 8 percent less likely to smoke, respectively, compared to children of parents who did not).

A substantial percentage of parents in the smoking families reported engaging in such anti-smoking actions: 29 percent reported not allowing smoking in their homes, 35 percent reported usually sitting in nonsmoking sections and 24 percent reported asking others not to smoke around them.

However, the best thing a parent can do to prevent their children from smoking is to refrain from smoking themselves, Andersen said.

"If you as a smoking parent don't want your kid to smoke, ideally you should quit smoking. But even if you can't, or until you do, there are things you can do, such as not allowing smoking in the house or sitting in nonsmoking sections. These actions help you back up your words when you tell your kids you don't want them to smoke, even if you are addicted to cigarettes. It appears to be a way to communicate that this is something that you seriously care about, it's important, and it's not just something you're saying," she said.

Raising smoke-free teens

Previous research indicates that if a child reaches age 18 without becoming a smoker, his or her odds of remaining smoke-free are around 90 percent. Therefore, such simple anti-smoking interventions potentially could prevent thousands of young people in the United States from becoming daily, long-term smokers, Andersen said. Statistics also show that having a smoking parent increases a child's chances of becoming a smoker by 12th grade by 10 percent compared to children of nonsmoking parents, she said.

Andersen's findings stem from data collected from more than 3,500 children and parents in 20 school districts in western Washington. Information on parental-smoking status and anti-smoking behavior came from the parents via survey when their children were in the 11th grade. A year later, the 12th-grade students participated in a classroom survey about their current smoking behavior. Saliva tests to check for the presence of cotinine, a byproduct of nicotine, verified that the students' self-reports of smoking activity were largely accurate.

Fifty-one percent of the students were male and 90 percent where white. Since the study sample was almost all Caucasian, reflecting the demographics of the area, the results may not generalize to a multiethnic community.

The students in the study comprised the control, or comparison, group for the Hutchinson Smoking Prevention Project, the largest and longest school-based intervention trial ever conducted in smoking-prevention research. Overall the study involved 8,400 students and 600 teachers throughout 40 school districts in Washington. Results of this 15-year study, funded by the National Cancer Institute, were published in 2000.

The study found that implementation of a school-based prevention program focused on teaching youth how to identify and resist social influences to smoke — the main thrust of smoking-prevention education and research for more than two decades — simply doesn't work. While the results were surprising, the data remain a rich resource for further analysis with regard to parental influences on smoking behavior, among other factors.

"Parents who would like to quit are encouraged to contact their primary physician for smoking-cessation guidance," Andersen said.

Anti-tobacco advertising campaign exhibition April 29 in PHS atrium

Cornish students (from left) Susan Kim, Justin Koh and Madoka Hayashi
Cornish students (from left) Susan Kim, Justin Koh and Madoka Hayashi display their counter-advertising campaign to discourage student smoking. Photo courtesy of Cornish College of the Arts

Faculty and staff are invited to attend an exhibition of anti-tobacco advertising campaigns, created by students enrolled in Major Design at Cornish College of the Arts, from 6 to 8 p.m. on Thursday, April 29 in the atrium of the Public Health Sciences Building. The campaigns are part of a design competition sponsored by The Campus Health Action on Tobacco Study (CHAT) — a group working to decrease the number of students that use tobacco and increase cessation rates.

Twenty Major Design students lent their talents towards campaigns emphasizing topics such as the health risks and consequences associated with tobacco use, the addictiveness of tobacco and manipulative-marketing practices of the tobacco industry.

Cornish College of the Arts is one of 30 colleges in Washington, Oregon and Idaho participating in the CHAT study. Fifteen colleges will conduct a variety of interventions designed to strengthen policies against smoking, decrease smoking onset and increase smoking cessation among students. Dr. Beti Thompson of the PHS Division is the principal investigator of the study, which receives funding from the National Cancer Institute.

Six judges will determine the three campaigns that most effectively raise awareness about the dangers of tobacco use and negate its social acceptability among the collegiate population. The winning ad campaigns will be reproduced and distributed to the other CHAT study intervention campuses. The counter-advertising campaign project receives support from a grant from the Seattle & King County Tobacco Prevention Program of the Washington State Department of Health. The department provides for tobacco education and control using a portion of the $4.5 billion settlement of a multi-state lawsuit filed in1996 against major tobacco companies.

Help Us Eliminate Cancer

Every dollar counts. Please support lifesaving research today.