5.27 Parent/family/home targeted interventions

Last updated April 2012 

In addition to the powerful influence of a parent's own smoking behaviour on the likelihood of adolescent smoking uptake1,2,3, other aspects of parenting have also emerged as significant contributors to adolescent smoking.1,4,5

Parental advice not to smoke or explicit disapproval of smoking has been shown in some studies to be effective in deterring young people from smoking.6 Yet there is also evidence to suggest that parents often doubt their capacity to positively influence their children in this regard, feeling that children ignore or disdain such advice.7 For example, qualitative research undertaken in Australia found that while young people cite parental disapproval of smoking as a barrier to smoking uptake, parents in the same study often felt that their opinions had little influence.8 A large-scale empirical study in Sweden similarly found that the majority of adolescents were in support of strong parental intervention to help them refrain from tobacco, but preferred this not to be done in a punitive manner.7 More specifically, of the 4500 adolescents surveyed in 2006, almost all strongly supported parental action including trying to persuade them not to smoke (94%), not smoking themselves (87%) and not allowing their children to smoke at home (86%). This support was evident across both smoking and non-smoking adolescents.7

Beyond parenting communications that are smoking specific, different parenting styles more broadly can potentially influence the likelihood of smoking uptake. For instance, a parenting style that combines both demanding and responsive management of children's behaviour has been shown to reduce smoking uptake, while more permissive home policies are associated with increased likelihood of experimentation.9,10 (See also Sections 5.7.1 and 5.7.1.1.) This section focuses on programs that attempt to train parents to adopt the kind of communication and parenting styles that have been associated with reduced uptake of smoking.

5.27.1 Do family-based interventions/programs work?

Programs to intervene against smoking at the home level have shown mixed effects, with evaluation of program effectiveness hindered by insufficient information reported or lack of rigour in program implementation.6 In the most recent (2009) Cochrane review of family-based programs (randomised controlled trials only included) for preventing youth smoking, four of nine trials testing a family intervention against a control group had significant positive effects, while one trial showed significant negative effects.6 The review also looked at five trials that compared the effectiveness of a family-based intervention with a school-based intervention. Only one of the five was shown to be effective, and interestingly in this study, there was no significant difference in the effectiveness of the family- versus school-based interventions at the six-year follow-up, but both intervention groups were less likely to take up smoking than the control group.11

Overall, the Cochrane review concluded that it may be possible to help family members strengthen non-smoking attitudes and promote non-smoking in children, but several factors related to intervention quality emerged as important. The extent of implementer training and the fidelity of implementation were higher in those studies with positive outcomes.6 However the number of sessions in the family intervention program was not related to positive outcomes, suggesting that program intensity is not a prerequisite for effectiveness.6

Another review published in 2011 looked at 16 studies that involved a parental intervention component, the nature of the parent involvement varying considerably and ranging from education via pamphlets, homework requiring parental involvement, parent and youth attendance at group sessions, and offering incentives for smoking cessation as a role model.12 Of the 25 trials reviewed, 10 were associated with a reduction in uptake of smoking, and six of these included parental involvement in the intervention program.12

Not many of the studies to date have looked at the effectiveness of family-based interventions over a longer time period. One exception is a study by Spoth and colleagues13 that found some evidence of a sustained effect, with lifetime cigarette use significantly lower among those participating in the Iowa Strengthening Families Program Group at six-year follow-up post intervention. Likewise, the intervention trial evaluated by Storr and colleagues11 observed that children in the family–school partnership intervention group (which targeted improvements in parent–teacher communication and parents' child behaviour management strategies) had reduced smoking uptake compared with the control group at six-year follow-up.

In addition to tobacco-specific family-based interventions, smoking is sometimes incorporated into broader programs targeting a number of adolescent risk behaviours. An Australian example of this was a Perth-based randomised controlled trial to assess the impact of a home-based intervention designed to encourage parent–child communication about tobacco and alcohol.14 Parents (n=1201) of children aged 10–11 years were recruited from 20 primary schools, and those in the intervention group were provided with information sheets, parenting tips and activities to help parents talk with their child about issues related to smoking cigarettes and drinking alcohol. Parents in the intervention group were more likely to have engaged their child in discussions and to have addressed topics identified in the provided materials as being protective of children's involvement in tobacco and alcohol.14

In a published review of the effectiveness of 20 parenting programs to prevent or reduce use of drugs, alcohol or tobacco by children (<18 years), five of the reviewed interventions were tobacco specific, five were alcohol specific and the rest addressed a combination of substance use.15 The format of these parenting interventions varied widely, including group parenting skills training, homework tasks requiring parental participation, mailed booklets, home visiting or a mixture of these approaches. As with the reviews of smoking-specific interventions, the results were somewhat mixed, and where programs included parental involvement among other strategies, it is difficult to disentangle the relative effect of this component.15 However, the authors did note that more active parental involvement was an important feature of successful interventions.15

While parental smoking itself is a significant predictor of smoking uptake, one interesting US study implemented a home-based program with parents who smoked.16 The program was framed around an 'anti-smoking socialisation approach', which focuses on influencing the development of children's cognitive and behavioural norms against smoking. As articulated by the researchers, although parents who smoke model smoking behaviour, this does not 'preclude a parent from eliminating a child's exposure to passive smoke, talking to a child about smoking, making cigarettes inaccessible, monitoring the smoking behaviour of children and their friends, and making clear the disciplinary consequences of smoking' (p57.16) In the follow-up evaluation three years after the intervention, those in the intervention group were far less likely to have begun smoking, with the odds of smoking twice as high among the control group compared with the intervention group, despite the fact that children in both groups had parents who smoked.16

While family-based interventions often focus on parents, having a sibling who smokes is also a significant predictor of smoking uptake. Given research indicating that older teenagers often hope that their younger siblings do not experiment with smoking17,18, siblings may be another ally for tobacco-control efforts within the family setting.19

5.27.2 Family-based smoking prevention interventions in Australia

In the National Preventative Health Strategy, The Roadmap for Action, assisting parents and educators to discourage use of tobacco is identified as a key action area (Chapter 3, Tobacco, key action area 9, along with assisting them to protect young people from secondhand smoke)i. The roadmap document goes on to identify a number of ways in which parents can help to discourage their children from taking up smoking, and within this, areas for possible tobacco-control efforts. Positive influences cited include quitting smoking if parents smoke themselves, effective strategies for dealing with family conflict, and spending time with children. Conversely, lack of parental supervision is noted as being strongly associated with smoking experimentation.20 In Australia, the role of families or parents in discouraging smoking has not been overtly addressed in many discrete programs, but is more likely to be incorporated into broader information for parents (see examples in Table 5.25.1), or as an element of school-based programs (such as the 'Why can't we smoke at school' resource developed in Victoria described in Table 5.25.1). A more targeted exception is the 'Clearing the air: talking to children and teenagers about smoking' pamphlet available in Western Australia, Victoria and the Australian Capital Territory (see Table 5.25.1).

 

Table 5.27.1
Home/parent-based programs and strategies to reduce smoking in Australian youth

Strategy/program

Description

Weblink

'Why can't we smoke at school?' Guidelines to address students' smoking

Developed by Quit Victoria, the kit contains a letter to parents and a tool to help students develop a management plan to not smoke at school.

www.oxygen.org.au/resources/tackling-smoking-in-schools

The Drug Info Clearinghouse

Internet site for parents to find information about drugs.

www.druginfo.adf.org.au/information-for/parents

'Car and home: smoke free zone'

Multifaceted approach targeting parents to decrease their smoking in the home and cars.

www.health.nsw.gov.au/pubs/2007/car_home_factsheet.html

ASH Australia:
information for parents

Action on Smoking and Health Australia. National health group dedicated to reducing tobacco diseases. Webpage resource for parents.

www.ashaust.org.au/lv3/Lv3informationparents.htm

'Clearing the air: talking to children and teenagers about smoking'

Resource developed and distributed to schools by the Smarter than Smoking project, Western Australia. Also available in Victoria and the Australian Capital Territory.

www.quit.org.au/downloads/schools/clearing_the_air.pdf

 

Recent news and research

For recent news items and research on this topic, click here (Last updated March 2018)  
 

References

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20. White VM and Hayman J. Victorian secondary school students' use of licit and illicit substances in 2005. Results from the 2005 Australian Secondary Students' Alcohol and Drug Survey. Melbourne: Victorian Department of Human Services, 2006. Available from: http://www.health.vic.gov.au/drugservices/pubs/vsss_2005.htm

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