Sitting in nonsmoking sections a powerful tactic for preventing teen smoking

The simple act of requesting to sit in a nonsmoking section may have profound benefits beyond avoiding second-hand smoke, according to new findings by researchers at Fred Hutchinson Cancer Research Center.

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, report M. Robyn Andersen, Ph.D., and colleagues in the April issue of The Archives of Pediatrics & Adolescent Medicine.

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 reported.

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,” Andersen said. “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,” said Andersen, an associate member of Fred Hutchinson’s Public Health Sciences Division.

The study, funded by the National Cancer Institute and a gift from the Northern Life Insurance Company of Minneapolis, Minn., is the first 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.

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 parent who smokes 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 are based on 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 was collected from the parents via survey when their children were in the 11th grade. A year later, the 12th-grade students were asked to complete a classroom survey about their current smoking behavior. Student self-reports of smoking activity were found to be largely accurate as verified through saliva tests that checked for the presence of cotinine, a byproduct of nicotine.

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 served as 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. Resources for free smoking-cessation assistance include:

The National Cancer Institute’s Smoke Quitline at (877) 44U-QUIT or www.smokefree.gov.
The Washington State Health Department Tobacco Quitline at (877) 270-STOP or www.quitline.com.

The Fred Hutchinson Cancer Research Center, home of two Nobel Prize laureates, is an independent, nonprofit research institution dedicated to the development and advancement of biomedical technology to eliminate cancer and other potentially fatal diseases. Fred Hutchinson receives more funding from the National Institutes of Health than any other independent U.S. research center. Recognized internationally for its pioneering work in bone-marrow transplantation, the center’s four scientific divisions collaborate to form a unique environment for conducting basic and applied science. Fred Hutchinson, in collaboration with its clinical and research partners, the University of Washington Academic Medical Center and Children’s Hospital and Regional Medical Center, is the only National Cancer Institute-designated comprehensive cancer center in the Pacific Northwest and is one of 38 nationwide. For more information, visit the center’s Web site at www.fhcrc.org.