Smoking and family harmony among Chinese in a general population: evidence from the family cohort

Abstract

Background: The importance of family social capital is increasingly recognised with emerging evidence for family harmony. Previous studies have shown that Chinese adolescents who smoked were more likely to report lower harmony in their families. Aims : To examine the cross-sectional association between smoking and family harmony among Chinese adults in Hong Kong. Key methods: Under Hong Kong FAMILY Project, a Jockey Club Initiative for a Harmonious Society, 17,896 randomly selected adults aged 15 or above were asked in baseline household interviews about their smoking habit (never, former and current smokers). Family harmony was assessed using a validated scale consisting of 5 items: “My family functions well for all members”, “My family’s day-to-day interactions are peaceful”, “Family members accommodate each other”, “I am proud of my family”, and “My family is harmonious”. Each item was rated on a 5-point Likert scale with 1 (strongly agree) and 5 (strongly disagree). The 5 item scores were summed to yield the Family Harmony Score (higher scores indicating greater harmony). The association between smoking and Family Harmony Score was analysed by multivariable linear regression model, adjusting for age, sex, educational attainment and self-reported chronic disease status. Results : 80.4% were never smokers, 14.1% were current smokers and 5.5% were former smokers. Compared to never smokers, current smokers and former smokers reported significantly lower family harmony (b = -0.25, 95% CI: -0.35 to -0.15, p<0.001; b = -0.18, 95% CI: -0.32 to -0.04, p<0.05 respectively). The family harmony of former smokers was not significantly different from that of current smokers (b = 0.074, 95% CI: -0.10 to 0.25, p=0.42). Conclusions : Baseline findings from a large, population-based Chinese cohort within a culture which highly values harmony showed that current and former smoking was associated with lower family harmony, and quitting showed some benefits. Future studies examining the bi-directional relationships between changes in smoking habit and in family harmony are needed. Funding: The Hong Kong Jockey Club Charities Trust was the sole funder of the FAMILY Project from 2007 to 2015. Corresponding Author: Tai Hing Lam, MBBS, MD(HK), The University of Hong Kong, hrmrlth@hku.hk