Perceived inter-parental relationship and smoking behaviours in Hong Kong adolescents

Abstract

SIGNIFICANCE: Family has important influences on adolescent smoking but no study has ever reported the association between quality of inter-parental relationship and adolescent smoking. We tested the association between adolescent smoking behaviours and perceived inter-parental relationship in Hong Kong. METHODS: During 2012-13, a representative school-based, cross-sectional sample of 45,857 secondary 1-6 (US grade 7-12) students in Hong Kong (boys 51.4%, mean age 14.6) rated inter-parental relationship as worse (fair/bad/very bad) versus good/very good (reference) and reported smoking behaviours. Data were weighted by sex, age and grade distributions of Hong Kong secondary students in 2012/13. Logistic and linear regression yielded adjusted odds ratios (AORs) of ever smoking, current smoking (smoked at least once in the past 30 days), morning smoking urge and intention to quit; and beta-coefficient (β) of daily cigarette consumption in relation to perceived inter-parental relationship, adjusting for sex, age, perceived family affluence, parental smoking, peer smoking and school clustering effects. RESULTS: In all students, 15.0% and 3.3% reported ever and current smoking, while 30.7% reported worse inter-parental relationship. Students reporting worse (vs good/very good) inter-parental relationship were more likely to be ever smokers (21.7% vs 10.7%; AOR 1.78, 95% CI 1.59 to 1.97), and current smokers (5.2% vs 2.0%; AOR 1.79, 95% CI 1.48 to 2.16). In current smokers, worse perceived inter-parental relationship was significantly associated with morning smoking urge (AOR 1.55, 95% CI 1.17 to 2.06) but neither with intention to quit (AOR 1.07, 95% CI 0.80 to 1.44) nor daily cigarette consumption (adjusted β -0.34, 95% CI -0.89 to 0.22). CONCLUSIONS: We found the first evidence that worse perceived inter-parental relationship in adolescents was associated with cigarette smoking. The findings suggest that family-based preventive measures strengthening inter-parental relationship and family wellbeing may be useful in preventing adolescent smoking.