Smoking mothers and snuffing fathers: behavioural influences on youth tobacco use in a Swedish cohort

Objective: To analyse the influences of parental use of cigarettes and snus (the Swedish variety of smokeless tobacco) on offspring's behaviour. Design: Prospective cohort study. Setting: The Stockholm County of Sweden. Subjects: 2232 adolescents recruited in the fifth grade (mean age 11.6 years) with follow up in the eighth grade. Main outcome measures: Self reported tobacco use (ever and current use of cigarettes and/or snus) in the eighth grade. Results: Parents' tobacco use was associated with adolescents' current use of cigarettes and snus (odds ratio (OR) 2.7, 95% confidence interval (Cl) 1.8 to 3.9 if both parents used tobacco v neither parent). Mother's cigarette smoking was associated with adolescents' current exclusive smoking (OR 2.4, 95% Cl 1.6 to 3.6). Father's use of snus was associated with current exclusive use of snus among boys (OR 3.0, 95% Cl 1.4 to 6.4), but not with current cigarette use. The overall prevalence of current smoking was lower among children whose fathers used snus than among those whose fathers smoked. Conclusions: Parental smoking, especially maternal smoking, enhances the risk of tobacco experimentation in youths, as does paternal use of smokeless tobacco. However, the transition to regular cigarette smoking is not likely to be affected by paternal use of smokeless tobacco. Contextual factors, in particular declining smoking trends and negative social acceptance of smoking, can explain most of these findings.