Effects of Family Structure and Social Influences on the Stage of Adolescent Smoking Behavior in Korea

Abstract

Introduction : High adolescent smoking prevalence has been remained as a major challenge in public health area worldwide. Although adolescent smoking rates in Korea have consistently declined over the past decade, 14% of male students and 4% of female students from both middle and high school reported as current smokers in 2014. To elicit effective prevention of adolescent smoking, differentiated strategies should be applied according to the smoking stages where adolescent are currently in. Family structure, socioeconomic status, and interpersonal factors such as friends, family smoking and connectedness are important predictors of adolescent smoking behavior. Therefore, this study aims to demonstrate the association of social influences with each stages of adolescent smoking behavior. Methods : The nationwide data were obtained from the 10th Korea Youth Risk Behavior Web-based Surveys (KYRBS) in 2014. The data from total 70,135 adolescents aged from 12-18 were analyzed. Smoking stages were categorized into three stages which are never smoker, tried/experimenter, and regular/daily smoker. Family structure, interpersonal factors such as friends and family smoking and connectedness, and lastly socioeconomic status were included as independent factors. To examine the association between adolescents smoking status and independent factors, frequency analysis, Chi-square test, multinomial logistic regression, and multiple logistic regression analysis were conducted. For multinomial logistic regression, gender and school type stratification were used.

Results : Male subjects in middle school were relatively more dependent on family related factors, while female in both middle and general high school were more dependent on family related factors than vocational high school students in general. For middle school students in broken families increased the likelihood of being tried/experimenter or current smoker than in two parent families for both gender. Family smokers and peer smokers increased the risk of smoking initiation and regular/daily smoking. Parents, siblings and grandparents smokers affect the adolescents smoking status especially for middle school students. Also middle school male students who mostly get advice from parents showed decrease in the risk across all stages. In contrast, for male, friends advising increased the risk across all stages regardless of school type. The effects of siblings advising, however, showed inverse association by gender. Fathers education level had significant association with smoking status for both male and female in middle school. Moreover, peer smoking was the most salient predictor of regular/daily smoking transition regardless of gender and school type. For male, smoking friends increased the risk of being tried/experimenter by 4 times compare to never smoker. Besides, the risk of being regular/daily smoker was about 12 times greater than that of being tried/experimenter, and the effects were greater for female.

Conclusion : Family can be either protective or risk factor on adolescents smoking behavior. As the study results show, connectedness to parents decreases risk of smoking initiation and escalation to regular/daily smoking. Prevention programs should address smoking parents or other smoking family members such as siblings and grandparents about the adverse consequences of their own smoking behavior on adolescents. Besides, since peer smoking is the most salient factor on smoking transition, intervention should be more reinforced on peer groups rather than family members. Therefore, strengthen the connectedness with parents or mentorship programs along with the monitoring and educating peer smoking groups may elicit effective implication to decrease and prevent tobacco use.