Abstract
Introduction:Parental factors may explain part of the social patterning of smoking among adolescents. This study aims at assessing the association between adolescent smoking and family characteristics (parental education, family wealth, and religion) and the mediating role of parental factors (smoking, control, and permissiveness towards smoking). Methods:In 2017, a cross-sectional survey was conducted in eight Indonesian cities among 2,393 students aged 13–18 years. Multilevel logistic regression analysis estimated the associations between family characteristics and adolescent smoking. Generalized Structural Equation Models (GSEM) quantified mediation of these associations by parental factors. Analyses were stratified by gender. Results:Smoking prevalence was 35.8% among boys and 2.6% among girls. Odds of smoking were higher among those with lower parental education among boys (low vs. high: OR:1.57, 95%CI:1.01-2.43), but not girls (OR:0.91, 95%CI:0.24-3.43). The association among boys was partially mediated by father’s smoking status, parental control, and parental permissiveness towards smoking. High family wealth was associated with higher odds of smoking among girls (poorer vs. wealthier: OR:0.39, 95%CI:0.15-0.99), but not boys (OR:0.76, 95%CI:0.52-1.10). This association among girls was not clearly mediated by parental factors. Religion was not associated with smoking among boys or girls. Conclusions:In Indonesia’s urban settings, inequalities in boys’ smoking by educational background may be addressed by measures aimed at supporting lower educated parents to improve parental control and to reduce permissiveness towards smoking.
Highlights
Parental factors may explain part of the social patterning of smoking among adolescents
This study aims at assessing the association between adolescent smoking and family characteristics and the mediating role of parental factors
Religious denomination has rarely been taken into account when describing the social patterning of adolescent smoking, despite previous research suggesting that cultural factors linked to religion may be an important determinant of adolescent smoking (Weaver et al, 2005; Barbosa Filho et al, 2012)
Summary
Parental factors may explain part of the social patterning of smoking among adolescents. High family wealth was associated with higher odds of smoking among girls (poorer vs wealthier: OR:0.39, 95%CI:0.15-0.99), but not boys (OR:0.76, 95%CI:0.52-1.10) This association among girls was not clearly mediated by parental factors. Smoking prevalence is higher among adolescents in poorer families and whose parents are less educated (Bardach et al, 2016; Talip et al, 2016; Xi et al, 2016) Such inequalities have been found in high-income countries (Moor et al, 2019), and in low and middle-income countries (LMICs) (Bardach et al, 2016; Talip et al, 2016; Xi et al, 2016; Kusumawardani et al, 2018). In Islam, smoking is often labelled as haram (strongly prohibited) or makruh (reprehensible but not fully prohibited) because smoking is not comprehensively referenced in two Islamic laws (i.e., Qur’an and Hadith) (Garrusi and Nakhaee, 2012)
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