A icle
T ansmission o Smoking ac oss Th ee Gene a ions
in Finland
Salma E. T. El-Amin 1, Jaana M. Kinnunen 1,*, Hanna Ollila 2, Mika Helminen 1,3, Joana Al es 4,
Pi jo Lind o s 1,5 and A ja H. Rimpelä 1,5,6
Recei ed: 22 Oc obe 2015; Accep ed: 21 Decembe 2015; Published: 24 Decembe 2015
Academic Edi o : Zubai Kabi
1School o Heal h Sciences, Uni e si y o Tampe e, 33014 Tampe e, Finland;
[email p o ec ed] (S.E.T.E.-A.); [email p o ec ed] (M.H.); [email p o ec ed] (P.L.);
[email p o ec ed] (A.H.R.)
2
Tobacco, Gambling and Addic ion Uni , Na ional Ins i u e o Heal h and Wel a e, 00271 Helsinki, Finland;
[email p o ec ed]
3Science Cen e, Pi kanmaa Hospi al Dis ic , 33521 Tampe e, Finland
4Na ional School o Public Heal h, Lisbon NOVA Uni e si y, P-1600-560 Lisbon, Po ugal;
[email p o ec ed]
5PERLA—Tampe e Cen e o Childhood, You h and Family Resea ch, Uni e si y o Tampe e,
33104 Tampe e, Finland
6Depa men o Adolescen Psychia y, Pi käniemi Hospi al, Tampe e Uni e si y Hospi al,
33380 Nokia, Finland
*Co espondence: jaana.m.kinnunen@s a .u a. i; Tel.: +358-40-190-1667
Abs ac :
The in luence o pa en s’ smoking on child en’s smoking is well known, bu ew s udies
ha e examined he associa ion be ween g andpa en s’ and g andchild en’s smoking. We s udied he
associa ion be ween pa e nal and ma e nal g andpa en s’ smoking and hei g andchild en’s obacco
use and assessed whe he pa en s’ smoking is a media o in his p ocess. Da a we e ob ained om a
na ional su ey o 12–18-yea -old Finns in 2013 (N= 3535, esponse a e 38%). Logis ic eg ession and
media ion analyses we e used. Bo h boys and gi ls had highe odds o smoking expe imen a ion,
daily smoking and o he obacco o obacco-like p oduc use i hei mo he , a he o any o he
ou g andpa en s we e cu en o o me smoke s. When pa en s’ and g andpa en s’ smoking s a us
we e included in he same model, g andpa en s’ smoking gene ally los s a is ical signi icance. In he
media ion analysis, 73% o he o al e ec o g andpa en s’ smoking on g andchild en’s daily smoking
was media ed h ough pa en s’ smoking, 64% on smoking expe imen a ion and 63% on o he obacco
o obacco-like p oduc use. The indi ec e ec o a mo he ’s smoking was highe han ha o
a a he ’s. To conclude, pa e nal and ma e nal g andpa en s’ smoking inc eases g andchild en’s
obacco use. The in luence is mainly, bu no comple ely, media ed h ough pa en s’ smoking.
Keywo ds:
smoking; obacco use; adolescen s; in e gene a ional ansmission; pa en s; g andpa en s
1. In oduc ion
Family has an impo an ole in p o iding models o beha io s and shaping he obacco p ac ices,
alues, belie s and a i udes o child en and adolescen s [
1
–
3
]. Child en lea n o cons uc hei eali y
based on ea ly expe iences in hei en i onmen , pee beha io s and cul u al no ms [
2
,
4
]. The e ec
o pa en al smoking on child en’s smoking has been well documen ed [
5
], bu he e ha e been
di e ences ound ega ding whe he a mo he ’s o a he ’s smoking is a mo e impo an isk ac o
and ega ding whe he he e ec a ies based on he child’s gende [
6
–
10
]. In hei sys ema ic e iew
and me a-analysis, Leona di-Bee e al. [
5
] concluded ha ha ing wo smoking pa en s inc eases he
child’s smoking isk compa ed o ha ing jus one smoking pa en . They also concluded ha a mo he ’s
In . J. En i on. Res. Public Heal h 2016,13, 74; doi:10.3390/ije ph13010074 www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2016,13, 74 2 o 15
smoking is a sligh ly mo e p ominen isk ac o han a a he ’s smoking (OR 2.19 s. OR 1.66).
They also p o ided some e idence o a sex-speci ic e ec in which boys we e mo e subs an ially
in luenced by pa e nal smoking, while gi ls we e in luenced mo e by ma e nal smoking.
Despi e he as e idence o he pa en al in luence on smoking ini ia ion, he in luence
o g andpa en s’ smoking and he in e gene a ional ansmission o smoking beha io beyond
wo gene a ions ha e a ely been s udied [
6
,
7
]. Howe e , he inc eased li e expec ancy o bo h
men and women in indus ialized coun ies [11] means ha g andpa en s li e longe and ha e mo e
oppo uni ies o wi ness hei g andchild en’s de elopmen om ea ly childhood o adolescence and
e en adul hood and hus hei smoking may play a ole in he ini ia ion o smoking among hei
g andchild en. Esca io and Wilkinson [
12
] showed ha smoking by a leas one g andpa en li ing in
he same amily as g andchild en inc eases he odds o smoking o boys bu no o gi ls. A s udy
om he U.S. examined he smoking beha io ac oss h ee gene a ions and showed ha smoking
beha io s a e ans e ed om p eceding gene a ions o la e gene a ions and ha pa en s ha e a
media ing ole in his p ocess [
8
]. The e a e no published s udies in which he e ec s o ma e nal and
pa e nal g andpa en s’ smoking on g andchild en’s smoking ha e been s udied sepa a ely; no ha e
he e been s udies on he use o obacco o obacco-like p oduc s o he han ciga e es. In his s udy,
o he obacco o obacco-like p oduc s include snus, wa e pipes and elec onic ciga e es, and he
sho e e m “o he obacco p oduc s” will be used o encompass hese p oduc s, al hough elec onic
ciga e es do no ac ually con ain obacco.
In his s udy, we add essed he ansmission o smoking ac oss h ee gene a ions. The esea ch
ques ions we e as ollows:
(1)
A e ma e nal and pa e nal g andmo he s’ and g and a he s’ smoking ela ed o hei
g andchild en’s smoking and use o o he obacco p oduc s?
(2)
Is he in luence o g andpa en s’ smoking independen o pa en s’ smoking o is i media ed
h ough pa en al smoking beha io ?
In addi ion, we s udied he ela ionship o mo he ’s and a he ’s smoking o hei child en’s
smoking and use o o he obacco p oduc s as well as di e ences be ween gende s.
2. Me hods
2.1. Sampling and Pa icipan s
Da a om he 2013 Adolescen Heal h and Li es yle Su ey (AHLS), he na ionwide moni o ing
sys em on adolescen heal h and heal h beha io s in Finland was used. AHLS is a c oss-sec ional
pos al su ey, wi h an op ion o answe secu ely online. I has been conduc ed biennially since 1977.
A na ionally ep esen a i e sample o indi iduals aged 12, 14, 16 and 18 yea s was ob ained om
he na ional Popula ion Regis e Cen e. All Finns bo n on sample days in June, July o Augus
in each age g oup we e selec ed o minimize he age a ia ion wi hin age g oups. The E hics
Commi ee o he Tampe e egion app o ed he s udy p o ocol. Filling in he ques ionnai e was
conside ed an adolescen ’s consen o pa icipa e, and no pa en al consen was needed acco ding
o he E hics Commi ee. In Janua y 2013, sel -adminis e ed ques ionnai es in Finnish we e sen
o 9398 adolescen s. They we e ollowed by h ee eminde s o non- esponde s. The numbe o
esponde s o he ques ionnai e was 3535, indica ing a esponse a e o 38% (including 1405 boys and
2130 gi ls).
2.2. Measu es
2.2.1. Child en’s Smoking
Child en’s smoking s a us was assessed wi h he ques ions: “Ha e you e e ied smoking?” wi h
he op ions “No” and “Yes”; “How many ciga e es ha e you smoked du ing you li e- ime un il now?”
wi h he op ions “None”, “Only one”, “App oxima ely 2–50” and “Mo e han 50”; and “Which o he
In . J. En i on. Res. Public Heal h 2016,13, 74 3 o 15
ollowing op ions bes desc ibes you cu en smoking?” wi h he op ions “I smoke once pe day o
mo e o en”, “I smoke once pe week o mo e o en bu no daily”, “I smoke less han once pe week”,
“I ha e s opped smoking” and “I don’ smoke”. Based on he answe s, he smoking s a us was di ided
in o h ee g oups: Ne e smoke s (ne e ied smoking), expe imen e s ( ied bu did no smoke daily)
and daily smoke s ( epo ed daily smoking and had smoked >50 ciga e es du ing hei li e imes). Fo
he analyses, dicho omiza ion was conduc ed o ied smoking (expe imen ing) and daily smoking
(No/Yes) based on he smoking ini ia ion p ocess whe e “ ied smoking” ep esen s he i s s eps and
“daily smoking” ep esen s egula smoking whe e nico ine addic ion has a s onge ole (See Table 1).
Table 1.
Dis ibu ion o child en’s smoking expe imen a ion, daily smoking and o he obacco p oduc
use *and pa en s’ and g andpa en s’ smoking by gende .
Smoking Gi ls Boys All
(n= 2130) (n= 1405) (N= 3535)
% (n) % (n) % (n)
Child en
T ied smoking
No 59.8 (1267) 61.6 (852) 60.5 (2120)
Yes 40.2 (851) 38.4 (531) 39.5 (1382)
Daily smoking
No 89.4 (1901) 91.0 (1277) 90.0 (3178)
Yes 10.6 (226) 9.0 (126) 10.0 (352)
O he obacco p oduc use *
No 72.6 (1547) 67.2 (939) 70.5 (2486)
Yes 27.4 (583) 32.8 (458) 29.5 (1041)
Pa en s
Fa he ’s smoking s a us
Ne e smoke 56.6 (1153) 56.1 (749) 56.4 (1902)
Ex-smoke 19.9 (406) 22.7 (303) 21.0 (705)
Cu en smoke 23.4 (477) 21.1 (282) 22.5 (759)
Mo he ’s smoking s a us
Ne e smoke 70.0 (1451) 71.7 (962) 70.7 (2413)
Ex-smoke 13.9 (288) 14.8 (199) 14.3 (487)
Cu en smoke 16.1 (333) 13.5 (181) 15.1 (514)
Pa e nal g andpa en s
G and a he ’s smoking s a us
Ne e smoke 75.5 (1070) 73.2 (736) 74.5 (1806)
Ex-smoke 14.4 (204) 17.0 (171) 15.5 (375)
Cu en smoke 10.2 (144) 9.8 (99) 10.0 (243)
G andmo he ’s smoking s a us
Ne e smoke 83.7 (1427) 85.8 (975) 84.5 (2402)
Ex-smoke 7.8 (133) 7.2 (82) 7.6 (215)
Cu en smoke 8.5 (145) 7.0 (80) 7.9 (225)
Ma e nal g andpa en s
G and a he ’s smoking s a us
Ne e smoke 71.0 (1132) 71.4 (761) 71.1 (1893)
Ex-smoke 17.1 (273) 17.6 (188) 17.3 (461)
Cu en smoke 11.9 (190) 11.0 (117) 11.5 (307)
G andmo he ’s smoking s a us
Ne e smoke 81.3 (1484) 82.9 (979) 81.9 (2463)
Ex-smoke 8.5 (155) 8.6 (102) 8.5 (257)
Cu en smoke 10.2 (186) 8.5 (100) 9.5 (286)
*Snus, wa e pipe and elec onic ciga e es.
In . J. En i on. Res. Public Heal h 2016,13, 74 4 o 15
The use o o he obacco o obacco-like p oduc s was assessed wi h he ollowing ques ions:
“Ha e you e e ied snus?” wi h he op ions “Ha e no ied”, “T ied once”, “Ha e used 2–50 imes”
and “Ha e used mo e han 50 imes”; and “Ha e you e e ied wa e pipe?” and “Ha e you e e
ied elec onic ciga e es?” wi h he op ions o bo h ques ions “I don’ know wha his is”, “No”,
“I ha e ied his p oduc once o wice”, “I ha e ied his p oduc 20 imes o ewe ” and “I ha e
ied his p oduc mo e han 20 imes”. Fo he analyses, hese h ee ques ions we e combined as
one dicho omized a iable “o he obacco p oduc use” such ha epo ing a ial o a leas one o
hese p oduc s was coded as “Yes”, and o he wise he esponse was coded as “No”.
2.2.2. Pa en s’ and G andpa en s’ Smoking
Da a on pa en s’ and g andpa en s’ smoking we e assessed wi h he ques ions “Ha e you
pa en s smoked du ing you li e ime?” and “Ha e you g andpa en s smoked du ing you li e ime?”
sepa a ely o a he and mo he , pa e nal g and a he and g andmo he , and ma e nal g and a he
and g andmo he . The op ions we e “Ne e ”, “Has s opped”, “Smokes cu en ly”, and “I don’
ha e one o I don’ know”. In he analyses, he answe s o he op ion “I don’ ha e one o I don’
know” we e included in he ca ego y “Ne e ”. The p opo ion o missing alues was 2.8% o a he ,
1.5% o mo he , 28.9% o pa e nal g and a he , 16.6% o pa e nal g andmo he , 22.3% o ma e nal
g and a he , and 12.4% o ma e nal g andmo he . Addi ionally, a combined a iable was c ea ed
o pa en s’, pa e nal g andpa en s’ and ma e nal g andpa en s’ smoking wi h ca ego ies “Nei he o
hem smokes”, “One o bo h has s opped”, “One o hem smokes” and “Bo h o hem smoke”.
2.2.3. O he Va iables
Pa en s’ employmen s a us was assessed and ca ego ized sepa a ely o a he s and mo he s
as “Wo king”, “Unemployed” and “O he ” ( e i ed o on a long sick lea e). Pa en s’ educa ion was
assessed sepa a ely and combined in o one a iable acco ding o he highes le el ha he pa en s
had achie ed wi h he ca ego ies “high” (mo e han 12 yea s o educa ion), “middle” (9–12 yea s) and
“low” (9 yea s o ewe ).
2.3. Analysis o Non-Response
Boys we e unde ep esen ed among he esponden s (40.6%) compa ed wi h he o e all sample
(50.7%). Fo age, adolescen s aged 12 yea s we e o e ep esen ed (16.3% s. 13.5%), and hose aged
18 yea s we e unde ep esen ed (25.7% and 30.4%, espec i ely), while di e ences we e small o hose
aged 14 yea s and 16 yea s. Boys we e mo e likely o be non- esponde s (p= 0.01), bu he di e ences
be ween age g oups we e no signi ican (p= 0.216). The impac o non- esponse on he epo s
o pa en s’ and g andpa en s’ smoking was assessed by di iding he esponde s in o ou g oups
acco ding o how p omp ly hey had answe ed he su ey. I was assumed ha he la e he pe son
answe ed, he mo e he/she esembled a non- esponde . The e we e no sys ema ic di e ences be ween
he g oups ha had answe ed ea ly o la e ha would ha e sugges ed an o e - o unde ep esen a ion
o pa en al o g andpa en al smoking among he non- esponden s (Appendix Table A1).
2.4. Da a Analysis
Logis ic eg ession analysis was used o s udy he associa ion o pa en s’ and g andpa en s’
smoking wi h child en’s smoking and o he obacco p oduc use. Resul s a e p esen ed as odds
a ios (ORs) and 95% con idence in e als (CIs). Fi s , age-adjus ed ORs and 95% CIs o boys’ and
gi ls’ obacco use a iables we e calcula ed acco ding o he mo he ’s, a he ’s, and each o he ou
g andpa en ’s smoking s a uses (Table 2). Second, ORs and 95% CIs we e calcula ed o child en’s
obacco use a iables acco ding o each g andpa en ’s smoking s a us, adjus ing i s o age and sex
(Model 1, Table 3) and hen o pa en s’ smoking s a us, employmen s a us and educa ion (Model 2,
Table 3). Thi d, logis ic eg ession analysis was conduc ed o child en’s obacco use acco ding o
he numbe o smoke s among pa en s, ma e nal g andpa en s and pa e nal g andpa en s (Model 1,
In . J. En i on. Res. Public Heal h 2016,13, 74 5 o 15
Table 4), adjus ing o age and sex. Finally, all h ee a iables we e included in he analysis a he same
ime, adjus ing o age, sex, pa en s’ educa ion, and employmen s a us (Model 2, Table 4).
The Pea son
χ2
es was used o examine he s a is ical signi icance; p- alues in Tables 2–4
ep esen he s a is ical signi icance o he ela ionship be ween child en’s obacco use and
pa en s’/g andpa en s’ smoking a iables (Wald es ). The logis ic eg ession analyses we e conduc ed
wi h IBM SPSS S a is ics . 20.0 so wa e (IBM Inc. A monk, NY, USA).
The media ion analysis [
13
] was pe o med o assess how much o he e ec o he exposu e o
g andpa en s’ smoking on child en’s smoking is media ed h ough mo he s’ and a he s’ smoking.
G andpa en s’ smoking was assumed o ha e an e ec on bo h mo he s’ and a he s’ smoking and
also on child en’s smoking (Figu e 1). Mo he s’ and a he s’ smoking was assumed o ha e e ec
only on child en’s smoking. All he dependen , independen and media o a iables we e coded as
bina y (No = 0, Yes = 1). Fo he mo he and a he , he ca ego iza ion was 0 = Ne e smoke and
1 = Smoke o ex-smoke , and o g andpa en s, 0 = All g andpa en s ne e smoke s and 1 = One o
mo e g andpa en s smoke s o ex-smoke s. STATA ( e sion 13.1) so wa e wi h a “bina y-media ion”
p og am was used o media ion analyses, oge he wi h a “boo s ap” command o p oducing he
con idence in e als [14].
3. Resul s
3.1. Smoking among Child en, Thei Pa en s and G andpa en s
O e all, 39.5% o he 12–18-yea -old esponden s had ied smoking, and 10.0% o hem smoked
daily (Table 1). Smoking, bo h expe imen a ion and daily smoking, was somewha mo e p e alen
among gi ls, bu he di e ence was no signi ican . O all esponden s, 29.5% had ied o he obacco
p oduc s, boys mo e o en han gi ls (p< 0.001). In o al, 15.1% o mo he s and 22.5% o a he s smoked
cu en ly, compa ed o less han 12% o all g andpa en s.
3.2. Associa ion o Pa en s’ and G andpa en s’ Smoking S a uses wi h Child en’s Tobacco Use
When analyzing boys and gi ls sepa a ely and adjus ing o age, a he s’ and mo he s’ cu en
smoking was associa ed wi h child en’s smoking expe imen a ion and daily smoking as well as
wi h o he obacco p oduc use (Table 2). The associa ions we e somewha s onge among gi ls;
he s onges associa ion was ound be ween mo he s’ cu en smoking and gi ls’ daily smoking.
Addi ionally, a he s’ and mo he s’ o me smoking we e associa ed wi h he child en’s smoking
expe imen a ion and daily smoking as well as wi h o he obacco p oduc use (See also Appendix
Table A2).

In . J. En i on. Res. Public Heal h 2016,13, 74 6 o 15
Table 2.
Age-adjus ed ORs and 95% CIs o boys’ and gi ls’ smoking expe imen a ion, daily smoking and o he obacco p oduc use
*
by pa en s’ and g andpa en s’
smoking s a uses.
Smoking S a us o Pa en s
and G andpa en s
T ied Smoking Daily Smoking O he Tobacco P oduc Use *
Gi ls Boys Gi ls Boys Gi ls Boys
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Pa en s
Fa he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.73 (1.35–2.22) 1.92 (1.44–2.57) 2.27 (1.56–3.30) 2.64 (1.66–4.21) 1.45 (1.11–1.90) 1.53 (1.14–2.05)
Cu en smoke 2.14 (1.70–2.71) 1.90 (1.41–2.55) 3.16 (2.25–4.44) 2.32 (1.43–3.76) 1.99 (1.55–2.54) 1.50 (1.11–2.03)
p- alue <0.001 <0.001 <0.001 <0.001 <0.001 0.009
Mo he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.88 (1.43–2.48) 2.06 (1.49–2.86) 2.33 (1.55–3.50) 1.55 (0.90–2.66) 1.96 (1.46–2.62) 1.44 (1.03–2.01)
Cu en smoke 2.71 (2.08–3.52) 1.56 (1.11–2.18) 5.18 (3.72–7.22) 2.91 (1.81–4.68) 2.85 (2.18–3.72) 1.46 (1.04–2.05)
p- alue <0.001 <0.001 <0.001 <0.001 <0.001 0.010
Pa e nal g andpa en s
G and a he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.42 (1.03–1.97) 1.36 (0.96–1.94) 1.29 (0.79–2.09) 2.19 (1.24–3.85) 1.44 (1.02–2.03) 1.35 (0.94–1.93)
Cu en smoke 1.84 (1.26–2.70) 1.34 (0.90–2.18) 2.63 (1.59–4.33) 1.74 (0.85–3.57) 2.40 (1.61–3.57) 1.17 (0.74–1.85)
p- alue 0.005 0.210 0.002 0.006 <0.001 0.291
G andmo he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 2.47 (1.67–3.64) 0.71 (0.43–1.17) 1.93 (1.14–3.25) 1.23 (0.53–2.82) 1.92 (1.28–2.86) 0.76 (0.45–1.28)
Cu en smoke 1.25 (0.86–1.83) 1.73 (1.06–2.81) 1.71 (1.01–2.90) 3.02 (1.50–6.09) 1.38 (0.92–2.06) 1.84 (1.14–2.99)
p- alue <0.001 0.055 0.005 0.001 0.005 0.054
In . J. En i on. Res. Public Heal h 2016,13, 74 7 o 15
Table 2. Con .
Smoking S a us o Pa en s
and G andpa en s
T ied Smoking Daily Smoking O he Tobacco P oduc Use *
Gi ls Boys Gi ls Boys Gi ls Boys
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Ma e nal g andpa en s
G and a he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.26 (0.95–1.68) 1.72 (1.23–2.42) 1.11 (0.71–1.73) 2.41 (1.42–4.08) 1.21 (0.89–1.65) 1.48 (1.05–2.08)
Cu en smoke 1.41 (1.00–1.97) 1.84 (1.22–2.78) 1.31 (0.78–2.20) 1.99 (1.02–3.89) 1.23 (0.85–1.79) 1.28 (0.84–1.96)
p- alue 0.004 0.001 0.111 0.004 0.219 0.112
G andmo he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.58 (1.10–2.27) 1.03 (0.67–1.59) 1.47 (0.85–2.53) 1.60 (0.84–3.06) 2.07 (1.42–3.03) 1.18 (0.76–1.82)
Cu en smoke 1.66 (1.19–2.32) 1.47 (0.95–2.29) 2.86 (1.88–4.36) 2.03 (1.00–4.10) 1.66 (1.16–2.36) 0.97 (0.60–1.55)
p- alue <0.001 0.205 <0.001 0.078 <0.001 0.895
*Snus, wa e pipe and elec onic ciga e es; No e: OR is gi en in bold ace when i indica es a s a is ically signi ican (p< 0.05) di e ence om he odds o he e e ence ca ego y.
In . J. En i on. Res. Public Heal h 2016,13, 74 8 o 15
Table 3.
Adjus ed ORs and 95% CIs o child en’s smoking expe imen a ion, daily smoking and o he obacco p oduc use
*
by g andpa en s’ smoking s a us in
wo models †.
G andpa en s’ Smoking
S a us
T ied Smoking Daily Smoking O he Tobacco P oduc Use *
Model 1 Model 2 Model 1 Model 2 Model 1 Model 2
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Pa e nal g andpa en s
G and a he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.40 (1.10–1.78) 1.16 (0.91–1.49) 1.59 (1.10–2.28) 1.20 (0.82–1.76) 1.40 (1.09–1.79) 1.21 (0.94–1.57)
Cu en smoke 1.61 (1.20–2.14) 1.23 (0.91–1.66) 2.27 (1.51–3.41) 1.50 (0.97–2.31) 1.69 (1.25–2.28) 1.35 (0.99–1.84)
p- alue <0.001 0.072 <0.001 0.189 <0.001 0.035
G andmo he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.52 (1.13–2.05) 1.14 (0.84–1.56) 1.68 (1.08–2.61) 1.10 (0.69–1.75) 1.32 (0.97–1.81) 1.03 (0.75–1.43)
Cu en smoke 1.40 (1.04–1.89) 1.07 (0.79–1.46) 2.07 (1.36–3.15) 1.34 (0.86–2.09) 1.54 (1.13–2.09) 1.20 (0.87–1.66)
p- alue <0.001 0.842 <0.001 0.441 0.007 0.515
Ma e nal g andpa en s
G and a he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.44 (1.16–1.80) 1.21 (0.97–1.51) 1.49 (1.07–2.09) 1.14 (0.80–1.62) 1.33 (1.06–1.67) 1.13 (0.89–1.43)
Cu en smoke 1.56 (1.20–2.02) 1.26 (0.96–1.65) 1.53 (1.02–2.30) 0.99 (0.64–1.53) 1.24 (0.94–1.64) 0.99 (0.74–1.33)
p- alue <0.001 0.203 0.019 0.831 0.052 0.529
G andmo he ’s smoking s a us
Ne e smoke 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smoke 1.30 (0.99–1.72) 1.01 (0.76–1.35) 1.54 (1.02–2.34) 1.03 (0.66–1.59) 1.57 (1.18–2.04) 1.26 (0.94–1.69)
Cu en smoke 1.58 (1.21–2.06) 1.14 (0.86–1.51) 2.60 (1.81–3.73) 1.47 (1.00–2.17) 1.35 (1.02–1.79) 0.99 (0.73–1.33)
p- alue <0.001 0.383 <0.001 0.260 0.002 0.163
*
Snus, wa e pipe and elec onic ciga e es;
†
Model 1: adjus ed o age and sex; Model 2: pa en s’ and g andpa en s’ smoking simul aneously in he model, adjus ed o age, sex and
pa en s’ educa ion and employmen s a us; No e: OR is gi en in bold ace when i indica es a s a is ically signi ican (p< 0.05) di e ence om he odds o he e e ence ca ego y.
In . J. En i on. Res. Public Heal h 2016,13, 74 9 o 15
Table 4.
Adjus ed ORs and 95% CIs o child en’s smoking expe imen a ion, daily smoking and o he obacco p oduc use
*
by numbe o smoking pa en s and
g andpa en s in wo models †.
Smoking S a us o Pa en s and
G andpa en s
T ied Smoking Daily Smoking O he Tobacco P oduc Use *
Model 1 Model 2 Model 1 Model 2 Model 1 Model 2
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Pa en s’ smoking
Bo h ne e smoke s 1.00 1.00 1.00 1.00 1.00 1.00
One o bo h ex-smoke s 2.04 (1.71–2.42) 1.93 (1.57–2.38) 2.79 (2.11–3.69) 2.77 (1.96–3.91) 1.73 (1.45–2.07) 1.70 (1.37–2.19)
One smoke 1.87 (1.50–2.33) 1.97 (1.50–2.58) 2.20 (1.54–3.15) 2.36 (1.52–3.68) 1.78 (1.42–2.24) 2.02 (1.52–2.67)
Bo h smoke s 2.55 (1.93–3.37) 2.60 (1.82–3.71) 5.63 (3.93–8.07) 5.65 (3.55–9.02) 2.42 (1.82–3.20) 2.51 (1.74–3.63)
p- alue <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Pa e nal g andpa en s’ smoking
Bo h ne e smoke s 1.00 1.00 1.00 1.00 1.00 1.00
One o bo h ex-smoke s 1.42 (1.15–1.75) 1.04 (0.82–1.32) 1.76 (1.28–2.41) 1.17 (0.81–1.71) 1.35 (1.08–1.68) 0.98 (0.76–1.27)
One smoke 1.22 (0.93–1.60) 1.10 (0.81–1.49) 1.85 (1.24–2.78) 1.50 (0.95–2.38) 1.28 (0.97–1.70) 1.16 (0.84–1.60)
Bo h smoke s 2.92 (1.65–5.15) 1.97 (1.05–3.68) 3.45 (1.73–6.86) 2.05 (0.95–4.42) 3.16 (1.80–5.55) 2.34 (1.42–4.91)
p- alue <0.001 0.198 <0.001 0.129 <0.001 0.018
Ma e nal g andpa en s’ smoking
Bo h ne e smoke s 1.00 1.00 1.00 1.00 1.00 1.00
One o bo h ex-smoke s 1.34 (1.10–1.64) 1.19 (0.95–1.49) 1.57 (1.14–2.14) 1.21 (0.85–1.73) 1.38 (1.12–1.70) 1.18 (0.93–1.50)
One smoke 1.50 (1.18–1.92) 1.67 (0.88–1.55) 2.02 (1.40–2.91) 1.05 (0.67–1.66) 1.28 (0.99–1.67) 0.96 (0.70–1.30)
Bo h smoke s 2.00 (1.22–3.23) 1.58 (0.92–2.71) 2.67 (1.33–5.33) 1.40 (0.64–3.04) 1.50 (0.88–2.58) 1.07 (0.59–1.95)
p- alue <0.001 0.185 <0.001 0.656 0.008 0.524
*
Snus, wa e pipe and elec onic ciga e es;
†
Model 1: adjus ed o age and sex; Model 2: pa en s’ and g andpa en s’ smoking s a uses included simul aneously in he model,
adjus ed o age, sex and pa en s’ educa ion and employmen s a us; No e: OR is gi en in bold ace when i indica es a s a is ically signi ican (p< 0.05) di e ence om he odds o he
e e ence ca ego y.