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Relationship between parental smoking and adolescent smoking: gender differences and mediation of resilience

Abstract

Background

Though the relationship between parental smoking and adolescent smoking has been established, gender differences, and mediation of resilience in this relationship are poorly understood. This research aims to investigate the prevalence of adolescent smoking, and to understand how consequences may differ for boys and girls, as well as to explore what role resilience played in this relationship.

Methods

Through the school-based cross-sectional survey, a total of 65,898 adolescents were involved in this study, and information were collected by self-reported questionnaire. Participants鈥 smoking status and their parental smoking status were collected by self-made questionnaire, and resilience was assessed by the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The multivariate logistic regression was conducted to explore the relationship between parental smoking and adolescent smoking. After that, the path analysis was applied to explore the mediation of resilience in this relationship.

Results

Of all participants, the rate of self-report current smoking and biologically verified smoking was 1.4% and 2.0%, respectively. Both self-reported and biologically verified prevalence of smoking among boys were higher than that in girls. There were gender differences in the impact of parental smoking on adolescent smoking: mother smoking had a negative effect on adolescent smoking, and resilience could mitigate this negative effect. Father smoking had no association with girl smoking, while father smoking was positively associated with boy smoking, and resilience was mediated in this association.

Conclusions

Our findings suggested smoking prevention in adolescents can be done differently for different genders. Besides, results indicated resilience was important in preventing adolescent smoking. Furthermore, parents quitting smoking can play an important role in preventing adolescent smoking to a certain extent.

Peer Review reports

Introduction

Smoking is a major public health problem that causes severe disabilities and high mortality. It is the leading risk factor for risk-attributable cancer deaths and disability-adjusted life-years (DALYs) [1, 2]. Approximately one billion people worldwide are smokers, and about 300听million of them are in China [2, 3]. As society develops rapidly, the trend of adolescent smoking in China has changed over time. According to Wang et al. [4], the cumulative incidence of smoking initiation among adolescents aged 12鈥18 years increased from 6.4% in 2003 to 10.9% in 2013. However, a more recent meta-analysis showed that the overall smoking rate among youth in mainland China was 8.17% [5]. Adolescence is a critical period of life, as most tobacco users initiate smoking before age 18 years [6, 7]. Smoking in adolescence is correlated with increased risk for psychiatric conditions and poorer cognitive function [8, 9], and they have the lowest rates of cessation attempts and success throughout their lives [10]. Therefore, preventing smoking among adolescents is essential to reduce morbidity and mortality caused by smoking.

Previous studies have shown that social and psychosocial factors were associated with adolescent smoking, including parental smoking, family structure, parental attitudes, sibling smoking, peer smoking, peer attitudes and norms, socioeconomic status, attachment to family and friends, lifestyle, stress, depression/distress, self-esteem, attitudes to smoking, and health concerns [11,12,13,14,15,16]. Parental smoking plays an important role in adolescent smoking. On the one hand, parental smoking increases the exposure to second-hand smoke, which is a risk factor for higher smoking rates and nicotine dependence among youth [17,18,19]. Another reason is that parents are one of the most important influences on the cognitions and behaviours of adolescents. The intergenerational transmission of smoking behaviour has been well documented [12, 20]. Previous studies have examined that parental smoking could increase the risk of adolescents smoking [16, 21,22,23]. However, these studies only explored the impact of parental smoking on adolescents鈥 smoking, ignoring the gender difference, which is closely correlated with adolescent smoking.

Resilience refers to an individual鈥檚 ability to adapt positively in the face of significant adversity or risk. It implies good adaptation under challenging circumstances [24]. Resilience can influence smoking behaviour by affecting the perception, appraisal, and response to stressors, as well as the vulnerability to smoking [25,26,27,28,29]. Adolescence, being a vulnerable period in one鈥檚 lifetime, is associated with an increased susceptibility to the negative impacts of adverse childhood experiences on health outcomes [30, 31]. Parental smoking can be considered as an adverse childhood experience that can affect the development of resilience among adolescents [31, 32] Parental smoking can serve as a negative role model that can influence their attitudes and behaviours toward smoking and to negative parental role modeling [33,34,35], undermining the development of resilience among adolescents, and make them more vulnerable to smoking initiation and progression [25, 26]. Based on these findings, we hypothesized parental smoking has a negative effect on adolescents smoking, and that resilience can mediate this effect.

Thus, in this large sample study, we aimed to: (1) estimate the prevalence of smoking among Chinese adolescents; (2) examine the association between parental smoking and adolescent smoking by gender; (3) explore the mediating role of resilience in the relationship between parental smoking and adolescent smoking.

Methods

Two datasets were involved in this study, and both of them were collected in Zigong, which is located in southwest China. The two datasets (N鈥=鈥90039 and N鈥=鈥2989) were from school-based cross-sectional studies.

Study procedures

The school-based survey including two waves. After applying a stratified cluster random sampling strategy, two districts and one county were chosen. In this survey, the investigators were local school teachers and experienced doctors from the local psychiatric hospital. They were trained before the survey to make sure they knew the purpose of the study, as well as the survey process and questionnaire content for better quality control. All participants and their guardian were fully informed and provided the written informed consent before they participated in.

Dataset 1 was from wave 1, which was conducted from October to December in 2020. In dataset 1, only participants aged between 12 and 18 were included, therefore the analytic sample was 62,909, of which 49.4% were boys. Dataset 1 was used to examine the self-report prevalence of current smoking. Besides, dataset 1 was also used to explore the influence of parental smoking on adolescents smoking, as well as the mediating role of resilience in parental influence on adolescents smoking.

Dataset 2 was from wave 2, conducted from April to July 2023. This dataset was applied to identify the biologically verified prevalence of adolescents smoking, in which 2989 adolescents were randomly chosen and provided their urine samples to do biological verification. The study was approved by the Ethics Committee of Zigong Mental Health Center [No. 2020-8-01].

Measures

Adolescents smoking status

The evaluation of smoking status was based on the question 鈥淲hich of the following is your smoking status?鈥 There were three options for answering: 鈥淣ever smoking (smoking less than 100 cigarettes in your lifetime)鈥, 鈥淧revious smokers (smoking more than 100 cigarettes in your lifetime but not in the past 28 days)鈥, and 鈥淐urrent smokers (smoking more than 100 cigarettes in your lifetime and smoking within the past 28 days)鈥. The ratio of different smoking statuses was calculated by the actual self-report. In the exploration of the relationship between adolescents smoking and parental smoking, adolescents鈥 smoking behaviour was divided into binary variables according to their report, participants who reported current smoking or previous smoking were regarded smokers, otherwise were regarded as non-smokers. The biological prevalence of smoking was used urinary cotinine test.

Parental smoking status

Questions 鈥淒id you father/ mother smoke鈥 were used to ask about parental smoking status separately, the options provided were 鈥渇requent smoking鈥, 鈥渟ometimes smoking鈥, 鈥渘ever smoking鈥, and 鈥淚 don鈥檛 know鈥. The answers to these questions were offered by participants鈥 self-report. In this study, parental smoking was classified into binary variables, namely 鈥淵es鈥 or 鈥淣o 鈥. Among them, choosing 鈥渇requently smoking鈥 or 鈥渟ometimes smoking鈥 is classified as 鈥淵es鈥, while the answers 鈥渘ever smoking鈥 and 鈥淚 don鈥檛 know鈥 are classified as 鈥渘ot smoking鈥.

Resilience

The 10-item Connor-Davidson Resilience Scale (CD-RISC-10) [36] was used to measure resilience. This scale consists of 10 items, with each item scoring 0鈥4 points. The higher the score, the stronger the resilience. The scale was widely used to assess resilience in different populations, and its validation was identified among Chinese adolescents [37]. In this study, the total score was used as measurement data.

Control variables

Information about control variables was collected by self-report questionnaire, including gender (boy/ girl), residence (rural area/ urban area), only child (yes/ no), left-behind children (yes/ no), grade (senior school/ high school), and family type (nuclear/ non-nuclear).

Data analysis

All the statistical analyses were performed using R software (Version 3.3.3). Descriptive analysis was applied to describe the characteristics of participants. To adjust the clustering effect and induce sampling error, R software and the 鈥渟urvey鈥 package () which was developed for analysing complex survey samples, was used to calculate the weighted prevalence of self-report smoking. The Univariate logistic regression was used to select control variables with a significant level of less than 0.1 (two-tailed). After that, the control variable that met the criterion could be included in the multivariate logistic regression model. The multivariate logistic regression was used to estimate the associations between adolescents鈥 smoking and parental smoking. The significant level was set at less than 0.05, two-tailed. To further explore the mediating effect of resilience on parental smoking on children鈥檚 smoking, the mediation analysis was used to explore direct and indirect effects among variables. This analysis was performed using structural equation modeling (SEM) with a statistical test level of p鈥&濒迟;鈥0.05.

Results

The demographic features of the participants are shown in Table听1. In dataset 1, 49.4% of participants were boys, and the resilience score was 22.6 (S.D. =7.0). Among all the participants in Dataset 1, 4.0% reported that their mother smoke, and 67.2% reported father smoked.

Table 1 Demographic features of participants

As shown in Table听2, among all participants, the weighted prevalence of self-reported current smoking was 1.4%, and 1.7% reported having ever tried smoking. In boys, the current smokers accounted for 2.2%, while only 0.6% of girls were current smokers. As for the biologically verified prevalence of smoking, 2.0% of participants were current smokers, and the prevalence was 3.4% in boys, and 0.7% in girls.

Table 2 Weighted prevalence of self-report smoking (N鈥=鈥62909)

Logistic regression analysis

After adjusting for control variables, as shown in Table听3 (model 1), among all participants, father smoking (AOR: 1.18, 95% CI: 1.02鈥1.38), and mother smoking (AOR: 2.35, 95% CI: 1.87鈥2.94) both were correlated with adolescents smoking, while resilience was negatively associated with adolescents smoking (AOR: 0.95, 95% CI: 0.94鈥0.96).

Table 3 Univariate and multivariate logistic regression models fitting results for smoking behaviour

Among boy participants, compared to adolescents whose mothers do not smoke, adolescents whose mothers smoking were more likely to smoke (AOR: 2.24, 95% CI: 1.70鈥2.91). Moreover, father smoking was positively related to adolescents smoking (AOR: 1.28, 95% CI: 1.08鈥1.52). An inverse relationship was found between resilience score and adolescent smoking (AOR: 0.95, 95% CI: 0.95鈥0.96). (Table听2, Model 2.)

As for girl participants, whose mother smoking was positively associated with their smoking behaviour (AOR:3.29, 95% CI: 2.08-5.00), while father smoking had no association with their smoking behaviour after adjustment. Resilience score turned to be negatively associated with smoking behaviour among girl participants. (AOR: 0.92, 95% CI: 0.90鈥0.93).

Mediation analysis

Based on the results of logistic regression, five hypothetical path models were conducted to explore the mediation of resilience in the association between parental smoking and adolescent smoking among different genders. (Fig.听1)

Fig. 1
figure 1

The mediation model of father/ mother smoking, adolescents/ boys/ girls smoking, and resilience. A: Father smoking-resilience-adolescents smoking; B: Mother smoking-resilience-adolescents smoking; C: Father smoking-resilience-boys smoking; D: Mother smoking-resilience-boys smoking; E: Mother smoking-resilience-girls smoking. (*, p鈥<鈥0.05; **, p鈥&濒迟;鈥0.001)

Among all participants, resilience accounted for 19.05%, and 8.05% of the total association in the relationship between father and mother smoking and adolescent smoking respectively. In boy participants, resilience accounted for 11.54%, 5.88% of the total association between father, and mother smoking and adolescent smoking. As for girl smoking, resilience was mediated in the association between mother smoking and girl smoking, accounting for 14.85%.

Discussion

In a sample of 62,909 Chinese adolescents, we identified 1.4% were current smokers by self-report questionnaire. Moreover, we innovatively applied biological verification to test smoking prevalence among another 2989 adolescents and found that the biologically verified prevalence of smoking was 2.0%. Additionally, parental smoking, especially mother smoking was positively associated with adolescent smoking regarding gender, and resilience could mitigate these negative effects.

In our study, both the self-reported and biologically verified current smoking rates were lower than previous studies conducted in China [5, 38]. On the one hand, those studies were conducted before 2019, whereas by this year more than 20 cities in China had formulated or revised local tobacco control regulations, which might have contributed to the decrease in the overall prevalence of current cigarette use among middle school students [38]. On the other hand, the participants of our study were all from academic middle school, previous studies had identified that smoking was much more prevalent in vocational high schools than the other settings. According to this result, the current smoking control policies in this area and even in China may be effective, but there is still room for improvement.

Results indicated that father smoking and mother smoking had different effects on their children. Specifically, father smoking was positively associated with boys smoking, while it had no effect on girls; Mother smoking was positively related to both boys鈥 and girls鈥 smoking. Consistent with previous findings, mother smoking had a greater influence on adolescent smoking than father smoking, regardless of gender difference [12]. One possible explanation for this might be that mothers were more involved than fathers with norm-setting, child-rearing, and caregiving, which means they spent more time with their children [39,40,41]. As for father smoking being a risk factor for boys鈥 smoking but not for girls鈥, this could be explained by the same-sex modeling theory based on social learning theory, which suggests that girls鈥 smoking is related to mother smoking rather than father smoking, and that father smoking affects boys鈥 smoking more strongly [42, 43].

Our results also revealed that resilience mediated the relationship between parental smoking and adolescent smoking, regardless of gender. In line with previous research, resilience could mitigate the negative effect of parental smoking on adolescent smoking, and play an important role in one鈥檚 development [44, 45]. Therefore, helping adolescents cultivate strong resilience could protect them from smoking when facing adversity and risk exposure.

Strengths of the present study include the biologically verified smoking rate, and the large sample size that allowed us to examine the differences by parents鈥 and adolescents鈥 gender. However, there were several limitations. First, the data we analyzed was from the cross-sectional survey, which limited us to draw a solid causal relationship between parental smoking and adolescent smoking, as well as to explore its underlying mechanisms. Future research should adopt a longitudinal design, and examine the underlying mechanisms from multiple perspectives. Second, the sampled adolescents were randomly chosen from one city in southwestern China, although we enlarged the sample size and weighted it based on the urban population, which could not eliminate sampling errors and clustering effects, nor represent China as a whole. Moreover, the information about parental smoking was reported by adolescents, which limited the assessment of nicotine addiction of parents who smoke. Thus, our results could not be directly compared to past studies that have measured parental tobacco use. Next, peer smoking is a relevant and influential factor that may affect adolescent smoking behaviour, however, this study did not collect any information on peer smoking, as it was not the main focus of this research question. Future studies should include peer smoking as a variable to better understand the relative effects of parental and peer smoking on adolescent smoking. Finally, the history and degree of environmental tobacco exposure could affect urinary cotinine levels [46] as well as raise the susceptibility to smoking [47].

Conclusion

In conclusion, based on a large sample, prevalence of adolescent smoking showed that China鈥檚 tobacco control policies are effective, but can be further improved. Smoking prevention among adolescents can be tailored to different genders. However, regardless of gender, enhancing resilience in adolescents seems beneficial. Furthermore, parents (especially mothers) quitting smoking can play an important role in preventing adolescent smoking to some extent. Despite several limitations, this research provides new insights and evidence for tobacco prevention and control.

Data availability

The dataset is still being analyzed by the primary research team. Anyone needing to access the data should e-mail liaoyanhui@zju.edu.cn. Any data sharing will be by individual request, and in consultation with researchers currently analyzing the data.

Abbreviations

DALYs:

Disability-Adjusted Life-Years

CD-RISC-10:

the 10-item Connor-Davidson Resilience Scale

AOR:

Adjusted odds ratio

CI:

Confidence interval

S.D.:

Standard deviation

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Acknowledgements

Not applicable.

Funding

This research was supported by STI 2030鈥擬ajor Projects (grant number 2022ZD0211200), the National Natural Science Foundation of China (grant number U22A20302), and Medical and Health Science and Technology Plan Project of Zhejiang Province (grant number 2023KY782). The funders had no role in study design, data collection and analysis, decision to write the report or to submit the paper for publication.

Author information

Authors and Affiliations

Authors

Contributions

YH Liao contributed to all aspects of the study. Y Liu, L Li contributed to the drafting of the manuscript. ZM Chen, SL Ren, RN He, YD Liang, YG Tan, SS Chen, X Shao, XG Chen, XG Chen, JS Tang, and YH Liao participated in conception and design. All authors contributed to survey development, and data acquisition. Y Liu and YH Liao contributed to data analysis and results interpretation. All authors contributed to the critical revision of the paper and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yanhui Liao.

Ethics declarations

Ethical approval and consent to participate

The study was approved by the Ethics Committee of Zigong Mental Health Center [No. 2020-8-01]. The study participants provided informed consent, and de-identified datasets were used.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Liu, Y., Li, L., Chen, Z. et al. Relationship between parental smoking and adolescent smoking: gender differences and mediation of resilience. 樱花视频 25, 434 (2025). https://doi.org/10.1186/s12889-025-21457-5

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  • DOI: https://doi.org/10.1186/s12889-025-21457-5

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