9.5 Smoking and intergenerational poverty

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Families where one or more parent uses tobacco not only suffer more immediate financial stress but also less financial security and a greater likelihood of poverty.

Spending on tobacco products, loss of school time and income due to smoking-related disease and premature death of breadwinners over a lifetime must all substantially reduce the capacity of a household to accumulate assets such as a family home, to insure against losses, to save for financial requirements in retirement and to pass on assets to the next generation—see Figure 9.14.

9.5.1 Spending on tobacco products and its impact on financial security and wealth accumulation

Higher rates of smoking and longer average times until cessation60 means that lower SES smokers are more likely to suffer both frequent financial stress and longer periods of compromised living standards than their counterparts in the higher strata.

Households where one or more adults smoke are also less likely to have funds for discretionary spending on items such as house contents insurance, motor vehicle insurance and health insurance.97, 98 Medical problems, accidents and thefts of cars and other goods are therefore more likely to hit such households hard, sending many into crisis and spiralling debt.

Low-income families where at least one person smokes are less likely to be able to save a deposit to buy property, so that even controlling for different levels of age and income, they are much less likely to be purchasing and owning their own home.90 Where they do buy a home, the average value of that home would tend to be lower than those of families of the same income where no adults spend money on tobacco products.

Low-income families where one or more adults smoke may also be less likely to invest in superannuation, life insurance and insurance against loss of income.97 All of this translates to less security of income in older age, and less wealth to help adult children or to pass on to children after death.

9.5.2 The long-term effects of smoking during pregnancy

The higher rates of smoking during pregnancy among disadvantaged groups may well have far-reaching effects on the health and even the temperament of offspring well into adolescence and adulthood.

While the effects of smoking on infant health are well-known,99, 100 a growing body of evidence suggests that foetal exposure to tobacco smoke also increases the risk of physical and behavioural problems in children and even in adult offspring, many of which themselves contribute to social disadvantage.

Children of parents who smoke are more likely to develop respiratory infections,101 impaired lung function,102 respiratory disease,103 asthma,104 and may also be more likely to develop leukaemia.105

Adult offspring of mothers who smoked during pregnancy also appear to be more likely to be obese,106–109 to develop diabetes,110, 111 high blood pressure112, 113 high cholesterol114 and cardiovascular disease.115–117 They are more likely to develop asthma118 and chronic obstructive disease.119 Fertility problems are also more common in both the female120–122 and the male123–126 offspring of women who smoke.127 It seems that exposure to tobacco smoke during pregnancy may exert a programming role in the functioning not just of respiratory systems but also the cardiovascular and other body systems.

Maternal smoking has been linked with compromised neuro-behavioural128, 129 and cognitive functioning,130, 131 including infant irritability,132 hearing problems,133 attention deficit disorders.134–138 A growing number of studies are demonstrating links and asserting a causal role for smoking in serious life outcomes such as reduced academic performance,139 psychological problems,140 conduct problems141–143, physical aggression in children,144 substance abuse including nicotine dependence145–147 and psychiatric problems in both teenagers148, 149 and adults 150, 151 and even arrest in adult offspring.152, 153

The increased risk of neurological, cognitive and behavioural problems associated with smoking during pregnancy must partly (if not largely) be explained by the more stressful social environments shared by offspring and mothers who were able unable to quit during pregnancy.154, 155 Children of mothers in less stressful environments are likely to enjoy more protective behavioural styles due both to the temperamental qualities they have inherited and the quality of parenting. However, many of the studies cited above have attempted to control for many of the social conditions that correlate with smoking during pregnancy.129 Further, the dose response found in studies of the impact of quitting compared to never, continued and reduced smoking during pregnancy on the temperament of very young infants suggest that increased risk of neuro-behavioural problems must also be partly due to the physiological effects of nicotine156 which has been demonstrated in animal studies to disrupt foetal brain development.157

9.5.3 Exposure to environmental tobacco smoke and school absence

Children who suffer asthma and frequent respiratory disease are likely to miss more time at school than healthier children. Even controlling for SES and parental smoking status, exposure to second-hand smoke has been demonstrated to reduce school attendance158 and the productivity of parents who need to stay home to care for children.159 Poor school attendance is a very strong predictor of academic failure.160

Exposure to second-hand smoke may still reduce academic performance even where children don't miss more school. A recent longitudinal analysis of educational achievement in children participating in the British National Child Development Study (NCDS) found that young people exposed to second-hand smoke at home were more likely to fail standardised UK O (Ordinary) level and A (Advanced) level achievement tests.161 This finding held regardless of prenatal exposure, school attendance and after controlling for socioeconomic status.

9.5.4 Parental example and smoking uptake: the cycle continues

Children who grow up in households where adults smoke are themselves more likely to take up smoking. As discussed in detail in Chapter 6, smoking by one or more parents is a very strong predictor of uptake among children162, 163 and smoking cessation by parents reduces the chances of children taking up smoking.164

Consistent with trends in other countries,165 Australian teenagers are much more likely to experiment and to smoke regularly if one or more of their parents smoke than if none of their parents smoke. Figure 9.15 plots the percentage of never smokers, experimenters and current smokers among secondary school smokers in Victoria according to parental smoking status.

Among 12-to-15-year-olds, children who reported that both parents smoked were twice as likely to have experimented with smoking than children who reported that neither parent smoked. They were four and half times more likely to be regular smokers. Among 16- and 17-year-olds, children who reported that both parents smoked were almost three times more likely to be regular smokers than children who reported that neither parent smoked. Children who reported that neither parent smoked were more than twice as likely to have never smoked than children who reported that both parents smoked. The association between smoking by children and the smoking status of their siblings is also striking.166

The impact of parental smoking appears to be a long-term one. Among Australian secondary school students interviewed in 1985, younger teenage boys who reported that both parents smoked were 50% more likely and younger teenage girls were 100% more likely to still be smokers 20 years later (males, RR 1.53, 95% CI 1.19–1.96; females, RR 1.99, 95% CI 1.52–2.61).163

Absence of smoking restrictions at home is also associated with increased risk of smoking uptake by children. US studies167, 168 have found that even after controlling for demographic factors and parents' smoking status, children who lived in homes where smoking was banned were more than 20% less likely to take up smoking than children who lived in homes where smoking was allowed.

In these ways (and for other reasons explored in Section 9.7) higher smoking prevalence among adults in lower socioeconomic families leads to higher uptake of smoking among children in lower socioeconomic groups.