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 (Figure 9.5.1).
Socio-economic influences on cardiovascular disease from a life-course perspective
Higher rates of smoking and longer average times until cessation2 mean that lower socio-economic status (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 less likely to have funds for discretionary spending on items such as house and contents insurance, motor vehicle insurance and health insurance.3,4 Medical problems, accidents and thefts of cars and other goods are therefore more likely affect these households significantly. Expenditure on health-risk behaviours are also more likely in smoking households– Siahpush and colleagues found odds of reporting expenditure on alcohol, drinking at licensed premises, and gambling were 100%, 50%, and 40% greater for smoking than for non-smoking households.4
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.3 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. Smokers are also more likely to report a higher level of perceived income inequality, lower perception of relative material wellbeing and living in a community with a lower degree of trust and safety.5
Low-income families where at least one person smokes are less likely to be able to save a deposit to buy a dwelling, so that even controlling for different levels of age and income, they are much less likely to be purchasing and owning their own home.6 Australians' average income doubled between 1984 and 2004; however house prices increased by 400%–making Australia one of the least affordable housing markets in the world. Nearly one-third of sole parents and single people were suffering from housing stressi during this time. A study by the National Centre for Social and Economic Modelling published in 2008 found that those buying their first home were particularly vulnerable to housing stress; they had had the lowest incomes, but paid the highest prices for houses, which put 62% of first-home buyers into housing stress.7
Jamsen and colleagues examined data from the Household Income and Labour Dynamics in Australia survey and found evidence of an association between being a smoking household (defined as having one smoker in the household) and having inadequate housing (though when adjusted for SES and age, this association was somewhat weakened).8
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,9-11 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.12, 13 These outcomes themselves contribute to social disadvantage. The effects of smoking during pregnancy are discussed in more detail in Chapter 3, Section 3.8.
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 secondhand smoke has been demonstrated to reduce school attendance14 and the productivity of parents who need to stay home to care for children.15 Poor school attendance is a very strong predictor of academic failure.16
Exposure to secondhand smoke may still reduce academic performance even where children don't miss more school. A longitudinal analysis of educational achievement in children participating in the British National Child Development Study found that young people exposed to secondhand smoke at home were more likely to fail standardised UK O (Ordinary) level and A (Advanced) level achievement tests.17 This finding held regardless of prenatal exposure, school attendance and after controlling for SES.
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 children18, 19 and smoking cessation reduces the chances of children taking up smoking.20
Consistent with trends in other countries,21 Australian teenagers are much more likely to experiment and to smoke regularly if one or more of their parents smoke than if neither of their parents smoke. Figures 9.5.2 and 9.5.3 plot the percentage of never smokers, experimenters and current smokers among secondary school smokers in Victoria according to parental smoking status.
Proportion of Victorian students aged 12–15 years who were never smokers, experimental smokers or current smokers among students with no parent smoking, one, or two parents smoking, Australia, 2008
Proportion of Victorian students aged 16–17 years who were never smokers, experimental smokers or current smokers among students with no parent smoking, one, or two parents smoking, Australia, 2008
Source: White and Smith (2010)22
Among students aged 12–15 years, those who reported that both parents smoked were more than twice as likely to have experimented with smoking than students who reported that neither parent smoked. They were about three times more likely to be regular smokers than students who reported that neither parent smoked. Students of parents who did not smoke were much more likely to be a never smokers compared with students who reported that both parents smoked (86% compared with 58%).22
Among students aged 16 and 17, those who reported that both parents smoked were more than twice as likely to be regular smokers as students who reported that neither parent smoked. Students who reported either one or two parents were smokers had about the same likelihood of having experimented with smoking. As seen in students aged 12–15 years, students aged 16 and 17 who reported neither parent smoking were much more likely to report never smoking.22
The impact of parental smoking appears to be a long-term one. Among Australian secondary school students interviewed in 1985, compared with their peers who reported neither parent smoking, 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 and females RR 1.99; 95% CI, 1.52–2.61).19
Keyes and colleagues reported that both genetic and environmental influences can increase the risk of cigarette use in the adolescent children, either biological or adoptive, of parents who smoke. They add that the effect of parental smoking on adolescents in biologically related families seems to be associated not only with cigarette use, but also with socially unacceptable behaviour (such as disruptive behaviour disorders, delinquency and preference for risk taking).23 Harvey reviews the work of Keyes and colleagues and notes that it is important to consider the influence of home environment/family dynamics (e.g. lack of parental supervision) and psychiatric diagnoses on the reported outcome of adolescents' behaviour disorders and socially unacceptable behaviour. In addition, he notes that a higher socio-economic household is not necessarily protective against adverse home conditions.24
Macleod and colleagues reported parental social disadvantage was predictive of childrens' tobacco and alcohol use. However some of this association appeared to be mediated by the greater experience of childhood behavioural and cognitive problems among the disadvantaged children.25
Absence of smoking restrictions at home is also associated with increased risk of smoking uptake by children.
US studies26,27 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 (see Section 5.14 for further information on the effects of smoking restrictions among young people, and see Section 126.96.36.199 for details on relative prevalence of smokefree homes by SES).
For recent news items and research on this topic, click here (Last updated October 2016)
i The 19th AMP.NATSEM report defines housing stress 'as households spending more than 30 per cent of their disposable (after tax) income on housing'.
1. National Public Health Partnership. Preventing Chronic Disease: a Strategic Framework. Background Paper. Melbourne, Australia: NPHP, 2001. Available from: www.nphp.gov.au/publications/strategies/chrondis-bgpaper.pdf
2. Siahpush M, Heller G, and Singh G. Lower levels of occupation, income and education are strongly associated with a longer smoking duration: multivariate results from the 2001 Australian National Drug Strategy Survey. Public Health. 2005;119(12):1105–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16085150
4. Siahpush M, Borland R, and Scollo M. Is household smoking status associated with expenditure on food at restaurants, alcohol, gambling and insurance? Results from the 1998-99 Household Expenditure Survey, Australia. Tobacco Control. 2004;13(4):409-14. Available from: http://tc.bmjjournals.com/cgi/content/abstract/13/4/409
5. Siahpush M, Borland R, Taylor J, Singh GK, Ansari Z, and Serraglio A. The association of smoking with perception of income inequality, relative material well-being, and social capital Social Science & Medicine 2006;63(11):2801–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16971030
6. Siahpush M. Socioeconomic status and tobacco expenditure among Australian households; results from the 1998-99 Household Expenditure Survey. Journal of Epidemiology and Community Health. 2003;57(10):798–801. Available from: http://jech.bmj.com/cgi/content/abstract/57/10/798
7. National Centre for Social and Economic Modelling. Wherever I lay my debt, that's my home. Income and Wealth Report Issue 19. Canberra, Australia: AMP-NATSEM, 2008. Available from: http://www.canberra.edu.au/centres/natsem/
8. Jamsen K, Siahpush M, and Simpson J. Smoking and inadequate housing: results from an Australian national survey Public Health. 2008;122(9):873–7. Available from: http://www.publichealthjrnl.com/article/PIIS0033350608000449/fulltext
9. Fleming P, and Blair P. Sudden Infant Death Syndrome and parental smoking. Early Human Development. 2007;83(11):721‚àí5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17881163
10. Salihu HM, and Wilson RE. Epidemiology of prenatal smoking and perinatal outcomes. Early Human Development. 2007;83(11):713-20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17884310
11. Aliyu MH, Salihu HM, Wilson RE, and Kirby RS. Prenatal smoking and risk of intrapartum stillbirth. Archives of environmental & occupational health. 2007;62(2):87-92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18316266
12. O'Callaghan F, Al Mamun A, O'Callaghan M, Alati R, Najman J, Williams G, et al. Maternal smoking during pregnancy predicts nicotine disorder (dependence or withdrawal) in young adults - a birth cohort study. Australian and New Zealand Journal of Public Health. 2009;33(4):371–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19689599
13. Agrawal A, Scherrer J, Grant J, Sartor C, Pergadia M, Duncan A, et al. The effects of maternal smoking during pregnancy on offspring outcomes. Preventive Medicine. 2010;50(1–2):13–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20026103
14. Charlton A, and Blair V. Absence from school related to children's and parental smoking habits. British Medical Journal. 1989;298(6666):90–2. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1835401&blobtype=pdf
15. Gilliland F, Berhane K, Islam T, Wenten M, Rappaport E, Avol E, et al. Environmental tobacco smoke and absenteeism related to respiratory illness in schoolchildren. American Journal of Epidemiology. 2003;157(10):861–9. Available from: http://aje.oxfordjournals.org/cgi/content/full/157/10/861
16. Zubrick S, Silburn S, Gurrin L, Teoh H, Shepherd C, Carlton J, et al. Western Australian Child Health Survey: Education, Health and Competence. Perth, Western Australia: Australian Bureau of Statistics and the TVW Telethon Institute for Child Health Research, 1997. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4305.5September%201993?OpenDocument
17. Collins BN, Wileyto EP, Murphy MFG, and Munafò MR. Adolescent environmental tobacco smoke exposure predicts academic achievement test failure. Journal of Adolescent Health 2007;41(4):363-70. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1054139X07001826
18. Rainio S, Rimpelä A, Luukkaala T, and Rimpelä M. Evolution of the association between parental and child smoking in Finland between 1977 and 2005. Preventive Medicine. 2008;46(6):565–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18289657
19. Paul SL, Blizzard L, Patton GC, Dwyer T, and Venn A. Parental smoking and smoking experimentation in childhood increase the risk of being a smoker 20 years later: the Childhood Determinants of Adult Health Study. Addiction. 2008;103(5):846-53. Available from: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1360-0443.2008.02196.x
20. Farkas A, Distefan J, Choi W, Gilpin E, and Pierce J. Does parental smoking cessation discourage adolescent smoking? Preventive Medicine. 1999;28(3):213–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10072737
21. Audrain-McGovern J, Rodriguez D, Tercyak KP, Neuner G, and Moss HB. The impact of self-control indices on peer smoking and adolescent smoking progression. Journal of Pediatric Psychology. 2006;31(2):139–51. Available from: http://jpepsy.oxfordjournals.org/cgi/content/abstract/31/2/139
22. White VM, and Smith G. Victorian secondary school students' use of licit and illicit substances in 2008. Results from the 2008 Australian Secondary Students' Alcohol and Drug Survey. Melbourne, Australia: Victorian Department of Human Services, 2010. Available from: http://www.health.vic.gov.au/aod/pubs/vsss.htm
23. Keyes M, Legrand L, Iacono W, and McGue M. Parental smoking and adolescent problem behavior: an adoption study of general and specific effects. The American Journal of Psychiatry. 2008;165(10):1338–44. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597022/
24. Harvey L. Teen behaviors reflective of parental smoking. American Journal of Psychiatry. 2009;166(3):373. Available from: http://ajp.psychiatryonline.org/cgi/reprint/166/3/373
25. Macleod J, Hickman M, Bowen E, Alati R, Tilling K, and Smith G. Parental drug use, early adversities, later childhood problems and children's use of tobacco and alcohol at age 10: birth cohort study. Addiction. 2008;103(10):1731–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18705686
26. Farkas AJ, Gilpin EA, White MM, and Pierce JP. Association between household and workplace smoking restrictions and adolescent smoking. Journal of the American Medical Association. 2000;284(6):717–22. Available from: http://jama.ama-assn.org/cgi/content/abstract/284/6/717
27. Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT, Barker DC, and Ruel EE. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. British Medical Journal. 2000;321(7257):333-7. Available from: http://www.bmj.com/cgi/content/abstract/321/7257/333