Last updated: December 2016
Suggested citation: Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.5 Smoking and intergenerational poverty. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-9-disadvantage/9-5-smoking-and-intergenerational-poverty
Families where one or more parent uses tobacco not only suffer more immediate financial stress, but also less long-term financial security and a greater likelihood of poverty.
Spending on tobacco products, absenteeism from school, and loss of income due to smoking-related disease and premature death of breadwinners substantially reduce the capacity of a household to accumulate assets such as a family home, to insure against losses, to save for 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. Research in the UK found that nearly half of all children in relative poverty in 2012 had at least one smoking parent, and about 432,000 additional children would be classed as being in poverty if parental tobacco expenditure were subtracted from household income.3 In low- and middle-income countries, daily tobacco use is associated with lower household expenditures on education and healthcare.4
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.5, 6 Expenditure on health-risk behaviours are also more likely in smoking households— one study 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.6
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.7 This translates to less security of income in older age, and less wealth to financially assist or leave inheritance for adult children. 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.8
Multiple studies have found associations between smoking, financial stress, and housing insecurity.9, 10 Further, low-income families where at least one person smokes are less likely to be able to save a house deposit, so that even controlling for different levels of age and income, they are much less likely to own their own home.11 ABS data show that between 2005 and 2015, property price growth has increased, with price-to-income and price-to-rent ratios indicating decreasing affordability.12 Data from the Household Income and Labour Dynamics in Australia survey showed 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).13
While the detrimental effects of smoking on foetal and infant health are well known,14-16 the higher rates of smoking during pregnancy among disadvantaged groups (see Section 22.214.171.124) appear to affect the health and temperament of offspring well into adolescence and adulthood.
A growing body of evidence suggests that foetal exposure to tobacco smoke increases the risk of long-term physical, mental, and behavioural problems in offspring.17-21 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 (which can be caused or exacerbated by exposure to secondhand smoke—see Chapter 4) miss more time at school than healthier children. Even after controlling for SES and parental smoking status, exposure to secondhand smoke reduces school attendance22 and in turn decreases the productivity of parents who need to miss work to care for children.23 Poor school attendance is a strong predictor of academic failure.24
Exposure to secondhand smoke may still reduce academic performance even where it does not affect school attendance. A longitudinal analysis of educational achievement in children in the UK found that young people exposed to secondhand smoke at home were more likely to fail standardised achievement tests.25 This finding held regardless of prenatal exposure, school attendance, and SES.
Children who grow up in households where adults smoke are more likely to take up smoking. As discussed in detail in Chapter 5, smoking by one or more parents is a very strong predictor of uptake among children,26, 27 while parents’ smoking cessation reduces the chances of children taking up smoking.28
Consistent with trends in other countries,29 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 2011 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, 2011
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, 2011
Source: Department of Health, 201330
The percentage of students who were experimental and current smokers increased as the number of parents who smoked increased. Among 12–15 year olds, the percentage who were current smokers, experimental smokers, and never smokers differed significantly between each of the three parent smoking groups. However, among older students, there was only a significant difference between students who had a smoking parent and those who did not, regardless of whether it was one or both parents.30
The effects of parental smoking on offspring smoking appear to be lasting. Among Australian secondary school students interviewed in 1985, compared to 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.27
Both genetic and environmental influences can increase the risk of cigarette use in adolescent children, either biological or adoptive, of parents who smoke. 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).31 It is also 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, a higher socio-economic household is not necessarily protective against adverse home conditions.32
Parental social disadvantage is predictive of children’s tobacco and alcohol use. However some of this association appears to be mediated by the greater experience of childhood behavioural and cognitive problems among disadvantaged children.33
Absence of smoking restrictions at home is also associated with increased risk of smoking uptake by children. US studies34, 35 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).
1. National Public Health Partnership. Preventing chronic disease: A strategic framework. Background paper. Melbourne 2001. Available from: http://www.health.vic.gov.au/archive/archive2014/nphp/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
3. Belvin C, Britton J, Holmes J, and Langley T. Parental smoking and child poverty in the UK: An analysis of national survey data. BMC Public Health, 2015; 15:507. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26021316
4. Do YK and Bautista MA. Tobacco use and household expenditures on food, education, and healthcare in low- and middle-income countries: A multilevel analysis. BMC Public Health, 2015; 15(1):1098. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26521133
6. 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
8. Siahpush M, Borland R, Taylor J, Singh GK, Ansari Z, et al. 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: https://www.ncbi.nlm.nih.gov/pubmed/16971030
9. Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, et al. Associations between smoking behaviors and financial stress among low-income smokers. Preventive Medicine Reports, 2015; 2:911–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26844167
10. Baggett TP, Rigotti NA, and Campbell EG. Cost of smoking among homeless adults. New England Journal of Medicine, 2016; 374(7):697–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26886544
11. 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
12. Australian Bureau of Statistics. 6416.0. Residential Property Price Indexes: Eight Capital Cities, Sep 2015: ABS, 2015. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/6416.0Feature+Article1Sep%202015
13. 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
14. Fleming P and Blair P. Sudden infant death syndrome and parental smoking. Early Hum Dev, 2007; 83(11):721−5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17881163
15. 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
16. Aliyu MH, Salihu HM, Wilson RE, and Kirby RS. Prenatal smoking and risk of intrapartum stillbirth. Arch Environ Occup Health, 2007; 62(2):87-92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18316266
17. O'Callaghan F, Al Mamun A, O'Callaghan M, Alati R, Najman J, 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
18. Agrawal A, Scherrer J, Grant J, Sartor C, Pergadia M, 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
19. Gard AM, Owens EB, and Hinshaw SP. Prenatal smoke exposure predicts hyperactive/impulsive but not inattentive ADHD symptoms in adolescent and young adult girls. Infant and Child Development, 2016; 25(4):339–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27516728
20. Melchior M, Hersi R, van der Waerden J, Larroque B, Saurel-Cubizolles MJ, et al. Maternal tobacco smoking in pregnancy and children's socio-emotional development at age 5: The eden mother-child birth cohort study. European Psychiatry, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25843027
21. Niemelä S, Sourander A, Surcel H-M, Hinkka-Yli-Salomäki S, McKeague IW, et al. Prenatal nicotine exposure and risk of schizophrenia among offspring in a national birth cohort. American Journal of Psychiatry, 2016; 173(8):799–806. Available from: http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2016.15060800
22. 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
23. Gilliland F, Berhane K, Islam T, Wenten M, Rappaport 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
24. Zubrick S, Silburn S, Gurrin L, Teoh H, Shepherd C, 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://trove.nla.gov.au/work/153144358?q&versionId=217785299
25. 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
26. 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
27. 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: https://www.ncbi.nlm.nih.gov/pubmed/18412765
28. 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
29. 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
30. Department of Health. Victorian secondary school students’ use of licit and illicit substances in 2011: Results from the 2011 Australian Secondary Students’ Alcohol and Drug (ASSAD) Survey: State Government of Victoria, 2013. Available from: https://www2.health.vic.gov.au/getfile/?sc_itemid=%7b81BB7BE2-131D-414B-9A4D-8B0A056FA6CA%7d&title=Key%20results%20of%20the%20Victorian%20secondary%20school%20students%27%20use%20of%20licit%20and%20illicit%20substances%20in%202011%20-%20Full%20Report
31. 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/
32. 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
33. Macleod J, Hickman M, Bowen E, Alati R, Tilling K, et al. 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
34. 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
35. Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT, Barker DC, et al. 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