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
Source: National Public Health Partnership 20011
Note: Adapted by M Scollo from Figure 6 in Preventing chronic disease: a strategic framework background paper1
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 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
9.5.2 The long-term effects of smoking during pregnancy
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 220.127.116.11) 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.
9.5.3 Exposure to environmental tobacco smoke and school absence
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.
9.5.4 Parental example and smoking uptake: the cycle continues
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 18.104.22.168 for details on relative prevalence of smokefree homes by SES).
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.(Last updated April 2019)
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
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