Across the sample, smoking was one of the dominant lines of discourse in the youth’s narratives of cancer and cancer prevention. This is not surprising and is consistent with a recent study examining perceived smoking related adverse effects, where youth consistently rated lung cancer as being most concerning
. It appears that youth are connecting smoking with cancer risk. Youth’s discourse (as reinforced through their photographs) reflected the broad public health messages conveyed by anti-tobacco and cancer prevention campaigns suggesting that youth are not passive and ill-informed with respect to tobacco use and health messages. Instead of being preached to by parents about the dangers of smoking, it was youth themselves who were speaking out against smoking. To date, very few studies have reported such behaviour.
Ours is one of few studies that detailed youth perceptions of parental smoking and second-hand smoke and their association with health concerns and family relationships. Although there is research indicating that youth believe parents have an obligation to do all that they can to support their children to not start smoking
, this study revealed that youth are taking responsibility by parenting the parent about the dangers of smoking. Youth in this study demonstrated a high awareness of the dangers of smoking. They expressed fear and concern about the health-related effects of smoking, especially regarding second-hand smoke in their families. Regardless if there was a history of smoking in their families, all youth were worried about the dangers of second-hand smoking for themselves and other family members. Moreover, their awareness and concern extended beyond their own family unit.
Our study supports previous research reinforcing that youth continue to be frequently exposed to second-hand smoke in their homes and in cars even though most youth do not approve of it
. Overall, youth viewed the smoking behaviours of significant adults in their lives as an unjust act that all adults should be aware of. Although the concern for protecting children from second-hand smoke should be about recognizing children's rights over adult smoker's rights, research has shown that the responses of adults to smoking bans in homes and cars have not always been met with compliance and acceptance
[17, 18]. In a study that investigated New Zealand policymakers’ views on the regulation of smoking in private and public places, findings revealed that policymakers were more apt to defer to a smoker’s right to smoke, rather than the protection of children from second-hand smoke
. In that same study, some participants suggested that the successful regulation of smoking around children in private places will require reconstructing the culture around smoking in which any smoking around children would be considered unacceptable.
Our current study adds to the literature as it identifies the various strategies youth use to deal with second-hand smoke in their home environments. In addressing second-hand smoking by their parents and other family members, youth opposed their parents’ smoking behaviours verbally or through their body language. Youth tried to cope with the situation in a variety of ways such as distancing themselves from family members, eating meals in their rooms, smoking with family members, and physically covering their faces to avoid exposure of second-hand smoke. However, despite their attempts, youth were forced to accept the fact that smoking was a defining feature of their families. Results suggest a great toll on youth’s emotional state and their ability to cope with their parents’ health compromising behaviours.
Although research discusses how parents’ behaviours, related to smoking, influence the behaviour of youth, there is minimal discussion on how youth view the impact of smoking on the family unit. Through using qualitative methods, this study showed how smoking was an agent that altered youth’s relationships with family members, usually in a negative way. This is in contrast to a qualitative study by Passey and colleagues that explored the social context of smoking among aboriginal women and girls
. The researchers found that for young girls, smoking was an important way of maintaining relationships within the extended family and community. Sharing a cigarette was seen as a social activity within the family that built a sense of belonging. However, in our study, smoking behaviours of parents and other family members tended to produce feelings of concern, hurt, resentment, and a detachment from the family. The positive or negative impact that cigarette smoking can have on relationships, suggests there is a strong relational component to the act of smoking.
While the focus on the dangers of second-hand smoke has mainly been on the physical health of children, our study reinforces how the harmful effects of parental smoking also extend to youth’s emotional well-being. Overall, youth reported experiencing stress, worry, helplessness, anxiety, and fear for their health and the health of friends whose parents smoked. These youth experienced a heavy emotional burden to parent the parent and carry concerns about siblings. Youth living in families where adult members smoke are least likely to have control over whether they are exposed to second-hand smoke; this places them not only at risk for physical health problems but for emotional distress as well. This study calls attention to the need for future research exploring how the emotional well-being of youth living in homes with adults who smoke, may go dismissed or unrecognized.
Although research has examined some of the health-related effects of having substance-abusing parents, it has for the most part overlooked the detrimental effects on children and family functioning where parents use more socially “acceptable” addictive substances such as tobacco and nicotine. The literature is robust in its findings about the negative effects of living with a parent who has an addiction to alcohol. For example, adolescents of alcoholic parents reported mental health difficulties (including emotional symptoms) and other behaviours (e.g., academic performance and conduct problems) compared to a control group
. Children growing up in substance-abusing families have been shown to have a disrupted family life with increased family conflict, and may be at greater risk for developing alcohol, drug-related, and behavioural problems
Tobacco addiction is a major public health concern. The findings emerging from this study reinforce the need for public health action in three areas. First, more public health-related research is warranted that examines youth’s perceptions about their life circumstances growing up in families where their parents smoke. Further research is needed to investigate possible linkages between youth exposed to second hand smoke in their home environment and emotional and lifestyle-related health difficulties.
Research is also needed to investigate how youth’s perceptions about being exposed to parental smoking behaviours and second-hand smoke impact on family relations and youth development. A report by Children’s Mental Health Policy Research Program at a Canadian University reinforces that research evidence on children's mental health needs may be best informed and strengthened by the participation and experiences of children and their families
. Creating a scientific base on youth’s perspectives of their health and well-being in the context of youth living with parents who smoke, is a critical step to improving and supporting youth's physical, mental, and emotional health.
Second, the findings also raise the issue of attending to the emotional well-being as well as the physical needs of children who reside in smoking households. We need to assist youth who live with second-hand smoke in their homes, and who worry about the health effects on their parents and other family members. Public health programs and policies that help to empower youth who live in families in which parents and other family members smoke are needed. Song et al. recommend that encouraging youth to express their objections to second-hand smoke, as well as encouraging smoke-free homes, may be powerful tobacco control strategies against youth smoking
. In addition to controlling smoking within households, the findings from this study may be used to move forward tobacco control programs and policies designed to prevent parents and other adults from smoking around youth in locations outside the home where parents and youth interact. A comprehensive tobacco control program should support the need for more smoke-free public places including patios, playgrounds, sports fields, beaches, provincial parks, public events, and building perimeters
Upon recognizing the potential toll that parental smoking can have on youth’s emotional well-being, community-based programs to help youth experiencing stress due to their concerns about the dangers of second-hand smoke are needed. Few supports are provided for youth of tobacco-addicted parents, especially for non-smoker youth who are experiencing distress because of their parents’ self-harming behaviours. Health care professionals also can be encouraged to give youth positive messages in dealing and coping with their parents’ smoking behaviour. Addressing youth’s concerns and distress related to second-hand smoke is essential for youth to thrive both physically and mentally.
A final area for public health action is that anti-tobacco messaging to adult smokers needs to emphasize the relational component of smoking, the vulnerable hidden population of children in the smoking household, and how parental smoking can lead to family stress and negative health consequences to their children. Messages should include scenarios where youth feel distressed and trapped within their own homes. As well, messages that show concern for their health as well as the health of their siblings and parents may prove to be of value in getting the attention of parents and other adults who smoke. In a study by Nilsson and Emmelin, Swedish youth who smoked, felt strongly that parents had a duty to care and an obligation to do all they could to support their children not to start smoking: "It's a parental duty"
. Messages such as those voiced by youth in Nilsson and Emmelin’s study as well as those conveyed in the current study could potentially be powerful tools in smoking prevention and cessation programs.
This study’s findings are relevant to issues of childhood agency discussed by others
. Panel discussions with experts of tobacco control and community development revealed themes of children's levels of agency and their power in reducing their exposure to second-hand smoke in the home
. In fact, children were seen as potential agents of change and it was suggested that the voices of children towards their caregivers are potentially central in creating smoke-free homes. Youth are often afforded little opportunity to have their voices heard, and it is noteworthy that some youth in the study did not feel they could speak their mind to their parents about their parent's smoking habits. It is a matter of social justice in allowing and encouraging these youth voices to be heard.
Strengths and limitations of the study
Using a qualitative research approach afforded the opportunity to understand youth from their frames of reference and experiences of reality. The findings reported here add to the existing literature by providing a richer description on youth’s experiences and beliefs about smoking. Limitations of our study included a sample that was primarily females (72%) and in the younger and middle age range of youth with only 17% of participants being 17 years and older. Fewer youth who are male and older could explain why we did not detect differences based on age or gender. Despite striving for a diverse sample, we were unable to obtain diversity in ethnic backgrounds and socioeconomic status. As well, most youth in this study did not smoke. Future work that accounts for limitations in the study’s sample might result in additional perspectives on the relational aspects of smoking that warrant tailoring smoking cessation programs and policies to address the differences. As well, longitudinal work is recommended, as the cross-sectional nature of our study did not afford us an understanding how perspectives of youth change over time.