Familial contribution to intergenerational psychosocial transmission of use of tobacco products: A hospital based case–control study

Shahina Yasmin; Archana KrishnaMurthy; Shilpashree Komarla Balaji; Mumin Rashid

doi:10.4103/JIMPH.JIMPH_17_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 1 | Issue : 2 | Page : 66-70

Familial contribution to intergenerational psychosocial transmission of use of tobacco products: A hospital based case–control study

Shahina Yasmin, Archana KrishnaMurthy, Shilpashree Komarla Balaji, Mumin Rashid
Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India

Date of Submission	28-Dec-2022
Date of Decision	03-Feb-2023
Date of Acceptance	05-Jan-2023
Date of Web Publication	20-Feb-2023

Correspondence Address:
Dr. Shahina Yasmin
Department of Public Health Dentistry, The Oxford Dental College, 10th Milestone Bomanahalli, Hongasandra, Bengaluru 560058, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIMPH.JIMPH_17_22

Abstract

INTRODUCTION: Family is considered to be the first and the most important child development and socialization bond. Parental use of tobacco increases the likelihood that children will also engage in uptake of similar habit and hence this study was conducted with the aim to assess the relationship between parental bonding and tobacco-specific familial practices as predictors of tobacco usage in adults. AIM: To assess the familial contribution to intergenerational psychosocial transmission of tobacco use among outpatients visiting The Oxford Dental College, Bengaluru. MATERIALS AND METHODS: A case–control study was conducted among 430 patients coming to the out-patient section in the Department of Oral Medicine and Radiology in a Dental College in Bengaluru, which included 215 tobacco users and 215 non-tobacco users. Study participants aged between 15 and 25 years and were age and gender matched in the ratio of 1:1. A self-administered questionnaire was used to collect information regarding their self-tobacco use, form of use, parental and grandparental tobacco use. Study participants‗ perception of the mother‗s and father‗s parenting behavior was assessed using modified version of the parental bonding instrument and assessment of the study participants nicotine dependency was done using the Parental Bonding Instrument(PBI). RESULTS: Among the 215 study participants in each group, the distributions of male and female participants were 212 (98.6%) and three (1.4%), respectively, with a mean age of 22.9 ± 3.05 years and the participants had high dependency with mean FTND score of 5.23 ± 2.77 and 5.57 ± 4.0 for the smoking and smokeless form, respectively. Results of the univariate logistic regression showed that study participants with paternal tobacco habit were 5.28 times more likely to adopt the tobacco habit compared to the study participants without paternal tobacco use (OR = 5.28, 95% CI: 2.70–10.30) and study participants with paternal grandfather tobacco use were 1.57 times (OR = 1.57, 95% CI: 1.47–2.74) more likely to develop the tobacco habit than the study participants without paternal grandfather tobacco use and both the association was found to be statistically highly significant (P < 0.001). Multivariate linear regression analysis showed that the study participants who had higher maternal strictness were 0.077 less likely [OR= −0.077, 95% CI: −0.146–(−0.008)] to develop the tobacco habit compared to the study participants with lower maternal strictness which was found to be statistically significant (P = 0.030*) and participants with higher paternal warmth were 0.097 times less likely to adopt the tobacco habit compared to study participants with lower paternal warmth [OR= −0.097, 95% CI: −0.097 [−0.190–(−0.005)] which was found to be statistically significant (P = 0.040*). CONCLUSION: For an effective tobacco control program among tobacco users, counseling of participants‗ father and mother should be done simultaneously. Further, anti-tobacco activities should emphasize and make parents realize the importance the family plays in the development of tobacco behavior through implicit influences such as the level of parental control of their children‗s behavior and make the family members understand the way in which they deal with tobacco at home will have an impact on their child tobacco behavior.

Keywords: Case–control, tobacco, intergenerational, psychosocial transmission

How to cite this article:
Yasmin S, KrishnaMurthy A, Komarla Balaji S, Rashid M. Familial contribution to intergenerational psychosocial transmission of use of tobacco products: A hospital based case–control study. J Integr Med Public Health 2022;1:66-70

How to cite this URL:
Yasmin S, KrishnaMurthy A, Komarla Balaji S, Rashid M. Familial contribution to intergenerational psychosocial transmission of use of tobacco products: A hospital based case–control study. J Integr Med Public Health [serial online] 2022 [cited 2023 Mar 27];1:66-70. Available from: http://www.jimph.org/text.asp?2022/1/2/66/370073

Introduction

Tobacco use is one of the major public health problems in the world, resulting in 5.4 million deaths every year. Total tobacco-attributable deaths are projected to rise to 6.4 million in 2015 and 8.3 million in 2030, and 80% of these deaths will be in the developing countries.^[1] Parental use of tobacco, alcohol, and other drugs increases the likelihood that children will also engage in substance use. While a genetic transmission of a propensity to use drugs, particularly tobacco, has been noted, parental use is typically understood to lead to children‗s use through social learning processes.^[2] Therefore, the present study was conducted with the aim to assess the relationship between parental bonding and tobacco specific familial practices as predictors of tobacco usage in adults.

Materials and Methods

Source of data

Patients coming to the out-patient section in the Department of Oral Medicine and Radiology in a Dental College, Bengaluru.

Method of collection of data

A pre-tested validated self-administered questionnaire was used to collect information from the study participants regarding their self-tobacco use, form of use, parental and grandparental tobacco use, study participants‗ perception of the mother‗s and father‗s parenting behaviors. Parental bonding instrument to assess the bonding between the subject and his parents before the age of 15 years^.[3] and Fagerstrom scale to assess the nicotine dependency. (In case the subject was a tobacco user).^[4]

Inclusion criteria

Study participants aged between 15 and 25 years.

Tobacco users in any form who continued their habit at least for 1 year were included in the study (for cases).

Study participants who did not consume tobacco were included in the study as cases.

Exclusion criteria

Study participants who were not brought up by their parents during childhood.

Matching

The study participants were age and gender matched in the ratio of 1:1.

Pair wise matching was done.

Sample size estimation

The sample size formula used to calculate sample size is as follows:^[5]

P₂ = proportion of controls with exposure = 40; OR = odds ratio = 2.4.

A sample size of 196, that is, 196 cases and 196 controls was obtained by using the above formula. Considering the non-response rate of 10%, the sample size taken was 215, that is, 215 cases and 215 controls for the study.

Results

In the present study, a total of 430 adults participated; out of which 212 (98.6%) were male participants in the case and control group each and three (1.4%) were female participants in the case and control group, respectively, and the mean age of the study subjects among the cases was found to be 22.9 ± 3.05 years, whereas among the control group it was 22.9 ± 3.05 years.

Univariate logistic regression analysis showed that the study participants who had paternal tobacco habit were 5.28 times more likely to adopt the tobacco habit compared to the study participants without paternal tobacco use (OR = 5.28, 95% CI: 2.70–10.30) and the association was found to be statistically highly significant (P < 0.001**). Furthermore, study participants‗ habit of tobacco use was significantly associated with study participants paternal grandfather tobacco use where it was found that study participants with paternal grandfather tobacco use were 1.57 times more likely to develop the tobacco habit than the study participants without paternal grandfather tobacco use and the association was found to be statistically highly significant (P < 0.001**) (OR = 1.57, 95% CI: 1.47–2.74).

Furthermore, it was seen that study participants who had parents who used tobacco at home were 1.54 times more likely to adopt the tobacco habit than the study subjects who had parents who did not use tobacco at home and it was found to be statistically significant [(OR = 1.57, 95% CI: 1.10–3.18) (P < 0.005*)]. Moreover, study participants‗ habit of tobacco use was significantly associated (P = 0.05*) with participants being allowed by parents to use tobacco where it was seen that the study participants‗ being allowed to use tobacco were 1.61 times more likely to develop the habit than the study participants‗ not being allowed to use tobacco (OR= 1.61, 95% CI: 1.10–2.99) [Table 1].

Table 1: Univariate logistic regression showing the associations between familial and study participants‗ tobacco habit

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In the multivariate analysis, it was seen that study participants with paternal tobacco use were 11.9 times more likely to adopt the tobacco habit compared to control subjects without paternal tobacco habit (OR= 11.9, 95% CI: 5.17–27.19) and the association was found to be statistically highly significant (P < 0.001*). Similarly, subjects who had paternal grandfathers with the habit of tobacco use were 1.91 times more likely to develop the habit of tobacco use compared to the study participants who had paternal grandfathers without the habit of tobacco (OR = 1.91, 95% CI: 1.35–2.93) and the finding was statistically significant (P < 0.05*).

Furthermore, it was seen that study participants who had parents who used tobacco at home were 1.54 times to adopt the tobacco habit than the study subjects who had parents who did not use tobacco at home and it was found to have a significant effect [(OR= 1.59, 95% CI: 1.30–2.93) (P < 0.005*)] [Table 2].

Table 2: Multivariate logistic regression showing the associations between study participants‗ tobacco habit and other predictors of tobacco use

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Multivariate linear regression of cases and controls showed that when maternal strictness was considered it was seen that study participants who had higher maternal strictness were 0.077 less likely [OR= −0.077, 95% CI: −0.146–(−0.008)] to develop the tobacco habit compared to the study participants with lower maternal strictness which was found to be statistically significant (P = 0.030*) [Table 3]

Table 3: Multivariate linear regression predicting the associations between maternal bonding and study participants‗ tobacco habit

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Multivariate linear regression showed that the study participants with higher paternal warmth were 0.097 times less likely to adopt the tobacco habit compared to study participants with lower paternal warmth [OR= −0.097, 95% CI: −0.097 [−0.190–(−0.005)] which was found to be statistically significant (P = 0.040*) [Table 4].

Table 4: Multivariate linear regression predicting the associations between paternal bonding and study participants‗ tobacco habit

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Discussion

The first lesson of smoking and tobacco consumption is usually learnt at home from a parent or a grown-up sibling, especially if the habit is acquired at an early age before 18 years_.^[6] Reports have shown that initiation of tobacco use during adolescence causes more tobacco dependence.^[7]

Regarding the main focus of the study, the intergenerational transfer of tobacco use, the results of the present study are conclusive: cohabitant grandparents‗ and parents‗ tobacco use increases the probability of the study participants tobacco habit. Thus, fathers‗ tobacco use, mothers‗ tobacco habit as well as their attitude toward tobacco use, along with tobacco habit of grandparents, the environment at home appear as important predictors of their children‗s tobacco habit but the most influential factors derived in the present study were: paternal tobacco use, paternal grandfather tobacco use, use of tobacco by parents at home, and study participants being allowed to use tobacco which were found to be significantly associated with the study participants own tobacco habit. These results are in line with prior research. This association could be due to the fact that children of parent tobacco users are more prone to emulate them through a process of social learning.

Furthermore, when paternal grandparents‗ tobacco habit was assessed, it was seen that in the present, study participants‗ habit of tobacco use was significantly associated with the study participants paternal grandfather tobacco use where it was found that the study participants with paternal grandfather tobacco use were 1.57 times more likely to develop the tobacco habit than the study participants without paternal grandfather tobacco use and the association was found to be highly significant statistically (P < 0.001) [OR= 1.57, 95% CI: 1.47–2.74] which was corroborated by the findings of the study conducted by El-Amin et al.^[8] where the participants were 1.84 more times likely to develop the habit of tobacco themselves than their counterparts without paternal grandfather tobacco use and the association was found to be statistically significant (P = 0.005) (OR= 1.84, 95% CI: 1.26–2.70). This significant association can be explained by the fact that the study participants with tobacco use had a cohabitant paternal grandfather and hence living and being raised with their paternal grandfather with tobacco habit would have an impact on their behavior and would lead to tobacco initiation.

When paternal association of tobacco was evaluated, in the present study it was seen that the study participants who had paternal tobacco habit were 5.28 times more likely to adopt the habit themselves compared to the study participants without paternal tobacco habit (OR = 5.28, 95% CI: 2.7–10.3) and the association was found to be statistically highly significant (P < 0.001). The findings of the present study were similar to the study conducted by Asawa et al.^[3] where the risk of smoking or using tobacco among participants increased with the paternal tobacco habit (OR 4.5, 95% CI: 2–10.1). However, the findings of the present study were in contrast to the findings of the study conducted by Duarte et al.^[9] and Gilman^[10] which showed that the subjects with paternal tobacco habit had only 1.25 and 1.67 times likeliness to adopt the habit themselves compared to the study participants without paternal tobacco habit (OR = 1.25; 95% CI = 1.16–1.35) and (OR = 1.67; CI = 1.12, 2.48) respectively.

Limitations

This study investigated the associations between familial and participant‗s tobacco habits, and explored whether this association is explained by parental behavior. The present study is subject to a number of limitations:

First and foremost is the results of the present study are based on participant‗s habit among subjects attending outpatient clinics of a dental institution located in Bengaluru.

Secondly, this study includes the study participants‗ retrospective reports of familial lifetime tobacco use to establish patterns of tobacco use, symptoms of nicotine dependence, and ages at smoking onset and offset which can lead to inaccurate results.

Another limitation of the study is the reliability of self-reports. Inaccuracies in these reports may have weakened the ability of the present study to distinguish between various aspects of intergenerational transmission.

Conclusion

The present study concluded that the tobacco consumption habit shows intergenerational continuity in families. In the present study, it was seen that the study participants‗ tobacco habit was significantly associated with their paternal tobacco use, paternal grandfather tobacco habit, use of tobacco by parents at home, and study participants being allowed to use tobacco. Consequently, the results of the present study suggests that an individual's social, genetic, and environmental constituents play a vital role in the nexus of tobacco-habit formation. Other significant association with the participants tobacco habit found in the present study are use of tobacco by parents at home and study participants being allowed to use tobacco are indicative of home environment and their familial attitude which has an important and complementary role in tobacco initiation among tobacco users thereby supporting the need for multigenerational psychosocial intervention for effective prevention of tobacco use in this population.

Ethical statement

Ethical Clearance was obtained from the Institutional Review Board of The Oxford Dental College, Bengaluru and permission to conduct the study was obtained from the Head of the department of Oral Medicine and Radiology of The Oxford Dental College, Bengaluru.

Declaration of patient consent

Voluntary written informed consent was obtained from participants participating in the study before the data collection in English and Kannada.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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