Parental prompting of smoking among adolescents in Tijuana, Mexico

INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, 1(2), 122-136 Copyright �9 1994. Lawrence Erlbaam Associates. Inc.

Parental Prompting of Smoking Among Adolescents in

Tijuana, Mexico

James F. Sailis, Kamala Deosaransingh, Susan I. Woodruff, Rigoberto Vargas,

Rafael Laniado-Laborin, Carmen Moreno, and John P. Elder

Latino adolescents in the United States and Mexico may have higher rates of tobacco experimentation than other ethnic groups, possibly due to cultural factors and parental influences. This study examined three parental behaviors that may prompt smoking in children in Grades 3, 5, 7, and 9 in Tijuana, Mexico. Surveys were administered to 758 students in randomly selected classes in randomly selected schools in Tijoana. The most frequenl prompt was the smoking parent asking the child to buy cigarettes (about two thirds), whereas about 60% asked the child to light the parent's cigarette, and about 20% of smoking parents asked the child to place the cigarette in his or her mouth to light it. Rates of prompting were very low among third graders but increased by Grade 5. Mother's smoking was associated with higher rates of all three types of parental prompting.

Key words: smoking, adolescents, Latino, family, Mexico

The majori ty of regular smokers in the United States begin smoking before the age of 18 (Pierce, Fiore, Novotny, Hatziandreu, & Davis, 1989). Experi- mentat ion usually occurs soon after 11 years of age and peaks at about age

James F. Sallis, Department of Psychology, San Diego State Universily, San Diego, CA, USA; Kamala Deosaransingh, Susan I. Woodruff, Rigoberto Vargas, Rafael Laniado-Labodn, Carmen Moreno, and John P. Elder, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.

This work was supported by a University of California Tobacco-Related Diseases Research Program Grant to James F. Sallis,

Correspondence concerning this arlicle should be addressed to James F. Sallis, Department of Psychology. San Diego Stale University, Suite 103, 6363 Alvarado Court, San Diego, CA 92120.

INTERNATfONAL JOURNAL OF BEHAVIORAL MEDICINE, 1(2), 122-136Copyright© 1994. Lawrence Erlbaum Associates. Inc.

Parental Prompting of SmokingAmong Adolescents in

Tijuana, Mexico

James F. Sallis, Kamala Deos.aransingh,Susan I. Woodruff, Rigoberto Vargas,

Rafael Laniado-Laborin, Carmen Moreno,and John P. Elder

Latino adolescents in the United States and Mexico may have higher rates oftobatco experimentation than other ethnic groups, possibly due to culturalfactors and parental influences. This study examined three parental behaviorsthat may prompt smoking in children in Grades 3, 5. 7, and 9 in Tijuana.Mexico. Surveys were administered to 758 students in randomly selectedclasses in randomly selected schools in Tijuana. The most frequent prompt wasthe smoking parent asking the child to buy cigarettes (about two thirds),whereas about 60% asked the child to light the parent's cigarette. and about20% of smoking parents asked the child to place the cigarette in his or hermouth to light it. Rates of prompting were very low among third graders butincreased by Grade 5. Mother's smoking was associated with higher rates of allthree types of parental prompting.

Key words: smoking, adolescents, Latino, family. Mexico

The majority of regular smokers in the United States begin smoking beforethe age of 18 (Pierce, Fiore, Novotny, Hatziandreu, & Davis. 1989). Experimentation usually occurs soon after 11 years of age and peaks at about age

James F. Sallis. Department of Psychology, San Diego State University, San Diego. CA, USA;Kamala Deosaransingh, Susan I. Woodruff. Rigoberlo Vargas, RaFael Laniado-LlIborin, Cart11c.nMoreno, and John P. Elder, Graduate School of Public Health, San Diego State University, SanDiego, CA, USA.

This work was supported by a University of California Tobacco-Related Diseases ResearchProgram Grant to 'amesF. Sallis.

Correspondence concerning this article should be addressed to James F. Sallis. Department ofPsychology, San Diego State University. Suite 103.6363 Alvarado Court, San Diego, CA 92120.

PARENTAL PROMPTS FOR SMOKING 123

18 for White, African-American, and Latino youth (Escobedo, Anda, Smith, Remington, & Mast, 1990). Within the United States there is some evidence of ethnic differences in youth smoking rates. A survey of over 6,000 Califor- nia adolescents, ages 12 to 17, found Latino youths experimented with smoking more and continued to smoke more when compared to adolescents of other ethnic groups, though the rates were not significantly different (Burns & Pierce, 1992).

Smoking rates of adults are known to differ among Latin-American countries (U.S. Department of Health and Human Services [USDHHS], 1992), but little is known about the smoking habits of Latin-American adolescents. A survey of sixth-grade students in Tijuana, Mexico found cigarette experimentation rates, as measured by smoking once or more (42%), were about the same as those of Mexican-American students in nearby San Diego, CA (44%), and rates for both Latino groups were considerably higher than their White-American counterparts (25%) (Elder, Molgaard, & Laniado-Laborin, 1988). These relatively high rates among Mexicans and Mexican Americans suggest that cultural factors such as family influences, and/or social--structural factors such as product availability, may partially explain the high prevalence of tobacco use by Latino youth.

Peer pressure and cigarette advertising are major influences on adolescent smoking (Flay, d'Avernas, Best, Kersell, & Ryan, 1983). In addition, studies have shown that parental smoking is an important influence on adolescent smoking experimentation (Elder et al., 1988; Friedman, Lichtenstein, & Biglan, 1985). The finding that 15% of young smokers have their first cigarette with a parent or relative suggests parents may influence their children to smoke in more direct ways than simply modeling tobacco use behavior (Friedman et al., 1985). Because of the central role of the family in Latino cultures (G. Marin & B. V. Marin, I991), family influences on smoking may be particularly important in Latin-American countries such as Mexico.

In a recent study, Moreno et al. (1994) found that Mexican and Mexican- American parents are more likely to prompt, directly or indirectly, their seventh-grade adolescents to engage in smoking-related behaviors than parents from other ethnic groups. Latino students were more likely than other groups to hold the lighter for their parents' cigarettes. The most direct parental prompt was asking the child to light a cigarette by placing it in his or her mouth. This type of prompt was reported almost exclusively by Latino youth, and it was found to be a culturally specific risk factor for Lafino youth smoking. These prompting behaviors appear to be common occurrences in some Mexican and Mexican-American households, and they may partially exp/ain the higher smoking prevalence rates of Latino adolescents reported by several investigators (Burns & Pierce; 1992; de Moor, Elder, Young, Wildey, & Moigaard, 1989; Marcus & Crane, 1985). If the importance of these parental prompting behaviors is replicated, then intervention strategies may be needed to reduce parental prompting of youth smoking in Mexican and Mexican-American families.


18 for White, African~American,and Latino youth (Escobedo, Anda, Smith,Remington, & Mast, 1990). Within the United States there is some evidenceof ethnic differences in youth smoking rates. A survey of over 6,000 California adolescents, ages 12 to 17, found Latino youths experimented withsmoking more and continued to smoke more when compared to adolescentsof (jther ethn ic groups, though the rates were not significantly different(Burns & Pierce, 1992).

Smoking rates of adults are known to differ among Latin-American countries (U.S. Department of Health and Human Services [USDHHSJ, 1992),but little is known about the smoking habits of Latin-American adolescents.A survey of sixth-grade students in Tijuana, Mexico found cigarette experimentation rates, as measured by smoking once or more (42%), were aboutthe same as those of Mexican-American students in nearby San Diego. CA(44%), and rates for both Latino groups were considerably higher than theirWhite-American counterparts (25%) (Elder, Molgaard, & Laniado-Laborin,1988). These relatively high rates among Mexicans and Mexican Americanssuggest that cultural factors such as family influences, and/or social-structural factors such as product availability, may partially explain the highprevalence of tobacco use by Latino youth.

Peer pressure and cigarette advertising are major influences on adolescentsmoking (Flay, d'Avernas, Best, KerseH. & Ryan, 1983). In addition, studieshave shown that parental smoking is an important influence on adolescentsmoking experimentation (Elder et aI., 1988; Friedman, Lichtenstein, & Biglan,1985). The finding that 15% of young smokers have their first cigarette with aparent or relative suggests parents may influence their children to smoke inmore direct ways than simply modeling tobacco use behavior (Friedman et aI.,1985). Because of the central role of the family in Latino cultures (G. Marin &B. V. Marin. 1991). family influences on smoking may be particularly importantin Latin-American countries such as Mexico.

In a recent study. Moreno et a1. (1994) found that Mexican and MexicanAmerican parents are more likely to prompt, directly or indirectly, theirseventh-grade adolescents to engage in smoking-related behaviors than parents from other ethnic groups. Latino students were more likely than othergroups to hold the lighter for their parents' cigarettes. The most directparental prompt was asking the child to light a cigarette by placing it in hisor her mouth. This type of prompt was reported almost exclusively by Latinoyouth, and it was found to be a culturally specific risk factor for Latino youthsmoking. These prompting behaviors appear to be common occurrences insome Mexican and Mexican-American households. and they may partiallyexplain the higher smoking prevalence rates of Latino adolescents reportedby several investigators (Burns & Pierce. 1992; de Moor, Elder. Young.Wildey, & Molgaard, 1989; Marcus & Crane, 1985). If the importance ofthese parental prompting behaviors is replicated, then intervention strategiesmay be needed to reduce parental prompting of youth smoking in Mexicanand Mexican-American families.

1 2 4 SAi iS ~:S~ Ai}

The Moreno et al. (1994) study left several questions about parental smoking prompts unanswered. Because onEy seventh-grade students were studied, it was not determined at what age parents began exposing children to cigarettes through these prompts. Few correlates of parental prompting were examined.

The purpose of our study is to evaluate a variety of parental influences on youth smoking in Grades 3, 5, 7, and 9 in Tijuana, Mexico and to examine factors that are associated with parental prompting behavior. It is hypothesized that parental prompts to smoke are significant factors in Latino youth smoking.

METHOD

Setting

The setting for this study was Tijuana, Baja California, Mexico. The city of Tijuana is located on the border of the U.S. and Mexico and is approximately 20 km from San Diego, CA. It has a population of between I and 2 million and includes many recent immigrants from Southern Mexico and Central America. In general, the children would be considered middle class in Mexico, although their socioeconomic status would be considered low by U.S. standards.

Subjects

A total of 820 students were surveyed at I0 Tijuana public schools. Ninety- two percent of these (n = 758) provided complete data, and their characteristics are shown in Table 1. Participants were enrolled in the U.S. equivalents of third (n = 154) and fifth (n = I97) grades at six primaria schools and seventh (n = 216) and ninth (n = 191) grades at four secundaria schools. As shown in Table I, the mean ages by grade were about 8, 1 I, 13, and 15 years, respectively. In Table 1 students are classified by parental smoking status, All subsequent analyses were performed onIy on students with at least one parent who smoked, because only the parents who smoked were expected to prompt their children to be exposed to cigarettes.

Procedures

After obtaining permission from the Baja California (Mexico) State Depart- ment of Schools, the participating schools were randomly selected, and permission was obtained from each principal. One or two classrooms, of 35 to 45 students each, were randomly selected from each grade level at each school. Students in each classroom completed a one-page, 17-item survey to assess smoking history and parental influences on adolescent smoking behavior. Third-grade participants were individually administered the survey

124 SALLIS ET AL.

The Moreno et al. (1994) study left several questions about parentalsmoking prompts unanswered. Because only seventh-grade students werestudied, it was not determined at what age parents began exposing childrento cigarettes through these prompts. Few correlates of parental promptingwere examined.

The purpose of our study is to evaluate a variety of parental influences onyouth smoking in Grades 3, 5, 7, and 9 in Tijuana, Mexico and to examinefactors that are associated with parental prompting behavior. It is hypothesized that parental prompts to smoke are significant factors in Latino youthsmoking.

METHOD

Setting

The setting for this study was Tijuana, Baja California, Mexico. The city ofTijuana is located on the border of the U.S. and Mexico and is approximately20 km from San Diego, CA. It has a population of between I and 2 millionand includes many recent immigrants from Southern Mexico and CentralAmerica. In general, the children would be considered middle class inMexico. although their socioeconomic status would be considered low byU.S. standards.

Subjects

A total of 820 students were surveyed at 10 Tijuana public schools. Ninetytwo percent of these (n = 758) provided complete data, and their characteristics are shown in Table I. Participants were enrolled in the U.S. equivalentsof third (n = 154) and fifth (n = 197) grades at six primaria schools andseventh (n =216) and ni nth (n =191) grades at four secundaria schools. Asshown in Table I, the mean ages by grade were about 8, II, 13, and 15 years,respectively. In Table 1 students are classified by parental smoking status.All subsequent analyses were performed only on students with at least oneparent who smoked. because only the parents who smoked were expected toprompt their children to be exposed to cigarettes.

Procedures

After obtaining permission from the Baja California (Mexico) State Department of Schools, the participating schools were randomly selected, andpermission was obtained from each principal. One or two classrooms. of 35to 45 students each, were randomly selected from each grade level at eachschool. Students in each classroom completed a one-page, 17-item survey toassess smoking history and parental influences on adolescent smoking behavior. Third-grade participants were individually administered the survey

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verbally by trained interviewers. Students in the other grades completed the self-administered survey in class.

Saliva samples were collected from all participants as a bogus pipeline procedure to enhance the validity of self-reported tobacco use (Murray, O'Connel], Schmid, & Perry, 1987). Students were informed that the saliva samples could be used to verity their smoking status before they completed the survey. Students were asked to hold a cotton dental roll in their cheeks for 2 to 3 rain. The rolls were then placed in labeled tubes and collected. A random sample of 90 tubes were sent for cotinine and nicotine analysis at the University of Minnesota. Two o f the subjects reported smoking within the past week, which is longer than the half-life of cotinine, and none reported smoking in the past 24 hr. All subjects were classified as nonsmokers by cotinine levels. These results confirm the self-reports of nonsmoking.

Survey fnstrument

The survey contained items on demographic characteristics, student smoking prevalence, whether the student had ever been offered cigarettes, father 's and mother 's smoking status, parental attitudes toward child smoking, and parental smoking prompts. The parental smoking prompt items assessed whether the parent had ever asked 'the child to (a) ~light the parent 's cigarette with a match or lighter, (b) put the cigarette in the child's mouth to light it, and (c) buy cigarettes for the parents. These items were based on information obtained from focus groups with public school students in Tijuana.

The dichotomous variables were coded as follows: parental prompting (0 = ne~,er. I = y e s ) , sex (0 = b o y , i = g i r l ) , mother 's smoking (0 = no, l = y e s ) ,

father 's smoking (0 = n o , 1 = y e s ) , parental attitude toward child smoking (0 = d o n o t f o r b i d , 1 = f o r b i d ) , ever been offered cigarettes (0 = n o , I = y e s ) ,

past month smoking (0 = n o n e , 1 = s o m e ) , and ever having smoked (0 --- no .

1 = y e s ) .

Data Analysis

All analyses were limited to students with at least one parent who smoked, because the purpose was to study parental prompting of child smoking. Across all grades, about 55% of students had at least one smoking parent. The first analysis examined rates of parental prompts and tested differences by sex and grade with chi-square tests. Subsequent analyses were limited to students in Grades 5, 7, and 9. Third-grade students were excluded because there was a low prevalence of parental prompts in this young group.

Logistic regression was used to examine within-grade correlates of three parental prompts: (a) light the cigarette with a match or lighter, (b) put the cigarette in the mouth to light, and (c) buy cigarettes for the parents. Corre- lates included student's sex, mother 's smoking status, father 's smoking status, and parental attitude toward child's smoking. An overall analysis across

126 SALLIS ET AL

verbally by trained interviewers. St udents in the other grades completed theself-administered survey in class.

Saliva samples were collected from all participants as a bogus pipelineprocedure to enhance the validity of self-reported tobacco use (Murray.O'Connell, Schmid, & Perry, 1987). Students were informed that the sal ivasamples could he used to verify their smoking status before they completedthe survey. Students were asked to hold a colton dental roll in their cheeksfor 2 to 3 min. The rolls were then placed in labeled tubes and collected. Arandom sample of 90 tubes were sent for cotinine and nicotine analysi s at theUniversity of Minnesota. Two of the subjects reported smoking within thepast week, which is longer than the half-life of cotinine, and none reportedsmoking in the past 24 hr. All subjects were classified as nonsmokers bycotini ne levels. These results confirm the self-reports of nonsmoking.

Survey Instrument

The survey contained items on demographic characteristics, student smokingprevalence, whether the student had ever been offered cigarettes, father'sand mother's smoking status, parental attitudes toward child smoking, andparental smoking prompts. The parental smoking prompt items assessedwhether the parent had ever asked the child to (a) Hght the parent's cigarettewith a match or lighter, (b) put the cigarette in the child's mouth to light it,and (c) buy cigarettes for the parents. These items were based on informationobtained from focus groups with public school students in Tijuana.

The dichotomous variables were coded as follows: parental prompting (0= never, I ;::; yes), sex (0 ;::; boy, I = girl). mother's smoking (0 =no, I '" yes),father's smoking (0 = no, [ = ye.f), parental attitude toward child smoking (0=do not forbid, 1 == forbid), ever been offered cigarettes (0 =no, I =yes),past month smoking (0 =none, 1= some), and ever having smoked (0 = no,1 =yes).

Data Analysis

All analyses were limited to students with at least one parent whb smoked,because the purpose was to study parental prompting of child smoking.Across all grades, about 55% M students had at least one smoking parent.The first analysis examined rates of parental prompts and tested differencesby sex and grade with chi-square tests. Subsequent analyses were limited tostudents in Grades 5, 7, and 9. Third-grade students were excluded becausethere was a low prevalence of parental prompts in this young group.

Logistic regression was used to examine within-grade correlates of threeparental prompts: (a) light the cigarette with a match or lighter, (b) pUI thecigarette in the mouth to light, and (c) buy cigarettes for the parents. Correlates included student's sex, mother's smoking status, father's smoking status, and parental attitude toward child's smoking. An overall analysis across


grades was conducted, and it included grade as a correlate in addition to the previously mentioned variables.

The relation between parental prompting and smoking outcomes was investigated at each grade and across Grades 5, 7, and 9. Two logistic regression analyses were conducted lor the dependent variables (a) past month smoking and (b) ever having smoked. The following independent variables were used in both regressions: sex, mother 's smoking status, father's smoking status, parental attitude toward the child's smoking, cigarette offers, and the three parental prompts. In the analysis across grades, grade was included as a predictor. Analyses were conducted using the SPSS/PC*.

RESULTS

Table 1 presents the percentages or means for the demographic variables age and sex, and for smoking-related variables. There were no sex differences, and only for third graders was there a significant age difference between students without smoking parents and those with at least one smoking parent. Seventh graders with smoking parents were more likely tO have ever tried a cigarette (p < .05), but there were no group differences on past month smoking. There were no group differences in percent of parents who forbid their children to smoke, but forbidding declined as the age of the children increased. Third-grade and fifth-grade students with smoking parents were significantly more likely than students from nonsmoking families to report they had been offered cigarettes.

Figures 1 through 3 present parental p]'ompting behaviors for those students with at least one smoking parent, by sex and grade. About 60% reported being asked to light the cigarette with a match or lighter (Figure I ). Less than 20% of fifth- through ninth-grade students reported their parents who smoked asked them to place the cigarette in their mouth to light it, and very few of the third graders reported this prompt (Figure 2). The most frequent prompt was asking the child to buy cigarettes (Figure 3), reported by about two thirds of fifth through ninth graders with smoking parents. All three parental prompts showed similar patterns by sex and age. There were no significant differences in parental prompts by sex at any grade, but there were important differences by grade. The reported prevalences of alI three parental prompts were low for third graders, but large increases in prompts were observed by the fifth grade. The rates for fifth, seventh, and ninth grades were similar, and there was no evidence of an age-related increase in parental prompts after the fifth grade.

Table 2 shows the percent of students reporting prompting in families in which only the mother smokes, only the father smoke.,;, or both parents smoke. The prevalence of all three prompting behaviors, in virtually all grades, appeare~ to be higher in mother-only smoking families thaft in father-only smoking families. The prevalence rates for families in which


grades Was conducted, and it included grade as a correlate in addition to thepreviously mentioned variables.

The relation between parental prompting and smoking outcomes wasinvestigated at each grade and across Grades 5. 7, and 9. Two logisticregression analyses were conducted for the dependent variables (a) pastmonth smoking and (b) ever having smoked. The following independentvariables were used in both regressions: sex. mother's smoking status,father's smoking status, parental attitude toward the child's smoking, cigarette offers, and the three parental prompts. In the analysis across grades,grade was included as a predictor. Analyses were conducted using theSPSS/PC.

RESULTS

Table I presents the percentages or means for the demographic variables ageand sex, and for smoking-related variables. There were no sex differences,and only for third graders was there a significant age difference betweenstudents without smoking parents and those with at least one smoking parent.Seventh graders with smoking parents were more likely to hllve ever tried acigarette (p < .05), but there were n(l group differences on past monthsmoking. There were no group differences in percent of parents who forbidtheir children to smoke. but forbidding declined as the age of the childrenincreased. Third-grade and fifth-grade students with smoking parents weresignificantly more likely than students from nonsmoking families 10 reporlthey had been offered cigarettes.

Figures 1 through 3 present parental prompting behaviors for those students with at least one smoking parent. by sex and grade. About 60%reported bei ng asked to light the cigarette with a match or lighter (Figure I).Less than 20% of fifth- through ninth-grade students reported their parentswho smoked asked them to place the cigarette in their mouth to light it. andvery few of the third graders reported this prompt (Figure 2). The mostfrequent prompt was asking the child to buy cigarettes (Figure 3), reportedby about two thirds of fifth through ninth graders with smoking parents. Allthree parental prompts showed similar patterns by sex and age. There wereno significant differences in parental prompts by sex at any grade, but therewere important differences by grade. The reported prevalences of all threeparental prompts were low for third graders, but large increases in promptswere observed by the fifth grade. The rates for fifth, seventh, and ninthgrades were similar, and there was no evidence of an age-related increase inparental prompts after the fifth grade.

Table 2 shows the percent of students reporting prompting in families inwhich only the mother smokes, only the father smokes, or both parentssmoke. The prevalence of all three prompting behaviors, in virtually allgrades, appeared to be higher in mother-only smoking families than infather-only smoking families. The prevalence rates for families in which

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G r a d e

Distributions for the parental prompt "light cigarette with match/lighter" in Smoking families by sex within grade.

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FIGURE 2 Dislrihution,~ for the parental prompt "p[ace cigarette in mouth le light" in smoking families by sex within grade.

1 2 8

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FIGURE 1 Distrihulions lor ihc parental prompt " l i ~h t cigarette with molchllightcr" in

smoking families hy sex wilhin gradc.

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n=123 n=1 24 n=88 Grade

FIGURE 2 Dislributions for the parental prompt "place cignretle in mouth lo light" in smoking families by scr within grade.

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FIGURE 1 Distribulions for the par~ntal prompt "light cigarelle wilh match/lighter" insmoking families hy se~ within grade.

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FIGURE 2 Distributions for the parental prompt "place· cigarette in mouth 10 light" insmoking families by sex within grade.

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Distributions ~rtheparentalprompt"buyeigarcttes"insmoking ~milies by sex wilhia grade.

TABLE 2 Distributions of Parental Prompts by Grade and Parental Smoking

% Reporting Prompt

Third Fifth Seventh Ninth Overall

Only mother smokes Light with match/ l ighter 0 57 54 58 47 Put in mou th to light 0 31 19 19 18 Buy cigarettes 17 71 69 77 64 ~

n 12 14 26 26 78 Only father smokes

Light with match/ t ighter 9 56 45 35 311 Put in mou th to light 2 15 l0 6 9 Buy cigarettes 9 66 46 56 45 =

n 45 59 53 34 19I Both smoke

Light with match/ l ighter 23 68 73 82 66 Put in mou th to light 5 25 24 2I 21 Buy cigarettes 14 80 76 75 68

n 22 50 45 28 145

~Signilicantly different f rom one another (p _< .01).

1 2 9

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3rdn=79

5th

0=123

Grade

7thn=124

9th0=88

FIGURE 3 Distributions for the parental prompt "buy cigarettes" in smoking families

by sex within grade.

TABLE 2DistrIbutions of Parental Prompts by Grade and Parental Smoking

% Reponing Prompt

Third Fifth Seventh Ninth Overall

Only mother smokesLight with match/lighter 0 57 54 58 47Put in mouth to light 0 31 19 19 18Buy cigarelles [7 71 69 77 64"

n 12 14 26 26 78Only father smokes

Light with match/lighter 9 56 45 35 38Put in mouth to light 2 15 IO 6 9Buy cigarettes 9 66 46 56 45"'

n 45 59 53 34 191Both smoke

Light with match/lighter 23 68 73 82 66Put in mouth to light 5 25 24 21 21Buy cigarettes 14 80 76 75 68

n 22 50 45 28 145

'Significantly different from one another (p :s .01).

t 3 0 S;ALI t:~ E r AL

both parents smoked resembled the rates for mother-only smoking families. This pattern of results suggests that mothers are more likely to prompt than fathers, Chi-square tests were conducted for the overall group, and the only statistically significant difference was prompting to buy cigarettes, Z-~( I, N = 414) = 7.55, p < .01.

Logistic regression, with simultaneous entry of independent variables, was conducted to evaluate the association of mother's smoking, father's smoking, and parent's attitude toward child smoking with parental prompt-

TABLE 3 Logistic Regression Derived Odds of Parental Prompts in Smoking Families

by Grade and Ovaralb

Ligh t Cigarette Predictors With Match~Ligh te r

Fifth grade

Odds of Prompt

P u t in M o u t h Buy to L ight Cigarettes

Sex Mother smoking Father smoking Parental attitudes

n Seventh grade

Sex Mother smoking Father smoking Parental attitudes 6

n Ninth grade

Sex Mother smoking 746 ~ ~ Father smoking 267 Parental attitudes 9 7

n 83 Overall (fifth, seventh, ninth)

Sex ,84

Grade 5!! :

9th i ~;(} Mother smoking 2 9 * ~ Father smoking i S 6 Parental attitudes

n

i i

79

i i

, 2 g

84

:~:~ 0 5

:2 7~ 9 ~

2

2L~;

1 ;i 8

6

t

4

:gO 2~

g3

7

~7

2:}

Note . Prompting variahle~ (n = never, I = ye'o: Sex (0 = ha3, I = gtr/); Mother smokLng (0 --- no. l - )e.q; Father smoking (0 = no. l = yes): Parental attitudes (0 --- do no t f o r b i d .

both parents smoked resembled the rates for mother-only smoking families. This pattern of results suggests that mothers are more likely to prompt than fathers. Chi-square tests were conducted for the overall group, and the only statistically significant difference was prompting to buy cigarettes. ~ ' ( 1 . N = 414) = 7.55,~ < .01.

Logistic regression, with simultaneous entry of independent variables. was conducted to evaluate the association of mother's smoking, father's smoking, and parent's attitude toward child smoking with parental prompt-

TABLE 3 Logistic Regression Derived Odds of Parental Prompts in Smoking Families

by Grade and Overall

Odds o/ Prompt

Light Cigorerte Put in Mouth BUY Predictors With Motch/Lighler to Light Cigorertes

Fifth grade Sex Mother smoking Father smoking Parental attitudes

n Seventh grade

Sex Mother smoking Father rmokmg Parental attitudes n

Ninth grade Sex Mother smoking Father smoking Parental attitude$

n Overall (fifth, seventh.

Sex Grade

9th Mother smoking Father smoking Parental attitudes

n

83 ninth)

.84

Note. Promplmg varmhle? (0 = never. I = yes): Sex (0 = hm. I = w n ; Mother makmg (0 - no. I - . L ~ . T I : Father smoking I0 = no. I = IPS): Parental arlltuder (0 -- donor/orhld.

130 SALLIS ET AL

both parents smoked resembled the rates for mother-only smoking families.This pattern of results suggests that mothers are more likely 10 prompt thanfathers. Chi-square tests were conducted for the overall group, and the onlystatistically significant difference was prompting to buy cigarettes. X2

( I, N =414) = 7.55. P < .01.

Logistic regression, with simultaneous entry of independent variables,was conducted to evaluate the association of mother's smoking, father'ssmoking, and parent's attitude toward child smoking with parental prompt-

TABLE 3Logistic RegressIon Derived Odds of Parental Prompts in Smoking Families

by Grade and Overall

Odds of Prompt

Light Cigarette Put in Mouth BuyPredictors With Match/Lighter to Light Cigarettes

Fifth gradeSex .91 1.53 .75Mother smoking 1.69 1.59 2.13Father smoking 1.46 .79 2.17Parental attitudes .90 .52 .58

n 116 116 118Seventh grade

Sex .87 .60 .63Mother smoking 3.11" 2.83 3.37"Father smoking 1.94 1.25 1.38Parental altitudes .61 .84 .73

n 122 122 119Ninth grade

Sex .7 J .80 .46Mother smoking 7.46·" 4.05 2.73Father smoking 2.67 1.00 .70Parental attitudes .97 1.09 1.28

n 83 83 83Overall (fifth, sev'enth. ninth)

Sex ,84 .95 .64Grade

5th 1.13 1.58 1.257th .94 1.27 .779th 1.00 1.00 1.00

Mother smoking 2.91··· 2.37· 2.64···Father smoking 1.86 .99 1.22Parental altitudes .78 ,69 .75

n 321 323 323

Note. Prompting varia hIes (0 = never, I = yes): Sex (0 = hO,I, I = Rlrf); Mother smoking(0 ,.. no, 1 - .~eSl: Father smoking (0 = no. I :: )'esl: Parental alllludes (0 ,. do nor forbid.1 = forbid) .

•p < .05. "p < .01. ".p < .001

F~REN [AL P:ROMPTS FOR SMOEfNG t 3~

~ng v a r i a M e s ~ (}redes; 5. L arid 9 ~epara te ly , and h~r the lh ree F a d e s

c o m b i ~ m d S e p a r a t e r e g r e s s i o n s f o r (a ) ligh~ ~he c i g a r e u e wi~h a m a t c h {~r

fb<h~e< {b) ptlI the c~gare t t e in ~he m o u t h {o h g h L and {el b u y c i g a r e H e s a re

~ u m m a r i z e d i~? F a b l e 3, Mo~ther~s s m o k i n g w a s s ~ g n i t i c a r ~ l y a s s o c i a t e d w~th

a s k i n g [he c h i t d ~o ~[ghI c i g a r e t t e s w i t h a m a t c h or t i g h t e r {~r ~ e v e m h a s d

Hin~h g r a d e r s a~ we l t as all g r a d e s c o m b i n e d . M o ~ h e r ' s s m o k i n g w a s a l so d~e e~Jy signi~%-aat v a r i a b l e in all g r a d e s c o m b i n e d ~ fo r lhe ~mrer~tal p r o m p { el

a s k : i ~ ~he c h i h i ~ p lace ~he c~gm-m~e ~ the mou~h /o ligh~ it. F i ~ m I b .

m e [ h e r ' s q m o k m g was {}]e <rely s , g n i f i c a o t v a r i a b l e ~ r c h i l d r e n buy[aye

cP~mrettes ~)w ~heir p a r e a t s , m s e v e n t h g r a d e r s m d aH g r a d e s c o m b i n e d in

~ e ;~ eraIl re~ , ress io~s , g r ade w a s oo~ a s i g m f h / a n ~ p r e d i c t o r ~Or any p a r e n t a l

promp~ N e s a r a t e t o ~ s t t c regre.~s o~ cq~mt~o~s we re c o n d u c t e d h~ de~ermir~e

m r e m ; f l p r o m p t i n g io s m o k e was ~e{a~e~l to {he chi}d eve~ {rym~ c { e a r e ~ e s

a n l the c M ] d s m o k i n g m Ihe pas~ m~mm T h e s e v a r i a t ies we re u s e d ~>

r e p r e s e m ~;moking e x p e r i m e n t a t i o n amf c u r r e ~ sm~ku'~g, r e s p e c t i v e l y Re-

~ r e s s i o n a m d v s e s were p e r f ~ r m e d {i~r el} ~hree e r a d e s a~ ~ e l ] as all g r a d e s

c ~ m h m e d P r e d i c t o r v a r i a b l e s i\~r the w h h i n o e r a d e a n a l y > , ~ inch~ded sex o f

e h i k i , m o ~ h e r ' s smok ing~ f i~ |her ' s smukir~g~ p a r e n F s a~f i tude u?ward ch i Id

~moki~U?, a n d c i g a r e l t e o f f e r s in a d d i t i o n ~o the t h r e e p a r e n m ~r~m~pts Fo r

dw 0.~verall a n a l y s e s , g r a d e w as i n c t u d e d as a predic t (~r t h e odds r a t i o m

e v e r ha~ h~v s m o k e d a n d pas~ month ~;mokic.g, m~d ~he r e s p e c t p r e s~y,0ific race

l eve l s , arc p r e s e n t e d ig T a b l e s 4 a n d 5.

/AELK 4 togistic Re~regs~on D e r i v e d Odds of Ever H e r i n 9 Smoked Within Smokn~

Fatuities b2 Grade and Overall

Odd~ o f E,~* Hevins ~mr

Ne} gl ,83 6/ .77

Fm her making 9q ~ 8;'{ <'~ Pafen[a[t aH~t~de5 ~ [2 1.25 Ng 1 26

Put in mtm[h ~<? ~ghl 27[ ~,22 27'_~} *~ 2.92 ~ ~ Buy cigarettes 7~ 9S t_05 .N~ (?~ade

};i h h t~ }

5eve~ t h 93 NiNth [{R}

smokms (9 : ~ I = )~#8~ Paren~i a Iih~dc5 {O : fro moCr I ~: ]k~f~ all: Fver {~I~ereJ


ing variables in Grades 5, 7, and 9 separately, and for the three gradescombined. Separate regressions for (a) light the cigarette with a match orlight~T, (b) put the cigarette in the mouth to light, and (c) buy cigarettes aresummarized in Table 3. Mother's smoking was significantly associated withasking the child to light cigarettes with a match or lighter for seventh andninth graders as well as all grades combined. Mother's smoking was also theonly significant variable, in all grades combined, for the parental prompt ofasking the child to place the cigarette in the mouth to light it Finally,mother's smoking was the only significant variable for children buyingcigarettes for their parents, in seventh graders and all grades combined. Inthe overall regressions, grade was not a significant predictor for any parentalprompt.

Separate logistic regression equations were conducted to determine ifparental prompting to smoke was related to the child ever trying cigarettesand the child smoking in the past month. These variables were used torepresent smoking experimentation and current smoking, respectively. Regression analyses were performed for all three grades as well as all gradescombined. Predictor variables for the within-grade analyses included sex ofchild, mother's smoking, father's smoking, parent's attitude toward childsmoking, and cigarette offers, in addition to the three parental prcmpts. Forthe overall analyses. grade was included as a predictor. The odds ratio forever having smoked and past month smoking, and the respective significancelevels. are presented in Tables 4 and 5.

TABLE 4Logistic Regression Derived Odds of Ever Having Smoked Within Smoking

FamHies by Grade and Overall

Odds ofEver Having Smoked

Predictor Fifth- Seventh b Nifllh C Overa/ld

Sex .81 .83 .61 .77Mother smoking 1.71 1.57 .46 1.26Father smoking .95 .35 .83 .68Parental attitudes 1.12 1.25 .88 1.26Offered cigarettes 7.58..... 12.66·" 7.88" 8.03·"Light with match/lighter 1.98 1.64 ,66 1.33Put in mouth to light 2.71 1.22 22.40*· 2.92"Buy cigarettes .78 .95 1.05 .86Grade

Fifth .60Seventh .93Ninth 1.00

Note. Ever having smoked (0 = never tried, I = tried at least once); Prompting variables(0 = never, I = yes); Sex (0 = boy. 1 = girl); Mother smoking (0 = no, 1 = yes); Fathersmoking (0 = no, 1 = yes); Parental attitudes (0 = do not forbid, I = forbid); Ever offeredcigarettes (0 = 710, 1 = yes).

"1'1 = 112. bn =; 119. Cn = 79. d n = 310.•p < .05 . ••p < .01. "'."'p < .001.

= v~ sOlllI/lll I [III0! I I l ~ I p UULI QII> IItOql~ uI cHI x H ) ~ l l o m ~ Ill $1hlol(] II lm~.~tl

J11t~]]:)111I i]~llli3.t I IJ2]A:IN ,II IOIAII ]@QI l i~ t t I t JOJd ]lllOll:=~I IILII IO ODiiIIeAaJil

~=i119 l l / . ~ t d l l : ~ l U i I } ; l I l l l g l { l p l I ] ~?l ,~I~{ i pO{) I / I IO ~ p l l g J I ( } i~ l l l l ) l t l I III

Q:' l%(? l ] l { l -~I<Ia.I iII l]! I IJIpl111Ol IQ I~IK% [)l l l t S I l 1 ~ H*i ~ OI / / l l I I I f ~ X O ?:?QJ!f~ : ) 1 ( i >

IIlll Ol {I191~} I)�9 IXIIOIll! IH I &~ % {I,~%11!11 ]II(~l l~ql l ]ol]IIdoI IIl,J~l ! I p lll(s!2I[il~

/H~I tO[~ IIl~:) /H! ~ t 3 1 ~ ~II @,t HI )qlI " s i sp l l~ i (IIIIAI~X I~I i p l l I 5 I I ! l ] I ;O 1I /11

N O I S S D t ) S / G

W3t ~.i~d :atLg ptx.~[qwoa s~[3~ ~ IV; p~e s:~p{P~G o:/~tl H{3 te po~e{ss ~u!aeq ~aas

{5 L~H~4

l~aoAo pu~ ap~,~�9 s so!i lu~ej 8u~4ow$ u 5 u f ~ o w s ~$~�9 ~:s~d fo ~DP(} poA!JaO u o ~ s

9 3 7 8 V 1

132 SALLIS ET AL.

TABLE 5LogiStic Regression Derived Odds of Pal:\t Month Smoking In Smoking

FamlUes by Grade and Overall

Odds ofPosr Month Smoking

Predictor

SexMother smokingFather smokingParental attitudesOffered cjgarettJ;lsLight with match/lighterPut in mouth to lightBuy cigarettesGrade

FifthSeventhNinth

Fifth"

1.52.71.17.39

14.98·"3.39

.72

.96

Seventll ~

.681.28

.48

.973.051.301.70

.64

Mnth C

.88

.61

.69

.713.781.251.27.43

.91

.93

.52

.634.70"·1.421.29.67

.92

.651.00

Nore. Past month smoking (0 = nOlie, 1 = some); Prompting variableS (0 = nf!W!r. 1 =yes); Sel[ (0 = boy. 1 = girT); Mother smoking (0 = 110, 1 = yes); Father smoking (0 = no.1 =yes); Par¢!lw attitudes (0 = do nor forbid. 1 = forbid); Ever offered cigarettes (0 = no,1 = yes).

an = 112. bn = 119."n = 79. dn = 310.•••p < .001.

Being offered cigarettes was a significant contributor to the model forever having smoked at all three grades and all grades combined. The parentalprompt of asking the child to place the cigarette in the mouth to light it wassignificantly related to ever having smoked at the ninth grade level and forall grades combined (Table 4).

In the logistic regression for child smoking in the past month. beingoffered cigarettes was significant for fifth graders and all grades combined.No parental prompting behaviors were significant (see Table 5).

DISCUSSION

In an earlier study of seventh graders, about 18% of Mexican and MexicariAmerican children reported that their parents who smoked asked them to putcigarettes in their mouths to fight them (Moreno et al., 1994). This encourages direct exposure to cigarettes and can be considered supervised practicein smoki ng. Our study extended previous findi ngs about this apparent culturally specific risk factor for Latino youth smoking. In our study, the reportedprevalence of this parental prompting behavior by seventh-grade studentswas about 17%, which closely replicates the Moreno et al. (1994) findings.The findings of these two studies support the cOriclusion that this directparental prompt to smoke oCcurs in about one fifth of Mexican families withsmoking parents aDd needs to be further investigated.

As in the Moreno et al. (1994) study, the most frequently reported prompt by Mexican students was to buy cigarettes. This prompt may have an indirect effect on youth smoking by providing contact with cigarettes and encourag~ ing the child to practice buying cigarettes. More than half of smoking parents asked their chi ldren to strike a match or bold a ligbler for them. This prompt exposes the child to cigarette smoke, involves the child in the act of smoking, and may stimulate careful observation of how the parent lights the cigarette. Although asking the child to light the cigarette in his or her mouth for the parent was the least frequent prompt, it is the prompt of most concern because it leads the child to inhale cigarette smoke, encourages the child to rehearse smoking behaviors, and may imply parental acceptance of the child smoking.

The lack of sex differences in parental prompting indicates that prompting is equally likely for boys and girls. This is somewhat discrepant from the finding of Moreno et al. (1994) that parents were more likely to prompt boys to engage in smoking-related behaviors.

Age differences in parental prompting were documented in our study. The prevalences of,'dl parental prompts were low in third-grade students, but the rates increased dramatically by the fifth grade for all prompting behaviors. There was no further increase after the fifth grade. These data suggest that Mexican parents who smoke begin to prompt their children to engage in smoking-related behaviors when lhe children are about 9 years old. The interpretation of the age trends is hampered because the personal interviews were required for third-grade students, whereas the older students self-administered the survey. This method difference could be partly responsible for the age differences in rates of parental prompting.

Rates of prompting appeared to be higher in families in which mothers smoked. In logistic regression analyses, mother smoking was the only variable significantly related to parental prompt ing , though the relation was not found with every prompt in every grade. In the overall analysis of three grades combined, mother smoking was significantly associated with all three prompts. This finding suggests that mothers are doing most of the prompting, but further studies are required to confirm this because students did not report the source of prompts. It is reasonable that smoking mothers would be more likely to prompt chiIdren than smoking fathers, because Latino mothers spend more time with children and interact with them more than do fathers. It is also possible that mothers who smoke tolerate prompting behaviors from fathers or other members of the household, whereas nonsmoking mothers do not usually Iolerate smoking prompts from other family members.

The lack of association of parental attitude toward the child's smoking with parental prompting replicates the findings of Moreno et al. (t904). This result is surprising, because asking the child to "practice" smoking by lighting the cigarette appears to imply approval of the child smoking. However, parents may not interpret the prompts as encouragement to smoke. It is possible that asking children to engage in smoking-related behaviors is


As in the Moreno et a!. (1994) study, the most frequently reported promptby Mexican students was to buy cigarettes. This prompt may have an indirecteffect on youth smoking by providing contact with cigarettes and encouraging the child to practice buying cigarettes. More than half of smoking parentsasked their children to strike a match or hold a lighter for them. This promptexposes the child to cigarette smoke, involves the child in the act of smoking. and may stimulate careful observation of how the parent lights thecigarette. Allhough asking the child to light the cigarette in his or her mouthfor the parent was the least frequent prompt, it is the prompt of most concernbecause it leads the child to inhale cigarette smoke, encourages the child torehearse smoking behaviors, and may imply parental acceptance of the childsmoking.

The lack of sex differences in parental prompting indicates that promptingis equally likely for boys and girls. This is somewhat discrepant from thefinding of Moreno et al. (1994) that parents were more Iikely to prompt boysto engage in smoking-related behaviors.

Age differences in parental prompting Were documented in our study. Theprevalences of all parental prompts were lowi n third-grade students, but therates increased dramatically by the fifth grade for all prompting behaviors.There was no further increase after the fi fth grade. These data suggest thatMexican parents who smoke begin to prompt their children to engage insmoking-related behaviors when the children are about 9 years old. Theinterpretation of the age trends is hampered because the personal interviewswere required for third-grade students, whereas the older students self-administered the survey. This method difference could be partly responsible forthe age differences in rates of parental prompting.

Rates of prompting appeared to be higher in families in which motherssmoked. In logistic regression analyses, mother smoking was the only variable significantly related to parenral prompting. though the relation was notfound with every prompt in every grade. In the overall analysis of threegrades combined, mother smoking was significantly associated with all threeprompts. This finding suggests that mothers are doing most of the prompting,but further studies are required to confirm this because students did notreport the source of prompts. It is reasonable that smoking mothers would bemore likely to prompt children than smoking fathers, because Latino mothersspend more time with children and interact with them more than do fathers.It is also possible that mothers who smoke tolerate prompting behaviorsfrom fathers or other members of the household, whereas nonsmoking mothers do not usually lolcrate smoking prompts from other family members.

The lack of association of parental attitude toward the child's smokingwith parental prompting replicates the findings of Moreno et al. (1994). Thisresult is surprising. because asking the child to "practice" smoking by lighting the cigarette appears to imply approval of the child smoking. However,parents may not interpret the prompts as encouragement to smoke. It ispossible that asking children to engage in smOking-related behaviors is

134 SALLIS ET AL,

merely a convenience to the parents or a sign of trust toward the child. The cultural meaning of these behaviors is not known and needs to be investigated. Such information about how parents and children view these smoking prompts may provide clues about how to design appropriate intervention approaches.

The analysis of risk factors for children's smoking did not provide strong support for the role of parental prompting. However, putting the cigarette in the mouth to light it was significantly associated with experimentation in ninth-grade students and in the overall analysis. Although the odds ratio for ninth graders was unusually high, inspection of bivariate cross-tabulations verified the strong association; all but one child lighting a parent's cigarette in their own mouth reported experimenting with smoking. It is not clear why parental prompting and smoking experimentation are only associated in the ninth graders, when both behaviors begin at much earlier ages. The associations in all grades could be exaggerated, because the items in the questionnaire do not discriminate between taking a puff when lighting a cigarette for a parent and smoking in other situations. However, there is no reason to expect that younger students would systematically interpret the items differently from the ninth graders.

The cross-sectional nature of the study does not allow interpretations to be made about the direction of influence. It is possible that parental prompts increase the probability Ihat the student will experiment with cigarettes. An alternative explanation is that parents only ask students to light their cigarettes when they know the child has already tried smoking. Prospective studies are needed to establish whether parental prompts are precursors to the acquisition of smoking.

None of the parental prompting variables were related to adolescent smoking in the past month. These results suggest that. if parental prompting of smoking-related behaviors has any influence on the smoking of Tiju~na adolescents, it influences experimentation in older adolescents (i.e., older than ninth-grade students).

Because the logistic regression analyses of correlates of youth smoking were only conducted with students with smoking parents, the results cannot be easily compared to other studies of the determinants of youth smoking, However, an examination of correlates of smoking within this select group may provide some information on the generalizability of studies on smoking initiation conducted primarily in the United States and Canada, As expected (Flay, d'Avernas, Best, Kersell, & Ryan, 19~3), being offered cigarettes was the most powerful correlate of experimentation with cigarettes and was the only correlate of past month smoking. Tijuana adolescents appear to be influenced by the same social pressures to smoke as found in studies from other countries. Boys and girls in Tijuana are equally likely to experiment with cigarettes, and to be current smokers, at all ages studied. Parental attitudes did not influence the child's smoking behavior in the selected group of children with smoking

134 SALLIS ETAL.

merely a convenience to the parents or a sign of trust toward the child. Thecultural meaning of these behaviors is not known and needs to be investigated. Such information about how parents and children view these smokingprompts may provide clues about how to design appropriate interventionapproaches.

The analysis of risk factors for children's smoking did not provide strongsupport for the role of parental prompting. However, putting the cigarette inthe mouth to light it was significantly associated with experimentation inninth-grade students and in the overall analysis. Although the odds ratio forninth graders was unusually high, inspection of bivariate cross-tabulationsverified the strong association; all but one child lighting a parent's cigarettein their own mouth reported experimenting with smoking. It is not clear whyparental prompting and smoking experimentation are only associated in theninth graders, when both behaviors begin at much earlier ages. The associations in all grades could be exaggerated, because the items in the questionnaire do not discriminate between taking a puff when lighting a cigarette fora parent and smoking in other situations. However, there is no reason toexpect that younger students would systematically interpret the items differently from the ninth graders.

The cross-sectional nature of the study does not allow interpretations tobe made about the direction of influence. ft is possible that parental promptsincrease the probability that the student wm experiment with cigarettes. Analternative explanation is that parents only ask students to light their cigarettes when they know the child has already tried smoking. Prospectivestudies are needed to establish whether parental prompts are precursors tothe acquisition of smoking.

None of the parental prompting variables were related to adolescentsmoking in the past month. These results suggest that. if parental promptingof smoking-related behaviors has any intluence on the smoking of Tijuanaadolescents, it intluences experimentation in older adolescents (i.e., olderthan ninth-grade students).

Because the logistic regression analyses of correlates of youth smoking were only conducted with students with smoking parents, the resultscannot be easily compared to other studies of the determinants of youthsmoking. However, an examination of correlates of smoking within thisselect group may provide some information on the generalizability ofstudies on smoking initiation conducted primarily in the United Statesand Canada. As expected (F1ay. d' Avernas, Best, Kerse\1, & Ryan, 1983),being offered cigarettes was the most powerful correlate of experimentalion with cigarettes and was the only correlate of past month smoking.Tijuana adolescents appear to be influenced by the same social pressures10 smoke as found in studies from other countries. Boys and girls inTijuana are equally likely to experiment with cigarettes, and to be currentsmokers, at all ages stud ied. Parental attitudes did not influence thechild's smoking behavior in the selected group of children with smoking

}35

parents. The lack of significance for grade is interesting and suggests that experimentat ion begins before the fifth grade for most children with smoking parents in Tijuana.

This study is limited by its reliance on child reports of parental behavior. Thes e data need to be co r robora ted through parental repor ts . The generalizability of the findings is limited because the sample is from one city in Mexico. The study also had limited statistical power to detect associations, especially in age-specific samples. Some of the odds ratios presented in Tables 3 through 5 are of sufficient magnitude to suggest excess "risk" among certain groups, yet they were not statistically significant. For example, Table 3 shows that ninth graders with a smoking mother were more likely to report prompts to light cigarettes in their own mouths (Odds ratio = 4.05), but this result was not significant because of the relatively small n of 83. Power tables (Cohen, 1988) indicate that 20 more students in the group would have resulted in a statistically significant finding. Thus, further studies with larger samples will be more sensitive to the associations under study. Strengths of the study include the random selection of public schools, the wide range of age groups, the use of bogus pipeline procedures to enhance accuracy of reported tobacco use, and cotinine analyses to verify smoking status on a subsample.

As tobacco companies increase their marketing efforts throughout the world (USDHHS, 1992), the need for international research on the process of smoking acquisition grows, because it is known that smoking patterns differ by country in ways that cannot be predicted (Grunberg, Winders, & Wewers, 1991). However, international research on smoking acquisition is complicated by the diversity of environments and cultures. Laws governing advertising, age restrictions on tobacco purchases, teachings of the dominant religions, the strength of the family, antitobacco educational programs, the cost of cigarettes, and many other factors differ by nation and are likely to interact with the social and media influences on smoking acquisition that have been identified in Western industrialized societies.

The limited data on adolescent smoking in Mexico and other Latin- American countries indicate that prevalence rates are comparable to, or higher than, rates among their U.S. counterparts. Thus, it is important to identify similarities and differences in the smoking acquisition process. Our results suggest that social pressures (e.g., offers of cigarettes) are the most important risk factors for smoking in Tijuana adolescents. There also may be some effect of parental prompting; specifically parental requests to put the cigarette in the mouth to light it. An important proporlion of Mexican parents who smoke appear to expose their children to smoking through this type of prompting, but prompting was an inconsistent correlate of adolescent smoking in this study. Further studies are needed to confirm the occurrence of prompting of smoking through surveys of parents, to explore the cultural meaning of these behaviors, and to establish whether parental prompting predicts tobacco use among youth


parents. The lack of significance for grade is interesting and suggests thatexperimentation begins before the fifth grade for most children withsmoking parents in Tijuana.

This study is limited by its reI iance on child reports of parental behavior.These data need to be corroborated through parental reports. ThegeneralizabiJity ofthe findings is limited because the sample is from one cityin Mexico. The study also had limited statistical power to detect associations, especially in age-specific samples. Some of the odds ratios presentedin Tables 3 through 5 are of sufficient magnitude to suggest excess "risk"among certain groups, yet they were not statistically significant. For example. Table 3 shows that ninth graders with a smoking mother were morelikely to report prompts to light cigarettes in their own mouths (odds ratio =

4.05), but this result wa,<:; not significant because of the relatively small n of83. Power tables (Cohen, 1988) indicate that 20 more students in the groupwould have resulted in a statistically significant finding. Thus. further studies with larger samples will be more sensitive to the associations understudy. Strengths of the study include the random selection of public schools.the wide range of age groups. the use of bogus pipeline procedures toenhance accuracy of reported tobacco use, and cotinine analyses to verifysmoking status on a subsample.

As tobacco companies increase their marketing efforts throughout theworld (USDHHS, 1992), the need for international research on the processof smoking acquisition grows, because it is known that smoking patternsdiffer by country in ways that cannot be predicted (Grunberg, Winders. &Wewers, J99 J). However. international .research on smoking acquisition iscomplicated by the diversity of environments and cultures. Laws governingadvertisi ng, age restrictions on tobacco purchases, teachings of the dominantreligions. the strength of the family, antitobacco educational programs, thecost of cigarettes, and many other factors differ by nation and are likely tointeract with the social and media influences on smoking acquisition thathave been identified in Western industrialized societies.

The limited data on adolescent smoking in Mexico and other LatinAmerican countries indicate that prevalence rates are comparable to, orhigher than. rates among their U.S. counterparts. Thus, it is important to

identify similarities and differences in the smoking acquisition process.Our results suggest that social pressures (e.g .• offers of cigarettes) are themost important risk factors for smoking in Tijuana adolescents. Therealso may be some effect of parental prompting; specifically parentalrequests to put the cigarette in the mouth to light it. An important proporlion of Mexican parents who smoke appear to expose their children tosmoking through this type of prompting, but prompting was an inconsistent correlate of adolescent smoking in this study. Further studies areneeded lo confirm the occurrence of prompting of smoking through surveys of parents, to explore the cultural meaning of these behaviors, and toestablish whether parental prompting predicts tobacco use among youth

1 8 @ S A [ L IS: E:::F % L

in prospective studies, Such studies may yield information that will aid in the development of culturally specific smoking prevention programs for Latino populations.

REFERENCES

Bums, D., & Pierce, J. P. (1992). Tobacco use in California t990- t99f . Sacramento: California Department of Health Services.

Cohen, J. (1988). Statistical power analysis lbr the behavioral sciences. Hillsdale, N J: Law- rence Ertbaum Associates, tnc.

de Moor, C., Elder, J P,, Young, R. L., WiIdey, M, B , & Molgaard, C, A (1989}. Generic tobacco use among four ethnic groups in school age population. Jottrnat r~ Drug Education, 19, 257-270.

Elder, J. P., Molgaard, C, A., & Laniado-Laborin, R, (1988), Patterns and predictors of cigarelte use among public school children in Tijnana, Mexico. International Quarterly ~{l" Community Heat/h Education, 8, 129-I 37.

Escobedo , L~ G., Anda, R. F., Smith, P_ F., Remington, P. L., & Mast, E. (1990}'. Soeiodemographic characteristics of cigarette smoking initiation in the United States: Im- plications for smoking prevention policy. Journal o[ the American Medical A.~sociatian. 264, 1550-1555.

Flay, B. R., d 'Avemas, J, R., Best, J, A., Kersell, M. W., & Ryan, K. B. (1983). Cigarette smoking: Why young people do it and ways of preventing it. In P I. McGrath & R Firestone (Eds.), Pediatric adMescent behavioral medicine: Issues and treatment (pp. 132-183). New York: Springer.

Friedman, L. S., Lichtenstcin, E., & Biglan, A. (19~5). Smoking nose! among teens: An empirical analysis of initial .~ituations. Addirtive Behav#m~, 10, I-13.

Grunberg, N, E., Winders, S. E., & Wewers, M. E. (1991L Gender differences in tobacco use. HeMth Psyrhoh,gy, t0, 14.%153.

Marcus, A. C., & Crane, L. A. (1985). Smoking behavior among US Latinos: An emerging challenge for public health, American ,hmrnal of Publiv Health, 75, 169-t72.

Maria, G., & Maria, B_ V. (1991). Research with Hispanic populations. Newbury Park, CA: Sage.

Moreno, C., Laniado-Labnrin, R., Sallis, J. F., Elder, J. P.. de Moor, C., Castro, F., & Deosaransingh, K. l1994}, Parental influences to smoke in Latino youMh. Preventive Medi- cine, 23, 4g-53.

Murray, D. M., O'Connell, C. M., Sehmid, T. A., & Perry, C, L. { 1987},. The validity of smoking self-reporl by adolescents: A reexamination of the bogus pipeline procedure. Addictive Behm'- iors, 12, 15-17.

Pierce, J. P., Fiore, M. C., Now~my, T. E., Hatziandreu, E. J., & Davis, R. M. (1989). Trends in cigarette smoking in the United Slates: Projections to Ihe year 2000. Journal t~f Amerir Medical As.vociation, 26f, 61-.45.

U.S. Department of Health and Human Services. ( 19921. Smoking and health in the Americas. A 1992 report o]" the Surgeon General in collaboration with the Pun American Health Organization (DI'[]'IS Publication No. 92-8419). Washington, DC: U.S. Government Priming Office.

136 SALLIS ET AL

in prospective studies, Such studies may yield information that will aid in thedevelopment of eu Iturally speci fie smok ing prevention programs for Latinopopulations.

REFERENCES

Bums. D.• & Pierce. 1. P. (1992). Tobaccn uS/' in California 1990-1991. Sacramenlo: CaliforniaDepartment of Health Services.

Cohen. J. (198B). Statistical power alJtlly.~i.~ }fIr till' velUlviowl .tI:ience,f. Hillsdale. NJ: Lawrence Erlbaum Associatcs, Inc.

de Moor, C.. Elder. J P.• Young, R. L.. Wildey. M. B, & Molgaard, C. A (1989). Genericlobacco use among four ethnic groups ill school age population. Journal rif DruJ! Edt/cation.19, 257-270.

Elder, J. P.• Molgaard, C. A., & Laniado-Laborin, R. (19S!!). Patlems and predictors of cigarelteusc among public school children in Tijuana, Mexico. Inlem'Jlimwl Quar/erly of C'IIrJ11runilyHeallh Edur:o/ion, R, 129-117.

Escobedo, L. G., Anda, R. F., Smith, P. F., Remington, P. L., & Mast, E. ([990).Sociodemographic characterislics of cigarette smoking initialion in the United States: Implications for smoking prevention policy. jourIlal of the Amair'on Medical A.uof'iation. 264.

1550-1555.Flay. B. R., d' Avemas. J. R., Best, J. A .• Kersell. M. W.• & Ryan, K. B. (1983). Cigarcll~

.~moking: Why young people do it and ways of preventing it. In P J. McGrath & P. Fire~tone

(Eds.l. Pediatric ad"lescent behavioral ml'di"ine: l.,ml's and treatment (pp. 132-183). NewYork: Springer.

Friedman. L. 5., Lichtcnslein, E., & Biglan, A. (1985). Smoking onsel among leens: Anempirical analy~is of initial situations. Addie/h'e Bel1rll'ior.~, 10, 1~ 13.

Grunberg, N. E.. Winders, S. E., & Wewers. M. E. (1991). Gender differences in IObaeco usc.Healtlr PJ)Tlwl/}!1Y, 10, 143--153.

Marcus. A. C., & Crane. L. A. (1985). Smoking behavior among US Latinos: An emergingchallenge for public health. tlmaicun .lollrllol of PIIMic fleolth. 75. 169- [72.

Marin. G .. & Marin, B. V. (1991). Research with Hispanic populalions, Newbury Park, CA:Sage.

Moreno. C .. Laniudo·Laborin, R., Sallis, J. F., Elder, J. P., de Moor. c., Castro, F., &

Deo~aransingh, K. (l994). Parental innuenees to smoke in Latino youth. Prew!ntil'l' Medi

cine, 23, 4R-53.Murrav, D. M., O'Connell, C. M., Schmid, T. A.. & Perry. C. L. (191\7). The validity of smoking

self-report by adolescents: A reexamination ofth~ bogus pipeline procedure. Aeldictive Belren'

iors, 12, 15-17.Pierce, J. P.. Fiore, M. C., Novotny. T. E., Hatziandreu, E. J., & Davis, R. M. (1989). Trcnds in

cigarette smoking in the United States: Projections to the year 2000. jOllrnal or Ameri,.,mMedical A.uor"iatian, 261, 61-65.

U.S. Department of Health and I·luman Services. (1992). Smoki'l/l. ami healtlr in tile A,m'rims:A 1992 report of tlrl' Surgeon General in ('ollalmration with the PI/n American lfeallhOrganizati"n (DI'IHS Publication No. 92-8419). Washington, DC: U.S. Government PrintingOffice.

Parental prompting of smoking among adolescents in Tijuana, Mexico

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