Parental smoking, rejection of parental smoking, and smoking susceptibility and behaviors in Hong Kong adolescents

Introduction: We explored the role of rejection of parental smoking in the association between parental smoking and smoking in adolescents. Methods: In 2010-11 cross-sectional survey, 61,810 Hong Kong secondary school students (mean age 14.6 years, 50.5% boys) reported their smoking (never, not susceptible; never, susceptible; ever, not current; current), paternal and maternal smoking, and whether they accepted paternal and maternal smoking (acceptance/rejection). We used multinomial logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of students' smoking in relation to acceptance and rejection of parental smoking, compared with no parental smoking. Results: The OR (95% CI) of never, susceptible, ever, not current, and current, compared with never, not susceptible, in relation to acceptance of paternal smoking was 1.81 (1.67-1.96), 2.46 (2.25-2.69), and 2.79 (2.51-3.10), respectively. The corresponding ORs for rejection were 0.70 (0.64-0.76), 1.23 (1.13-1.35), and 0.47 (0.40-0.56). The OR (95% CI) of never, susceptible, ever, not current, and current, compared with never, not susceptible, in relation to acceptance of maternal smoking was 2.05 (1.80-2.33), 2.57 (2.29-2.88), and 6.33 (5.39-7.44), respectively. The corresponding ORs for rejection were 0.85 (0.69-1.05), 1.59 (1.39-1.81), and 2.14 (1.71-2.68). No overlapping was observed between the 95% CIs for acceptance and rejection of paternal or maternal smoking. Conclusions: While adolescent smoking was associated with parental smoking, especially in those who accepted parental smoking, the association was attenuated or reversed in those who rejected parental smoking.