Prediction of adolescent smoking from family and social risk factors at 5 years, and maternal smoking in pregnancy and at 5 and 14 years

AIMS: This study examines associations between maternal smoking and family, social or child risk factors when the child is aged 5 and adolescent smoking. The influence of mothers who smoke in pregnancy or continue to smoke at 14 years was also examined. DESIGN: The Mater-University of Queensland Study of Pregnancy is a prospective cohort study. PARTICIPANTS: Participants included 8556 women enrolled between 1981 and 1984 at their first antenatal visit. Completed questionnaires were obtained for 7223 offspring, comprising the study birth cohort. Of the 7223 eligible children a total of 4541 had information on both maternal smoking when the child was aged 5 years and adolescent smoking at 14 years. MEASUREMENTS: Measures included maternal smoking during pregnancy and when the child was aged 5 and 14 years, child smoking at 14 years, maternal alcohol use, child behaviour problems and social and demographic variables. FINDINGS: Adolescent smoking was predicted by a risk score at 5 years involving maternal smoking and alcohol use, non-married status, having a partner who had ever been arrested, having four or more children in the household, and child aggression at 5 years. Continued maternal smoking from 5 to 14 years was associated strongly with adolescent smoking. There was also evidence that smoking in late pregnancy may exert an independent effect on adolescent smoking. CONCLUSIONS: The results suggest the possibility of a direct effect of prenatal smoking on adolescent smoking and highlight a set of environmental risk factors in the development of adolescent smoking. These risk factors may be used as early warning signs that intervention may be needed, and given the similarities with risk factors for other adverse childhood outcomes, the benefits of early intervention may extend beyond smoking to other problem behaviours. The possibility of being able to predict other disorders, because of these associations, also warrants further investigation.