Where do our children learn to smoke?
BACKGROUND
Primary prevention of smoking in children is mostly carried out through school education schemes organised by trained teachers. The generally accepted notion is that children's opinions and behaviour are influenced by the school, but mainly by the family and their peers, as well as by the broader society. The primary preventive programme aimed at the first three years of primary schools, called "No Smoking is a Norm" strives to encourage parents to take an active part in the education of their children against smoking, as well as about other aspects of a healthy lifestyle. This paper analyses the data documenting the effectiveness of the programme with respect to children's family smoking history.


METHODS
The information about smokers in families was collected during enquiries prior to the initiation of the 1st and 2nd stage (in the 1st and the 2nd class), and again after their conclusion. In the first stage, smoking of mothers, fathers, and grandparents was followed separately. In the second stage, the category of smokers that can influence children, included parents, grandparents, siblings, aunts, and uncles, with whom the children are in contact (the so-called "broader family"). Questionnaires answered by children who did not know whether their parents or grandparents smoked were excluded from the survey The analysis included 1423 (i.e., 76.6%) from the total number of 1857 children from the programme and control groups. The answers were coded and analysed using the chi2 test in EPI INFO software, version 3.3.2.


RESULTS
Approximately 30% of the children's parents are smokers. Almost 60% of the children were exposed to the influence of smoking parents and grandparents, and more than three quarters of the children experienced smoking from the "broader family". The more smokers there are in the family, the more children have the opportunity to handle cigarettes and smoking accessories from an early age: they get, buy, or even light cigarettes. Smoking of parents and other relatives led to a substantial increase in the number of children who were determined to smoke in the future or were considering it. More than half of the eight-year-olds have tasted an alcoholic drink, and significantly more frequently in the families of smokers. 8% of the eight-year-olds have gone through their first smoking attempts and all of them from families with adult smokers. On the other hand, the smoking or non-smoking family environment of the respondents did not influence the knowledge part of the intervention programme. In the study group, in comparison with the control group, there were significantly more children exposed to the influence of smokers in the "broader" family (80.1% vs. 73.0%). This could explain why evaluation of the medium-term efficiency of the programme without consideration of the family environment was highest in the knowledge area, while differences in change of opinions and behaviour were mostly insignificant.


CONCLUSIONS
Smoking of family members significantly reduces the efficiency of school educational anti-smoking activities aimed at children and young people.
Hrubá
Drahoslava
D
Department of Preventive Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic. hruba@med.muni.cz
Zaloudíková
Iva
I
D000328:Adult; D002648:Child; D002652:Child Behavior / Q000208:ethnology / Q000523:psychology*; D018153:Czech Republic / Q000453:epidemiology; D005190:Family / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006266:Health Education / Q000379:methods / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010287:Parent-Child Relations / Q000208:ethnology; D011322:Primary Prevention / Q000379:methods / Q000592:standards*; D015397:Program Evaluation; D012572:School Health Services / Q000458:organization & administration / Q000592:standards*; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D000074606:Smoking Prevention; D012925:Social Conformity; D012928:Social Desirability; D011795:Surveys and Questionnaires