title: Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9-10 year old children from deprived neighbourhoods: a cross-sectional study.
abstract: BACKGROUND
  Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods.
  
  
  METHODS
  Cross-sectional data was collected from 9-10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level.
  
  
  RESULTS
  Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is 'definitely' bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to 'definitely' believe that the smoke from other people's cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to 'definitely' believe that smoking is bad for health.
  
  
  CONCLUSIONS
  This study indicates that sibling and friend smoking may represent important influences on 9-10 year old children's cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2AT, UK. c.e.mcgee@ljmu.ac.uk.
authors.forename: Ciara E
authors.initials: CE
authors.lastname: McGee
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, City Campus, Leeds, LS1 3HE, UK. j.trigwell@leedsbeckett.ac.uk.
authors.forename: Joanne
authors.initials: J
authors.lastname: Trigwell
authors.affiliation: Department of Sport and Physical Activity, Edge Hill University, St. Helens Road, Ormskirk, Lancashire, L39 4QP, UK. stuart.fairclough@edgehill.ac.uk.|Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland. stuart.fairclough@edgehill.ac.uk.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Fairclough
authors.affiliation: Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 62 Great Crosshall Street, Liverpool, L3 2AT, UK. R.C.Murphy@ljmu.ac.uk.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Murphy
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2AT, UK. L.A.Porcellato@ljmu.ac.uk.
authors.forename: Lorna
authors.initials: L
authors.lastname: Porcellato
authors.affiliation: Institution of Population Health Research, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK. mussher@sgul.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.affiliation: Department of Sport and Physical Activity, Edge Hill University, St. Helens Road, Ormskirk, Lancashire, L39 4QP, UK. lawrence.foweather@edgehill.ac.uk.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Foweather
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005190:Family / Q000523:psychology*; D005260:Female; D033062:Friends / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008297:Male; D010290:Parents; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D012307:Risk Factors; D020377:Self Efficacy; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires