This study assessed the relationship between the smoking behavior of adolescents and the smoking status of their parents and friends among adolescents from six European countries. A longitudinal study collected data from 15 705 adolescents on their own smoking status, and that of their parents, best friend and friends in general. Cross-sectional regression analysis showed that adolescent smoking was most strongly associated with friends' smoking and best friend's smoking, explaining 38% of the variance in the total sample. Longitudinal regression analysis, however, showed that the beta coefficients of the smoking status of the best friend and friends in general were comparable to that of parental smoking. Parental smoking behavior was found to be as predictive of smoking onset after 1 year as friends' smoking status.

The European Smoking Prevention Framework Approach (ESFA) study in six countries tested

No abstract

The European Smoking Prevention Framework Approach (ESFA) resulted in a smoking prevention project for six European countries. It included activities on four levels: adolescents, schools, parents and out-of-school activities. Common goals and objectives were developed, but countries were also able to include additional objectives. National diversities required country-specific methods. The most important common element was a school-based programme consisting of at least five lessons paying attention to social influence processes and training in refusal skills. During the first year, significantly more smoking prevention activities were realized in experimental schools compared with control schools. Not all countries had the same number of lessons on resisting peer pressures. Significant cognitive changes were observed in Spain, resulting in more negative attitudes, increased self-efficacy levels and a more negative intention towards smoking in the experimental group. Counter-productive cognitive effects were observed in the UK. Significantly less onset of weekly smoking in experimental groups was found in Finland (4.7%) and Spain (3.1%). Counter-productive effects were observed in Denmark and the UK. In conclusion, while having common objectives, the ESFA approach allowed for a great deal of diversity. Fundamental research using dismantling designs is needed to be able to detect the most effective elements of smoking prevention programmes for different age groups. Attention to parenting styles and practices is also needed.

The findings suggest that the development of alcohol and tobacco use patterns are closely related, but the order of progression is not universal and may reflect cultural factors.