Online Program

Role of maternal and paternal tobacco use behaviors in adolescents' cigarette, waterpipe and dual smoking

Sunday, November 1, 2015

Sukaina A. Alzyoud, PhD, Community and Mental Health, Hashemite University, Zarqa, Jordan
Sreenivas P. Veeranki, MBBS, DrPH, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
Lori Pbert, Ph.D., Division of Preventive & Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
Khalid A. Kheirallah, PhD, Public Health, Medical Faculty of Jordan University of Science and Technology (JUST), Irbid, Jordan
Kenneth Ward, PhD, School of Public Health, University of Memphis, Memphis, TN
Fawaz Mzayek, MD, MPH, PhD, School of Public Health, University of Memphis, Memphis, TN
Abdallah Alzoubi, Jordan University of Science and Technology, Irbid, Jordan
Leah Dierking, M.A., Preventive Medicine and Community Health, University of Texas Medical Branch, Houston, TX

Several studies have demonstrated the influence of parental cigarette smoking on children and adolescents’ cigarette smoking behavior. However no study has been conducted to understand the relationship in great detail. In this study, we aimed to assess the relationship between parental (maternal and/or paternal) smoking and adolescent smoking including cigarette, waterpipe, and/or dual cigarette/waterpipe tobacco smoking.


In a pooled analysis of 17 Arab nations with nationally representative Global Youth Tobacco Surveys, tobacco-related information was obtained from 34,788 adolescents representing 6,109,572 youth. The study outcome was adolescents’ tobacco smoking categorized into cigarette smoking only, waterpipe smoking only and dual cigarette and waterpipe smoking. The primary exposure was parental (mother, father or both) smoking status. Weighted multinomial regression models were conducted to determine the relative odds of parental smoking on adolescents’ tobacco use adjusting for potential confounders including secondhand smoke exposure, knowledge about tobacco harm, school anti-smoking education, age, sex, country and year survey was administered.


 Approximately 23%, 6% and 14% of adolescents smoke only cigarettes, only waterpipes, and both respectively, with highest estimates reported in Lebanon, Kuwait, and West Bank. Among parental cigarette smoking, paternal cigarette smoking was significantly associated with adolescents’ waterpipe, cigarette and dual smoking. Among paternal waterpipe smoking, maternal and both parents’ waterpipe smoking was significantly associated with adolescents’ smoking. Similarly, adolescents exposed to both parents' cigaretter and waterpipe smoking had higher odds of smoking cigarette [odds ratio(OR) 2.53, 95% confidence interval (CI) 1.33-4.81], waterpipe [OR 6.08, 95% CI 2.38-15.51] and both [OR 3.86, 95% CI 1.430-10.43], respectively.


This is the first study to examine parental tobacco use on adolescent different methods of smoking in great detail. Study findings will help understand the need to tailor cessation interventions involving parents when targeting adolescents to prevent the rising waterpipe and dual tobacco smoking strain of the global tobacco epidemic.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related education
Public health or related research
Social and behavioral sciences

Learning Objectives:
Evaluate the burden of tobacco use, including cigarette smoking, waterpipe tobacco smoking and dual cigarette and waterpipe smoking among adolescents. Assess the relationship between parental tobacco use and adolescents’ cigarette, waterpipe, and dual smoking

Keyword(s): Children and Adolescents, Tobacco Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a researcher in the area of tobacco use among youth I have conducted and published studies that examine this problem with different factors such as health perception, familial relationships, and religion. My primary research focus is the design and evaluation of research studies of health risk behavior particularly waterpipe tobacco use among adolescents in community settings. I have been the principle or co-investigator of multiple funded grants focusing on tobacco and other substances use.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.