Table 1.
Studies examining the association between parental SES and smoking.
| SN | Authors | Methodology description | Findings | Key strengths and limitations | Quality score | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Study design | Sample size (n) | Continent/country | Age range | SES measure | Method of analysis | |||||
| 1 | Moore and Littlecott (2015) | Cross-sectional, National representative | 9,194 | Wales | 11–16 years | SES | The mixed-effects logistic regression model | Adolescents from high SES were less likely (OR: 0.88, 95% CI, 0.81 to 0.95) to smoke than those from low SES. | High parental SES was linked to healthier behaviors in children and adolescents. Yet, this cross-sectional study, potential self-reporting bias, and the lack of established causation limit definitive conclusions regarding the high SES and reduced adolescent smoking relationship. | 8 |
| 2 | Liu et al. (2016) | Cross-national study | 3,690 | China and Finland | 11–15 years | SES | Logistic regression | In China, low SES adolescents (boys: OR 2.12, 95% CI 1.49–3.01; girls: OR 1.07, 95% CI 0.64–1.81) were more likely to ever smoke compared to those from middle/high SES. In Finland, low SES adolescents (boys: OR 1.17, 95% CI 0.77–1.79; girls: OR 1.68, 95% CI 1.07–2.65) were more likely to smoke weekly than their middle/high SES counterparts. |
Social, economic, and cultural factors influence smoking behaviors among children and adolescents. However, this study used only FAS as the SES measure due to limited common indicators between Chinese and Finnish surveys, suggesting a need to include perceived family wealth for cross-country comparisons. | 8 |
| 3 | Simetin et al. (2013) | Cross-sectional, national representative | 1,601 | Croatia | 15 years | SES | Multi-level logistic regression | Adolescents from high SES were 1.56 times more likely to smoke than those from medium and low SES. | Disposable income, different peer influences, parental attitudes, and access to resources are associated with smoking in adolescents. However, the association between socioeconomic factors and risk behaviors may be influenced by adolescents’ relative resilience to socioeconomic inequalities. | 8 |
| 4 | Levin et al. (2014) | Cross-sectional, National representative | 2,692 | Scotland | 15 years | SES | The multilevel logistic regression model | Low SES adolescents had higher odds of smoking, current smoking, daily smoking (Boys: OR smoking 1.58, 95% CI 0.97–2.56; OR current smoking 1.69, 95% CI 0.87–3.29; OR daily smoking 1.82, 95% CI 0.82–4.03; Girls: OR smoking 1.26, 95% CI 0.97–1.64; OR current smoking 1.63, 95% CI 1.18–2.25; OR daily smoking 1.56, 95% CI 1.03–2.25) compared to high SES peers. Low SES adolescents (boys and girls) were also more likely to smoke weekly (OR boys: 1.14, 95% CI 1.00–1.31; OR girls: 1.17, 95% CI 1.02–1.32) than those from high SES. | Lack of educational awareness, and cultural factors contribute to smoking behaviors. However, a study has a low sample size for geographic comparison in ever smoking. Therefore, results might not be conclusive. | 8 |
| 5 | Richter et al. (2009a) | Cross-national survey | 97,721 | 33 countries consisting of Asia (n = 1), Europe (n = 30), and North America (n = 2) | 13–15 years | SES | The multilevel logistic regression model | Adolescents from low SES backgrounds had higher weekly smoking rates (Boys: OR 1.14, 95% CI 1.00–1.31; Girls: OR 1.17, 95% CI 1.02–1.32) compared to their high SES counterparts. | Economic stress and parental smoking behaviors are more common in low SES backgrounds. However, interpreting adolescent behavioral patterns obtained from self-reports can be challenging due to the potential influence of social desirability bias, especially in the case of health behaviors like smoking. | 8 |
| 6 | Doku et al. (2010) | Longitudinal | 96,747 | Europe (Finland) | 12–18 years | Parental occupation, parental educational level | Logistic regression | Adolescents (boys and girls) with fathers in blue-collar occupations had a higher likelihood of smoking (Boys: OR 1.3, 95% CI 1.2–1.4; Girls: OR 1.4, 95% CI 1.3–1.5). Similarly, adolescents (boys and girls) with lower levels of maternal education had a higher chance of smoking (Boys: OR 1.5, 95% CI 1.3–1.6; Girls: OR 1.5, 95% CI 1.4–1.7) compared to those with high maternal educational levels. |
Lower occupations and educational levels are often associated with smoking behaviors in children and adolescents. However, this study has a higher non-response rate. | 8 |
| 7 | Richter et al. (2009) | Cross-national | 86,667 | Europe (n = 26) North America (n = 2) | 13–15 years | Parental occupation, and SES | Logistic regression | European adolescents (from West, North, South, Central, and East regions) with low SES and parental occupation were more likely to smoke compared to those with high or middle SES. Similarly, adolescents in Canada and the USA with low SES had a higher likelihood of smoking than their high or middle-SES peers, particularly when their parents had lower occupational status | Adolescent smoking behaviors were largely determined by low parental SES backgrounds. However, methodological constraints limit findings. | 9 |
| 8 | Poulain, et al. (2019) | Longitudinal | 992 | German | 3–18 years | SES | Mixed-effect model | Children and adolescents aged 10 to 18 with mothers having higher education (OR: 0.86, 95% CI 0.74–0.99), higher occupational status (OR: 0.61, 95% CI 0.47–0.79), and high SES (OR: 0.77, 95% CI 0.58–1.02) had a reduced likelihood of smoking compared to their peers. | Educational influence and role models provide their children with accurate information about the health consequences of smoking. However, this study potentially lacks representativeness in the distribution of socioeconomic classes which may restrict the applicability of the study’s results to the broader population. | 8 |
| 9 | Melotti et al. (2011) | Longitudinal | 5,699 | UK | 13 years | Maternal education and parental social status | Multiple logistic regression model | Adolescents with mothers lacking education, lower social class, or low family income had higher odds of ever smoking (OR: 1.14, 95% CI 0.95–1.38; OR: 1.15, 95% CI 0.81–1.60; OR: 1.17, 95% CI 0.92–1.48) compared to their counterparts. | Limited awareness and education associated with risks associated with smoking in adolescents. However, the study has large missing data which might influence the findings. | 9 |
| 10 | Moor et al. (2015) | Cross-national | 52,709 | 35 countries (33 in Europe, North- America and Israel) | 15 years | SES | Multilevel regression model | Adolescents with low parental SES had a higher risk of smoking compared to those with higher SES, with more pronounced differences among girls (Boys: OR 1.14, 95% CI 1.05–1.23; Girls: OR 1.36, 95% CI 1.26–1.46). | Social class and peer influence increases the likelihood of smoking. The study measures family SES by material consumption. This may lead to the misclassification of parental social class. | 10 |
| 11 | Park and Hwang (2017) | Cross-sectional | 72,435 | South-Korea | 13–18 years | SES | Multivariate logistic regression | Adolescents from low parental SES had a slightly higher chance of smoking (OR: 1.027, 95% CI 0.929–1.136) compared to those from high parental SES. | Economic instability and stressful events contribute to an increased probability of engaging in smoking behavior. However, the study has some methodological constraints. | 8 |
| 12 | Johansen et al. (2006) | Cross-sectional | 3,458 | Denmark | 14–16 years | Maternal occupation | GEE logistic regression | Adolescents with unemployed mothers had a slightly higher risk of daily smoking (OR: 1.10, 95% CI 0.77–1.56) compared to their counterparts. | Parental unemployment can increase the probability of smoking in a family, including their children. However, the study did not provide a clear pattern of how SES contributes to smoking. | 8 |
| 13 | Kislitsyna et al. (2010) | Cross-sectional | 815 | Russia | 12–17 years | SES | Logistic regression model | Adolescents with lower parental SES had higher odds of smoking, particularly among girls (Boys: OR: 1.31, 95% CI 0.73–2.35; Girls: OR: 4.08, 95% CI 1.13–14.69), compared to those from higher parental SES. | Higher parental education helps to reduce smoking behaviors in children and adolescents. However, this study underreports the smoking data and leads to inconclusive of findings. | 6 |
| 14 | Doku et al. (2010) | Cross-sectional | 1,165 | Ghana | 13–18 years | Parental income and parental education | Logistic regression | Adolescents with low parental income had a higher smoking risk (OR: 2.2, 95% CI 0.9–5.3) than those from high parental SES. Likewise, those with lower parental education (illiterate) faced a higher smoking risk (OR: 3.0, 95% CI 1.3–7.3) compared to those with high parental education (tertiary). | Income plays a crucial role in adjusting the behaviors of individuals including children and adolescents. However, cause and effect cannot be emphasized as etiological conclusions. | 7 |
| 15 | Simetin et al. (2011) | Cross-sectional. | 3,296 | Croatia | 11–15 years | SES | Binary logistic regression | Children and adolescents with high parental SES had a reduced smoking likelihood (Children: OR 0.4, 95% CI 0.1–1.2; Adolescents: OR 0.8, 95% CI 0.6–1.1) compared to those with low parental SES. | High social class and prestige help to adopt healthy behaviors and reduce the chances of smoking. Self-reporting bias and lack of causation limit conclusions on the high SES and smoking relationship. | 6 |
| 16 | Lazzeri et al. (2014) | Cross-sectional | 3,291 | Italy | 11–15 years | Parental income | Logistic regression | Children and adolescents with high parental income had a reduced smoking likelihood (Children: OR 0.28, 95% CI 0.030–2.40; Adolescents: OR 0.92, 95% CI 0.50–1.67) compared to those with low parental income. | High SES contributes to reducing smoking behaviors in children and adolescents. However, this study also used the self-reported questionnaire, which may introduce inaccuracies that affect statistical connections. | 6 |
| 17 | Sweeting and Hunt (2015) | Cross-sectional | 2,503 | Scotland | 13–15 years | SES | Logistic regression | Adolescents with low parental SES had higher odds of ever smoking and weekly smoking (OR ever smoke: 1.27, 95% CI 0.91–1.78; OR weekly smoke: 1.37, 95% CI 0.91–2.05) compared to those with high parental SES. | The pattern of smoking behaviors is based on parental SES background. However, methodological constraints affect the findings of this study. | 6 |
| 18 | Pförtner et al. (2015) | Cross-national survey | 6,511 | Belgium, Canada, England, Romania | 15 years | SES | Pooled logistic regression models | Adolescents from low SES had a higher chance of smoking (OR: 1.44, OR 95%: CI 1.19–1.83) than those from medium and high SES. | The difference in smoking prevalence is determined by SES. Despite the statistical significance, this study has effect sizes that raise doubts about the significance of these findings. | 8 |