Melanie A Wakefield PhD et al.
Reviewer: Donald Reid
Importance
This paper is of considerable general importance in view of current concerns regarding levels of teenage smoking in most industrialised countries. It also adds powerfully to the case for restrictions on smoking in public, which not only reduce the hazards of passive smoking, but also restrict active smoking by adults. Hence the paper provides valuable underpinning for global efforts to prevent smoking - related disease, and is well worth publishing in a journal such as the BMJ, especially as the findings are likely to apply to many industrialised countries.
It is therefore of considerable interest to policy makers and the general reader, as well as to all who are closely involved in the prevention of smoking related disease.
The paper does add somewhat to existing knowledge (but see below), is well written and approaches the subject in a logical and coherent manner.
Scientific Reliability (this reviewer is not a qualified research scientist or statistician)
Overall, this appears to be a competently conducted piece of work, adequately described, with well presented answers to the research questions. The conclusions do appear to be justified by the data.
Originality
However, although, as the authors point out, it probably is the first to examine the effects of restrictions on teenage smoking in a range of environments, comparable studies of these effects have appeared before for each environment separately. Hence to a specialist, the findings are no surprise, though it is convenient to have them all included in one paper of recent date.
References
From a UK point of view, it is a pity that the work of Anne Charlton on home influence is not mentioned (see attached note from her). However, I appreciate that the journal in which she published her main findings is not well known. Nevertheless, I hope the authors will feel able to cite her work, as it has always been the principal source of information for the UK on this subject. It is all the more important for it to be cited if the paper is to appear in a British journal.
Conclusion
The paper is worthy of publication in a journal such as the BMJ, because the resulting publicity will assist the work of many campaigners, and will also inform specialists who have recently entered this field. It provides a useful compilation of a wide range of effects in one up to date study, as well as a valuable confirmation of previous findings - many of which appeared in relatively obscure journals. So although the findings are no surprise, publication in a journal as well known as the BMJ would be very much in the interests of public health, even if the findings are not a great surprise to experts in the field.
Note from Anne Charlton in response to my request for the most appropriate citation of the her work on the effects of restrictions in the home
From: Dr Anne Charlton
Sent: 12 April 2000 11:05
To: Donald Reid
Subject: Re: Request for a reference on the influence of parents on teenage smoking (other than parental smoking)
I can give you several references on this Topic, all old and not all of them mine
Davison RL, Fletcher SM. Education about smoking among young adults. Journal of the Institute of Health Education 1974;12:19-24. (N.B. These young adults were 16+ at FE College)
Aaro LE, Hauknes A, Berglund E-L. Smoking among Norwegian school children 1975-1980. II: The influence of the social environment. Scandinavian Journal of Psychology 1981; 22:297-309.
Charlton A. Children who smoke. Health at School 1986:1; 125-127.
These three studies all show the greater effect of parental opinion, as perceived by the young person, than parental smoking itself. It is a while since I looked at these papers, but mine showed something
like a seven times greater risk of a child being a smoker if he or she thought their parent approved and only a two times increase in risk for parental smoking. the others, so far as I remember were not
dissimilar. I referred to the findings of my study in a lot of my publications and I know others have done so too. Years ago, in the days of BMA Press Conferences, we even based a conference on them!!
I hope this is helpful
Anne Charlton