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"Honey, Have Some Smokes"

Madeline A. Dalton, PhD; Amy M. Bernhardt, MEd; Jennifer J. Gibson, MS; James D. Sargent, MD; Michael L. Beach, MD, PhD; Anna M. Adachi-Mejia, PhD; Linda T. Titus-Ernstoff, PhD; Todd F. Heatherton, PhD

Arch Pediatr Adolesc Med. 2005;159:854-859.

Objective  To examine preschoolers’ attitudes, expectations, and perceptions of tobacco and alcohol use.

Design  Structured observational study. Children used props and dolls to act out a social evening for adults. As part of the role play, each child selected items from a miniature grocery store stocked with 73 different products, including beer, wine, and cigarettes, for an evening with friends.

Setting  A behavioral laboratory at the Department of Psychological and Brain Sciences, Dartmouth College.

Patients  One hundred twenty children, 2 to 6 years old, participated individually in the role-playing.

Main Outcome Measure  Whether or not a child purchased cigarettes or alcohol at the store.

Results  Children purchased a mean of 17 of the 73 products in the store. Thirty-four children (28.3%) bought cigarettes and 74 (61.7%) bought alcohol. Children were more likely to buy cigarettes if their parents smoked (adjusted odds ratio [OR], 3.90; 95% confidence interval [CI], 1.20-12.63). Children were more likely to buy beer or wine if their parents drank alcohol at least monthly (adjusted OR, 3.04; 95% CI, 1.02-9.10) or if they viewed PG-13– or R-rated movies (adjusted OR, 5.10; 95% CI, 1.14-22.90). Children’s play behavior suggests that they are highly attentive to the use and enjoyment of alcohol and tobacco and have well-established expectations about how cigarettes and alcohol fit into social settings.

Conclusions  The data suggest that observation of adult behavior, especially parental behavior, may influence preschool children to view smoking and drinking as appropriate or normative in social situations. These perceptions may relate to behaviors adopted later in life.

Author Affiliations: Departments of Pediatrics (Drs Dalton, Sargent, and Adachi-Mejia and Ms Bernhardt), Anesthesia (Dr Beach), and Community and Family Medicine (Ms Gibson and Drs Sargent, Beach, and Titus-Ernstoff), Dartmouth Medical School, Norris Cotton Cancer Center, Lebanon, NH; and Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH (Dr Heatherton).

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