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The contribution of parental smoking history and socio-demographic factors to the smoking behavior of Israeli women a

b

Dorit Segal-Engelchin , Enav Friedmann & Julie G. Cwikel

a

a

Ben Gurion University of the Negev, Social Work and Center for Women’s Health Studies and Promotion, Beer Sheva, Israel b

Department of Management, Ben Gurion University of the Negev, Beer Sheva, Israel Published online: 25 Nov 2013.

To cite this article: Dorit Segal-Engelchin, Enav Friedmann & Julie G. Cwikel (2014) The contribution of parental smoking history and socio-demographic factors to the smoking behavior of Israeli women, Psychology, Health & Medicine, 19:6, 625-634, DOI: 10.1080/13548506.2013.859713 To link to this article: http://dx.doi.org/10.1080/13548506.2013.859713

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Psychology, Health & Medicine, 2014 Vol. 19, No. 6, 625–634, http://dx.doi.org/10.1080/13548506.2013.859713

The contribution of parental smoking history and socio-demographic factors to the smoking behavior of Israeli women

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Dorit Segal-Engelchina*, Enav Friedmannb and Julie G. Cwikela a Ben Gurion University of the Negev, Social Work and Center for Women’s Health Studies and Promotion, Beer Sheva, Israel; bDepartment of Management, Ben Gurion University of the Negev, Beer Sheva, Israel

(Received 21 July 2013; accepted 21 October 2013) This study examined the interplay between sociodemographic factors and parental smoking history in shaping the smoking behavior of Israeli women (N = 302). The study was conducted in the Negev region, which is characterized by a high proportion of immigrants and high percentage of low socioeconomic and educational groups. The specific objectives of this study were to examine: (1) The prevalence and characteristics of women smokers, ex-smokers and never-smokers; and (2) the contribution of education and parent smoking history to women’s current smoking. Low levels of education, being Israeli born or veteran immigrants of European– American origin significantly increased the risk of smoking, whereas an orthodox lifestyle and new immigrant status significantly reduced the likelihood of smoking. Occasional smokers reported significantly higher primary care utilization than never smokers. A significant relationship between smoking and pain, gynecological symptoms and depression was found. Results indicate that childhood exposure to maternal smoking was a significant risk factor for smoking, whereas paternal past smoking negatively affects smoking in women. Also, results show that parental educational level affects women’s smoking behavior indirectly by influencing their own educational attainment, which in turn is negatively associated with the likelihood of smoking. Mothers with higher education were more likely to smoke, an effect that was reversed for their daughters. Our results demonstrate how demographic, parental and lifestyle factors affect women’s smoking in a multi-ethnic society and highlight the need to examine both generational and intergenerational effects. Keywords: women’s smoking behavior; health status; socio-demographic factors; parental smoking history

A substantial proportion of women are smokers; 16.5% in the United States (Centers for Disease Control and Prevention [CDC], 2012) and in Israel, a similar proportion of Jewish women (16%) (Israel Ministry of Health, 2012). The increase in women’s smoking prevalence over the last decades has been attributed to changes in traditional gender roles (Flandorfer, Wegner, & Buber, 2010). Israel is an interesting setting for studying women’s smoking behavior since while the country as a whole has adopted an egalitarian ideology, a substantial portion of the population still holds a traditional gender role ideology (Lavee & Katz, 2003). Women’s smoking has been linked to sociodemographic factors including: Ethnicity; religiosity (Baron-Epel, Haviv-Messika, Tamir, Nitzan-Kaluski, & Green, 2004); low *Corresponding author. Email: [email protected] © 2013 Taylor & Francis

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SES, education and early motherhood (McGee & Williams, 2006; Watt, Carson, Lawlor, Patel, Ebrahim, 2009). Additional factors include: emotional distress, depression, the belief that smoking is stress-relieving, concerns about weight control, lifetime intimate partner violence and childhood abuse (Jessup, Dibble, & Cooper, 2012; Kaufman & Augustson, 2008; Khor et al., 2006; McGee & Williams, 2006; World Health Organization [WHO], 2010). Parental smoking has also been linked to smoking among women (Oh et al., 2010), with adolescents with smoking parents more likely to become daily smokers (Peterson et al., 2006). Some studies have found a gender-specific effect, with maternal smoking increasing the risk in girls and paternal smoking increasing the risk in boys (Gilman et al., 2009; Loureiro, Sanz-de-Galdeano, & Vuri, 2010; White, 2012). Maternal smoking has also been linked to a higher risk of smoking in women (Ensminger, Smith, Juon, Pearson, & Robertson, 2009; Khor et al., 2006). The current study was the first to examine correlates of smoking behavior among women living in the Negev region of Israel, which has a high proportion of immigrants and high percentage of low socioeconomic and educational groups (Swirski, 2007). The study objectives were to examine: (1) The prevalence and characteristics of women smokers, ex-smokers and never-smokers; (2) the contribution of education and parent smoking history to women’s current smoking.

Method Sample A random telephone survey was conducted during the years 2002–2003 to explore correlates of women’s psychological and physical health (Cwikel & Mendlinger, 2003). The study protocol was approved by a departmental ethics committee at Ben-Gurion University of the Negev and verbal informed consent obtained. A sampling frame of 1196 women was drawn from the Israeli population registry of women between the ages of 25 and 42, with children under the age of 18 and resident in the Negev. Of the 538 women contacted, complete interviews were obtained from 302; with a response rate of 56%. The average age was 37.7 years (SD = 3.5); the majority were married (97%) and had an average of three children each. Over half (54%) had post-high school education (mean years of education, 14.2, SD = 2.9). The sample was predominantly Jewish (98%). Approximately, two-thirds of the sample reported some religious observance; 35% defined themselves as secular. The majority were Israeli born (68.2%), others immigrated from the Former Soviet Union (FSU) (13.6%), Middle East/North Africa (12.6%), or Europe/America (EA) (5.6%). Income difficulties were reported by about half of the sample. Most women were employed (77.5%) with the modal answer being 35–40 h a week. Measures Smoking Measures included: (1) Never smoked (2) smoked but quit (3) smoke occasionally (4) daily smoker. Those who ever smoked were asked to indicate their age at smoking initiation and the number of cigarettes smoked per day. For occasional smokers, the number of cigarettes smoked per week was converted into a daily smoking fraction (e.g. smoking five cigarettes per week converts to 0.71 cigarettes per day). All respondents were asked if their parents smoked during their childhood and whether their

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parents smoke today. For some analyses, a dichotomous variable was used representing never-quit vs. current smoking (occasionally and daily). Health status Women’s health status was assessed by several measures. Two additive measures reflecting the number of general health and gynecological symptoms felt in the past 12 months were created, each consisting of five common symptoms derived from the WHA studies (Bell & Lee, 2003). An additive index of diagnosed chronic illnesses was created by adding the number of conditions that a physician had diagnosed in the past two years. These were summed to give a score from 0 to 5 for each scale. In addition, a dichotomous question asked about the experience of pain in the past four weeks and for those answering in the affirmative, the intensity of the pain (1–5, light through very intense) was multiplied by the degree to which this interfered with daily functioning (1-not at all to 5-interfered a great deal). The number of visits to a primary care clinic in the past year was included. Depressive symptoms These were measured by a six-item abbreviated version of the Center for Epidemiological Studies-Depression Scale (CES-D) (Radloff, 1977; Sherbourne, Dwight-Johnson, & Klap, 2001) with a four-point frequency scale (Cronbach’s alpha ά = .68). Demographic measures included: years of education (respondent and her parents), income difficulties, age, ethnic background (respondents and parents) (Israeli born, North-African/Middle East, EA, FSU), immigrant status (veteran: before 1983, new: Between 1983 and 2000), religion, religious observance (ultra-orthodox, religious, traditional, secular) and employment status (employed, not working). Results Prevalence of smoking by demographic characteristics Descriptive statistics such as mean, standard deviation and Pearson’s correlation coefficients were calculated to describe participants’ smoking behaviors. When dichotomous relationships were examined, ORs (odd ratios) were calculated. As shown in Table 1, 66.2% of the sample never smoked, 9.3% were former smokers, 5.6% were occasional smokers and 18.9% were daily smokers. Thus, approximately, one-quarter (24.5%) of the sample were current smokers. Daily smokers averaged 20.65 cigarettes (SD = 11.9) per day, occasional smokers 2.59 per day (SD = 3.5, since some reported only per week consumption), and former smokers 15.9 per day (SD = 6.7). The average age was 18.8 (SD = 3.7) at smoking initiation and 26.5 (SD = 6.6) at quitting. The four smoking groups differed in several demographic features, including ethnic group origin. Never smokers were mostly of North African/Middle Eastern (84.2%) or FSU (82.9%) backgrounds; ex-smokers were mostly of EA origin (23.5%), occasional smokers were mostly from the FSU (7.3%), and daily smokers were most likely to be Israeli born (22.8%) or of EA backgrounds (29.4%). New immigrants were also unlikely to daily smoke (3.3%) compared with Israeli born (23.3%) and veteran immigrants (14.8%). Education was also associated with smoking status with the highest rate of smoking (37.5%) among those with lower education, and the highest rates of never

68.2 12.6 5.6 13.6 21.9 56.6 21.5 8.0 38.5 53.5 35.8 45.7 18.5 57.5 30.3 12.3 57.0 24.5 18.5 69.9 20.2 9.9

206 38 17 41 65 168 64 24 116 161 108 138 56 173 91 37 172 74 56 211 61 30

Missing data: Age (years) n = 5; sufficiency of family income n = 1.

a

100.0

%

302

N

Total

130 44 26

117 51 32

117 60 22

68 83 49

11 67 121

46 102 49

126 32 8 34

200

N

61.6 72.1 86.7

68.0 68.9 57.1

67.6 65.9 59.5

63.0 60.1 87.5

45.8 57.8 75.2

79.8 60.7 76.6

61.2 84.2 47.1 82.9

66.2

%

Never smoked

Respondents’ smoking behaviors by socio-demographic characteristics.

Total Ethnic origin Israel Middle East/North Africa Western Europe/America Eastern Europe/Former Soviet Union Age (years)a 25–35 36–40 40–45 Education (years) Less than high school Completed high school Academic Religious observance groups Secular Traditional/observant Orthodox/ultra-orthodox Sufficiency of family incomea Sufficient Less than sufficient Not at all sufficient Work Status Employed full-time Employed part-time Unemployed or housewife Immigrant status Israeli born Immigrated before 1983 Immigrated from 1983–2000

Table 1.

21 6 1

21 4 3

20 6 2

14 10 4

2 5 21

6 16 6

20 3 4 1

28

N

10.0 9.8 3.3

12.2 5.4 5.4

11.6 6.6 5.4

13.0 7.2 7.1

8.3 4.3 13.0

9.2 9.5 9.4

9.7 7.9 23.5 2.4

9.3

%

Used to smoke

13 2 2

8 5 4

7 6 4

6 10 1

2 10 5

5 11 1

13 1 0 3

17

N

6.2 3.3 6.7

4.7 6.8 7.1

4.0 6/6 10.8

5.6 7.2 1.8

8.3 8.6 3.1

7.7 6.5 1.6

6.3 2.6 0.0 7.3

5.6

%

Occasional smoker

47 9 1

26 14 17

29 19 9

20. 35 2

9 34 14

8 39 8

47 2 5 3

57

N

23.3 14.8 3.3

15.1 18.9 30.4

16.8 20.9 24.3

18.5 25.4 3.6

37.5 29.3 8.7

12.3 23.2 12.5

22.8 5.3 29.4 7.3

18.9

%

Daily smoker

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12.9

10.21

6.2

22.67

35.17

10.1

22.5

χ2

6

6

6

6

6

6

9

df

.045

.116

.397

The contribution of parental smoking history and socio-demographic factors to the smoking behavior of Israeli women.

This study examined the interplay between sociodemographic factors and parental smoking history in shaping the smoking behavior of Israeli women (N = ...
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