Most tobacco and alcohol prevention studies target children during adolescence, the peak age for initiating alcohol and tobacco use, but early exposure to these behaviors through family members, community and social events and media may influence attitudes and expectations about alcohol and tobacco use long before children ever consider using these products themselves, according to background information in the article. Young children's attitudes have been difficult to assess because of their limited language skills.
Madeline A. Dalton, Ph.D., of Dartmouth College, Hanover, N. H., and colleagues used a role-playing scenario to assess preschoolers' attitudes, expectation and perceptions of tobacco and alcohol use and compared their observations with parent surveys on their own alcohol and tobacco use and their children's movie viewing. Children three to six years of age were given two dolls. They were asked to pretend to be one of the dolls and the researcher pretended to be the other, a friend who was invited over to watch a movie and have something to eat. When the "friend" commented that there was nothing to eat, the child was invited to "shop" at a doll grocery store. The child's purchase of alcohol and tobacco products at the "store" and subsequent inclusion of alcohol and tobacco products in the social setting were recorded. For children two years of age, the scenario was simplified to just asking the children to select a doll and take it shopping.
The children purchased an average of 17 of the 73 products in the store. Of the 120 children participating in the study, 34 (28.3 percent) bought cigarettes and 74 (61.7 percent) bought alcohol. Children were 3.9 times as likely to buy cigarettes if their parents smoked. Children were three times as likely to choose wine or beer if their parents drank alcohol at least once a month; children who viewed PG-13- or R-rated movies were five times as likely to choose wine or beer.
"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," the researchers report. "Several children were also highly aware of cigarette brands, as illustrated by the six-year-old boy who was able to identify the brand of cigarettes he was buying as Marlboros but could not identify the brand of his favorite cereal as Lucky Charms."
"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," the authors conclude. "Although it is not clear whether these expectations predict future use, the data provide compelling evidence that the process of 'initiation,' which typically involves shifts in attitudes and expectations about the behavior, begins as young as three years of age. The results from this study suggest that alcohol and tobacco prevention efforts may need to be targeted toward younger children and their parents."
(Arch Pediatr Adolesc Med. 2005; 159:854-859. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was funded by a grant from the Robert Wood Johnson Foundation, Princeton, N.J.
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Journal
Archives of Pediatrics and Adolescent Medicine