Associations of perceived interparental relationship, family harmony and family happiness with smoking intention in never-smoking Chinese children and adolescents: a cross-sectional study

OBJECTIVE: To examine the associations of perceived interparental relationship, family harmony and family happiness with smoking intention in never-smoking Chinese children and adolescents in Hong Kong. DESIGN, SETTINGS AND PARTICIPANTS: Cross-sectional surveys of 15 753 primary (grades 4–6) and 38 398 secondary (grades 7–12) never-smoking students from 71 to 75 randomly selected primary and secondary schools in Hong Kong, 2012–2013. MEASUREMENTS: Outcome variable was smoking intention which denoted any affirmative response to smoke within the coming year or when a cigarette was offered by a good friend. Exposure variables were perceived interparental relationship and family harmony each measured on a five-point scale from ‘very good’ to ‘very bad’ and perceived family happiness on a four-point scale from ‘very happy’ to ‘not happy at all’. Potential confounders included age, sex, family structure, perceived family affluence, parental smoking and sibling smoking. RESULTS: In primary students, the adjusted ORs (AORs) (95% CI) of smoking intention generally increased with more negative perception of the family relationship: up to 3.67 (1.91 to 7.05) for interparental relationship, 7.71 (4.38 to 13.6) for family harmony and 5.40 (3.41 to 8.55) for family happiness. For secondary students, the corresponding AORs (95% CI) were 2.15 (1.64 to 2.82) for interparental relationship, 2.98 (2.31 to 3.84) for family harmony and 2.61 (1.80 to 3.79) for family happiness. All p for trend <0.001. CONCLUSIONS: More negatively perceived interparental relationship, family harmony and family happiness were associated with higher odds of smoking intention with dose–response relationships in never-smoking Chinese children and adolescents in Hong Kong. Children’s perception of their family relationship may be an important intervening point for preventing youth from initiating smoking.