Communication about smoking between depressed adolescents and their parents

Introduction: Better understanding of effective parent-adolescent communication regarding tobacco use could inform smoking cessation intervention. Methods: Semistructured interviews related to communication about smoking were conducted with 15 depressed adolescent smokers and their parents, primarily from urban areas. This study, conducted in 2006-2008, was funded by the Pennsylvania Department of Health. Interview transcripts (N = 30) were coded in QSR N6. Results: Quality of communication, rather than content, seemed to determine whether parental communication was effective. Parents reactivity to, or avoidance of, adolescent smoking presented a barrier to effective communication. In this sample, parents and adolescents were more concerned about problems, such as depression, than smoking. Discussion: Involving parents in adolescent smoking cessation programs may be promising. Parental involvement may include teaching parent-child communication skills, building stronger relational bonds, or helping parents quit simultaneously. Further research is needed to explore whether coupling smoking cessation with depression treatment increases parent and adolescent treatment engagement and effectiveness. Despite decreases in rates of adolescent cigarette smoking and development of effective cessation programs (National Institute on Drug Abuse, 2003; Stanton & Smith, 2002; Sussman, Sun, & Dent, 2006), smokers are increasingly resistant to cessation efforts (Augustson & Marcus, 2004). One group particularly resistant to intervention is smokers with depression, who comprise 22%-61% of adolescent smokers (e.g., Wilhelm, Wedgwood, Niven, & Kay-Lambkin, 2006). Depression likely increases the risk of smoking initiation and is associated with both regular and heavy smoking (Duncan & Rees, 2005; Escobedo, Reddy, Giovino, 1998; Fleming, Kim, Harachi, & Catalano, 2002; Patton et al., 1998; Windle & Windle, 2001). Furthermore, depression may inhibit adolescent cessation efforts (e.g., Burgess et al., 2002; Thompson et al., 2007). Thus, depressed adolescents are at increased risk of suffering the negative health consequences of cigarette smoking. Adolescence may be an opportune time to intervene, given that smoking and depression commonly onset during adolescence (Vogel, Hurford, Smith, & Cole, 2003). Adolescence also presents a prime time to intervene because the quality of parent-adolescent relationships is known to exacerbate or buffer against adolescent risk-taking behaviors, including smoking (Ary, Duncan, Duncan, & Hops, 1999). Parents influence smoking through antismoking socialization, restrictive home smoking rules, modeling nonsmoking behaviors, monitoring of adolescents, restricting cigarette access, and positive parenting (Castrucci & Gerlach, 2006; Chassin, Presson, Todd, Rose, & Sherman,1998; Chilcoat & Anthony,1996; Griesler & Kandel,1998; Jackson & Henriksen, 1997; Kegler, Cleaver, & Yazzie-Valencia, 2000; Kegler et al., 2002; Komro, McCarty, Forster, Blaine, & Chen, 2003; Proescholdbell, Chassin, & MacKinnon, 2000). Most research focuses on how parents influence smoking initiation rather than cessation. While this can inform prevention efforts, it may be less informative for intervention development. Parent and adolescent communication about cessation is an area of particular interest for intervention researchers. For depressed teens, improved communication has been shown to influence the course of their depression, and consequently, parents have increasingly been involved in depression treatment (Restifo & Bogels, 2009; Sheeber, Hops, & Davis, 2001). Better understanding of parent-adolescent communication around smoking cessation might lead to similar intervention developments.