Staying smoke-free: Factors associated with nonsmoking among urban Aboriginal adolescents in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)

Issue addressed: To examine the factors associated with preventing regular smoking among Aboriginal adolescents. 

Methods: Cross-sectional analysis of data from 106 Aboriginal adolescents aged 12-17 years, and their caregivers, from four Aboriginal Community Controlled Health Services in urban New South Wales, 2008-2012. The relation of individual, social, environmental and cultural factors to having ‘never’ smoked tobacco regularly was examined using Poisson regression. 

Results: Overall, 83% of adolescents had never smoked regularly; 13 reported current and five past smoking. Most lived in smoke-free homes (60%) despite 75% reporting at least one current smoker caregiver. Participants were significantly more likely to have never smoked regularly if they had good mental health (PR = 1.4, 95% CI: 1.1-1.9), their mother as their primary caregiver (1.3, 1.0-1.6), good family relationships (1.2, 1.0-1.5), stable housing (1.3, 1.1-1.7), had never used alcohol (1.8, 1.3-2.4), were not sexually active (3.1, 1.3- 7.2) and had no criminal justice interactions (1.8, 1.2-2.8). 

Conclusions: Most participants lived in smoke-free homes and the vast majority had never smoked regularly. Promoting good mental health and strengthening social connections may be protective against smoking as those experiencing less social disruption were more likely to have never smoked regularly. Smoking may be an indicator of psychosocial conditions and a prompt for screening and simultaneous treatment. 

So what?: Organisations should be resourced to deliver holistic adolescent health promotion programs. Programs and policies should support positive family relationships and stable housing as this may protect against the uptake of regular smoking.