Higher nicotine dependence and greater smoking abstinence in parental than non-parental smokers: A secondary analysis of smoking cessation trials

Yiran Ge¹Mengyao Li¹Tzu Tsun Luk¹Yee Tak Derek Cheung¹Ningyuan Guo²Henry Sau Chai Tong³Vienna Wai Lai³Sophia Siu Chee Chan⁴Shengzhi Zhao^1*Man Ping Wang¹

• ¹School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, SAR China
• ²Shanghai Jiao Tong University School of Nursing, Shanghai, China
• ³Hong Kong Council on Smoking and Health, Wan Chai District, Hong Kong, SAR China
• ⁴The University of Hong Kong, Hong Kong, Hong Kong, SAR China

Objective: Parental smokers represent approximately one-third of smokers worldwide and often exhibit distinct smoking and quitting behaviors compared to non-parental smokers. Understanding these differences is crucial for developing targeted cessation interventions, yet evidence remains limited. Methods: This secondary analysis pooled individual participant data from 10 community-based smoking cessation trials conducted in Hong Kong between 2010 and 2020 (N=10,871 adult daily smokers). We compared parental smokers (those with at least one child) and non-parental smokers on sociodemographic characteristics, smoking behaviors, nicotine dependence (Heaviness of Smoking Index), quitting motivation, and cessation outcomes at 6 months post-intervention. Outcomes included biochemically validated abstinence (exhaled carbon monoxide <4 ppm and salivary cotinine <10 ng/mL) and self-reported 7-day point-prevalence abstinence (PPA). Multivariable regression models were adjusted for age, sex, education, income, and trial year. Results: Of the participants, 42.2% were parental smokers, who were older, had lower education and income (all P<0.001). They had higher daily cigarette consumption (mean: 14.8 vs. 12.9, adjusted β=1.59, P=0.004) and higher nicotine dependence (9.2% vs. 5.9%, AOR=1.36, P<0.001). More parental smokers had past quit attempts (61.8% vs. 54.0%, AOR=1.25, P<0.001) and intentions to quit within 30 days (61.2% vs. 46.4%, AOR=1.31, P<0.001). At 6 months, parental smokers showed higher validated (7.7% vs. 5.9%, AOR=1.37, P<0.001) and self-reported 7-day PPA (15.6% vs. 13.9%, AOR=1.21, P=0.002). Among parental smokers, those co-living with children had greater abstinence than those not necessarily co-living, for both self-reported 7-day PPA (AOR=1.43, 95% CI 1.03-1.98, P=0.032) and validated abstinence (AOR=1.62, 95% CI 1.04-2.52, P=0.032). Conclusions: Parental smokers showed higher nicotine dependence but greater motivation and higher abstinence rates following brief community-based interventions. Tailored programs should address their elevated addiction while leveraging their motivation to enhance cessation success.