Family structure and adolescent cigarette smoking in eleven European countries.

AIMS: This study seeks to establish (1) if different types of non-traditional family structures are related equally to adolescent cigarette smoking; (2) if each type of family structure is related equally to adolescent smoking in different countries and (3) if differences in such patterns can be explained by the prevalence of such family structures in each country.
DESIGN: Self-reported cigarette smoking among 33 978 students in Cyprus, France, Hungary, Iceland, Ireland, Lithuania, Malta, Slovak Republic, Slovenia, Sweden and the United Kingdom is analysed with multi-level hierarchical regression models.
FINDINGS: Adolescents living with both biological parents smoke less than those living with single mothers, who in turn smoke less than those living with single fathers, mothers-stepfathers, or with neither biological parent. Living with fathers-stepmothers is associated with less smoking than living with single fathers, mother-stepfathers, or with neither biological parent, but does not differ from living with both biological parents or single mothers. The effects of living with single mothers, single fathers, or with neither biological parent are stronger in countries where such family types are less common. Differences in the strength of effects between countries become non-significant once the prevalence of each family type has been taken into account.
CONCLUSIONS: Adolescents living with both biological parents smoke less than their counterparts in most other family types, and adolescents living with single mothers or fathers-stepmothers smoke less than those living in other non-traditional family structures. The strength of this pattern varies inversely with the prevalence of such households in each country.