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Preschoolers mimic adults' use of cigarettes and alcohol

Dartmouth study suggests prevention efforts should begin early

Children form attitudes about smoking and drinking at a very young age, picking up cues about cigarettes and alcohol from their parents, according to a behavioral study conducted at Dartmouth. The results, published in the Sept. 5 Archives of Pediatrics & Adolescent Medicine, demonstrate that preschool-aged children already have social cognitive scripts of adult social life where alcohol and tobacco use play central roles.

Madeline Dalton
Madeline Dalton, lead author of the study, with the miniature grocery store where children were asked to "shop" in preparation for an evening with friends. (photo by Andrew Nordhoff)

Addressing what they called "a striking lack of research examining young children's perceptions of and receptivity to tobacco and alcohol," researchers at Dartmouth Medical School (DMS) and Dartmouth College designed an observational study in which children two through six years of age used adult dolls to purchase items from a miniature grocery store in preparation for an evening with friends. The store was stocked with 73 different miniature products, including vegetables, meat, fruit, candy, milk, desserts, medicine, cereal, cigarettes, beer and wine. Cigarettes and alcohol accounted for 11 percent of the total items in the store and children "purchased" an average of 17 products.

Of the 120 children who took part in the study, 62 percent bought alcohol and 28 percent bought cigarettes. Children were more likely to buy cigarettes if their parents smoked and more likely to buy alcohol if their parents drank more than once a month. Researchers confirmed that the children knew what they were buying by asking them to identify each of the products as they placed them on the check-out counter. Cigarettes and alcohol were only counted if the children identified them correctly.

"The percentage of children who bought cigarettes and alcohol was much higher than we expected," said lead author Madeline Dalton, Research Associate Professor of Pediatrics at DMS and Director of the Hood Center for Children and Families at Dartmouth, "but even more surprising was the level of detail with which the children mimicked the use of these products."

After leaving the grocery store, children were free to play with their pretend purchases. The study cited instances in which a child suggested that the dolls go outside after dinner to smoke a cigarette, one served champagne because it was a birthday party and a four-year old girl said the male dolls were going to stay home and drink beer while the female dolls went out shopping.

Todd Heatherton, co-author of the study and Professor of Psychological and Brain Sciences at Dartmouth said, "because cognitive scripts guide behavior without people really being aware of them, children may be developing unquestioned beliefs that alcohol and tobacco are a normal part of adult social life. During adolescence, children with such beliefs are likely to act on them, choosing to smoke and drink when the opportunity permits."

"We created this role-playing methodology to study young children's perceptions in a way that minimizes the influence of the researcher and creates a setting in which children can act things out on their own," said Dalton.

The authors concluded that alcohol and tobacco prevention efforts may need to be targeted toward younger children and their parents.

The work was supported by a grant from the Robert Wood Johnson Foundation. Co-authors were Amy Bernhardt, Jennifer Gibson, Anna Adachi-Mejia, James Sargent, Michael Beach and Linda Titus-Ernstoff, all researchers at DMS.

By ANDREW NORDHOFF

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Last Updated: 12/17/08