For Release: September 7, 2005
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Preschoolers Use Cigarettes and Alcohol While Role Playing as Adults
Dartmouth Study Suggests that Drinking and Smoking Prevention Efforts Should Start Long Before Adolescence

Dr. Madeline Dalton

HANOVER, NH - Children form attitudes about smoking and drinking at a very young age, picking up many cues about cigarettes and alcohol from their parents, according to a behavioral study conducted at Dartmouth. The results, published in the September 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.

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 ages 2-6 years old 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% 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% bought alcohol and 28% 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 or still decided to buy it after it was correctly identified by the store's "cashier." Terms such as "booze," "Daddy's juice," and "smokes," were counted.

"The percentage of children who bought cigarettes and alcohol was much higher than we expected," said lead author Dr. 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 3 to 6 years of age returned to the dining room and living room set-up with the dolls and were free to play with their purchases. The study cites instances in which a six-year-old suggested that the dolls go outside after dinner to smoke a cigarette, a four-year-old served "champagne" because it was a birthday party, and a four-year old girl said the men (male dolls) were going to stay home and drink beer while the women (female dolls) went out shopping.

The miniature store where participating children "bought" their groceries.

Dr. Todd Heatherton, co-author of the study and professor of psychological and brain sciences at Dartmouth College 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, noting that this approach is especially well-suited for preschoolers because they become so absorbed in the play that they feel free to express themselves.

The authors conclude that alcohol and tobacco prevention efforts may need to be targeted toward younger children and their parents. "As parents, we need to be very aware of the behavior we and others model for our children," said Dalton. "More importantly, we should recognize that children are forming positive perceptions of alcohol and tobacco use long before they reach middle school."

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


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