https://doi.org/10.4081/monaldi.2026.4279
Prevalence and risk of smoking behaviors following parental separation: a systematic review
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Accepted: 6 October 2026
Published: 22 October 2026
Parental separation is a recognized adverse childhood experience that alters family structure and psychological development. While Western studies link family dissolution to substance use, synthesized prevalence and risk estimates, particularly within low- and middle-income countries like India, remain fragmented across different developmental stages. This systematic review evaluated the prevalence, odds, and moderating factors of smoking initiation, persistence, and nicotine dependence in offspring exposed to parental separation compared to those from intact families.
Following the PRISMA guidelines, systematic searches were executed across PubMed/Medline, Embase, PsycInfo, Scopus, and Indian regional databases using the CoCoPop framework. Peer-reviewed observational studies evaluating childhood exposure to parental separation and subsequent smoking behaviors across global and Indian cohorts were included and assessed for risk of bias.
A total of 22 observational studies met all inclusion criteria. Offspring exposed to parental separation demonstrated a consistently elevated risk of smoking initiation and regular tobacco consumption (odds ratio: 1.50-2.80$). Pooled smoking prevalence among individuals from separated households ranged from 28.5% to 52.0%, compared to 14.2% to 29.1% among peers from intact households. In India, exposure to parental marital disruption significantly predicted early tobacco experimentation, with bidis and smokeless tobacco accounting for a substantial proportion of initial use. Key moderating factors included post-separation socioeconomic decline, intergenerational parental smoking, male sex, and separation occurring in early childhood (<6 years). Main endpoints were smoking initiation, regular daily smoking, and nicotine reliance. Traditional tobacco (cigarettes and bidis) predominated; e-cigarette and pack-year data were unavailable, and no behavioral-disorder association was established.
Parental separation serves as a robust, independent risk factor for early smoking onset and persistent nicotine reliance globally and within the Indian socio-cultural framework. Public health, school, and pediatric programs should routinely screen for family structural transitions to enable targeted prevention before tobacco habits become entrenched.
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Halpern SD, Ubel PA, Caplan AL. Solid-organ transplantation in HIV-infected patients. N Engl J Med 2002;347:284-7. DOI: https://doi.org/10.1056/NEJMsb020632
Repetti RL, Taylor SE, Seeman TE. Risky families: family social environments and the mental and physical health of offspring. Psychol Bull 2002;128:330-66. DOI: https://doi.org/10.1037/0033-2909.128.2.330
Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998;14:245-58. DOI: https://doi.org/10.1016/S0749-3797(98)00017-8
Anda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood. Eur Arch Psychiatry Clin Neurosci 2006;256:174-86. DOI: https://doi.org/10.1007/s00406-005-0624-4
Arkes J. The temporal effects of parental divorce on youth substance use. Subst Use Misuse 2013;48:290-7. DOI: https://doi.org/10.3109/10826084.2012.755703
Jackson KM, Rogers ML, Sartor CE, et al. Parental separation and offspring smoking trajectories across adolescence. Drug Alcohol Depend 2016;161:274-82.
Kristjansson AL, Sigfusdottir ID, Allegrante JP. Parental divorce and adolescent cigarette smoking and alcohol use: assessing the importance of family conflict. Acta Paediatr 2009;98:537-42. DOI: https://doi.org/10.1111/j.1651-2227.2008.01133.x
Amiri S, Fathi-Ashtiani M, Sedghijalal A, et al. Parental divorce and offspring smoking and alcohol use: a systematic review and meta-analysis of observational studies. J Addict Dis 2021;39:388-416. DOI: https://doi.org/10.1080/10550887.2021.1886576
Fernandes GS, Spiers A, Vaidya N, et al. Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort. BMC Public Health 2021;21:1920. DOI: https://doi.org/10.1186/s12889-021-11892-5
Dierker P, Kühn M, Mönkediek B. Does parental separation moderate the heritability of health risk behavior among adolescents? Soc Sci Med 2023;31:116070. DOI: https://doi.org/10.1016/j.socscimed.2023.116070
Strine TW, Dube SR, Edwards VJ, et al. The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults. Subst Abuse Treat Prev Policy 2012;7:30. DOI: https://doi.org/10.1186/1747-597X-7-30
Singh S, Mishra A. Impact of divorce on child's well-being and long term consequences of disputed custody. White Black Legal J 2023;4:45-58.
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