A fascinating study published in the Archives of Pediatrics and Adolescent Medicine in September 2005 draws some remarkable conclusions about the awareness in preschoolers of their parents' drinking and smoking habits.

The study included 120 children, 2 to 6 years old. The children were predominantly white, living in a rural or semirural area, and 87 percent of the children had parents with college degrees or higher. Each child was asked individually to play a game of shopping and choose products at the "store," buy them at the check-out counter, and bring them home. Props for the play scenario included a Barbie store stocked with 73 different miniature products. Adult dolls were used to choose the products, which included fruits and vegetables, meats and dairy, breads, desserts, snacks, candy, toiletries, beer, wine, and cigarettes. Alcohol and cigarette products accounted for 11 percent of items stocked in the store. The children were also asked to identify the products to verify their awareness of their choices. Parents completed a questionnaire concerning their alcohol and tobacco use, and the children's exposure to movies.

Children's choices reflected items expected as their preferences (66 percent purchased cake). They also bought items that adults would typically buy (77 percent purchased at least one fruit or vegetable, and 38 percent purchased chicken). In addition, 62 percent of the children bought alcohol, and 28 percent of the children bought cigarettes.

Analysis of the data revealed that children whose parents smoked or drank alcohol were much more likely to purchase these items. Children whose parents smoked were 4 times as likely to buy cigarettes compared to children whose parents did not smoke. Similarly, children whose parents drank alcohol at least monthly were 3 times as likely to buy beer or wine compared to those with parents who drank less than once a month. The researchers also noted that children were 5 times more likely to purchase alcohol if they watched PG-13 or R rated movies compared to children who watched only G-rated movies infrequently.

The children revealed their awareness of their choices with telling comments as well.

A 6-year-old boy offered Barbie the cigarettes saying: "Honey, have some smokes. Do you like smokes? I like smokes."

After returning from the store with beer, a 4-year-old girl said, "The girls are going to go back to the store [to shop] while the boys stay here and drink [beer]."

After "eating," a 6-year-old girl said to her "friend" (the other doll), "Let's smoke these now. Here, which ones do you want?" She took Marlboros for herself and offered the Camels to the doll. "Let's go outside and smoke these." The researcher asked why they had to go outside, and the child replied, "Because it's bad for your lungs or something."

The authors conclude that "preschoolers have already begun to develop behavioral expectations regarding the use of cigarettes and alcohol…. The data provide compelling evidence that the process of "initiation," which typically involves shifts in attitudes and expectations about the behavior, begins as young as 3 years of age." Although parents often believe that children at this young age do not think about tobacco or alcohol, prevention of these behaviors should probably begin with 2 or 3 year-olds. And parents need to evaluate their own behavior as role models to create healthy habits in their very impressionable children.