In recent years, because of an increasingly aging population, the number of deaths from cancer, heart disease, and cerebrovascular diseases is increasing in Japan, accounting for about 60% of all deaths. These chronic, noninfectious diseases, often called "lifestyle-related diseases," are related to everyday behaviors such as smoking cigarettes, excessive intake of fat, sugar, and salt, and physical inactivity. Compared to other lifestyle behaviors, cigarette smoking is considered the major cause of preventable diseases in Japan. Several national surveys indicate the percentage of adult Japanese males smoking cigarettes remains high (about 60%). In addition, the rate among young adult Japanese females also is increasing, from 9.8% in 1970 to 16.7% in 1992 among 20 year-olds.
Because it is difficult for most smokers to quit, health professionals have shifted the emphasis from treating adult smokers to preventing children and adolescents from starting to smoke. Initiation of smoking generally occurs during adolescence. According to one Japanese national study, the percentage of monthly smokers who had smoked at least one cigarette in the past month increased among boys from 9% at the eighth-grade level (approximately 14 years old) to 37% at the 12th-grade level (approximately 18 years old). Among girls, the increase was from 2% to 15%. Therefore, smoking prevention programs need to target early adolescence.
To develop effective smoking prevention programs for early adolescence, it is necessary to clarify factors associated with smoking at these ages. Recent studies in the United States, Europe, and Japan indicate that a combination of social and personal factors are associated with cigarette smoking among adolescents. For example, Botvin et al suggest that social factors including peers' smoking may be important early in the smoking initiation process, but personal factors such as perceived smoking norms and intrapersonal factors including decision making, self-efficacy, and self-esteem may play an important role in maintaining the smoking habit in Black adolescents.
Interest in the relationship between low self-esteem and several risk-taking behaviors among adolescents has been increasing since the 1980s, especially more recently in Japan. Self-esteem is generally defined as an evaluative term that reflects a person's perceptions about his or her personal characteristics and abilities. It is believed that adolescents who lack confidence in themselves are more likely to be influenced by social pressures from groups such as their peers, parents, and the media. Within the school context many behaviors reflect low self-esteem, including aggression, antisocial behavior, depression, underachievement, and social withdrawal.
Previous research revealed that self-esteem may be a factor in smoking behavior among adolescents.[4,7-15] However, these studies have several limitations related to their methodologies or application to effective smoking prevention programs. First, subjects in some studies were senior high school students where the smoking behavior already may be established.[11,14] A prevention program should focus on factors leading to initiation of smoking rather than those related to the maintenance of smoking habits. Second, some studies used only global and unidimensional self-esteem scales such as the Rosenberg Self-Esteem Scale,[9,14] modified Coopersmith Self-Esteem Scale, or a scale developed by researchers themselves. However, as Emery et al suggested, these measures may be too general for use with youth populations, and these studies provided little valuable information to develop effective smoking prevention programs.
Considering the limitations of previous research, a three-year longitudinal study was initiated to determine the relationship between self-esteem and health-related behaviors among Japanese elementary and junior high school students. Data were collected not …