Smoking is known to be initiated during adolescence, making this age group a relevant target for intervention. Quantitative survey data from a sample of Romanian teenagers (N=1562) as well as qualitative data (30 interviews) were gathered as part of the Health Behavior in School Children Study. Psychosocial factors related to smoking onset, maintenance and reasons for quitting, as well as gender differences in tobacco use were explored. Results show that more teenagers experiment with smoking rather than actually being regular smokers. Gender differences emerge in smoking behavior, with boys smoking more and starting cigarette use earlier. Different reasons are provided by boys and girls for initiating and maintaining this habit, confirming the need for different approaches to intervention. Smoking, as well as smoking early initiation are is significantly associated with having more friends who smoke; having a bad communication with ones' mother, experiencing negative emotions, having a low social self esteem and being engaged in other risk behaviors. The number of friends who smoke, negative emotions and being engaged in other risk behaviors predict smoking frequency in the 15 year old sample, while cognitive factors like general self-efficacy and social self esteem do not. Negative "smoker prototypes" as well as gender differences in choosing strategies to withstand taking up smoking were identified. Therefore, interventions to prevent smoking initiation in teenagers should start early, integrate gender differences, focus on increasing the ability to resist peer pressure, develop negative smoker prototypes, promote control of negative emotions and aim at increasing frequency of alternative behaviors like physical exercise.
KEYWORDS: adolescents, risk behavior, smoking, social-cognitive theory, smoker prototype, interviews, content analysis.
Smoking is considered to be one of the most harmful risk behaviors due to its association with a wide range of health problems like cardiovascular disease, obstructive pulmonary disease and lung cancer, as well as its addictive properties. Smoking was also found to represent a burden for the healthcare system, as the annual costs of healthcare for smokers are double in comparison to those of nonsmokers (World bank, 1999). Moreover, poverty and cigarette use also seem to be connected since research shows smoking to be the largest single cause of socioeconomical inequalities in morbidity and mortality (Kunst, Giskes, & Mackenbach, 2004).
Regardless of all the known negative health and economical consequences of smoking, tobacco use continues to represent the leading cause of preventable death worldwide (WHO, 2007). Studies also predict that if smoking trends continue to rise at the present rate, tobacco-attributable deaths will reach 8.3 million by 2030 (Mathers & Loncar, 2006). Therefore, preventing the onset of smoking has been defined as a major public health priority that would contribute to the reduction of smoking prevalence (Pierce, Choi, Gilpin, Farkas, & Merritt, 1996) and tobacco caused deaths.
Previous studies show that most adult smokers had their first cigarette or became regular smokers before they reached the age of 18 (Lamkin & Huston, 1998), highlighting the importance of intervention in the adolescent population in order to prevent future adult smoking behavior. Moreover, next to the association with long-term disease, smoking also has a series of negative short term consequences for teenagers, like shortness of breath, decreased lung function, coughing and wheezing and decreased overall physical fitness (US Department of Health and Human Services, 1994). However, apart from the negative consequences of smoking, this behavior also has a series of positive aspects that contribute to its maintenance among teenagers. For example, it is used as a relaxation method, a way to reduce stress and boredom; it helps increase concentration and control negative emotions like depression and anxiety. …