Abstract
BackgroundSmoking among youths is a worldwide problem, particularly in China. Many endogenous and environmental factors influence smokers’ intentions to smoke; therefore, a comprehensive model is needed to understand the significance and relationship of predictors. This study aimed to develop a prediction model based on problem-behavior theory (PBT) to interpret intentions to smoke among Chinese youths.MethodsWe conducted a cross-sectional study of 26,675 adolescents from junior, senior, and vocational high schools in Shanghai, China. Data on smoking status, smoking knowledge, attitude toward smoking, parents’ and peers’ smoking, and media exposure to smoking were collected from students. A structural equation model was used to assess the developed prediction model.ResultsThe experimental smoking rate and current smoking rate among the students were 11.0% and 3%, respectively. Our constructed model showed an acceptable fit to the data (comparative fit index = 0.987, root-mean-square error of approximation = 0.034). Intention to smoke was predicted by perceived environment (β = 0.455, P < 0.001) system consisting of peer smoking (β = 0.599, P < 0.001), parent smoking (β = 0.152, P < 0.001), and media exposure to smoking (β = 0.226, P < 0.001), and behavior system (β = 0.487, P < 0.001) consisting of tobacco experimentation (β = 0.663, P < 0.001) and current smoking (β = 0.755, P < 0.001). Smoking intention was irrelevant for personality system in students (β = -0.113, P>0.05) which consisted of acceptance of tobacco use (β = 0.668, P < 0.001) and academic performance (β = 0.171, P < 0.001).ConclusionThe PBT-based model we developed provides a good understanding of the predictors of intentions to smoke and it suggests future interventions among youths should focus on components in perceived environment and behavior systems, and take into account the moderating effects of personality system.
Highlights
As the largest cigarette manufacturer and consumer in the world, China, according to national surveys conducted in 1984, 1996, 2002 and 2014, has seen a substantial increase in the prevalence of cigarette smoking among adolescents [1,2]
Our constructed model showed an acceptable fit to the data
Intention to smoke was predicted by perceived environment (β = 0.455, P < 0.001) system consisting of peer smoking (β = 0.599, P < 0.001), parent smoking (β = 0.152, P < 0.001), and media exposure to smoking (β = 0.226, P < 0.001), and behavior system (β = 0.487, P < 0.001) consisting of tobacco experimentation (β = 0.663, P < 0.001) and current smoking (β = 0.755, P < 0.001)
Summary
As the largest cigarette manufacturer and consumer in the world, China, according to national surveys conducted in 1984, 1996, 2002 and 2014, has seen a substantial increase in the prevalence of cigarette smoking among adolescents [1,2]. Given the health-related consequences [6] resulting from tobacco use, preventing youths from smoking initiation remains a public health priority [7]. Intentions to smoke—thoughts developed before smoking behavior about experimenting with smoking [8]—are worth paying special attention to in adolescent smoking. Pierce’s longitudinal study pointed out that youths’ resolve to remain smoke-free against future smoking initiation is strongly associated with future smoking behaviors [9]. Smoking among youths is a worldwide problem, in China. This study aimed to develop a prediction model based on problem-behavior theory (PBT) to interpret intentions to smoke among Chinese youths
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