Pro-smoking Attitudes Research Articles

Prevalence, Trends, and Harm Perception Associated with E-Cigarettes and Vaping among Adolescents in Saudi Arabia

Younger generations are an important market for the tobacco products industry since most smokers try their first cigarette before the age of 18. Electronic cigarettes (e-cigarettes) are a common mode of smoking among teens, and the number of users is increasing exponentially. This study aimed to estimate the current prevalence of e-cigarettes and vaping usage among adolescents between the ages of 15 and 19 in the city of Mecca, Saudi Arabia. This study was conducted among 534 students at four high schools. They were asked to complete a 23-item questionnaire retrieved from the Global Youth Tobacco Survey. Descriptive statistics and regression analysis were conducted. The study was approved by the Ministry of Health Saudi Arabia Medical Research Center Institutional Review Board committee on October 10, 2018 (research number 18-506E). A total of 109 (20.6%) of the participants reported being smokers of e-cigarettes. Being a male (OR = 1.55; 95% CI: [1.01-2.37]), in the second year of high school (OR = 2.91; 95% CI: [1.61-5.24], ever experimenting with regular tobacco cigarettes, being a current shisha smoker, living with a smoker, and believing that e-cigarettes are less addictive than traditional cigarettes are all factors independently associated with e-cigarette use in this sample of adolescents. Among adolescent smokers, even minimal experience with smoking is correlated with pro-smoking attitudes. E-cigarette use is common in adolescents and related to the use of other combustible tobacco products. Tobacco control efforts at all levels should eliminate factors fostering future tobacco use to minimize the burden of disease and disability in vulnerable populations.

The impact of the point-of-sale tobacco display ban on young people in Scotland: before-and-after study

Background Tobacco displays at point of sale have been shown to increase young people’s pro-smoking attitudes, susceptibility to smoking and smoking initiation. In Scotland, legislation that prohibited tobacco point-of-sale displays was implemented in large stores (i.e. those > 280 m2) in April 2013 and in small retailers in April 2015. Objective To assess the impact of the point-of-sale tobacco display ban on young people’s exposure to tobacco advertising, their attitudes to smoking and smoking susceptibility, and their risk of smoking initiation. Design Multimodal before-and-after study design using mixed methods to collect data at baseline (2013) and then longitudinally for 4 years. Setting Four main study communities in the central belt of mainland Scotland, UK, purposively selected to reflect two levels of urbanity (urban vs. small town) and two levels of deprivation (high vs. medium/low). Four matched communities. Participants In the main study communities, 94 tobacco retail outlets. All Secondary 2 (aged 13 years) and Secondary 4 (aged 15 years) pupils in 2013 and 2014 together with all Secondary 1 to Secondary 6 (aged 12–17 years) pupils in 2015–17. This included 6612 pupils who completed 14,344 questionnaires over 5 years. Three hundred and eighty-two participants in 80 focus groups who were recruited from Secondary 2 and Secondary 4 in 2013–17. In matched communities, 24 retail panel members in 2013–17. Main outcome measures Tobacco product and tobacco storage visibility, density of retail outlets (the number of retailers in a pre-defined area such as a residential neighbourhood), tobacco product exposure, brand awareness, perceived accessibility of tobacco, pro-smoking attitudes, pro-smoking norms, smoking susceptibility and smoking initiation. Data platform and methods The study had four components – a mapping and spatial analysis of retail outlets; a tobacco marketing audit, including retail panel interviews in matched communities; school surveys; and focus group discussions with secondary school pupils. Limitations The study was based on a small number of communities and did not include communities in remote areas. Results Compliance with the point-of-sale legislation in Scotland was high. This led to a large reduction in the visibility of tobacco products in retail outlets. However, when the results were stratified by socioeconomic status, declines in retailer density, weighted by total product visibility, were restricted to the least disadvantaged tertile of participants. Nevertheless, the implementation of the legislation was associated with a reduction in risk of both smoking susceptibility and smoking initiation in young people, as well as a reduction in the perceived accessibility of tobacco and in pro-smoking attitudes after both the partial and the comprehensive bans were introduced. Conclusions The Scottish point-of-sale legislation has been successful in reducing the overall visibility of tobacco products and is associated with improvements in attitudinal and behavioural outcomes in young people. However, cues that tobacco is for sale are still highly visible, particularly in retail outlets in areas of deprivation. In addition, the increase in retailer density that was observed after 2015 increased inequalities in product visibility. There was also evidence that the emergence of e-cigarettes may have disrupted the full impact of the legislation. Future work Our research indicates that further research is needed to examine the longitudinal relationships between tobacco outlet availability and product visibility inequalities; and the impact of e-cigarettes and standardised packaging on smoking initiation and prevalence. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

Prevalence and determinants of smoking initiation among school students in Bosnia and Herzegovina.

Tobacco smoking amongst the young is a matter of public health concern because of the immediate and long-term health consequences associated with tobacco use, such as asthma, cancers, and cardiovascular diseases. The purpose of this study was to identify the determinants of smoking initiation among a sample of high school students in Bosnia and Herzegovina. The study was conducted among 198 high school students in Zvornik, Bosnia and Herzegovina, during April 2013. A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection. Fourth grade students mainly initiated smoking in high school (45%), while the majority of third and second grade students initiated smoking in primary school. Among students who smoke, an average duration of the smoking habit was <2 years. A multivariate analysis showed that males were 5.27 times more likely to have initiated smoking. For every unit increase in pro-smoking attitude towards smoking, students were 5.3 times more likely to have initiated smoking. Those with parents and friends who are smokers were 6.106 and 5.175 times, respectively, more likely to have initiated smoking. This study indicates that a high proportion of 15-18 year olds in the town of Zvornik are current smokers. Gender, age, and parent and peer influence were identified as important associations with smoking. Interventions should not only be confined to the secondary school environment but they should also extend to their places of residence so that influences in the home environment and social surroundings that contribute to tobacco use are also tackled.

Determinants of Smoking Initiation and Susceptibility to Future Smoking among School-Going Adolescents in Lagos State, Nigeria

It is projected that low and middle-income countries will bear a major burden of tobacco related morbidity and mortality, yet, only limited information is available on the determinants of smoking initiation among youth in Africa. This study aimed to assess the determinants of smoking initiation and susceptibility to future smoking among a population of high school school students in Lagos, Nigeria. Baseline data from an intervention study designed to assess the effect of an anti-smoking awareness program on the knowledge, attitudes and practices of adolescents was analyzed. The survey was carried out in six randomly selected public and private secondary schools in local government areas in Lagos state, Nigeria. A total of 973 students completed self-administered questionnaires on smoking initiation, health related knowledge and attitudes towards smoking, susceptibility to future smoking and other factors associated with smoking. Of the respondents, 9.7% had initiated smoking tobacco products with the predominant form being cigarettes (7.3%). Males (OR: 2.77, 95%CI: 1.65-4.66) and those with more pro-smoking attitudes (OR: 1.44, 95%CI: 1.34-1.54) were more likely to have initiated smoking. Those with parents and friends who are smokers were 3.47 (95%CI: 1.50-8.05) and 2.26 (95%CI: 1.27-4.01) times more likely to have initiated smoking. Non-smoking students, in privately owned schools (OR: 5.08), with friends who smoke (5.09), with lower knowledge (OR: 0.87) and more pro-smoking attitudes (OR 1.13) were more susceptible to future smoking. In addition, respondents who had been sent to purchase cigarettes by an older adult (OR: 3.68) were also more susceptible to future smoking. Being male and having parents who smoke are predictors of smoking initiation among these students. Consistent with findings in other countries, peers not only influence smoking initiation but also influence smoking susceptibility among youth in this African setting. Prevention programs designed to reduce tobacco use among in-school youth should take these factors into consideration. In line with the recommendations of article 16 of the WHO FCTC, efforts to enforce the ban on the sales of cigarettes to minors should be also emphasised.

Smoking-specific communication and children's smoking onset: An extension of the theory of planned behaviour

The aim of this study was to test whether maternal smoking-specific communication and parental smoking related to smoking cognitions (i.e. attitude, self-efficacy and social norm) derived from the Theory of Planned Behaviour in association with smoking onset during preadolescence. A total of 1478 pairs of mothers and children participated (mean age: 10.11; standard deviation = 0.78). Structural equation models in Mplus were used to examine whether smoking-specific communication influences children's smoking cognitions, which in turn, affect smoking onset. A positive association was found between pro-smoking attitudes and smoking onset. Smoking-specific communication and parental smoking were related to smoking cognitions. Specifically, frequency of communication was negatively associated with pro-smoking attitudes, social norms of mother and best friend. Quality of communication related negatively to pro-smoking attitudes and positively to self-efficacy and norms of friends. Parental smoking was positively associated with pro-smoking attitudes and norms of mother and (best) friends. Additionally, more frequent communication and higher levels of parental smoking were associated with higher smoking onset. In conclusion, smoking-specific communication and parental smoking were associated with smoking cognitions and smoking onset. Already during preadolescence, parents contribute to shaping the smoking cognitions of their children, which may be predictive of smoking later in life.

Quitting Trajectories of Chinese Youth Smokers Following Telephone Smoking Cessation Counseling: A Longitudinal Study

The smoking patterns of youth remain unknown after they have received smoking cessation counseling. This study aims to examine the quitting trajectories of Chinese youth smokers after they have received quitline services and to examine factors to predict their quitting trajectories. A total of 402 Chinese youth smokers (aged 12-25 years) called a quitline and participated in telephone follow-ups at 1 week, 1 month, and 3 and 6 months after initial telephone counseling. Finite mixture modeling was employed to examine the quitting trajectories by the SAS Proc Traj group-based modeling procedure. Hierarchical multinomial logistic regression was used to compare the baseline intention to quit smoking, prosmoking attitudes, social influences, self-efficacy to quit, smoking profile, quitting history, and demographic characteristics among the trajectory groups. Three distinct quitting trajectory groups were identified: quitters, reducers, and persistent smokers. Both quitters and reducers dramatically reduced the level of their cigarette consumption immediately after initial counseling. Youth smokers who were intended to quit at baseline, perceived confidence to quit, and perceived importance of quitting were more likely to have successfully quit smoking at six-month follow-up. Those who had prosmoking attitudes were less likely to quit smoking. The findings reveal the profiles of youth smokers who can quit successfully and can guide the development of better and relevant interventions based on the psychosocial characteristics of youth smokers. Short-term goals such as an abrupt quit attempt or immediately reducing cigarette consumption by half may be the key to help youth smokers quit successfully.

Smoking-related attitudes and perceptions among young adults in Malta and the UK

Although youth smoking in Europe has been highlighted as a significant public health concern, there is little data available to guide development of population-specific smoking prevention measures. In this study, we examined smoking-prevalence and smoking-related attitudes and perceptions among 118 young adults in Malta (a country for which there is little existing data), with comparison data from a sample of young adults in the UK (N = 112). To ensure that samples were demographically similar (e.g. in terms of age, level of education, and social status) we obtained data from university students. Only students of Maltese nationality (in Malta), or British nationality (in the UK) were invited to participate. Participants completed measures of smoking behavior, perceived risks of smoking, subjective norms, temptation to smoke, and attitudes towards smoking cessation. Almost half (46%) of the Maltese students were current smokers, compared to 25% of the British students. British students were more aware of the risks of smoking than their Maltese counterparts, perceived greater social pressure not to smoke and held more positive attitudes towards smoking cessation; Maltese students reported greater temptation to smoke and were around others who smoke more often than the British students. Attitudes and perceptions were associated with smoking behavior in both samples although the relative importance of psychological determinants of smoking varied between the two samples. Our data indicate higher smoking prevalence and more pro-smoking attitudes/ perceptions among students in Malta, consistent with data for other Southern European countries. Findings also indicate that the influence of smoking-related attitudes and perceptions varies between populations and the influence of social norms in particular may be moderated by nationality.

The Gendered Social Politics of Health Issues

The Gendered Social Politics of Health Issues Laury Oaks (bio) Amy Borovoy. The Too–Good Wife: Alcohol, Codependency, and the Politics of Nurturance in Postwar Japan. Berkeley: University of California Press, 2005. xvii + 234 pp. ISBN 0–520–24451–6 (cl); 0–520–24452–4 (pb). Kirsten E. Gardner. Early Detection: Women, Cancer, and Awareness Campaigns in the Twentieth–Century United States. Chapel Hill: University of North Carolina Press, 2006. xii + 282 pp.; ill. ISBN 0–8078–3014–3 (cl); 0–8078–5682–7 (pb). James S. Olson. Bathsheba’s Breast: Women, Cancer, and History. Baltimore: Johns Hopkins University Press, 2002. x + 302 pp. ISBN 0–8018–8064–5 (pb). Kerry Segrave. Women and Smoking in America, 1880–1950. Jefferson, NC: McFarland, 2005. v + 245 pp.; ill. ISBN 0–7864–2212–2 (pb). Since the late 1960s in the United States, the women’s health movement has emphasized that health issues are never merely medical, but are shaped by historical, social, personal, and political dynamics. Each of these books contributes to scholarship dedicated to understanding how these forces have operated, and what the consequences have been for women’s bodies and lives. The authors illustrate women’s and health experts’ perspectives, presenting women as central actors in defining public health issues and analyzing how social understandings of gender and gender roles influence public, governmental, professional, and individual responses to health concerns. Kerry Segrave’s book documents how women smokers gained the same level of acceptance as male smokers by 1950. Beginning his study in 1880, Segrave also presents opposition to smoking. He identifies this period as the “innocent years,” preceding dominant medical warnings against tobacco use. The author’s presence is less pronounced than in the other books reviewed, and the main contribution of this book is its documentation of varied public attitudes toward women’s cigarette smoking. The text does not include a discussion of methods; one sentence states that research was conducted at three Canadian institutions “using various online and traditional databases” (2). The majority of sources are newspaper articles, [End Page 188] eye–catching advertisements (sources not given, which will frustrate readers seeking originals), film stills, and actress/model photographs. As with Segrave’s other books, the focus is on public culture. Segrave adheres to a chronological, four–period timeline based on widespread shifts in public attention to women’s smoking, and a concise, but repetitive, organization. Three chapters are devoted to each of four time periods and the categories “Abroad,” “America,” and “The Opposition.” The book provides an overview of the period before 1880, the year women’s tobacco use—pipe–smoking, snuff dipping, or less so, cigarette smoking—became an issue of public attention despite the fact that women did not use tobacco in public. Segrave offers an analysis of the class and regional (primarily in Europe and the United States) differences in and meanings of women’s tobacco use. Women’s cigarette smoking dominated public attention, with cigarettes being seen as both “more effeminate and more vicious than any other form of tobacco” (9). Segrave provides dramatic quotes to illustrate the passion of debate around women and smoking; for example, “Between the lips of a woman [the cigarette] was generally regarded as no less than a badge of questionable character” (12). Between 1880 and 1908, women reformers, particularly members of the Women’s Christian Temperance Union (WCTU), sought to ban smoking by everyone and emphasized the moral and health ills of smoking for women and minors. The WCTU and other organizations successfully pressured states and territories to ban the sale of cigarettes to minors (42). Lucy Page Gaston was a leading anticigarette reformer who was deputized by the Chicago police and went to court over 600 times in ten years to prosecute tobacco dealers who violated the law (46). In this same period there was little opposition to tobacco use in other parts of the world. American women’s smoking was on the rise, partially attributed to importation of cigarettes and pro–smoking attitudes from Europe, in the period 1908 to 1919. Whether it was proper or legal for women to smoke in public was the main question, and “as World War I ended...

Smoking Susceptibility and Attitudes Toward Smoking Among Chinese and Vietnamese American Adolescents

In California, 641 Chinese and 629 Vietnamese age 12–17 participated in a longitudinal telephone study from 1999 to 2001. Four attitude scales were constructed: acceptance of smokers, addictive nature of smoking, psychosocial reasons to smoke, and gender roles and smoking. Vietnamese American adolescents had more pro-smoking attitudes than Chinese American adolescents. Male gender, having friends who smoked, and baseline smoking were associated with smoking susceptibility at follow-up. Those factors, U.S. birthplace, and the acceptance and psychosocial scales were associated with smoking. Smoking prevention efforts targeting Chinese and Vietnamese American adolescents should focus on gender, birthplace, peer smoking, and attitudes.

Psychosocial correlates of cigarette smoking among college students in China

The objectives are to examine the smoking practice and intention among Chinese college students and to explore the association between cigarette smoking and individual and psychosocial factors. Cross-sectional data were collected from 1874 students from 19 college campuses in Jiangsu province, China. Both bivariate and multivariate analyses were performed to assess the associations of smoking practice and smoking intention with various individual and psychosocial factors. There was a significant gender difference in both smoking practice and smoking intention. Overall, 53% of the participants (70% male and 31% female) reported ever having smoked in their lifetime and 29% of the sample (49% male and 5% female) reported having smoked in the past 30 days. About one-fourth of the sample (44% male and 6% female) thought they were likely to smoke in the next 6 months. Male gender, low family socioeconomic status, perception of more peer smoking, more perceived benefits of smoking, higher level of pro-smoking attitude, higher level of perceived cost of non-smoking and more involvement in other health risk were positively associated with being a past or current smoker. Likewise, male gender, older age, more friends smoking, greater perceived benefits of smoking, higher pro-smoking attitudes and more health risk involvement were associated with the likelihood to smoke in the next 6 months. The data suggest a substantial smoking experimentation among college students in China, which presents both a challenge and an opportunity to prevent a large proportion of experimenters from progressing to regular smokers. The findings in the current study can be used to inform the development of effective smoking intervention prevention programs among college students in China.

Parenting style and adolescent smoking cognitions and behaviour

Parenting style and smoking-related cognitions have both successfully predicted adolescent smoking behaviour. Data were collected among 482 Dutch adolescents to examine whether effects of parenting styles (authoritative, permissive, authoritarian, rejecting, neglecting, measured by underlying dimensions support, strict control, and psychological control) on adolescent lifetime smoking were mediated by cognitions (pro-smoking attitude, social norm, self-efficacy, intention) and to study the role of gender in this process. Support was not significantly associated with smoking behaviour. The inverse relation between strict control and smoking was partly mediated by attitude and intention, both associated with increased smoking. Psychological control related directly to increased lifetime smoking. Combinations of dimensions creating the specific styles were not associated with cognitions or behaviour. Maternal and paternal parenting were equally associated with smoking cognitions and behaviour; nor were effects moderated by adolescent gender. Interventions to prevent adolescent smoking initiation should aim at increasing strict control and reducing psychological control.

Does the campaign against tobacco use necessarily reduce the attractions of smoking for young people? Identity issues surrounding initiation into tobacco consumption

The present study examines the attitude of Swiss adolescents towards tobacco consumption as a function of its implications for identity and their perception of the antismoking social norm. A total of 228 girls and 213 boys, aged 11–15 years, answered a questionnaire assessing personal attitude towards tobacco consumption (the main dependent variable), the salience of the antismoking norm (perceived attitudes of family, teachers, politicians and society in general), and their identification with smokers, as well as their self-image and their perception of the image (positive and negative) of smokers. The results show that a prosmoking attitude is associated with a stronger identification with smokers, a more positive (and less negative) image of smokers, a more negative self-image, and weaker salience of the antismoking norm. A pro-smoking attitude is also associated with a self-image that is closer to the image of the smoker, independently of the latter's valence. Finally, a prosmoking attitude is associated with a negative self-image specifically among those who identify more strongly with smokers but who also perceived a strong antismoking norm. This last result suggests that a strong antismoking norm can help to make smoking an attractive behaviour for young people, in particular those with a negative self-image.

Adolescent Smoking Continuation: Reduction and Progression in Smoking after Experimentation and Recent Onset

In the present study, the role of cognitive concepts derived from the Theory of Planned Behavior in adolescent smoking reduction, continuation, and progression was investigated. These concepts include pro-smoking attitudes, perceived social norms regarding smoking, and self-efficacy to resist smoking. Logistic regression analyses were performed on data from 397 Dutch adolescents aged 11-15 years, who had at least once tried smoking. Attitudes, perceived social norms, and self-efficacy, including significant interactions between these three concepts, explained up to 41% of variance in smoking behavior cross-sectionally. Longitudinally, an interaction between pro-smoking attitudes and low self-efficacy increased the chance of reduction in smoking, and all three cognitions inclusive of two interactions between pro-smoking perceived social norms and low self-efficacy or positive attitudes towards smoking predicted progression of smoking. Cognitions may play relatively small roles in adolescent smoking reduction, but do seem to be relevant in progression in smoking after experimentation or recent onset. Interactions between positive attitudes towards smoking and prosmoking perceived social norms provide cumulative risks for adolescents to increase their levels of smoking, whereas interactions between less favorable attitudes and high self-efficacy to resist smoking may provide a protective effect for adolescents to reduce or to quit their smoking.

Factors Associated With Smoking Onset: 3-Year Cohort Study of Schoolchildren

To analyze the predictors of smoking onset among schoolchildren. A cohort study of 1056 children starting in first year secondary school at 44 schools in Barcelona was carried out. Participating children were invited to answer a lifestyle questionnaire every year for 4 years. Each questionnaire carried a personal code to allow the 4 questionnaires to be matched. Matching questionnaires were found for 729 children, 70% of the initial sample. Over the study period, the prevalence of regular smokers increased from 1.7% to 22% among boys and from 1.6% to 38.2% among girls. The predictors of smoking onset among boys were scoring high on the pro-smoking attitudes index (odds ratio [OR]=1.2; 95% confidence interval [CI], 1.1-1.3), intention to smoke in the future (OR=2.2; 95% CI, 1.0-4.9), low self-efficacy in resisting pressures to smoke (OR=0.98; 95% CI, 0.96-0.99), having siblings that smoke (OR=2.5; 95% CI, 1.2-5.4), and spending some free time in bars (OR=2.4; CI, 1.1-4.9). Among girls, the predictors were having low self-esteem (OR=0.94; 95% CI, 0.88-0.99), scoring low on the anti-tobacco attitudes index (OR=0.92; 95% CI, 0.88-0.97), having siblings who smoke (OR=2.5; 95% CI, 1.2-5.5), spending some free time in discotheques (OR=4.5; 95% CI, 1.9-11.8), and living in high socioeconomic-status neighborhoods (OR=3.1; 95% CI, 1.4-10.9). The results show the importance of cognitive variables as well as a variety of environmental variables, particularly the pattern of free time use and the influence of sibling models. Prevention programs must take into account smoking onset risk factors as a whole.

Texas Tobacco Prevention Pilot Initiative: processes and effects

The study was designed to examine how intensity of anti-smoking media campaigns and differing types of anti-smoking community-based programs influence young adolescents' tobacco use and related psychosocial variables. Sixth grade students attending 11 middle schools in eight study communities assigned to varying intervention conditions were assessed by a pre-intervention survey conducted in spring 2000. The assessment was followed by summer and fall 2000 media and community interventions that were evaluated by post-intervention data collection taking place with a new cohort of sixth graders in the same 11 schools in late fall 2000. In analyses conducted at the school level, the enhanced school and comprehensive community program conditions outperformed the no intervention program condition to reduce tobacco use and intentions to use tobacco. Combining the intensive or low media campaign with the comprehensive community program was most effective in suppressing positive attitudes toward smoking, while the enhanced school program alone was less effective in influencing attitudes. The most consistent changes, at least short-term, to reduce teen tobacco use, susceptibility to smoking and pro-smoking attitudes were achieved by combining the intensive media campaign with the comprehensive community program condition.

Predictors of the transition to regular smoking during adolescence and young adulthood

Purpose To identify predictors of the transition from experimentation to regular smoking in middle adolescence, late adolescence, and young adulthood. Methods California and Oregon students completed self-report surveys assessing the following potential predictors of the transition to regular smoking from grades 8 to 10 (n = 2496), grades 10 to 12 (n = 2149), and grade 12 to age 23 years (n = 1534): demographic characteristics; smoking-related attitudes, behaviors and environment; other problem behaviors; academic orientation; parental bonding; and mental health. Huberized regression techniques, which adjust for weighting and clustering of observations, were used to determine the independent associations of the predictor variables on subsequent smoking status. Results Risk factors for the transition to regular smoking during middle adolescence included being white, prosmoking attitudes, friend smoking, weak academic orientation, and less parental support. During late adolescence, being African-American was protective, whereas risk factors included prosmoking attitudes, drinking, non-intact nuclear family, and less parental support. Risk factors in young adulthood included younger age and prosmoking attitudes. Conclusions Results point to several smoking-related attitudes, social influences, and behaviors that prevention efforts may target to curb the escalation of smoking.

Cigarettes: A Growing Problem for Taiwanese Adolescents

An alarming number of Taiwanese teenagers continue to smoke despite the adverse health consequences of cigarette smoking. This research review describes the prevalence and onset of smoking behavior among Taiwanese adolescents and analyzes the risk factors contributing to smoking initiation. The findings of this review suggest that health educators need to target high-risk groups before they initiate smoking. High-risk groups are those who have poor school achievement, have an external locus of control, have a prosmoking attitude, know others who smoke, and are from low socioeconomic status families. These risk factors support the need for nurses to implement an effective smoking prevention program for adolescents.