Factors associated with smoking initiation among Saudi male adolescents: A longitudinal study

INTRODUCTION: Knowing country-specific predictors of smoking behaviour for adolescents is crucial for successful smoking prevention programs. This study aims to assess demographic and socio-cognitive variables related to smoking initiation among Saudi male adolescents. METHODS: Longitudinal data were collected at T1 (baseline) and at T2 (followup at 6 months) using a self-administered questionnaire. We assessed smoking behaviour and related demographic variables and socio-cognitive variables. Chi-squared tests and independent-samples t-tests were used to identify differences in baseline characteristics between smokers and non-smokers at T1. Furthermore, non-smokers at T1 were included in logistic regression analyses to examine the predictors of smoking initiation between T1 and T2. RESULTS: At T1, the non-smokers who were included in further analysis were 523 (84.9%) of whom 48 (9.2%) had initiated smoking at T2. They differed significantly from non-initiators, including having a more positive attitude towards smoking, reporting more social norms, modelling and pressure to smoke, having a lower self-efficacy to refrain from smoking and higher intention to smoke in the future (all p<0.001). The regression analysis revealed that: adolescents with disrupted-families, being of low academic achievement, with relatively high monthly-income families, having more smoking-peers, high-perceived pressure to smoke from parents (p=0.002) and teachers (p=0.001), have smoking supportive-norms of parents and having high intention to smoke in the future (p<0.001) were at higher risk of being smokers. CONCLUSIONS: Findings suggest that health-promoting programs should address strengthening of self-efficacy and enhancing refusal skills against modelling of peers, pressure and norms of parents.