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Social-Cognitive and School Factors in Lifetime Smoking among Adolescents

Departments of ¹ Psychosocial Cancer Research and ² Statistics and Epidemiology, Institute of Cancer Epidemiology, Danish Cancer Society; ³ Research Unit and Department of General Practice, and ⁴ Department of Health Psychology, Institute of Public Health, University of Copenhagen; ⁵ Department of Pallative Medicine, Bispebjerg Hospital; and ⁶ Danish National Institute of Public Health, Copenhagen, Denmark

Requests for reprints: Pernille Envold Bidstrup, Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Phone: 45-3525-7600; Fax: 45-3525-7721. E-mail: pernille{at}cancer.dk

Background: Smoking is a serious health threat and identifying risk factors for smoking is thus of great importance. The aim of the study was to examine the effects of social-cognitive factors and school factors on lifetime smoking status among adolescents.

Methods: The study was based on cross-sectional data on 2,913 Danish adolescents in grade 7 attending 118 randomly selected public schools. Social-cognitive factors were examined with five measures: self-efficacy to resist pressure to smoke, social influence (norms), social influence (behavior), social influence (pressure), and attitude. We used multilevel analyses to estimate the associations between social-cognitive factors and lifetime smoking status as well as the group-level effects of school, school class, and gender group in the school class.

Results: Each social-cognitive factor was significantly associated with lifetime smoking status, even when several potential confounders and the effects of school, school class, and gender group were taken into account. Of the three group-level school factors, gender group in the school class had the strongest effect on smoking status.

Conclusion: We conclude that self-efficacy to resist pressure to smoke, attitude, and the three types of social influence are significantly associated with lifetime smoking status, even when the effects of group-level school factors are taken into account. The strong effect of gender group in school class on lifetime smoking status indicates that prevention actions should address the social context of adolescents. (Cancer Epidemiol Biomarkers Prev 2008;17(8):1862–71)

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				P. E. Bidstrup, K. Frederiksen, V. Siersma, E. L. Mortensen, L. Ross, M. Vinther-Larsen, M. Gronbaek, and C. Johansen Social-Cognitive and School Factors in Initiation of Smoking among Adolescents: A Prospective Cohort Study Cancer Epidemiol. Biomarkers Prev., February 1, 2009; 18(2): 384 - 392. [Abstract] [Full Text] [PDF]