Factors associated with tobacco use among adolescents: the role of parents, peers, attitudes and skills

INTRODUCTION. Tobacco use among adolescents represents a major public health problem. Smoking initiation can be influenced by several factors such as peer smoking, social influences, individual risk conditions, parental tobacco smoking and related behaviors. OBJECTIVES. The purpose of this study is to investigate risk factors for adolescent lifetime tobacco use and to evaluate differences by gender and socio-economical status. METHODS. This is a secondary analysis of the baseline survey of the EU-Dap (European Drug Addition Prevention) randomized controlled trial. The analytical sample included 7,011 students 12-14 years old from seven European countries who participated in the baseline survey of the trial and answered the questions investigating lifetime smoking. Socio-demographic characteristics, friends’ substance use, knowledge, attitudes and beliefs toward substances, risk perceptions, refusal and decision making skills, self-esteem, parental tobacco smoking and permissiveness, and family climate were studied as risk factors for lifetime tobacco use through a forward multivariate logistic regression model. RESULTS. Low refusal skills toward tobacco use was the strongest predictor of lifetime smoking (OR 6.09, 95% CI 5.08-7.30), followed by having friends who smoke (OR 3.79, 95% CI 2.95-4.86). One-parent household (OR 1.44, 95% CI 1.14-1.82), parental smoking (OR 1.42, 95% CI 1.23-1.64), parental permissiveness to smoke out of home (OR 1.43, 95% CI 1.15-1.79), bad family relationship (OR 1.30, 95% CI 1.12-1.52) and low connectedness with parents (OR 1.24, 95% CI 1.02-1.51) proved to be associated with adolescent smoking. Wrong risk perceptions and beliefs, negative self-esteem, positive attitudes toward substances, negative decision making skills and low respect for teachers were also significantly associated with tobacco use. Differences by gender and socio-economic status were observed. CONCLUSIONS. The present findings identified some risk factors for lifetime smoking among European adolescents. Forthcoming prevention programs should address these factors in order to prevent smoking initiation.