The Pattern, Correlates, and Predictors of Cigarette Smoking in Adolescence

Abstract The health effects of smoking are well known and, despite efforts to reduce smoking in adolescence, prevalence of smoking during the teenage years in the UK has remained stable over recent years. This thesis examines smoking uptake during adolescence and identifies the social, psychological and physical factors associated with this process using data from the longitudinal Health And Behaviour In Teenagers study (HABITS). Between 1999 and 2003 over 5000 students from South London were assessed annually from age 11 to age 16. Self-report questionnaires identified smoking status as well as a range of demographic, social and psychological variables. Objective height, waist and weight data were taken and saliva samples provided for cotinine assay. First, analyses examining smoking prevalence and the sociodemographic factors associated with smoking behaviour were conducted. Gender and ethnicity differences were observed, although the association between smoking and deprivation was less clear. The development of smoking behaviour among an understudied group, ‘one time triers’ of cigarettes, was tracked, revealing that even brief experimentation with cigarettes leads to a lasting vulnerability for later smoking. Second, social factors associated with smoking were examined and the association between smoking by friends, parents and step-parents and adolescent smoking documented. An independent relationship between early dating and later smoking was also revealed. Third, psychological factors associated with adolescent smoking were identified, and the lack of a prospective relationship between attitudes towards smoking and smoking behaviour was confirmed. Fourth, significantly smaller increases over time in BMI and waist, but not height, were observed among smokers compared with non-smokers. Finally, a population level model of the vulnerability and trigger factors associated with smoking, based on an individual level theory of motivation, was constructed. The findings presented extend current literature on adolescent smoking and have implications for effective prevention strategies.