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.

Smoking uptake among Saudi adolescents: tobacco epidemic indicators and preventive actions needed.

The aim of this cross-sectional school-based study was to assess smoking prevalence, indicators for the smoking epidemic and determinants of smoking among Saudi adolescents. The study included 695 male adolescents from 11 to 16 years of age who filled out self-report questionnaires based on the European Smoking Framework Approach questionnaire, which uses the I-Change model to assess attitude, social influence and the self-efficacy of the participants. Smokers were 275 (39.6%) adolescents. Smokers tended to receive more daily pocket money, live in more affluent families and show lower academic performance. Non-smokers were inclined to believe that smoking may help people to feel relaxed and confident, encountered less social influences to smoke than smokers, but reported low self-efficacy not to smoke when with smoker friends and when offered a cigarette. Smokers reported the lowest self-efficacy not to smoke in all situations assessed. The results suggest the smoking epidemic among male Saudi adolescents may still be in the early stages, providing ample opportunity for preventive actions aimed at halting the further progress of this epidemic. Secondly, smoking prevention programs in Saudi Arabia need to reinforce non-smoking attitudes, address how to resist pressure to smoke, and how to develop high self-efficacy towards non-smoking in various situations.

Effects of a randomized controlled trial to assess the six-months effects of a school based smoking prevention program in Saudi Arabia.

OBJECTIVE: To examine the efficacy of a smoking prevention program which aimed to address smoking related cognitions and smoking behavior among Saudi adolescents age 13 to 15. METHOD: A randomized controlled trial was used. Respondents in the experimental group (N=698) received five in-school sessions, while those in the control group (N=683) received no smoking prevention information (usual curriculum). Post-intervention data was collected six months after baseline. Logistic regression analysis was applied to assess effects on smoking initiation, and linear regression analysis was applied to assess changes in beliefs and analysis of covariance (ANCOVA) was used to assess intervention effects. All analyses were adjusted for the nested structure of students within schools. RESULTS: At post-intervention respondents from the experimental group reported in comparison with those from the control group a significantly more negative attitude towards smoking, stronger social norms against smoking, higher self-efficacy towards non-smoking, more action planning to remain a non-smoker, and lower intentions to smoke in the future. Smoking initiation was 3.2% in the experimental group and 8.8% in the control group (p<0.01). CONCLUSION: The prevention program reinforced non-smoking cognitions and non-smoking behavior. Therefore it is recommended to implement the program at a national level in Saudi-Arabia. Future studies are recommended to assess long term program effects and the conditions favoring national implementation of the program.