Social-cognitive and school factors in lifetime smoking among adolescents

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.