Identification of factors promoting abstinence from smoking in a cohort of elementary schoolchildren

Background. Despite the progress made in smoking prevention among youth, few scientific reports have identified the determinants underlying the abstinence from cigarettes, and even fewer have made an assessment of their evolution over time. It has been proposed that this could be done by modeling after theoretical frameworks. Methods. A self-reported questionnaire developed according to Ajzen's Theory of Planned Behavior was repeatedly administered to a cohort of 373 grade 5 students (191 girls and 182 boys) during their transition from elementary to secondary school. Four measures spanning a 26-month period were thus obtained and analyzed according to the GEE method. Results. After 26 months, 76.14% of the students in the sample remained abstinent from cigarettes. The perceived smoking behaviors of friends and of a brother, intention over time, perceived self-efficacy, parental supervision, and socioeconomic status predicted the maintenance of abstinence from smoking. The final predictive model had a sensitivity of 79.8% and a specificity of 75.6%, with an average rate of accurate classification of 79.1%. Conclusions. The predictive model yielded by this study represents an important step toward developing tools to help 10-12 years olds maintaining their abstinent behavior. It emphasizes positive protective factors and guides health promoters in the choice of their interventions' contents and targets. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.