Why to smoke? why not to smoke? Major reasons for children's decisions on whether or not to smoke

Abstract

This study, aimed at the primary prevention of smoking behaviour in children and adolescents, attempts to find the main factors that distinguish smokers and non-smokers in the period of their first experimentation with cigarettes. There are only a few studies dealing with investigations into current motivations of teenagers as to whether or not to smoke. The programme entitled "Normal is not to smoke", using evaluation questionnaires given to children in the 3rd and 5th classes, also contains - among many other things - specifics on reasons children have for making the decision whether to become a smoker or non-smoker. The results are reported in this paper. Methodology: Responses concerning potential inclination to smoking that were collected from children on the basis of questionnaires were categorized into the following groups: image, the influence of a role model, the effects of smoking, curiosity. Reasons for non-smoking were categorized into the following groups: health, aesthetic, economic, restrictive, other aspects. Children were also asked to describe smokers by using three pairs of opposite characteristics: education, success, wealth. The frequencies of answers were analysed for the whole set, for boys and girls and for children with different smoking behaviour; the differences were evaluated using the statistical programme EPI INFO, version 6. Results: A total of 1153 children in the 3rd class and 799 children in the 5th class completed the questionnaire. Motivations for smoking were given by nearly 17% of children in the 3rd class and by nearly 27% of the same cohort in the 5th class. Aspects such as image (41.9% vs. 46.2%) were mentioned most frequently, by boys more frequently than by girls (OR 1.77; 95% CI 0.93-3.36; p=0.06), by children from smokers' families more frequently than by children from non-smokers' families (OR 1.33; 95% CI 0.69-2.57; p=0.3) and more frequently by children with repeated attempts to smoke (OR 3.93; 95% CI 2.32-6.65) or children who had only had a single smoking attempt (OR 3.18; 95% CI 1.52-6.75). Also the role of models (parents, relatives, friends) was often mentioned (12.9% in the 3rd class and 10.2% in the 5th class). Potential beneficial effects of smoking were expressed by 13% of children in the 3rd class and by 55% of children in the 5th class (p<0.0001). About 40 % of children considered smoking as effective coping with stress and about 20% of them declared smoking for mood improvement. Beneficial effects of smoking significantly more often described children with repeated smoking attempts (OR 2.91; 95% CI 1.73-4.89; p<0.001). Children often linked smoking to the less educated and less successful social groups but also to the rich. In both investigations, health aspects were the most common reasons for choosing not to smoke (69.2% vs. 73.3%), being more frequently presented by girls and non-smokers. A significant shift in the negative aesthetic perception of smoking (14.1% in the 3rd class vs. 40.2% in the 5th class) and economic disadvantages of smoking (3.9% vs. 24.8%) was observed in the given period of time. Restrictive reasons were given only rarely by pupils in the 3rd class (0.7%), unlike pupils in the 5th class who feared the reaction of their parents (24.8%). Conclusion: Our study provides an overview of current motivations in children aged 9 and 11 years that are crucial for their future smoking/nonsmoking behaviour. The results of the study are important for developing a strategy for the primary prevention of smoking in school programmes and for introducing a general social approach to address the problem of the decreasing age of smoking initiation.