The study extends previous research on adults by assessing the role of cognitive factors of smoking behaviour in 885 teenagers

Griffiths, MD

Umeh, K

English

Nottingham Trent Institutional Repository (IRep)

Cardiovascular disease is the leading causeof death in the UK, accounting for over200,000 deaths each year.Health experts now accept that cigarettesmoking is one of the main modifiable risk fac-tors for cardiovascular disease and it isestimated that smoking accounts for about onein five of these deaths. While the percentage ofadult cigarette smokers continues to decline,the prevalence of regular smoking among sec-ondary school girls (11%) has shown littledecrease since 1982, although smoking in boyshas fallen slightly (11% to 8%). Since manyhealth-compromising habits have their originsin adolescence, identifying the psychologicalpredictors of smoking in this age group mayhave significant implications for public health.Current health behaviour models proposethat health-related decisions are determined by(i) perceptions of vulnerability to ill health, (ii)the seriousness of disease, (iii) the benefits ofpreventive action in averting disease, and (iv)capacity to adopt preventive behaviour. Riskybehaviour (such as smoking) is least probablewhen people believe that the danger is serious(severity), feel that they are personally at risk(vulnerability), believe that preventive actionwill effectively diminish the risk (benefits), andperceive few obstacles to or feel capable of tak-ing preventive action (self- efficacy). Thus,people are least likely to smoke if they feel vul-nerable to cardiovascular disease (or otherrisks), perceive the disease as life-threatening,believe that not smoking will reduce the risk,and feel able to perform these preventivebehaviours.Several studies focusing on adults havecompared the predictive profiles of cognitivefactors of cigarette use. By and large, this litera-ture has shown strong relations between riskbehaviours and cognitive factors (especiallyself-efficacy). Risk perceptions have fared rela-tively poorly as predictors, especially inanalysis accounting for self-efficacy, perceivedbenefits, and past behaviour. Predictive powerhas differed across risk behaviours. For exam-ple, some researchers have found thatperceived susceptibility to serious illness pre-dicts cigarette use, but not physical activity, orconsumption of fried foods. By contrast, per-ception of health benefits predicted fried foodintake and exercise, but not smoking. Self-effi-cacy predicted dietary fat consumption andsmoking cessation but not physical exercise. Anumber of conditions may account for these dif-ferentials. For instance, in behaviours wherethe benefits are widely understood, (such assmoking), risk perceptions may play a morecrucial role.Our own research in this area has exploredthe extent to which perceptions of risk, benefits,and self-efficacy, predict cardiovascular riskbehaviours in adolescents. Our focus has beenon intention rather than behaviour in view ofVol. 19 No.4, 2001 Education and Health 31Today’s adolescents continue to be at risk for cardiovascular disease later in life, and need assistance inavoiding cigarettes. Health promotion initiatives need to be behaviour-specific to maximise theireffectiveness.Kanayo Umeh and Mark GriffithsAdolescent smoking:Behavioural risk factors andhealth beliefsThe study extends previous research on adultsby assessing the role of cognitive factors ofsmoking behaviour in 885 teenagers.The prevalence ofregular smokingamong secondaryschool girls (11%)has shown littledecrease since1982.Kanayo Umeh isand Dr Mark Griffiths is aReader in Psychology in thePsychology Division,Nottingham Trent University.the growing acceptance that health behaviourmodels are primarily concerned with explain-ing people’s motivation to perform a healthbehaviour. In one of our studies we gave out aquestionnaire to 885 teenagers (aged 13 to 17years; mean age 14.47 years) that assessedhealth beliefs, behavioural risk factors, inten-tions, and demographic variables. Cigaretteuse was measured with five options adaptedfrom previous surveys of school children.These were ‘never smoked’, ‘tried smokingonce’, ‘used to smoke’, ‘occasional smoker’, and‘regular smoker’. Perceptions of vulnerabilityand severity were assessed in relation to heartdisease and stroke. Our respondents were alsoasked to rate the seriousness to their own healthof each disease on a 10-point scale ranging from‘not at all serious’ to ‘very serious’. They werealso asked to estimate the probability that theywould contract each disease by the age of 40,using a 10-point scale from ‘not at all likely’ to‘very likely’. Assessing people’s perceptions ofrisk concerning CHD and stroke may be prob-lematic if they are unaware of these particularhealth problems. However, research suggeststhat young people are generally aware of thelink between cardiovascular disease and associ-ated behavioural risk factors, especiallysmoking.Perceived benefits and self-efficacy wereassessed in relation to behavioural risk factors,Participants indicated the degree to which theybelieved not smoking reduced their chances ofdeveloping health problems. Responses weremade on a 10-point scale from ‘no, not at all’ to‘yes, very much’. Respondents also estimatedthe extent to which they thought they couldavoid smoking cigarettes if they wanted to.Answers were also made on a 10-point scalefrom ‘no I don’t’ to ‘yes, I do’. To assess behav-ioural intention, participants indicated onanother 10-point scale the extent to which theyintended to smoke cigarettes during the nexttwo months (‘no, I don’t’ to ‘yes, I do’).So what did we find? Just over a third ofrespondents (35%) had never smoked, 19% hadtried smoking once, 17% used to smoke, 8%were occasional smokers, and 21% were regularsmokers. Preliminary analyses showed thatdemographic factors and past behaviour weresignificantly associated with intentions mea-sures across smoking. Health beliefs aboutsmoking also showed significant correlationswith intentions, with perceived self-efficacyand benefits showing the strongestassociations.We also tried to identify important predic-tor variables. Age and measures of pastbehaviour predicted intended cigarette use,with older age, occasional smoking, regularsmoking, and having smoked in the past, relat-ing to stronger intentions to smoke. Theaddition of cognitive factors revealed self-effi-cacy and severity of cardiovascular disease asimportant factors. Lower perceived ability toavoid smoking and higher perceived severity ofcardiovascular illness predicted stronger inten-tions to smoke. Age, occasional smoking,regular smoking and having smoked previ-ously remained significant, but no othercognitions were salient.So what did our results tell us? Prevalencepatterns for smoking were roughly comparableto trends reported in other surveys. Just over athird of our respondents had never smokedwhile just over one in five were regular smok-ers. Our study demonstrated perceivedself-efficacy consistently predicted smokingintentions, and that severity estimates were pre-dictive of smoking intentions. Our studyextends previous research on adults by assess-ing the role of cognitive factors of smokingbehaviour in adolescents. The consistent asso-ciation between self-efficacy and intentionsendorses previous reviews of empirical tests ofthis construct.The significance of self-efficacy suggests adiminished role for perceived benefits of smok-ing, reflecting the view of outcome expectanciesas antecedent cognitions which serve to stimu-late self-efficacy considerations. Previousexperimental research has found that informa-tion about health benefits affects intentions onlyunder conditions of low self-esteem. Whilecross-sectional correlations do not determinedirectional inferences, the relationship of per-ceived severity of CHD with smokingintentions suggest that adolescents based theirrisk perceptions on future risk behaviour.Interestingly, perceptions of vulnerabilitywere unrelated to intentions. Previous studieshave reported positive associations betweenadolescents’ perceived vulnerability to lungcancer and cigarette smoking. Evidence sug-gests that young people more closely associatecigarette use with lung cancer than with CHD.This seems to be reflected in risk percep-tion-intention relations, and mirrors nationalstatistics showing that, while 90% of all lungcancer mortality is attributable to cigarette use,only 18% and 11% of deaths from CHD andstroke, respectively, are connected with smok-ing. In short, it appears that although smokingincreases the likelihood of cardiovascular dis-ease the threat is simply too remote to be.Nevertheless, adolescents anticipating future32 Education and Health Vol. 19 No. 2, 2001Evidence suggeststhat young peoplemore closelyassociate cigaretteuse with lungcancer than withchronic heartdisease.risk behaviour expect the consequences, nomatter how improbable, to be dire. Demo-graphic factors were also predictive ofintentions, with older respondents being moreprone to smoke than younger teenagers.In conclusion, our findings demonstrate thepredictive profile of cognitive factors in relationto smoking and cardiovascular risk behavioursin adolescents.Health promotion initiatives need to bebehaviour-specific to maximise their effective-ness. Today’s adolescents continue to be at riskfor cardiovascular disease later in life, and needassistance in avoiding cigarettes. Improvingself-efficacy beliefs may encourage healthierhabits although, considering the importance ofpast behaviour, efforts to discourage smokingought to target younger adolescents before theyVol. 19 No.4, 2001 Education and Health 33...efforts todiscourage smokingought to targetyoungeradolescents beforethey startexperimenting.

Adolescent smoking: behavioural risk factors and health beliefs

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