Cigarette use among Israeli adolescents: Why do they smoke?

Background: Efforts to prevent adolescents from smoking have limited efficacy, with little understanding of why they smoke. We examine many of the factors which may influence a teenager's decision to start smoking. Methods: A self-completed questionnaire was distributed among pre-draft teenagers (age 16-18 years) with questions regarding current smoking habits as well as smoking habits of family members. Smokers were asked why they started, and attitudes regarding the dangers of smoking and anti-smoking legislation were examined. Results: A total of 1067 questionnaires were completed (707 males, 360 females). In all, 25.7% were current smokers (26.2% of male and 21.1% of females; p=0.069), with smoking rates highest among those born in Middle Eastern countries and lowest among those born in Ethiopia. Those from single-parent families had a higher smoking rate (relative risk: 1.28), as did those with either parents or siblings who smoked. Parents who were smokers were more likely to tell their children not to smoke, while smoking teenagers were more likely to have been told by their parents not to smoke. Most smokers (58.2%) did not give a specific reason for smoking while 30.3% listed "peer pressure", 8.4% "parents smoking" and 3.1% "advertisements" as the major factor. Smokers were less likely to agree that smoking is harmful and more likely to oppose anti-smoking legislative measures. Conclusions: Many factors influence a teenager's decision to smoke, including cultural norms and habits of friends and family members. Educating both adolescents and those around them may help prevent smoking among this age group.