Correlates of Susceptibility to Smoking among Secondary School Students in Kota Tinggi District, Johor, Malaysia

  • Published : 2013.11.30


Background: Smoking among adolescents has been linked to a variety of adverse and long term health consequences. "Susceptibility to smoking" or the lack of cognitive commitment to abstain from smoking is an important predictor of adolescent smoking. In 2008, we conducted a study to determine the psycho-sociological factors associated with susceptibility to smoking among secondary school students in the district of Kota Tinggi, Johor. Materials and Methods: Two thousand seven hundred students were randomly selected by proportional stratified sampling. Analyses on 1,736 non-smoking students revealed that prevalence of adolescents susceptible to smoking was 16.3%. Results: Male gender (aOR=2.05, 95%CI= 1.23-3.39), poor academic achievement (aOR 1.60, 95%CI 1.05-2.44), ever-smoker (aOR 2.17, 95%CI 1.37-3.44) and having a smoking friend (aOR 1.76, 95%CI 1.10-2.83) were associated with susceptibility to smoking, while having the perception that smoking prohibition in school was strictly enforced (aOR 0.55, 95%CI 0.32-0.94), and had never seen friends smoking in a school compound (aOR 0.59, 95%CI 0.37-0.96) were considered protective factors Conclusions: These results indicate that follow-up programmes need to capitalise on the modifiable factors related to susceptibility to smoking by getting all stakeholders to be actively involved to stamp out smoking initiation among adolescents.


Susceptibility;adolescents smoking;Kota Tinggi;Malaysia;psycho-socio factors


  1. Albers AB, Biener L, Siegel M, Cheng DM, Rigotti N (2008). Household smoking bans and adolescent antismoking attitudes and smoking initiation: findings from a longitudinal study of a Massachusetts youth cohort. Am J Public Health, 98, 1886-93.
  2. Arnett J, Jensen LA (1994). Socialization and risk behavior in two countries: Denmark and the United States. Youth Soc, 6, 3-22.
  3. Ayo-Yusuf OA, Rantao MM (2013). Influence of rural non smoking adolescents’ sense of coherence and exposure to household smoking on their commitment to a smoke-free lifestyle. Int J Environ Res Public Health, 10, 2427-40.
  4. Azagba S, Absridge M (2013). School Connectedness and susceptibility to smoking among adolescents in Canada. Nicotine Tob Res, 15, 1458-63.
  5. Baumrind D (1991). Effective parenting during the early adolescent transition. In Family Transitions. Edited by Cowan PA, Hetherington M. Hillsdale, NJ: Lawrence Erlbaum, 111-65.
  6. Bhojani UM, Elias MA, Devadesan N (2011).Adolescents' perceptions about smokers in Karnataka, India. BMC Public Health, 11, 563.
  7. Biener L, Cullen D, Di ZX, Hammond SK (1997). Household smoking restrictions and adolescents' exposure to environmental tobacco smoke. Prev Med, 26, 358-63.
  8. Bryant AL, Schulenberg J, Bachman JG, O'Malley PM, Johnston LD (2000). Understanding the links among school misbehavior, academic achievement and cigarette use: A national panel study of adolescent. Prev Sci, 1, 71-87.
  9. Buller DB, Borland R, Woodall WG, et al (2003). Understanding factors that influence smoking uptake. Tob Control, 12, 16-25.
  10. Carvajal SC, Anson CH, Downing RA, Coyle KK, Pederson LL (2004). Theory-based determinants of youth smoking: a multiple influence approach. J Appl Soc Psychol, 34, 59-84.
  11. Castrucci BC, Gerlach KK, Kaufman NJ, Orleans CT (2002). The association among adolescents' tobacco use, their beliefs and attitudes, and friends' and parents' opinions of smoking. Matern Child Health J, 6, 159-67.
  12. Chan WC, Leatherdale ST (2011). Tobacco retailer density surrounding schools and youth smoking behaviour: a multi-level analysis. Tob Induc Dis, 9, 9.
  13. Chen J, Millar WJ (1998). Age of smoking initiation: implications for quitting. Health Rep, 9, 39-46.
  14. Chen PL, Huang WG, Chao KY (2009). Susceptibility to initiate smoking among junior and senior high school nonsmokers in Taiwan. Prev Med, 49, 58-61.
  15. Chen W, Bottorff JL, Johnson JL, Saewyc EM, Zumbo BD (2008). Susceptibility to smoking among White and Chinese nonsmoking adolescents in Canada. Public Health Nurs, 25, 18-27.
  16. Chen CY, Lim IF, Huang SL, Tsai TI, Chena YY (2013). Dispoable income with tobacco smoking among Young adolescents: a multilevel analysis. J Adolesc Health, 52, 724-30.
  17. Collins LM, Sussman S, Rauch JM, et al (1987). Psychosocial predictors of young adolescent cigarette smoking: A sixteen-month, three-wave longitudinal study. J Appl Soc Psychol, 17, 554-73.
  18. Difranza JR, Sargent JD, Weitzman M, Hipple BJ, Winickoff JP (2006). Tobacco promotion and the initiation of tobacco use: assessing the evidence of causality. Pediatric, 117, 1237-48.
  19. Elder JP, Campbell NR, Litrownik AJ et al (2000). Predictors of cigarette and alcohol susceptibility and use among hispanic migrant adolescents. Prev Med, 31, 115-23.
  20. Elton-Marshall T, Leatherdale ST, Burkhalter R, Stephen-Brown K (2013). Changes in tobacco use, susceptibility to future smoking, and quit attempts among Canadian youth over time: A comparison of off-reserve Aboriginal and Non-Aboriginal Youth. Int J Environ Res Public Health, 10, 720-41.
  21. Ertas N (2007). Factors associated with stages of cigarette smoking among Turkish youth. Eur J Public Health, 17, 155-61.
  22. Evans N, Gilpin E, Farkas AJ, Shenassa E, Pierce JP (1995). Adolescents' perceptions of their peers' health norms. Am J Public Health, 85, 1064.
  23. Flay BR, Petraitis J, Hu FB (1999). Psychosocial risk and protective factors for adolescent tobacco use. Nicotine Tob Res, 1, 59-65.
  24. Fisher LB, Winickoff JP, Camargo CA Jr, Colditz GA, Frazier AL (2007). Household smoking restrictions and adolescent smoking. Am J Health Promot, 22, 15-21.
  25. Fleming R, Leventhal H, Glynn K, Ershler J (1989). The role of cigarettes in the initiation and progression of early substance use. Addic Behav, 14, 261-72.
  26. Forrester K, Biglan A, Severson HH, Smolkowski K (2007). Predictors of smoking onset over two years. Nicotine Tob Res, 9, 1259-67.
  27. Griesbach D, Currie C (2001). CAS Fact Sheet 5: news from the international study: Smoking, school achievement and educational aspirations among Scottich adolescents. Child and Adolescent Health Research Unit (CAHRU), Edinburgh: University of Edinburgh; 2001.
  28. Gritz ER, Prokhorov AV, Hudmon KS, et al (2003). Predictors of susceptibility to smoking and ever smoking: A longitudinal study in a triethnic sample of adolescents. Nicotine Tob Res, 5, 493-506.
  29. Guindon GE, Georgiades K, Boyle MH (2008). Susceptibility to smoking among South East Asian youth: a multilevel analysis. Tob Control, 17, 190.
  30. Hammond D (2005). Smoking behaviour among young adults: beyond youth prevention. Tob Control, 14, 181-5.
  31. Hanjeet K, Wan Rozita WM, Amal NM (2001) Risk Factors among secondary school adolescents in Kuala Lumpur. Int Med Res J, 5, 59-63.
  32. Huang M, Hollis J, Polen M, Lapidus J, Austin D (2005). Stages of smoking acquisition versus susceptibility as predictors of smoking initiation in adolescents in primary care. Addict Behav, 30, 1183-94.
  33. Huang C, Koplan C, Liu J, et al (2012). Smoking susceptibility and its predictors among adolescents in China: Evidence from Ningbo City. J Addict Res Ther, 8, 4.
  34. Jackson C (1998). Cognitive susceptible to smoking and initiation of smoking during childhood. A Longitudinal study. Prev Med, 27, 129-34.
  35. Jeganathan PD, Noran HH, Al Sadat N, Chinna K (2013). Smoking stage relations to peer, school and parental factors among secondary school students in Kinta, Perak. Asian Pac J Cancer Prev, 14, 3483-9.
  36. Kandel DB (1996). The parental and peer contexts of adolescent deviance. An algebra of interpersonal influences. J Drug Issues, 26, 289-315.
  37. Kentala J, Utriainen P, Pahkala K, Mattila K (2004). Verification of adolescent self-reported smoking. Addict Behav, 29, 405-11.
  38. Kong G, Camenga D, Cavallo D, et al (2012). The Role of ethnic pride and parental disapproval of smoking on smoking behaviors among minority and white adolescents in a suburban high school. Am J Addict, 21, 424-34.
  39. Leatherdale ST, Broen SK, Cameron R, Mcdonald PW (2005) Social modeling in the school environment, student characteristics, and smoking susceptibility: A multi-level analysis. J Adolescent Health, 37, 330-6.
  40. Leventhal H, Cleary PD (1980). The smoking problem: a review of the research and theory in behavioral risk modification. Psychol Bull, 88, 370-405.
  41. Lim KH, Kee CC, Sumarni MG, Norhamimah A, Amal NM (2011). Susceptibility to smoking as a reliable predictor of smoking initiation among adolescents. Med and Heal, 6, 49-58.
  42. Lim KH, Amal NM, Hanjeet K, et al (2006). Prevalence and factors related to smoking among secondary school students in Kota Tinggi District, Johor, Malaysia. Trop Biomed, 23, 75-84.
  43. Marshall L, Schooley M, Ryan H, et al (2006). Youth tobacco surveillance-United States, 2001-2002. Morbidity and Mortality Weekly Report CDC Surveill Summ, 55, 1-56.
  44. Martinez-Donate AP, Johnson-Kozlow M, Hovell MF, Guillermo J, Perez G (2009). Home smoking bans and secondhand smoke exposure in Mexico and the US. Prev Med, 48, 207-12.
  45. McLeod JD, Uemura R, Rahrman S (2012). Adolescent mental health, Behavior problems ,and academic achievement. J Health Soc Behav, 53, 482-97.
  46. Morin AJS, Rodriguez D, Fallu JS, Maiano C, Janosz M (2011). Academic achievement and smoking initiation in adolescence: a general growth mixture analysis. Addict, 107, 819-28.
  47. Norsiah Ali (2013). Smoking Cessation: Bringing aspiration into reality.
  48. Ozturk C, Kahraman S, Bektas M (2013). Effects of perceived parental attitudes on children's views of smoking. Asian Pac J Cancer Prev, 14, 2615-9.
  49. Page RM, Nguyen TH, Hoang KC, Truong QT (2012). Social normative beliefs about smoking among Vietnamese adolescents. Asia Pac J Pub Hlth, 24, 68-81.
  50. Park SB, Yoon SN, Yi YJ, Cui WY, Nam B (2011). Prevalence and risk factors of adolescents smoking: difference between Korean and Korean-Chinese. Asian Nurs Res, 5, 189-95.
  51. Pennanen M, Haukkala A, De Vries H, Vartiainen E (2011). Academic achievement and smoking: Is self-efficacy an imporatnt factor in understanding social inequalities in finnish adolescents? Scand J Public Hlth, 39, 714-22.
  52. Pierce JP, Gilpin EA (1996). How long will today's new adolescent smokers be addicted to cigarettes? Am J Public Health, 86, 253-6.
  53. Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK (1996). Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol, 15, 335-61.
  54. Primack BA, Switzer GE, Dalton MA (2007). Improving measurement of normative beliefs involving smoking among adolescents. Arch Pediatr Adolesc Med, 161, 434-9.
  55. Proescholdbell RJ, Chassin L, MacKinnon DP (2000). Home smoking restrictions and adolescent smoking. Nicotine Tob Res, 2, 159-67.
  56. Sargent JD, Dalton M (2001). Does parental disapproval of smoking prevent adolescents from becoming established smokers? Pediatrics, 108, 1256-62.
  57. Schultz ASH, Nowatzki J, Dunn DA, Griffith EJ (2010). Effects of socialization in the household on youth susceptibility to smoking: a secondary analysis of the 2004/05 Canadian Youth Smoking Survey. Chronic Dis Can, 30, 71-7.
  58. Szabo E, White V, Hayman J (2006). Can home smoking restrictions influence adolescents' smoking behaviors if their parents and friends smoke? Addict Behav, 31, 2298-303.
  59. Unger JB, Stoddard CA, Nezemi E, Chou CP (1997). Identification of adolescents at risk for smoking initiation: Validation of a measure of susceptibility. Addic Bahav, 22, 81-91.
  60. Vazques-Rodrigues CF, Vazquez-Nava F, Vazques-Rodrigues EM, et al (2012). A Smoking in Non-student Mexican adolescents with Asthma, Relation with family structure, educational al level, parental approval of smoking, parents who smoke, and smoking friends. Arch Bronconeumol, 48, 37-42.
  61. Waa A, Edwards R, Newcombe R, et al (2011). Parental behaviours, but not parental smoking, influence current smoking and smoking susceptibility among 14 and 15 year-old children, Aust N Z J Public Health, 35, 530-6.
  62. Wilkinson AV, Waters AJ, Vasudevan V, et al (2003). Correlates of susceptibility to smoking among Mexican origin youth residing in Houston, Texas: A cross-sectional analysis. BMC Public Health, 8, 337.
  63. Wilson JS, Elborn JS, Fitzsimons D, McCrum-Gardner E (2011). Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation. Int J Nurs Stud, 48, 856-62.
  64. Wiwon SY, Leatherdale ST, Ahmad R (2011). Smoking susceptibility among never smokers: Data from the 2006-07 Youth Smoking Survey. Can J Public Health, 102, 254-7.
  65. Zhu BP, Liu M, Shelton D, Liu S, Giovino GA (1996). Cigarette smoking and its risk factors among elementary school students in Beijing. Am J Public Healt, 86, 368-75.

Cited by

  1. Prevalence and Factors Associated with Smoking Intentions among Non-smoking and Smoking Adolescents in Kota Tinggi, Johor, Malaysia vol.15, pp.10, 2014,
  2. Susceptibility to cigarette smoking among secondary and high school students from a socially disadvantaged rural area in Poland vol.14, pp.1, 2016,
  3. Susceptibility to cigarette smoking and associated factors among high school students in western Ethiopia vol.11, pp.1, 2018,