Determinants of tobacco use among Korean female adolescents: Longitudinal test of the theory of triadic influence

• Social factors including parental supervision, attachment to friends, and peer smoking prevalence caused adolescent smoking.
• Stigma on the distal level and attitude towards smoking on the proximal level were significant attitudinal factors.
• Among intrapersonal factors, self-control on the distal level and stress on the proximal level were significant.

This study aimed to examine the influences of social, attitudinal, and intrapersonal factors at three levels on tobacco use among female adolescents in South Korea using longitudinal national data. The study analyzed data from the Korean Youth Panel Study, with a study population consisting of middle-school second-graders (N = 1594). Using time dependent Cox regression, our analyses yielded the following main findings: the theory of triadic influence was verified to provide a theoretical framework for smoking among Korean female adolescents. All of the social factors at the three levels, including parental supervision, attachment to friends, and peer smoking prevalence, were found to influence tobacco use among Korean female adolescents. Stigma on the distal level and attitude towards smoking on the proximal level were significant attitudinal factors. Among intrapersonal factors, self-control on the distal level and stress on the proximal level were found to be significant. The study findings suggest that including parental education and promoting attachment to non-smoking friends, as well as enhancing sound relationships with them, would provide an effective strategy for the prevention and cessation of smoking. Prevention and cession should include strategies that alleviate stigma and stress, and improve negative attitude toward smoking and the level of self-control.