Smoking behaviors and intentions among adolescents in rural China: The application of the Theory of Planned Behavior and the role of social influence

• This study examined factors associated with smoking among adolescents in rural China.
• Attitudes, peer influence and subjective norms were associated with ever smoking.
• Attitudes, peer influence and perceived control were related to regular smoking.
• Attitudes, peer influence and perceived control were related to current smoking.
• Attitudes, peer influence and perceived control were related to smoking intention.

IntroductionThis study investigated the associations between the variables of the theory of planned behavior (TPB), influence of significant others, and smoking intentions and behaviors among adolescents living in rural southern China.MethodsA cross-sectional study was conducted among 2609 students in two junior high schools in rural Shantou, Guangdong province, using a self-administered questionnaire. Logistic regression models were fitted to estimate univariate and adjusted odds ratios and corresponding 95% confidence intervals.ResultsMultivariate analyses showed that having favorable attitudes towards smoking on psychological and social aspects, perceived behavioral control, and having most friends who were current smokers were significantly associated with smoking intentions in the next six months and in the next five years. Having most family members who were current smokers was also significantly related to smoking intention in the next five years. Having favorable attitudes towards smoking on psychological aspect and negative attitudes on physical aspect, perceived support from friends on smoking, and having most friends and senior relatives being current smokers were significantly associated with increased likelihood of ever smoking. Perceived behavioral control and having most friends being current smokers were also significantly associated with regular smoking and smoking in the past 30 days.ConclusionsOur results suggest that the key constructs of the TPB model and friends' smoking behaviors play important roles in accounting for smoking intentions and behaviors among a sample of rural Chinese adolescents.