RESEARCH PAPER
Towards a better understanding of factors affecting smoking uptake among Saudi male adolescents: A qualitative study
 
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1
Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
2
College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
CORRESPONDING AUTHOR
Mutaz Mohammed   

Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, 6200, MD, The Netherlands
Publication date: 2020-05-15
Submission date: 2020-02-25
Final revision date: 2020-03-29
Acceptance date: 2020-04-01
 
Tob. Prev. Cessation 2020;6(May):29
KEYWORDS
TOPICS
ABSTRACT
Introduction:
An increased smoking uptake by Saudi male adolescents and a lack of data about its determinants emphasize the need for a better understanding of factors leading to the onset of smoking and identifying ways to prevent it. The aim of this qualitative study is to explore adolescents’ views on smoking and their opinions about a smoking prevention program.

Methods:
A total of 103 school-going adolescents, aged 12–16 years, were purposely selected from grades seven, eight and nine from nine schools in Taif in Saudi Arabia. They were interviewed in 11 focus group discussions; five groups were held for smokers and six for non-smokers. An interview scheme was developed based on the I-Change Model, a model used for understanding smoking onset and prevention. We used QDA Lite version 2:0 software for data analysis.

Results:
Most of the participants agreed on the importance of social influences as determining factors to start smoking. The presence of smoking friend(s) and family member(s), especially the father, were mentioned. Factors such as having extra pocket money, absence of alternatives, showing off, to be seen as western, to be seen as an adult and the good taste of cigarettes were also mentioned as beliefs associated with smoking. Adolescents indicated to have low confidence not to smoke under peer pressure, suggesting self-efficacy problems. Intentions to smoke were also often mentioned. Almost all participants agreed that an interactive approach is optimal for an effective smoking prevention program.

Conclusions:
Determinants of smoking seem to be very similar to those outlined by previous studies. A smoking prevention program for Saudi adolescents should address how to cope with social pressure to smoke, the advantages connected with smoking, and how to increase self-efficacy. Information should be presented in an interactive rather than static way.

ACKNOWLEDGEMENTS
We would like to thank the participating schools, the schools’ principals and the participating students. Special thanks for Fahad Alotaibi who was in charge of the audio-visual recording and Ahmed Alzahrany who arranged the school visits.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (36)
1.
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. Atlanta, GA: Centers for Disease Control and Prevention; 2010.
 
2.
Mermelstein R. Moving tobacco prevention outside the classroom. The Lancet. 2008;371(9624):1556-1557. doi:10.1016/S0140-6736(08)60668-6
 
3.
Evans RI, Henderson A, Raines B. Smoking in children and adolescents: psychosocial determinants and prevention strategies. NIDA Res Monogr. 1979;(26):69-96. doi:10.1037/e497372006-006
 
4.
Peterson AV, Kealey KA, Mann SL, Marek PM, Sarason IG. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention--results on smoking. J Natl Cancer Inst. 2000;92(24):1979-1991. doi:10.1093/jnci/92.24.1979
 
5.
de Vries H, Mudde A, Kremers S, et al. The European Smoking Prevention Framework Approach (ESFA): short-term effects. Health Educ Res. 2003;18(6):649-663. doi:10.1093/her/cyg033
 
6.
Campbell R, Starkey F, Holliday J, et al. An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. Lancet. 2008;371(9624):1595-1602. doi:10.1016/S0140-6736(08)60692-3
 
7.
Flay BR. School-based smoking prevention programs with the promise of long-term effects. Tob Induc Dis. 2009;5(March). doi:10.1186/1617-9625-5-6
 
8.
Panday S, Reddy SP, Ruiter RA, Bergström E, de Vries H. Determinants of smoking among adolescents in the Southern Cape-Karoo region, South Africa. Health Promot Int. 2007;22(3):207-217. doi:10.1093/heapro/dam018
 
9.
Farajat MA. Beliefs of tenth grade Jordanian students regarding cigarette smoking. Implications for prevention. Saudi Med J. 2010;31(7):831-832. PMID:20635022.
 
10.
de Vries H, Weijts W, Dijkstra M, Kok G. The utilization of qualitative and quantitative data for health education program planning, implementation, and evaluation: a spiral approach. Health Educ Q. 1992;19(1):101-115. doi:10.1177/109019819201900107
 
11.
Bryman A. Quantitative and qualitative research: further reflections on their integration, in Mixing methods: Qualitative and quantitative research. London, United Kingdom: Routledge; 2017. doi:10.4324/9781315248813-3
 
12.
Sheer VC, Mao CM, Chen YR. Focus Group Findings of Smoking Onset Among Male Youth in China. Subst Use Misuse. 2017;52(7):866-874. doi:10.1080/10826084.2016.1264972
 
13.
Krølner R, Rasmussen M, Brug J, Klepp KI, Wind M, Due P. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies. Int J Behav Nutr Phys Act. 2011;8:112. doi:10.1186/1479-5868-8-112
 
14.
Newman P, Fantus S, Woodford M, Rwigema MJ. “Pray That God Will Change You”: The Religious Social Ecology of Bias-Based Bullying Targeting Sexual and Gender Minority Youth-A Qualitative Study of Service Providers and Educators. Journal of Adolescent Research. 2017;33(5):523-548. doi:10.1177/0743558417712013
 
15.
Jennings L, Mathai M, Linnemayr S, Trujillo A, Mak'anyengo M, Montgomery BEE, Kerrigan DL. Economic Context and HIV Vulnerability in Adolescents and Young Adults Living in Urban Slums in Kenya: A Qualitative Analysis Based on Scarcity Theory. AIDS Behav. 2017;21(9):2784-2798. doi:10.1007/s10461-017-1676-y
 
16.
Bassiony MM. Smoking in Saudi Arabia. Saudi Med J. 2009;30(7):876-881. PMID:19617999.
 
17.
Alasqah I, Mahmud I, East L, Usher K. A systematic review of the prevalence and risk factors of smoking among Saudi adolescents. Saudi Med J. 2019;40(9):867-878. doi:10.15537/smj.2019.9.24477
 
18.
Alsamghan AS, Bharti RK, Alhussain MA, et al. Smoking Pattern and determinants among Adults Attending Anti-Smoking Clinic in Aseer Region, Saudi Arabia. Int J Med Res Health Sci. 2017;6(9):101-106. https://www.ijmrhs.com/medical.... Accessed February 25, 2020.
 
19.
Alsubaie ASR. Prevalence and determinants of smoking behavior among male school adolescents in Saudi Arabia. Int J Adolesc Med Health. 2018. doi:10.1515/ijamh-2017-0180
 
20.
Park HK, Al Agili DE, Bartolucci A. Factors affecting tobacco use among middle school students in Saudi Arabia. Matern Child Health J. 2012;16(9):1828-1836. doi:10.1007/s10995-011-0929-z
 
21.
de Vries H. An integrated approach for understanding health behavior; the I-change model as an example. Psychol Behav Sci Int J. 2017;2(2):1-6. doi:10.19080/pbsij.2.2
 
22.
de Vries H, Mudde A, Leijs I, et al. The European Smoking Prevention Framework Approach (EFSA): an example of integral prevention. Health Educ Res. 2003;18(5):611-626. doi:10.1093/her/cyg031
 
23.
Lewis BR, Maas SM. QDA Miner 2.0: Mixed-Model Qualitative Data Analysis Software. Field Methods. 2007;19(1):87-108. doi:10.1177/1525822X06296589
 
24.
Bigwanto M, Mongkolcharti A, Peltzer K, Laosee O. Determinants of cigarette smoking among school adolescents on the island of Java, Indonesia. Int J Adolesc Med Health. 2017;29(2). doi: 10.1515/ijamh-2015-0036
 
25.
Fulmer EB, Neilands TB, Dube SR, Kuiper NM, Arrazola RA, Glantz SA. Protobacco Media Exposure and Youth Susceptibility to Smoking Cigarettes, Cigarette Experimentation, and Current Tobacco Use among US Youth. PLoS One. 2015;10(8):e0134734. doi:10.1371/journal.pone.0134734
 
26.
Al Nohair SF. Prevalence of Smoking and its Related Behaviors and Beliefs Among Secondary School Students in Riyadh, Saudi Arabia. Int J Health Sci. 2011;5(1):51-57. PMID:22489230.
 
27.
Selim MM, Al-Rushood RM. Statistical investigation of prevalence of smoking among rural primary and secondary school students in Aflaj area, Kingdom of Saudi Arabia. International Journal of Basic & Applied Sciences. 2011;11(2):47.
 
28.
Al Agili DE, Park HK. The prevalence and determinants of tobacco use among adolescents in Saudi Arabia. J Sch Health. 2012;82(3):131-138. doi:10.1111/j.1746-1561.2011.00676.x
 
29.
Moor I, Rathmann K, Lenzi M, et al. Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers. Eur J Public Health. 2015;25(3):457-463. doi:10.1093/eurpub/cku244
 
30.
Schwarzer R. Self-efficacy: Thought control of action. United Kingdom: Taylor & Francis; 2014.
 
31.
Elfeddali I, Bolman C, Candel MJ, Wiers RW, De Vries H. The role of self-efficacy, recovery self-efficacy, and preparatory planning in predicting short-term smoking relapse. Br J Health Psychol. 2012;17(1):185-201. doi:10.1111/j.2044-8287.2011.02032.x
 
32.
Bolman C, Eggers SM, van Osch L, Te Poel F, Candel M, de Vries H. Is Action Planning Helpful for Smoking Cessation? Assessing the Effects of Action Planning in a Web-Based Computer-Tailored Intervention. Subst Use Misuse. 2015;50(10):1249-1260. doi:10.3109/10826084.2014.977397
 
33.
Ruiter R, Abraham C, Kok G. Scary warnings and rational precautions: A review of the psychology of fear appeals. Psychol Health. 2001;16(6):613-630. doi:10.1080/08870440108405863
 
34.
Sussman S, Black DS, Rohrbach LA. A concise history of school-based smoking prevention research: a pendulum effect case study. J Drug Educ. 2010;40(3):217-226. doi:10.2190/DE.40.3.a
 
35.
Thomas RE, McLellan J, Perera R. Effectiveness of school-based smoking prevention curricula: systematic review and meta-analysis. BMJ Open. 2015;5(3):e006976. doi:10.1136/bmjopen-2014-006976
 
36.
Waller G, Finch T, Giles EL, Newbury-Birch D. Exploring the factors affecting the implementation of tobacco and substance use interventions within a secondary school setting: a systematic review. Implement Sci. 2017;12(1):130. doi:10.1186/s13012-017-0659-8
 
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