Perspectives on Smoking Initiation and Maintenance: A Qualitative Exploration among Singapore Youth

Abstract

Studies among adolescents have shown that several important interpersonal, intrapersonal and environmental factors are associated with smoking behaviour. The current qualitative research project aimed to explore the determinants of smoking initiation and maintenance, from a youth perspective, among young people who smoked, living in a multi-ethnic Asian country. Focus group discussions (FGDs) were conducted with youths in Singapore in youth-friendly and accessible locations. Young people, from a variety of social contexts—varying on age, gender, ethnicity and educational level, were included in the study. All FGDs were conducted in English and participants were recruited using a mix of network and purposive sampling. All FGDs were audio recorded and transcribed verbatim. The data were analyzed using qualitative content analysis, allowing themes to emerge from the data with the goal of answering the research question. Ninety-one youth smokers (54 males, 37 females), aged between 14 to 29 years, participated in the study. The majority were males (59%) and of Chinese ethnicity (52%). Participants identified multiple personal, social, and familial influences on young adults’ smoking behaviors. Peer and family influences, as well as risk minimization, played a key role in smoking initiation and maintenance. While young people were aware of policies that restricted smoking, these did not directly affect their decision to start smoking. The theory of triadic influence provided a promising theoretical framework to understand smoking initiation and maintenance in a sample of young adult smokers from a multi-ethnic Asian country. It also provides actionable information for initiatives to prevent smoking in young people, which includes their perspectives and emphasizes an inclusive approach without stigmatizing those who smoke.

Parents’ and peers’ normative influence on adolescents’ smoking: results from a Swiss-Italian sample of middle schools students

“…Adolescents imitate, and are influenced by models who smoke and to whom they are exposed. They smoke more frequently when they are associated with others, family members or peers, who smoke or who have a pro-smoking attitude [9, 10, 11, 19, 20]. Research shows that both types of norms (injunctive and descriptive) and both referents (parents and peers) influence adolescents’ smoking, and play a key role in adolescents’ decision to engage in such behavior [21–27].…”

“…Research provides evidence that supports the influence of peers’ (dis)approval and parents’ (dis)approval on adolescents’ smoking and intention [20–23, 36, 37], but while peer influence increases with adolescents’ age, parent influence decreases [21, 36]. …”

An Examination of the Ethnicity-Specific Prevalence of and Factors Associated with Substance Use and Misuse: Cross-Sectional Analysis of Croatian and Bosniak Adolescents in Bosnia and Herzegovina

“…The extent to which adolescents exhibit SUM behaviors differs across a number of sociocultural factors, including ethnicity [13,14,15,16]. The studies conducted thus far fairly consistently show ethnic differences in certain SUM templates, but there is an evident lack of investigations that examined the ethnicity-specific prevalence and correlates of SUM in European countries [17,18,19,20].…”

Progress in Tobacco Control in Singapore: Lessons and Challenges in the Implementation of the Framework Convention on Tobacco Control

“…This is in view of evidence the National Health Survey that Singaporean smokers start smoking at the average age of 16, and half of the smokers in Singapore start smoking regularly between the age of 18 and 21. Similar to previous research on smoking behaviours of young adults in other countries, a 2015 qualitative study in Singapore pointed to the social factors, that is, peer and family influences, and their perceived risks and benefits of smoking influence initiation to smoking and maintenance among young smokers (Subramaniam et al 2015).…”