'A Review of Qualitative Research on Teenage Smoking Habits\r'

'A Review of Qualitative investigate on Teen hop on skunk Habits Grand bathon University: NRS-433V-O103 intromission to Nursing Research September 20, 2012 Introduction The purpose of this document is to summarize the studys of the look for article, explain the research methods implemented, and offer cortical potential on how the findings establish to nursing intrust. Second, there will be an ex pictureation of ethical considerations associated with the conduct of nursing research. Finally, the outset document, â€Å"What Determines Teen mount uprs Smoking Behaviour? : A Qualitative strike” will be attached for review. SummaryThe articles purpose was to landing field ingest behavior among Malayansian teens. The specific aras of pursual include: roll of tobacco outset, fag outgo, intention to degree sens, and attempts to intermit sess. The first stratum of teen pot behavior begins with casual experimentation and is followed by the nutrition phase whe n anyday ritual gage is present. The succeeding(a) tense dependance on dope digest be predicted by the individual’s actions during experimentation with tushs. Curiosity, friction match closet, and agnatic weed were all report reasons that teens dogged to try goats.In children less than thirteen year old, it was reason out that parental take played the largest role in behavior choices. This finding suggests that children are modeling the parents’ pot behavior. However, older teens in secondary give instruction inform comrade blackmail to be the reason for choices regarding behinds. cardinal percent of the participants describe that they smoke-cured less than pentad cigarettes insouciant. This same portion or participants admitted that they smoke-cured beca use up they face physical symptoms of nicotine withdraw when they didn’t smoke daily.Consumption of cigarettes in this separateing was reported as a kindly activity among friend s but most(prenominal)ly in surreptitious areas, to avoid getting caught. well-nigh all adolescents that were industrious in this sphere reported that they had intended to forgo weed in the future. The teachingity of participants had no ca-ca proposal on how they were going to tolerate and most had admitted to several failed attempts to stop take without help. Aspects to consider: relationships, gymnastic involvement, health concerns, lack of finances, and parental concern are all reasons that would cause a teen smoker to consider haltting.The participants that were able to stop sess had a plan and picked a specific sidetrack date. Methods of tuition This culture was collected and exploited by means of a qualitative involve. Specifically, it involved twenty-six teens from tether do main(prenominal)(prenominal) trailings. Twenty-thee members of this sample group were smokers while trio of the members had halt pot. Information was gathered through three revolve astir(predicate) group hearings, three in-depth interviews all oer twenty months, and questionnaires.The questions were asked in a non-formal conversational manner with important points or answers recorded on a document intentional to evaluate and sort randomness (site). The mixer cognitive hypothe babe was used to organize solicitation of information and analysis. This theoretical frame cultivate was chosen based on the need for an explanation of teen skunk cogitate to to individuals, heath behaviors, and surroundingss. The expectation is that Social cognitive possible action would offer more than(prenominal) insight on how these three elements would move with each other simultaneously.Contribution to Nursing Smoking tobacco keeps to be hotshot of the top causes of frustrateable causes for death in America. There are 430,000 deaths, adept point five million years of capableness life lost, and fifty billion of lost medical exam debt related to to to bacco use (Hollis, J. , Pollen, N,… 2005). Nurses that pose junior clients at risk for tobacco apprise contribute to decline in morbidity related to gage and assist in the decrease of medical debt. â€Å"The junior that young are when they start using tobacco, the more likely theyll be addicted (CDC, 20012). The story offers insight to nursing practice for specific tailoring of a care plan for teens who smoke, parents who smoke, and how to target the preparation for digressting. The areas that bear upon teen’s interest in injectting include: gymnastic improvement, parents dis laudation, health concerns, and lack of finances. Nurses peck use the information from this reputation to reinforce the health promotion and benefits of being a non-smoker. The recognition of how parents affect skunk behaviors will aid the nurse in preparing nurture that is directed at the entire family to deter puerility and teen smoke.The contribution to patient care can be seen with health promotion assessment use. The conclusions were clear virtually teens needing a plan to submit aft(prenominal) they reached the maintenance phase of fume. This result alerts nurses to assess smoking in unsalteder adolescence and offer assistance with smoking terminus. moral principleal Issues First, The Research and Ethic Committee of University Kebangsaan Malaysia gave approval onwards the news report was started. Second, The Ministry of breeding Malaysia offered authorization for interviews in the indoctrinate system for children who were non involved in some type of major examination.Third, all of the teens on with parents provided a written and signed befool for participation. The confidentiality of watercourse smoking emplacement was kept intact and solitude was maintained. Lastly, at the conclusions of each interview the teens were offered smoking cession counseling at a doctor’s clinic. To match reliability of the choose, several school s were used and unalike types of data accretion utilized. There was self-reflexivity in minimizing opinions of the researchers. organization was offered by minimal prompting, statement clarification, and rephrasing of questions. ConclusionThe report identified divisors like nicotine addiction, personal, and environmental issues that influence of smoking behaviors in teens. These areas should be of great priority when underdeveloped smoking point programs for teens. The Social Cognitive supposition utilized in this report is an aid that helps nurses to take smoking behaviors in teens and how to address barriers to break those potent factors. Since this contemplate was make in one locality of Malaysia, it whitethorn non apply to all areas orthogonal of it. This was a really small study that cannot be applied to all cultures, geographic locations, and race.A better eyeshot would have been attained by selecting a wider group with random geographic location and equal sexual activity participation. The male to female ratio for the study was inadequate and this causes a shift in the standard diversion when scrutinizing the study from a statistical view. Having unequal grammatical gender numbers could cause a type I or II error which makes the information not entirely reliable (Grove, S. , 2012). References Center for Disease reassure. (2012, January). We can make the next generation tobacco-free. Retrieved from http://www. cdc. gov/Features/ youthfulnessTobaccoUse/ Grove, Susan K. (2012).Statistics for wellness accusation Research: A Practical Workbook [1] (VitalSource Bookshelf), Retrieved from http://pageburstls. elsevier. com/books/978-1- 4160-0226-0/outline/11 Hollis, J. , Polen, M. , Whitlock, E. , Lichtenstein, E. , Mullooly, J. , Velicer, W. , & Redding, C. (2005). Teen Reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in ancient medical care. Pediatrics, 115(4 Part 1), 981-989. Tohi d, H. , Ishak, N. d. , Muhammad, N. , Hassan, H. , & Omar, K. (2011). What determines pueriledrs’ smoking behavior? : A qualitative study. global health check Journal, 18(3), 194-198. 194PSYCHIATRY Article Ititernational Medical Joumal. Vol. 18, No. 3, pp. 194 †198 , September 2011 What Determines Teenagers Smoking Behaviour? : A Qualitative Study Hizlinda Tohid”, Noriah Mohd. Ishak^, Noor Azimah Muhammad”, Hasliza Abu Hassan^, Farah Naaz Momtaz Ahmad”, Khairani Omar* ABSTRACT Objective: The study aimed to explore smoking behavior among Malaysian puerilers that were related to their smoking groundwork, cigarette consumption, intercept intention, and dispense with attempts. Methods: It was a qualitative study that used multiple boldness study design, involving 26 teenrs (23 smokers and three former smokers) from three semi macrocosm schools. info was collected via questionnaires, three focus group interviews and three in-depth interview s over 20 months, A measure semi-structured interview protocol was utilised. Results: Among the participants, 74% of them started smoking after the age of 12 years old. The majority (20/23) of the teenage smokers admitted to smoking every day and 74% of them take in not more than 5 cigarettes a day. solely of the smokers had the intention to contain but merely 22 out of the 23 teenage smokers had attempted terminateting. 60 percent of these teenagers had more than three quit attempts.In general, this study captured the complexity of the teenagers smoking conduct that could be influenced by multiple factors, including deportmental (e,g, nicotine addiction), personal (e,g, conception of smoking and quitting, curiosity, protagonist seeking, knowledge slightly smoking cessation, stress, maintaining acrobatic performance, and finance,) and environmental (e,g, socialisation, peer pressure, parental smoking, parental comment, and boy- or female child aversion) factors. Conclusi ons: This study describe the complex and three-d nature of teenage smoking insidengs.The findings overly likely matched the Social Cognitive Theory (SCT), therefore suggesting the theorys suitability in elucidating smoking behaviour among the Malaysian teenagers, unlikeiate WORDS smoking, teenagers, smoking introduction, cigarette consumption, quit smoking INTRODUCTION Adolescence is a crucial time in which a relatively dependent child transforms into a relatively independent adult. During this transitional period, many teenagers often experiment risky behaviours as a promulgation of their autonomy.This risky behaviour includes cigarette smoking, using adulterous drugs and cirinking alcohol. (Epps, Manley, & Glynn, 1995; Kulig, & American Academy of Pediatrics Committee on Substance Abuse, 2005) Experimenting with cigarette smoking is an initial stage of teenagers smoking behaviour before it becomes established. (Nichter, Vuckovic, Quintero, & Ritenbaugh, 199 7; Seguire, & Chalmers, 2000; Curry, Mermelstein, & Sporer, 2009) This smoking initiation predicts their long-term tobacco use and heavier levels of dependence. (Breslau, & Peterson, 1996; Escobedo, Marcus,Holtzman, & Giovino, 1993; Chen, & Millar, 1998) Their experimenting behaviour may be influenced by various factors including curiosity, peer pressure, parental smoking, sensation seeking, social norms for smoking, and misconception of smoking (e. g. popular opinion that smoking provides benefits, much(prenominal) as coping, sense of belonging, style, relaxation, and coolness). (Dijk, de Nooijer, Heinrich, & de Vries, 2007; Naing et at. , 2004; Khairani, Norazua, & Zaiton, 2004; Vuckovic, Polen, & Hollis, 2003; Nichter, Vuckovic, Quintero, & Ritenbaugh, 1997) These factors could cause teenagers to continue smoking.Teenage smoking maintenance is likewise influenced by nicotine addiction. It has been shown to be substantially authori tative among teenagers fifty-fifty with low cigarette consumption. (The topic wellness and Morbidity Survey, 2009; Hammond et al. , 2008; Khairani, Norazua, & Zaiton, 2004; Naing et al. , 2004; DiFranza et at. , 2007; Balch et al. , 2004; Amos, Wiltshire, utter, & McNeill, 2006) This may be over ascribable(p) to a very rapid impairment of autonomy over tobacco even with minimal exposure to nicotine in adolescents, as demonstrated by the slap-up study. (DiFranza et al. , 2007; DiFranza et al. , 2002)Consequently, majority of teenage smokers struggle to quit smoking. (Balch et at. , 2004; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Amos, Wiltshire, Haw, & MeNeill, 2006; Seguire, & Chalmers, 2000) Thus, smoking behaviour among teenagers is a complex phenomenon, since it is influenced by multiple factors. This complexity requires great grounds of the behaviour from those who are involved in the care of these teenagers. This light would certai nly help the care providers to curb teenage smoking, which is a dangerous, addictive and destructive behaviour. US discussion section of Health and Human Services, 2004) Therefore, many studies have get on Augtist 28, 2010 and accepted on November 29, 2010 1) Department of Family Medicine, mental faculty of Medicine, Universiti Kebangsaan Malaysia Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lutnpur, Malaysia 2) Pusat PERMATApintar Negara, Universiti Kebangsaan Malaysia Bangl, 43600 Selangor, Malaysia 3) Setapak Health Clinic, Kuala Lumpur, Malaysia Correspondence to: Hizlinda Tohid (e-mails; [email protected] com) 2011 Japan International Cultural Exchange Foundation & Japan Health Sciences UniversityTobitJ H, et al. 195 give in 1. Participants gender, status of smoking and types of interviews TYPES OF schooldays potent GENDER FcEeM. . AALIEE SMOKERS STATUS OF SMOKING NON SMOKERS FOCUS convocation INTERVIEW TYPES OF INTERVIEWS IN DEPTH INTERVIEW SCHOOL 1 URBAN 9 3 9 3 1 3 SCHOOL 2 SEMI-URBAN 7 7 1 SCHOOL 3 RURAL 7 7 1 primitive 3 23 3 23 3 3 3 been carried out to examine the phenomenon of teenage smoking. In Malaysia, majority of such(prenominal) studies were quantitative studies. (Naing et al. , 2004; Hoi, & Hong, 2000; Khairani, Norazua, & Zaiton, 2004; Zulkifli, Rogayah, Razian, & Nyi Nyi, 2001)Nevertheless, studies that qualitatively describe Malaysian teenagers smoking behaviour are still lacking. This deficiency may affect our understanding of the matter in great depth and holistically. Thus, this study aimed to explore smoking behaviour among Malaysian teenagers related to their smoking initiation, cigarette consumption, quit intention, and quit attempts. This information could provide us with better conception round their smoking behaviour, and subse-‘ quently eould help us to identify areas for improvement. METHODSThis study used a multiple case study design, involving 26 teenagers (23 smokers and three former smokers) from three humans schools (urban, semi-urban and rural). selective information was collected via selfadministered questionnaires, focus group interviews (FGI) and indepth interviews (IDI) over a period of 20 months, mingled with 2008 until 2010. hypothetical framework This study utilised the Social Cognitive Theory (SCT) to guide the researchers in data collection and analysis. The SCT was also used for ‘analytieal generalisation in which findings of the study were mapped against the theory.It was chosen as the studys theoretical framework due to its rightness and comprehensiveness in capturing a complex phenomenon of eigarette smoking that is influenced by multiple factors. (Baranowski, Perry, & Parcel, 2002) The SCT describes how individuals, environments and health behaviour interact with each other simultaneously (reciprocal determinism). (Baranowski, Perry, & Pareel, 2002) Study macrocosm Twenty six teenagers (23 boys and three girls, as shown in Table I) were selected via purposive and snowballing sampling, based on shape criteria.The teenage smokers and former smokers were sampled because their experience in cigarette smoking and smoking cessation was crucial for this study. These teenagers were 16 years old Malays, recruited from three varied (urban, semiurban and rural) worldly concern schools from 2 states in Malaysia. Recruitment of teenagers Teenagers were recruited with the assistance from school counsellors from eaeh sehool. An agreement for no disciplinary action against teenagers who were uncoerced to participate in this study was made with the counsellors prior to the recruitment.The students smoking status was also eoneealed from other school staff to avoid stigmatisation. Twelve teenagers who were selected from one of the schools were introdueed to the main researcher during an informal meeting for study apprise (refer to Table 1). The teenagers were invited to participate and were given parent al packages, which comprised of an quotation letter to parents, the studys information sheet, and a parental consent form. Subsequently, dates for tbe FGI and IDI were set. The completed parental eonsents forms were eolleeted prior the interviews by the school counsellor.The other 14 teenagers (7 students from each remaining school, as shown in Table 1) were reeruited by sehools counsellors, who had training in qualitative research and were well informed nigh the study. Similar method of obtaining eonsent from their parents was carried out by these counsellors. Data collection Three in-depth interviews and three focus-group interviews were carried out (refer to Table 1). Prior to the interviews, all participants were given a outline overview of the study and the process of the interviews. Written eonsents from eaeh partieipant were also obtained.They were whence required to answer a brief self-administered questionnaire on their socio-demography, smoking status and smoking behav iour (age of initiation, cigarette consumption, quit intention and quit attempts). The interviews were conducted in Malay language and eaeh interview lasted less than twain hours. A semi-structured interview protocol was used to guide interviewers in questioning the participants. Anti-smoking posters and pamphlets were also used to facilitate discussion. Data analysis During eaeh interview, the conversation was recorded using digital voice recorders.The voice recording was subsequently transeribed into textbook by using Microsoft Office Word 2007. The put down text was reviewed against the audio-recordings for several times until the accuracy of the transcripts was get wordd. either uncertainty during the transcription, assistance from other researehers was sought to think of over its accuracy and reliability. (Yin, 2003; Yin, 1994) The transcribed text was then trade into NVIVO 7. The main researcher then analysed the data to identify themes and categories (‘thematie analysis) that would explain patterns of pereeption related to teenagers smoking behaviour.In order to ensure high reliability of the eoding proeess, tbe coded data was eross-checked by two experts in adolescence health. Kappa was calculated by using the Cohen kappa pattern to determine the reliability index, which was maintained to a higher place 0. 8. The process of transcription and analysis was repeated for every interview and ‘cross-case conclusion was drawn between the analyses of eases. Findings of the study were also mapped against the SCT for ‘ analytic generalisation. Ettiical issues, reliability and validity Approval from the Research and Ethic Committee of Universiti Kebangsaan Malaysia was obtained prior to the study.Authorisation for interviewing teenagers from the schools was also acquired from the Ministry of Education Malaysia that check interviewing students who were not sitting for any major examination (i. e. exeept students aged 15 and 17 years ol d). obscure from these, all of these teenagers and their parents were required to provide written eonsents for their participation. The confidentiality of the participants, e. g. obscuring teenagers status of smoking from the knowledge of their parents and other sehool staffs, was also guaranteed end-to-end the study.Finally, medical responsibility of the main researcher in preventing smoking-related illnesses, as she was also a medieal doctor, was realised by offering teenagers consultation for smoking eessation at her clinic. This was done at the end of each interview to prevent any biased answers from the partieipants. Validity and reliability of the study were ensured via a number of methods, ineluding; (1) triangulation of sourees of data (teenagers from three different sehools), as well as methods of data collection 196 What Determines Teenagers Smokitig Behaviour? Table 2. Smoking behaviour of the teenagers who smokedTEENAGERS WHO smoke-cured (N = 23) AGE OF INITIATION (YE ARS) NUMBER OF CIGARRETTES SMOKED/ solar day STAGE OF CHANGE NUMBER OF QUIT ATTEMPTS FGD(n = 21) IDl(n = 2) amount < 12 5 1 6 > 13 16 1 17 20 2 1 3 PRE COMTEMPLATION 5 1 7 CONTEMPLATION 4 4 PLANNING II 12 0 1 1 1-3 7 1 8 S4 13 1 14 (questionnaire, three FGI and three IDI), (2) self reflexivity in minimising biases that the researchers may bring into the study due to our previous involvement in managing problematic teenagers and chronic smokers, (3) ‘adjective validity via rephrasing of questions, elarifying of statement and minimal prompting as ecessary,(Fliek, 2009) and (4) inter-coder agreement or reliability index of above 0. 8. RESULTS Twenty three boys and three girls were interviewed (referred to Table 1), in which two of the boys and one of the girls were former smokers. The remaining 23 teenagers were smokers at the time of the interviews. These teenagers smoking behaviour (age of smoking initiation, cigarette consumption, intention to quit and history of quit a ttempts) is summarised in Table 2. Age and reasons of smoking initiation Six of the 23 (26%) teenage smokers in this study started smoking during primary school (before the age of 13).The youngest age of smoking initiation was 10 years old. Nevertheless, 74% of these teenage smokers started smoking when they were in the secondary school. Most of the teenagers admitted that curiosity [â€Å"Felt curious to try (smoking)”], sensation seeking [â€Å"Just for fun”], parental modeling of smoking [â€Å"Sinee my let smokes… I always watch him smoking. When he smokes, it looks pleasurable… gratifying”], peer pressure [â€Å"Peer influence”], and misconception of smoking [â€Å"Style (because of smoking). Siyle”] were common factors for them to experiment with smoking.The teenagers who started smoking before the age of 13 claimed that curiosity and smoking modelling by parents were their main reasons for experimenting with smoking. This is c ontrary to those who started smoking at the age of 13 years or older. These teenagers admitted that peer pressure was the major factor for them to start smoking. Cigarette consumption volume (20/23) of the teenage smokers in this study admitted to smoking every day and 74% of these teenagers smoked not more than 5 cigarettes a day.The teenagers believed that their daily smoking behaviour was mainly due to nicotine addiction in which they described substantial physical (e. g. tiredness, lethargy, flu-like symptoms) and psychological (e. g. loosen up thinking, depressed, craving) sezession symptoms that they experienced during smoking abstinence [â€Å"My brain line ups slow”; â€Å"(If I stop smoking) I feel restless. â€Å"]. The daily smokers also admitted to smoking when they were with their friends. They claimed this behaviour could be due to a number of reasons: a) sharing the cost of cigarettes with their friends, and then tend to smoke together, as explained by a teenager: Between 14 of us. we overlap RMI per person, we can get 2 big boxes of cigarettes. ” b) socialisation, as one teenager noteworthy: â€Å"When we hang around (with friends), we smoke, sis” c) peer pressure, as a teenager claimed: â€Å"When we see our friends smoked, the appetite to smoke is too intense. ” d) sense of belonging, for lawsuit: â€Å"We all belong to a gang who shared our cigarettes together” However, three of the current smokers admitted to smoking just now(prenominal) once a week. They stated that they particularly smoked during stressful period [â€Å"Especially when I am doing something. When its hard then Ill smoke. ]. A few of the teenagers reported that the national anti-tobacco policy, as well as the school regulations had restricted their smoking behaviour. These teenagers admitted to commonly smoke in secluded areas outside of public view, such as in school toilets and stairways of shopping malls. The regulatory e nvironment for public smoking was believed to influence tbeir cigarette consumption. invention to quit All teenage smokers in this study had the intention to quit smoking. However, 7 of them (30%) did not plan to quit within the next 6 months (in the pre-contemplation stage).Twelve of them (52%) were in the planning stage, but none had set their quit dates. The smokers diselosed that a number of factors could influence tbeir desire to quit, which included: a) impaired athletic performance, as one of the teenagers claimed: â€Å"When (I) flair… I will hecome breathless” b) boy- or girlfriend aversion, for example: â€Å"Maybe (I get the desire to stop smoking) from my girlfriend. If she express â€Å"If you do not stop smoking, we should break-up”. Huh. (I feel like to quit smoking)” c) parental disapproval, as noted by one boy: If mother scolded me for smoking, until she cried.. I would feel ? ike I want to quit, but it was short only. afterwardswards. . I continue smoking” d) concern about health, shown by one of the teenagers excerpt: â€Å"Smoking can make me feel breathless, sis (thats why I feel like to quit)” e) finaneial problems, as a teenager stated: â€Å"(I) think about my parents, sis. My mother and my father are not wealthy, (when I) think about that, it could (trigger my desire to quit)” Similar move factors were also reported by former smokers in this study prior to their fortunate smoking cessation.Nevertheless, these former smokers admitted that only personalised motivating factors could render them to quit successfully. Their personalised motivators were parental disapproval [â€Å"(Parental disapproval) effective, its effective. Ive stopped smoking. â€Å"], maintaining athletic performance [â€Å"(I) stopped smoking (for athletic performance). I got selected (to play football for my district) later on”]. and saving stemmas /”/ stopped (smoking) to save money to buy a motor bike”]. Previous quit attempts Almost all (22/23) teenage smokers in this study had attempted smoking cessation prior to the interviews.The teenagers deseribed that quitting was very difficult because of withdrawal symptoms that they experienced during the quit attempts [â€Å"(If I stop smoking) I feel restless”]. cardinal percent of the teenage smokers had actually attempted to quit four times or more. All of the teenagers claimed that they neer reeeived any professional helps when they made their attempts to quit in the past. Majority of them declared that they sought their friends advice on how to quit and among the common methods that they had tried were drinking a clump of water, chewing gums and taking sweets, as one of the teenagers said:Tohid H. et al. 197 â€Å"Usuatty (I) asked my friends how to quit. They advised me to drink a tot of minerat water. ” word In Malaysia, the mean age of smoking initiation among teenage smokers is between 12-14 years old, (The National Health and Morbidity Survey, 2009; Hammond et at. , 2008; Khairani, Norazua, & Zaiton, 2004; Naing et at. , 2004) whieh is concurrent with the findings of this study. The common reasons for smoking initiation, such as curiosity, peer pressure, and parental smoking, reported by tbe participants in tbis study were akin(predicate) to otber studies. (Naing et at. 2004; Kbairani, Norazua, & Zaiton, 2004) This study also suggested that curiosity and parental modelling of smoking bebaviour could be teenagers main reasons for experimenting smoking at younger age (less tban 13 years old). In contrary, peer pressure was rear to be a major factor for teenagers wbo started smoking at seeondary sehools. However, the significance of tbese associations should be corroborate by future quantitative studies. Cigarette consumption reported by teenagers in this study was institute to be lesser tban tbose of Malaysian adults, who averagely smoke between 11 to 14 cigarett es per day. World Health face (WHO) Framework Convention on Tobacco Control, 2010) Tbis may be due to a number of factors as suggested by tbese teenagers, such as; (a) meagerly fund to purchase cigarettes, (b) ‘occasional smoking, and (c) restrictive environment for smoking. Nevertheless, underreporting of smoking behaviour by these teenagers may also explain the bring low estimated number of cigarettes smoked by them. Tbis is because teenagers have a tendency to report socially desirable behaviour and attitudes. (Hammond et at. , 2008; Klein, Havens, & Carlson, 2005)Insufficient fund to purebase cigarettes were described by some of the teenagers in this study, who claimed that they had to share their pocket money with their peers to buy cigarettes. Tbis is to ensure their continuous supply of cigarettes and to develop bonding among tbe peers. (Vuckovic, Polen, & Hollis, 2003; Amos, Wiltsbire, Haw, & McNeill, 2006; Niehter, Vuckovic, Quintero, & Ritenbau gh, 1997; Seguire, & Cbalmers, 2000) Tbis practice in turn increases tbe level of acceptance by peers and promote sense of belonging tbat is pertinent to teenagers psychosocial development. Mermelstein, 2003; Vuckovic, Polen, & Hollis, 2003; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Nicbter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, c& Chalmers, 2000) However, some teenagers in this study, who had no financial diffidence because they had personal income (e. g. from part-time job or significant allowance from parents), admitted to smoke only wben socialising and set about adversities (e. g. relation problems, inability to cope witb academic or part-time job). (Vuekovic, Polen, & Hollis, 2003; Balch et at. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006; Hoi, 8L Hong, 2000;Khairani, Norazua, & Zaiton, 2004; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, & Chalmers, 2000) These teenagers can be defined as occasional smokers, whose smoking was apparently influenced by peer pressure and tbeir inability to control themselves over smoking or to cope with stress. (Vuckovic, Polen, & Hollis, 2003; Seguire, & Chalmers, 2000; Patten et al. , 2003; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Mermelstein, 2003; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Khairani, Norazua, & Zaiton, 2004; Balch et at. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006; Hoi, & Hong, 2000) Teenagers smoking in esponse to hardship shows that smoking is their way of coping since it calms them through nicotine effects on the central nervous system. (Niebter, Vuckovic, Quintero, & Ritenbaugh, 1997; Curry, Mermelstein, & Sporer, 2009) In addition, smoking creates a social space in which they can calm down and relieve tension. (Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Curry, Mermelstein, & Sporer, 2009) asunder from financial constraint and occ asional smoking, restrietive environment for public smoking was also lay down to be creditworthy for tbe partieipants low cigarette consumption in this study.Therefore, these teenagers commonly smoked in secluded areas outside of public view, sucb as scbool toilets and stairways of shopping malls. These findings are consistent with a number of other studies that have found restrictive environment to be effective in trim down teenage smoking. (Wakefield ct at. , 2000; Lipperman-Kreda, & Grube, 2009; Crawford, Balcb, Mermelstein, & Tobacco Control net income create verbally Group, 2002) Majority of teenage smokers bave intention to quit. (Khairani, Norazua, & Zaiton, 2004; Krishnan M, 2003; Mermelstein, 2003; Naing ct at. 2004; The National Health and Morbidity Survey, 2009) Tbis was also found by tbis study, in wbich almost all teenagers who smoked eonsidered to quit smoking sometime in the future. They admitted that a number of factors could trigger tbeir quit int ention, wbich include; (a) athletic performance, (b) boy- or girlfriend aversion, (c) parental disapproval, (d) concern about bealtb, and (e) money saving. Tbese faetors were similarly found to motivate teenagers to eease smoking by previous studies. (Vuckovic, Polen, & Hollis, 2003; Mermelstein, 2003; McVea, Miller, Creswell,McEntarrfer, & Coleman, 2009; Balcb ct al. , 2004) However, tbe teenagers reported tbat these extrinsie motivations were insufficient to keep them from total smoking abstinence. Nevertbeless, excerpts made by tbe former smokers in this study suggested that teenagers would only stop smoking when they are desperate to change due to compelling personal reasons. This finding is corroborateed by McVea et al who found only emotionally compelling and inevitable quit reasons were the most motivating reasons for teenagers to stop smoking. (McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009)Even though majority of tbe teenagers in this study had inten tion to quit smoking, they did not have any quitting plans, not even setting their quit dates. These findings are similar to those reported by Mermestein. (Mermelstein, 2003) It is possible tbat the teenagers were; (a) not ready to quit (Balch ct al. , 2004) (e. g. some of the teenagers in the eurrent study would only quit when they experience major life transition, such as after graduation and tnarriage), (b) ambivalent about quitting (MeVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Patten et al. 2003) (e. g. a number of teenagers repetitively answered, â€Å"I am not sure” when they were asked about tbeir plan to quit smoking), and (c) very confident that they could control themselves over smoking (Niehter, Vuckovic, Quintero, & Ritenbaugb, 1997; Amos, Wiltshire, Haw, & McNeill, 2006) (e. g. a teenager assertively admitted that he could stop stroking on his own without relying on helps from other). The later seems to be related to teenagers belief tbat ‘quitting is fitting a matter of will power. (Amos, Wiltsbire, Haw, & McNeill, 2006; Balcb el at. 2004) After all, these teenagers ehanees for successful quit attempts would be reduced if they did not have strategic quitting plans. Multiple unsuccessful quit attempts were also reported by many teenagers in tbis study, in which the findings were concurrent with other studies. (World Health governing (WHO) Framework Convention on Tobacco Control, 2010; The National Health and Morbidity Survey, 2009; Klein, Havens, & Carlson, 2005; Balch ct at. , 2004) This could be due to several reasons which can be summarised into three categories; (1) nicotine addiction,(Amos,Wiltsbire, Haw, & McNeill, 2006; Balch et al. , 2004; DiFranza et at. , 2007; DiFranza ct at. , 2007) (2) factors related to environment and situation which could promote teenage smoking (e. g. strong peer pressure, poor support from friends, smoking tnodelling by family members, stress etc, as higbligb ted by tbe current study), (Balch et at. , 2004; Crawford, Balch, Mermelstein, & Tobacco Control Network Writing Group, 2002; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Nicbter, Vuckovic, Quintero, & Ritenbaugb, 1997) and (3) personal factors (e. g. oor risk assessment, poor knowledge, poor self efficacy and control, mi,sconception about smoking and quitting, strong belief in unassisted quit attempts etc, as found by this study) (Niehter, Vuckovic, Quintero, & Ritenbaugb, 1997; Balcb ct at. , 2004). These tbree categories appear to matcb tbe model of the Social Cognitive Theory. Overall, this study provides beneficial information for future development of interventions of smoking cessation for teenagers. Nevertheless, appropriate eontext which is similar to tbose of this study should be taken into consideration before applying such information since this is a ease study.Interviewing only teenagers aged 16 years old also limits the findings of this stu dy. This is because teenagers at different stages of adolescence (early, middle and late) may bave different developmental characteristics which may influence their pereeption and attitude towards cigarette smoking. Teenagers from different stages of adolescence should then be included in future studies as differences in tbeir perception, attitude and bebaviour could be explored. CONCLUSION This study bad captured tbe complexity of tbe teenagers smoking bebaviour that could be influenced by multiple factors.Tbese faetors included behavioural (e. g. nicotine addiction), personal and environmental factors matched the Social Cognitive Theory (SCT). These 198 What Determines Teenagers Smoking Behaviour? multiple factors should be considered in developing interventions for smoking cessation suited for teenagers. The corresponding mapping of the findings against the SCT also supports the use of the SCT in aid us to comprehensively understand teenage smoking behaviour and to overcome the influential factors. FUNDING This work was funded by the Universiti Kebangsaan Malaysia UKM-GUP-TKS-07-12-097 and FF-127-2008). DECLARATION OF INTERESTS All authors declare that they have no conflicts of interests. 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