Examining External and Internal Factors That Could Influence Adolescent Smoking Behaviors in Adolescents of Crete, Greece: The Cross-Sectional FRESHAIR4Life Study.

Abstract

Introduction: Adolescent smoking continues to pose significant public health challenge, persisting due to a multifaceted interplay of internal and external factors. The present study aimed to explore internal and external factors that may influence adolescents' smoking behaviors in Crete, Greece.

Methods: Conducted as part of Phase A of the European-funded FRESHAIR4Life Program; this cross-sectional study included adolescents aged 14 to 21 years, recruited between January and February of 2024. Ten educational institutions in the Municipality of Heraklion, Crete, were selected, including high schools (n = 7), technical schools (n = 2), and universities (n = 1).

Results: The sample consisted of 179 participants with a mean (SD) age of 16.8 (1.9). Smoking history was reported by 34% (n = 60). Older adolescents had higher odds of ever smoking (OR = 1.57, 95% CI: 1.32-1.88; P < .001). The most prevalent reasons for smoking initiation were reported to be addiction after the initial use of nicotine products (60%), stress (43%), and to look cool and attractive (27%). Ignoring smoking's negative consequences was positively associated with ever smoking (OR = 3.89, 95% CI: 1.85-7.99, P < .001). The perception of smoking as a risk factor for the development of illness (OR = 2.6, 95% CI: 1.2-5.3, P = .012), and concerns about the health impact (OR = 5.7, 95% CI: 2.3-14.1, P < .001) were positively associated with non-smoking behaviors. External factors positively associated with ever smoking were smoking exposure at school (OR = 2.81, 95% CI: 1.36-5.81; P = .005), use of nicotine products by parent(s) (OR = 7.64, 95% CI: 1.95-29.96, P = .004), close friend(s) (OR = 12.88, 95% CI: 3.24-51.15, P < .001), and sibling(s) (OR = 25.13, 95% CI: 3.23-195.63, P = .002).

Conclusion: Our findings highlight the need for multifaceted, targeted interventions. Future research should evaluate tailored interventions and investigate emerging potential influences like social media and alternative nicotine products on youth smoking.