Psychosocial factors related to adolescent smoking: a critical review of the literature

Objective-To extend the analysis of psychosocial risk factors for smoking p resented in the United States surgeon general's 1994 report on smoking and health, and to propose a theoretical frame of reference for understanding t he development of smoking. Data sources-General Science Index, Medline, PsycLIT, Sociofile, Sociologic al Abstracts, and Smoking and Health. Holdings of the Addiction Research Fo undation of Ontario Library as well as the authors) personal files. Study selection-Reviewed literature focused on studies that examined the as sociation of sociodemographic, environmental, behavioural, and personal var iables with smoking. Data synthesis-Adolescent smoking was associated with age, ethnicity, famil y structure, parental socioeconomic status, personal income, parental smoki ng, parental attitudes, sibling smoking, peer smoking, peer attitudes and n orms, family environment, attachment to family acid friends, school factors , risk behaviours, lifestyle, stress, depression/distress, selfesteem, atti tudes, and health concerns. It is unclear whether adolescent smoking is rel ated to other psychosocial variables. Conclusions-Attempts should be made to use common definitions of outcome ac id predictor variables. Analyses should include multivariate and bivariate models, with some attempt in the multivariate models to test specific hypot heses. Future research should be theory driven and consider the range of po ssible factors, such as social, personal, economic, environmental, biologic al, and physiological influences, that may influence smoking behaviour. The apparent inconsistencies in relationships between parental socioeconomic s tatus and adolescent disposable income need to be resolved as does the unde rlying constructs for which socio-economic status is a proxy.