Factors associated with daily smoking among Israeli adolescents: A prospective cohort study with a 3-year follow-up

Background. A prospective, 3-year cohort study of smoking habits was conduc ted among 9th grade pupils in Israel. Methods. A self-administered questionnaire was answered by pupils in the 9t h grade and again in the 11th and 12th grades. Results. The baseline questionnaire was answered by 748 9th graders. In the 11th grade 448 (60%) completed the questionnaire for the second time, and in the 12th grade 388 (52%) completed the questionnaire. In all, 312 pupils (42% of the original cohort) completed all three questionnaires. There wer e no significant sociodemographic differences between these 312 and the ori ginal 748. Eight 9th graders (2.6%) were active smokers (at least one cigar ette daily for the last month) compared with 64 (20.5%) in the 11th grade ( P < 0.0001 vs 9th grade) and 70 (22.4%) in the 12th grade (P = 0.34 vs 11th grade). Most pupils knew the health hazards of smoking. Variables associat ed with smoking in the 11th grade included religiosity (religion was associ ated with lower smoking rates, P = 0.07), past experimentation with smoking (P < 0.0001), smoking among family members (P < 0.01), perceived future sm oking status (P < 0.001), self-image (P < 0.001), influence of a teacher (P = 0.07) or celebrity (P < 0.05), and effect of peer pressure (P < 0.01). T hese results were similar for the 12th grade students except for active or previous smoking by gender (a significantly greater proportion of females t han males, P = 0.04). Conclusions. The study design reduces the potential bias of follow-up attri tion on assessment of predictors for smoking initiation. Gender, social mod eling and peer pressure, past experimentation with smoking, smoking among f amily members, role models, and self-image were associated with smoking. Th ese factors should be emphasized in intervention programs. (C) 2001 America n Health Foundation and Academic Press.