The Factors Associated with Persistent Smoking in Adolescents

Main Article Content

Jintara Meetawon
Komsan Kiatrungrit
Sirichai Hongsanguansri
Vasin Pipattanachat



 Objective: To study the prevalence of ever smoking and persistent smoking among Thai students in the high school level as well as factors associated with those behaviours.

Methodology: This study was a cross-sectional survey in students in Mathayomsuksa 1-6 under supervision of the Bangkok Metropolitan Administration. The research instrument was the questionnaire to investigate: 1) personal data; 2) smoking; 3) nicotine addiction level; 4) self-esteem; 5) depression level; and 6) attachment with parents. Data was analysed by descriptive and analytical statistics (chi-square test, ANOVA, t-test, and Multiple Regression Analysis).

Results: From the sample consisting of 1,014 students, 108 out of them were the participants who ever smoked (10.61%) while 29 out of them were the persistent smokers (2.85%). The risk factors associated with ever smoking behavior were: achieving the GPA less than or equal to 2.00 (OR (CI) = 29.2 (1.52 – 5.62)), being induced by friends to smoke (OR (CI) = 3.93 (2.23 – 6.92)), having close friends who smoked (OR (CI) = 5.42 (3.20-9.18)), percept that getting cigarettes to smoke is easy (OR (CI) = 3.19 (1.74-5.84)), and having high depression scores (OR (CI) = 1.06 (1.03-1.10)). However, the protective factor against smoking was the high scores of attachment with parents in term of trust (OR (CI) = 0.09 (0.82 – 0.99)). The only risk factor of persistent smoking was their parents’ acceptance in smoking (OR (CI) = 5.64 (1.67-19.60)).

Conclusion: The persistent smokers had certain different risk factors from the participants who ever smoked, that is, the parents’ concern and disapproval of smoking were the factors preventing students from the persistent smoking. However, the factors related to smoking initiation were also important to prevent the initiation of smoking, which may take effect to health in the long term, even a short-period smoking.

Keywords: adolescence, attachment with parents, self-esteem, smoking, depression


Download data is not yet available.

Article Details

How to Cite
Meetawon จ., Kiatrungrit ค. ., Hongsanguansri ศ. ., & Pipattanachat ว. . (2022). The Factors Associated with Persistent Smoking in Adolescents. Journal of the Psychiatric Association of Thailand, 67(1), 21–34. Retrieved from
Original Articles



World Health Organization. Global status report on alcohol and health. Geneva, Switzerland: WHO; 2011.

Department of Disease Control [homepage on the Internet]. Nonthaburi: DDC; 2014 [update 2015; cited 2021 Feb 12]. National trustworthy and competent authority in epidemiological surveillance and investigation; [about 1 screen]. Available from:

Sarachitti R, Polsiri P, Sithipongpanich T. Costs of smoking: literature review. J Health Sci. 2013; 22(1):172-86.

Pitayarangsarit S, Punkrajang P, Preechawong S. Summary situation of major risk factors for tobacco's Thailand in 2014. Bangkok: Thai Health Promotion Foundation and Tobacco Control Research and Knowledge Management Center; 2014.

Burden of Disease Thailand, Ministry of Public Health. Disability adjusted life years (DALYs) Thailand 2014. Nonthaburi: Ministry of Public Health; 2014.

Supawongse C. Evolution of tobacco control in Thailand. In: Slama K, editor. Tobacco and health: Proceedings of the 9th World Conference Held; 1994 Oct 10-14; Paris, France: Springer, 1995. p.1-6.

National Statistical office. The smoking and drinking behavior survey 2014. [homepage on the Internet]. National Statistical office Thailand ; [updated 2019 Dec 16; cited 2021 May 12]. [about 1 screens]. Available from: National Statistical office. The smoking and drinking behavior survey 2014. [homepage on the Internet]. National Statistical office Thailand ; [updated 2019 Dec 16; cited 2021 May 12]. [about 1 screens]. Available from:ด้านสังคม/สาขาสุขภาพ/พฤติกรรมการสูบุหรี่และการดื่มสุรา/พฤติกรรมการสูบุหรี่และการดื่มสุรา57/6เล่มสมบูรณ์.pdf

Ministry of Public Health [homepage of the Internet]. Nonthaburi: Department of Disease Control; 2020 [update 2020 Jun 16; cited 2021 Feb 5]. 2nd National Tobacco Control Strategy Plan; [about 5 screens]. Available from:

Preechawong S. Project on knowledge management for driving tobacco control in schools. Bangkok: Tobacco Control Research and Knowledge Management Center, Mahidol University; 2012.

Macdonald DI. Drugs, drinking, and adolescents. Chicago: Year Book Medical; 1984.

McGee R, Stanton WR. A longitudinal study of reasons for smoking in adolescence. Addiction. 1993; 88(2):265-71.

McNeill AD, Jarvis MJ, Stapleton JA, Russell MA, Eiser JR, Gammage P, et al. Prospective study of factors predicting uptake of smoking in adolescents. J Epidemiol Community Health. 1989; 43(1):72-8.

Tuakli N, Smith MA, Heaton C. Smoking in adolescence: methods for health education and smoking cessation. J Fam Pract. 1990; 31(4):369-74.

Stanton WR, Oei TP, Silva PA. Sociodemographic characteristics of adolescent smokers. Int J Ment Health Addict. 1994; 29(7):913-25.

Botvin GJ, Baker E, Goldberg CJ, Dusenbury L, Botvin EM. Correlates and predictors of smoking among black adolescents. Addict Behav. 1992; 17(2):97-103.

Ogawa H, Tominaga S, Gellert G, Aoki K. Smoking among junior high school students in Nagoya, Japan. Int J Epidemiol. 1988; 17(4):814-20.

Hu J, Liu R, Zhang H, Xu X, Li K, Yang R, et al. A survey of cigarette smoking among middle school students in 1988. Public Health. 1990; 104(5):345-51.

Mendis S. Tobacco use in a cohort of children in Sri Lanka. Br J Addict. 1990; 85(3):397-8.

Chen Y, Pederson LL, Lefcoe NM. Fathers' educational level, adult's smoking status, and children's smoking behavior in Shanghai. Health Values: J Health Behav, Educ & Promot. 1992; 16(2):51-6.

Zhu BP, Liu M, Shelton D, Liu S, Giovino GA. Cigarette smoking and its risk factors among elementary school students in Beijing. Am J Public Health. 1996; 86(3):368-75.

Isohanni M, Moilanen I, Rantakallio P. Determinants of teenage smoking, with special reference to non standard family background. Br J Addict. 1991; 86(4):391-8.

Oakley A, Brannen J, Dodd K. Young people, gender and smoking in the United Kingdom. Health Promot Int. 1992; 7(2):75-88.

Stanton WR, Oei TP, Silva PA. Sociodemographic characteristics of adolescent smokers. Int J Addict. 1994; 29(7):913-25.

Creswell WH, Jr, Huffman WJ, Stone DB. Youth smoking behavior characteristics and their educational implications (Report). Champaign, IL: University of Illinois; 1970.

Trangkasombat U. Family therapy and family counseling. 5th ed. Bangkok: Department of Psychiatry, Faculty of Medicine, Chulalongkorn University; 2001.

Arimitt R, editor. Textbook of adolescent medicine. Bangkok: Child Health Supervision; 2016.

Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerström test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict. 1991; 86(9):1119-27.

Wongpgarun T, Wongpakaran N. Confirmatory factor analysis of Rosenberg self-esteem scale: a study of Thai student sample. J Psychiatr Assoc Thailand. 2011; 56(1):59-70.

Jiamjaroenkul J, Limsuwan N. Depression among junior high school students in Muang District, Chiang Mai Province. J Psychiatr Assoc Thailand. 2015; 60(4):253-63.

Lucktong A. The impact of parental, peer and school attachment on the psychological well-being of early adolescents in Thailand. Int J Adolesc Youth: 2016.; 23(2):1-15

Murat A, Memis CO, Turan MK, Benli AR, Taskin E, Yasar Z, et al. Smoking prevalence, associated attitudes and comparison of negative automatic thoughts among high school students in Turkey. Eur Respir J. 2015; 6(46):1-6.

Centers for Disease Control and Prevention [homepage on the Internet]. Atlanta, GA: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; 2020 [updated 2020 Dec 16; cited 2021 Feb 12]. Youth and tobacco use: youth use of tobacco products in any form is unsafe; [about 9 screens]. Available from:

Wilawan P, Pornthep L, Wanpha P, Studying in the smoking behavior of youth in Nonthaburi Province. Bangkok.; 2017. [updated 2020 Dec 16; cited 2021 May 12]. The Tobacco Control Research and Knowledge Management Center (TRC); [about 109 screens]. Available

Kengganpanich M, Suwanrassami S, Phavaputanondh C, Kengganpanich T. Factors associated with smoking behavior among female adolescents in Bangkok metropolitan. J Health Educ. 2014; 37(128):


Homsin P, Srisuriyawet R. Smoking stages among adolescents in the eastern part of Thailand (Study report). Chonburi: Burapha University; 2008.

Tobacco Control Research and Knowledge Management Center. A knowledge collection for researching on tobacco control. Nonthaburi: Ministry of Public Health; 2011.

Audrain-McGovern J, Rodriguez D, Kassel JD. Adolescent smoking and depression: evidence for self medication and peer smoking mediation. Addiction. 2009; 104(10):1743-56.

US Public Health Service, Office of the Surgeon General, National Center for Chronic Disease Prevention, & Health Promotion. Preventing tobacco use among youth and young adults: a report of the surgeon general. Chicago, IL: US Government Printing Office; 2012.

Wu LT, Anthony JC: Tobacco smoking and depressed mood in late childhood and early adolescence. Am J Public Health. 1999, 89 (12): 1837-1840. 10.2105/AJPH.89.12.1837.

Chaiton, Michael O, Cohen, Joanna E, O'Loughlin, Jennifer, Rehm, Jurgen. A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health. 2009; 1(9):356.

Yeepoo C, Kongthong U, Sriherun B. The development of a learning activity model for reducing and stop smoking behavior of drug addiction for children and adolescent patients. Journal of Humanities and Social Sciences Valaya Alongkorn. 2018; 8(1):131-46.

Hanchana C, Leetagool S, Aridech P. Causal factors affecting self esteem of pratomsuksa 6 students in border area of Chiangrai Province. Journal of Graduate Studies in Northern Rajabhat Universities. 2014; 4(6):57-70.

Treepatee S. Know children including both body and heart: development of the children and adolescents. Nakhon Pathom: Child and Youth Health program, National Institute for Child and Family Development, Mahidol University; 2011.

Orenstein GA, Lewis L. Eriksons Stages of Psychosocial Development. [Updated 2020 Nov 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:

Mahabee-Gittens EM, Khoury JC, Huang B, Dorn LD, Ammerman RT, Gordon JS. The protective influence of family bonding on smoking initiation in adolescents by racial/ethnic and age subgroups. J Child Adolesc Subst Abuse. 2011; 20(3):270-87

Nakhoul L, Obeid S, Sacre H, Haddad C, Soufia M, Hallit R, et al. Attachment style and addictions (alcohol, cigarette, waterpipe and internet) among Lebanese adolescents: a national study. BMC Psychol. 2020; 8(33):1-10.

Kassel JD, Wardle M, Roberts JE. Adult attachment security and college student substance use. Addict. Behav. 2007; 32(6):1164-76.

Wise MH. Tobacco use and attachment style (Dissertation). Tennessee, East Tennessee State University; 2015. 25p.

Chaikoolvatana C, Sutti P, Jaimalai W. Smoking behaviors and risk factors associated with smoking of elderly adolescents in Pha Yao Province, Thailand. Nurs J Ministry Public Health, 2017; 27(3):57-67.

Richter M. Risk behaviour in adolescence: Patterns, determinants and consequences, 2010. 1-123 p.

Valdez CR, Lambert SF, Ialongo NS. Identifying patterns of early risk for mental health and academic problems in adolescence: a longitudinal study of urban youth. Child Psychiatry Hum Dev. 2011; 42(5):521-38.

Wiangkamon S, Homsin P, Srisuriyawet R. Life assets and factors related to early smoking stage among male upper primary school students, Kalasin Province. Public Health Nurs. 2017; 31(2):89-107.

Brown BB, Clasen DR, Eicher SA. Perceptions of peer pressure, peer conformity dispositions, and self-reported behavior among adolescents. Dev. Psychol. 1986; 22(4):521–530.

Brown BB. Peer groups and peer cultures. In: Feldman SS, Elliott GR, editors. At the threshold: the developing adolescent. Cambridge, MA: Harvard University Press; 1990. pp. 171–196.

Bandura A. Social learning theory. Englewood Cliffs, NJ: Prentice-Hall; 1977.

Kirke DM. Chain reactions in adolescents’ cigarette, alcohol and drug use: similarity through peer influence or the patterning of ties in peer networks? Soc Networks. 2004;26(1):3–28.

Action on Smoking and Health Foundation. Cigarettes divided for sale, so the harder it is to quit smoke [homepage on the Internet]. Bangkok: Action on Smoking and Health Foundation; c2016 [updated 2016 Nov 24; cited 2021 Feb 25]; [about 2 screens]. Available from:

Troelstra SA, Bosdriesz JR, De Boer MR, & Kunst AE. Effect of tobacco control policies on information seeking for smoking cessation in the Netherlands: a Google trends study. PLoS One. 2016; 11(2), e0148489. doi:10.1371/journal.pone.0148489.

Aghar H, El-Khoury N, Reda M, Hamadeh W, Krayem H, Mansour M, et al. Knowledge and attitudes towards E-cigarette use in Lebanon and their associated factors. BMC Public Health. 2020; 20(1):1-18.

Carter BL, Tiffany ST. The cue-availability paradigm: the effects of cigarette availability on cue reactivity in smokers. Exp Clin Psychopharmacol. 2001; 9(2):183–90.

Homsin P, Srisuphan W, Pohl JM, Tiansawad S, Patumanond J. Predictors of early stages of smoking uptake among Thai male adolescents. Thai J Nurs Res. 2009; 13(1):28-42.

Phetcharaporn K. Learning theory [update 2020 Jun 16; cited 2021 Feb 5]. Bangkok: Suan Sunandha Rajabhat University; [about 22 screens]. Available from:


Nilsson M, Weinehall L, Bergstrom E, Stenlund H, Janlert U. Adolescent's perceptions and expectations of parental action on children's smoking and snus use; national cross sectional data from three decades. BMC Public Health. 2009; 9(1):1-8.