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A Longitudinal Test of the Theory of Planned Behavior Predicting Smoking Onset among Asthmatic and Non-asthmatic Adolescents

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Abstract

Despite the particularly detrimental health risks of smoking for adolescent with asthma, several studies demonstrated higher smoking rates among asthmatic adolescents than among healthy adolescents. To gain insight into underlying mechanisms, longitudinal studies on differences in smoking predictors between asthmatic and non-asthmatic adolescents are essential. This longitudinal study with two waves with an 18 months interval tests the Theory of Planned Behavior (TPB) among 346 asthmatic adolescents and 3,733 non-asthmatic adolescents aged 12–16 years. Structural equation models were used to test the predictive value of the TPB in these two groups. The results show, consistent with the TPB, that smoking-related cognitions (attitude, perceived behavioral control, and subjective norm) predict smoking onset via intention among both asthmatic and non-asthmatic adolescents. The TPB predicted smoking onset even stronger among adolescents with asthma. These findings may contribute to the development of tailored interventions for the prevention of smoking among asthmatic adolescents.

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Notes

  1. To test whether the differences in associations between subjective norm of parents and intention to smoke are caused by differences in parental smoking, we conducted additional analyses including parental smoking in the model (with a direct path to smoking onset, as well as an indirect path via intention). If the relation between subjective norm of parents and intention can be explained by parental smoking, the regression weights of subjective norm parents and intention would decrease. Including parental smoking in the model did not significantly alter the model findings in both groups. The same paths between the variables of the TPB, smoking intention and smoking onset were significant. Most of the regression weights did not change either, except for small changes the in regression weights of subjective norm of parents. For the non-asthmatic adolescents, subjective norm parents to intention became .04 instead of .05 after including parental smoking, and the regression weight of subjective norm parents to smoking onset became .06 instead of .07. For the asthmatic adolescents, subjective norm parents to intention became .13 instead of .14. Although a small decrease in the effect of subjective norm parents was found, this did not significantly change the model, indicating that in both groups, the effect of subjective norm of parents was hardly affected by parental smoking behavior.

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Acknowledgments

This research was funded by a grant from the Dutch Asthma Foundation. The contribution of Rutger Engels was supported by the Netherlands Organization for Scientific Research.

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Authors and Affiliations

  1. Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen, 6500 HE, The Netherlands

    Monique O. M. Van De Ven, Rutger C. M. E. Engels, Roy Otten & Regina J. J. M. Van Den Eijnden

  2. IVO, Heemraadssingel 194, Rotterdam, 3021 DM, The Netherlands

    Regina J. J. M. Van Den Eijnden

Authors
  1. Monique O. M. Van De Ven
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  2. Rutger C. M. E. Engels
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  3. Roy Otten
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  4. Regina J. J. M. Van Den Eijnden
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Corresponding author

Correspondence to Monique O. M. Van De Ven.

Appendix: Questionnaire Items and Response Scales

Appendix: Questionnaire Items and Response Scales

Pro-smoking Attitude: 7-Point Likert scale

I think daily smoking is…

  1. 1.

    Unpleasant (1) to pleasant (7)

  2. 2.

    Harmful (1) to innocent (7)

  3. 3.

    Useless (1) to useful (7)

  4. 4.

    Boring (1) to exciting (7)

  5. 5.

    Hazardous (1) to harmless (7)

  6. 6.

    Unhealthy (1) to healthy (7)

  7. 7.

    Bad (1) to good (7)

Perceived Behavioral Control (PBC): 5-Point Likert scale

  1. 1.

    Not to smoke if my friends smoke is…very difficult (1) to very easy (5) for me

  2. 2.

    To refuse a cigarette when it is offered to me is…very difficult (1) to very easy (5) for me

  3. 3.

    To stay or become a non-smoker is…very difficult (1) to very easy (5) for me

  4. 4.

    To think of a reason not to smoke is…very difficult (1) to very easy (5) for me

  5. 5.

    To explain why I do not want to smoke is…very difficult (1) to very easy (5) for me

  6. 6.

    To respond when someone thinks I am a coward because I do not smoke is…very difficult (1) to very easy (5) for me

Subjective Norm: 4-Point Likert scale

  1. 1.

    Do you think your best friend would approve when you smoke (or would smoke)? Definitely not (1) to definitely yes (4)

  2. 2.

    Do you think your friends would approve when you smoke (or would smoke)? Definitely not (1) to definitely yes (4)

  3. 3.

    Do you think your parents would approve when you smoke (or would smoke)? Definitely not (1) to definitely yes (4)

Intention

Which of the following statements applies to you?

  1. 1.

    I am sure I will never start smoking

  2. 2.

    I think I will never start smoking

  3. 3.

    I think I will start smoking in the future

  4. 4.

    I think I will start smoking within 5 years

  5. 5.

    I think I will start smoking within 1 year

  6. 6.

    I think I will start smoking within 6 months

  7. 7.

    I think I will start smoking within 1 month

Smoking Behavior

Which of the following statements applies to you?

  1. 1.

    I never smoked, not even a puff

  2. 2.

    I have tried smoking, but I do not smoke anymore

  3. 3.

    I have quit smoking after smoking less then once a week

  4. 4.

    I have quit smoking after smoking at least once a week

  5. 5.

    I try smoking every now and then

  6. 6.

    I smoke less than once a month

  7. 7.

    I smoke less than weekly, but at least once a month

  8. 8.

    I smoke less than daily, but at least once a week

  9. 9.

    I smoke at least once a day

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Van De Ven, M.O.M., Engels, R.C.M.E., Otten, R. et al. A Longitudinal Test of the Theory of Planned Behavior Predicting Smoking Onset among Asthmatic and Non-asthmatic Adolescents. J Behav Med 30, 435–445 (2007). https://doi.org/10.1007/s10865-007-9119-2

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