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You read ‘A Review of Qualitative Study on Young Smoking Habits’ in category ‘Essay examples’ The male to female percentage for the analysis was unequal and this triggers a move in the common deviation the moment scrutinizing the study from a statistical watch. Having unequal gender figures could cause a type I or II error which makes the information not entirely reliable (Grove, S., 2012). References Middle for Disease Control. (2012, January). We could make the lastest tobacco-free. Gathered from http://www. cdc. gov/Features/YouthTobaccoUse/ Grove, Leslie K. (2012).

Statistics pertaining to Health Care Research: A Practical Workbook [1] (VitalSource Bookshelf), Retrieved from http://pageburstls. elsevier. com/books/978-1- 4160-0226-0/outline/11 Hollis, J., Polen, M., Whitlock, E., Lichtenstein, E., Mullooly, J., Velicer, W., , Redding, C. (2005). Teenager Reach: final results from a randomized, controlled trial of the tobacco lowering program for teens noticed in primary health care. Pediatrics, 115(4 Part 1), 981-989. Tohid, H., Ishak, N. d., Muhammad, D., Hassan, H., , Omar, K. (2011). What can determine teenagers’ cigarette smoking behavior?: A qualitative analyze. International Medical Journal, 18(3), 194-198. 194

PSYCHIATRY Document Ititernational Medical Joumal. Vol. 18, No . 3, pp. 194 , 198, September 2011 What Determines Teenagers’ Smoking Behavior?: A Qualitative Study Hizlinda Tohid”, Noriah Mohd. Ishak^’, Noor Azimah Muhammad”, Hasliza Abu Hassan^’, Farah Naaz Momtaz Ahmad”, Khairani Omar’* ABSTRACT Goal: The study aimed to explore smoking cigarettes behaviour amongst Malaysian young adults that were linked to their cigarette smoking initiation, cigarette consumption, give up intention, and quit efforts. Methods: It was a qualitative study that used multiple case study design, involving 26 teenagers (23 smokers and three past smokers) via three community schools.

Info was accumulated via questionnaires, three focus group interviews and three in-depth selection interviews over 20 weeks, A standardised semi-structured interview protocol was utilised. Results: Among the participants, 74% of which started smoking cigarettes after the associated with 12 years old. The majority (20/23) of the young smokers accepted to smoking cigarettes every day and 74% of which smoked only 5 cigs a day. All the smokers got the intention to quit although only twenty-two out of the 23 teenage people who smoke and had tried quitting. Sixty percent of these young adults had a lot more than three leave attempts.

On the whole, this analyze captured the complexity in the teenagers’ smoking behaviour that might be influenced simply by multiple factors, including behavioural (e, g, nicotine addiction), personal (e, g, conceiving of smoking and stopping, curiosity, feeling seeking, knowledge about smoking ukase, stress, retaining athletic performance, and financing, ) and environmental (e, g, socialization, peer pressure, parental smoking cigarettes, parental disapproval, and boy- or girl aversion) elements. Conclusions: This kind of study referred to the complicated and multidimensional nature of teenage smoking behaviour.

The findings also correspondingly coordinated the Social Cognitive Theory (SCT), as a result suggesting the theory’s suitability in elucidating smoking actions among the Malaysian teenagers, KEY PHRASES smoking, teens, smoking initiation, cigarette consumption, quit smoking ADVANTAGES Adolescence can be described as crucial amount of time in which a relatively dependent kid transforms into a relatively impartial adult. In this transitional period, many teens often research risky behaviors as a déclaration of their autonomy.

This risky behaviour contains cigarette smoking, using illicit medicines and cirinking alcohol. (Epps, Manley, , Glynn, 1995, Kulig, , American Senior high of Pediatrics Committee about Substance Abuse, 2005) Experimenting with smoking cigarettes is a primary stage of teenagers’ smoking cigarettes behaviour prior to it becomes proven. (Nichter, Vuckovic, Quintero, , Ritenbaugh, 1997, Seguire, , Chalmers, 2150, Curry, Mermelstein, , Sporer, 2009) This smoking avertissement predicts all their long-term tobacco use and heavier numbers of dependence. (Breslau, , Peterson, 1996, Escobedo, Marcus

Holtzman, , Giovino, 1993, Chen, , Sinnumero, 1998) Their particular experimenting behaviour may be motivated by numerous factors which include curiosity, expert pressure, parental smoking, feeling seeking, sociable norms pertaining to smoking, and misconception of smoking (e. g. belief that smoking cigarettes provides benefits, such as coping, sense of belonging, style, relaxation, and coolness). (Dijk, de Nooijer, Heinrich, , de Vries, 2007, Naing et for., 2004, Khairani, Norazua, , Zaiton, 2005, Vuckovic, Polen, , Hollis, 2003, Nichter, Vuckovic, Quintero, , Ritenbaugh, 1997) These kinds of factors might lead to teenagers to stay smoking.

Teenage smoking protection is also influenced by nicotine addiction. It is shown to be greatly significant among teenagers despite having low cigarette consumption. (The National Into the Morbidity Survey, 2009, Hammond et al., 2008, Khairani, Norazua, , Zaiton, 2005, Naing et al., 2005, DiFranza ain at., 2007, Balch ainsi que al., 2004, Amos, Wiltshire, Haw, , McNeill, 2006) This may be because of a very fast loss of autonomy over smoking cigarettes even with minimal exposure to pure nicotine in children, as shown by the SNOB study. (DiFranza et approach., 2007, DiFranza et ‘s., 2002)

As a result, majority of teenage smokers find it difficult to quit smoking. (Balch et for., 2004, McVea, Miller, Creswell, McEntarrfer, , Coleman, 2009, Amos, Wiltshire, Haw, , MeNeill, 2006, Seguire, , Chalmers, 2000) Thus, smoking cigarettes behaviour between teenagers is actually a complex happening, since it is influenced by simply multiple elements. This difficulty requires great understanding of the behaviour via those who are active in the care of these types of teenagers. This comprehension would certainly help the attention providers to curb adolescent smoking, a dangerous, addicting and harmful behaviour. ALL OF US Department of Health and Human being Services, 2004) Therefore , many investigations have Received on Augtist twenty-eight, 2010 and accepted on November 29, 2010 1) Department of Family Treatments, Faculty of drugs, Universiti Kebangsaan Malaysia Sarana Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lutnpur, Malaysia 2) Induk PERMATApintar Negeri, Universiti Kebangsaan Malaysia Bangl, 43600 Selangor, Malaysia 3) Setapak Wellness Clinic, Kuala Lumpur, Malaysia Correspondence to: Hizlinda Tohid (e-mails, [email, protected] com) 2011 The japanese International Ethnic Exchange Groundwork , The japanese Health Sciences University

TobitJ H, ainsi que al. 195 Table 1 ) Participants’ gender, status of smoking and types of interviews TYPES OF SCHOOL MAN GENDER FcEeM.. AALIEE SMOKERS STATUS OF SMOKING NO SMOKERS FOCUS GROUP INTERVIEW TYPES OF INTERVIEWS THOROUGH INTERVIEW UNIVERSITY 1 DOWNTOWN 9 several 9 a few 1 3 SCHOOL a couple of SEMI-URBAN 7 7 one particular SCHOOL a few RURAL several 7 you TOTAL several 23 three or more 23 3 3 3 been carried out to examine the phenomenon of teenage smoking. In Malaysia, majority of this sort of studies had been quantitative research. (Naing ou al., 2004, Hoi, , Hong, 2000, Khairani, Norazua, , Zaiton, 2004, Zulkifli, Rogayah, Razian, , Nyi Nyi, 2001)

Nevertheless, research that qualitatively describe Malaysian teenagers’ smoking behaviour are still lacking. This deficiency might affect the understanding of the matter in superb depth and holistically. As a result, this study aimed to explore smoking behavior among Malaysian teenagers linked to their smoking cigarettes initiation, cigarette consumption, leave intention, and quit tries. This information could provide us with better getting pregnant about their smoking behaviour, and subse-, quently eould support us to identify areas pertaining to improvement. STRATEGIES

This research used a multiple example design, involving 26 teens (23 smokers and three former smokers) from three public schools (urban, semi-urban and rural). Data was collected through selfadministered forms, focus group interviews (FGI) and indepth interviews (IDI) over a period of 20 months, among 2008 right up until 2010. Theoretical framework This study utilised the Interpersonal Cognitive Theory (SCT) to steer the experts in info collection and analysis. The SCT was also utilized for , analytieal generalisation’ in which findings in the study were mapped against the theory.

It was chosen while the study’s theoretical structure due to its appropriateness and comprehensiveness in capturing a complex trend of eigarette smoking that is influenced simply by multiple elements. (Baranowski, Perry, , Package, 2002) The SCT details how persons, environments and health conduct interact with one another simultaneously (reciprocal determinism). (Baranowski, Perry, , Pareel, 2002) Study populace Twenty six teens (23 kids and three girls, as shown in Table I) were chosen via purposive and snowballing sampling, depending on predetermined conditions.

The young smokers and former people who smoke and were experienced because their particular experience in cigarette smoking and smoking escale was important for this research. These teenagers were sixteen years old Malays, recruited via three several (urban, semiurban and rural) public colleges from two states in Malaysia. Recruitment of teenagers Teenagers were recruited together with the assistance from institution counsellors coming from eaeh sehool. An agreement pertaining to no disciplinary action against teenagers who had been willing to engage in this research was made with all the counsellors prior to the recruitment.

The students’ smoking status was also eoneealed from other college staff in order to avoid stigmatisation. A dozen teenagers who were selected from one of the colleges were introdueed to the key researcher during an informal conference for examine briefing (refer to Desk 1). The teenagers were invited to participate and were given parent packages, which will comprised of a great acknowledgement notification to parents, the study’s information sheet, and a parental permission form. Consequently, dates intended for tbe FGI and IDI were collection. The finished parental eonsents forms had been eolleeted prior the interviews by the university counsellor.

The other 14 teenagers (7 students coming from each remaining school, as shown in Table 1) were reeruited by sehools’ counsellors, who training in qualitative research and were well informed about the analysis. Similar technique of obtaining eonsent from their parents was completed by these counsellors. Data collection Three complex interviews and three focus-group interviews were carried out (refer to Stand 1). Prior to the interviews, almost all participants were given a brief review of the study plus the process of the interviews. Created eonsents by eaeh partieipant were also received.

They were in that case required to answer a brief self-administered questionnaire on the socio-demography, smoking status and smoking behavior (age of initiation, cigarette consumption, give up intention and quit attempts). The selection interviews were done in Malay language and eaeh interview lasted below two hours. A semi-structured interview process was used to steer interviewers in questioning the participants. Anti-smoking posters and pamphlets were also used to assist in discussion. Data analysis During eaeh interview, the chat was recorded applying digital voice recorders.

The voice recording was subsequently transeribed into text message by using Microsoft company Office Phrase 2007. The transcribed text was examined against the audio-recordings for several times until the accuracy with the transcripts was ensured. Any kind of uncertainty through the transcription, the help of other researehers was wanted to ascertain its veracity and dependability. (Yin, the year 2003, Yin, 1994) The transcribed text was then brought in into NVIVO 7. The key researcher in that case analysed the data to identify designs and classes (, thematie analysis’) that could explain habits of pereeption related to teenagers’ smoking actions.

In order to guarantee high stability of the eoding proeess, tbe coded data was eross-checked by two experts in adolescence wellness. Kappa was calculated by using the Cohen kappa formula to determine the reliability index, which was preserved above 0. 8. The process of transcription and analysis was repeated for each interview and , cross-case conclusion’ was drawn between analyses of eases. Conclusions of the research were also planned against the SCT for , analytical generalisation’. Ettiical concerns, reliability and validity Approval from the Exploration and Ethic Committee of Universiti Kebangsaan Malaysia was obtained prior to the study.

Authorisation for interviewing teenagers through the schools was also obtained from the Ministry of Education Malaysia that limited interviewing students who were not sitting down for any main examination (i. e. exeept students old 15 and 17 years old). In addition to these, all of these teenagers and their parents had been required to give written eonsents for their engagement. The confidentiality of the individuals, e. g. obscuring teenagers’ status of smoking in the knowledge of all their parents and other sehool staffs, was likewise guaranteed over the study.

Finally, medical responsibility of the key researcher in preventing smoking-related illnesses, while she was also a medieal doctor, was realised by offering teenagers consultation for cigarette smoking eessation at her medical center. This was done at the end of each and every interview to avoid any prejudiced answers from your partieipants. Validity and stability of the examine were guaranteed via a number of methods, ineluding, (1) triangulation of sourees of data (teenagers from 3 different sehools), as well as ways of data collection 196 What Determines Teenagers’ Smokitig Behaviour? Table 2 . Smoking actions of the young adults who smoked cigarettes

TEENAGERS WHO HAVE SMOKED (N = 23) AGE OF AVERTISSEMENT (YEARS) VOLUME OF CIGARRETTES SMOKED/DAY STAGE OF CHANGE RANGE OF QUIT TRIES FGD(n = 21) IDl(n = 2) TOTAL &lt, 12 your five 1 six &gt, 13 16 you 17 twenty 2 you 3 PRE COMTEMPLATION a few 1 several CONTEMPLATION 4 4 PLANNING II 12 0 you 1 1-3 7 you 8 S4 13 1 14 (questionnaire, three FGI and three IDI), (2) self reflexivity in reducing biases that the researchers may well bring in the study as a result of our earlier involvement in managing troublesome teenagers and chronic smokers, (3) , procedural validity’ via rephrasing of concerns, elarifying of statement and minimal prompting as ecessary, (Fliek, 2009) and (4) inter-coder arrangement or trustworthiness index of above zero. 8. OUTCOMES Twenty three boys and three girls were interviewed (referred to Table 1), in which two of the boys and one of the girls were previous smokers. The rest of the 23 teens were smokers at the time of the interviews. These kinds of teenagers’ cigarette smoking behaviour (age of cigarette smoking initiation, cigarette consumption, goal to quit and history of stop attempts) is definitely summarised in Table installment payments on your Age and reasons of smoking avertissement Six from the 23 (26%) teenage people who smoke and in this examine started cigarette smoking during primary school (before the age of 13).

The most youthful age of smoking initiation was 10 years aged. Nevertheless, 74% of these teen smokers began smoking whenever they were inside the secondary college. Most of the teens admitted that curiosity [“Felt interested to make an effort (smoking)”], experience seeking [“Just to get fun”], parent modelling of smoking [“Sinee my dad smokes, I always watch him smoking. If he smokes, it appears to be pleasurable, gratifying”], peer pressure [“Peer influence”], and misconception of smoking [“Style (because of smoking). Siyle”] were prevalent factors for them to experiment with smoking cigarettes.

The teens who started smoking before the regarding 13 claimed that fascination and smoking modelling simply by parents were their major causes for experimenting with smoking. This really is contrary to individuals who started smoking at the age of 13 years or older. These kinds of teenagers confessed that peer pressure was your major element for them to begin smoking. Cigarette consumption Majority (20/23) of the teenage smokers in this analyze admitted to smoking each day and 74% of these teens smoked not more than 5 cigarettes a day.

The teenagers assumed that all their daily cigarette smoking behaviour was mainly because of nicotine craving in which they will described considerable physical (e. g. fatigue, lethargy, flu-like symptoms) and psychological (e. g. slower thinking, frustrated, craving) revulsion symptoms that they can experienced during smoking continence [“My brain feels slow”, “(If I quit smoking) Personally i think restless. “]. The daily smokers also admitted to smoking whenever they were using their friends. They will claimed this kind of behaviour could possibly be due to numerous reasons: a) sharing the expense of cigarettes using their friends, as a result tend to smoke cigarettes together, since explained by a teen: Between 14 of us. we shared RMI per person, we can make 2 big boxes of cigarettes. ” b) socialisation, as one teenager observed: “When we hang around (with friends), we smoke, sis” c) expert pressure, being a teenager said: “When we come across our friends smoked cigarettes, the desire to smoking is too powerful. ” d) sense of belonging, by way of example: “We most belong to a gang who also shared our cigarettes together” However , three of the current smokers confessed to smoking cigarettes only once every week. They explained that they specifically smoked during stressful period [“Especially when I i am doing some thing. When it’s hard then I will smoke. ]. A few of the teenagers reported the fact that national anti-tobacco policy, and also the school regulations had constrained their cigarette smoking behaviour. These teenagers publicly stated to generally smoke in secluded areas outside of public view, such as in school toilets and stairways of shopping malls. The restrictive environment to get public cigarette smoking was thought to influence tbeir cigarette usage. Intention to give up All teenage smokers in this study got the purpose to quit smoking. However , several of them (30%) did not intend to quit within the next 6 months (in the pre-contemplation stage).

A dozen of them (52%) were in the planning level, but non-e had arranged their quit dates. The smokers diselosed that a range of factors could influence tbeir desire to leave, which included: a) impaired athletic performance, among the teenagers claimed: “When (I) sprint, I will hecome breathless” b) boy- or partner aversion, by way of example: “Maybe (I get the prefer to stop smoking) from my girlfriend. If she said “If you never stop smoking, we have to break-up”. Right. (I think that to quit smoking)” c) parent disapproval, because noted by simply one young man: If mom scolded me personally for smoking cigarettes, until your woman cried.. I would feel? ike I want to quit, but it was temporary only. Afterwards.. I continue smoking” d) matter about health, shown by simply one of the teenagers’ excerpt: “Smoking can make myself feel breathless, sis (that’s why I believe like to quit)” e) finaneial problems, being a teenager stated: “(I) consider my parents, sis. My mother and my father are not wealthy, (when I) think about that, it could (trigger my desire to quit)” Identical motivating factors were also through former cigarette smokers in this analyze prior to all their successful smoking cigarettes cessation.

However, these former smokers confessed that only customised motivating elements could provide them to leave successfully. Their personalised motivators were parental disapproval [“(Parental disapproval) effective, really effective. I have stopped cigarette smoking. “], maintaining athletic efficiency [“(I) stopped smoking (for athletic performance). I got selected (to play football for my own district) afterwards”]. and lowering costs /”/ ended (smoking) to save money to buy a motorbike”]. Previous quit efforts Almost all (22/23) teenage cigarette smokers in this research had tried smoking ukase prior to the interviews.

The teens deseribed that quitting was very difficult as a result of withdrawal symptoms that they skilled during the quit attempts [“(If We stop smoking) I feel restless”]. Sixty percent of the teenage smokers had actually attempted to give up four instances or more. All the teenagers believed that they never reeeived any kind of professional will help when they manufactured their tries to quit during the past. Majority of all of them declared that they can sought their particular friends’ suggestions on how to give up and among the list of common strategies that they got tried were drinking a lot of water, chewing gums and choosing sweets, among the teenagers said:

Tohid H. et ing. 197 “Usuatty (I) asked my friends tips on how to quit. They advised me to drink a tot of minerat drinking water. ” DISCUSSION In Malaysia, the imply age of smoking cigarettes initiation among teenage cigarette smokers is between 12-14 years old, (The National Health and Morbidity Survey, 2009, Hammond et at., 08, Khairani, Norazua, , Zaiton, 2004, Naing et by., 2004) whieh is concurrent with the findings of this research. The common reasons behind smoking initiation, such as interest, peer pressure, and parental smoking, reported by tbe participants in tbis study were similar to otber studies. (Naing et in. 2004, Kbairani, Norazua, , Zaiton, 2004) This examine also advised that interest and parental modelling of smoking bebaviour could be teenagers’ main reasons pertaining to experimenting smoking at more youthful age (less tban 13 years old). In contrary, peer pressure was located to be a significant factor teens wbo began smoking at seeondary sehools. However , the value of tbese associations should be confirmed simply by future quantitative studies. Cigarette consumption through teenagers with this study was found to become lesser tban tbose of Malaysian adults, who averagely smoke between 11 to 14 smoking cigarettes per day. Globe Health Organization (WHO) Framework Convention upon Tobacco Control, 2010) Tbis may be because of a number of elements as recommended by tbese teenagers, such as, (a) inadequate fund to get cigarettes, (b) , occasional’ smoking, and (c) restrictive environment intended for smoking. Nevertheless, underreporting of smoking behavior by these kinds of teenagers can also explain the lower estimated quantity of cigarettes smoked by these people. Tbis is really because teenagers tend to report socially desirable conduct and thinking. (Hammond ainsi que at., 2008, Klein, Havens, , Carlson, 2005)

Not enough fund to purebase cigarettes were defined by a number of the teenagers through this study, who also claimed that they had to discuss their pocket money with the peers to acquire cigarettes. Tbis is to assure their constant supply of cigarettes and to develop bonding between tbe peers. (Vuckovic, Polen, , Hollis, 2003, Amos, Wiltsbire, Haw, , McNeill, 2006, Niehter, Vuckovic, Quintero, , Ritenbaugh, 1997, Seguire, , Cbalmers, 2000) Tbis practice subsequently increases tbe level of approval by peers and encourage sense of belonging tbat is essential to teenagers’ psychosocial advancement. Mermelstein, the year 2003, Vuckovic, Polen, , Hollis, 2003, McVea, Miller, Creswell, McEntarrfer, , Coleman, 2009, Nicbter, Vuckovic, Quintero, , Ritenbaugh, 1997, Seguire, c, Chalmers, 2000) However , a few teenagers with this study, who no financial constraint mainly because they had personal income (e. g. by part-time task or significant allowance by parents), confessed to smoke cigars only wben socialising and facing adversities (e. g. relation problems, inability to manage witb academics or part-time job). (Vuekovic, Polen, , Hollis, 2003, Balch ainsi que at., 2005, Amos, Wiltshire, Haw, , McNeill, 06\, Hoi, 8L Hong, 2k

Khairani, Norazua, , Zaiton, 2004, Niehter, Vuckovic, Quintero, , Ritenbaugh, 1997, Seguire, , Chalmers, 2000) These teenagers can be defined as occasional people who smoke and, whose smoking was obviously influenced by peer pressure and tbeir inability to manage themselves above smoking as well as to cope with pressure. (Vuckovic, Polen, , Hollis, 2003, Conseguire, , Chalmers, 2000, Patten et ing., 2003, Niehter, Vuckovic, Quintero, , Ritenbaugh, 1997, Mermelstein, 2003, McVea, Miller, Creswell, McEntarrfer, , Coleman, 2009, Khairani, Norazua, , Zaiton, 2004, Balch et by., 2004, Amos, Wiltshire, Haw, , McNeill, 2006, Hoi, , Hong, 2000) Teenagers’ smoking in esponse to hardship implies that smoking is usually their method of coping since it calms all of them through pure nicotine effects on the central nervous system. (Niebter, Vuckovic, Quintero, , Ritenbaugh, 1997, Curry, Mermelstein, , Sporer, 2009) In addition , smoking creates a social space by which they can relax and ease tension. (Niehter, Vuckovic, Quintero, , Ritenbaugh, 1997, Curry, Mermelstein, , Sporer, 2009) Apart from economical constraint and occasional smoking, restrietive environment for community smoking was also found to be responsible for tbe partieipants’ low cigarette intake in this analyze.

Therefore , these teenagers commonly smoked in secluded areas outside of general public view, sucb as scbool toilets and stairways of shopping malls. These types of findings happen to be consistent with numerous studies that contain found restricted environment to work in minimizing teenage cigarette smoking. (Wakefield ct at., 2150, Lipperman-Kreda, , Grube, 2009, Crawford, Balcb, Mermelstein, , Tobacco Control Network Publishing Group, 2002) Majority of young smokers salive intention to stop. (Khairani, Norazua, , Zaiton, 2004, Krishnan M, the year 2003, Mermelstein, the year 2003, Naing computertomografie at. 2005, The National Health and Morbidity Survey, 2009) Tbis was also found simply by tbis study, in wbich almost all teenagers who used to smoke eonsidered to quit smoking between the future. That they admitted that the number of factors could result in tbeir give up intention, wbich include, (a) athletic performance, (b) boy- or partner aversion, (c) parental disapproval, (d) concern about bealtb, and (e) money saving. Tbese faetors had been similarly discovered to motivate teenagers to eease cigarette smoking by past studies. (Vuckovic, Polen, , Hollis, 2003, Mermelstein, 2003, McVea, Callier, Creswell

McEntarrfer, , Coleman, 2009, Balcb ct approach., 2004) Nevertheless , tbe teens reported tbat these extrinsie motivations were insufficient to keep them by total smoking abstinence. Nevertbeless, excerpts made by tbe ex – smokers from this study advised that young adults would just stop smoking if they are desperate to transform due to compelling personal causes. This getting is maintained McVea ain al who have found only ’emotionally powerful and inescapable quit reasons’ were the most motivating reasons for teenagers to avoid smoking. (McVea, Miller, Creswell, McEntarrfer, , Coleman, 2009)

Even though most of tbe young adults in this study had goal to quit smoking, they did not have any quitting strategies, not even setting their quit dates. These kinds of findings are similar to those through Mermestein. (Mermelstein, 2003) It will be possible tbat the teenagers had been, (a) not ready to leave (Balch computertomografie al., 2004) (e. g. some of the teens in the eurrent study might only stop when they experience major life transition, such as after graduation and tnarriage), (b) doppelwertig about stopping (MeVea, Burns, Creswell, McEntarrfer, , Coleman, 2009, Patten et approach. 2003) (e. g. numerous teenagers repetitively answered, “I am not sure” after they were asked about tbeir intend to quit smoking), and (c) very confident that they can control themselves over smoking cigarettes (Niehter, Vuckovic, Quintero, , Ritenbaugb, 97, Amos, Wiltshire, Haw, , McNeill, 2006) (e. g. a teenager assertively admitted that he may stop stroking on his own with out relying on helps from other). The later seems to be associated with teenagers’ idea tbat , quitting is really a matter of will power’. (Amos, Wiltsbire, Haw, , McNeill, 2006, Balcb el by. 2004) In the end, these teenagers’ ehanees intended for successful quit attempts will be reduced if they did not need strategic stopping plans. Multiple unsuccessful give up attempts were reported by various teenagers in tbis research, in which the conclusions were concurrent with other studies. (World Overall health Organization (WHO) Framework Meeting on Smoking cigarettes Control, 2010, The Nationwide Health and Morbidity Survey, 2009, Klein, Havens, , Carlson, 2005, Balch ct at., 2004) This can be due to a lot of reasons which may be summarised into three categories, (1) pure nicotine addiction, (Amos

Wiltsbire, Haw, , McNeill, 2006, Balch et ‘s., 2004, DiFranza et for., 2007, DiFranza ct for., 2007) (2) factors relevant to environment and situation which may promote adolescent smoking (e. g. good peer pressure, poor support from good friends, smoking tnodelling by members of the family, stress and so forth, as higbligbted by tbe current study), (Balch ainsi que at., 2004, Crawford, Balch, Mermelstein, , Tobacco Control Network Publishing Group, 2002, McVea, Callier, Creswell, McEntarrfer, , Coleman, 2009, Nicbter, Vuckovic, Quintero, , Ritenbaugb, 1997) and (3) personal factors (e. g. oor risk assessment, poor expertise, poor do it yourself efficacy and control, mi, sconception regarding smoking and quitting, good belief in unassisted stop attempts and so forth, as identified by this study) (Niehter, Vuckovic, Quintero, , Ritenbaugb, 97, Balcb ct at., 2004). These tbree categories apparently matcb tbe model of the Social Cognitive Theory. Total, this examine provides effective information intended for future development of interventions of smoking escale for teenagers. Nevertheless, appropriate eontext which is similar to tbose on this study ought to be taken into consideration just before applying this sort of information since this is a ease study.

Interviewing only young adults aged of sixteen years old also limits the findings of this study. The reason is , teenagers by different levels of adolescence (early, central and late) may crachotement different developmental characteristics which can influence their pereeption and attitude towards cigarette smoking. Young adults from distinct stages of adolescence should certainly then always be included in upcoming studies while differences in tbeir perception, frame of mind and bebaviour could be looked into. CONCLUSION This kind of study negative captured tbe complexity of tbe teenagers’ smoking bebaviour that could be motivated by multiple factors.

Tbese faetors included behavioural (e. g. smoking addiction), personal and environmental factors matched up the Sociable Cognitive Theory (SCT). These 198 What Determines Teenagers’ Smoking Actions? multiple elements should be considered in developing interventions for smoking cigarettes cessation fitted to teenagers. The corresponding mapping with the findings up against the SCT as well supports the SCT in helping us to comprehensively understand teenage cigarette smoking behaviour also to overcome the influential factors. FUNDING This work was funded by the Universiti Kebangsaan Malaysia UKM-GUP-TKS-07-12-097 and FF-127-2008). DECLARATION OF INTERESTS Most authors declare that they have not any conflicts of interests. ACKNOWLEDGEMENTS The creators would also like to express appreciation to the Ministry of Education Malaysia, the Ministry of Health Malaysia and the school counsellors who helped us throughout the study. REFERENCES Amos A. Wiltshire S, Haw S. McNeill A. (2006). Ambivalence and uncertainty: activities and elevations towards addiction and cigarette smoking cessation inside the mid-to-late young adults. Heatiti Educ Re. h. 21. 181-191. doi: l0. 1093/her/cyh054 Baick GI.

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