What question did this study set out to answer?

The study aims to investigate how peer smoking affects adolescents' intentions to smoke and the role of their beliefs and attitudes.

March 5, 2026Open Access

Study on adolescents’ smoking intentions: the influence of peer smoking and the mediating roles of beliefs and attitudes toward smoking behavior

Key Points

The study aims to investigate how peer smoking affects adolescents' intentions to smoke and the role of their beliefs and attitudes.
Utilized a multi-stage stratified cluster sampling method to select 4,617 students from Cixi City.
Administered the 2023 China High School Students Tobacco Use Survey Questionnaire.
Employed structural equation modeling to analyze relationships among peer smoking, beliefs, attitudes, and smoking intentions.
Beliefs and attitudes significantly mediate the effect of peer smoking on adolescents' future smoking intentions.
Two mediation pathways were identified: an independent effect of attitudes and a chain effect involving both beliefs and attitudes.
The standardized total effect of peer smoking on smoking intentions was 0.233.

Abstract

Background Reducing adolescents’ smoking rates is an important priority for global public health. Smoking intention is the most direct factor influencing smoking behavior and the best predictor of its occurrence. Smoking intention is influenced by peer smoking behavior, which strengthens adolescents’ willingness to smoke. Understanding adolescents’ smoking intentions and their influencing factors will be a key component of future tobacco control. This study aims to explore the relationship between peer smoking and adolescents’ future smoking intentions, investigate the potential roles of beliefs and attitudes toward smoking behavior in this process, and identify the pathways among these variables. Method A multi-stage stratified cluster sampling method was adopted to select 4,617 students from 16 junior and senior high schools in Cixi City as study subjects. The 2023 China High School Students Tobacco Use Survey Questionnaire was used to investigate data such as students’ basic demographics, awareness, and usage status of tobacco products. Structural Equation Modeling (SEM) was employed to analyze the impact of peer smoking on adolescents’ future smoking intentions, as well as the mediating roles of beliefs and attitudes toward smoking behavior. Results Among participants, 2,359 (51.1%) were male, and 2,258 (48.9%) were female. SEM showed a significant mediating effect of beliefs and attitudes toward smoking behavior in the relationship between peer smoking and adolescents’ future smoking intentions. This mediating effect consists of two pathways: the independent mediating effect of attitudes toward smoking behavior, and the chain mediating effect of beliefs and attitudes toward smoking behavior. Through bootstrap testing, the standardized total effect was 0.233 (0.185–0.280), the standardized direct effect was 0.167 (0.119–0.216), accounting for 71.7% of the standardized total effect, and the standardized indirect effect was 0.066 (0.049–0.081), accounting for 28.3%. Conclusion Peer smoking not only directly enhances adolescents’ future smoking intentions but also indirectly reinforces this effect by altering their beliefs and attitudes toward smoking behavior. Therefore, conducting precise interventions targeting beliefs and attitudes toward smoking behavior can effectively mitigate the negative influence of peer smoking, thereby providing empirical evidence for adolescent tobacco control strategies.

Bookmark

View Full Paper