Parental and Peer Influences on Adolescent Smoking Initiation 1 Kuang Hock Lim1, Pei Pei Heng1, Hui Li Lim2, Sumarni Mohd Ghazali1, Yoon Ling Cheong1, Chee Cheong Kee3, Chien Huey Teh1, Balvinder Singh Gill1, Jia Hui Lim 4 1. Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia 2. Hospital Sultan Ismail, Johor Bharu, Ministry of Health Malaysia 3. Sector for Biostatistics and Data Repository, National Institutes of Health,Ministry of Health Malaysia. 4. Monash University Malaysia, Jalan Lagoon Selatan,47500 Bandar Sunway, Selangor Darul Ehsan P. 59 NMRR NO:12-1210-12399 INTRODUCTION: • The smoking habit is learnt and initiated in adolescence. Among daily smokers, over 85% attempted first cigarette at age of 18 ; almost 65% began smoking regularly by the same age 1. • Malaysian National Health and Morbidity Survey in 2015 reported that 70% of adult smokers started smoking before the age of 18 2 . • Ample studies have documented that parents and peers are dominant factors contribute to smoking initiation among adolescents 3 . • This study aimed to determine the actual causation factors of smoking initiation among non-smoking school-going adolescents METHDOLOGY: • Study Design: Prospective Cohort • Study Population: Non-smoking secondary school-going adolescents of form 1 (13 years), form 2 (14 years) and form 4 (16 years) • Study Location: Kota Tinggi district, Johor. • Sampling: Multistage, proportionate to size and cluster sampling . Respondents were followed-up for one year. • Measures: Dependent variable -> smoking status at follow-up (Smoked at least once in past 30 days identified as current smokers). Independent variables -> ―Number of best friends who smoke‖ (0, 1-5), and ―parent(s) smoking status‖ (Yes/No). • Data analysis: Descriptive analysis and Multivariable Logistic Regression was employed to determine the associated factors. RESULTS: Out of the 1682 non-smoking respondents at baseline, a total of 1282 (74.1%) participated at follow-up. Approximately 1 in 10 non-smoking Malaysian youth initiate smoking after a period of one year. Factors significantly associated with smoking initiation (Univariate Analysis) Risk of Smoking Initiation (Multivariable Analysis) Male ( Female as reference) 95% CI (2.93-12.95) Lower secondary (Upper secondary as reference) 95% CI (1.05-2.93) Smoking Parent/s 95% CI (1.06-2.95) DISCUSSION: • This was the first study to determine the factors influencing smoking initiation among non-smoking school-going adolescents in Malaysia. • About 1 in 10 non-smoking Malaysian youth initiated smoking after one year, which is higher than the 5% and 7% among cohorts reported in Portugal 4. • Smoking parent/s was more likely to influence smoking initiation among non-smoking adolescents, which was in consistent with the study among Taiwanese youth 5 that concluded that parents were the dominant role models for the smoking habit development among children. Parents who smoke in front of children indirectly provide the impression that smoking is a normative behaviour among adults.6 This positive finding also lends support to Bandura’s Cognitive Social Theory which posits that we tend to adopt behaviours that we learn from observing others, especially our role models for whom we have much respect such as our parents/guardians. • Our study found insignificant influence of peers on smoking initiation, in-line with several studies conducted overseas 7, which was contrary to several systematic review on longitudinal studies reporting causal-relationship between peer smoking and smoking initiation and non-smoking youth 8 . However, the influence of peers should be tested in more future studies. CONCLUSION: • The study revealed that parental influence was more dominant than peer influence with regards to smoking initiation. • Therefore, intervention program should involve parents/guardians to enhance the success rate and reduce the incidence of smoking among non-smoking schoo