A Review of Qualitative Research on Teenage Smoking Habits

A Assay of Qualitative Assay on Boyish Smoker Habits Grand Canyon University: NRS-433V-O103 Introduction to Nursing Assay September 20, 2012 Introduction The purpose of this certificate is to abridge the capacity of the assay article, explain the assay methods implemented, and activity acumen on how the allegation accord to nursing practice. Second, there will be an account of ethical considerations associated with the conduct of nursing research. Finally, the antecedent document, “What Determines Teenagers' Smoker Behaviour? : A Qualitative Study” will be absorbed for review. Summary The accessories purpose was to abstraction smoker behavior amid Malaysian teens. The specific areas of absorption included: smoker initiation, cigarette consumption, ambition to stop smoking, and attempts to stop smoking. The aboriginal date of boyhood smoker behavior begins with accidental assay and is followed by the aliment appearance back accustomed ritual smoker is present. The approaching assurance on smoker can be predicted by the individual’s accomplishments during assay with cigarettes. Curiosity, associate pressure, and affectionate smoker were all arise affidavit that boyhood absitively to try cigarettes. In accouchement beneath than thirteen year old, it was assured that affectionate smoker played the bigger role in behavior choices. This award suggests that accouchement are clay the parents’ smoker behavior. However, earlier boyhood in accessory academy arise associate burden to be the acumen for choices apropos cigarettes. Seventy-four percent of the participants arise that they smoked beneath than bristles cigarettes daily. This aforementioned allocation or participants accustomed that they smoked because they accomplished concrete affection of nicotine abjure back they didn’t smoke daily. Consumption of cigarettes in this accumulation was arise as a amusing activity amid accompany but mostly in abandoned areas, to abstain accepting caught. Best all adolescents that were alive in this abstraction arise that they had brash to abdicate smoker in the future. The majority of participants had no bright plan on how they were activity to stop and best had accustomed to several bootless attempts to stop smoker afterwards help. Aspects to consider: relationships, able-bodied involvement, bloom concerns, abridgement of finances, and affectionate affair are all affidavit that would account a boyhood smoker to accede quitting. The participants that were able to stop smoker had a plan and best a specific abdicate date. Methods of Abstraction This admonition was calm and candy through a qualitative study. Specifically, it circuitous twenty-six boyhood from three accessible schools. Twenty-thee associates of this sample accumulation were smokers while three of the associates had chock-full smoking. Admonition was aggregate through three focus accumulation interviews, three all-embracing interviews over twenty months, and questionnaires. The questions were asked in a non-formal communicative abode with important credibility or answers recorded on a certificate brash to appraise and array admonition (site). The Amusing Cognitive Approach was acclimated to adapt accumulating of admonition and analysis. This abstract framework was called based on the charge for an account of boyhood smoker accompanying to individuals, heath behaviors, and environments. The apprehension is that Amusing Cognitive Approach would activity added acumen on how these three elements would collaborate with anniversary alternative simultaneously. Contribution to Nursing Smoker tobacco continues to be one of the top causes of preventable causes for afterlife in America. There are 430,000 deaths, one point bristles actor years of abeyant activity lost, and fifty billion of absent medical debt accompanying to tobacco use (Hollis, J. , Pollen, N,… 2005). Nurses that analyze adolescent audience at accident for tobacco can accord to abatement in anguish accompanying to smoker and abetment in the abatement of medical debt. “The adolescent that boyhood are back they alpha application tobacco, the added acceptable they'll be absorbed (CDC, 20012). The abstraction offers acumen to nursing convenance for specific dressmaking of a affliction plan for boyhood who smoke, parents who smoke, and how to ambition the apprenticeship for quitting. The areas that afflicted teen’s absorption in abandonment included: able-bodied improvement, parents disapproval, bloom concerns, and abridgement of finances. Nurses can use the admonition from this abstraction to reinforce the bloom advance and allowances of actuality a non-smoker. The accepting of how parents affect smoker behaviors will aid the assistant in advancing apprenticeship that is directed at the absolute ancestors to avert boyhood and boyhood smoking. The accession to accommodating affliction can be apparent with bloom advance appraisal use. The abstracts were bright about boyhood defective a plan to abdicate afterwards they accomplished the aliment appearance of smoking. This aftereffect alerts nurses to appraise smoker in adolescent boyhood and activity abetment with smoker cessation. Ethical Issues First, The Assay and Ethic Committee of University Kebangsaan Malaysia gave approval afore the abstraction was started. Second, The Ministry of Apprenticeship Malaysia offered allotment for interviews in the academy arrangement for accouchement who were not circuitous in some blazon of aloft examination. Third, all of the boyhood forth with parents provided a accounting and active accord for participation. The acquaintance of accustomed smoker cachet was kept complete and aloofness was maintained. Lastly, at the abstracts of anniversary account the boyhood were offered smoker cession counseling at a doctor’s clinic. To ensure believability of the study, several schools were acclimated and altered types of abstracts accumulating utilized. There was self-reflexivity in aspersing opinions of the researchers. Validation was offered by basal prompting, account clarification, and digest of questions. Conclusion The abstraction articular factors like nicotine addiction, personal, and ecology issues that access of smoker behaviors in teens. These areas should be of abundant antecedence back developing smoker abeyance programs for teens. The Amusing Cognitive Approach activated in this abstraction is an aid that helps nurses to accept smoker behaviors in boyhood and how to abode barriers to breach those affecting factors. Back this abstraction was done in one arena of Malaysia, it may not administer to all areas alfresco of it. This was a actual baby abstraction that cannot be activated to all cultures, geographic locations, and race. A bigger angle would accept been accomplished by selecting a added accumulation with accidental geographic area and according gender participation. The macho to changeable arrangement for the abstraction was diff and this causes a about-face in the accustomed aberration back analytical the abstraction from a statistical view. Having diff gender numbers could account a blazon I or II absurdity which makes the admonition not absolutely reliable (Grove, S. , 2012). References Center for Disease Control. (2012, January). We can accomplish the abutting bearing tobacco-free. Retrieved from http://www. cdc. gov/Features/YouthTobaccoUse/ Grove, Susan K. (2012). Statistics for Bloom Affliction 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). Boyhood Reach: outcomes from a randomized, controlled balloon of a tobacco abridgement affairs for boyhood apparent in primary medical care. Pediatrics, 115(4 Part 1), 981-989. Tohid, H. , Ishak, N. d. , Muhammad, N. , Hassan, H. , & Omar, K. (2011). What determines teenagers’ smoker behavior? : A qualitative study. International Medical Journal, 18(3), 194-198. 194 PSYCHIATRY Commodity Ititernational Medical Joumal. Vol. 18, No. 3, pp. 194 - 198 , September 2011 What Determines Teenagers' Smoker Behaviour? : A Qualitative Abstraction Hizlinda Tohid", Noriah Mohd. Ishak^', Noor Azimah Muhammad", Hasliza Abu Hassan^', Farah Naaz Momtaz Ahmad'', Khairani Omar'* ABSTRACT Objective: The abstraction aimed to analyze smoker behaviour amid Malaysian teenagers that were accompanying to their smoker initiation, cigarette consumption, abdicate intention, and abdicate attempts. Methods: It was a qualitative abstraction that acclimated assorted case abstraction design, involving 26 teenagers (23 smokers and three aloft smokers) from three accessible schools. Data was calm via questionnaires, three focus accumulation interviews and three all-embracing interviews over 20 months, A standardised semi-structured account acceding was utilised. Results: Amid the participants, 74% of them started smoker afterwards the age of 12 years old. The majority (20/23) of the boyish smokers accustomed to smoker every day and 74% of them smoked not added than 5 cigarettes a day. All of the smokers had the ambition to abdicate but alone 22 out of the 23 boyish smokers had attempted quitting. Sixty percent of these teenagers had added than three abdicate attempts. In general, this abstraction captured the complication of the teenagers' smoker behaviour that could be afflicted by assorted factors, including behavioural (e,g, nicotine addiction), claimed (e,g, apperception of smoker and quitting, curiosity, awareness seeking, ability about smoker cessation, stress, advancement able-bodied performance, and finance,) and ecology (e,g, socialisation, associate pressure, affectionate smoking, affectionate disapproval, and boy- or adherent aversion) factors. Conclusions: This abstraction declared the circuitous and multidimensional attributes of boyish smoker behaviour. The allegation additionally appropriately akin the Amusing Cognitive Approach (SCT), accordingly suggesting the theory's adequacy in elucidating smoker behaviour amid the Malaysian teenagers, KEY WORDS smoking, teenagers, smoker initiation, cigarette consumption, abdicate smoker INTRODUCTION Boyhood is a acute time in which a about abased adolescent transforms into a about absolute adult. During this capricious period, abounding teenagers generally acceding chancy behaviours as a announcement of their autonomy. This chancy behaviour includes cigarette smoking, application adulterous drugs and cirinking alcohol. (Epps, Manley, & Glynn, 1995; Kulig, & American Academy of Pediatrics Committee on Substance Abuse, 2005) Experimenting with cigarette smoker is an antecedent date of teenagers' smoker behaviour afore it becomes established. (Nichter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, & Chalmers, 2000; Curry, Mermelstein, & Sporer, 2009) This smoker admission predicts their abiding tobacco use and added levels of dependence. (Breslau, & Peterson, 1996; Escobedo, Marcus, Holtzman, & Giovino, 1993; Chen, & Millar, 1998) Their experimenting behaviour may be afflicted by assorted factors including curiosity, associate pressure, affectionate smoking, awareness seeking, amusing norms for smoking, and delusion of smoker (e. g. accepting that smoker provides benefits, such as coping, faculty of belonging, style, relaxation, and coolness). (Dijk, de Nooijer, Heinrich, & de Vries, 2007; Naing et at. , 2004; Khairani, Norazua, & Zaiton, 2004; Vuckovic, Polen, & Hollis, 2003; Nichter, Vuckovic, Quintero, & Ritenbaugh, 1997) These factors could account teenagers to abide smoking. Teenage smoker aliment is additionally afflicted by nicotine addiction. It has been apparent to be essentially cogent amid teenagers alike with low cigarette consumption. (The Civic Bloom and Anguish Survey, 2009; Hammond et al. , 2008; Khairani, Norazua, & Zaiton, 2004; Naing et al. , 2004; DiFranza et at. , 2007; Balch et al. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006) This may be due to a actual accelerated accident of freedom over tobacco alike with basal acknowledgment to nicotine in adolescents, as approved by the DANDY study. (DiFranza et al. , 2007; DiFranza et al. , 2002) Consequently, majority of boyish smokers attempt to abdicate smoking. (Balch et at. , 2004; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Amos, Wiltshire, Haw, & MeNeill, 2006; Seguire, & Chalmers, 2000) Thus, smoker behaviour amid teenagers is a circuitous phenomenon, back it is afflicted by assorted factors. This complication requires abundant compassionate of the behaviour from those who are circuitous in the affliction of these teenagers. This apperception would absolutely admonition the affliction providers to barrier boyish smoking, which is a dangerous, addictive and annihilative behaviour. US Department of Bloom and Human Services, 2004) Therefore, abounding studies accept Received on Augtist 28, 2010 and accustomed on November 29, 2010 1) Department of Ancestors Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lutnpur, Malaysia 2) Pusat PERMATApintar Negara, Universiti Kebangsaan Malaysia Bangl, 43600 Selangor, Malaysia 3) Setapak Bloom Clinic, Kuala Lumpur, Malaysia Correspondence to: Hizlinda Tohid (e-mails; [email protected] com) 2011 Japan International Cultural Exchange Foundation & Japan Bloom Sciences University TobitJ H, et al. 195 Table 1. Participants' gender, cachet of smoker and types of interviews TYPES OF SCHOOL MALE GENDER FcEeM. . AALIEE SMOKERS STATUS OF SMOKING NON SMOKERS FOCUS GROUP INTERVIEW TYPES OF INTERVIEWS IN DEPTH INTERVIEW SCHOOL 1 URBAN 9 3 9 3 1 3 SCHOOL 2 SEMI-URBAN 7 7 1 SCHOOL 3 RURAL 7 7 1 TOTAL 3 23 3 23 3 3 3 been agitated out to appraise the abnormality of boyish smoking. In Malaysia, majority of such studies were quantitative studies. (Naing et al. , 2004; Hoi, & Hong, 2000; Khairani, Norazua, & Zaiton, 2004; Zulkifli, Rogayah, Razian, & Nyi Nyi, 2001) Nevertheless, studies that qualitatively call Malaysian teenagers' smoker behaviour are still lacking. This absence may affect our compassionate of the amount in abundant abyss and holistically. Thus, this abstraction aimed to analyze smoker behaviour amid Malaysian teenagers accompanying to their smoker initiation, cigarette consumption, abdicate intention, and abdicate attempts. This admonition could accommodate us with bigger apperception about their smoker behaviour, and subse-' quently eould admonition us to analyze areas for improvement. METHODS This abstraction acclimated a assorted case abstraction design, involving 26 teenagers (23 smokers and three aloft smokers) from three accessible schools (urban, semi-urban and rural). Abstracts was calm via selfadministered questionnaires, focus accumulation interviews (FGI) and indepth interviews (IDI) over a aeon of 20 months, amid 2008 until 2010. Abstract framework This abstraction utilised the Amusing Cognitive Approach (SCT) to adviser the advisers in abstracts accumulating and analysis. The SCT was additionally acclimated for 'analytieal generalisation' in which allegation of the abstraction were mapped adjoin the theory. It was called as the study's abstract framework due to its account and amplitude in capturing a circuitous abnormality of eigarette smoker that is afflicted by assorted factors. (Baranowski, Perry, & Parcel, 2002) The SCT describes how individuals, environments and bloom behaviour collaborate with anniversary alternative accompanying (reciprocal determinism). (Baranowski, Perry, & Pareel, 2002) Abstraction citizenry Twenty six teenagers (23 boys and three girls, as apparent in Table I) were called via brash and accumulative sampling, based on agreed criteria. The boyish smokers and aloft smokers were sampled because their acquaintance in cigarette smoker and smoker abeyance was acute for this study. These teenagers were 16 years old Malays, recruited from three altered (urban, semiurban and rural) accessible schools from 2 states in Malaysia. Application of teenagers Teenagers were recruited with the abetment from academy counsellors from eaeh sehool. An acceding for no antidotal activity adjoin teenagers who were accommodating to participate in this abstraction was fabricated with the counsellors above-mentioned to the recruitment. The students' smoker cachet was additionally eoneealed from alternative academy agents to abstain stigmatisation. Twelve teenagers who were called from one of the schools were introdueed to the capital researcher during an breezy affair for abstraction conference (refer to Table 1). The teenagers were arrive to participate and were accustomed affectionate packages, which comprised of an accepting letter to parents, the study's admonition sheet, and a affectionate accord form. Subsequently, dates for tbe FGI and IDI were set. The completed affectionate eonsents forms were eolleeted above-mentioned the interviews by the academy counsellor. The alternative 14 teenagers (7 accepting from anniversary actual school, as apparent in Table 1) were reeruited by sehools' counsellors, who had training in qualitative assay and were able-bodied abreast about the study. Agnate adjustment of accepting eonsent from their parents was agitated out by these counsellors. Abstracts accumulating Three all-embracing interviews and three focus-group interviews were agitated out (refer to Table 1). Above-mentioned to the interviews, all participants were accustomed a abrupt overview of the abstraction and the action of the interviews. Accounting eonsents from eaeh partieipant were additionally obtained. They were again adapted to acknowledgment a abrupt self-administered check on their socio-demography, smoker cachet and smoker behaviour (age of initiation, cigarette consumption, abdicate ambition and abdicate attempts). The interviews were conducted in Malay accent and eaeh account lasted beneath than two hours. A semi-structured account acceding was acclimated to adviser interviewers in analytic the participants. Anti-smoking posters and pamphlets were additionally acclimated to facilitate discussion. Abstracts assay During eaeh interview, the chat was recorded application agenda articulation recorders. The articulation recording was afterwards transeribed into argument by application Microsoft Office Word 2007. The transcribed argument was brash adjoin the audio-recordings for several times until the accurateness of the transcripts was ensured. Any ambiguity during the transcription, abetment from alternative researehers was approved to ascertain its accurateness and reliability. (Yin, 2003; Yin, 1994) The transcribed argument was again alien into NVIVO 7. The capital researcher again analysed the abstracts to analyze capacity and categories ('thematie analysis') that would explain patterns of pereeption accompanying to teenagers' smoker behaviour. In adjustment to ensure aerial believability of the eoding proeess, tbe coded abstracts was eross-checked by two experts in boyhood health. Kappa was affected by application the Cohen kappa blueprint to actuate the believability index, which was maintained aloft 0. 8. The action of archetype and assay was again for every account and 'cross-case conclusion' was fatigued amid the analyses of eases. Allegation of the abstraction were additionally mapped adjoin the SCT for 'analytical generalisation'. Ettiical issues, believability and authority Approval from the Assay and Ethic Committee of Universiti Kebangsaan Malaysia was acquired above-mentioned to the study. Authorisation for interviewing teenagers from the schools was additionally acquired from the Ministry of Apprenticeship Malaysia that bound interviewing accepting who were not sitting for any aloft assay (i. e. exeept accepting age-old 15 and 17 years old). Apart from these, all of these teenagers and their parents were adapted to accommodate accounting eonsents for their participation. The acquaintance of the participants, e. g. abashing teenagers' cachet of smoker from the ability of their parents and alternative sehool staffs, was additionally affirmed throughout the study. Finally, medical albatross of the capital researcher in preventing smoking-related illnesses, as she was additionally a medieal doctor, was realised by alms teenagers appointment for smoker eessation at her clinic. This was done at the end of anniversary account to anticipate any biased answers from the partieipants. Authority and believability of the abstraction were ensured via a cardinal of methods, ineluding; (1) triangulation of sourees of abstracts (teenagers from three altered sehools), as able-bodied as methods of abstracts accumulating 196 What Determines Teenagers' Smokitig Behaviour? Table 2. Smoker behaviour of the teenagers who smoked TEENAGERS WHO SMOKED (N = 23) AGE OF INITIATION (YEARS) NUMBER OF CIGARRETTES SMOKED/DAY STAGE OF CHANGE NUMBER OF QUIT ATTEMPTS FGD(n = 21) IDl(n = 2) TOTAL < 12 5 1 6 > 13 16 1 17 20 2 1 3 PRE COMTEMPLATION 5 1 7 CONTEMPLATION 4 4 PLANNING II 12 0 1 1 1-3 7 1 8 S4 13 1 14 (questionnaire, three FGI and three IDI), (2) cocky reflexivity in minimising biases that the advisers may accompany into the abstraction due to our antecedent captivation in managing ambiguous teenagers and abiding smokers, (3) 'procedural validity' via digest of questions, elarifying of account and basal bidding as ecessary,(Fliek, 2009) and (4) inter-coder acceding or believability basis of aloft 0. 8. RESULTS Twenty three boys and three girls were interviewed (referred to Table 1), in which two of the boys and one of the girls were aloft smokers. The actual 23 teenagers were smokers at the time of the interviews. These teenagers' smoker behaviour (age of smoker initiation, cigarette consumption, ambition to abdicate and history of abdicate attempts) is summarised in Table 2. Age and affidavit of smoker admission Six of the 23 (26%) boyish smokers in this abstraction started smoker during primary academy (before the age of 13). The youngest age of smoker admission was 10 years old. Nevertheless, 74% of these boyish smokers started smoker back they were in the accessory school. Best of the teenagers accustomed that affair ["Felt analytical to try (smoking)"], awareness gluttonous ["Just for fun"], affectionate modelling of smoker ["Sinee my ancestor smokes... I consistently watch him smoking. Back he smokes, it looks pleasurable... gratifying"], associate burden ["Peer influence"], and delusion of smoker ["Style (because of smoking). Siyle"] were accepted factors for them to acceding with smoking. The teenagers who started smoker afore the age of 13 claimed that affair and smoker modelling by parents were their capital affidavit for experimenting with smoking. This is adverse to those who started smoker at the age of 13 years or older. These teenagers accustomed that associate burden was the aloft agency for them to alpha smoking. Cigarette burning Majority (20/23) of the boyish smokers in this abstraction accustomed to smoker every day and 74% of these teenagers smoked not added than 5 cigarettes a day. The teenagers believed that their circadian smoker behaviour was mainly due to nicotine addiction in which they declared abundant concrete (e. g. tiredness, lethargy, flu-like symptoms) and cerebral (e. g. apathetic thinking, depressed, craving) abandonment affection that they accomplished during smoker abnegation ["My academician feels slow"; "(If I stop smoking) I feel restless. "]. The circadian smokers additionally accustomed to smoker back they were with their friends. They claimed this behaviour could be due to a cardinal of reasons: a) administration the amount of cigarettes with their friends, appropriately tend to smoke together, as explained by a teenager: Amid 14 of us. we aggregate RMI per person, we can get 2 big boxes of cigarettes. " b) socialisation, as one jailbait noted: "When we adhere about (with friends), we smoke, sis" c) associate pressure, as a jailbait claimed: "When we see our accompany smoked, the admiration to smoke is too intense. " d) faculty of belonging, for example: "We all accord to a assemblage who aggregate our cigarettes together" However, three of the accustomed smokers accustomed to smoker alone already a week. They declared that they decidedly smoked during demanding aeon ["Especially back I am accomplishing something. Back it's adamantine again I'll smoke. ]. A few of the teenagers arise that the civic anti-tobacco policy, as able-bodied as the academy regulations had belted their smoker behaviour. These teenagers accustomed to frequently smoke in abandoned areas alfresco of accessible view, such as in academy toilets and stairways of arcade malls. The akin ambiance for accessible smoker was believed to access tbeir cigarette consumption. Ambition to abdicate All boyish smokers in this abstraction had the ambition to abdicate smoking. However, 7 of them (30%) did not plan to abdicate aural the abutting 6 months (in the pre-contemplation stage). Twelve of them (52%) were in the planning stage, but none had set their abdicate dates. The smokers diselosed that a cardinal of factors could access tbeir admiration to quit, which included: a) broken able-bodied performance, as one of the teenagers claimed: "When (I) sprint... I will hecome breathless" b) boy- or adherent aversion, for example: "Maybe (I get the admiration to stop smoking) from my girlfriend. If she said "If you do not stop smoking, we should break-up". Huh. (I feel like to abdicate smoking)" c) affectionate disapproval, as acclaimed by one boy: If mother scolded me for smoking, until she cried.. I would feel ? ike I appetite to quit, but it was acting only. Afterwards.. I abide smoking" d) affair about health, apparent by one of the teenagers' excerpt: "Smoking can accomplish me feel breathless, sis (that's why I feel like to quit)" e) finaneial problems, as a jailbait stated: "(I) anticipate about my parents, sis. My mother and my ancestor are not wealthy, (when I) anticipate about that, it could (trigger my admiration to quit)" Agnate affective factors were additionally arise by aloft smokers in this abstraction above-mentioned to their acknowledged smoker cessation. Nevertheless, these aloft smokers accustomed that alone personalised affective factors could cede them to abdicate successfully. Their personalised motivators were affectionate disapproval ["(Parental disapproval) effective, it's effective. I've chock-full smoking. "], advancement able-bodied achievement ["(I) chock-full smoker (for able-bodied performance). I got called (to comedy football for my district) afterwards"]. and extenuative money /"/ chock-full (smoking) to save money to buy a motorbike"]. Antecedent abdicate attempts About all (22/23) boyish smokers in this abstraction had attempted smoker abeyance above-mentioned to the interviews. The teenagers deseribed that abandonment was actual difficult because of abandonment affection that they accomplished during the abdicate attempts ["(If I stop smoking) I feel restless"]. Sixty percent of the boyish smokers had absolutely attempted to abdicate four times or more. All of the teenagers claimed that they never reeeived any able helps back they fabricated their attempts to abdicate in the past. Majority of them declared that they approved their friends' admonition on how to abdicate and amid the accepted methods that they had approved were bubbler a lot of water, chewing gums and demography sweets, as one of the teenagers said: Tohid H. et al. 197 "Usuatty (I) asked my accompany how to quit. They brash me to alcohol a tot of minerat water. " DISCUSSION In Malaysia, the beggarly age of smoker admission amid boyish smokers is amid 12-14 years old, (The Civic Bloom and Anguish Survey, 2009; Hammond et at. , 2008; Khairani, Norazua, & Zaiton, 2004; Naing et at. , 2004) whieh is circumstantial with the allegation of this study. The accepted affidavit for smoker initiation, such as curiosity, associate pressure, and affectionate smoking, arise by tbe participants in tbis abstraction were agnate to otber studies. (Naing et at. 2004; Kbairani, Norazua, & Zaiton, 2004) This abstraction additionally adapted that affair and affectionate modelling of smoker bebaviour could be teenagers' capital affidavit for experimenting smoker at adolescent age (less tban 13 years old). In contrary, associate burden was begin to be a aloft agency for teenagers wbo started smoker at seeondary sehools. However, the acceptation of tbese associations should be accepted by approaching quantitative studies. Cigarette burning arise by teenagers in this abstraction was begin to be bottom tban tbose of Malaysian adults, who abundantly smoke amid 11 to 14 cigarettes per day. World Bloom Organization (WHO) Framework Convention on Tobacco Control, 2010) Tbis may be due to a cardinal of factors as adapted by tbese teenagers, such as; (a) bereft armamentarium to acquirement cigarettes, (b) 'occasional' smoking, and (c) akin ambiance for smoking. Nevertheless, underreporting of smoker behaviour by these teenagers may additionally explain the lower estimated cardinal of cigarettes smoked by them. Tbis is because teenagers accept a addiction to address socially adorable behaviour and attitudes. (Hammond et at. , 2008; Klein, Havens, & Carlson, 2005) Insufficient armamentarium to purebase cigarettes were declared by some of the teenagers in this study, who claimed that they had to allotment their abridged money with their aeon to buy cigarettes. Tbis is to ensure their connected accumulation of cigarettes and to advance bonding amid tbe peers. (Vuckovic, Polen, & Hollis, 2003; Amos, Wiltsbire, Haw, & McNeill, 2006; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, & Cbalmers, 2000) Tbis convenance in about-face increases tbe akin of accepting by aeon and advance faculty of accepting tbat is pertinent to teenagers' psychosocial development. Mermelstein, 2003; Vuckovic, Polen, & Hollis, 2003; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Nicbter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, c& Chalmers, 2000) However, some teenagers in this study, who had no banking coercion because they had claimed assets (e. g. from part-time job or cogent allowance from parents), accustomed to smoke alone wben socialising and adverse adversities (e. g. affiliation problems, disability to cope witb bookish or part-time job). (Vuekovic, Polen, & Hollis, 2003; Balch et at. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006; Hoi, 8L Hong, 2000; Khairani, Norazua, & Zaiton, 2004; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, & Chalmers, 2000) These teenagers can be authentic as casual smokers, whose smoker was allegedly afflicted by associate burden and tbeir disability to ascendancy themselves over smoker or to cope with stress. (Vuckovic, Polen, & Hollis, 2003; Seguire, & Chalmers, 2000; Patten et al. , 2003; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Mermelstein, 2003; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Khairani, Norazua, & Zaiton, 2004; Balch et at. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006; Hoi, & Hong, 2000) Teenagers' smoker in esponse to accident shows that smoker is their way of arresting back it calms them through nicotine furnishings on the axial afraid system. (Niebter, Vuckovic, Quintero, & Ritenbaugh, 1997; Curry, Mermelstein, & Sporer, 2009) In addition, smoker creates a amusing amplitude in which they can calm bottomward and abate tension. (Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Curry, Mermelstein, & Sporer, 2009) Apart from banking coercion and casual smoking, restrietive ambiance for accessible smoker was additionally begin to be amenable for tbe partieipants' low cigarette burning in this study. Therefore, these teenagers frequently smoked in abandoned areas alfresco of accessible view, sucb as scbool toilets and stairways of arcade malls. These allegation are constant with a cardinal of alternative studies that accept begin akin ambiance to be able in abbreviation boyish smoking. (Wakefield ct at. , 2000; Lipperman-Kreda, & Grube, 2009; Crawford, Balcb, Mermelstein, & Tobacco Ascendancy Network Writing Group, 2002) Majority of boyish smokers bave ambition to quit. (Khairani, Norazua, & Zaiton, 2004; Krishnan M, 2003; Mermelstein, 2003; Naing ct at. 2004; The Civic Bloom and Anguish Survey, 2009) Tbis was additionally begin by tbis study, in wbich about all teenagers who smoked eonsidered to abdicate smoker ancient in the future. They accustomed that a cardinal of factors could activate tbeir abdicate intention, wbich include; (a) able-bodied performance, (b) boy- or adherent aversion, (c) affectionate disapproval, (d) affair about bealtb, and (e) money saving. Tbese faetors were analogously begin to actuate teenagers to eease smoker by antecedent studies. (Vuckovic, Polen, & Hollis, 2003; Mermelstein, 2003; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Balcb ct al. , 2004) However, tbe teenagers arise tbat these extrinsie motivations were bereft to accumulate them from absolute smoker abstinence. Nevertbeless, excerpts fabricated by tbe aloft smokers in this abstraction adapted that teenagers would alone stop smoker back they are atrocious to change due to acute claimed reasons. This award is accurate by McVea et al who begin alone 'emotionally acute and assured abdicate reasons' were the best affective affidavit for teenagers to stop smoking. (McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009) Even admitting majority of tbe teenagers in this abstraction had ambition to abdicate smoking, they did not accept any abandonment plans, not alike ambience their abdicate dates. These allegation are agnate to those arise by Mermestein. (Mermelstein, 2003) It is accessible tbat the teenagers were; (a) not accessible to abdicate (Balch ct al. , 2004) (e. g. some of the teenagers in the eurrent abstraction would alone abdicate back they acquaintance aloft activity transition, such as afterwards graduation and tnarriage), (b) clashing about abandonment (MeVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Patten et al. 2003) (e. g. a cardinal of teenagers repetitively answered, "I am not sure" back they were asked about tbeir plan to abdicate smoking), and (c) actual assured that they could ascendancy themselves over smoker (Niehter, Vuckovic, Quintero, & Ritenbaugb, 1997; Amos, Wiltshire, Haw, & McNeill, 2006) (e. g. a jailbait assertively accustomed that he could stop acclamation on his own afterwards relying on helps from other). The afterwards seems to be accompanying to teenagers' accepting tbat 'quitting is aloof a amount of will power'. (Amos, Wiltsbire, Haw, & McNeill, 2006; Balcb el at. 2004) Afterwards all, these teenagers' ehanees for acknowledged abdicate attempts would be bargain if they did not accept cardinal abandonment plans. Assorted bootless abdicate attempts were additionally arise by abounding teenagers in tbis study, in which the allegation were circumstantial with alternative studies. (World Bloom Organization (WHO) Framework Convention on Tobacco Control, 2010; The Civic Bloom and Anguish Survey, 2009; Klein, Havens, & Carlson, 2005; Balch ct at. , 2004) This could be due to several affidavit which can be summarised into three categories; (1) nicotine addiction,(Amos, Wiltsbire, Haw, & McNeill, 2006; Balch et al. , 2004; DiFranza et at. , 2007; DiFranza ct at. , 2007) (2) factors accompanying to ambiance and bearings which could advance boyish smoker (e. g. able associate pressure, poor abutment from friends, smoker tnodelling by ancestors members, accent etc, as higbligbted by tbe accustomed study), (Balch et at. , 2004; Crawford, Balch, Mermelstein, & Tobacco Ascendancy Network Writing Group, 2002; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Nicbter, Vuckovic, Quintero, & Ritenbaugb, 1997) and (3) claimed factors (e. g. oor accident assessment, poor knowledge, poor cocky ability and control, mi,sconception about smoker and quitting, able accepting in abandoned abdicate attempts etc, as begin by this study) (Niehter, Vuckovic, Quintero, & Ritenbaugb, 1997; Balcb ct at. , 2004). These tbree categories arise to matcb tbe archetypal of the Amusing Cognitive Theory. Overall, this abstraction provides benign admonition for approaching development of interventions of smoker abeyance for teenagers. Nevertheless, adapted eontext which is agnate to tbose of this abstraction should be taken into application afore applying such admonition back this is a affluence study. Interviewing alone teenagers age-old 16 years old additionally banned the allegation of this study. This is because teenagers at altered stages of boyhood (early, average and late) may bave altered adorning characteristics which may access their pereeption and attitude appear cigarette smoking. Teenagers from altered stages of boyhood should again be included in approaching studies as differences in tbeir perception, attitude and bebaviour could be explored. CONCLUSION This abstraction bad captured tbe complication of tbe teenagers' smoker bebaviour that could be afflicted by assorted factors. Tbese faetors included behavioural (e. g. nicotine addiction), claimed and ecology factors akin the Amusing Cognitive Approach (SCT). These 198 What Determines Teenagers' Smoker Behaviour? assorted factors should be advised in developing interventions for smoker abeyance ill-fitted for teenagers. The agnate mapping of the allegation adjoin the SCT additionally supports the use of the SCT in allowance us to assiduously accept boyish smoker behaviour and to affected the affecting factors. FUNDING This assignment was adjourned by the Universiti Kebangsaan Malaysia UKM-GUP-TKS-07-12-097 and FF-127-2008). DECLARATION OF INTERESTS All authors acknowledge that they accept no conflicts of interests. ACKNOWLEDGEMENTS The authors would additionally like to accurate acknowledgment to the Ministry of Apprenticeship Malaysia, the Ministry of Bloom Malaysia and the academy counsellors who had helped us throughout the study. REFERENCES Amos A. Wiltshire S, Haw S. McNeill A. (2006). 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Age of smoker initiation: implications for quitting, tiealttt Rep, 9. 39-46. (Eng); 39. Retrieved from http://www. statcan. gc. ca/studies-etudes/82- 003/archive/1998/3685-eng. pdf Crawford MA. Balch GI. Mermelstein R, Tobacco Ascendancy Network Writing Group. (2002). Responses to tobacco ascendancy behavior amid youth. Tob Control. 11. 14-19. Retrieved from http://www. bvsde. paho. org/bvsacd/cd26/tc/vl In 1/14. df Curry SJ. Mermelstein RJ, Sporer AK. (2009). Therapy for specific problems: boyhood tobacco cessation. Annu Rev Psyctwt. 60. 229-255. doi:10. 1146/annurev. psych. 60. l 10707. 163659 DiFranza JR. Savageau JA. Fletcher K, O'Loughlin J. Pbert L. Ockene JK. et at. (2007). Affection of tobacco assurance afterwards abrupt alternate use: the Development and Appraisal of Nicotine Assurance in Youth-2 study. Arcii Pediatr Adotesc Med. 161, 704-710. doi:IO. IOOI/archpedi. 161. 7. 704 DiFranza JR. Savageau JA. Fletcher K. Ockene JK. Rigotti NA. McNeill AD. t al. (2002). 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