Do smoking attitudes predict behaviour? A longitudinal study on the bi-directional relations between adolescents' smoking attitudes and behaviours

Aims Prevention and intervention programmes focus frequently upon retaining or creating negative attitudes towards smoking in an effort to prevent adolescents from smoking. As the focus upon attitudes is central in these programmes it is essential to know whether smoking attitudes actually precede smoking behaviour or, conversely, are affected by it. Therefore, in the present study we examined to what extent bi-directional relations existed between smoking attitudes and behaviour. Design Data were used from the three annual waves of the 'Family and Health' project. Setting Participants were asked to complete questionnaires individually at their homes. Participants Addresses of families consisting of two parents and two adolescents were obtained from the records of 22 municipalities in the Netherlands. At baseline, 428 families participated with a response rate of 94% at the third measurement. Measurements Self-reports were used to assess adolescents' smoking attitudes and behaviour. Associations between smoking attitudes and behaviour were tested using structural equation modelling. Findings Findings revealed that smoking attitudes did not predict smoking consistently over time. However, past smoking affected subsequent attitudes moderately, suggesting that adolescents who started to smoke developed less negative attitudes towards smoking. Conclusions The current findings imply that smoking behaviour predominantly shapes smoking-related attitudes, rather than vice versa. Focusing merely on smoking attitudes is probably not enough to prevent adolescents from smoking.