Background: Despite overwhelming evidence of the deleterious health effects of cigarette smoking and a barrage of prevention efforts, smoking among adolescents has shown no sign of decline in over a decade. Rather, recent data reveal an alarming increase in teen smoking. There is little research focusing on the identification of variables that mediate the link between baseline smoking and post-intervention smoking behavior in adolescent population.
Objective: The purpose of this study was to test a mediating effect of intention of smoking on relationship between baseline and post-intervention smoking behavior in 6th grade students. Four hypotheses were tested to examine a mediating effect of intention of smoking in this study: (1) Baseline smoking status (independent variable, IV) has significant effect on post-intervention smoking status (escalation of smoking; dependent variable, DV), (2) IV has significant effect on baseline intention of smoking in near future, (3) Baseline intention of smoking accounts for a significant amount of additional variance in the DV not explained by the IV, and (4) Effect of the IV on the DV diminishes upon the addition of the baseline intention of smoking on the model.
Sample: The sample consisted of 104 sixth grade middle school students (48 girls and 56 boys) who participated in a smoking prevention program. 31.7% were 11 years old or younger; 65.4% 12 years old; and 2.9% were 13 years old. Most of the students (91.3%) were white.
Design and Method: This sub-study was part of a pilot study seeking to examine the impact of an 8-week smoking prevention intervention program - Life Skills Program (Botvin et al., 1980) on student smoking outcomes with repeated measures (baseline and post-intervention) design. Baseline and post-intervention questionnaires included the Adolescent Smoking Stages of Change Form (ASSC) and Fagerstrom Tolerance Questionnaire (FTQ). Intention of smoking in near future was measured by the ASSC and escalation of smoking was measured by the FTQ. A series of path analyses was used to test a mediating effect of intention of smoking in the relationship between baseline and post-intervention smoking behavior. Path analyses tested whether the intention of smoking explains a significant amount of additional variance in the DV above and beyond the IV and whether the effect of IV on the DV diminished upon the addition of the intention of smoking on the model.
Findings: Results on the effect of the IV on the DV (Hypothesis 1) showed a significant effect of baseline status of smoking on post-intervention smoking status (p=.037). Results for Hypothesis 2 showed a significant effect of baseline status of smoking on the intention of smoking in near future (p<.001). Results for Hypothesis 3 indicated that the intention of smoking accounted for a significant amount of additional variance in post-intervention smoking behavior beyond the baseline smoking behavior (p=.046). Results for Hypothesis 4 indicated that the effect of the baseline smoking behavior on post-intervention smoking behavior diminished and became non-significant (from p=.037 to p=.972) upon the addition of the intention of smoking on the model.
Conclusion: We conclude that the intention of smoking could be considered as a mediator because (1) the baseline smoking behavior has significant effect on post-intervention smoking behavior, (2) the baseline smoking behavior significantly affected the intention of smoking, (3) the intention of smoking had a significant unique effect on the post-intervention smoking behavior, and (4) the effect of the baseline smoking behavior on post-intervention smoking behavior diminished and became non-significant upon the addition of the intention of smoking on the model.
Implication: Results of this study have important implications in the development of a prevention/intervention modality that reduces intention of smoking and attenuate the strength of the link between baseline and post-intervention smoking behavior. The present results indicate the need for continued inquiry into the effect of smoking intention as a mediator of decisions to escalate smoking after prevention intervention in this age group.
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