Factors influencing adolescent smoking behaviors in Crete: The cross-sectional Greek FRESHAIR4Life study

Introduction: Understanding the factors influencing adolescent smoking is crucial for developing effective prevention and implementation strategies. We aimed to explore associations between individual, community, and environmental factors that influence adolescent smoking. Method: A cross-sectional survey of adolescents living in Crete, Greece was conducted as part of the FRESHAIR4Life Study. The overall objective of FRESHAIR4Life study was to mitigate tobacco use and air pollution exposure among adolescents. This study presents a quantitative analysis of adolescents’ smoking behaviors derived from questionnaire data. Adolescents, aged 14–21 years old, were recruited between January and February of 2024 from ten educational institutions purposely selected to represent middle to lower socioeconomic strata, including high schools (n=7), technical schools (n=2), and universities (n=1). Results: The final sample consisted of 179 participants with a mean (SD) age of 16.8 (1.9). A smoking history was reported by 34% (n=60) of adolescents. Cigarettes (55%) and e-cigarettes/heated tobacco products (41%) were the most ever used tobacco products. Older adolescents had higher odds of ever smoking than their younger counterparts (OR=1.57,95%CI:1.32-1.88; p<0.001). Environmental factors significantly associated with the likelihood of ever smoking were school second hand smoke exposure (OR=2.81,95%CI:1.36-5.81; p=0.005), smoking of one or both parents (OR=7.64,95%CI:1.95–29.96, p=0.004), one or more closest friends (OR=12.88,95%CI:3.24–51.15, p<0.001), one or more siblings (OR=25.13,95%CI:3.23–195.63, p=0.002). Ignoring smoking’s negative consequences was also found to increase the likelihood of ever smoking (OR=3.89,95%CI:1.85–7.99, p<0.001), whereas the perception of smoking as a risk factor for their illness (OR=2.6,95%CI:1.2–5.3, p=0.012), and concerns about its impact on human health (OR=5.7,95%CI:2.3–14.1, p<0.001) were associated with never-smoking behaviors. Discussion: Our study identified several individual, community, and environmental factors among adolescents that influence tobacco use. These findings have significant implications for developing anti-tobacco programs that utilize social/peer support interventions to specifically target smoking behaviors in Greek adolescents. Funding: FRESHAIR4Life study is a Horizon programme of EU.