Smoking onset and the time-varying effects of self-efficacy, environmental smoking, and smoking-specific parenting by using discrete-time survival analysis

This study examined the timing of smoking onset during mid- or late adolescence and the time-varying effects of refusal self-efficacy,
parental and sibling smoking behavior, smoking behavior of friends and best friend, and parental smoking-specific communication.
We used data from five annual waves of the ‘Family and Health’ project. In total, 428 adolescents and their parents participated
at baseline. Only never smokers were included at baseline (n = 272). A life table and Kaplan–Meier survival curve showed that 51% of all adolescents who did not smoke at baseline did
not start smoking within 4 years. The risk for smoking onset during mid- or late adolescence is rather stable (hazard ratio
between 16 and 19). Discrete-time survival analyses revealed that low refusal self-efficacy, high frequency of communication,
and sibling smoking were associated with smoking onset one year later. No interaction effects were found. Conclusively, the
findings revealed that refusal self-efficacy is an important predictor of smoking onset during mid- or late adolescence and
is independent of smoking-specific communication and smoking behavior of parents, siblings, and (best) friend(s). Findings
emphasize the importance of family prevention programs focusing on self-efficacy skills.