'It won't happen to me': the knowledge-attitude nexus in adolescent smoking

Behavioral models state that adolescents need not only to know about the dangers of smoking, but also to perceive themselves as susceptible to those dangers prior to modifying their smoking behavior. However, this hypothesis has not been tested in developing world settings where the context of tobacco use may differ.

Survey data were collected from a sample of 1294 adolescents 13-20 years of age--from three under-privileged suburbs of Beirut, Lebanon. Scores were calculated to measure the knowledge of and the perceived susceptibility by a series of statements related to the consequences of tobacco use. Bivariate and multivariate methods were used to assess the association of knowledge and perceived susceptibility with smoking, controlling for socio-demographic variables.

A logistic regression model showed that the odds of ever smoking among adolescents who had less knowledge of smoking were 1.9 times those of adolescents with more knowledge. Similar odds were demonstrated for adolescents who did not perceive themselves susceptible to smoking hazards compared with those who did.

These results suggest that awareness campaigns should focus on raising the perceived susceptibility of adolescents by including items that are more within the realm of an adolescent's frame of mind such as smelly clothes and discolored teeth.