Beliefs about smoking cigarettes among adolescents in Yunnan Province, China

Figures & data

Table 1. Means and standard deviations of beliefs, Pearson correlations between beliefs and smoking intention, and F statistics of differences by gender.

Code	Belief	M	SD	r	M	SD	r	F
		Female			Male
Behavioral beliefs
BB1	Relaxation	−12.00	10.72	.54**	−7.88	11.99	.53**	30.94**
BB2	Entertainment	−14.64	9.77	.54**	−9.66	11.70	.55**	50.47**
BB3	Feeling alert/attentive	−13.20	11.02	.46**	−7.90	13.07	.47**	45.52**
BB4	Facilitates social interaction	−13.45	10.77	.48**	−8.01	12.50	.48**	51.46**
BB5	Anxiety/distress relief	−12.21	11.19	.48**	−7.00	12.78	.50**	44.34**
BB6	Unhealthy	−2.98	16.75	.03	−3.45	15.06	.02	.20
BB7	Lung damage	−3.08	18.16	.07	−4.04	16.96	.01	.70
BB8	Bothers others	−3.72	16.88	.07	−4.24	15.37	.01	.24
BB9	Harmful to the mind	−3.35	15.55	.06	−3.71	13.90	.03	.14
BB10	Bad smell	−4.00	16.98	.04	−4.55	15.28	.01	.27
BB11	Addiction	−4.26	16.35	.09	−4.23	14.85	.09	.00
BB12	Financial cost	−4.85	16.74	.10*	−4.64	15.43	.05	.04
BB13	Benefits of not smoking	−15.35	8.23	.51**	−12.98	8.95	.51**	17.60**
Normative beliefs
NB1	Close friend’s approval	−11.38	7.59	.46**	−7.95	9.51	.50**	37.76**
NB2	Parents’ approval	−15.14	7.53	.42**	−11.73	9.59	.37**	37.36**
NB3	Best friend’s approval	−12.91	7.75	.53**	−8.87	10.16	.54**	47.54**
NB4	Classmates’ approval	−10.69	7.15	.52**	−7.87	8.84	.51**	29.17**
NB5	Playmates’ approval	−11.43	7.29	.49**	−7.91	9.71	.57**	40.05**
NB6	Mother’s approval	−15.79	7.26	.37**	−12.40	9.58	.33**	37.89**
NB7	Father’s approval	−15.23	7.77	.39**	−11.60	10.12	.38**	38.23**
NB8	Family’s approval	−13.83	7.66	.44**	−10.70	9.22	.40**	32.37**
NB9	Partner’s approval	−12.31	7.94	.48**	−10.56	9.18	.37**	9.76**
NB10	Other students’ approval	−9.88	7.12	.46**	−6.93	8.89	.53**	31.81**
NB11	Teachers’ approval	−13.95	7.32	.39**	−11.06	9.02	.36**	29.42**
Control beliefs
CB1	Encouragement	−2.00	5.72	.43**	−.18	6.98	.53**	19.30**
CB2	Feeling depressed	−1.40	5.73	.52**	.52	7.76	.52**	18.85**
CB3	Encouragement from classmates	−2.51	4.78	.39**	−1.52	6.40	.37**	7.25*
CB4	Bars/KTV/mah-jongg	−1.66	5.63	.51**	.24	7.53	.49**	19.36**
CB5	School pressure	−1.56	5.21	.59**	.02	7.26	.54**	15.00**
CB6	Face-saving	−2.20	4.08	.45**	−1.27	5.57	.34**	8.67**
CB7	Cigarette gifting	−2.14	3.83	.50**	−1.72	4.84	.34**	2.23
CB8	Parental permission at home	−2.44	4.16	.37**	−2.25	5.33	.16**	.38
CB9	Permission at school	−2.43	4.29	.40**	−2.32	6.07	.14**	.10
CB10	Obeying parents	−9.12	11.86	.29**	−5.47	11.75	.33**	22.49**
CB11	Concerns about bad health	−8.28	14.80	.24**	−5.94	13.32	.32**	6.53*
CB12	Tobacco smell	−9.58	13.13	.26**	−7.31	10.60	.42**	8.41**
CB13	Unhappiness	−2.40	8.28	.50**	.09	9.25	.55**	19.01**
CB14	Objections of other people	−8.32	11.21	.27**	−5.96	10.49	.36**	11.01**
CB15	Financial cost	−6.82	10.09	.28**	−4.54	9.80	.40**	12.36**

*p < .05, **p < .01. r = Pearson product-moment correlation coefficient. Given the relatively large sample size, only beliefs highly associated with intention (p < .01) were entered into the analyses.

For behavioral beliefs, confirmatory factor analyses following the TPB were conducted using the 13 belief items resulting in a final model with two factors. The first model with beliefs about advantages of smoking (i.e., relaxation, entertainment, feeling alert/attentive, facilitates social interaction, anxiety/distress relief) and disadvantages of smoking (i.e., unhealthy, lung damage, bothers others, harmful to the mind, bad smell, addiction, financial cost, benefits of not smoking) showed a mediocre fit, ${\chi }_{\left(64\right)}^2$= 847.44, p < .01, CFI/TLI = .94/.93, RMSEA = .11, SRMR = .09, with a modification index suggesting that the beliefs about benefits of not smoking had a strong relationship with the factor regarding advantages of smoking. As a result, the final model containing beliefs about advantages of smoking (Cronbach’s α = .92; relaxation, entertainment, feeling alert/attentive, facilitates social interaction, anxiety/distress relief, benefits of not smoking) and disadvantages of smoking (Cronbach’s α = .97; unhealthy, lung damage, bothers others, harmful to the mind, bad smell, addiction, financial cost) showed a good fit, ${\chi }_{\left(64\right)}^2$= 653.35, p < .01, CFI/TLI = .96/.95, RMSEA = .10, SRMR = .04

Table 2. Summary of stepwise regression results identifying key beliefs regarding intention to smoke.

Beliefs predicting intention	Key beliefs of each construct		Final key beliefs regressed on intention
	B		B
	Female	Male	Female	Male
Behavioral beliefs
BB1. Relaxation	.03**		.03**
BB2. Entertainment	.03**	.05**		.02*
BB5. Anxiety/distress relief		.03**		.01*
BB13. Benefits of not smoking	.05**	.07**	.04**	.04**
Normative beliefs
NB3. Best friend’s approval	.05**		.03**
NB4. Classmates’ approval	.03*
NB5. Playmates’ approval		.07**		.03**
NB6. Mother’s approval	−.04**		−.03**
NB8. Family’s approval	.03*
NB9. Partner’s approval	.03**		.03**
NB10. Other students’ approval		.05**		.03**
Control beliefs
CB1. Encouragement		.06**		.04**
CB5. School pressure	.08**	.06**	.08**	.03**
CB7. Cigarette gifting	.07**
CB11. Concerns about bad health		.02**
CB13. Unhappiness	.03**	.05**		.03**

*p < .05, **p < .01. B = unstandardized coefficient.

Figure 1. Distinct subgroups and patterns of key beliefs contributing to smoking intention among female and male Chinese adolescents.

Higher scores in behavioral beliefs (BB), normative beliefs (NB), and control beliefs (CB) mean that one is more in favor of smoking, perceives more social pressure to smoke, and feels less control over smoking, respectively. The beliefs displayed on the x-axis were generated from stepwise regression analyses of key beliefs.

Table 3. Fit indices for latent class analysis (LCA).

		Female
	2-class		3-class		4-class
SSBIC	19420.29		19015.79		18824.96
Entropy	.95		.98		.95
Adj. LMR-LRT (p)	748.02 (.016)		416.05 (.184)		207.19 (.466)
Subgroup size (%)
C1	407	83.1%	121	24.7%	315	64.3%
C2	83	16.9%	354	72.2%	95	19.4%
C3			15	3.1%	47	9.6%
C4					33	6.7%
		Male
	2-class		3-class		4-class
SSBIC	25534.85		25003.05		24893.05
Entropy	.93		.95		.91
Adj. LMR-LRT (p)	1016.16 (<.001)		548.46 (<.001)		134.16 (.480)
Subgroup size (%)
C1	233	50.8%	225	49.0%	223	48.6%
C2	226	49.2%	45	9.8%	63	13.7%
C3			189	41.2%	130	28.3%
C4					43	9.4%

SSBIC = Sample size adjusted Bayesian information criteria. Adj. LMR-LRT = Adjusted Lo-Mendell-Rubin Likelihood Ratio Test. The optimal models are shown in bold.

To decide the optimal number of latent classes with similar patterns of smoking-related beliefs, multiple fit indices were considered (Wickrama et al., 2016). First, Sample-size Adjusted Bayesian Information Criterion (SSABIC) statistics were compared, and the model with the smallest SSABIC was considered best. Second, entropy and likelihood ratio were evaluated, as higher entropy suggests better separation between classes, and significant results from the likelihood ratio test indicate the k-class model has a better fit than the k-1-class model; the Lo-Mendell-Rubin Likelihood Ratio Test (LMR-LRT) was used as it is regarded as a robust fit index. Third, a model was regarded as problematic if its smallest subgroup size was too small (proportion < 5.0%; Nylund et al., 2007).

Table 4. Covariates of latent class membership.

Variable	Female		Male
	Hesitant girls		Stressed-out boys			Anxious boys
	Estimate	S.E.	Estimate	S.E.		Estimate	S.E.
Han ethnicity	−.22	.32	−.40	.65		−.87*	.37
Current smoker	1.07*	.49	1.41**	.21		.65**	.15
Mother who smoked	.49	.54	−.69	.73		.33	.53
Father who smoked	.25	.30	−.71	.49		−.08	.26
Best friend(s) who smoked	1.49**	.29	−1.80**	.50		−1.53**	.26

*p < .05, **p < .01. Reference group: socially conscious girls (female); anti-smoking boys (male). All variables are binary (Yes = 1; No = 0).

Wickrama, K. A. S., Lee, T. K., O’Neal, C. W., & Lorenz, F. O. (2016). Higher-order growth curves and mixture modeling with Mplus: A practical guide. Routledge.

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Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14(4), 535–569. https://doi.org/10.1080/10705510701575396

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