Smoking continues to be a major but preventable cause of death and diseases worldwide
]. Recent declines in smoking following a range of tobacco control measures have been limited to developed countries while a rise in smoking rates has been observed in several developing countries
]. It is suggested that if major preventive measures are not put in place, smoking-related death and diseases in many of these developing countries will increase rapidly as the number of smokers continues to rise
]. Indeed, the WHO report estimates that with the steady increase in tobacco use, more than 8 million people worldwide will die each year by the year 2030, 80% of which will occur in developing countries.
The literature on smoking in many developing countries is scant and for Africa, the available literature suggests considerable variation across the different countries
]. In Ghana, general rates of smoking are suggested to be low, with males smoking more than females
]. In a random sample of 30 regional census enumeration areas, comprising all individuals 14
years of age and above,
] smoking rates of 8.9% and 0.3% were reported for males and females, respectively. However, the Global Youth Tobacco Survey (GYTS) reported higher rates among young people between ages 13 and 15. The 2006 GYTS revealed that 11.6% of boys and 10.9% of girls in Ghana used a tobacco product, while 9.4% boys and 8.0% girls have ever smoked cigarettes
]. Higher rates of tobacco use among the youth may point to a rise in future use. Therefore even if the prevalence of tobacco use in African countries is generally low, it offers an opportunity for the control of the epidemic in these countries, the only region where the epidemic seems to be at its initial stages in many countries.
A large body of research has investigated factors that may determine smoking initiation as well as the relationship between smoking intentions and smoking behaviour among adolescents in Western countries
]. It has been shown that intention to smoke in the future predicts both smoking initiation and subsequent smoking
]. However, little is known about various factors behind youth smoking intentions in developing countries. Identifying factors that influence smoking intentions among young people in Ghana may thus be essential for preventing smoking among this vulnerable group.
Social cognition models have been extensively used to examine factors that tend to predict health behaviour, including smoking. In an integrated theoretical model, Fishbein and colleagues put together concepts from several major social cognition models that may promote or prevent the performance of health behaviour
]. The social cognition models that constitute the integrative model are the theory of reasoned action
], the social cognitive theory
] and the health belief model
]. In line with the integrative model, behavioural intention, skills and environmental constraints are directly related to behaviour. Thus, a strong intention to smoke, the necessary skills to engage in the behaviour and the ability to overcome environmental constraints could facilitate smoking. For intention to smoke, the model postulates three determining factors: attitudes, perceived norm and self-efficacy. Attitude towards smoking reflects the person’s favourable or unfavourable evaluation of smoking behaviour, while perceived norms reflect both the support from important referents to engage in the behaviour or not and the referents’ own engagement in the behaviour. Self-efficacy expresses the individual’s perception of being able to perform the behaviour under a variety of challenging circumstances.
Although, the social cognition models that constitute the integrative model were developed in Western countries and have mostly been studied in Western populations, the theoretical concepts of the model have been applicable also in non-Western countries. Attitudes, perceived norm and self-efficacy have each been found to predict a range of health behaviours such as oral health, food choices, condom use and smoking, among others in several African and Asian countries
]. The predictive power of these theoretical concepts tends to be affected by the context, a finding which is consistent with the assumption of the integrative model that the relationship between the theoretical factors and behaviour may vary across different populations and behaviours. Smith and colleagues
] found that differences in intentions between Western and non-Western countries may occur for variety of reasons, for example individuals’ attitudes, beliefs and knowledge, socio-environmental and cultural norms as well as several tobacco-related factors (factors that reflect several of the concepts of the integrative model).
From the public health viewpoint of developing countries, a better understanding of the factors influencing youth smoking intentions is essential to identifying the specific risk groups for smoking, allowing tailored preventive programs to be developed. In this paper, we explored smoking intentions among Ghanaian youth aged 12 to 20
years with regard to tobacco promoting and restraining factors, including several environmental, familial, attitudinal and knowledge measures. Because of the collective culture and the age of the participants, familial and environmental measures may be more strongly associated with smoking intentions than attitudes and knowledge.