Longitudinal association of smoking-related attitude to oral health with adolescents' smoking onset

Objective: The negative oral health effects of smoking, such as stained teeth, gum infection, and bad breath may be more salient to adolescents, and therefore, more important expectancies for adolescent smokers and nonsmokers alike. Informed by the social cognitive theory, this prospective study sought to determine the role of smoking-related attitude to oral health on smoking onset among adolescents over a 12-month interval. Method: This prospective study involved a community sample of 422 nonsmoking eighth graders selected from three public schools in the capital city of South Africa. Data were collected through a questionnaire, which included a 5-point Likert-scale-type question on dental disease belief related to smoking (smoking causes plaque and bad breath) and an affective evaluation of this effect (bad breath causes peer rejection). The product of these two later variables was used to compute an attitude score. Higher scores represent a more favorable oral health attitude. Health-risk behaviors recorded included past month smoking and alcohol use. Results: The mean age of the participants was 13.9 years at baseline. At 1-year follow-up, 11.4 percent (n = 48) of nonsmokers at baseline had initiated smoking. Compared to nonsmokers, current smokers were more likely to report frequent bleeding gums (51.2 versus 33.1 percent; P = 0.02), but there was no significant difference in proportions brushing twice daily (64.4 versus 56.5 percent; P = 0.30). In addition to the independent influence of peers and binge drinking, smoking-related attitude to oral health significantly influenced smoking onset. Conclusion: The study findings support the development of smoking prevention programs that include restructuring of cognitions about the oral health outcomes of smoking.