Predictors of Intention to Smoke among Junior High School Students in Shanghai, China: An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model

PLOS ONE, Dec 2019

Background Adolescent smoking is a worldwide problem that is particularly severe in low- and middle-income countries. Many endogenous and environmental factors affect the intention to smoke, so a comprehensive model is needed to understand the significance and relationship of predictors. The study aimed to test the associations among information-motivation-behavioral skills (IMB) model constructs as predictors of intention to smoke in junior high school students in Shanghai, China. Methods We conducted a cross-sectional study of 16,500 junior high school students in Shanghai, China. Data on tobacco-related information, motivation, behavioral skills, and behaviors were collected from students. Structural equation model (SEM) was used to assess the IMB model. Results The mean age of participants was 13.8 years old (standard deviation = 1.02; range 11–17). The experimental smoking rate among junior high school students was 6.6% and 8.7% of the participants expected that they would be smokers in 5 years. The IMB model provided acceptable fit to the data (comparative fit index = 0.984, root mean square error of approximation = 0.04). Intention to smoke was predicted by behavioral skills (β= 0.670, P < 0.001) and motivation (β= 0.095, P<0.001) among junior high school students. Conclusion The IMB model provides a good understanding of the predictors of intention to smoke and it suggests future interventions among junior high school students should focus on improving motivation and behavioral skills.

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Predictors of Intention to Smoke among Junior High School Students in Shanghai, China: An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model

China: An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model. PLoS ONE 8(11): e80482. doi:10.1371/journal.pone.0080482 Predictors of Intention to Smoke among Junior High School Students in Shanghai, China: An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model Chendi Zhu 0 Yong Cai 0 Jin Ma 0 Na Li 0 Jingfen Zhu 0 Yaping He 0 Pamela Redmon 0 Yun Qiao 0 Reury F.P Bacurau, University of Sao Paulo, Brazil 0 1 School of Public Health, Shanghai JiaoTong University , Shanghai , PR China , 2 Global Health Institute, Emory University , Atlanta , Georgia , United States of America, 3 Pudong Institute for Health Development , Shanghai , PR China Background: Adolescent smoking is a worldwide problem that is particularly severe in low- and middle-income countries. Many endogenous and environmental factors affect the intention to smoke, so a comprehensive model is needed to understand the significance and relationship of predictors. The study aimed to test the associations among information-motivation-behavioral skills (IMB) model constructs as predictors of intention to smoke in junior high school students in Shanghai, China. Methods: We conducted a cross-sectional study of 16,500 junior high school students in Shanghai, China. Data on tobacco-related information, motivation, behavioral skills, and behaviors were collected from students. Structural equation model (SEM) was used to assess the IMB model. Results: The mean age of participants was 13.8 years old (standard deviation = 1.02; range 11-17). The experimental smoking rate among junior high school students was 6.6% and 8.7% of the participants expected that they would be smokers in 5 years. The IMB model provided acceptable fit to the data (comparative fit index = 0.984, root mean square error of approximation = 0.04). Intention to smoke was predicted by behavioral skills (= 0.670, P < 0.001) and motivation (= 0.095, P<0.001) among junior high school students. Conclusion: The IMB model provides a good understanding of the predictors of intention to smoke and it suggests future interventions among junior high school students should focus on improving motivation and behavioral skills. - Funding: This study was funded by (or in part by) the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. This publication is also supported by the following: Key liberal arts innovative project, Shanghai Municipal Education Commission (12ZS106) General program for young researchers of humanities and social studies, China Ministry of Education (12YTC840001); The New Hundred Program on Outstanding Teacher of the School of Medicine of Shanghai Jiaotong University and the Young Teachers Overseas Visiting and Training Program from Shanghai Municipal Education Commission. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. These authors contributed equally to this work. Non-communicable diseases (NCDs) are the leading cause of mortality, contributing to 36 million of the 57 million global deaths in 2008 [1]. In China, tobacco use is one of the most preventable causes of NCD [2]. Tobacco causes about a million deaths per year in China, and the deaths are likely to increase to 3 million by the middle of this century [3,4]. Adolescent smoking has increased continuously in China, with the average age of onset of smoking has been decreasing [5,6]. Children and adolescents are the most vulnerable of experimental smokers (smoking one or two puffs of a cigarette) and are more likely to progress to current smokers [5]. Tobacco experimentation among school children aged 13-15 in Shanghai is nearly 7% and the estimated prevalence of current cigarette smoking is 28.1% among adults aged 15 years and above in China[7]. Once adolescents begin to experiment with smoking, they are likely to become regular smokers and the earlier individuals start smoking the higher risk of addiction in later life [8]. An understanding what lead adolescents decide or intent to smoke is an important issue on the future of tobacco control. Intention usually represents a decision to exert effort to perform the behavior [9]. Although there is a gap between intention and behavior, intention measurement remains a useful construct and is widely used in researches [1012]. Intention to smoke is considered to be the major predictor of smoking behavior since numerous theories in social and health psychology assume that intention cause behaviors [11,12]. Cross-sectional and cohort studies have been used to evaluate the factors predicting adolescent smoking intention and behavior [7,8,10,13]. A previous study suggested that information, or ones recognition of the health hazard of (...truncated)


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Chendi Zhu, Yong Cai, Jin Ma, Na Li, Jingfen Zhu, Yaping He, Pamela Redmon, Yun Qiao. Predictors of Intention to Smoke among Junior High School Students in Shanghai, China: An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model, PLOS ONE, 2013, 11, DOI: 10.1371/journal.pone.0080482