Gender differences in susceptibility to smoking among high school students

J Adv Nurs. 2023 May;79(5):1912-1925. doi: 10.1111/jan.15382. Epub 2022 Jul 22.


Aims: To analyse the degree of susceptibility to smoking according to gender in students between 12 and 16 years of age and study the role of factors associated with gender and the extended index of susceptibility to smoking.

Design: Cross-sectional study.

Methods: Between November 2019 and March 2020, 12- to 16-year-old students were recruited from three educational centres in western Spain. Sociodemographic, environmental, social and personal variables were analysed. The value of the extended index of susceptibility to smoking was calculated, and the associations between the students' genders and smoking susceptibility were studied. Multinomial logistic regression was used to study associations between the independent variables and Expanded Susceptibility Index (ESSI) results. The roles of factors in this association were explored through mediation analysis.

Results: A total of 364 students participated in the study (53% females). A total of 79.3% of females and 61.4% of males presented a medium-high level of the extended index of susceptibility. Females reported greater cigarette use (28% vs. 12.3%), hookah (19.9% vs 9.9%) and alcohol consumption (20.7% risk alcohol consumption). They obtained higher scores on the impulsivity scale in the urgency domain and the negative affect scale. Regardless of other factors, females showed more than double the smoking susceptibility (aOR: 2.05, 95% CI: 1.03-4.07, p = .041). Mediation analysis showed that gender had a total effect on the extended susceptibility index β = .023 (95% CI: 0.07-0.38, p = .01). The effect appeared to be mediated only by having smoking friends (0.08; 95% CI: 0.03-0.15, p = .001).

Conclusions: The greater susceptibility to smoking found in females may be related to a greater influence of smoking among friends.

Impact: These results show that smoking friends have a strong influence among adolescent females; therefore, developing preventive programmes with gender approaches aimed at reducing the influence of these environmental factors would be of interest.

Keywords: Adolescent; femalegendergender perspectivemalepublic health nursingschool nursingsmokingsusceptibilitytobacco products.

MeSH terms

  • Adolescent
  • Alcohol Drinking
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Prevalence
  • Sex Factors
  • Smoking* / epidemiology
  • Students*
  • Surveys and Questionnaires