Smoking Prevalence, Susceptibility to Cigarette Smoking, and Its Causes in 568 Adolescent Male High School Students in Southern Saudi Arabia: A Cross-Sectional Study

BACKGROUND Smoking is the single largest and most critical public health issue in the world, if smoking is initiated early in life, it can have long-term consequences. This study aimed to evaluate the prevalence of cigarette smoking in 568 adolescent male high school students in southern Saudi Arabia and their susceptibility to smoking using the Expanded Susceptibility to Smoking Index (ESSI), the short version of the UPPS-P Impulsive Behavior Scale (UPPS-P), and the Positive and Negative Affect Schedule (PANAS). MATERIAL AND METHODS A cross-sectional study was conducted among 568 male students aged 15-18 years in randomly selected high schools. Data were collected using a structured questionnaire that included the ESSI, the UPPS-P, and the PANAS. Descriptive statistics and inferential analysis using chi-square tests and logistic regression were performed using SPSS. RESULTS The prevalence of current cigarette smoking was 19.4%. Among non-smokers, 41.9% were not susceptible, 34.9% were susceptible, and 23.2% were highly susceptible, but the differences were not statistically significant. A higher susceptibility to smoking was significantly associated with higher impulsivity (P<0.001) and greater negative affect (P<0.05). Multivariate analysis identified key predictors, including peer influence, sensation seeking, and emotional affect. CONCLUSIONS The findings reveal a notable prevalence of cigarette smoking and high susceptibility among non-smoking adolescent males. Psychological traits such as impulsivity and emotional affect were significantly linked to smoking risk. These results highlight the need for targeted school-based prevention programs addressing both behavioral and emotional factors.