Evaluation of Smoking Habits Among Middle and High School Students in the Central Black Sea Region: A Comparative Analysis with Two Studies in the Same Region

Conventional Cigarette Smoking Among Adolescents in the Central Black Sea Region: A Comparative Analysis of Two Studies in the Same RegionBackground: Smoking remains a significant and preventable public health problem affecting adolescents. This study evaluated the prevalence of conventional (packaged) cigarette use among middle and high school students, identified associated factors, and assessed temporal trends by comparing the findings with those of previous studies conducted in the same region.Materials and Methods: A cross-sectional study was conducted with 785 students (383 males, 402 females; mean age 15.6±1.32 years) selected via stratified random sampling in the Samsun province. Data were collected using self-administered questionnaires. Chi-square tests and multivariate logistic regression were used for statistical analysis.Results: The prevalence of conventional cigarette use was 3.82% (2.72% in males, 1.10% in females; p<0.05), representing a significant decline compared with rates reported in the same region in 1997 (13.1%) and 2012 (13.0%) (p<0.0005). The mean age at smoking initiation was 13.6±1.31 years, with females starting later than males (14.0±1.38 vs. 13.2±1.62 years; p<0.001). In multivariate analysis, peer smoking was the strongest predictor (β=0.613), followed by parental smoking (β=0.286) and sibling smoking (β=0.144). The primary reasons for initiation were stress/boredom (43.3%) and peer influence (40.0%). Among students, 44.1% had smoking fathers, 21.4% had smoking mothers, 8.9% had smoking siblings, and 35.3% had smoking peers. While 44.8% recognized respiratory harms and 29.6% recognized cancer risks, only 33.2% believed public service announcements would be effective.Discussion: Conventional cigarette use has decreased markedly; peer and family influences are the principal determinants. E-cigarettes and novel nicotine products were not assessed; future studies should encompass all nicotine products.