Mechanism Linking Cigarette Pack Factors, Point-of-Sale Marketing and Individual Factors With Smoking Intention Among School-Going Adolescents

Context:Tobacco usage accounts for one of the most preventable causes of death.Objective:This study aimed to explore mechanisms linking cigarette pack factors, point-of-sale marketing, and individual factors (psychological reactant trait) to predict smoking intention among school-going adolescents.Design, Setting, and Participants:This was a cross-sectional study conducted among 6 urban secondary schools. A pretested and validated self-administered questionnaire was used. Data analysis for structural equation modeling was done using SMART-PLS v3.2.8.Main Outcome Measure:The main outcome measure was to determine the direct and indirect effects of cigarette pack factors, point-of-sale marketing, and individual factors (psychological reactant trait) to predict smoking intention among school-going adolescents in a theory-based model.Results:A total of 386 adolescents fulfilling the inclusion criteria participated. Pictorial warning message reactance (beta = .153, P <= .001), pack receptivity of conventional pack (beta = .297, P = .004), and psychological reactant trait (beta = .174, P <= .001) were positively related to smoking intention. Pictorial warning negative affect (beta = -.153, P = .001) was negatively related to smoking intention. The psychological reactant trait was positively related to message reactance (beta = .340, P <= .001). However, recall exposure to point-of-sale marketing and pack appraisal of conventional pack was not positively related to smoking intention (beta = .038, P = .22 and beta = -.026, P = .39, respectively). Pictorial warning message reactance also positively mediates the relationship between psychological reactant trait and smoking intention (beta = 0.05, p = .001). The model has strong predictive power.Conclusion:In conclusion, cigarette pack factors and psychological reactant traits are essential in predicting smoking intention. Hence, policymakers should consider these factors in developing smoking policies.