Academic achievement and smoking: Is self-efficacy an important factor in understanding social inequalities in Finnish adolescents?

Aims: Poor academic achievement is strongly related to smoking but studies that examine the mechanism between academic achievement and smoking are lacking. The aim of this study, therefore, was to examine the smoking-related cognitions (i.e. attitude, social influence, self-efficacy and intention to smoke) in relation to academic achievement and determine whether these cognitions explain different patterns of smoking. Methods: The study uses the data of a longitudinal study that was carried out in Finland, and the sample comprised 1,096 students in grades seven to nine. Results: During the seventh-grade students with poor academic achievement reported more positive attitudes to smoking and a greater social influence of their peers regarding smoking, weaker self-efficacy to refuse smoking and more intentions to smoke in the future compared to students with high academic achievement. Moreover, the follow-up analyses after a 24-month interval revealed that sel-fefficacy to refuse smoking of students with poor grades had become weaker compared to students with high grades. Furthermore, the influence of seventh-grade academic achievement predicting ninth-grade weekly smoking was partially mediated through the self-efficacy beliefs and the intention to smoke. Conclusions: Differences in academic achievement may have an impact on adolescents' self-efficacy beliefs and the intention to smoke in the future. To reduce health inequalities a strong input on continuing research to improve smoking prevention methods, especially for students with low academic achievement, is needed