ORIGINAL ARTICLE

Adolescent Smoking: A Cross-sectional Study

on the Knowledge, Attitude and Practices of
Filipino Adolescents in a Tertiary Hospital
Natasha Ann R. Esteban-Ipac, MD and Vanessa Maria Torres-Ticzon, MD

Division of Adolescent Medicine, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila

ABSTRACT

Objective. The study aims to determine the knowledge, attitudes and practices of Filipino adolescents aged 13-18
years old regarding cigarette smoking.

Methods. This is a descriptive cross-sectional study that utilized a questionnaire adapted from the Global Youth
Tobacco Survey.

Results. The prevalence among study participants who tried smoking (11.8%) and current users (3.6%) is lower than
the global statistics and the country’s reported prevalence, but started at a younger age (5.3% started smoking at
12-13 years old). Electronic cigarette (12.9%) is more commonly tried and used than conventional cigarettes (11.8%).
Ninety five percent (95%) of the participants view smoking as harmful. Some (13.5%) do not know the effects of
smoking, 1.1% consider it harmless, and 8.2% have no objections to starting to smoke someday. Most adolescents
(49.1%) do not know the price of cigarettes, but 22% prefer to pay less than the actual price.

Conclusion. Adolescents are knowledgeable and have a negative attitude towards smoking. Regardless if they are
non-smokers, tried smoking, or are currently smoking, they still need to be educated more regarding the effects and
consequences of smoking.

Keywords: smoking, tobacco use, electronic cigarette, vaping, adolescents

INTRODUCTION
Tobacco is the leading behavioral risk factor that causes
preventable death and is the single largest cause of death and
disability worldwide.1 Adolescence is a susceptible time for
initiation of cigarette use. In the Philippines, the average
age of initiation of smoking is 17.5 years old.2 During this
period, smoking is mere experimentation, but it can also lead
to the formation of habits that may continue on to adult life.3
The adolescent’s transition to adulthood is a critical
period for the development of enduring smoking-related
attitudes and behaviors, and presents an important population
to target with tobacco prevention messages, public health
intervention, and regulatory interventions.4
The Philippines is the second biggest market for
cigarettes in Asia.5 Being a tobacco-growing country, it is
Corresponding author: Natasha Ann R. Esteban-Ipac, MD one of the countries with high prevalence of tobacco use
Division of Adolescent Medicine in the Western Pacific Region.6 The Global Youth Tobacco
Department of Pediatrics Survey (GYTS) is the global standard for monitoring youth
Philippine General Hospital
University of the Philippines Manila
tobacco use using a school-based survey. It has been done in
Taft Avenue, Ermita, Manila 1000, Philippines the country with the sixth and latest report being completed
Email: nrestebanipac@up.edu.ph in 2019.7 Among 13 to 15 years old alone, 12.5% are current

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Adolescent Smoking in an Adolescent Clinic of a Tertiary Hospital

cigarette smokers (those who smoked cigarettes anytime factors related to smoking. The adolescent medicine clinic in
during the past 30 days) where 18.3% are males while 6.9% the Philippine General Hospital screen adolescent patients
are females. This number increases for those who ever smoked for psychosocial risk factors, including smoking behaviors
cigarettes, even one or two puffs, to 26.8% with 36.0% males during consults. Although the clinic caters to adolescents
and 18.1% females.7,8 The National Capital Region (NCR) 10-19 years old, only patients 13-18 years old are directly
had the highest reported proportion of youth smokers at triaged to the clinic, since younger patients are triaged to
26.6%.9 the Sick Child Clinic, while older patients are decked to the
The World Health Organization (WHO) came up with Adult Services, either Internal Medicine or Family Medicine
a Framework Convention on Tobacco Control (FCTC) outpatient services.
treaty to respond to the tobacco epidemic. It was developed Since this study will be done in a hospital-based clinic,
to protect every person, including adolescents, from exposure this study would include those who are out of school not
to tobacco and to inform everyone about the health covered by GYTS. Identifying the present knowledge, attitude
consequences, addictive nature and health risks associated and practices of these adolescents in a tertiary hospital will
with tobacco consumption and exposure to tobacco smoke.10 allow us to identify how adolescents view smoking in general.
In 2008, WHO introduced MPOWER, a package of six An in-depth understanding of the different factors that
evidence-based tobacco control measures to reduce tobacco make adolescents smoke is necessary to assist us establish
use.11 MPOWER refers to: important strategies for preventive guidelines and facilitate
M: monitoring of tobacco use and prevention policies the implementation of some programs and policies which are
P: protecting people from tobacco use geared towards eradication of smoking among adolescents.
O: offering help to quit tobacco use
W: warning about the dangers of tobacco Factors related to Adolescent Smoking
E: enforcing bans on tobacco advertising, promotion The number of youths initiating smoking in the country
and sponsorship, and is increasing.7 Understanding the different factors leading to
R: raising taxes on tobacco smoking in adolescents is a matter that must be explored. This
includes their knowledge, attitudes and practices regarding
In the Philippines, although tobacco control efforts smoking.
started in 1987, it was only in 2003 that the Republic Act Interplay of different factors determines if an adolescent
9211, known as Tobacco Regulation Act of 2003 was passed. will smoke or not.13 Individual factors including age, sex
One of the law’s main thrusts is to protect the youth from and grade level affect the knowledge, attitude and practices
starting a life-long addiction to tobacco use by prohibiting of an adolescent. This will be influenced by interpersonal
the sale of tobacco products to minors. The National Tobacco factors including behavior of parents, peers and the media.
Control Strategy was developed to reduce the prevalence of Moreover, this will be further influenced by societal factors
smoking and its effects, and to improve the health and lives or community/national factors which includes exposure
of Filipinos.6 to second hand smoke as well as the laws available and
Other tobacco control policies include establishing implementation (or lack thereof ) of such laws. All these
smoke-free environments such that there is a complete factors affect the knowledge, attitudes and practices which
smoking ban on schools and healthcare facilities. Advertising in turn is the basis of the smoking behavior of an adolescent
and promoting cigarettes are banned on local television, (Figure 1).
radio and newspaper as well as having health warnings on
the cigarette product packaging.2 One of the most efficient Objectives of the Study
smoking cessation policies implemented across the world is This study aims to determine the knowledge, attitudes
the cigarette price policy. Adolescents are two to three times and practices of Filipino adolescents consulting an Adolescent
more responsive to tax and price changes, hence reducing Clinic of a tertiary hospital regarding cigarette smoking. The
their tobacco initiation and consumption.12 following are the specific objectives:
Tobacco control is a multi-sectoral undertaking which is 1. To describe the demographic and socio-economic profile
not limited to the government and school system. Healthcare of Filipino adolescents consulting in an Adolescent
providers are likewise important partners. such that it is one of Clinic of a tertiary hospital
the advocacies of the Philippine Pediatric Society. Physicians 2. To determine the prevalence of cigarette smokers among
can help protect adolescents from tobacco use, monitor their adolescent Filipinos consulting a tertiary hospital
use and warn about its dangers as well as offer help to quit. 3. To identify factors that encourage adolescents to smoke
Presently, since studies are mostly done in schools, no hospital
or clinic-based study is available. METHODS
Although GYTS is being periodically done every
3-4 years, efforts must be done to reduce smoking among Research Design
adolescents by continuously identifying other issues and A descriptive cross-sectional study design was used.

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A pilot test was done to a sample of 50 participants

in the Adolescent Medicine clinic, who also accomplished
Societal factors the assent and parental consent forms (Supplementary
Material). There were no issues noted and questions raised
during the pilot study hence, there were no revisions made
Social factors in the survey used for the study proper.

Data Collection Procedure

Individual
Ethical clearance was secured from the Ethics Review
factors
Committee. A research assistant took charge of recruitment
Knowledge to minimize risk of coercion from the primary investigator.
The details of the study, informed consent and assent form
Attitude
Smoking were discussed with the patient and parents/guardians.
behavior Parental consent and assent forms were obtained prior to
distribution of the survey forms. Qualified participants
Practice
answered the survey alone and privately inside the Adolescent
clinic. Obtained surveys were encoded electronically using
Microsoft Excel.

Outcome measures
Figure 1. Conceptual framework of adolescent smoking Demographic and clinical variables including age (in
behavior. years), sex, grade level and weekly allowance were determined.
The main outcome variable for this study is the collected
Sampling Design and Participants comprehensive information from each selected respondent
The target subjects of the study are Filipino adolescents on the knowledge, attitude and practice of tobacco use among
seen at the Adolescent Medicine Clinic of the University of the participants from the survey.
the Philippines-Philippine General Hospital (UP-PGH)
from August to October 2018. Ethical consideration
The study was extensively reviewed, approved and
Inclusion Criteria monitored by the University of the Philippines, Manila
Patients aged 13 to 18 years of age and seen at the Ethics Review Board. Participant assent and parental
Adolescent Medicine Clinic of the UP-PGH from August permission forms were obtained from all participants prior
to October 2018, who were willing to participate voluntarily to answering the survey. Confidentiality was assured by
and accomplished an assent form and parental consent form. removing any identifying information from the survey forms
and allowing the participant to answer the survey alone and
Exclusion Criteria privately. Information obtained from the survey was kept
Patients who refused to join the study, or failed to submit confidential, even to the parents, by properly securing them.
a completed parental consent and assent form, or failed to Only the investigator and the research assistant had access
complete the survey, or were not able to participate due to to the information.
mental or physical incapacity were excluded.
RESULTS
Sample Selection
All patients who came in for a consult at the Adolescent A total of 170 adolescents answered and completed the
Medicine clinic were qualified to be part of the study. Parental survey and were included in the study. The mean age was
consent forms and assent forms were given. Only subjects 15 years old (standard deviation of 1.6), most of whom are
with completed parental consent, assent and survey forms 14 to 16 years old (52.9%) and more than half of them are
were included in the study. female (62.9%) (Figure 2). Most of the participants are in
school with majority of them in Grade 7 to 10 (55.3%) while
Survey there are 11.2% who are at their college level, and 1.8% are
A survey was used to measure the knowledge, attitude taking alternative learning school (ALS). The regular weekly
and practices of high school students regarding cigarette allowance is less than 50 pesos weekly allowance (42.4%),
smoking. Questions on the survey were mostly adapted from while 23.5% are given from 51 to 150 pesos weekly allowance.
the Global Youth Tobacco Survey, but was translated to Majority of the participants (85%) reported they never
Filipino and took into consideration the current local pricing smoked. However, there are 11.8% who tried smoking and
of cigarettes. 3. 6% are current smokers. Although majority also reported

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Adolescent Smoking in an Adolescent Clinic of a Tertiary Hospital

Friends and peers are perceived as the most common

120
influence to start smoking (10.6%), while a little percentage
100 (1.2% are affected by advertisements and other reasons such
as sadness). As much as 40% of the participants have friends
80
17 to 19 years old who smoke, with four (2.4%) claiming all of his/her friends
60 smoke. Most of the smokers get their cigarettes from their
14 to16 years old
friends who give it to them for free (4.7%) while others buy
40 12 to 13 years old it with their own money (4.1%). They most often smoke in
20 a public place (7.1%) or at their friend’s place (4.7%) while
a few smokes at home (2.4%) and none regularly smoke in
0
Male Female
their school.
A good number of adolescents (81.2%) perceive smoking
to be harmful, however, some (13.5%) do not know the effects
Figure 2. Age and sex distribution of adolescents from the of smoking and one participant even considered smoking as
adolescent clinic (n=170). healthy. Secondhand smoke is perceived to be harmful by
the majority as well.
that they never used an electronic cigarette, there are more Although around half of the participants (52.9%) claim
participants who tried e-cigarette (12.9%) compared with that they did not see anyone smoking in front of them for
the regular cigarette (Figure 3). Among those currently using the past week, but 4% claims that they were still exposed to
e-cigarette, half of them have not tried using the regular smoking and cigarette use through television. Almost a third
cigarettes. of the participants (32.9%) have fathers or male guardians
Among those who are smoking and tried smoking, who smoke and 6% have mothers or female guardians who
most of them have started when they were 12 to 13 years smoke. Nearly everyone (97.1%) is not allowed to smoke at
old with one participant even starting as early as 10-11 years home. Six (3.5%) of the smokers have parents or guardians
old. Those who use e-cigarettes started at a later age at 16- who know that they do smoke.
17 years old, although one participant as young as 7 years Generally, adolescents have parents or guardians who
old tried it. Among those who are smoking, most smoke for discuss the dangers of smoking as well as classes which
1-2 days in a week while one participant smokes 5-6 days teach about smoking and where to get help to stop smoking.
in a week and another one smokes daily. Among those who Among the participants who bought a cigarette in the past 30
smoke, majority already tried to stop smoking. days, eight (4.7%) of them were refused to be sold cigarettes

Figure 3. Prevalence of cigarette smoking and electronic cigarette smoking among

adolescents in a tertiary hospital (n=170).

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because of their age. Five (2.9%) were not prohibited despite willing to pay from P4.00 to 5.99 (4.7%), and as high as
their young age. more than P20.00 per stick (4.1%).
Although majority claims they do not smoke and
have no plans of smoking, 8.2% have no objections to start DISCUSSION
smoking. All participants also plan to quit smoking, with
most of them planning to stop in the next few days or within Prevalence of adolescent smoking and vaping
1 year. The prevalence of smoking among the study participants
In terms of attitude towards smoking (Table 1), the is lower than the global statistics and the country’s reported
participants strongly disagree that smoking should be prevalence of youth smoking.7,8 This may suggest that there
allowed in all places (mean of 1.870) and to allow everyone really is a lower prevalence of smoking among adolescents
(adults and young people) to smoke (mean 1.38). Participants who consult a tertiary clinic or that the adolescents were,
disagree about allowing smoking in outdoor public places despite the confidentiality, did not report their real smoking
only (mean of 2.21) and allowing adults only to smoke (mean status. Majority of adolescents in the clinic started smoking
of 2.48). They are, however, undecided if smoking should 6 months to 1.5 years earlier compared to the country’s
be allowed in enclosed public places only (2.88). reported average age of initiation of smoking.2 Similarly
Different factors affect the smoking status of the par- though, some adolescents are exposed early on that they tried
ticipant (Table 2). Age (p=0.3542), sex (p=0.1065), grade smoking at a very young age.10 E-cigarette use is common
level (p=0.6372), whether they are allowed to smoke at and is increasingly recognized among adolescents14,15 but
home or not (p=0.0850) and whether dangerous effects despite being more expensive, electronic cigarettes are more
were discussed by parents or guardians (p=0.4035) were not commonly tried than the conventional cigarette.
significant. On the other hand, number of friends who are
smoking proved to be a significant factor, where those who Risk factors for adolescent smoking
have either tried smoking or are currently smoking have Different factors determine if an adolescent will smoke
friends who also smoke, while those who do not smoke or or not. A study by Cosci done in 2013 noted that the lack of
have not tried smoking have no friends who are smokers knowledge on the negative effects of smoking and second-
(p=0.0001). Allowance is also a significant factor, specifically, hand smoking is a strong predictor of youth smoking.16
those whose weekly allowance is from P51 to P150, they This highlights the importance of educating the adolescents
are more likely to be try or be a smoker (p=0.0370). On the regarding the effects of smoking even at an early age.
other hand, adolescents report that the main reason why they A favorable attitude towards smoking is an important
should not smoke is that it is bad for their health (94.7%). determinant of the desire to smoke among adolescents.
Adolescents consider that the cost of each stick of Some of these attitudes associated with cigarette smoking
cigarette is less than 4 Philippine pesos (22.4%) while half are related to the belief that students who smoke cigarettes
of them (49.1%) responded that they have no idea about have more friends and are more attractive. Others would
the price. Additionally, 25.9% of them think that cigarettes view smoking as a way to express feelings, cope with stress,
should cost more than the actual retail price. Among those or lose weight.3,17
who smoke, only 4 will still smoke despite a price increase. Practices are related to individual, social, and societal
Most are willing to pay less than P4.00 per stick; some are factors. Individual factors would include age, where youth

Table 1. Attitudes towards smoking

SA A N D SD
Attitudes towards smoking Mean Interpretation
n % n % n % n % n %
Smoking should be allowed in all 1.80 Strongly 9 5.3 7 4.1 15 8.8 49 28.8 90 52.9
places Disagree
Smoking should be allowed in 2.88 Neutral 21 12.4 40 23.5 34 20.0 47 27.6 28 16.5
enclosed public places only
Smoking should be allowed in 2.21 Disagree 7 4.1 30 17.6 25 14.7 38 22.4 70 41.2
outdoor public places only
Allow everyone (adults and young 1.38 Strongly 3 1.8 1 0.6 6 3.5 38 22.4 122 71.8
people) to smoke Disagree
Allow only adults to smoke and 2.48 Disagree 17 10.0 36 21.2 18 10.6 39 22.9 60 35.3
prevent young people from smoking
Allow only young people to smoke 1.31 Strongly 1 0.6 0 0.0 8 4.7 32 18.8 129 75.9
and prevent adults from smoking Disagree
SA=Strongly agree; A=Agree; N=Neutral; D=Disagree; SD=Strongly Disagree

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Table 2. Factors affecting smoking

Factors Never Tried Smoking Tried but Quit Smoking Smoker p-value
Age
12 to 13 14 (9.7) 1 (5.0) 0 (0.0) 0.3542
14 to 16 76 (52.8) 12 (60.0) 2 (33.3)
17 to 19 54 (37.5) 7 (35.0) 4 (66.7)
Sex
Male 49 (34.0) 10 (50.0) 4 (66.7) 0.1065
Female 95 (66.0) 10 (50.0) 2 (33.3)
Grade Level
Out of School 8 (6.0) 2 (10.0) 0 (0.0) 0.6372
Grade 1 - 12 116 (81.0) 16 (80.0) 6 (100.0)
College 17 (12.0) 2 (10.0) 0 (0.0)
ALS 3 (2.0) 0 (0.0) 0 (0.0)
Weekly Allowance
Less than 50 65 (45.1) 6 (30.0) 1 (16.7) 0.2017
P51 to P150 29 (20.1) 8 (40.0) 3 (50.0) 0.0370*
P151 to P250 17 (11.8) 3 (15.0) 0 (0.0) 0.8670
P251 to P350 11 (7.6) 1 (5.0) 1 (16.7) 0.6127
P351 to 450 8 (5.6) 0 (0.0) 0 (0.0) 0.6998
P451 to P550 12 (8.3) 1 (5.0) 0 (0.0) 1.0000
More than P550 2 (1.4) 1 (5.0) 1 (16.7) 0.0530
Smoking Allowed at Home
Yes 3 (2.1) 1 (5.0) 1 (16.7) 0.0850
No 141 (97.9) 19 (95.0) 5 (83.3)
Discussed about the dangers of smoking with your parents/guardians
Yes 97 (67.4) 11 (55.0) 5 (83.3) 0.4035
No 47 (32.6) 9 (45.0) 1 (16.7)
Number of friends who smoke
None of my friends 98 (68.1) 3 (15.0) 1 (16.7) 0.0001*
With Friends Smoking 46 (31.9) 17 (85.0) 5 (83.3)
Few of my friends 30 (20.8) 9 (45.0) 1 (16.7)
Half of my friends 14 (9.7) 7 (35.0) 3 (50.0)
All of my friends 2 (1.4) 1 (5.0) 1 (16.7)
*Statistically significant

who start smoking before age 14 years are less likely to as compared to those students who did not receive pocket
quit smoking and more likely to continue smoking into money.21
adulthood.18 In the Philippines, 12% tried their first One of the most studied social factors is family/parents.
cigarette at the age of 7 years old or even younger10 and the A study by Malta revealed that family plays an essential role
prevalence of smoking increase substantially with age.19 in prevention of not only tobacco, but also alcohol, and drug
Gender has been a major predictor of smoking in some use as well as promote health among teenagers.22 Parents
countries across the globe where males smoke more than who smoke leads to adolescent smoking.20,23 This risk-taking
females. In a study done by Teixeira, prevalence of smoking behavior may be changed by modifying the attitude of the
initiation among the boys was 49% higher than among the parents and increasing their parental supervision. Adolescents
girls (p = 0.010).20 In the Philippines, men are more likely would not begin or continue to smoke if they think their
than women to smoke probably due to the social norm parents do not approve it.19,24
on gender behavior where men have more liberty and are Other factors affecting an adolescent’s decision to smoke
allowed more range of social activities compared to women.19 include (a) grade level, where the higher the grade a student
A study by Teixeira noted that children with an is, the higher the chances that the student smokes cigarettes21,
allowance and greater purchasing power, enables them to (b) peers, where the more smoker friends an adolescent
make decisions and purchases without the financial barrier has, the higher likelihood of smoking, even alcohol use.25,26
which often induces them to try cigarettes.20 In another study and (c) media, where viewing movie depictions of tobacco use
by Siziya done in Zambian schools, students who received is associated with higher receptivity to smoking.27
pocket money were 2.3 times more likely to be smokers

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 Adolescent Smoking in an Adolescent Clinic of a Tertiary Hospital

The environment per se is a societal factor, which engage in risky behaviors. So, even if they are aware of the ill
includes cigarette taxes and prices, as well as implementation effects of smoking, and even know that they should not be
of smoking prevention programs specifically for the smoking, adolescents may still really engage in smoking. This
youth. Living in a more socioeconomically disadvantaged adds up to the multifactorial aspect of adolescent smoking
neighborhood is independently associated with increased and that there is a greater need to educate our adolescents
smoking.26 On the other hand, taxes and price increases also regarding the adverse effects of smoking, even if they are
influences cessation or reduction of cigarette consumption.28 aware of these effects already.
In a study in India, providing professional and program All of the participants plan to quit smoking someday.
advice for quitting smoking is very effective for adolescents, They are contemplating on stopping smoking since there is
hence more programs and healthcare professionals must be already the intention to quit. This gives us the opportunity to
employed to prevent the use of tobacco.29 educate them more early on so they may start quitting earlier
In the study, age, sex, grade level and knowledge on than intended and prevent the development of enduring
effects of smoking were not considered as significant factor, smoking related attitudes and behavior as they grow older.
contrary to what the studies show.16,19-21 However, it must
be noted that aside from the factors per se, the relationship Price levels adolescents are willing to pay
and interplay between the different factors contribute to the Although most of the participants do not know the price
general behavior of the adolescent regarding smoking. Peers of each stick of cigarette, some are willing to pay at a higher
have a great and significant impact on adolescents’ decision price up to P20.00 per stick, however most would prefer to
to start smoking, serving as the most common influence pay for it at less than P4.00 per stick compared to the actual
to start smoking. Peer pressure affects the adolescents’ current price of cigarette. Some of the participants answered
behavior as shown in the study: the more friends that they that cigarettes should cost higher. Most of the participants
have that smoke, the more likelihood that they will smoke. would not smoke if the price increases which shows that
Allowance is also a significant factor, in which a weekly adolescents are price sensitive and that they are more
allowance of P51-P150 can already make an adolescent try to responsive to tax and price changes. This finding is consistent
smoke or actually smoke. Giving adolescents money provide with prior literature that cigarette taxes are associated with
them greater purchasing power which allows them to buy reduced smoking among adolescents.26,28,32-34 Increasing
cigarettes even if it means using almost half of their daily the price through these taxes decreases the buying capacity
allowance for it.20,21 of the teens, hence disabling them to buy any cigarette to
One of the countries tobacco control efforts is to ban start smoking or forcing them to quit if they are currently
advertising and promoting cigarettes on local television, smoking. A similar finding is also noted in electronic
however, this was reported to be inconsistent with the data cigarettes where higher prices is associated with reduced use
where some of the participants who stated that they are among adolescents.35
still exposed to it through commercials on television. One The possible expansion of this research would benefit
significant exposure of the participants are family members other adolescents through the development of programs
themselves, mostly fathers. aimed at helping to identify and educating adolescents in
Smoking and dangers associated with it are regularly need. Other factors related to smoking behaviors among
discussed by parents and guardians and even in school or in adolescents, such as the effect of graphic warnings, as well
class. For adolescents, the main reason for not smoking is that as exploring the factors why electronic cigarettes are being
it is bad for their health. Adolescents mostly view smoking used by adolescents despite it being more expensive than
as harmful and have a negative attitude against it saying that conventional cigarette.
smoking should not be allowed in all places and that everyone,
including adults, should not be allowed to smoke. Generally, CONCLUSION
parents and guardians as well as school teach about effects
of smoking. However, although majority already know the Adolescents are knowledgeable and have a negative
negative consequences of smoking and second-hand smoke, attitude towards smoking, however, other factors have
there is still a handful who express that they do not know the a significant impact on their decision to start smoking.
true effects of smoking and some even consider it harmless. Regardless if they are non-smokers, tried smoking, or are
There are even some who despite knowing the harmful currently smoking, they still need to be educated more
effects of smoking, have no objections of starting to smoke. regarding the effects and consequences of smoking.
This emphasizes the vulnerability of adolescents during this Electronic cigarette use is becoming more common
time period. Brain development during this period is not yet among adolescents, so psychosocial risk assessment and
well mature and established hence the difficulty controlling preventive health guidance should not be limited to
their impulsivity.30,31 Teens are mostly driven by motivation conventional cigarettes, but should also cover electronic
and emotion rather than cognitive and self-control, and as smoking or vaping. More studies are recommended to explore
such are really prone to explore and try out novel things and the increasing prevalence of electronic cigarettes.

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Adolescent Smoking in an Adolescent Clinic of a Tertiary Hospital

Supplementary Material 2014 [cited 2021 Aug 30]. Available from: https://www.drdf.org.ph/
The supplementary survey forms are available upon sites/default/files/YAFS4%20Key%20Findings/YAFS4%20Key%20
Findings.pdf
request from the authors. 10. World Health Organization. WHO Framework Convention on
Tobacco Control [Internet]. Geneva, CH: World Health Organization;
Statement of Authorship c2003 [updated 2005; cited 2021 Aug 30]. Available from: http://
Both authors contributed in the conceptualization of apps.who.int/iris/bitstream/handle/10665/42811/9241591013.
pdf ?sequence=1
work, acquisition and analysis of data, drafting and revising 11. World Health Organization. WHO report on the global tobacco
and approved the final version submitted. epidemic 2021: addressing new and emerging products [Internet].
Geneva: World Health Organization; 2021. License: CC BY-NC-SA
Author Disclosure 3.0 IGO. [cited 2021 Aug 30]
12. WHO Framework Convention on Tobacco Control, Conference of
Both authors declared no conflicts of interest. the Parties to the WHO Framework Convention on Tobacco Control,
sixth session. DECISION: Guidelines for implementation of Article
Funding Source 6 of the WHO FCTC (Price and tax measures to reduce the demand
This study has no funding support. for tobacco) [Internet]. 2014 [cited 2021 Aug 30]. Available from:
http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6(5)-en.pdf
13. Geckova A, van Dijk JP, van Ittersum-Gritter T, Groothoff JW, Post D.
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