Psychological and Health Predictors of Self-Rated Health Among Adolescent Smokers in Santiago, Chile

Background and Purpose: Previous research has found that self-rated health is a predictor of morbidity and mortality. However, the majority of studies have used risk factors such as smoking to predict self-rated health, and the inclusion of psychological factors of self-rated health has been limited. In addition, research in this area has focused on differences in self-rated health among adult populations that include both smokers and nonsmokers. To address these gaps, this study examines both psychological and health predictors of self-rated health among adolescent smokers. In addition, the youth sample is from Chile, a country that has a high rate of adolescent smokers compared to other Latin American countries and the United States.

Methods: This study used cross-sectional data from the first wave of the Santiago Longitudinal Study, a study of substance use among youth in Santiago, Chile. Participants include 1002 youth (mean age= 14 years, SD=1.5, 51% male) from municipalities of mid- to low- socioeconomic status. Youth completed a 2-hr. questionnaire administered by psychologists that included items on cigarette use, physical activity, and self-esteem, among others. The dependent variable was measured by asking youth, “How is your health in general?”. Response categories were 1=poor/fair, 2=good, 3=very good, 4=excellent. A nurse collected youth's height and weight to determine BMI, and caregivers reported on household income. Data were analyzed using bivariate and ordinal logistic regression statistics. A check of the parallel test assumption to analyze the data with ordinal regression indicated no violation of the assumption.

Results: Of the 1002 adolescents, 308 reported having smoked cigarettes in their lifetime. Age of first cigarette use was 12 years for both males and females, and the percent of smokers was nearly equal between the sexes. Adolescent smokers rated their health as follows: 15% Poor/Fair, 30% Good, 35% Very Good, and 20% Excellent. Results suggested that smokers who reported having better physical well being and higher self-esteem were more likely to report being healthier, even after adjusting for age, sex, income, BMI, and level of physical activity. Youth with ‘Excellent' health were those who completely agreed on items such as being able to resist illness well, recover quickly after getting sick, being socially accepted, and having much to be proud of. An interaction effect was identified with sex. If respondents were female, the predicted probability of rating ones health as ‘Excellent' decreased, after controlling for all other factors. Respondents' age, income, BMI, and level of physical activity did not distinguish how smokers rated their health.

Conclusions and Implications: The results suggest that self-esteem and perception of physical well-being are important indicators of how youth smokers think about their health, which differs between males and females. Subsequently, adolescent smokers' beliefs about their health status may influence their future smoking habits. Social workers and other professionals may enhance youth's self-esteem and perception of physical well-being in youth smoking prevention and cessation programs.