The Association Between Social Support and Trying Smoking Among Rural Adolescents in Rural Western China: The Intermediary Role of Mental Health Problems and Life Satisfaction

Abstract Introduction Most adult smokers develop their addiction by trying smoking during adolescence. Elucidation of the psychosocial mechanisms underlying smoking initiation may be crucial for the prevention of adolescent tobacco use. The study aimed to identify key psychosocial factors to provide a scientific basis for preventing and reducing the occurrence of initial smoking behavior among adolescents. Methods A total of 2671 students from rural middle schools in western China were surveyed three times as part of a 2-year longitudinal study. The adolescent health questionnaire included the Global Youth Tobacco Survey, the Mental Health Inventory of Middle School Students, the Social Support Rating Scale, and the Adolescent Life Satisfaction Scale. Structural equation modeling was used to analyze the direct or indirect relationships between smoking initiation and psychosocial factors. Results The prevalence of trying smoking among adolescents was 28.3%, with boys (38.3%) having a higher rate than girls (19.7%; p < .05). Mental health problems were positively associated with trying smoking (β = 0.112, p < .05). Greater life satisfaction had a negative direct effect on trying smoking (β = −0.125, p < .05) and also played a mediating role in the relationship between mental health problems and trying smoking (β = 0.016, 95% CI = 0.008 to 0.025), accounting for 20.7% of the total effect. Social support had a full mediating effect on smoking initiation through both mental health problems and life satisfaction (β = −0.022, 95% CI = −0.028 to −0.016). Conclusions The behavior of young people who try smoking is associated with complex psychosocial factors. Interventions aimed at preventing adolescent tobacco use should prioritize the provision of social support and the promotion of life satisfaction. Implications The study elucidated the direct and indirect relationships between psychosocial factors and trying smoking behavior. To prevent adolescents from trying smoking, it is essential to intervene through external social support and internal development of mental health and well-being to improve adolescents’ social support, increase their life satisfaction, and maintain their mental health.