{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:54:43Z","timestamp":1790686483927,"version":"4.1.0"},"reference-count":43,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100022974","name":"Global Alliance for Chronic Diseases","doi-asserted-by":"publisher","award":["101095461"],"award-info":[{"award-number":["101095461"]}],"id":[{"id":"10.13039\/100022974","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp; Addiction Journal"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Adolescent smoking continues to pose significant public health challenge, persisting due to a multifaceted interplay of internal and external factors. The present study aimed to explore internal and external factors that may influence adolescents\u2019 smoking behaviors in Crete, Greece.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Conducted as part of Phase A of the European-funded FRESHAIR4Life Program; this cross-sectional study included adolescents aged 14 to 21\u2009years, recruited between January and February of 2024. Ten educational institutions in the Municipality of Heraklion, Crete, were selected, including high schools (n\u2009=\u20097), technical schools (n\u2009=\u20092), and universities (n\u2009=\u20091).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The sample consisted of 179 participants with a mean (SD) age of 16.8 (1.9). Smoking history was reported by 34% (n\u2009=\u200960). Older adolescents had higher odds of ever smoking (OR\u2009=\u20091.57, 95% CI: 1.32-1.88;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). The most prevalent reasons for smoking initiation were reported to be addiction after the initial use of nicotine products (60%), stress (43%), and to look cool and attractive (27%). Ignoring smoking\u2019s negative consequences was positively associated with ever smoking (OR\u2009=\u20093.89, 95% CI: 1.85-7.99,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). The perception of smoking as a risk factor for the development of illness (OR\u2009=\u20092.6, 95% CI: 1.2-5.3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.012), and concerns about the health impact (OR\u2009=\u20095.7, 95% CI: 2.3-14.1,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) were positively associated with non-smoking behaviors. External factors positively associated with ever smoking were smoking exposure at school (OR\u2009=\u20092.81, 95% CI: 1.36-5.81;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.005), use of nicotine products by parent(s) (OR\u2009=\u20097.64, 95% CI: 1.95-29.96,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.004), close friend(s) (OR\u2009=\u200912.88, 95% CI: 3.24-51.15,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and sibling(s) (OR\u2009=\u200925.13, 95% CI: 3.23-195.63,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our findings highlight the need for multifaceted, targeted interventions. Future research should evaluate tailored interventions and investigate emerging potential influences like social media and alternative nicotine products on youth smoking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342261446843","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T17:40:49Z","timestamp":1779730849000},"page":"1151-1163","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Examining External and Internal Factors That Could Influence Adolescent Smoking Behaviors in Adolescents of Crete, Greece: The Cross-Sectional FRESHAIR4Life Study"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1148-7869","authenticated-orcid":false,"given":"Theodoros","family":"Krasanakis","sequence":"first","affiliation":[{"name":"Department of Social Medicine, University of Crete, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5903-3550","authenticated-orcid":false,"given":"Izolde","family":"Bouloukaki","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, University of Crete, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0544-851X","authenticated-orcid":false,"given":"Antonios","family":"Christodoulakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9104-9525","authenticated-orcid":false,"given":"Antonia","family":"Aravantinou-Karlatou","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, University of Crete, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte M.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rianne M. 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