Author ORCID Identifier

0009-0001-9929-7697

Date of Award

8-31-2026

Document Type

Open Access Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Sun S. Kim

Second Advisor

Sabreen A. Darwish

Third Advisor

Qian Song

Abstract

Tobacco use among Thai adolescents is shaped by personal, environmental, and product-related factors. However, the pathways linking these influences to actual behavior remain unclear. This study examined how personal, environmental, and product-related factors, along with intentions to use, relate to tobacco use among Thai adolescents. A cross-sectional secondary analysis was conducted using data from the 2022 Thailand Global Youth Tobacco Survey of 6,235 students aged 13–15 years. Survey weights methods were applied to produce nationally representative estimates. Confirmatory factor analysis and structural equation modeling assessed latent constructs, and multinomial logistic regression examined predictors of single, dual, and multiple product use. The prevalence of current tobacco use was 19.5%. The final SEM showed adequate fit (SRMR=0.071, CD =0.997) and explained 30.9% of the variance in intentions and 55.9% in tobacco use. Accessibility was the strongest direct predictor of tobacco use (b = 0.474, p < .001), followed by intentions (b = 0.404, p < .001), while perceived harms (b = −0.088, p < .001) and perceived addictiveness (b = −0.048, p < .01) were negatively associated with use. Peer tobacco use showed significant indirect effects (b = 0.039, p < .05) and stronger effects via intentions (b = 0.114, p < .001). Flavor appeal, lack of point‑of‑sale restrictions, and social media exposure (p < .001) predicted single, dual, and multiple‑product use, whereas school anti‑tobacco campaigns were protective, especially against multiple‑product use (p < .01). Findings suggest that tobacco prevention efforts should prioritize reducing access, banning flavored products, enforcing age restrictions, and limiting peer and media influences within Thai adolescent populations.

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