England :: essays research papers

History of England The Ice Age ended about 8000 BC, during which the Neanderthals and Cro-Magnons lived in Great Britain. Because of the melting ice the water level rose and the English Channel was created, making Great Britain an island. The Middle Stone Age passed in this new forest and swamp, followed by the New Stone Age when the practice of farming began. During this period a lot of new people came to Britain. By 2500 BC the Beaker people had moved there. They were named after their pottery, and noted for their bronze tools and huge stone monuments, like Stonehenge. These Monuments prove they had an excellent economic organization as well as their technical skill and ability. Around 1000 BC the Celts took over the British Isles, they also took over most of western Europe. Because of their iron plows, iron weapons, and horse-drawn chariots, they were able to take over the inhabitants of the islands. Their priests dominated their society. King Alfred became king of Wessex in one of England's darkest hours. The Danes, viking forces that had raided the English coasts in the 8th century, planned to take over England. All that stood in their way were Wessex and Alfred. After Alfred's victory at Edington in 878 AD he made the Danish king Guthrum accept baptism and a division of England took place. The two parts were Wessex and Danelaw. By creating a navy, reorganizing the militia, allowing warriors to switch between farming and fighting, and building forts, Alfred was able to take over London and begin to take over tthe Danish. The battel to take over the Danish was completed by Alfred's son, Edward the Elder, and by his grandson Athelstan. Athelstan won a battle at Brunanburth in 937 AD and most of the rest of the century was peaceful. Saint Dunstan, Archbishop of Canterbury was able to restore the Church. The conquest of the Danelaw meant the creation of unified government for all of England. Despite this the Danish invasions came again during Ethelred II's reign. In 1154 Henry II took the throne. During his reign he strengthened the government, developed the common law, created the grand jury, and attempted to reduce the jurisdiction of church courts. He was opposed by Thomas Becket, his former chancellor, who King Henry had made archbishop. His anger at Becket led to his murder. His empire included half of France and lordship over Ireland and Scotland.

fidel castro :: essays research papers

Fidel Castro was born on August 13, 1926. He attended Catholic schools before graduating from the University of Havana with a degree in law. Castro was a member of the Ortodoxo Party, a social-democrat party, and strongly criticized the government of Fulgencio Batista. On the 26th of July in 1953, Fidel Castro launched an attack on the Moncada army barracks. It failed, and most involved were killed or captured. Fidel was captured and given a trial, which he used to make his famous speech, "History Will Absolve Me". Sentenced to 15 years, he was pardoned after just two. He then went into exile in Mexico, where he trained and assembled the 26th of July Movement. He gained support from Che Guevara and others before leaving aboard the Granma to invade Cuba in 1956. Returning to Cuba, the revolutionaries hid in the Sierra Maestra mountains, gaining support among the peasants. Eventually, Batista was forced to flee in 1959 and Castro took over. Many Cubans left when it became clear that the Revolution was a Marxist one. Economic antagonism from the United States caused Castro to nationalize all American property. The United States Government tried various schemes to assassinate Fidel Castro and continues to economically isolate Cuba. The CIA even tried to invade Cuba at the Bay of Pigs to remove Fidel Castro from power, but the Cubans successfully fought it off. As a result, Castro became closely aligned with the Soviet Union. The Soviets bought large amounts of sugar and supplied Cuba with economic and military assistance. This money fueled many of Castro's social programs, such as his war on illiteracy and free universal health care. Unfortunately, aligning Cuba with the USSR only led to more friction between Cuba and the United States.

Adversity and What We Gain From It :: Personal Narratives Sports Medicine Essays

Adversity and What We Gain From It In all parts of life there are periods of adversity that we must face, the real challenge however, is what and how we gain from conquering those trials. There have been many times that I have been faced with adversity, it has happened in all aspects of my life at one time or another. Whether it is dealing with the ups and downs of hockey or balancing the pressure that comes with an elite hockey schedule and high school, there are always obstacles. Some of these challenges can bring about positive effects that influence the path of one’s life. In one such experience of mine, the amount of adversity was not near as great as the positive out come that came from my experience. It happened when I was thirteen, I suffered a hockey injury that helped me to realize the area I wanted to study and hopefully have career in. The time it took me to rehabilitate my shoulder was a time of great learning for me but it also came with a great deal of adversity. It was an injury that sidelined me for weeks while at the same time pushed me on my way to a new work ethic and a new enthusiasm for learning. When I was in grade seven, I was playing my second year of peewee hockey and playing for my junior high school team as well. The junior high league allowed checking and the peewee league did not. Because of this I was not accustomed to the new aspect of hockey brought on by checking. I was injured in an intense game against our rival junior high, which was filled with plenty of checking. I was on the receiving end of a brutal check from behind which is something not permitted in any league, the player that hit me received a penalty and a game expulsion. I tried to continue playing but it was no use, I was barely able to raise my arm. I ended up in the hospital where the doctor informed me that I had severely dislocated my left shoulder and would have to miss up to three weeks of play. I had never been forced to miss hockey because of an injury before and it was the worst news I had ever heard. The time I missed from hockey was one of the most difficult periods I had been through up t o that point.

Passing: Black People and Hold Clare Essay

People as the victim of inequality and social restriction (â€Å"Passing†_Nella Larsen) The novel â€Å"Passing† was written in 1929 and become one of the most famous novels of Nella Larsen. Like other novels which were also written about â€Å"passing†, â€Å"Passing† of Nella Larsen reflects the tough life of African-American in the 19th century, when they were struggling with racism to have the equal rights. Clare Kendry and Irene Redfield in â€Å"Passing† both were born Negroes but with light skin so that they could be â€Å"passing†. However, these two women have different choices in their life, which lead to the tragedy when they meet each other after twelve years. The novel ends with Clare’s death without revealing to the readers who kills her, which encourages the readers to think of the uncertain end of â€Å"Passing† by logically interpreting evidence throughout of the novel. By that way, Nella Larsen might want her readers to be open-minded to understand how people become the victim of inequality and social restriction in term of race and gender. Ending her novel in uncertainty, Nella Larsen makes her readers curious about who is responsible for Clare’s death. The two possible things might happen are whether Clare commits suicide or Irene pushes her out of the window. Clare has her reasons to commit suicide since her husband finds out that she was born a Negro. For him, all Negroes are â€Å"black scrimy devils† and â€Å"always robbing and killing people† (70). These prejudices exist not only in Jack’s mind but also among many white people. These cruel prejudices and discrimination had threatened Clare’s marriage for a long time before her death. Clare might be always ready for the day that the truth about her race would take everything from her. When Irene asked her whether she thought of how she could do if her husband finds out about her race, she just said yes with a smile. And at the moment Clare stands near the window, â€Å"she seemed unaware of danger or uncaring. There was even a faint smile on her full, red lips, and in her shining eyes† (209). When Clare takes a risk by joining the Negroes community, she might prepare for that day, for her death. However, there are also evidences for the possibility that Irene kills Clare. First, she has the motivation. In Irene’s mind, Clare is one who â€Å"not only that she wanted to have her cake and eat it too, but that she wanted to nibble at the cakes of other folk as well† (88). Before seeing Clare, Irene’s life keeps going on under her control: a family with a doctor husband and two kids, living in Negroes community†¦ But Clare comes and raises the fear inside Irene that Clare and Brian, Irene’s husband, might have an affair. Although Irene doesn’t have any clear proofs for what she suspect, but she can feel it through the changing in attitude of Brian: â€Å"For a minute, Irene hesitated, then turned her head, though she knew what it was the held Hugh’s gaze. Clare, who had suddenly clouded all her days. Brian, the father of Ted and Junior†¦then she saw him smile, and the smile made his face all eager, and shining. †(169-170). Secondly, the readers can realize how the presence of Clare makes Irene suffers: â€Å"It hurt. It hurt like hell†¦She was very tired of Clare Kendry. She wanted to be free of her. †(174-179). The readers also has reason to suspect Irene since she already think of how to get rid of Clare before Clare’s death: â€Å"If Clare should die†¦To think, yes, to wish that†¦the thought stayed with her. She could not get rid of it†(187). In the party, before Clare falls out from the window, Irene is the one who open it despite of the cold outside. The image of Irene â€Å"watching the tiny spark drop slowly to the white ground† makes the readers relates to the falling down of Clare after that (207). At the moment that Clare stands at the window, Irene â€Å"laid a hand on Clare’s bare arm. One thought possessed her. She couldn’t have Clare Kendry cast aside by Bellew. She couldn’t have her free†(209). And watching Clare falls out from the window, â€Å"Irene wasn’t sorry. She was amazed†(210). Irene’s thought and attitude towards Clare at the moment she falls out from the window proved that Irene, whether responsible for Clare’s death or not, wants Clare to die. Therefore, the readers can suspect that Irene is the one who push Clare out of the window, leading to Clare’s death. Despite of many clues support for the possibility that Irene kills Clare, the author doesn’t want an obvious end for her novel. She keeps questioning her readers about how much they could trust what they see. Throughout the novel, Nella Larsen expresses her attitude in ridicule of white people’s blindness when they discriminate black people without knowing who they really are. Jack, a racist, marries a Negro woman because he believes in what he sees. Many people witness Clare’s death but nobody could be sure about what they saw. They even suspect Jack since he is the only white people there. By ending the novel in uncertainty, Nella Larsen questions her readers about how they interpret and understand who or what pushes people to death. If there is no racism, Clare would not commit suicide, and Jack wouldn’t be suspected just because he is white. Therefore, the most suspicious person would be Irene. If Irene doesn’t have any pressure about keeping her life as it must be according to social norms, she wouldn’t have motivation to kill Clare since she doesn’t love Brian: â€Å"She couldn’t now be sure that she had ever truly known love. Not even for Brian†¦ she still intended to hold fast to the outer shell of her marriage, to keep her life fixed, certain† (201). The image of Irene put her hand on Clare’s bare arms before Clare falling out of the window symbolize for the struggling inside Irene. Irene plays the role of one who could help Clare come back to her community, but she also puts Clare in risk by not telling Clare about Jack seeing Irene with a black woman. Before Clare died, Irene must be the one hold Clare back, but she is also suspicious for killing Irene. The truth isn’t always revealed in what we see, but also in how we interpret what we know about it, which depends much on our attitude toward it. Nella Larsen let her readers have their own way to think of this uncertain end in order to question their beliefs and their values. This uncertain end of â€Å"Passing† also like the uncertainty of people’s life under various pressures comes from social restriction such as race and gender. Clare’s death symbolize for people as the victim of inequality and social restriction.

Home school vs Public school Essay

More parents are choosing to home school their child or children rather than enrolling their children in a public school system. The parent’s make their decision based upon the school district that they live in. Some public schools do not have up to date materials. There are certain public schools that have a more difficult curriculum, which challenges students academically. Parents want what is best for their children’s education, public or homeschooled. Public-schools give children a chance to make lifelong friends and homeschooling is more hands on learning.  One of the most important things to a parent is their child’s learning environment. Homeschooling his or her child or children will give the parent the opportunity to control his or her learning environment. By doing so parents are ensuring that nothing tragic would happen. Homeschooling is a parent who teaches his or her child or children. The parent is going to give positive feed back to their child or children. There are fewer home schooled students in a classroom than there are in a public classroom. Homeschooling has more positive influences. They do not have bullies or feel pressure from trying to fit in certain groups in school or the clothes and shoes they wear. By not acquiring those things homeschooled students have a relaxed learning environment that has the advantage o f the teacher’s attention. There are many negative influences in a public-school system. A student who attends public-school can be harassed or bullied because of the clothes or shoes a student wears. Also, students can be harassed because of by their nationality, features or their grades. In public school there is always that one student that is very popular and dresses in the new fashions, but has the worst grades and makes jokes about student’s shoes or the way they  dress. There are students who are have seen and done things that a normal child has not, which makes these students a product of their environment. These are students who have a different childhood than most children. The things they see daily like fighting, hearing gun shots, and murders daily. These students will take things into their own hands if they are confronted by a person. The learning environment in public school is unsafe. In the past decade there has been a school shooting because students were teased, bullied, students ju st did not like them. Those shootings have had a major impact on parents who choose to have their child or children in public school. It is very important for a student to develop socially in fact, students who attend public school develop better socially than home schooled students. Public-schools have interaction with different levels of students or faculty each day of the school year. By learning how to talk to different levels of students or faculty will help students choose friends. In public schools you have a variety of friends like students that have attended the same schools through their child hood. There are new students that find his or her niche, which makes the transition to a new school easy for them. Having friends that are coworkers is something a public-school student would achieve before a homeschooled student. Homeschooled students do not have any interaction with other students during school unless they have siblings who are being home schooled. The only person a homeschooled student has to interact with is their siblings and their teacher, which is their parent. Being homeschooled a student would have to find kids in their neighborhood to be friends with. That is a hard thing to do because of the fact the other kids in their neighborhood attend public school, and have friends with the same interest that they play with five days a week that builds loyalty between the friends. Nevertheless, the teaching curriculum in public school is accredited meaning the school meets the states requirements. When a student attends and accredited school it is easier for the student to transfer credits. Teaching in a public-school where everyone has to learn at the same pace sometimes hurts students. However, it also helps some students pass a test because of the test scores the teacher would grade on curve. This allows some students to achieve a passing grade. Public school students will  not have a problem with the transition from high school to college. When attending public school all students learn at the same pace. Since public school students interact with different levels of students and faculty, they feel more comfortable when attending college. Home schooling is not and accredited curriculum meaning that the curriculum that the parent is teaching was not approved by the state where they live. Furthermore, a parent cannot teach a subject better than a licensed teacher unless the parent is a licensed teacher. Employment plays a vital role for single parents sending their child or children to public school allows him or her to obtain a job and provide for their family. Single parents would not be able to home school their child or children. Simply, because they would question how will the bills get paid and get the materials needed for homeschooling. A duel parent home may choose to have their child or children attend public schools so both parents can have jobs to his or her financial needs. It also allows the student to make their own decisions while they are away from their parent or parents. They have more responsibility and pressure on them to do their school work, get help if needed, and turn in assignments in by the due date. In order to home school a child or children there must be two parents in the household. One parent must obtain a job and the other teaches their child or children. Certain rooms in the house may become the classroom. Someone would lose their room or the kitchen table would become covered with piles of paper and books. Home schooling will allow the parent to be around their child or children 24 hours a day. They will not get a break from each other and this can cause trust issues between the child or children and parent. As the child or children gets older they are going to want some type of freedom. Suffocating them can push them away from the parent or it can make the child or children be socially challenged not being able to control his or her selves when they are not around their parents. Home school students would struggle in the real world because their parent or parents have controlled everything around his or her child or children. In conclusion public school students have a responsibility to do their work and make their own decisions, by doing so it will prepare them for real life  situations. For example, attending college the instructor is not going to spoon feed the students. It will be up to the students to get help if needed and complete assignments by the due date. Public schooled students will adapt to their environment easily. Also there are more free programs, school memories like prom, sporting events, and having childhood friends from different neighborhoods through you school years. All these things are something a home schooled student will not have the chance to achieve.

Foreign and Local Literature Essay

This particular chapter presents the review of Foreign and Local Literature and Studies relevant to the present study. Related Literature Foreign Literature According to the book entitled â€Å"Call Center 100 Success Secrets† in December 6, 2007 authored by Gerard Blokdijk. The 100 Success Secrets is not about the ins and outs of the call center. Instead, it answers the top 100 questions that we are asked and those we come across in forums, our consultancy and education programs. It tells you exactly how to deal with those questions, with tips that have never before been offered in print. This book is also not about a call centers best practice and standards details. Instead it introduces everything you want to know to be successful with and in a call center. Well this book gives emphasis about the topics. The Difference Between an Advanced Call Center and A Large Call Center What Does an Appointment Setter Call Center Part Time Employee Do? Taking a Closer Look at Customer Service Offices in Call Centers The Voice of your Product or Service Get the information you need through A Data Entry Call Center Call Center Jobs Taking Chances on a Call Center Career Conquering Challenges of Call Center/Customer Service Managers Manage the Telemarketing of Products through Call Center The Qualities of an Effective Call Center Financial Services Representative Qualities of a Call Center Representative Call Center here at your Service Call Center Supervisor Manager for High Tech Companies in Austin, Texas The Need to Train a Call Center Agent Tips on How to Provide Excellent Customer Service towards an Exciting Call Center Career Call Center: An Answer To All Your Queries Standard Requirements for A Call Center Agent Applicant What is the Nature of the Job of Call Center Agents? How the Call Center Airline Industry Works The Life of A Call Center Analyst The Call Center and its Customer Service Why Choose Call Center Careers? The Call Center Conference Call Center Consultants: A Hassle Free Solution To Manage Call Center Call Center Consulting For Your Company Call Center And Customer Service: One And The Same Customer Service And Call  Center Jobs: The responsibilities Of Order Desk Supervisors That Can Lead You To Great Opportunities The Many Career Options Open To An Experienced Call Center Customer Service Rep Call Center Customer Service: Supervisor and Manager Positions The Responsibilities Of Call Center Director How Call Center Employment Keeps BPO Companies Grounded in Reality Why You Need A Call Center Furniture Call Center Jobs: How To Find One? What You Need To Know About Call Center Management The Different Types of Call Center Management Jobs The Main Responsibilities Of Call Center Managers The Operation in a Call Center Call Center Operations Manager The Operators in a Call Center Call Center Or Customer Service: What It Can Do To Your Company The Facts About Call Center Outsourcing Call Center Pricing Is Affordable The On-the-Job Duties of A Call Center Rep Call Center Representative: Frontline In Customer Service Why Call Center Sales Training is Important for New Hires The Services In a Call Center Call Center Software: A Great Tool For Call Center Management Offshore Outsourcing the Call Center Solution for Western Companies Why Call Center Solutions Are Important to Everyone Your Challenge: Being A Supervisor In A Call Center Why You Need Call Center Support The Qualities of a Call Center Vice President How to Prepare for Call Center Work at Home The Many Advantages of Establishing a Call Center Work from Home Call Center Career: Clerical, Typing And Word Processing Skills A Must! Client Services, Call Center And Customer Service: A Great Solution To Meet Consumer Needs When Is A Collection Call Center Customer Service Representative Necessary? The difference of our thesis with this book is our thesis mainly focus on the questions to be answer such Why the undergraduate people was able to get a job while the fresh graduate was havin g a problem? Why Call Centers always get sick easily, headache, fever, stress and etc? How to adapt this kind of environment? Why lot of people are resigning after a couple of the months? , also the result of our study will be serving as a guide of other people who would like to enter this kind of industry. According to the article entitled â€Å"Making the Right Calls† in March 09, 2006 authored by Tom Rieger . If a representative meets all the quality requirements but does not help the customers , the representative and the company is considered fail. Providing great customer service in a call  center is challenging. The action never stops, and managers are inundated with data. Everything a call center employee or team does is measured and monitored, from call quality to handle time to schedule adherence to unit cost. Reports are constantly sent out, and feedback sessions are frequent. Ultimately, success in a call center comes down to how well each customer service representative engages each customer. Despite continuous reporting, feedback, and monitoring, and regardless of the reams of data, many call centers struggle to improve their levels of performance, and organizational barriers often prevent improvement. By conducting a series of formal audits in nine different call centers in four different industries, Tom Rieger had identified four barriers that can substantially undermine local efforts to improve employee and customer engagement in call centers. Those are the following , No time to coach , No time to learn , Confusing the process with the result , Poor alignment and communication with other departments . Well this journal mainly focus with the barriers that can substantially undermine local efforts to improve employee and customer engagement in call centers such as team leaders have limited time to invest in their teams, such as coaching CSRs on how to create customer engagement or working to improve employee engagement. And training is useless if centers don’t give CSRs time to apply their new learning on the job. Most call centers, though, don’t allocate any time to help CSRs stay informed about changes; even when centers make time, they don’t help managers or CSRs sort to the highest priority changes. Yet CSRs are held accountable for implementing these changes, even though they often get in trouble for logging off the phones or checking e-mail to find out about them. The most important part of a customer service representative’s job is providing good customer service. But few centers enable customers to rate their experience; fewer still track the customer experience at the individual CSR level. More often, a CSR’s customer service performance is subjectively determined by someone other than his customers, using a checklist of phrases and behaviors that may not have anything to do with providing good customer service. Ultimately, â€Å"what you grade† determines â€Å"what you get.† If a CSR meets all his quality requirements but does not help the customer, the CSR and the company have failed. Too often, call center managers’ goals are unrelated to the goals of  the internal groups they support; similarly, the internal groups’ goals can be unrelated to what happens in the call center or to the customers who call. As a result, promises made at one customer touchpoint may not be fulfilled at another. It also gives emphasis that few companies use their customer service centers to channel customer opinions back to the organization. Instead, too many companies use their call centers to push multiple and often conflicting initiatives at their customers. In our thesis focus on why the undergraduates was able to get a job while the fresh graduate was having a problem? Why Call Centers always get sick easily, headache, fever, stress and etc? How to adapt with this kind of environment? Why lot of people are resigning after a couple of the months? , also th e result of our study will be serving as a guide of other people who would like to enter this kind of industry.

A Review of Qualitative Research on Teenage Smoking Habits

A Review of Qualitative Research on Teenage Smoking Habits Grand Canyon University: NRS-433V-O103 Introduction to Nursing Research September 20, 2012 Introduction The purpose of this document is to summarize the contents of the research article, explain the research methods implemented, and offer insight on how the findings contribute to nursing practice. Second, there will be an explanation of ethical considerations associated with the conduct of nursing research. Finally, the source document, â€Å"What Determines Teenagers' Smoking Behaviour? : A Qualitative Study† will be attached for review. SummaryThe articles purpose was to study smoking behavior among Malaysian teens. The specific areas of interest included: smoking initiation, cigarette consumption, intention to stop smoking, and attempts to stop smoking. The first stage of teen smoking behavior begins with casual experimentation and is followed by the maintenance phase when everyday ritual smoking is present. The fut ure dependence on smoking can be predicted by the individual’s actions during experimentation with cigarettes. Curiosity, peer pressure, and parental smoking were all reported reasons that teens decided to try cigarettes.In children less than thirteen year old, it was concluded that parental smoking played the largest role in behavior choices. This finding suggests that children are modeling the parents’ smoking behavior. However, older teens in secondary school reported peer pressure to be the reason for choices regarding cigarettes. Seventy-four percent of the participants reported that they smoked less than five cigarettes daily. This same portion or participants admitted that they smoked because they experienced physical symptoms of nicotine withdraw when they didn’t smoke daily.Consumption of cigarettes in this group was reported as a social activity among friends but mostly in secluded areas, to avoid getting caught. Most all adolescents that were active i n this study reported that they had intended to quit smoking in the future. The majority of participants had no clear plan on how they were going to stop and most had admitted to several failed attempts to stop smoking without help. Aspects to consider: relationships, athletic involvement, health concerns, lack of finances, and parental concern are all reasons that would cause a teen smoker to consider quitting.The participants that were able to stop smoking had a plan and picked a specific quit date. Methods of Study This information was collected and processed through a qualitative study. Specifically, it involved twenty-six teens from three public schools. Twenty-thee members of this sample group were smokers while three of the members had stopped smoking. Information was gathered through three focus group interviews, three in-depth interviews over twenty months, and questionnaires.The questions were asked in a non-formal conversational manner with important points or answers rec orded on a document designed to evaluate and sort information (site). The Social Cognitive Theory was used to organize collection of information and analysis. This theoretical framework was chosen based on the need for an explanation of teen smoking related to individuals, heath behaviors, and environments. The expectation is that Social Cognitive Theory would offer more insight on how these three elements would interact with each other simultaneously.Contribution to Nursing Smoking tobacco continues to be one of the top causes of preventable causes for death in America. There are 430,000 deaths, one point five million years of potential life lost, and fifty billion of lost medical debt related to tobacco use (Hollis, J. , Pollen, N,†¦ 2005). Nurses that identify younger clients at risk for tobacco can contribute to decline in morbidity related to smoking and assist in the decrease of medical debt. â€Å"The younger that youth are when they start using tobacco, the more likely they'll be addicted (CDC, 20012). The study offers insight to nursing practice for specific tailoring of a care plan for teens who smoke, parents who smoke, and how to target the education for quitting. The areas that affected teen’s interest in quitting included: athletic improvement, parents disapproval, health concerns, and lack of finances. Nurses can use the information from this study to reinforce the health promotion and benefits of being a non-smoker. The recognition of how parents affect smoking behaviors will aid the nurse in preparing education that is directed at the entire family to deter childhood and teen smoking.The contribution to patient care can be seen with health promotion assessment use. The conclusions were clear about teens needing a plan to quit after they reached the maintenance phase of smoking. This result alerts nurses to assess smoking in younger adolescence and offer assistance with smoking cessation. Ethical Issues First, The Research and Ethi c Committee of University Kebangsaan Malaysia gave approval before the study was started. Second, The Ministry of Education Malaysia offered authorization for interviews in the school system for children who were not involved in some type of major examination.Third, all of the teens along with parents provided a written and signed consent for participation. The confidentiality of current smoking status was kept intact and privacy was maintained. Lastly, at the conclusions of each interview the teens were offered smoking cession counseling at a doctor’s clinic. To ensure reliability of the study, several schools were used and different types of data collection utilized. There was self-reflexivity in minimizing opinions of the researchers. Validation was offered by minimal prompting, statement clarification, and rephrasing of questions. ConclusionThe study identified factors like nicotine addiction, personal, and environmental issues that influence of smoking behaviors in teens . These areas should be of great priority when developing smoking cessation programs for teens. The Social Cognitive Theory utilized in this study is an aid that helps nurses to understand smoking behaviors in teens and how to address barriers to break those influential factors. Since this study was done in one region of Malaysia, it may not apply to all areas outside of it. This was a very small study that cannot be applied to all cultures, geographic locations, and race.A better perspective would have been attained by selecting a wider group with random geographic location and equal gender participation. The male to female ratio for the study was unequal and this causes a shift in the standard deviation when scrutinizing the study from a statistical view. Having unequal gender numbers could cause a type I or II error which makes the information not entirely reliable (Grove, S. , 2012). References Center for Disease Control. (2012, January). We can make the next generation tobacco- free. Retrieved from http://www. cdc. gov/Features/YouthTobaccoUse/ Grove, Susan K. (2012).Statistics for Health Care Research: A Practical Workbook [1] (VitalSource Bookshelf), Retrieved from http://pageburstls. elsevier. com/books/978-1- 4160-0226-0/outline/11 Hollis, J. , Polen, M. , Whitlock, E. , Lichtenstein, E. , Mullooly, J. , Velicer, W. , & Redding, C. (2005). Teen Reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care. Pediatrics, 115(4 Part 1), 981-989. Tohid, H. , Ishak, N. d. , Muhammad, N. , Hassan, H. , & Omar, K. (2011). What determines teenagers’ smoking behavior? : A qualitative study. International Medical Journal, 18(3), 194-198. 194PSYCHIATRY Article Ititernational Medical Joumal. Vol. 18, No. 3, pp. 194 – 198 , September 2011 What Determines Teenagers' Smoking Behaviour? : A Qualitative Study Hizlinda Tohid†, Noriah Mohd. Ishak^', Noor Azimah Muhammad†, Hasliza Abu Has san^', Farah Naaz Momtaz Ahmad†, Khairani Omar'* ABSTRACT Objective: The study aimed to explore smoking behaviour among Malaysian teenagers that were related to their smoking initiation, cigarette consumption, quit intention, and quit attempts. Methods: It was a qualitative study that used multiple case study design, involving 26 teenagers (23 smokers and three former smokers) from three public schools.Data was collected via questionnaires, three focus group interviews and three in-depth interviews over 20 months, A standardised semi-structured interview protocol was utilised. Results: Among the participants, 74% of them started smoking after the age of 12 years old. The majority (20/23) of the teenage smokers admitted to smoking every day and 74% of them smoked not more than 5 cigarettes a day. All of the smokers had the intention to quit but only 22 out of the 23 teenage smokers had attempted quitting. Sixty percent of these teenagers had more than three quit attempts.In gen eral, this study captured the complexity of the teenagers' smoking behaviour that could be influenced by multiple factors, including behavioural (e,g, nicotine addiction), personal (e,g, conception of smoking and quitting, curiosity, sensation seeking, knowledge about smoking cessation, stress, maintaining athletic performance, and finance,) and environmental (e,g, socialisation, peer pressure, parental smoking, parental disapproval, and boy- or girlfriend aversion) factors. Conclusions: This study described the complex and multidimensional nature of teenage smoking behaviour.The findings also correspondingly matched the Social Cognitive Theory (SCT), therefore suggesting the theory's suitability in elucidating smoking behaviour among the Malaysian teenagers, KEY WORDS smoking, teenagers, smoking initiation, cigarette consumption, quit smoking INTRODUCTION Adolescence is a crucial time in which a relatively dependent child transforms into a relatively independent adult. During this transitional period, many teenagers often experiment risky behaviours as a proclamation of their autonomy.This risky behaviour includes cigarette smoking, using illicit drugs and cirinking alcohol. (Epps, Manley, & Glynn, 1995; Kulig, & American Academy of Pediatrics Committee on Substance Abuse, 2005) Experimenting with cigarette smoking is an initial stage of teenagers' smoking behaviour before it becomes established. (Nichter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, & Chalmers, 2000; Curry, Mermelstein, & Sporer, 2009) This smoking initiation predicts their long-term tobacco use and heavier levels of dependence. (Breslau, & Peterson, 1996; Escobedo, Marcus,Holtzman, & Giovino, 1993; Chen, & Millar, 1998) Their experimenting behaviour may be influenced by various factors including curiosity, peer pressure, parental smoking, sensation seeking, social norms for smoking, and misconception of smoking (e. g. belief that smoking provides benefits, such as coping, sense of belon ging, style, relaxation, and coolness). (Dijk, de Nooijer, Heinrich, & de Vries, 2007; Naing et at. , 2004; Khairani, Norazua, & Zaiton, 2004; Vuckovic, Polen, & Hollis, 2003; Nichter, Vuckovic, Quintero, & Ritenbaugh, 1997) These factors could cause teenagers to continue smoking.Teenage smoking maintenance is also influenced by nicotine addiction. It has been shown to be substantially significant among teenagers even with low cigarette consumption. (The National Health and Morbidity Survey, 2009; Hammond et al. , 2008; Khairani, Norazua, & Zaiton, 2004; Naing et al. , 2004; DiFranza et at. , 2007; Balch et al. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006) This may be due to a very rapid loss of autonomy over tobacco even with minimal exposure to nicotine in adolescents, as demonstrated by the DANDY study. (DiFranza et al. , 2007; DiFranza et al. , 2002)Consequently, majority of teenage smokers struggle to quit smoking. (Balch et at. , 2004; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Amos, Wiltshire, Haw, & MeNeill, 2006; Seguire, & Chalmers, 2000) Thus, smoking behaviour among teenagers is a complex phenomenon, since it is influenced by multiple factors. This complexity requires great understanding of the behaviour from those who are involved in the care of these teenagers. This comprehension would certainly help the care providers to curb teenage smoking, which is a dangerous, addictive and destructive behaviour. US Department of Health and Human Services, 2004) Therefore, many studies have Received on Augtist 28, 2010 and accepted on November 29, 2010 1) Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lutnpur, Malaysia 2) Pusat PERMATApintar Negara, Universiti Kebangsaan Malaysia Bangl, 43600 Selangor, Malaysia 3) Setapak Health Clinic, Kuala Lumpur, Malaysia Correspondence to: Hizlinda Tohid (e-mails; [email  protected] com) 2011 Japan International Cultural Exchange Foundation & Japan Health Sciences UniversityTobitJ H, et al. 195 Table 1. Participants' gender, status of smoking and types of interviews TYPES OF SCHOOL MALE GENDER FcEeM. . AALIEE SMOKERS STATUS OF SMOKING NON SMOKERS FOCUS GROUP INTERVIEW TYPES OF INTERVIEWS IN DEPTH INTERVIEW SCHOOL 1 URBAN 9 3 9 3 1 3 SCHOOL 2 SEMI-URBAN 7 7 1 SCHOOL 3 RURAL 7 7 1 TOTAL 3 23 3 23 3 3 3 been carried out to examine the phenomenon of teenage smoking. In Malaysia, majority of such studies were quantitative studies. (Naing et al. , 2004; Hoi, & Hong, 2000; Khairani, Norazua, & Zaiton, 2004; Zulkifli, Rogayah, Razian, & Nyi Nyi, 2001)Nevertheless, studies that qualitatively describe Malaysian teenagers' smoking behaviour are still lacking. This deficiency may affect our understanding of the matter in great depth and holistically. Thus, this study aimed to explore smoking behaviour among Malaysian teenagers related to their smoking initiation, cigarette consumption, quit intention, and quit attempts. This information could provide us with better conception about their smoking behaviour, and subse-‘ quently eould help us to identify areas for improvement. METHODSThis study used a multiple case study design, involving 26 teenagers (23 smokers and three former smokers) from three public schools (urban, semi-urban and rural). Data was collected via selfadministered questionnaires, focus group interviews (FGI) and indepth interviews (IDI) over a period of 20 months, between 2008 until 2010. Theoretical framework This study utilised the Social Cognitive Theory (SCT) to guide the researchers in data collection and analysis. The SCT was also used for ‘analytieal generalisation' in which findings of the study were mapped against the theory.It was chosen as the study's theoretical framework due to its appropriateness and comprehensiveness in capturing a complex phenomenon of eigarette smoking that is influenced by multiple factors. (Baranowski, Perry, & Parc el, 2002) The SCT describes how individuals, environments and health behaviour interact with each other simultaneously (reciprocal determinism). (Baranowski, Perry, & Pareel, 2002) Study population Twenty six teenagers (23 boys and three girls, as shown in Table I) were selected via purposive and snowballing sampling, based on predetermined criteria.The teenage smokers and former smokers were sampled because their experience in cigarette smoking and smoking cessation was crucial for this study. These teenagers were 16 years old Malays, recruited from three different (urban, semiurban and rural) public schools from 2 states in Malaysia. Recruitment of teenagers Teenagers were recruited with the assistance from school counsellors from eaeh sehool. An agreement for no disciplinary action against teenagers who were willing to participate in this study was made with the counsellors prior to the recruitment.The students' smoking status was also eoneealed from other school staff to avoid s tigmatisation. Twelve teenagers who were selected from one of the schools were introdueed to the main researcher during an informal meeting for study briefing (refer to Table 1). The teenagers were invited to participate and were given parental packages, which comprised of an acknowledgement letter to parents, the study's information sheet, and a parental consent form. Subsequently, dates for tbe FGI and IDI were set. The completed parental eonsents forms were eolleeted prior the interviews by the school counsellor.The other 14 teenagers (7 students from each remaining school, as shown in Table 1) were reeruited by sehools' counsellors, who had training in qualitative research and were well informed about the study. Similar method of obtaining eonsent from their parents was carried out by these counsellors. Data collection Three in-depth interviews and three focus-group interviews were carried out (refer to Table 1). Prior to the interviews, all participants were given a brief overv iew of the study and the process of the interviews. Written eonsents from eaeh partieipant were also obtained.They were then required to answer a brief self-administered questionnaire on their socio-demography, smoking status and smoking behaviour (age of initiation, cigarette consumption, quit intention and quit attempts). The interviews were conducted in Malay language and eaeh interview lasted less than two hours. A semi-structured interview protocol was used to guide interviewers in questioning the participants. Anti-smoking posters and pamphlets were also used to facilitate discussion. Data analysis During eaeh interview, the conversation was recorded using digital voice recorders.The voice recording was subsequently transeribed into text by using Microsoft Office Word 2007. The transcribed text was reviewed against the audio-recordings for several times until the accuracy of the transcripts was ensured. Any uncertainty during the transcription, assistance from other researeher s was sought to ascertain its accuracy and reliability. (Yin, 2003; Yin, 1994) The transcribed text was then imported into NVIVO 7. The main researcher then analysed the data to identify themes and categories (‘thematie analysis') that would explain patterns of pereeption related to teenagers' smoking behaviour.In order to ensure high reliability of the eoding proeess, tbe coded data was eross-checked by two experts in adolescence health. Kappa was calculated by using the Cohen kappa formula to determine the reliability index, which was maintained above 0. 8. The process of transcription and analysis was repeated for every interview and ‘cross-case conclusion' was drawn between the analyses of eases. Findings of the study were also mapped against the SCT for ‘analytical generalisation'. Ettiical issues, reliability and validity Approval from the Research and Ethic Committee of Universiti Kebangsaan Malaysia was obtained prior to the study.Authorisation for intervie wing teenagers from the schools was also acquired from the Ministry of Education Malaysia that limited interviewing students who were not sitting for any major examination (i. e. exeept students aged 15 and 17 years old). Apart from these, all of these teenagers and their parents were required to provide written eonsents for their participation. The confidentiality of the participants, e. g. obscuring teenagers' status of smoking from the knowledge of their parents and other sehool staffs, was also guaranteed throughout the study.Finally, medical responsibility of the main researcher in preventing smoking-related illnesses, as she was also a medieal doctor, was realised by offering teenagers consultation for smoking eessation at her clinic. This was done at the end of each interview to prevent any biased answers from the partieipants. Validity and reliability of the study were ensured via a number of methods, ineluding; (1) triangulation of sourees of data (teenagers from three diff erent sehools), as well as methods of data collection 196 What Determines Teenagers' Smokitig Behaviour? Table 2. Smoking behaviour of the teenagers who smokedTEENAGERS WHO SMOKED (N = 23) AGE OF INITIATION (YEARS) NUMBER OF CIGARRETTES SMOKED/DAY STAGE OF CHANGE NUMBER OF QUIT ATTEMPTS FGD(n = 21) IDl(n = 2) TOTAL < 12 5 1 6 > 13 16 1 17 20 2 1 3 PRE COMTEMPLATION 5 1 7 CONTEMPLATION 4 4 PLANNING II 12 0 1 1 1-3 7 1 8 S4 13 1 14 (questionnaire, three FGI and three IDI), (2) self reflexivity in minimising biases that the researchers may bring into the study due to our previous involvement in managing problematic teenagers and chronic smokers, (3) ‘procedural validity' via rephrasing of questions, elarifying of statement and minimal prompting as ecessary,(Fliek, 2009) and (4) inter-coder agreement or reliability index of above 0. 8. RESULTS Twenty three boys and three girls were interviewed (referred to Table 1), in which two of the boys and one of the girls were former smokers . The remaining 23 teenagers were smokers at the time of the interviews. These teenagers' smoking behaviour (age of smoking initiation, cigarette consumption, intention to quit and history of quit attempts) is summarised in Table 2. Age and reasons of smoking initiation Six of the 23 (26%) teenage smokers in this study started smoking during primary school (before the age of 13).The youngest age of smoking initiation was 10 years old. Nevertheless, 74% of these teenage smokers started smoking when they were in the secondary school. Most of the teenagers admitted that curiosity [â€Å"Felt curious to try (smoking)†], sensation seeking [â€Å"Just for fun†], parental modelling of smoking [â€Å"Sinee my father smokes†¦ I always watch him smoking. When he smokes, it looks pleasurable†¦ gratifying†], peer pressure [â€Å"Peer influence†], and misconception of smoking [â€Å"Style (because of smoking). Siyle†] were common factors for them to e xperiment with smoking.The teenagers who started smoking before the age of 13 claimed that curiosity and smoking modelling by parents were their main reasons for experimenting with smoking. This is contrary to those who started smoking at the age of 13 years or older. These teenagers admitted that peer pressure was the major factor for them to start smoking. Cigarette consumption Majority (20/23) of the teenage smokers in this study admitted to smoking every day and 74% of these teenagers smoked not more than 5 cigarettes a day.The teenagers believed that their daily smoking behaviour was mainly due to nicotine addiction in which they described substantial physical (e. g. tiredness, lethargy, flu-like symptoms) and psychological (e. g. slow thinking, depressed, craving) withdrawal symptoms that they experienced during smoking abstinence [â€Å"My brain feels slow†; â€Å"(If I stop smoking) I feel restless. â€Å"]. The daily smokers also admitted to smoking when they were with their friends. They claimed this behaviour could be due to a number of reasons: a) sharing the cost of cigarettes with their friends, thus tend to smoke together, as explained by a teenager: Between 14 of us. we shared RMI per person, we can get 2 big boxes of cigarettes. † b) socialisation, as one teenager noted: â€Å"When we hang around (with friends), we smoke, sis† c) peer pressure, as a teenager claimed: â€Å"When we see our friends smoked, the desire to smoke is too intense. † d) sense of belonging, for example: â€Å"We all belong to a gang who shared our cigarettes together† However, three of the current smokers admitted to smoking only once a week. They stated that they particularly smoked during stressful period [â€Å"Especially when I am doing something. When it's hard then I'll smoke. ]. A few of the teenagers reported that the national anti-tobacco policy, as well as the school regulations had restricted their smoking behaviour. These teenagers admitted to commonly smoke in secluded areas outside of public view, such as in school toilets and stairways of shopping malls. The restrictive environment for public smoking was believed to influence tbeir cigarette consumption. Intention to quit All teenage smokers in this study had the intention to quit smoking. However, 7 of them (30%) did not plan to quit within the next 6 months (in the pre-contemplation stage).Twelve of them (52%) were in the planning stage, but none had set their quit dates. The smokers diselosed that a number of factors could influence tbeir desire to quit, which included: a) impaired athletic performance, as one of the teenagers claimed: â€Å"When (I) sprint†¦ I will hecome breathless† b) boy- or girlfriend aversion, for example: â€Å"Maybe (I get the desire to stop smoking) from my girlfriend. If she said â€Å"If you do not stop smoking, we should break-up†. Huh. (I feel like to quit smoking)† c) parental disapprova l, as noted by one boy: If mother scolded me for smoking, until she cried.. I would feel ? ike I want to quit, but it was temporary only. Afterwards.. I continue smoking† d) concern about health, shown by one of the teenagers' excerpt: â€Å"Smoking can make me feel breathless, sis (that's why I feel like to quit)† e) finaneial problems, as a teenager stated: â€Å"(I) think about my parents, sis. My mother and my father are not wealthy, (when I) think about that, it could (trigger my desire to quit)† Similar motivating factors were also reported by former smokers in this study prior to their successful smoking cessation.Nevertheless, these former smokers admitted that only personalised motivating factors could render them to quit successfully. Their personalised motivators were parental disapproval [â€Å"(Parental disapproval) effective, it's effective. I've stopped smoking. â€Å"], maintaining athletic performance [â€Å"(I) stopped smoking (for athletic p erformance). I got selected (to play football for my district) afterwards†]. and saving money /†/ stopped (smoking) to save money to buy a motorbike†]. Previous quit attempts Almost all (22/23) teenage smokers in this study had attempted smoking cessation prior to the interviews.The teenagers deseribed that quitting was very difficult because of withdrawal symptoms that they experienced during the quit attempts [â€Å"(If I stop smoking) I feel restless†]. Sixty percent of the teenage smokers had actually attempted to quit four times or more. All of the teenagers claimed that they never reeeived any professional helps when they made their attempts to quit in the past. Majority of them declared that they sought their friends' advice on how to quit and among the common methods that they had tried were drinking a lot of water, chewing gums and taking sweets, as one of the teenagers said:Tohid H. et al. 197 â€Å"Usuatty (I) asked my friends how to quit. They a dvised me to drink a tot of minerat water. † DISCUSSION In Malaysia, the mean age of smoking initiation among teenage smokers is between 12-14 years old, (The National Health and Morbidity Survey, 2009; Hammond et at. , 2008; Khairani, Norazua, & Zaiton, 2004; Naing et at. , 2004) whieh is concurrent with the findings of this study. The common reasons for smoking initiation, such as curiosity, peer pressure, and parental smoking, reported by tbe participants in tbis study were similar to otber studies. (Naing et at. 2004; Kbairani, Norazua, & Zaiton, 2004) This study also suggested that curiosity and parental modelling of smoking bebaviour could be teenagers' main reasons for experimenting smoking at younger age (less tban 13 years old). In contrary, peer pressure was found to be a major factor for teenagers wbo started smoking at seeondary sehools. However, the significance of tbese associations should be confirmed by future quantitative studies. Cigarette consumption reporte d by teenagers in this study was found to be lesser tban tbose of Malaysian adults, who averagely smoke between 11 to 14 cigarettes per day. World Health Organization (WHO) Framework Convention on Tobacco Control, 2010) Tbis may be due to a number of factors as suggested by tbese teenagers, such as; (a) insufficient fund to purchase cigarettes, (b) ‘occasional' smoking, and (c) restrictive environment for smoking. Nevertheless, underreporting of smoking behaviour by these teenagers may also explain the lower estimated number of cigarettes smoked by them. Tbis is because teenagers have a tendency to report socially desirable behaviour and attitudes. (Hammond et at. , 2008; Klein, Havens, & Carlson, 2005)Insufficient fund to purebase cigarettes were described by some of the teenagers in this study, who claimed that they had to share their pocket money with their peers to buy cigarettes. Tbis is to ensure their continuous supply of cigarettes and to develop bonding among tbe peer s. (Vuckovic, Polen, & Hollis, 2003; Amos, Wiltsbire, Haw, & McNeill, 2006; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, & Cbalmers, 2000) Tbis practice in turn increases tbe level of acceptance by peers and promote sense of belonging tbat is pertinent to teenagers' psychosocial development. Mermelstein, 2003; Vuckovic, Polen, & Hollis, 2003; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Nicbter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, c& Chalmers, 2000) However, some teenagers in this study, who had no financial constraint because they had personal income (e. g. from part-time job or significant allowance from parents), admitted to smoke only wben socialising and facing adversities (e. g. relation problems, inability to cope witb academic or part-time job). (Vuekovic, Polen, & Hollis, 2003; Balch et at. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006; Hoi, 8L Hong, 2000;Khairani, Norazua, & Zaiton, 2004; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Seguire, & Chalmers, 2000) These teenagers can be defined as occasional smokers, whose smoking was apparently influenced by peer pressure and tbeir inability to control themselves over smoking or to cope with stress. (Vuckovic, Polen, & Hollis, 2003; Seguire, & Chalmers, 2000; Patten et al. , 2003; Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Mermelstein, 2003; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Khairani, Norazua, & Zaiton, 2004; Balch et at. , 2004; Amos, Wiltshire, Haw, & McNeill, 2006; Hoi, & Hong, 2000) Teenagers' smoking in esponse to hardship shows that smoking is their way of coping since it calms them through nicotine effects on the central nervous system. (Niebter, Vuckovic, Quintero, & Ritenbaugh, 1997; Curry, Mermelstein, & Sporer, 2009) In addition, smoking creates a social space in which they can calm down and relieve tension. (Niehter, Vuckovic, Quintero, & Ritenbaugh, 1997; Curry, Mermelstein, & Sporer, 2009) Apart from financial constraint and occasional smoking, restrietive environment for public smoking was also found to be responsible for tbe partieipants' low cigarette consumption in this study.Therefore, these teenagers commonly smoked in secluded areas outside of public view, sucb as scbool toilets and stairways of shopping malls. These findings are consistent with a number of other studies that have found restrictive environment to be effective in reducing teenage smoking. (Wakefield ct at. , 2000; Lipperman-Kreda, & Grube, 2009; Crawford, Balcb, Mermelstein, & Tobacco Control Network Writing Group, 2002) Majority of teenage smokers bave intention to quit. (Khairani, Norazua, & Zaiton, 2004; Krishnan M, 2003; Mermelstein, 2003; Naing ct at. 2004; The National Health and Morbidity Survey, 2009) Tbis was also found by tbis study, in wbich almost all teenagers who smoked eonsidered to quit smoking sometime in the future. They admitted that a number of factors could trigger tbeir quit intention, wbich include; (a) ath letic performance, (b) boy- or girlfriend aversion, (c) parental disapproval, (d) concern about bealtb, and (e) money saving. Tbese faetors were similarly found to motivate teenagers to eease smoking by previous studies. (Vuckovic, Polen, & Hollis, 2003; Mermelstein, 2003; McVea, Miller, Creswell,McEntarrfer, & Coleman, 2009; Balcb ct al. , 2004) However, tbe teenagers reported tbat these extrinsie motivations were insufficient to keep them from total smoking abstinence. Nevertbeless, excerpts made by tbe former smokers in this study suggested that teenagers would only stop smoking when they are desperate to change due to compelling personal reasons. This finding is supported by McVea et al who found only 'emotionally compelling and inescapable quit reasons' were the most motivating reasons for teenagers to stop smoking. (McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009)Even though majority of tbe teenagers in this study had intention to quit smoking, they did not have any quit ting plans, not even setting their quit dates. These findings are similar to those reported by Mermestein. (Mermelstein, 2003) It is possible tbat the teenagers were; (a) not ready to quit (Balch ct al. , 2004) (e. g. some of the teenagers in the eurrent study would only quit when they experience major life transition, such as after graduation and tnarriage), (b) ambivalent about quitting (MeVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Patten et al. 2003) (e. g. a number of teenagers repetitively answered, â€Å"I am not sure† when they were asked about tbeir plan to quit smoking), and (c) very confident that they could control themselves over smoking (Niehter, Vuckovic, Quintero, & Ritenbaugb, 1997; Amos, Wiltshire, Haw, & McNeill, 2006) (e. g. a teenager assertively admitted that he could stop stroking on his own without relying on helps from other). The later seems to be related to teenagers' belief tbat ‘quitting is just a matter of will power'. (Amos, Wilts bire, Haw, & McNeill, 2006; Balcb el at. 2004) After all, these teenagers' ehanees for successful quit attempts would be reduced if they did not have strategic quitting plans. Multiple unsuccessful quit attempts were also reported by many teenagers in tbis study, in which the findings were concurrent with other studies. (World Health Organization (WHO) Framework Convention on Tobacco Control, 2010; The National Health and Morbidity Survey, 2009; Klein, Havens, & Carlson, 2005; Balch ct at. , 2004) This could be due to several reasons which can be summarised into three categories; (1) nicotine addiction,(Amos,Wiltsbire, Haw, & McNeill, 2006; Balch et al. , 2004; DiFranza et at. , 2007; DiFranza ct at. , 2007) (2) factors related to environment and situation which could promote teenage smoking (e. g. strong peer pressure, poor support from friends, smoking tnodelling by family members, stress etc, as higbligbted by tbe current study), (Balch et at. , 2004; Crawford, Balch, Mermelstein , & Tobacco Control Network Writing Group, 2002; McVea, Miller, Creswell, McEntarrfer, & Coleman, 2009; Nicbter, Vuckovic, Quintero, & Ritenbaugb, 1997) and (3) personal factors (e. g. oor risk assessment, poor knowledge, poor self efficacy and control, mi,sconception about smoking and quitting, strong belief in unassisted quit attempts etc, as found by this study) (Niehter, Vuckovic, Quintero, & Ritenbaugb, 1997; Balcb ct at. , 2004). These tbree categories appear to matcb tbe model of the Social Cognitive Theory. Overall, this study provides beneficial information for future development of interventions of smoking cessation for teenagers. Nevertheless, appropriate eontext which is similar to tbose of this study should be taken into consideration before applying such information since this is a ease study.Interviewing only teenagers aged 16 years old also limits the findings of this study. This is because teenagers at different stages of adolescence (early, middle and late) may bav e different developmental characteristics which may influence their pereeption and attitude towards cigarette smoking. Teenagers from different stages of adolescence should then be included in future studies as differences in tbeir perception, attitude and bebaviour could be explored. CONCLUSION This study bad captured tbe complexity of tbe teenagers' smoking bebaviour that could be influenced by multiple factors.Tbese faetors included behavioural (e. g. nicotine addiction), personal and environmental factors matched the Social Cognitive Theory (SCT). These 198 What Determines Teenagers' Smoking Behaviour? multiple factors should be considered in developing interventions for smoking cessation suited for teenagers. The corresponding mapping of the findings against the SCT also supports the use of the SCT in helping us to comprehensively understand teenage smoking behaviour and to overcome the influential factors. FUNDING This work was funded by the Universiti Kebangsaan Malaysia UKM- GUP-TKS-07-12-097 and FF-127-2008). DECLARATION OF INTERESTS All authors declare that they have no conflicts of interests. 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