Adolescents’ Attitudes on Smoking Are Related to Experimentation with Smoking, Daily Smoking and Best Friends’ Smoking in Two Karelias in Finland and in Russia Annamari Aura 1 & Tiina Laatikainen 2,3,4 & Hannu Isoaho 5 & Galina Lazutkina 6 & Kerttu Tossavainen 1 # International Society of Behavioral Medicine 2016 Abstract Purpose Becoming a smoker usually starts during adoles- cence and is a dynamic process involving experimentation before the establishment of daily smoking. It has been sug- gested that adolescents who smoke differ from those who do not in their attitudes to smoking. The purpose of this study was to find out whether attitudes related to smoking legislation and restrictions, social pressures in smoking and image of smokers are associated with smoking experimentation, daily smoking and best friends’ smoking. Method The data were gathered with a self-administered questionnaire in North Karelia, Eastern Finland and in the Pitkyaranta district, Republic of Karelia, Russia. The respon- dents were 15-year-old 9th grade pupils in local schools. In Pitkyaranta, the data analyses covered pupils in all eight schools in the area (n =179). In North Karelia, the data anal- yses comprised of selected eight schools (n = 601). Data were analysed with exploratory factor analysis. Results The models revealed that attitudes related to restric- tions and social pressure were significantly associated with experimenting with smoking [OR (95 % CI) 7.923 (5.787– 10.847)], daily smoking [OR (95 % CI) 9.575 (6.727– 13.628)] and the likelihood of best friends’ smoking [OR (95 % CI) 3.154 (2.579–3.858)]. The stronger the young peo- ples’ attitudes and opinions, for example, towards restrictions and with more difficulties in refusing smoking, the higher the likelihood for smoking experimentations, daily smoking as well as the likelihood for their best friends’ smoking. The coun- try and factor interactions were not associated with smoking experimentations, daily smoking or best friends’ smoking. Conclusion Regardless of cultural background, adolescents who smoke have more positive attitudes to smoking, and per- ceive more social support for smoking, than do adolescents who do not smoke. The study stresses the similarity of the results in both Karelia’ s despite the enormous differences in culture, economy and public policy. Keywords Attitudes . Adolescents . Smoking . Peer Introduction Annually, cigarette smoking accounts for approximately 5 million deaths world-wide [1], and this number has been esti- mated to rise to over 8 million by 2030 [2]. Primarily, smoking is started during adolescence [3–6]. It has been shown that the earlier the stage of life for starting smoking, the bigger the risk for daily smoking in adulthood [4], and over a half of the adolescent smokers who develop smoking as a lifelong daily habit have been estimated to die of tobacco-related diseases [7]. Therefore, adolescent smoking is a remarkable challenge. Becoming a smoker is a dynamic and complex process involving experimentation before establishing smoking as a * Annamari Aura annamari.aura@uef.fi 1 Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland 2 National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland 3 Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland 4 Hospital District of North Karelia, Tikkamäentie 16, 80210 Joensuu, Finland 5 Statcon Ltd., Salo, Finland 6 State Budgetary Health Care Institution of the Republic of Karelia, Pitkyaranta, Russia Int.J. Behav. Med. DOI 10.1007/s12529-016-9566-7