Background: A recent WHO data report on mortality attributable to tobacco use including cigarette smoking
indicated a very high burden of deaths in Asia and that people often initiate smoking as early as young adolescents.
The objectives of this study were to systematically review peer-reviewed articles on cigarette smoking initiation
among Asian adolescents and to develop a conceptual model of factors influencing smoking initiation by integrating
all relevant factors based on existing data. Materials and Methods: Following a PRISMA guideline, a systematic
review of articles published between 2005 and June 2015 was conducted using 5 databases on cigarette smoking
initiation among adolescents (aged 10-19 years) living in Asia. We summarized the main findings of each study
according to our research questions and data that emerged during the data extraction process. Analysis and
categorization were based on the TTI and TPB models and classification of factors extracted from the study, were
as follows: personal factors, social factors, broader environmental factors, mediators, and intention to initiate
smoking and smoking behavior. Results: Of 1,227 identified studies, only 20 were included in this review. Our
findings found that the mean age of cigarette smoking initiation ranged from 10 to 14 years and those who are
more likely to initiate smoking are male, older adolescents, adolescents with low parental SES, individuals with
low parental monitoring, low parental education level and having no discussion on smoking at home, those living
in public housing and those exhibiting health-risk behavior. Our study also revealed that the risk of smoking
initiation increased when they are exposed to smokers, influenced by peers, exposed to tobacco advertisements,
receive pocket money, have lack of knowledge about smoking, have poor school performance, have a family
conflict and have psychological problems. The conceptual model developed demonstrated complex networks of
factors influencing initiation. Conclusions: This systematic review presents various factors influencing smoking
initiation of the Asian adolescents and provides a conceptual framework to further analyze factors. Future
studies should have a standard measure of smoking initiation, should analyze interactions and the intensity of
relationships between different factors or variables in the conceptual model. This will in turn consolidate the
understanding of the different factors affecting smoking initiation and will help to improve interventions in this
area.