Background: The aim of the review was to identify factors contributing to adolescent smoking initiation.

Methods: PICO framework was used to formulate literature review question and to help in formulating the search. In this study, the population is adolescents aged 10-18 years, intervention and comparison are none and outcomes are the risk factors of smoking initiation. Three electronic databases; Scopus, CINAHL, and OVID were used in conducting searches. We summarized the main findings of each study based on three construct of Theory on Triadic Influence; personal factors, social factors and environmental factors and integrate with the Theory of Planned Behaviour model.

Result: Of 104 identified studies, only 14 were included in this review. Our finding found that, majority of the adolescents started smoking between 13 to 15 years old and those who are more likely to initiate smoking are male, have psychological problems, have lack of knowledge about smoking, poor performance at school, low parental monitoring and peer influence. Our study also revealed that, the strict enforcement of non-smoking rules in school and religion were significant protective factors in order to prevent smoking uptake among adolescents.

Conclusion: The current review had provided a baseline idea regarding factors associated with smoking initiation among adolescents in Malaysia. It provides useful clues for the development of effective strategies for a future program to curb smoking uptake among Malaysian adolescents.