Elsevier

Preventive Medicine

Volume 81, December 2015, Pages 309-313
Preventive Medicine

The influence of the social environment on youth smoking status

https://doi.org/10.1016/j.ypmed.2015.09.017Get rights and content

Highlights

  • Pro-smoking attitudes and behaviors in the social environment are important institutional factors that can strongly influence youth smoking status.

  • Ambient school-level attitudes and behaviors predict youth smoking susceptibility net of individual factors.

  • Hispanic youth have increased risk of being susceptible nonsmokers relative to non-susceptible nonsmokers compared to non-Hispanic White youth.

Abstract

Objective

Youth smoking is complex with multilevel influences. While much is known about certain levels of influence on youth smoking, the lack of focus on institutional influences is notable. This study evaluated the effects of ambient smoking attitudes and behaviors in schools on individual youth smoking.

Method

Data from the 2012 Florida Youth Tobacco Survey (n = 67,460) were analyzed. Multinomial logistic regression was used to investigate individual and aggregated school-level factors that were associated with a youth being classified as a “susceptible nonsmoker” (SN) or “current smoker” (CS) relative to a “non-susceptible nonsmoker” (NN).

Results

The aggregated percentage of regular smokers at a school, ambient school level positive smoking perceptions, and the standardized difference between individual and school-level positive smoking perceptions were statistically significant in the fully adjusted model. We also found an increased risk of being a SN relative to a NN for Hispanic youth. Moreover, our approach to modeling institutional-level factors raised the pseudo r-squared from 0.05 to 0.14.

Conclusion

These findings suggest the importance of ambient smoking attitudes and behaviors on youth smoking. Prevention efforts affecting ambient smoking attitudes may be beneficial.

Introduction

Youth cigarette smoking continues to be an important public health concern in the United States (Centers for Disease Control and Prevention (CDC), 2010, US Department of Health and Human Services, 2014). Youth smoking is complex with multilevel influences impacting the likelihood that an individual youth will smoke. An extensive literature exists for many of the levels of influence identified by the ecological model of health behavior (Glanz et al., 2002) and youth smoking status. For example, intrapersonal attitudes and behaviors (Carvajal et al., 2000, Conrad et al., 1992, Flay et al., 1998, Lopez et al., 2010), peer and family influence as a function of interpersonal processes and primary groups (Bauman et al., 2001, Clark et al., 1999, Gritz et al., 2003, Kegler et al., 2002, Landrine et al., 1994), neighborhood and built environment influences as community factors (Goldade et al., 2012, Pickett and Pearl, 2001), and public policy initiatives to increase taxes on tobacco products (Lando et al., 2005), ban indoor smoking (Siegel et al., 2008), and restrict advertising and point of sale purchases of tobacco products to minors (DiFranza et al., 2006, Gostin et al., 1997, Kessler et al., 1996, Willemsen and de Zwart, 1999) have all shown direct influence on youth smoking. However, the lack of focus on institutional influences, particularly the influence of the school environment on youth smoking, is a notable exception to this otherwise extensive body of work.

The institutional influence of the school environment on susceptibility to youth risk behaviors, like smoking, is particularly important given the proportion of waking hours adolescents spend at school (Flannery et al., 1999, Fuller and Clarke, 1994, Stewart, 2008). Although studies have examined the effect of perceived peer attitudes and behaviors on youth smoking (Maxwell, 2002, Prinstein et al., 2001, Urberg et al., 1990), we found no studies exploring the effect of the school environment via the aggregate attitudes and behaviors of students who may or may not be friends with a focal respondent.

The school environment can influence smoking through passive exposure social attitudes and behaviors regarding smoking. Positive social attitudes regarding smoking can be expressed in two main ways by either direct or indirect endorsements of smoking behavior (Nosek, 2007, Petty and Brinol, 2006). Direct endorsement of smoking behavior could be captured by engaging in smoking with or without expressing pro-smoking attitudes (i.e. the act of smoking provides advertisement of the behavior). Conversely, indirect endorsement of smoking behavior would be captured by expressing pro-smoking attitudes with or without engaging in smoking behaviors (Huijding et al., 2005). It is possible that one or both mechanisms affect youth smoking status.

This study addresses the relative dearth of knowledge about how the school environment affects youth smoking. Specifically, we examined the following research questions: (1) Does exposure to explicit peer smoking influence youth smoking status? We predict that youth smoking status will vary by the percentage of smokers in the focal respondent's school net of individual demographic characteristics. Second, does exposure to peer attitudes regarding social benefits of smoking influence youth smoking status? We predict that youth smoking status will vary as a function of differences in exposure to positive social perceptions regarding smoking in the school environment. Further, we predict that this effect will increase after adjusting for the difference between individual and aggregate implicit positive social perceptions regarding smoking in the school environment.

Section snippets

Materials and methods

Data from the 2012 Florida Youth Tobacco Survey (FYTS) were analyzed. The Florida Youth Tobacco Survey is a school-based survey administered annually by the Florida Department of Health. The sample includes students across the state of Florida in middle (38,989 students) and high schools (36,439 students), using a two-stage cluster probability design. The complex sampling design included a random sampling of public middle and high schools across the state and random sampling of classrooms

Results

Table 1 includes the weighted means for all variables in the full sample and by smoking status. Current smokers were significantly different from both non-susceptible nonsmokers and susceptible nonsmokers by age (slightly older), sex (more males), race (higher proportion non-Hispanic White, lower proportion non-Hispanic Black), housing type (fewer residing in single family homes), rural residency (more rural), and higher rates of in-home smoking. Current smokers were also more likely to come

Discussion and conclusion

The purpose of this paper was to address how the institutional effects of social attitudes about smoking and smoking behavior at the school-level affect individual youth smoking status. This paper adds to the literature in three important ways. First, this paper demonstrates that pro-smoking attitudes and behaviors at the institutional level in the social environment are important and can strongly influence youth smoking status above and beyond individual factors. Second, we find that

Conflict of interest

We have no known conflicts of interest.

Acknowledgment

Dr. Bellatorre and Dr. Choi's effort on the study is funded by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health. Dr. Bernat's effort is supported with a grant from the National Cancer Institute (R03 CA168411; D. Bernat, Principal Investigator). The views presented in this paper don't necessarily reflect the views of the Florida Department of Health, the NIH, or the University of Maryland.

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