Peers, Tobacco Advertising, and Secondhand Smoke Exposure Influences Smoking Initiation in Diverse Adolescents

Am J Health Promot. Jan-Feb 2011;25(3):e1-11. doi: 10.4278/ajhp.090604-QUAN-180.


Purpose: Identify demographic, social, and environmental factors associated with smoking initiation in a large, racially and ethnically diverse sample of underage youth participating in the 2006 Maryland Youth Tobacco Survey.

Design: Cross-sectional, multistage, probability sample survey.

Setting: Schools (308 middle and high schools) in Maryland.

Subjects: Subjects were 12- to 17-year-old adolescents participating in a school-based survey. New smokers and nonsmokers were included in the analysis (n = 57,072).

Measures: Social and media influence, secondhand smoke exposure, tobacco product use, and demographic information including age, race/ethnicity, and geographic region.

Analysis: Chi-square and multiple logistic regression analyses controlling for clustering.

Results: Hispanic and Hawaiian/Pacific Islander youth were most likely and Asian and Black youth were least likely to be new smokers. Smoking initiation was positively associated with higher age, living with a current smoker, secondhand smoke exposure, exposure to advertisements for tobacco products, having more friends that smoke, tobacco products offered by friends, risk perceptions, and use of other tobacco products such as smokeless tobacco and cigars. Multivariate logistic regression results suggested that composite measures of peer influence, advertising exposure, and secondhand smoke exposure were independently associated with smoking initiation.

Conclusions: Media, peer influence, and secondhand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study. Interventions combining targeted public awareness, education, and media campaigns directed at parents/guardians should be investigated.

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Advertising*
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Maryland / epidemiology
  • Peer Group
  • Persuasive Communication
  • Smoking / epidemiology*
  • Tobacco Smoke Pollution*


  • Tobacco Smoke Pollution