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Brian A. Primack, MD, EdM; Galen E. Switzer, PhD; Madeline A. Dalton, PhD

Arch Pediatr Adolesc Med. 2007;161(5):434-439.

Objectives  To identify different components of smoking normative beliefs and determine if each component is independently associated with 2 clinically relevant measures of smoking in adolescents.

Design  Cross-sectional survey.

Setting  One large suburban high school.

Participants  A total of 1211 high school students aged 14 to 18 years.

Outcome Measures  Current smoking and susceptibility to smoking.

Results  Of the 1138 students with data on current smoking, 216 (19.0%) reported current smoking, and 342 (38.3%) of the 893 nonsmoking students with susceptibility data were susceptible to future smoking. Factor analysis identified 3 normative belief constructs, labeled "perceived prevalence of smoking," "perceived popularity of smoking among elite/successful elements of society," and "disapproval of smoking by parents/peers." On average, students believed that 56% of people in the United States smoke cigarettes; 27.7% believed that wealthy people smoke more than poor people. Multiple logistic regression showed that each of the 3 constructs was independently associated with current smoking (adjusted odds ratios, 1.05 [95% confidence interval {CI}, 1.02-1.08], 1.12 [95% CI, 1.02-1.23], and 0.66 [95% CI, 0.59-0.75], respectively), even after controlling for covariates. Students' perceptions of smoking among the successful/elite and disapproval by parents/peers were independently associated with susceptibility to future smoking (adjusted odds ratios, 1.20 [95% CI, 1.11-1.29] and 0.87 [95% CI, 0.79-0.96], respectively).

Conclusions  Adolescents' normative beliefs about smoking are multidimensional and include at least 3 distinct components, each of which was independently related to smoking outcomes. These distinct components should be considered in the design and evaluation of programs related to prevention and cessation of adolescent smoking.

Author Affiliations: Division of General Internal Medicine, Department of Medicine (Drs Primack and Switzer), Center for Research on Health Care (Drs Primack and Switzer), and Division of Adolescent Medicine, Departments of Pediatrics (Dr Primack) and Psychiatry (Dr Switzer), University of Pittsburgh School of Medicine, and Center for Health Equity and Promotion, VA Pittsburgh Healthcare System (Dr Switzer), Pittsburgh, Pa; and Department of Pediatrics and Community Health Research Program, Hood Center for Children and Families, Dartmouth Medical School, Hanover, NH (Dr Dalton).

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