Analyzing Multilevel Factors Underlying Adolescent Smoking Behaviors: The Roles of Friendship Network, Family Relations, and School Environment.

Background: This study investigates the extent to which friendship network, family relations, and school context are related to adolescent cigarette smoking. Friendship network is measured in terms of delinquent peers; family relations in terms of parental supervision; and school environment in terms of objective (eg, antismoking policy) and subjective (eg, school attachment) characteristics.

Methods: Findings are based on the secondary analysis of the health behavior in school-aged children, 2009-2010. Two-level hierarchical generalized linear models are estimated using hierarchical linear modeling 7.

Results: At the student level, ties to delinquent friends is significantly related to higher odds of smoking, while greater parental supervision is associated with lower odds. At the school level, antismoking policy and curriculum independently lower smoking behavior. Better within-class peer relations, greater school attachment, and higher academic performance are also negatively related to smoking. Last, the positive association between delinquent friends and smoking is weaker in schools with a formally enacted antismoking policy. However, this association is stronger in schools with better peer relations.

Conclusions: Adolescent smoking behavior is embedded in a broader ecological setting. This research reveals that a proper understanding of it requires comprehensive analysis that incorporates factors measured at individual (student) and contextual (school) levels.