title: Peers, tobacco advertising, and secondhand smoke exposure influences smoking initiation in diverse adolescents.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional, multistage, probability sample survey.
  
  
  METHODS
  Schools (308 middle and high schools) in Maryland.
  
  
  METHODS
  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).
  
  
  METHODS
  Social and media influence, secondhand smoke exposure, tobacco product use, and demographic information including age, race/ethnicity, and geographic region.
  
  
  METHODS
  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.
authors.affiliation: Department of Public and Community Health, School of Public Health, University of Maryland College Park, Maryland 20742-2611, USA. ccv@umd.edu
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Voorhees
authors.forename: Cong
authors.initials: C
authors.lastname: Ye
authors.forename: Olivia
authors.initials: O
authors.lastname: Carter-Pokras
authors.forename: Laura
authors.initials: L
authors.lastname: MacPherson
authors.forename: Mariano
authors.initials: M
authors.lastname: Kanamori
authors.forename: Guangyu
authors.initials: G
authors.lastname: Zhang
authors.forename: Lu
authors.initials: L
authors.lastname: Chen
authors.forename: Robert
authors.initials: R
authors.lastname: Fiedler
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000329:Advertising; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D010379:Peer Group; D010565:Persuasive Communication; D012907:Smoking / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution
chemical_list: D014028:Tobacco Smoke Pollution