title: Descriptive norms and male youth smoking in rural Minya, Egypt: a multilevel analysis of household and neighborhood normative influences.
abstract: BACKGROUND
  Research links normative influence to youth smoking in Egypt. This analysis assesses the association of descriptive norms at the household and neighborhood levels with the smoking behavior of 1,366 men aged 15-24 in rural Minya governorate, Egypt.
  
  
  METHODS
  Data come from the 2004 Minya Village Health Survey of 6,096 people from 2,093 households. A two-level, random effects multivariate logistic regression model with individual data clustered at the neighborhood level was fit to the data. The strengths of normative influence at the household and neighborhood levels on male youths' smoking behavior were assessed, controlling for age, education, employment, outcome beliefs about smoking, and household wealth.
  
  
  RESULTS
  Male youths who lived in a household with an adult male who smoked were much more likely to smoke than were youth who lived in a household with adult male(s) who did not smoke (odds ratio [OR] = 2.73, 95% CI = 1.84-4.07, p < .001). Living with one or more male youth who smoked was also strongly associated with male youth smoking (OR = 1.91, 95% CI = 1.29-2.84, p = .001). Living in a neighborhood with an SD greater than the population mean proportion of males who smoked (both adult and youth) was associated with a 24% greater likelihood of youth smoking (OR = 1.24, 95% CI = 1.04-1.48, p = .017). Unmeasured factors at the neighborhood level accounted for 3.1% of the variability.
  
  
  CONCLUSIONS
  Young men in Minya who live with smokers or in neighborhoods with smokers are more likely to smoke. Policies and interventions enacted at the household and neighborhood levels may prevent youth smoking.
authors.affiliation: Center for Communication Programs, Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21202, USA. charbour@jhsph.edu
authors.forename: Catherine
authors.initials: C
authors.lastname: Harbour
mesh_terms: D000293:Adolescent; D004534:Egypt / Q000453:epidemiology; D005191:Family Characteristics; D006306:Health Surveys / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008954:Models, Biological; D016017:Odds Ratio; D012111:Residence Characteristics; D012309:Risk-Taking; D012424:Rural Population; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D012959:Socioeconomic Factors; D055815:Young Adult