We do not smoke but some of us are more susceptible than others: a multilevel analysis of a sample of Canadian youth in grades 9 to 12.
BACKGROUND
Smoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12.


METHODS
Student-level data from the 2008-2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses.


RESULTS
The likelihood of a never smoker being susceptible to smoking significantly varied across schools (p=0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility.


CONCLUSIONS
These findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking.
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1 Canada. Electronic address: skaai@uwaterloo.ca.
Susan C
SC
Kaai
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1 Canada; Propel Centre for Population Health Impact, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1 Canada; Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1 Canada. Electronic address: ksbrown@uwaterloo.ca.
K Stephen
KS
Brown
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1 Canada. Electronic address: sleatherdale@uwaterloo.ca.
Scott T
ST
Leatherdale
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1 Canada; Propel Centre for Population Health Impact, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1 Canada. Electronic address: steve.manske@uwaterloo.ca.
Stephen R
SR
Manske
School of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3 Canada. Electronic address: dmurnaghan@upei.ca.
Donna
D
Murnaghan
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D001294:Attitude to Health; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D005190:Family / Q000523:psychology; D005260:Female; D033062:Friends / Q000523:psychology; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology / Q000523:psychology; D012424:Rural Population / Q000706:statistics & numerical data; D012649:Self Concept; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D012931:Social Environment; D012959:Socioeconomic Factors; D013334:Students / Q000523:psychology; D014505:Urban Population / Q000706:statistics & numerical data
Adolescents; Canada; Multilevel analysis; Susceptibility; Tobacco smoking