title: The influence of the social environment on youth smoking status.
abstract: OBJECTIVE
  Youth smoking is complex with multilevel influences. While much is known about certain levels of influence on youth smoking, the lack of focus on institutional influences is notable. This study evaluated the effects of ambient smoking attitudes and behaviors in schools on individual youth smoking.
  
  
  METHODS
  Data from the 2012 Florida Youth Tobacco Survey (n=67,460) were analyzed. Multinomial logistic regression was used to investigate individual and aggregated school-level factors that were associated with a youth being classified as a "susceptible nonsmoker" (SN) or "current smoker" (CS) relative to a "non-susceptible nonsmoker" (NN).
  
  
  RESULTS
  The aggregated percentage of regular smokers at a school, ambient school level positive smoking perceptions, and the standardized difference between individual and school-level positive smoking perceptions were statistically significant in the fully adjusted model. We also found an increased risk of being a SN relative to a NN for Hispanic youth. Moreover, our approach to modeling institutional-level factors raised the pseudo r-squared from 0.05 to 0.14.
  
  
  CONCLUSIONS
  These findings suggest the importance of ambient smoking attitudes and behaviors on youth smoking. Prevention efforts affecting ambient smoking attitudes may be beneficial.
authors.affiliation: National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Bellatorre
authors.affiliation: National Institute on Minority Health and Health Disparities, Bethesda, MD, USA. Electronic address: Kelvin.choi@nih.gov.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Choi
authors.affiliation: University of Maryland, College Park, MD, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Bernat
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D005260:Female; D005431:Florida; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010379:Peer Group; D012307:Risk Factors; D012574:Schools; D012907:Smoking / Q000208:ethnology; D000074606:Smoking Prevention; D012931:Social Environment; D011795:Surveys and Questionnaires
keywords: Adolescent health; Peer influence; Tobacco