Youths' exposure to environmental tobacco smoke (ETS): associations with health beliefs and social pressure.

Youths' exposure to environmental tobacco smoke (ETS) is a significant public health problem in the United States. This study examined the associations between health beliefs, social pressure, and exposure to ETS among high school youth. Data were collected in 65 schools in 18 California counties during the 1996-1997 school year as part of the Independent Evaluation of the California Tobacco Control, Prevention, and Education Program. The total sample (N = 6902) represents 10th grade California youth attending public schools. The multiple group analysis approach of structural equation modeling (SEM) was employed to test the associations of five constructs of the health belief model (HBM) and one construct of perceived social pressure with ETS exposure among nonsmokers and smokers. Results demonstrated that high perceived susceptibility to disease was significantly associated with lower levels of ETS exposure for both nonsmokers (beta = -0.11, P < .01) and smokers (beta = -0.20, P < .01). High social pressure to smoke was significantly associated with higher exposure to ETS for both nonsmokers (beta = 0.30, P < .01) and smokers (beta = 0.41, P < .01). Perceived barriers predicted lower exposure to ETS for nonsmokers (beta = -0.09, P < .01) but higher exposure for smokers (beta = 0.11, P < .01). Cues to action and self-efficacy were not significantly associated with ETS exposure among nonsmokers or smokers. These findings underscore the need to increase the awareness of harms associated with second hand smoke and alter social pressure, to minimize exposure to ETS. Copyright 2002 Elsevier Science Ltd.