A multi-level analysis examining how smoking friends, parents, and older students in the school environment are risk factors for susceptibility to smoking among non-smoking elementary school youth.

The purpose of this study was to examine how social models for smoking are related to smoking susceptibility among a sample of non-smoking elementary school students. The Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) was administered to 6,431 students (grades 6 to 8) in 57 elementary schools in the province of Ontario, Canada. Multi-level logistic regression analysis was used to examine how smoking friends, parents, and the prevalence of smoking among grade 8 students at a school were related to smoking susceptibility among the 2,478 non-smoking grade 6 and 7 students. Findings indicate that non-smoking grade 6 and 7 students are more likely to be susceptible to smoking if they have (a) smoking friends, (b) a mother who smokes, or (c) two or more close friends who smoke and attend a school with a relatively high smoking rate among the grade 8 students. Sub-populations of non-smoking youth may be at increased risk for smoking because of the elementary school they attend. Future school-based smoking prevention programs might benefit from targeting prevention programming activities to the schools that are putting students at the greatest risk for smoking.