• Anna Bellatorre, Kelvin Choi, and Debra Bernat.
• National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
• Prev Med. 2015 Dec 1; 81: 309-13.

ObjectiveYouth 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.MethodData 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).ResultsThe 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.ConclusionThese findings suggest the importance of ambient smoking attitudes and behaviors on youth smoking. Prevention efforts affecting ambient smoking attitudes may be beneficial.Published by Elsevier Inc.

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