Psychosocial determinants of the onset and escalation of smoking: Cross- sectional and prospective findings in multiethnic middle school samples

Purpose: To investigate a broad range of social influence-related and global determinants of smoking to aid in the design of comprehensive multiethnic interventions by testing the most important factors of initiation and escalation of smoking across various subgroups. Methods: Cross-sectional (N = 2546) and cohort (N = 736) samples of multiethnic middle school students near a large Southwestern metropolis were surveyed through self-report questionnaires. The confidential questionnaires included information on demographics, risk factors, and smoking behavior and were administered in class by trained data collectors. Multivariable logistic regression analysis was used to examine the statistical significance and strength of the factors. Results: Those lower in self-esteem and higher in social assertiveness appeared to be most at risk for the onset of smoking, whereas those low in optimism appeared to be the most at risk for the escalation of smoking. Attitudes, friends' norms, parents' norms, perceived behavioral control, and perceived prevalence were consistent predictors of all smoking status outcomes. Conclusions: The behavioral-specific determinants of smoking appear to be important predictors of smoking status outcomes in all demographic subgroups. The relationships of the global determinants were more dependent on the smoking outcome variable and subgroup examined. The findings may serve to help facilitate the targeting of comprehensive interventions aimed at reducing adolescent smoking in multiethnic and ethnic group-specific populations. (C) Society for Adolescent Medicine, 2000.