Multilevel modeling of peers, parents, school, and state influences on adolescent cigarette use


Clark, Trenette T. (2014). Multilevel modeling of peers, parents, school, and state influences on adolescent cigarette use. Society for Social Work and Research Annual Conference. San Antonio, TX.


Background and Purpose: Cigarette smoking during adolescence, even when experimental, is associated with transitioning to regular smoking, addiction, and health consequences. Despite national prevention efforts, the prevalence of cigarette smoking remains high. To develop evidence-based smoking prevention programs, etiological studies that examine the complex factors associated with cigarette smoking are needed. The purpose of this study was to examine the relationship between peer, parent, school, and state contexts and cigarette smoking.

Methods: The analysis sample included 18,255 adolescents from 146 schools, and was drawn from the National Longitudinal Study of Adolescent Health (Add Health) database. Add Health is an ongoing, longitudinal study with a nationally representative sample of U.S. adolescents who have been followed from adolescence into adulthood via four waves of data collection. Because of the nested data structure (i.e., wave nested in individual, individual nested in school), this analysis employed hierarchical linear modeling (HLM) to account for intraclass correlation. The HLM included sociodemographic variables, such as age and gender and variables from several contextual domains: peer (number of friends who smoke at least one cigarette a day), family (maternal or paternal cigarette smoking, access to cigarettes at home, parental warmth, parental control, maternal or paternal engagement), school (school or school district have policy that prohibits teacher and staff smoking at school, tobacco marketing restricted by schools), and state (tobacco marketing restricted by state, state cigarette tax, percent of high school students in the state who smokes, percent of adults in the state who smoked). For the current analysis, we focused on the number of days of cigarette smoking during the past 30 days.

Results:The unconditional model indicated that variation in the number of days of cigarette smoking during the past 30 days is partitioned into three components: variation due to temporal change (60%), variation due to difference among students within schools (35%), and variation due to differences among schools (5%). Results from the conditional model suggested that affiliation with peers who smoke and all family variables, except parental control, were associated with cigarette use. The school variables were not associated with cigarette smoking. The results indicated that one state variable, percent of high school students who smoked in the respondents’ state, was associated with cigarette use. In addition, an additional state variable, state cigarette tax, approached significance (p=.055). Peer and family variables explained 36% of the variance at the individual level and school variables explained 33% of the variance due to differences among schools.

Conclusions and Implications: This study provides evidence that multiple peer, family, and state contextual factors are important in explaining cigarette smoking. The findings support the existing literature that suggests that context matters. However, it extends the literature by using HLM and a comprehensive set of theoretical constructs to explain cigarette use. Future studies should examine whether and how these contextual factors interact to explain cigarette smoking. Prevention programs should continue to include parents and emphasize the importance of parental warmth, engagement and limiting access to cigarettes and friends who smoke.


Reference Type

Conference proceeding

Book Title

Society for Social Work and Research Annual Conference


Clark, Trenette T.

Year Published


City of Publication

San Antonio, TX

Reference ID