Multilevel predictors of smoking initiation among adolescents: Findings from the Minnesota Adolescent Community Cohort (MACC) study

Kate Goldade, Kelvin Choi, Debra H. Bernat, Elizabeth G. Klein, Kola Okuyemi, Jean Forster

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Objective: To understand how factors at multiple levels of influence impact adolescent smoking initiation. Method: Data from the Minnesota Adolescent Community Cohort, a population-based cohort, were analyzed. Adolescents were recruited from randomly selected geopolitical units (GPUs) in Minnesota at ages 12 to 13 (n = 1953), and were surveyed every six months (2000-2006) until 18. The association between baseline social factors and smoking initiation was analyzed using logistic regression. Linear regression was used to analyze predictors and age of initiation among smokers (n = 603). Results: Higher proportion of 15-16. year-olds who smoke at the area-level (GPU) was associated with younger initiation (15.47 vs 15.87, p < .05). Higher proportion of the population employed and higher median household income were associated with older initiation (15.90 vs. 15.56 p < .05). Parent education, living with parents or siblings who smoke, living in homes that allow smoking, and having friends who smoke at baseline were associated with smoking initiation or younger initiation (p < .05). Participants whose parents had less than a high school education were 1.6 times more likely than those with college educated parents to have smoked at least a whole cigarette (CI = 1.06, 2.26). Conclusion: Factors at multiple levels of influence effect adolescent smoking initiation. Smoking by older age peers and lower SES predicts earlier smoking.

Original languageEnglish (US)
Pages (from-to)242-246
Number of pages5
JournalPreventive medicine
Issue number3-4
StatePublished - Mar 2012

Bibliographical note

Funding Information:
The authors thank Rose Hilk for her assistance with data management, Clearwater Research, Inc. for its careful implementation of the telephone survey procedures, and the Health Survey Research Center for its assistance with tracking participants. This research was funded by the National Cancer Institute ( R01 CA86191 ; Jean Forster, Principal Investigator) and ClearWay Minnesota ( RC-2007-0018 ; Jean Forster and Debra Bernat, Co-Principal Investigators). The contents of this article are solely the responsibility of the authors. The authors thank David Van Riper of the Minnesota Population Center for his knowledge of geocoding addresses and linking census data. Finally and foremost we thank the participants.


  • Adolescent smoking initiation
  • Age of smoking initiation
  • Individual, proximal, and area-level social factors
  • Longitudinal cohort study
  • Multi-level analysis


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