The role of socioeconomic status, peer and school context for adolescent smoking

Objective: To examine socioeconomic differences in regular tobacco smoking among German adolescents and to analyse the importance of peer and school factors for tobacco use in relation to socioeconomic status. Methods: Data were obtained from the German part of the cross-sectional 'Health Behaviour in School-aged Children' survey in 2001/02 with a total of 5,650 respondents aged 11 to 15. Socioeconomic status was assessed using the family affluence scale. Bi- and multivariate logistic regression models adjusted for age were used to determine the independent effect of SES, and several peer and school factors, such as number of close friends, contacts of friends, classmate support, and satisfaction with school, on adolescent smoking, separately for girls and boys. Results: Adolescent tobacco use was found to be largely unrelated to family affluence. No socioeconomic differences in regular smoking were found in boys and only minor differences in girls. Bivariate analyses showed that several social and psychosocial peer and school factors were significantly associated with smoking among both girls and boys. Peer variables were generally more important for the prediction of adolescent smoking. In multivariate analyses, peer and school factors had a much larger effect on regular smoking than family affluence suggesting that the peer and school context is more important for adolescent smoking than socioeconomic background. Discussion: The findings support the idea of an equalising impact of peer and school variables on health inequalities in early adolescence. Health promoting actions focussing on smoking in early adolescence need to be targeted at schools and peers.