Do popular students smoke? The association between popularity and smoking among middle school students

Background: Several studies have shown an association between popularity and behavior, indicating that popular people tend to reflect the norms of their group. Among adolescents, it has been hypothesized that popular students are more likely to smoke, especially in schools with high smoking prevalence. Methods: Data were collected on friendship patterns and smoking from 1,486 sixth and seventh graders in 16 middle schools in southern California. Susceptibility to smoke was measured as not stating a commitment not to smoke in the future, and smoking as ever taken a puff or smoked a whole cigarette. We measured popularity as the number of times a student was chosen as a friend. Multivariate logistic regression was used to correlate popularity with susceptibility to smoke and smoking at follow-up controlling for baseline outcomes, demographic characteristics, and clustering within schools. Results: Popularity was associated with increased susceptibility to smoke (Adjusted Odds Ratio [AOR] = 5.64, p < .001) and smoking (AOR = 5.09, p < .05) over the I-year interval between surveys. Although the association was strongest for non-White boys, we did not find evidence of interactions between popularity and gender or ethnicity. Conclusions: Popular middle school students were more likely to become smokers compared to their less popular peers. Although there seems some difference in the association by gender and ethnicity, the evidence does not suggest subgroup effects in this population. Implications for the study of adolescent smoking and prevention programming are discussed. (c) 2005 Society for Adolescent Medicine. All rights reserved.