Peer Smoking Research Articles

Smoking in European adolescents: Relation between media influences, family affluence, and migration background

Seeing smoking depictions in movies has been identified as a determinant of smoking in adolescents. Little is known about how such media influences interact with other social risk factors. Differences in smoking rates in different socio-economic status groups might be explainable by differences in media exposure. There might also be differences in the average response to movie smoking exposure. We tested this hypothesis within a cross-national study conducted in six European countries. A total of 16,551 pupils from Germany, Iceland, Italy, Netherlands, Poland, and Scotland with a mean age of 13.4years (SD=1.18) were recruited from 114 state funded schools. Using previously validated methods, exposure to smoking depictions in movies was estimated for each student and related to ever smoking. The analysis was stratified by level of family affluence (low, medium, high) and migration history of parents (yes vs. no), controlling for a number of covariates like age, gender, school performance, television screen time, sensation seeking and rebelliousness and smoking within the social environment (peers, parents, siblings). We found a significant association for each category of family affluence and ethnicity between ever smoking and movie smoking exposure, also significant adjusted odds ratios for age, school performance, sensation seeking, peer smoking, mother smoking, and sibling smoking. This relationship between movie smoking and adolescent smoking was not moderated by family affluence or ethnicity. Although we used a very broad measure of economic status and migration history, the results suggest that the effects of exposure to movie smoking can be generalized to the population of youths across European countries.

Use of smokeless tobacco and cigarettes among Nigerian youths: implications for tobacco control policies in Africa

Background: Smokeless tobacco (SLT) use among youths in Africa is an emerging epidemic. This paper aimed to determine patterns of tobacco use among youths in Nigeria and the implications for tobacco control in Africa. Methods: The cross-sectional study was conducted in Benue state, Nigeria, in 2011. The study population comprised of 536 randomly selected senior high school students aged 9–19 years. Results: About 17.7% of high school youths were current SLT users, 19.4% were current smokers and an alarming 11.9% used both smokeless and cigarette tobacco. After adjustment, significant predictors of SLT use among youths included their parents’ smoking status (OR 1.70, 95% C.I.: 1.01–2.87, p = 0.046) and the perception of the lack of harm from tobacco use (OR 2.06, 95% C.I.: 1.08–3.92, p = 0.027). Current cigarette smoking was again predicted by parental and peer smoking status (OR 2.58, 95% C.I.: 1.55–4.31and OR 2.93, 95% C.I.: 1.84–4.66, respectively). Adjusted regression analysis for dual tobacco use provided similar results. Conclusion: Both SLT and cigarette use, as well as dual use remains high, particularly among rural youth. Tobacco control policies based on the Framework Convention on Tobacco Control (FCTC) that primarily focus on reducing smoking in Nigeria and other African nations where SLT is popular should be modified to address not only cigarettes but also SLT use given the high use of both products singly and concurrently.

Use of Illicit Substances Among Schoolchildren in Colombo District, Sri Lanka

ABSTRACT Objective: This study aimed to understand the usage patterns and correlates of illicit drug use among schoolchildren in Colombo district, Sri Lanka. Methods: A cross-sectional study was carried out among grade 10 and 12 students using a self-administered questionnaire. Results: From the 6000 students selected, 5353(89.22%) responded. Betel chewing with tobacco was seen in 28.48% males and 10.44% females. Substances such as Barbul, Madana Modaka, and cough syrups that are not established as illicit drugs were used as psychoactive substances. Ingredients of some of these compounds are not fully understood or regulated. Prevalence of cannabis use was 3.85% in males and 0.24% in females. Studying nonscience subjects for Advanced Level, doing sports, low academic performance, and peer smoking significantly increased the odds of using one or more substances (P < .05). Conclusions: Many types of illicit substances were used by schoolchildren. More strategies to prevent further aggravation of these behaviors are needed. Constituents of some compounds are not understood and need further evaluation. Recognized high-risk groups can be targets for preventive and cessation programs.

Developmental Trajectories of Cigarette Use and Associations With Multilayered Risk Factors Among Chinese Adolescents

We aimed to identify developmental trajectories of cigarette use and risk factors associated with the distinct developmental courses of smoking in Chinese early adolescents from age 12 to 16 years. Analysis was conducted with secondary data from a longitudinal, prospective cohort of 3,521 Chinese adolescents randomly selected from 4 rural and 7 urban middle schools in Wuhan, China. A group-based growth mixture modeling approach was adopted to identify developmental trajectories of cigarette use. Multilayered intrapersonal (e.g., attitudes toward smoking) and interpersonal (e.g., parental smoking and perceived parental disapproval of smoking) risk factors selected from an ecological perspective were prospectively linked to the identified patterns of smoking trajectory. Three trajectory patterns were identified from the whole cohort: nonsmokers (48.7%), stable light/occasional smokers (48.6%), and accelerating smokers (2.7%). After adjustments for gender, urban residence, and family socioeconomic status, adolescents with higher levels of problems in parent-child relationships and family disharmony, higher perceived norms of peer smoking, higher proportion of good friend smoking, having more troubles with teachers, poorer academic performance, and reporting more frequent depressive symptoms were significantly more likely to be in the trajectory group of either stable light/occasional smokers or accelerating smokers than in the group of nonsmokers. The probability of being in the accelerating smoking trajectory group was positively and significantly related to parental smoking and lack of school bonding. Study findings help to advance knowledge of the distinct developmental courses of smoking behavior and their associations with multilayered risk factors among Chinese early adolescents.

Individual- and community-level correlates of cigarette-smoking trajectories from age 13 to 32 in a U.S. population-based sample

BackgroundCharacterizing smoking behavior is important for informing etiologic models and targeting prevention efforts. This study explored the effects of both individual- and community-level variables in predicting cigarette use vs. non-use and level of use among adolescents as they transition into adulthood. MethodsData on 14,779 youths (53% female) were drawn from the National Longitudinal Study of Adolescent Health (Add Health); a nationally representative longitudinal cohort. A cohort sequential design allowed for examining trajectories of smoking typologies from age 13 to 32 years. Smoking trajectories were evaluated by using a zero-inflated Poisson (ZIP) latent growth analysis and latent class growth analysis modeling approach. ResultsSignificant relationships emerged between both individual- and community-level variables and smoking outcomes. Maternal and peer smoking predicted increases in smoking over development and were associated with a greater likelihood of belonging to any of the four identified smoking groups versus Non-Users. Conduct problems and depressive symptoms during adolescence were related to cigarette use versus non-use. State-level prevalence of adolescent smoking was related to greater cigarette use during adolescence. ConclusionsIndividual- and community-level variables that distinguish smoking patterns within the population aid in understanding cigarette use versus non-use and the quantity of cigarette use into adulthood. Our findings suggest that efforts to prevent cigarette use would benefit from attention to both parental and peer smoking and individual well-being. Future work is needed to better understand the role of variables in the context of multiple levels (individual and community-level) on smoking trajectories.

Characteristics Associated With Awareness, Perceptions, and Use of Electronic Nicotine Delivery Systems Among Young US Midwestern Adults

We assessed the characteristics associated with the awareness, perceptions, and use of electronic nicotine delivery systems (e-cigarettes) among young adults. We collected data in 2010-2011 from a cohort of 2624 US Midwestern adults aged 20 to 28 years. We assessed awareness and use of e-cigarettes, perceptions of them as a smoking cessation aid, and beliefs about their harmfulness and addictiveness relative to cigarettes and estimated their associations with demographic characteristics, smoking status, and peer smoking. Overall, 69.9% of respondents were aware of e-cigarettes, 7.0% had ever used e-cigarettes, and 1.2% had used e-cigarettes in the past 30 days. Men, current and former smokers, and participants who had at least 1 close friend who smoked were more likely to be aware of and to have used e-cigarettes. Among those who were aware of e-cigarettes, 44.5% agreed e-cigarettes can help people quit smoking, 52.8% agreed e-cigarettes are less harmful than cigarettes, and 26.3% agreed e-cigarettes are less addictive than cigarettes. Health communication interventions to provide correct information about e-cigarettes and regulation of e-cigarette marketing may be effective in reducing young adults' experimentation with e-cigarettes.

The dynamic role of parental influences in preventing adolescent smoking initiation

BackgroundAs adolescents grow, protective parental influences become less important and peer influences take precedence in adolescent's initiation of smoking. It is unknown how and when this occurs. We sought to: prospectively estimate incidence rates of smoking initiation from late childhood through mid-adolescence, identify important risk and protective parental influences on smoking initiation, and examine their dynamic nature in order to identify key ages. MethodsLongitudinal data from the National Survey of Parents and Youth of 8 nationally representative age cohorts (9–16years) of never smokers in the U.S. were used (N=5705dyads at baseline). Analysis involved a series of lagged logistic regression models using a cohort-sequential design. ResultsThe mean sample cumulative incidence rates of tobacco use increased from 1.8% to 22.5% between the 9 and 16years old age cohorts. Among risk factors, peer smoking was the most important across all ages; 11–15year-olds who spent time with peers who smoked had 2 to 6.5 times higher odds of initiating smoking. Parent–youth connectedness significantly decreased the odds of smoking initiation by 14–37% in 11–14year-olds; parental monitoring and punishment for smoking decreased the odds of smoking initiation risk by 36–59% in 10–15year-olds, and by 15–28% in 12–14year-olds, respectively. ConclusionsParental influences are important in protecting against smoking initiation across adolescence. At the same time, association with peers who smoke is a very strong risk factor. Our findings provide empirical evidence to suggest that in order to prevent youth from initiating smoking, parents should be actively involved in their adolescents' lives and guard them against association with peers who smoke.

Tobacco advertising/promotions and adolescents’ smoking risk in Northern Africa

BackgroundComprehensive tobacco advertising/promotion bans are effective against adolescent smoking but many developing countries have implemented only partial bans. This study examines the association between advertising/promotions exposure and adolescent cigarette smoking...

A Multiple Indicators and Multiple Causes Model of Alternative Tobacco Use

To examine the relationship between adolescents' cigarette smoking experiences and alternative tobacco product (ATP) use. Multiple indicators and multiple causes (MIMIC) models estimated simultaneously the relationship between cigarette smoking experiences and ATP use among high school students (N=1827) completing the 2009 Virginia Youth Tobacco Survey. Overall, ATP use was associated with adolescents' ever use of cigarettes, early onset of cigarette smoking, cigarettes smoked per day, and peer smoking; however, important model differences between racial/ethnic groups were observed. Prevention and cessation programs might reduce adolescent ATP use by targeting specific characteristics of cigarette smoking.

Hábitos tabágicos dos jovens do 9.° ano: estereótipos sobre fumadores, fatores familiares, escolares e de pares e a relação com o consumo de tabaco

The prevalence of smoking has become a major public health issue in the past century. The Portuguese Healthy Cities Network conducted an investigation/action project directed at 9th graders in public schools of 16 member municipalities, applying the Global Youth Tobacco Survey questionnaire to 3.649 students. The study showed that half of the students enquired have tried smoking, mainly women and between the ages of 12 and 15 years, and especially in association with smoking peers. At the level of stereotypes about people who smoke, smokers have slightly less negative perceptions than non-smokers.

Adapting the Stage of Change model to investigate adolescent behavior related to reducing second hand smoke exposure

Aims: Second hand smoke (SHS) exposure is increasingly recognized as a major public health concern. Assessing adolescents’ motivational level to avoid SHS is vital to promote and reinforce reductions in SHS exposure. Methods: A brief measure based on the Stage of Change model was developed to characterize adolescents’ behavior related to reducing SHS exposure and used to identify potential determinants of SHS stage of change. The sample consisted of 1172 adolescents aged 13 to 15 years who participated in an internet-based cohort study of youth in British Columbia, Canada. Results: Sixty-six percent of the adolescents reported they had consistently made efforts to reduce exposure to SHS for more than 6 months, while 19% did not intend to reduce their exposure to SHS in the next 6 months. Adolescents’ SHS stage of change significantly differed by ethnicity, whether they had tried cigarettes, amount of tobacco smoked in their lifetime, parental and peer smoking statuses, past months’ exposure to SHS, frequent smoking in the home, and home smoking restrictions (all p exposure. Conclusion: This brief measure based on the Stage of Change model can be used in future studies to characterize adolescents’ behavior around SHS. Adolescents who smoke or have parents and/or friends who smoke appear to be a population that could benefit from stage-matched interventions designed to raise awareness of the risks associated with SHS for smokers and non-smokers, and ultimately reduce SHS exposure.

Developing a comprehensive smoking cessation program in patients with lung cancer: The role of social smoking environments.

75 Background: Smoking during cancer treatment negatively impacts outcome, survival, and quality of life. Social smoking environments (SSEs) (i.e., smoking in household, peers, and spouse) influence cessation rates in non-cancer patients, but are understudied in cancer patients. Methods: Lung cancer patients, recruited from Princess Margaret Hospital (2006-2012) were given baseline and follow-up questionnaires (median of 2 years apart) evaluating changes in smoking habits and SSEs. Multivariate logistic regression and Cox-proportional hazard models evaluated the association of socio-demographics, clinicopathological and SSE factors with smoking cessation and time to quitting, respectively. Results: 721 patients completed both questionnaires. Of the 261 current smokers at diagnosis, 180 (69%) had quit by follow-up. Among 318 ex-smokers, 5 re-started smoking after diagnosis. All of the 140 never smokers remained non-smoking. Home smoke exposure (OR=9.4; 95% CI: 3.4-26.2; p=2.0 x 10E-5), spousal smoking (OR=4.7, 95% CI:1.7-12.6; p=3.0 x 10E-3) and peer smoking (OR=2.6; 95% CI:1.1-6.1; p=0.03) were each associated with reduced cessation, adjusted for a base multivariate model that included education and past history of depression. Individuals with no SSE factors had a much higher chance of quitting smoking when compared to patients with multiple areas of SSEs (0 vs. 3, OR=16.4; 95% CI: 4.1-66.7; p=7.3 x 10E-5). Similar results were seen when using time-to-quitting as the outcome (0 vs 3, OR=4.4, 95% CI=1.4-14.1, p=0.01). Time to quitting analysis found that 60% of patients with at least one SSE who did quit, did so within 6 months of diagnosis. Subgroup analysis revealed similar associations in early- and late-stage patient groups. Conclusions: SSE is a key factor in smoking cessation, where household smoke exposures reduces the chance of quitting up to 9-fold. SSEs should be a key consideration when developing smoking cessation programs in lung cancer patients, as part of quality improvement strategies. Approaches incorporating household members or spouses into the smoking cessation intervention, around the time of diagnosis, should be researched further. GL and WX are co-senior authors.

Predictors of nicotine dependence symptoms among never-smoking adolescents: A longitudinal analysis from the Nicotine Dependence in Teens Study

BackgroundRecent cross-sectional studies suggest some adolescents who have never smoked cigarettes experience nicotine dependence (ND) symptoms and that exposure to second-hand smoke, social exposure to smoking, and alcohol use are plausible correlates. The aim of this study was to replicate and extend these findings by investigating possible predictors of ND symptoms longitudinally. MethodParticipants included 847 secondary school students who had never smoked cigarettes enrolled in the Nicotine Dependence in Teens Study. Adolescents completed self-report questionnaires measuring smoking status, ND symptoms, and risk factors for ND in smokers (i.e., socio-demographic indicators, social exposure to smoking, psychosocial indicators, and substance use) in 20 survey cycles from 7 to 11th grade. Generalized estimating equations, which account for repeated measures within individuals, were used to test the predictors of ND symptoms. ResultsConsistent with previous research, 7.8% of never-smokers across all cycles endorsed at least one ND symptom. Younger age (p≤.001), country of birth (p≤.05), peer smoking (p≤.001), teacher smoking (p≤.05), depression (p≤.05), stress (p≤.001), lower self-esteem (p≤.05), impulsivity (p≤.05), and alcohol use (p≤.001) predicted greater ND symptoms in multivariable modeling. ConclusionsReplicating previous cross-sectional findings, peer smoking and alcohol use predicted ND symptoms among never-smoking adolescents. Extending these findings, previous predictors only observed among ever-smokers, including socio-demographic and psychosocial indicators, also predicted ND symptoms. This longitudinal investigation demonstrated the temporal relation of the predictors preceding ND symptoms. Future research should consider longer prospective studies with younger children to capture early onset of ND symptoms and with longer follow-up to detect eventual smoking uptake.

Social, Psychological, and Environmental-Structural Factors Associated with Tobacco Experimentation among Adolescents in Shanghai, China

Objective: To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. Methods: We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global Youth Tobacco Survey (GYTS) to investigate smoking behavior among 19,117 students from 41 junior and senior high schools in Shanghai, China. The association between potential factors and tobacco experimentation were assessed using complex samples procedure logistic regression. Results: Of the 19,117 respondents, 10.5% (15.3% boys and 6.2% girls) reported the tobacco experimentation. The main social, psychological, and environmental-structural factors associated with tobacco experimentation were having close friends who smoke (AOR = 8.21; 95% CI: 6.49–10.39); one or both parents smoking (AOR 1.57; CI: 1.39–1.77); a poor school tobacco control environment (AOR 1.53; CI: 1.37–1.83); a high acceptance level of tobacco use (AOR 1.44; CI: 1.28–1.82); and a high level of media tobacco exposure (AOR 1.23; CI: 1.10–1.37). Peer smoking might contribute to smoking experimentation among girls (AOR 8.93; CI: 5.84–13.66) more so than among boys (AOR 7.79; CI: 5.97–9.94) and media tobacco exposure had no association with tobacco experimentation among female students. Conclusions: Social, psychological, and environmental factors are closely associated with tobacco experimentation among adolescents. Prevention programs aimed at reducing teen tobacco experimentation should be conducted at home and school with support by parents, peers and teachers. Our findings should prove useful for future development of intervention strategies among adolescents in Shanghai, China.

Young Adult Smoking in Peer Groups: An Experimental Observational Study

The aim of this experimental observational study is to examine whether, in a group setting (same-sex triads), passive peer influence (imitation) in the context of homogeneous and heterogeneous (contradictory) behavior of peer models affects young adults' smoking behavior. An experiment was conducted among 48 daily-smoking college and university students aged 17-25. Participants had to complete a 30-min music task with two same-sex confederates. We tested the following three conditions: (a) neither of the confederates is smoking, (b) one confederate is smoking and the other is not, and (c) both confederates are smoking. The primary outcome tested was the total number of cigarettes smoked during the task. Students in the condition with two smoking peer models and in the condition with one smoking peer model and one nonsmoking peer model smoked significantly more cigarettes than those in the condition with two nonsmoking peer models. However, results for the condition with two smoking peer models did not differ significantly from the condition with one smoking peer model and one nonsmoking peer model. Our findings show that in a group setting, the impact of the homogeneity of smoking peers on young adults' smoking behavior is not greater than the impact of the heterogeneity of smoking and nonsmoking peers. This would suggest that the smoking peer in the group has a greater impact on the daily-smoking young adult, thus reducing or even eliminating the protective effect of the nonsmoking peer model.

Factors Associated With Growth in Daily Smoking Among Indigenous Adolescents

North American Indigenous adolescents smoke earlier, smoke more, and are more likely to become regular smokers as adults than youth from any other ethnic group yet we know very little about their early smoking trajectories. We use multilevel growth modeling across five waves of data from Indigenous adolescents (aged 10 to 13 years at Wave 1) to investigate factors associated with becoming a daily smoker. Several factors, including number of peers who smoked at Wave 1 and meeting diagnostic criteria for major depressive episode and conduct disorder were associated with early daily smoking. Only age and increases in the number of smoking peers were associated with increased odds of becoming a daily smoker.

Parent, sibling and peer associations with subtypes of psychiatric and substance use disorder comorbidity in offspring

BackgroundParental substance use disorder (SUD) is associated with a range of negative offspring outcomes and psychopathology, but the clustering of these outcomes into subtypes has seldom been examined, nor have the familial and environmental contexts of these subtypes been reported. The present study examines the clustering of offspring lifetime substance use and psychiatric disorders into subtypes and characterizes them in terms of familial and non-familial influences using an offspring-of-twins design. MethodTelephone-administered diagnostic interviews were used to collect data on psychiatric disorders and SUD from 488 twin fathers, 420 biological mothers and 831 offspring. Latent class analysis (LCA) was used to derive subtypes of lifetime comorbidity in offspring. Familial risk and environmental variables associated with each subtype (i.e., parenting, childhood physical or sexual abuse, perceived sibling and peer substance use) were identified using multinomial logistic regression. ResultsFour classes identified by LCA were characterized as (1) unaffected, (2) alcohol abuse/dependence, (3) alcohol abuse/dependence comorbid with anxiety and depression, and (4) alcohol, cannabis abuse/dependence and nicotine dependence comorbid with conduct disorder. Inconsistent parenting, childhood physical/sexual abuse, and perceived sibling and peer substance use were significantly associated with profiles of offspring comorbidity after adjusting for familial vulnerability. Some associations were specific (i.e., perceived peer alcohol use to the AUD class), while others were general (peer smoking to all 3 comorbidity classes). ConclusionsWe observed distinct subtypes of psychiatric and SUD comorbidity in adolescents and young adults. Subtypes of offspring psychopathology have varied associations with parental psychopathology, family environment, and sibling and peer behaviors.

The role of environmental smoking in smoking-related cognitions and susceptibility to smoking in never-smoking 9–12 year-old children

Environmental smoking has numerous adverse effects on child health, and children are frequently exposed to environmental smoking. In the present study, we investigated the role of environmental smoking (parental smoking, sibling smoking, peer smoking) in smoking-related cognitions (pros of smoking, perceived safety of casual smoking, cue-triggered wanting to smoke) and susceptibility to smoking among 9–12year old never-smoking children (N=778). We collected cross-sectional survey data from children attending 15 Dutch primary schools. Using structural equation modelling, we assessed direct as well as indirect relationships among study variables. The results showed that children who were exposed to more smoking parents, siblings, and peers perceived more pros of smoking. Additionally, parental smoking was associated with higher perceived safety of casual smoking and more cue-triggered wanting to smoke. In turn, perceiving a higher safety of casual smoking and more cue-triggered wanting to smoke were associated with a higher susceptibility to smoking in children. No direct effects of environmental smoking on children's susceptibility to smoking were found. However, parental smoking was associated with children's susceptibility to smoking through children's perceived safety of casual smoking and cue-triggered wanting to smoke. The present study indicates that pre-adolescents may already display favourable smoking-related cognitions and that these cognitions may be an early indicator of a child's vulnerability to smoking. Environmental smoking, particularly parental smoking, is associated with more favourable smoking-related cognitions in never-smoking children. In the intergenerational transmission of smoking from parents to children, children's risk perceptions of smoking and the experience of cue-triggered wanting to smoke may constitute mechanisms of action, which need to be investigated in longitudinal research.

Cigarette smoking among medical students in China and modifiable risk factors for smoking prevention

PurposeThe reduction of tobacco use among medical students is a potentially powerful strategy to reduce tobacco use among future health professionals, who in turn, can have significant impact on tobacco use among patients as well as the general population in China. The goal of this study is to update information on the prevalence of cigarette smoking among Chinese medical students and to assess modifiable factors for smoking reduction.Design/methodology/approachPresented in the paper are descriptive, associative and path model analyses of survey data collected among 758 medical students in year one through year three from Hainan Medical College, Hainan, China.FindingsAmong the total 758 participants, 66.9 percent of males and 26 percent of females smoked and 26.5 percent of males and 1.6 percent of females had smoked in the past 30 days. The median monthly expenditure on cigarettes was 30 Chinese Yuan (approximately US$4.25). The likelihood of smoking increased with male gender, more advanced year group, poor academic performance, perceived peer smoking, and depressive symptoms, after controlling for covariates.Originality/valueFindings reported in this study provide further insight into the smoking prevalence among medical students in China as well as adding to knowledge about several potentially modifiable factors that are related to smoking. Data collected in this study are likely to prove valuable in prioritizing tobacco control among Chinese medical students, as they are future medical doctors, and their smoking behaviors will have strong influence on their patients as well as the general public.

Exposure to peers who smoke moderates the association between sports participation and cigarette smoking behavior among non-White adolescents

Adolescent sports participants are less likely to smoke cigarettes, and sports participation may prevent young people from smoking. Research suggests that the relationship between sports participation and smoking may vary by race/ethnicity and is also possibly moderated by exposure to peer smoking. We investigated these relationships in a sample of 311 adolescents ages 13–21 presenting for well-visit medical appointments. Participants completed valid assessments of demographics, sports participation, exposure to peer smoking, and smoking behavior. The primary outcome was smoking status (never smoked, tried smoking, experimental/current smoker). Ordinal logistic regression was used separately for non-Hispanic White (n=122) and non-White (n=189; 70.4% Black, 14.3% Hispanic, and 15.3% other) adolescents. Among White adolescents, sports participants had significantly lower odds of smoking than non-sports participants, independent of age, gender, and peer smoking. For non-Whites, the adjusted effect of sports participation on smoking depended upon exposure to peers who smoke. Compared with non-sport participants with no exposure to peer smoking, sports participants with no exposure to peer smoking had significantly lower odds of smoking, whereas sports participants with exposure to peer smoking had significantly higher odds of smoking. Sports appear to be protective against smoking among non-Hispanic White adolescents, but among non-White adolescents exposure to peer smoking influences this protection. Interventions incorporating sports to prevent smoking should consider these racial/ethnic differences to address disparities in smoking-related disease.