We do not smoke but some of us are more susceptible than others: A multilevel analysis of a sample of Canadian youth in grades 9 to 12

Background Smoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12. Methods Student-level data from the 2008–2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses. Results The likelihood of a never smoker being susceptible to smoking significantly varied across schools (p=0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility. Conclusion These findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking.