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Objectives. We examined whether individual and neighborhood characteristics associated with smoking were also predictive of exposure to smoking prevention education in schools, to determine whether education programs were targeted appropriately to reach neighborhoods with the greatest need.
Methods. We merged data from 2 sources-the 2005 Virginia Youth Tobacco Survey (n=2208) and the Census 2000 School District Demographics Project- and used binary multilevel models with random effects to determine whether the same demographic characteristics and neighborhood characteristics predicted both adolescent smoking and exposure to prevention programs.
Results. We found that although light, medium, and heavy smoking rates were higher in neighborhoods of lower socioeconomic status (relative risk ratio=1.49, 1.36, and 1.65, respectively), prevention programs were less available in those areas (odds ratio=0.82).
Conclusions. Our study indicates that school prevention programs are not being effectively targeted and that more effective ways to reach high-risk and disadvantaged neighborhoods are needed. (Am J Public Health. 2010;100: 1708-1713. doi:10.2105/AJPH.2008.145557)
Tobacco use is the most common cause of preventable death in the United States, and most tobacco users initiate use before they are aged 18 years.1-3 Reducing adolescent smoking initiation is therefore an important health education goal. In 2005, 23% of high school students reported current smoking; the US Department of Health and Human Services has set a national health objective of reducing that prevalence to less than 16% by 2010.2,4 To accomplish this goal and to reduce health inequities, both individual and environmental indicators must be identified to target education interventions efficiently.
Several national studies of adolescent tobacco use have noted differences in school and neighborhood rates of tobacco use.5,6 Neighborhood factors of interest for smoking and health behaviors have often included social disorganization, poverty, and race. For example, neighborhood disorganization indicators (e.g., percentage of people seeking work or in households without access to a car) appear to have an independent effect on individual smoking status even after a large range of individual characteristics are taken into account.6 Other studies have found that neighborhood socioeconomic factors and ethnicity affect smoking behaviors. 5,7 However, inconsistent and sometimes weak associations between neighborhood factors and adolescent smoking have been observed, perhaps as a result of the different ways in which neighborhood-level variables were operationalized.8
Because smoking prevalence can vary dramatically between neighborhoods...