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Smoking on School Property as

a Risk Factor for Substance Use
Among Adolescent Smokers
a

Carl D. Sneed , Nicole F. Mehdiyoun , Scott H.

a

Matsumura & Ryan A. Hess

a

California State University, Dominguez Hills

Indiana University

Ball State University

Published online: 28 Feb 2014.

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To cite this article: Carl D. Sneed, Nicole F. Mehdiyoun, Scott H. Matsumura & Ryan
A. Hess (2015) Smoking on School Property as a Risk Factor for Substance Use Among
Adolescent Smokers, The Journal of Psychology: Interdisciplinary and Applied, 149:1,
19-28, DOI: 10.1080/00223980.2013.837021
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doi: 10.1080/00223980.2013.837021

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Smoking on School Property as a Risk

Factor for Substance Use Among
Adolescent Smokers
CARL D. SNEED
California State University, Dominguez Hills
NICOLE F. MEHDIYOUN
Indiana University
SCOTT H. MATSUMURA
California State University, Dominguez Hills
RYAN A. HESS
Ball State University

ABSTRACT. The purpose of the current study was to determine if smoking on high-school
property was associated with increased risk for other substance use among U.S. adolescents.
Secondary analyses were carried out with data from the 2011 Youth Risk Behavior Survey
(YRBS, N = 15,503). Only adolescents who reported smoking at least one cigarette in
the last 30 days were selected for analyses (n = 2531, 44% female). Alcohol, marijuana,
and cocaine use was assessed among participants. Binary logistic regression analysis was
carried out to examine the relationship between smoking on school property (yes versus
no) with each of the substance use variables. Adolescent smokers who reported smoking on
school property were significantly more likely to report substance use across all substances
examined compared to smokers who did not smoke on campus. For example, campus
smokers were 3.91 times more likely to use marijuana in their lifetime and 3.85 times more
likely to have used crack or cocaine in their lifetime compared to smokers who did not
smoke on campus. Health care providers who provide services to adolescents should screen
for smoking on school property to help identify adolescents at increased risk for substance
use.
Keywords: adolescent, alcohol, marijuana, substance use, tobacco

Address correspondence to Carl D. Sneed, Ph.D., Department of Psychology, California

State University, Dominguez Hills, 1000 East Victoria St., Carson, CA 90047, USA;
csneed@csudh.edu (e-mail).
19

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20

The Journal of Psychology

ACCORDING TO DATA FROM the 2011 Youth Risk Behavior Survey (YRBS),
almost half (45%) of high-school adolescents have tried cigarette smoking at least
once in their lifetime and approximately 18% are regular smokers (CDC, 2012a).
Tobacco use can result in a lifelong pattern of nicotine dependence, increase
the chances of contracting an oral cancer such as pharyngeal, laryngeal, and
esophageal cancers (Pelucchi, Gallus, Garavello, Bosetti, & La Vecchia, 2006),
and adversely affects the cardiovascular system. In addition to tobacco use among
adolescents use of other substances is also fairly prevalent. As of 2011, 23% of
adolescents had smoked marijuana and 7% had tried cocaine at least once (CDC,
2012a).
Though smoking by itself can be detrimental to any adolescents health, it can
also be a sign of further drug problems. Early use of tobacco among adolescents
predicts later frequency of alcohol and tobacco use as well as the use of marijuana
and other illicit substances (Ellickson, Tucker, & Klein, 2001; Grant & Dawson,
1998; Hawkins, Catalano, & Miller, 1992; Kandel, Davies, Karus, & Yamaguchi,
1986). Compared to adolescents who never smoked cigarettes, high school seniors
who started smoking before age 13 are 3.11 times more likely to use marijuana
(Merrill, Kleber, Shwartz, Liu, & Lewis, 1999). Forty-nine percent of adults ages
20 to 30 years old, proceeded to use one or more illicit substance after using alcohol
or tobacco (Kandel, 2002) and adolescents who progressed to cocaine started using
tobacco two years earlier than those who did not progress to cocaine use (Kandel
& Yamaguchi, 1993). Prior research has also found that nicotine dependence
and/or more frequent cigarette use is associated with a high probability of using
other substances (Dierker, Ramirez, Chavez, & Canino, 2005; Dierker et al., 2007;
Perkonigg et al., 2006).
As with other adolescent risk behaviors that involve substance use, adolescent
smokers may face negative consequences such as punishment from parents and
school. Many school environments enforce policies that prohibit adolescents from
smoking on campus (Sabiston et al., 2009; Wakefield et al., 2000). School sanctions
for smoking on campus may include suspension, expulsion, and notification of
parents (see Martin, Levin, & Saunders, 1999). Prior research has also found that
many adolescent smokers are aware that cigarette use is not approved by their
parents (Thomson, Siegel, Winickoff, Biener, & Rigotti, 2005).
Increased pressure to reduce smoking behavior in the United States may
be one reason why schools have adopted anti-smoking policies and interventions (Lovato, Sabiston, Hadd, Nykiforuk, & Campbell, 2007; Reid, Manske, &
Leatherdale, 2008). These policies seek to make smoking a socially unacceptable
behavior. However, smoking is the norm among adolescent smokers (Kobus,
2003). As part of this norm, adolescent smokers typically do not smoke on school
property (Sabiston et al., 2009). Thus, school policies, parental disapproval, and
smoking behavior of adolescents provide support for the assertion that smoking
on school property is not normative behavior. An adolescent willing to break the
norm of not smoking on school property may also be willing to break other drug

Sneed et al.

21

related social norms (Donovan, Jessor, & Costa, 1991). The purpose of the current study was to determine if breaking the social norm of smoking on campus
amongst adolescent smokers would be associated with increased risk for use of
other substances beyond that found in the population of adolescent smokers. It
is our hypothesis that adolescent smokers who are willing to break the social
norm of smoking on campus are at an increased risk for alcohol, marijuana, and
cocaine use in comparison to adolescent smokers who did not smoke on school
property.

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Methods
Participants and Procedure
Secondary analyses were conducted with data from the 2011 Youth Risk
Behavior Survey (YRBS). The YRBS is a nationally representative sample of
high-school students ranging from grades 9 to 12. In 2011, a total of 15,503
useable surveys were completed (overall response rate of 71%). Only adolescents
who self-reported smoking at least one cigarette in the last 30 days were selected
for analyses (n = 2531, 44% female). The ethnic background of the truncated
sample was: 50% Caucasian, 10% African American, 30% Latino, and 10%
other. Sampling strategies and other information on the dataset is available (CDC,
2012b). Secondary analysis was deemed exempt from approval by the institutional
review board at California State University, Dominguez Hills.
Instruments
The 2011 YRBS is an 86-item multiple choice self-administered survey that
assesses a wide variety of health and risk behaviors. Smoking on school property
was assessed with the following question, During the past 30 days, on how many
days did you smoke cigarettes on school property? The participants self-reports
were dichotomized into smoking on school property on one or more days versus
not smoking on school property. Recent substance use was operationalized as
substance use in the past 30 days.
Questions on alcohol, marijuana, and cocaine use were utilized to assess
substance use. Age of first use questions were dichotomized into use before age
13, for example, adolescents who had a drink before 13 versus adolescents who
DID NOT have a drink before 13. Past 30 days questions were dichotomized
into used during the past 30 days versus DID NOT use during the past 30 days.
Lifetime questions were dichotomized into used at least once in your life versus
never used.
The alcohol questions utilized were: How old were you when you had your
first drink of alcohol other than a few sips?, During the past 30 days, on how
many days did you have at least one drink of alcohol?, During the past 30 days,
on how many days did you have 5 or more drinks of alcohol in a row, that is,

22

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within a couple of hours?, and During the past 30 days, on how many days did
you have at least one drink of alcohol on school property?
The marijuana questions utilized were: During your life, how many times
have you used marijuana?, How old were you when you tried marijuana for the
first time?, During the past 30 days, how many times did you use marijuana?,
and During the past 30 days, how many times did you use marijuana on school
property?
Cocaine use was assessed with: During your life, how many times have you
used any form of cocaine, including powder, crack, or freebase? and During the
past 30 days, how many times did you use any form of cocaine, including powder,
crack, or freebase?
Data Analyses
All analyses were carried out with SPSS version 19.0 with the complex
samples module. Chi-square analyses were used to examine differences in the distribution of smoking on school property by gender, grade, and ethnicity. Bivariate
logistic regression analyses were carried out on substances (yes versus no) for
participants who reported smoking on school property versus participants who did
not report smoking on school property.
Results
Of the adolescents who smoked in the past 30 days, 28% (n = 683) reported
smoking on school property in the past 30 days. The percent of participants
who smoked on school property versus participants who did not smoke on school
property are presented by gender, grade, and ethnicity in Table 1. Only the analysis
for gender was significant ( 2 = 5.01; df = 1, 43; p < .05). Although a larger
percentage of male smokers smoked on school property when compared to female,
overall a small percent of both genders reported smoking on school property. The
effect size of the gender difference was small. In addition, the findings for male
and female adolescents were similar. That is, a smaller percent of male and female
smokers reported smoking on school property. Therefore, subsequent analyses
were not carried out adjusting for gender.
Separate binary logistic regression analyses were conducted with smoking
on school property as the dependent variable and substance use (yes versus no)
as the factors. The results of the analyses are presented in Table 2. All of the
logistic regression analyses were significant (all ps < .001). The odds ratios
ranged from 2.26 to 8.14. The highest odds ratio was for adolescents who reported
using marijuana on school property in the last 30 days. Adolescents who reported
smoking on campus were 8.1 times more likely to smoke marijuana on school
property in the last 30 days when compared to youth who did not smoke cigarettes
on school property.

Sneed et al.

TABLE 1. Unweighted Counts With Weighted Percentages for Gender, Grade,

and Ethnicity by Smoking on School Property (Yes/No) and Total Sample

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Smoked on School Propertya

Gender
Male
Female
Grade
9th
10th
11th
12th
Ethnicity
Caucasian
African American
Latino
Other
aRow

Yes

No

Total Sampleb

415(31%)
261(24%)

936 (69%)
810 (76%)

1408(56%)
1106(44%)

115(27%)
156(30%)
199(29%)
199(26%)

312 (73%)
362 (70%)
481 (71%)
578 (74%)

440(18%)
538(22%)
705(28%)
811(32%)

324(27%)
65(30%)
191(26%)
85(36%)

870 (73%)
153 (70%)
546 (74%)
150 (64%)

1238(50%)
235(10%)
753(30%)
248(10%)

percent is presented in the table text.

percent is presented in the table text.

bColumn

TABLE 2. Odds Ratios for Smoking on School Property by Substance

Questions

Odds ratio (95 CI)a

Had a drink before age 13

During the past 30 days, at least one drink
During the past 30 days, five or more drinks of
alcohol in a row (binge drinking)
During the past 30 days, at least one drink of
alcohol on school property
Used marijuana at least once in their life
Used marijuana before age 13
During the past 30 days, used marijuana at least
once
During the past 30 days, used marijuana on
school property at least once
Used cocaine at least once in their life
During the past 30 days, used cocaine at least once

2.26 (1.782.87)b
2.72 (2.013.70)b
2.77 (2.053.74)b

a95%
bP

Confidence Interval in parentheses.

< 0.001.

5.70 (4.297.57)b
3.91 (2.316.62)b
2.30 (2.303.82)b
3.06 (2.324.03)b
8.14 (5.9011.23)b
3.85 (3.987.75)b
5.55 (3.987.75)b

23

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Adolescents who smoked on school property were; 2.26 times more likely
to have drank before the age of 13, 2.72 times more likely to have had at least
one drink in the last 30 days, 2.77 times more likely to have had five or more
drinks in a row in the last 30 days (data calculated for adolescents who reported
drinking), 5.7 times more likely to have drank alcohol on school property in the
last 30 days (data calculated for adolescents who reported drinking), 3.91 times
more likely to have used marijuana in their lifetime, 2.30 times more likely to have
used marijuana before 13 years old (data calculated for adolescents who reported
smoking marijuana), and 3.85 times more likely to have used cocaine at least once
in their lifetime compared to adolescent smokers who did not smoke on school
property.
Discussion
The purpose of the current study was to determine if smoking on high school
property was associated with increased risk for other substance use among U.S.
adolescents. In comparison to those individuals who did not smoke on school
property, adolescent smokers who smoked on school property were at increased
risk for using all substances examined in this study. Within the previous month of
taking the CDC survey, adolescents who smoked on campus were nearly 3 times
more likely to have engaged in binge drinking, nearly 6 times more likely to have
drank alcohol on school property, 8 times more likely to have smoked marijuana
on school property, and 5 and a half times more likely to have used cocaine. Campus smokers were also 4 times more likely to have used marijuana at least once
in their life and nearly 4 times more likely to have used cocaine at least once in
their life. These findings support the contention that an adolescents willingness
to break the social norm of smoking on school property is positively associated
with increased risk for use of other substances. Prior research has demonstrated
the relationship between tobacco use and substance use among adolescents. It has
generally been found that adolescents who smoke are more likely to use other
substances (Kandel, 2002). Our research provides a novel approach to understanding the relationship between adolescent smoking and their use of other substances. We were able to identify increased risk for adolescent substance use based
on the location of smoking. Specifically, we found smoking on school property
was associated with increased risk for use of other substances among adolescent
smokers.
Other studies have found predictors for alcohol and drug use. For example,
peer influence and parental monitoring are two of the most commonly researched
factors associated with substance use among adolescents (Dishion & McMahon, 1998; Sussman, Pokhrel, Ashmore, & Brown, 2007). Assessment of these
predictors may be somewhat complex and often require a series of questions
embedded in a research study. In addition, the risk and protective factors for

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Sneed et al.

25

adolescent drug use are many and interdependent. Thus, identifying adolescents
at risk for more serious or illicit drug use may be difficult (Newcomb, 1995). Identifying adolescents who smoke on school property offers a simple yet important
method to screen adolescents for more serious substance use. Thus, this information can be used as a point of intervention for substance using adolescents. It is
also important considering that substance abuse at this young age increases their
chances of becoming long time abusers of that drug as an adult (Grant & Dawson,
1998).
The findings of the current study are limited. Smoking on school property
is one specific behavior and will not identify all adolescents with substance use
problems. That is, a myriad of factors that may impact substance use among
adolescents. However, we believe that identifying and targeting adolescents who
smoke on campus can be used as a supplement to an array of techniques used to
identify substance use.
Changing social norms on marijuana can also impact the implications of the
current study. The legalization of marijuana, or semi-legalization in the case of
medical marijuana, may change its perception to one similar to that of cigarettes
or alcohol. In such a scenario, the relationship between smoking on school property and marijuana use is likely to change along with changes in societal values
concerning marijuana use. Thus, it may be interesting to replicate the current
study in cities in the United States where marijuana use is legal for medicinal
purposes.
Our findings may have important implications for public health interventions to reduce or prevent substance use among adolescents. Interventions that
include students who have smoked on school property may want to adapt their
anti-smoking program to other types of drug abuse, such as binge drinking and
marijuana (Riedel, Robinson, Klesges, & McLain-Allen, 2002). Identifying adolescents who have smoked on school property does not need to be limited to school
authorities as eye witnesses. Medical personnel (e.g., doctors, nurses) during an
adolescent health visit can question students on substance abuse issues, including
asking if they have smoked on school property (Kulig, 2005). This approach may
be useful for adolescents that may be more willing to discuss smoking than use of
other substances.
Future studies can identify other drug related behaviors that break social
norms to determine further drug abuse. For example, what are the nonnormative
behaviors that are associated with alcohol or marijuana use among adolescents
that indicate a more severe substance use problems. As a whole, this method
could offer a wide range of simple drug abuse identifiers for educators and school
authorities. Multiple identifiers could help nullify an adolescents adaptation from
being caught. That is, once a particular technique is used to identify substance
abuse, teenagers tend to learn how to evade it (Hyde et al., 2001). Having multiple
indicators of serious drug use may make it more difficult for adolescents to conceal
their substance abuse problems.

26

The Journal of Psychology

Conclusion

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The results of the current study are novel because we demonstrated that
smoking on school property placed adolescent smokers at increased risk for other
substance use. We concluded adolescents who are willing to break the social
norm by smoking on school property have a high likelihood of binge drinking,
marijuana use, and cocaine use. From these findings, school officials can use this
simple identifier to screen for possible serious drug use problems and provide
intervention to prevent substance use continuing into late adolescence and early
adulthood. The findings are limited because there are several other factors that
may contribute to adolescent substance use.
AUTHOR NOTES
Carl D. Sneed is an associate professor at California State University,
Dominguez Hills. His research interests are in adolescent health and risk behavior.
Nicole F. Mehdiyoun is a clinical research manager of the Indiana University
Psychotic Disorders Program (IUPDP). Her research interests are in symptom
reduction, improved cognition, and comorbid substance use among people diagnosed with psychotic disorders. Scott H. Matsumura is a research assistant
at California State University, Dominguez Hills. His research interests are in
cognitive neuroscience. Ryan A. Hess is a doctoral candidate in counseling psychology at Ball State University in Indiana (USA). His research interests are in
help-seeking, social justice, attachment theory, and traumatic brain injuries.
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Original manuscript received November 25, 2012

Final version accepted August 18, 2013