Susceptibility of youth to tobacco: a social ecological framework for prevention

For most smokers, tobacco dependence begins in childhood or adolescence. Th is review summarizes the state of social science with respect to the preven tion of tobacco use. Social ecology is introduced as a theoretical framewor k useful for organizing prevention approaches. In recent years, the field h as shifted from approaches directed at individuals, towards appreciation of additional, more comprehensive social and environmental influences on init ation. These range from intra-individual factors (including physiological r esponses to nicotine and the psychology of use) to individual, interpersona l, organizational, community, and population factors affecting access and d emand. This review highlights prevention approaches that address social and societal influences, from school programs that attempt to change susceptib ility of individual youth to tobacco, to community projects, media campaign s, restrictive policies, and tobacco pricing. The most promising approaches are those designed with input based on extensive formative research includ ing studies with youth, directed at multiple levels of the social ecology, and sustained over time with significant resources and ongoing, multi-secto r inputs. (C) 2001 Elsevier Science B.V. All rights reserved.