Influence of microenvironmental factors on tobacco consumption among Spanish youth

<h2>Abstract</h2><h3>Introduction</h3> The onset of tobacco use is occurring at increasingly younger ages. Numerous studies have identified risk and protective factors associated with smoking in adolescents, with family factors being among the most influential. Likewise, the group of friends and the role of teachers as role models also exert a notable influence on the onset of consumption. <h3>Objective</h3> To analyze the influence of social and family role models on tobacco consumption in adolescents, considering these factors as elements of the microenvironment. <h3>Method</h3> A retrospective cohort study was conducted at three points (2011, 2016 and 2019). The sample, incidental in nature, consisted of 3,928 Spanish students aged 12-14 years, enrolled in Compulsory Secondary Education in 54 educational centers. Data collection was performed by means of a self-administered questionnaire designed ad hoc, with adequate internal consistency (Cronbach's alpha). Previously, a health education and prevention program developed by the Spanish Association Against Cancer (Asociación Española Contra el Cáncer) was applied. Both the intervention and data collection complied with the established ethical principles. Statistical analysis included descriptive techniques, bivariate and multivariate analyses and binary logistic regression models. <h3>Results</h3> The influence of family and social models on tobacco use varied between cohorts. The paternal figure showed an influence of 1.3% in 2011, 0.7% in 2016, and 0.8% in 2019; the maternal figure of 2.2%, 1.5% and 0.3%, respectively. Siblings had an influence of 4.3% in 2011, 1.6% in 2016 and 0.5% in 2019. The influence of the best friend was 23.2% in 2011, 18.7% in 2016 and 1.7% in 2019. The figure of the teacher was relevant in 2011 (0.9%) and 2019 (0.4%). Regarding multivariate predictive models, in 2011 older age explained 10.5% of consumption. In 2016, older age, peer pressure and less family communication explained 20.4%. In 2019, younger age, more available money and peer pressure explained 2.4% of consumption. <h3>Conclusions</h3> The results reinforce the importance of social and family patterns as risk factors in the early stages of adolescent smoking. The multicausal nature of smoking in this vital stage justifies the design of preventive interventions aimed at modifying risk factors and promoting protective factors.