Original article Perceived smoking norms, socioenvironmental factors, personal attitudes and adolescent smoking in China: a mediation analysis with longitudinal data Xinguang Chen, M.D., Ph.D. a, *, Bonita Stanton, M.D. a , Xiaoyi Fang, Ph.D. b , Xiaoming Li, Ph.D. a , Danhua Lin, Ph.D. b , Jintao Zhang, M.S. b , Hongjie Liu, Ph.D. a , and Hongmei Yang, Ph.D. a a Pediatric Prevention Research Center, Wayne State University School of Medicine, Detroit, Michigan b Institute of Developmental Psychology, Beijing Normal University, Beijing, China Manuscript received August 30, 2004; manuscript accepted March 14, 2005 Abstract Purpose: To gather information on inter-relationships among risk factors affecting adolescent smoking for tobacco control in China, the world’s largest tobacco producer and consumer. Method: Longitudinal data were collected six months apart in 2003 from 813 students in grades 7, 8, 10, and 11 from two schools in Beijing, China. Linear regression was used to assess both the direct effect from predictor variables (smoking among influential others, pro-tobacco media, and attitudes toward smoking) on cigarette use and the indirect effect mediated through the perceived smoking norms (percentage of smokers among peers). Results: Among the 803 subjects (mean age of 15.5 years, SD = 1.7; 52.1% female), 18.3% of males and 1.7% of females smoked in the past 30 days. Smoking among influential others (best friends, father, mother, male teachers, female teachers, and adults in general) and perceived positive psychological and social rewards from smoking at baseline were associated with number of cigarettes smoked at follow-up, whereas exposure to pro-tobacco media was not significantly associated with smoking. The mediated effect was greater for adult smoking (70% to 90%) than for best friend smoking (11% to 16%). Conclusion: Smoking among influential others and attitudes toward smoking influence adolescent smoking both directly and indirectly. The finding of the indirect effect mediated through perceived smoking norms expands our knowledge on smoking etiology. Effective adolescent smoking inter- vention programs in China need to include a component targeting adult smoking to reduce perceived smoking norms. © 2006 Society for Adolescent Medicine. All rights reserved. Keywords: Perceived smoking norms; Socioenvironmental factors; Adolescent smoking; China Despite substantial progress in our understanding of to- bacco use over the past decades, further advances in tobacco research require in-depth research to examine the relation- ships among risk factors in predicting adolescent tobacco use [1,2]. Using linear and/or logistic regression methods, numerous studies have identified that smoking norms, smoking among important others (best friends, siblings, parents), pro-tobacco media exposure, and personal atti- tudes in favor of tobacco use are associated with increased risk of smoking in adolescents [3–5]. However, little is known about the possible relationships among these risks and their interactions with each other in predicting adoles- cent smoking. Understanding both the independent effect and “joint” effect of these variables would not only further our understanding of the etiology of adolescent tobacco use, but also facilitate the development of health behavioral *Address correspondence to: Dr. Xiaoyi Fang, Institute of Develop- mental Psychology, Beijing Normal Univrsity, Beijing, China. E-mail address: xyfang@email.bnu.edu.cn Journal of Adolescent Health 38 (2006) 359 –368 1054-139X/06/$ – see front matter © 2006 Society for Adolescent Medicine. All rights reserved. doi:10.1016/j.jadohealth.2005.03.010