Large-scale environmental risk factors for substance use

This article discusses evidence on the importance of large-scale environmental risk factors for onset of tobacco, alcohol, and other drug use. It is suggested that smoking onset occurs through a process in which some individuals change from nonsmoking to susceptibility, experimentation, and adoption of regular we. A distinction is made between distal and proximal risk factors, and a model is outlined that encompasses both levels. We consider evidence on large-scale variables including socioeconomic status, ethnicity, and media advertising as factors in onset and discuss how the effects of these large-scale variables are mediated. Recommendations for research and program development are made.