Protocol - Peer and Family Influence on Smoking

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The Pierce 5-item National Cancer Institute (NCI) measure consists of 5 questions about peer and family smoking. The indices are scored dichotomously as "no exposure" versus "exposure." No exposure to family smoking: "No" on both family items (items 1 and 3). No exposure to friend smoking: "00" on both friend items (items 4 and 5).

Specific Instructions:

Although it has not been used with people over age 22, to date, scientists may consider using this measure with participants up to age 26 as the most recent Surgeon General’s Report on young adult smokers, published in 2012, indicates that smoking initiation continues up to age 26.


1. Do any of your parents, step-parents, or guardians now smoke cigarettes?

[ ] 1 YES

[ ] 2 NO

[ ] -7 REFUSED

[ ] -8 DON’T KNOW

2. Do you have any older brothers or sisters?

[ ] 1 YES

[ ] 2 NO

[ ] -7 REFUSED

[ ] -8 DON’T KNOW

3. Do your older brothers or sisters smoke cigarettes?

[ ] 1 YES

[ ] 2 NO

[ ] -7 REFUSED

[ ] -8 DON’T KNOW

4. Of your best friends who are male, how many of them smoke?

NUMBER |_|_|


[ ] -7 REFUSED

[ ] -8 DON’T KNOW

5. Of your best friends who are female, how many of them smoke?

NUMBER |_|_|


[ ] -7 REFUSED

[ ] -8 DON’T KNOW

Protocol Name from Source:


Publicly available

Personnel and Training Required


Equipment Needs


Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered or interviewer-administered questionnaire

Life Stage:

Adolescent, Adult


Adolescents ages 12-17 and young adults ages 18-22.

Selection Rationale

The Pierce 5-item measure focuses on exposure to family and social network tobacco use and can be applied to teens and young adults. It is recommend by the National Cancer Institute (NCI) Measures Guide on Youth Tobacco Use.

The Working Group recommends that these items can be applied to other tobacco use (e‑cigarette, hookah), although the measure has only been validated using cigarettes. Therefore, caution should be taken when applying it to other tobacco products.

It should also be noted that "best friend" networks have changed and the use of hookah, e‑cigarettes, and cigars are often done in bars or lounges with groups. For example, social media, technology, and social environments (like hookah lounges) may have changed how young people define "best friends." Although this has not been studied extensively, young people who consider their social media friends as best friends may indicate that they have large numbers of people in their best friend network, increasing the density of that network. Therefore, when asked the question, "How many of your best friends who are male smoke e-cigarettes?" they may be responding to this question based on social media friends. In addition, they may also be responding based on the friends that they meet with on a regular basis to smoke hookah in lounges.



Common Data Elements (CDE) Tobacco Use Peer and Family Influence Assessment Score 4719175 CDE Browser
Derived Variables


Process and Review

Not applicable.


National Cancer Institute (NCI). (1998). NCI Measures Guide for Youth Tobacco

Research-Peer and Family Smoking. cancercontrol.cancer.gov/brp/tcrb/guide_measures.html

General References

Pierce, J. P., Choi, W. S., Gilpin, E. A., Farkas, A. J., & Berry, C. C. (1998).Tobacco industry promotion of cigarettes and adolescent smoking. Journal of the American Medical Association, 279, 511-515.

Pierce, J. P., Distefan, J. M., Jackson, C., White, M. M., &Gilpin, E. A. (2002). Does tobacco marketing undermine the influence of recommended parenting in discouraging adolescents from smoking? American Journal of Preventive Medicine, 23, 73-81.

Protocol ID:


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX710901050000 Of your best friends who are female, how more
many of them smoke? Number? show less
PX710901040000 Of your best friends who are male, how many more
of them smoke? Number? show less
PX710901020000 Do you have any older brothers or sisters? N/A
PX710901030000 Do your older brothers or sisters smoke more
cigarettes? show less
PX710901010000 Do any of your parents, step-parents, or more
guardians now smoke cigarettes? show less
Tobacco Regulatory Research
Measure Name:

Peer and Family Influence on Smoking

Release Date:

February 20, 2015


This measure assesses the adolescent’s assessment of the use of cigarettes by parents and siblings and perception (not actual use) of the number of friends who use tobacco in their best-friend social network. This measure focuses on exposure of the adolescents to smoking in their immediate social networks.


This specific index was developed to assess the smoking status of immediate family members and best friends.


Peer influence, smoking influence, parental influence, smoking exposure