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American Behavioral Scientist
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Large-Scale Environmental Risk Factors for Substance Use

THOMAS A. WILLS

Albert Einstein College of Medicine

JOHN P. PIERCE

University of California, San Diego

RICHARD I. EVANS

University of Houston

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 use. 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.

American Behavioral Scientist, Vol. 39, No. 7, 808-822 (1996)
DOI: 10.1177/0002764296039007004
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