The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.

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This prospective study compared the ability of 4 smoking expectancy measures to mediate the influence of peer, parent, and current smoking on adolescents' cigarette use 3 months later. No evidence for mediation was found when expectancies were operationalized as unidimensional subjective expected utility (SEU), multidimensional SEU, or unidimensional SEU decomposed into probability and desirability main effects and their interaction. Evidence for partial mediation was found for the decomposed multidimensional SEU measure. The results suggest that (a) peer and current cigarette use may influence future smoking indirectly through adolescents' probability estimates that smoking will control negative emotions and (b) the relationship between current and future smoking also may be mediated by adolescents' beliefs about the desirability of weight control.

This investigation describes what smoking means to adolescents, and attempts to better understand it as a rite of passage. Applying a social ontology to an often‐individualized issue, interviews were conducted with 20 adolescent smokers between the ages of 13 and 19. Results show that adolescents possess detailed information about the risks of smoking. Both age and gender differentiated the meanings of smoking which were found to be both positive and negative. Valence inconsistency increased with age. Results are interpreted within a cultural, developmental framework and suggest reconstructing smoking risks as potentially positive. Implications for research and prevention are discussed.

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