IntroductionThere is a well-recognized relationship between smoking trends and psychosocial differences and other personal characteristics. This study aims to examine smoking patterns in boys and girls and to identify genetic/biological (sex) and environ-mental/cultural (gender) risk factors associated with adolescent tobacco smoking.MethodsThe National Adolescent Health Survey (NAHS) pro-vided a representative sample of 11,582 students in French secon-dary public schools from eight metropolitan districts, who completed a self-administered standardized questionnaire. The questionnaire consisted of socio-demographic items and various adolescent risk behaviors. Variables were classified as sex-specific (puberty, menstrual cycle, hormone intake), gender-specific (envi-ronmental tobacco smoking, alcohol consumption, drug abuse) and sex/gender influenced factors (sexual intercourse, contraceptive use, body mass index (BMI), physical activity).ResultsThe overall prevalence of active smoking was 15.6% and there was no statistically significant difference between girls (15.8%) and boys (15.4%). Boys and girls differed considerably regarding smoking behavior and factors that were socially influenced or mediated: puberty (adjusted odds-ratio for being regular smoker compared to non smokers (OR) = 4.7 [95% CI: 3.5, 6.5] in boysvs.18.0 [9.6,32.0] in girls), exposure to passive smoking (OR=3.3 [2.3,4.8]vs.4.8 [3.2,7.2]), alcohol consumption (OR=2.9 [2.1,3.9]vs.4.6 [2.7,7.9]) and drug abuse (OR=15.0 [12.0,20.0]vs.12.0 [8.8,16.0]). Girls using birth control pill had an increased tobacco consumption (OR=2.5 [1.8, 3.6]). No other statistically significant differences were observed between sexes. The only protective factor for both boys and girls was living with parents (OR= 0.61 and 0.62 respectively).ConclusionsThe prevention of unfavorable health behavior like smoking among adolescents is linked to understanding the interactions of various individual characteristics and therefore the determination of sex-related and gender-specific or sex/gender influenced factors of risk is indispensable.