Diana Zuckerman, PhD
Everyone knows that smoking is unhealthy, but that didn’t stop major tobacco companies from spending $12 billion on tobacco advertising and promotion in 2006.[end Federal Trade Commission. “Cigarette Report for 2006” July 2009. August 2010 http://ftc.gov/os/2009/08/090812cigarettereport.pdf] Nor has it stopped one in five Americans who still smoked in 2008.[end Centers for Disease Control. “Cigarette smoking among adults and trends in smoking cessation – United States, 2008.” Morbidity and Mortality Weekly Reports. November 19 2009, August 16, 2010 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm] Almost all started smoking as children or youth, despite drug prevention efforts in most schools. The key to preventing adults dying from smoking is to understand how to prevent a nonsmoking child from becoming a smoker.
One study of more than 17,000 students ages 13-19, in grades 9-12 set out to provide that information. In addition to the large sample size, the study is impressive because it attempted to delineate the stages by which teens change from nonsmokers to regular smokers. They start with teens who have never smoked, categorizing them as “susceptible” if they didn’t say they “absolutely would not smoke” some time during the next year or ever in the future, even if one of their best friends offered a cigarette. The next stage – the experimenter – has never smoked an entire cigarette but has tried at least a few puffs. Those who have ever smoked an entire cigarette are categorized in terms of whether they smoked in the last 30 days. If not, they are categorized as former smokers who either think they would definitely never smoke again, or think they might. “Regular smokers” are defined as those who smoked at least one day during the previous 30 days and smoked at least 100 cigarettes in their lifetime.
Among the youngest (ages 13-14), 41 percent were deemed susceptible to smoking- which means that they did not vehemently rule out smoking in the future – compared to only 26 percent of the 17-18 year olds. Approximately one in three of the White and Hispanic youth were susceptible compared to 27 percent of the black youth. Approximately one in three females who had never smoked were susceptible, which was slightly higher than the males.
Approximately 9 percent of all adolescents were experimenters, regardless of their age. Blacks were more likely to be experimenters (14 percent) than whites (7 percent) or Hispanics (11 percent) Given the addictive nature of smoking and the cost, it is not surprising that older youth were more likely to be regular smokers – one in four of 17-18 year olds compared to 13 percent of 13-14 year olds. However, the 26 percent of white adolescents who were regular smokers was more than twice as high as the 12 percent of Hispanics and almost five times as high as the 5 percent of black adolescents who were regular smokers.[end Kaufman et al. Predictors of change on the smoking uptake continuum among adolescents Archives of Pediatrics and Adolescent Medicine, 2002;158:581-587]
In addition to demographics, there are other predictors of whether a youth is likely to smoke. Youth who are exposed to the smoking of friends or family members are more susceptible, more likely to have experimented with a few puffs, and much more likely to be regular smokers.[end Foster et al. Family socialization of adolescent’s self reported cigarette use: The role of parents’ regular smoking and parenting style. Journal of Pediatric Psychology. 2006;32:481-492]
Attitudes of adult role models can have as much of an impact on youth smoking habits as their behavior, and those attitudes don’t need to be explicit. A 2009 study found that a mother’s implicit attitude toward smoking, which was measured by a version of the Implicit Association Test to measure feelings that are not influenced by social cues, directly influences her child’s implicit attitudes about smoking. Similarly, a mother’s explicit attitudes towards smoking influenced her children’s explicit and implicit attitudes. A child’s implicit (but not explicit) attitudes then predict whether or not that he or she will be a smoker 18 months later. Teens who have positive implicit attitudes about smoking are more likely to smoke than their counterparts who do not view smoking positively. So, mothers’ attitudes about smoking, even if they are not consciously aware of them, influence children’s smoking habits by influencing the children’s implicit attitudes, but the fathers’ attitudes do not.[end Sherman SJ, Chassin L, Presson C, Seo D, Macy JT. The intergenerational transmission of implicit and explicit attitudes toward smoking: Predicting adolescent smoking initiation. Journal of Experimental Social Psychology. 2009;45:313-319]
Marketing by tobacco companies also plays a big role in getting kids to start smoking. Youth who were exposed to pro-tobacco media, whether through advertising or not, were more likely to hold a positive attitude of tobacco, and express intent to use tobacco in the future.[end Wellman et al. The extent to which tobacco marketing and tobacco use in films contribute to children’s use of tobacco. Pediatrics. 2006:160;1285-1296]
Skipping school and doing poorly in school also predicted being an experimenter or regular smoker. Lack of attendance in religious activities predicted regular smoking but not other behavior. “No smoking” policies at school – either on paper or enforced – were not related to whether students smoked or thought about smoking. Students who described themselves as having a favorite advertisement predicted being susceptible to smoking or having experimented by puffing on a cigarette, but did not predict being a regular smoker.3