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Cigarette Smoking Motives
in Young Adolescents
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This paper examines motives that influence adolescents in their decision to use tobacco products in the United States and also suggests programs to prevent young adults from becoming users. Based on a study of almost 1500 adolescents aged 11 to 14 years old, results suggest that friends' and parents' smoking and cigarette advertising have a strong effect on adolescents' smoking behavior. Introduction Today, as in every other day of the year, more than 3,000 US adolescents will smoke their first cigarette on their way to becoming regular smokers as adults.1 During their lifetime, it can be expected that, of these 3,000, about 23 will be murdered, 30 will die in traffic accidents, and nearly 750 will be killed by a smoking-related disease.2 The number of deaths attributed to cigarette smoking clearly outweighs all other factors, whether voluntary or involuntary, as a cause of death. Furthermore, tobacco use in adolescence is associated with a range of health compromising behaviors, including being involved in fights, carrying weapons, engaging in higher-risk sexual behavior and using alcohol and other drugs. The Federal Trade Commission reports that: One out of the every seven deaths in the United States is related to smoking. * Smoking by mothers diminishes the mental and physical capabilities of their children. * Tobacco kills 13 times as many Americans as hard drugs and eight times as many as automobile accidents. * Passive smokers (those who must inhale the smoke of others'cigarettes) are perhaps three times likelier to die of lung cancer than they would be otherwise. * Smoking kills 52,000 Americans each year through bronchitis and emphysema. * About 30 percent of high-school boys chew tobacco or use snuff. Unfortunately these forms of tobacco are strongly linked to oral cancer.3 Direct economic cost of smoking in the United States amounts to $12-35 billion per year (three to nine percent of all health care costs). Further, lost income and work due to death and illness caused by smoking cost the United States $27-65 billion a year. Thus, health expenditures plus economic losses in the US range from $38-95 billion or $1.27-3.17 per pack. Despite the explicit health warnings, large numbers of young people continue to take up tobacco; in the United States, currently over three million adolescents smoke cigarettes, and over one million adolescent males currently use smokeless tobacco.4 Clearly, effective interventions are needed to prevent more young people from trying tobacco. To achieve significant long-term reductions in tobacco use and tobacco-related death in the United States, we must examine the nature and scope of youth tobacco use, explore the social, psychological, and marketing motives that influence young people in their decision to use tobacco products, and develop strategies and programs to prevent young people from becoming users. This paper examines motives for smoking and provides a comprehensive approach to smoking cessation. Predictors of Cigarette Consumption Research into the forces affecting cigarette consumption has identified a number of influential factors: 1. Socio-economic Variables: Several researchers have highlighted income levels and the price of cigarettes as key factors influencing consumption. Bishop and Yoo,5 Wilcox and Vacker6 and Wörgötter and Kunze7 concluded that cigarette costs and excise taxes have a greater impact on consumption than the health scare or the advertising ban. However, Balgati and Levin8 and Franke9 suggested that taxation may not be as effective as previously thought due to low per capita income elasticity. 2. Health Care Issues: A number of researchers have examined the effects of anti-smoking messages and the health scare associated with smoking. Hamilton10 concluded that anti-smoking messages and the U.S. Surgeon General's Report reduced cigarette consumption much more than advertising had increased it. Warner and Murt11 and Wilcox and Richards,12 however, found that the health scare had little or no effect on cigarette consumption. 3. Broadcast Advertising Ban: Early studies did not discover any significant impact of the U.S. ban on broadcast advertising for cigarettes on their consumption13,14. Boddewyn15 reported that cigarette advertising bans in 16 countries have had little, if any, effect on the demand for cigarettes. 4. Advertising: The effect of advertising on cigarette consumption has been examined by several researchers. Based on annual data covering the years 1925 to 1970, Hamilton10 concluded that the demand for cigarettes was only minimally related to advertising. In contrast, after analyzing data for the years 1952 to 1968 in the United Kingdom, McGuinesss and Cowling16 found that advertising had a statistically significant effect on aggregate consumption. Similarly, Leefland and Revijl17 concluded that advertising appeared to have a significant effect on the primary demand for cigarettes in the German market, although its influence diminished over time. In a recent study, Wilcox18 determined that the demand for five cigarette brands exhibited significant positive relationships with their advertising levels. On the other hand, Smith19 also studied the impact of advertising on juvenile smoking behavior in 15 countries and found that tobacco advertising controls did not appear to have the intended impact on the incidence of juvenile smoking. 5. Interpersonal Variables: Research on adolescent smoking suggests that for beginning smokers, curiosity, social norms, peer influence, and social pressures were the most frequently given reasons for smoking. For current smokers, pleasure and addiction were mentioned most often.20 Hill and Borland21 studied the influences of school, work, and other settings on adults' regular smoking behavior. Their results suggested that although school was the dominant setting particularly for younger respondents, the workplace was also an important setting for uptake of regular smoking. Furthermore, about two-thirds of the sample indicated that either friends, family, or workmates had influenced them to take up smoking. More recently, Flay et al.22 also investigated the differential influence of parental smoking and friends' smoking on adolescents' smoking initiation and escalation of smoking. They found that friends' smoking had both direct and indirect influences on adolescent initiation of smoking, but only indirect effects on escalation. Parental smoking had only indirect effects on initiation and escalation. In general, they concluded that friends' smoking had a stronger effect on adolescents' smoking behavior. This may suggest that when developing interventions, smoking prevention programs need to consider the reasons adolescents give for smoking. Understand-ing which reasons for tobacco use that are most prevalent at various stages of the smoking onset process might be useful in designing prevention program components to address specific motivations for using tobacco at the various stages. A total of 1462 adolescents (55.3 percent males, 44.7 percent females) ages 11 - 14 in four geographically and demographically diverse rural and suburban elementary schools in New York state participated in this study. The questionnaire was delivered to each school by project staff members and administered to students by their respective classroom teachers with parental permission and the willing participation of each child. Through an informational letter to parents and by in-class procedures, parents and students were fully informed in advance and were given an opportunity to ask questions and to decline participation. The participating adolescents were shown a list of possible motives for starting to smoke and asked to indicate which, if any, applied to them. Motives for adolescents' tobacco use were: 1. advertising ("I have seen cigarette advertising"), 2. curiosity ("to see what it is like"), 3. social norms ("my parents smoke," "my brother[s]/sister[s] smoke[s])", "all my idols smoke," "some of my friends smoke"), 4. enhancement of self-image ("to look grown up"), 5. desire ("for a dare"), 6. preconceived expectations ("to look tough" and/or "having confidence", "to show off", and "calming nerves"), and 7. offers and/or pressures ("someone gives me" and "special occasion"). The most frequently reported motives for beginning to smoke among 1462 adolescents were social norms (17.7% males, 14.5% females, overall 32.2%), cigarette advertising (16.6% males, 20.8% females, overall 18.6%), offers and pressures (7.8% males, 6.8% females, overall 14.6%), and curiosity (11.3% males, 10.6% females, overall 10.9%). Significantly more females (20.8%) than males (16.6%) reported cigarette advertising as the primary motive for beginning to smoke. A gender difference was also found for desire and social norms, significantly more females than males reported desire (males 7.8% and females 8.7%) and social norms (males 14.5% and females 17.7%) as motives for beginning to smoke. An age difference was also found only for cigarette advertising. The influence of cigarette advertising as a motive for beginning to smoke has diminished as adolescents get older (for ages 11, 20.7%; 12, 17.3%; 13, 17.4%; and 14, 6.9%). Smoking cessation interventions should target the youth because of their greater vulnerability to a variety of smoking-related influences. If they can be prevented from taking up the habit, they will never have to kick it. Efficient smoking cessation programs should be carried out in schools as the majority of the smoking adolescents want to quit. The reasons for their desire to quit may suggest the appropriate content for a program, but the development of an effective program also requires insight into the motives of adolescents who become smokers. Considering the great health risk of young smokers, studies aimed at uncovering motives responsible for initiation of smoking and conditions that promote the continuation of smoking in youngsters are needed. The study reported in this article responds to these calls. Results clearly suggest that adolescents whose parents and/or friends use tobacco are more likely to smoke cigarettes. These findings are consistent with previous research23,24,25 on adolescent socialization into smoking and other substance use on the following points: (a) friends can influence adolescents' behavior through direct modeling as well as cognitive mediation, or both; and (b) in general, friends and idols have more influence than parents in early adolescence. Education about the influence of smoking on health must be strengthened. Strengthening adolescents' belief in their ability to control their own health may be an important component in preventing smoking initiation and in effective counseling of those wishing to stop. School education programs are clearly important in giving information, and with its focus on individual health, can change the perception of personal control and have important potential for reducing adolescent smoking. The education needs to be systematic, age-specific, and constant. The American Medical Association (AMA) is giving 18 states a $10 million grant to develop tobacco control and prevention programs. The educational programs need to be tailored to the minority use patterns and sensitive to special obstacles facing the community. The implementation of smoking prevention programs in school settings may be productive in reducing the influence of cigarette smoking. The underlying strategy is to harness the power of peer pressure in friendship and support groups to reinforce behavior as cool and acceptable behavior. These programs would attempt to dissuade the youth by providing them with factual information concerning the deleterious effects of cigarette smoking. These programs would also familiarize youths with the nature of the major social pressures to smoke and to teach ways of objectively coping with these pressures. The social pressures approach to smoking prevention has proven efficacious in several studies26,27. The approach concentrates on making adolescents aware of the social pressures to smoke from peers, parents, idols, and the mass media and on teaching them behavior skills with which to resist such pressures. Furthermore, prevention programs for adolescents will need to go beyond the school setting. Early cessation programs also need to be developed for this group and these will require components designed to motivate young adults to consider quitting, something which most current smoking cessation programs do not include. The success in preventing tobacco use is through persuasive messages which directly target tobacco-specific beliefs. The messages should increase adolescents' expectations regarding the adverse consequences of using tobacco and decrease their expectations regarding the potential benefits of using tobacco. A major key to prevention lies in making tobacco using role models less salient. Still further, teaching refusal skills and enhancing adolescents' refusal skills are crucial as well. Findings also suggest that cigarette advertising has stronger influence on smoking initiation. These results are counter to Smith's study19 which indicated that tobacco advertising has neither direct nor indirect effect on adolescent smoking. It would, therefore, seem a reasonable strategy to suggest further restriction of cigarette advertising by banning the Old Joe Camel cartoon character or all such characters, prohibiting cigarette advertising in magazines with significant youth audiences, permitting only "tombstone" advertising (with just the product packaging), or even banning cigarette advertising entirely. Banning advertising makes it much more difficult for cigarette manufacturers to market their products through warnings on cigarette packs. The federal government ought to embark on an anti-smoking advertising campaign. Although most consumers have been exposed to the general dangers of smoking, policy makers feel that many are unaware of the specific risks involved. The policy makers particularly note a lack of awareness among potential young adult smokers whose attitudes toward smoking are still evolving. Presenting young adults with specific warning information to assist them over time in their attitude formation about the dangers of smoking can be seen ultimately as one factor influencing smoking behavior. If this information is presented in a way that consumers who acquire it also believe in it, the protective influence intended more likely would result. In order for teen smoking to be curbed, society must be willing to first take responsibility for teens who are already smoking and learn from them. This means parents must be the cornerstone of the prevention. Education from schools and the community must augment parents' efforts. Community leaders and organizations should urge consumers to avail themselves of the educational programs that exist. These programs can help consumers decide that it is not worth the risk to buy and consume such products. Finally, the tobacco industry should admit what we already know to be true that kids are targets. The industry must be ethical and responsible. "Do the right thing" is what children need from their support systems, but children also must be helped to be responsible for their actions. For all of these factors to come together is not an easy task, it is not a band-aid solution, but the children of the world are at stake. 1. Roberts, S. "Teens on tobacco." U.S. News & World Report (April 18,1994): 38-43. 2. Glynn, T.J. "School-based programs for smoking prevention." Journal of School Health (May 1989): 181-188. 3. The Gallup Organization. Youth smoking cessation study. 1994. 4. Delener, N. The effects of advertising and social-cultural values on children's smoking behavior. Paper presented at the International Congress on Smoking Cessation. Glasgow, Scotland, 1994. 5. Bishop, J.A. andJ.H. Yoo. "Health scare, excise taxes and advertising ban in the cigarette demand and supply." Southern Economic Journal 52 (1985): 402-411. 6. Wilcox, G.B. & B. Vacker. "Cigarette advertising and consumption in the United States: 1961-1990." International Journal of Advertising 11 (1992): 269-278. 7. Wörgötter, G.F. and M. Kunze. "Cigarette prices and cigarette consumption in Austria,1955-1983." New York State Journal of Medicine (1986): 478-479. 8. Balgati,
B.H. and D. Levin. "Estimating dynamic demand for cigarettes using panel
data: The effects of bootlegging, taxation,
and advertising reconsidered." 9. Franke, G.R. "Determinants of U.S. cigarette consumption." Unpublished manuscript 1991. 10. Hamilton, J.J. "The demand for cigarettes: Advertising, the health scare, and the cigarette adver tising ban." Review of Economics and Statistics 54 (1972): 401-410. 11. Warner, K.E. and H.A. Murt. "Premature deaths avoided by the anti-smoking campaign." American Journal of Public Health 73 (1983): 672-677. 12. Wilcox, G.B. and J.J. Richards. "The cigarette advertising controversy: Will regulation help?" Proceedings of the American Academy of Advertising (1990): 61-64. 13. Peto, J. "Price and consumption of cigarettes: A case for intervention?" British Journal of Preventive Social Medicine 28 (1974): 241-245. 14. Teel, S.T., J.E. Teel, and W.O. Bearden. "Lessons learned from the broadcast cigarette advertising ban." Journal of Marketing 43 (1979): 45-50. 15. Boddewyn, J.J. Tobacco advertising bans and consumption in 10 countries. New York: International Advertising Association, 1986. 16. McGuinness, T. and K. Cowling. "Advertising and the aggregate demand for cigarettes." European Economic Review (1975): 311-328. 17. Leefland, R.S.H., and J.C. Revijl. "Advertising and industry sales: An empirical study of the West German cigarette market." Journal of Marketing (1985): 92-98. 18. Wilcox, G.B. "Cigarette brand advertising and consumption in the United States: 1949-1985." Journal of Advertising Research 31 (1991): 61-67. 19. Smith, G. "The effect of advertising on juvenile smoking behavior." International Journal of Advertising 9 (1990): 57-79. 20. Bertrand, L.D., and Abernathy, T.J. "Predicting cigarette smoking among adolescents using c cross-sectional and longitudinal approaches." Journal of School Health 63 (1993): 98- 103. 21. Hill, D., and R. Borland. "Adults'accounts of onset of regular smoking: Influences of school, work, and other settings." Public Health Reports 106 (1991): 181-185. 22. Flay, B.R., F.B. Hu, O. Siddiqui, L.E. Day, D. Hedeker, J. Petraitis, J.Richardson, and S. Sussman. Differential influence of parental smoking and friends'smoking on adolescent initiation and escalation of smoking." Journal of Health and Social Behavior 35 (1994): 248-265. 23. Conrad,
K.M., B.R. Flay, and D. Hill. "Why children start smoking cigarettes:
24. Charlton, A., and V. Blair. "Predicting the onset of smoking in boys and girls." Social Science and Medicine 29 (1989): 813-818. 25. Goddard, E. Why children start smoking: An enquiry carried out by social service division of OPCS on behalf of the department of health. London: HMSO, 1990. 26. Flay, B.R. "Psychosocial approaches to smoking prevention: A review of findings. "Health Psychology 4 (1985): 449-488. 27. Flay, B.R. "Social psychological approaches to smoking prevention: Review and recommenda tions." In Advances in Health Promotion and Education W. Ward, S. Simonds, P.D. Mullen, and M.H. Becker. (Eds.), Greenwich, CT:JAI Press, 1987. top
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Assessing
Cigarette Smoking Motives 