This section outlines four psychosocial theories of adolescent smoking behaviour. Each model gives insight into different driving forces that encourage adolescents to initiate and continue smoking. Smoking behaviour has a high element of risk associated with it and each of these models is important in explaining why young people still choose to experiment with tobacco.
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Adolescent perceptions of risk
The risks of smoking are well-known to young people. Addiction to, and disease arising from, tobacco products are widely publicised. Young people are the predominant targets of these messages. Why do youth continue to initiate smoking at such young ages when there appear to be no benefits to them by doing so?
Frankenberger (2004) proposes that the perceived risk of smoking makes it appealing to adolescents through their creation of a ‘personal fable’, a belief that they are not susceptible to such risks. The author found that young people who have tried smoking previously were likely to believe that they are invulnerable to tobacco addiction. This increases the chance that these individuals will smoke again in the future as they conclude that they will not become addicted. Perceptions of addiction also vary by gender; girls are more likely than boys to believe that smoking is not addictive (Lundborg & Andersson 2008). This research found that both girls and boys take into account the risk of addiction and mortality when experimenting with tobacco. The authors proposed that this plus the varying perceptions of addiction might go some way to explain the gender gap in adolescent smoking rates given that females are more susceptible to tobacco addiction than males and fewer females successfully quit smoking.
Adolescent beliefs that they are not vulnerable to the risks associated with smoking go hand in hand with their perceptions of the benefits associated with smoking initiation. Song et al. (2009) supported the previously mentioned papers in linking perceptions of risk to youth smoking initiation. This research found that adolescents who had the lowest perceptions of long-term smoking risks were 3.64 times more likely to initiate smoking. Those with the lowest perceptions of short-term smoking risks were 2.68 times more likely to do so. The authors also looked at the perceived benefits of smoking initiation. These included “looking cool, feeling relaxed, becoming popular, and feeling grown up.” Adolescents who had the highest perceptions of such benefits were 3.31 times more likely to initiate smoking.
24 If the health messages that seek to inform adolescents of the related risks are the very reason that they take up smoking then it will be difficult to stop adolescents from initiating smoking. Both risks and benefits are important to young people when experimenting with tobacco. Young people are likely to weigh up their perceptions of such benefits and risks when making the decision to start smoking.
Stress-coping model
The stress-coping model (Wills & Filer 1996) states that stress is an important factor in adolescent substance abuse. Smoking plays a major role in self-help strategies when dealing with stress and individuals who smoke are likely to go on to use a wider range of psychoactive substances to help them cope (Revell et al. 1985). This behaviour is considered self-reinforcing as smoking does not deal with the original source of stress while consumption increases. Smokers widely report that they feel more relaxed following a cigarette but they also report higher levels of stress than non-smokers (Long 2003). This theory is related to Marmot & Wilkinson’s (2001) argument for the effect of psychosocial pathways in relation to inequalities and health. The authors, without discussing smoking directly, stated that individuals living in countries that have pronounced income inequalities are likely to experience greater stress in their lives (Marmot & Wilkinson 2001). Individuals living in deprived circumstances are more likely than less deprived adolescents to experience stress and take up smoking as a means of self-help.
Finkelstein et al. (2006) examined the relationship between stress, social status and adolescent smoking. The authors found that youth with lower social status, measured by parental education and school social status, were more likely to be current smokers. In addition, higher levels of perceived stress were associated with increased risk of an adolescent being a current smoker. Perceived stress did not explain the relationship between lower social status and adolescent smoking rates. These results suggest that interventions focused on providing young people with stress reduction techniques may be effective in reducing youth smoking initiation. Based on the research these
25 interventions would not be effective in reducing current social inequalities in youth smoking.
Scales et al. (2008) stated that the attitude of teens who use their smoking as a relief from stress is picked up from cultural cues. The roles of media, friends, and family are important in building the perception that smoking reduces stress. The authors also found that teen smokers often viewed smoking cessation as a stressful experience so they are less motivated to quit. An attempt to quit may result in an increase in stress levels and in turn lead to a continuation of smoking to cope with the situation.
Social-influence model
The social-influence model states that role models, in particular parents and peers, can influence adolescents’ substance use through self-modeling or explicit encouragement (Wills et al. 2004). Social learning theory shows that there are three steps in adolescent involvement in substance use. First, is the observation and imitation of substance use behaviours, followed by social reinforcement for the continued use of a specific substance before the adolescent has finally created their own social and psychosocial expectations of the outcome of substance use (Petraitis et al. 1995). This suggests that peers and family members can encourage smoking initiation both actively and passively, and the continuation of adolescent smoking behaviour. Focus group interviews of African American adolescents found that many of the participants first experience with smoking was lighting cigarettes for their parents (Beech & Scarinci 2003). There was a direct link between these experiences during childhood and early adolescence and smoking initiation as the adolescents began to smoke their parents’ cigarettes.
Brown et al. (2006) found that adolescents were likely to over-report on peer smoking rates. This led young people to believe that smoking is a significantly more normal and socially acceptable behaviour than is true in reality. Notably, the majority of participants believed that smoking was not a popular or desirable behaviour for young people to engage in, but over 60% stated that
26 the primary reason for adolescents to start smoking was to become more popular and to ‘fit in’. These findings were supported by Scales et al. (2008) who found that the teenager’s social environment plays a major role in defining their smoking behaviour. Adolescents begin smoking mainly to improve their social image; this attitude is developed largely by media portrayals of smoking and of smoking being an adult behaviour which young people aspire to in order to appear more mature. If smoking continues to be seen as a positive behaviour in the social environment, young people may potentially decide that the personal benefits of such behaviour outweigh the costs and continue smoking independent of external influences.
Problem-behaviour theory
Problem behaviour theory (Jessor & Jessor 1977) suggests that some adolescents are more prone than others to engage in deviant behaviour leading to the possible onset and continuation of substance use. This theory is closely tied to the previous two models, as peer and parental influences can often modify attitudes either positively or negatively. Reinforcement of deviant behaviour from social sources will likely lead to continuation of the behavior, while some evidence suggests that the reverse may also be true (Wills et al. 2004). Problem behaviour theory is also linked to stress-coping theories where the underlying cause or escalator of substance use may be stress- related. In turn, adolescents with poor coping techniques and support will likely continue with substance use, such as smoking, while those who find support and have the psychosocial ability to cope may produce better outcomes over time (Downey et al. 2010).