5.24 Peer influence and education

Show / hide chapter menu

5.1 Introduction

5.2 Stages in the uptake of smoking

5.3 Factors influencing uptake by young people—overview

5.4 Physiological aspects

5.5 Individual personality traits and psychiatric influences

5.6 Intentions, attitudes and beliefs

5.7 The home environment

5.8 The smoking behaviour of peers, and peer attitudes and norms

5.9 The educational environment: achievements, aspirations and 'school connectedness'

5.10 Other drug use

5.11 Accessibility of tobacco products to young smokers

5.12 Affordability of tobacco products

5.13 Opportunity to smoke

5.14 Cultural background

5.15 Tobacco advertising and promotion targeted at young people

5.16 Products and packaging created to appeal to new users

5.17 Factors influencing uptake of smoking later in life

5.18 Uptake—a concluding note

5.19 What is meant by prevention?

5.20 Approaches to youth smoking prevention

5.21 Mass media strategies/campaigns

5.22 Interactive technology and multimedia

5.23 School-based interventions

5.24 Peer influence and education

5.25 Parent/family/home targeted interventions

5.26 Reducing tobacco access and supply

5.27 Reducing product appeal

5.28 Promotion and visibility of tobacco

5.29 Denormalising smoking

5.30 Taxation and pricing of tobacco products

5.31 Harnessing predictors of uptake to prevent smoking

5.32 Preventing smoking in more 'at risk' groups

Acknowledgments

References

As discussed in Section 5.8, peer influences on youth smoking have received considerable, and some would argue disproportionate research and intervention attention in tobacco control. For a long time, 'peer pressure' or perceptions that 'smoking is cool' were touted by the 'man in the street' as primary determinants of youth smoking. The evidence suggests that it is less simple, with peer influences interacting with and compounded by a host of other predictive factors, and the nature of peer influences on smoking changing over time and across social and cultural groupings.

Peer influence can also work to normalise non-smoking, with young people commenting negatively on the smoking habits of peers. Smarter than Smoking advertisements featuring young people reflecting on the lack of money or fitness of peers who smoke is an example of an Australian intervention tapping into the peer influence psyche. Nowadays young people are more likely to exert pressures on smokers by asking them not to smoke, or outwardly displaying their disgust.201 However, there is also some contrary evidence to suggest that smoking is very much seen as an individual choice, and not something friendships are judged by or based on.54

5.24.1 Peer education approaches to youth smoking

The theoretical roots of peer education approaches can be traced to Bandura's social learning theory, and to social inoculation theory.300 While the applications of peer education have been across a diverse range of settings and health issues, including smoking, the common elements relate to the 'tapping into' and utilisation of the existing social processes among young people to influence their health related knowledge, attitudes, skills and behaviour.300 Social influence-based programs may foster social norms that reduce adolescent social motivation to commence smoking,220, 301 and peer education strategies can complement and reinforce other health promotion approaches.239

The role of peer educators varies considerably across programs, and may include formal or informal counselling, information provision one-to-one or in a group, participation in interactive strategies with peers, staffing of hotlines and resource centres,300 modelling of interpersonal skills,302 and fostering of peer mentors.303 Young people involved in peer education may also serve as viable role models, and help to project norms of acceptable and unacceptable health-related behaviours.220, 304 Research by Allbutt et al in Scotland295 found that older teenagers were adamant about not wanting younger teenagers to start smoking, and it is suggested that this may be capitalised on in peer education approaches.

5.24.2 Peer-based smoking interventions in Australia

Peer-based education in Australia appears to be more commonly applied to drug education and sexual health issues, but programs have been developed within tobacco control also, some examples of which are outlined in Table 5.7.

5.24.3 Are peer education interventions effective?

The complex nature of adolescent health behaviour and their peer interactions, and the influences of the broader social milieu in which they live, makes it difficult to measure behavioural change that is directly attributable to peer education.300 In a meta-analysis of smoking prevention programs, Rooney and Murray concluded that peer or social type programs should be continued as part of smoking prevention efforts, but that the overall magnitude of effect is quite limited.230 They argue that the impact of such programs may be improved if delivered early in the transition from elementary to middle school, if same-aged peers play a significant role in delivery of the program, and if they are part of a multicomponent health program. Interactive programs and those led by peers addressing the social influences of drug use were indicated as being effective in a meta-analysis of these techniques.305

The results of another meta-analysis302 indicated that interactive peer interventions for middle-school students are superior. The Minnesota Smoking Prevention Program in the USA uses peer leaders to conduct many of its program activities, and has been in use (with revisions) for nearly 20 years.220 A significant reduction in smoking onset and prevalence is attributed to this program,220 but it is not clear what proportion of this success is due to the peer education component alone.

As with youth mass media and school-based interventions, the quality, design, expectations and evaluation deficiencies of programs sometimes make it difficult to ascertain whether peer education is flawed per se, or flawed in its delivery. In a review of the effectiveness of youth peer interventions generally, Walker306 identifies a number of reasons for intervention failure, including a lack of clear aims and objectives; inconsistency between the project design and the external environment/constraints; inadequate appreciation of the fact that peer education is a complex and skilled process to manage; and inadequate training and support for peer educators.