5.8 The smoking behaviour of peers, and peer attitudes and norms
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Smoking during adolescence is primarily a social activity,7 and research has consistently identified peer group influences as a significant factor in uptake of smoking.1, 10, 11, 44, 84 Peer groups may variously be defined as best friendships, romantic attachments, small social 'networks' and larger social 'crowds'.[6]91 Each of these types of peer group may influence the decision to smoke or not to smoke.91
Just how influential peer pressure is, however, remains a matter of some debate. Some commentators have argued that the importance of peer influence has been overestimated, and that the clustering of smoking behaviour within peer groups could be because adolescents seek out friendships with individuals who share similar interests, of which smoking may be just one signifier.92, 93 In a review of peer influence and smoking behaviour, Michell94 concluded that the effect of peer pressure as an influence on adolescent health behaviour is not proven, and is in practice, very complex to decipher. It is important to understand that young people are not a homogeneous group, and that there are distinct peer clusters who smoke and do so for different reasons.94 It is probable that peer influences both interact with and are compounded by a host of other predictive factors, and that the nature of peer influences on smoking changes over time and across social and cultural groupings. Recent research also suggests that peer influences may vary in importance at differing points along the adolescent continuum, with the influence of close friends' smoking having most impact in earlier adolescence.95
The common perception that 'peer group pressure' equates with open coercion is not necessarily the case. Initiating smoking may arise as a response to more subtle influences, such as being a means of facilitating acceptance and bonding, and avoiding exclusion from peer groups.7, 91 Research from Western Australia in 2004 found that some adolescent experimenters and smokers saw trying a cigarette in the spirit of 'joining in' or 'giving it a go.' However, the same research found that young people of Indigenous or lower SES background were much more likely to describe overt peer pressure or inducement to try smoking.54
Being 'cool' is important to teenagers96 although what is deemed to be cool also changes across time, peer groups and social contexts. Smoking has traditionally been viewed as one of the badges of 'coolness' among teenagers.97 While 'coolness' is still identified by young people as one of the reasons why some of their peers smoke,98 research undertaken in Western Australia in 2004 suggests that the inverse is increasingly true, with those who smoke often regarded as 'losers' or 'trying too hard to be cool'.54 Refusing an offer of cigarettes or declaring that 'I don't smoke' is increasingly socially acceptable and normative among many youth cohorts.54 Among groups with a negative prevailing attitude to smoking, peer influence may, of course, deter uptake of smoking.7, 91
British research has found that forming romantic attachments ('dating') at an earlier age is a predictor for becoming a smoker later, independent of other possible confounding factors. The authors speculate that dating and smoking behaviours may be connected by a desire to appear to be more grown up,99 which is consistent with tobacco industry advertising to link its products with sex appeal and popularity.100 Research also suggests that young people who are lesbian, gay or bisexual (LGB) have a higher risk of taking up smoking.101, 102 Reasons for this could be that LGB teenagers may be at greater risk of experiencing loneliness, isolation, harassment and depression. The LGB population has also been specifically targeted in tobacco advertising.102
Young smokers tend to congregate together, and also to overestimate the extent of smoking in their own age group, giving them a distorted sense of what is normal behaviour.10, 44, 56 The National Drug Strategy Household Survey for 20043 found that about two-thirds (64%) of recent smokers aged 12–15 said that 'all or most' of their friends and acquaintances were smokers as well. A further 20% said that 'about half' of their peer group were smokers. Only 1% of smokers in this age group said that none of their friends and acquaintances smoked. The effect declined with increasing age, with 28% of smokers aged 20 years or older reporting that 'all or most' of their friends and acquaintances were smokers, 32% saying 'around half were', and 39% saying only a few of their peer group smoked. Adolescents who think that smoking is normative and that most of their peers smoke, are more likely to start smoking.4, 7, 10
5.8.1 Influence of gender
A large number of studies have examined whether boys and girls are similarly affected by the various factors that influence smoking behaviour. In a major review of the literature, the US Surgeon General's report for 2001 (Women and smoking)10 concluded that 'Most risk factors for smoking initiation appear to be similar among girls and boys.' (p.477) However, the review did find that girls may be more likely to be influenced by positive images of smoking, perceptions about smoking and weight control, and the belief that smoking helps to improve mood. There was also some evidence that girls are more likely to smoke than boys out of rebelliousness, rejection of conventional values, lack of religious conviction, poor self-esteem and emotional distress.
Other research has proposed that males are more likely to smoke as a result of 'psychosocial' factors (such as risk-taking, rebelliousness, self-esteem and coping ability), whereas girls tended more to be influenced by 'environmental' factors such as parental smoking habits, peer group attitudes and behaviours. The strength of the relative influence of these factors is likely to change during teenage years.103 Koval et al have found that psychosocial factors are more closely associated with smoking in young teenage girls than in older girls, who are more influenced by attitude variables (including beliefs about smoking); while younger boys are less susceptible to the influences of both psychosocial factors and environmental variables than older males.
Australian studies have reported that uptake of smoking in adolescent girls is strongly related to a desire to adopt and reinforce their reputation among a specific peer group,104 and that strength of self-concept in girls (defined as how an individual perceives her physical presentation and appearance to others) is more closely connected with increased likelihood of smoking than in boys.105 The authors of this study speculate that environmental pressures on adolescent girls to be self-confident, socially aggressive and sexually precocious may lead to cigarette smoking, in an effort to boost physical self-concept.105
5.8.1.1 Do concerns about body weight influence the uptake of smoking?
The perception that smoking depresses appetite, hence assisting with weight control, has long been considered a possible enticement for smoking, especially among females.[7] Over many decades the tobacco industry has overtly targeted the female market with brands and imagery connecting cigarettes with a slim and shapely female form.10, 106, 107
A large number of studies have investigated the relationship between adolescent smoking and body weight. A review by Potter et al108 analyses 55 studies published between 1980–2003. Taking into account the wide variation in study methodologies, this review concluded that there was some evidence that:
- young smokers were more likely to perceive that they were overweight
- some adolescents smoked because they thought it would help with weight control, and that
- adolescent smokers were more likely to have engaged in dieting, the evidence being strongest for girls.
Research from Western Australia54 has shown that young people (both smokers and non-smokers) cite 'to be thin' as a reason for smoking.
[6] The tobacco industry's use of 'viral' and 'buzz' marketing capitalises on the effectiveness of peer 'crowds.' See Chapter 11, Section 11.6.
[7] Although smokers weigh, on average, less than people who have quit smoking and who have never smoked, the effect is modest and accrues over decades of smoking. Taking up smoking does not appear to be associated with weight loss.10 (see Chapter 3, Section 3.28.5).
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