Anxious adults vs. cool children: children's views on smoking and addiction

Exploring Transgender and Gender Diverse Young Adult Tobacco Use

Aside from prevalence estimates and comparisons to heterosexual and presumed cisgender (i.e., not transgender) samples, little is known about transgender and gender diverse (TGD) young adult tobacco use. This study explored reasons and contexts TGD young adults used a variety of tobacco products through 25 one-on-one semi-structured qualitative interviews in 2018. Thematic analysis yielded four themes: (1) smoking in response to anxiety, depression, or stress, (2) social smoking, (3) accepting smoking-related norms, and (4) appealing aspects of tobacco. The first three themes contained elements specifically tied to TGD identity; the final theme related to perceptions of tobacco unrelated to identity. Findings suggest reasons for smoking that are unique to TGD young adults, who frequently reported smoking cigarettes as a coping response to an amalgam of stressors. Accounting for unique stressors related to TGD identity will assist in developing culturally relevant interventions to reduce the disproportionate tobacco burden in TGD communities.

Global Health Determinants Perceived and Expressed by Children and Adolescents Between 6 and 17 Years: A Systematic Review of Qualitative Studies

Aim: To identify the determinants of global health in the literature as perceived and expressed by children and adolescents in order to adapt prevention actions to this young audience. To also question the pertinence of a qualitative approach when interviewing children. Method:Systematic review of the literature from PubMed, Google Scholar, CINAHL, PsycINFO databases. The studies selected used qualitative methods alone for investigating the views of health determinants in children and adolescents. Results:185 articles were read to reach a final selection of 13 articles on global health, excluding studies with children who were ill, studies using quantitative, mixed, or retrospective methodologies, and those dealing exclusively with themes of health. Collecting information from children and adolescents showed the pertinence and effectiveness of qualitative methods. It also appears necessary to explore new paths: improving and adapting the tools and methodological supports used and combining them to enrich repositories. Conclusion:The small amount of qualitative data available with the views of children and adolescents on health determinants requires that new studies with better adapted collection methodologies be set up. To increase pertinence and effectiveness among a young audience, it is necessary, considering the methodologies identified during this literature review, to turn toward a multi-phase method that combines these methods. A methodology in several phases allows each one to use a different approach with young people and to obtain richer and more varied information. A corpus of images appeared as a powerful tool for collection: it facilitates children's capacity for oral expression and places the researcher in a position of listening.

Nicotine addiction as a moral problem: Barriers to e-cigarette use for smoking cessation in two working-class areas in Northern England

Tobacco use in high-income countries correlates with socio-economic disadvantage, but although switching to electronic cigarettes could be a safer alternative, little is known about barriers to use. Drawing on eighteen months of data collection in two areas of Northern England in 2017/18 including ethnography and interviews with 59 smokers and e-cigarette users, I show that concern about continued nicotine addiction either deterred working-class smokers from switching to e-cigarettes or dictated the conditions of their use. Research participants were unhappy about addiction both as loss of control experienced as moral failure and as neglect of financial responsibilities i.e. role performance failure in relation to family responsibilities, or what I call ‘thrift as care’. They reduced the moral burden of addiction by lowering nicotine content, rejecting pleasure and minimising expenditure. They chose the cheapest possible tobacco, switched from combusted tobacco to cheaper e-cigarettes and bought cheap e-cigarettes and liquids. For working-class smokers, minimising spend on what they perceive negatively as addiction may be a greater moral concern than reducing health risk. I conclude that ensuring that vaping is significantly cheaper than smoking may be key to addressing health inequalities linked to tobacco use.

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Working-class smokers avoided e-cigarettes because of concern about addiction.

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Those who did switch preferred a medical to a recreational model of use.

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Users reduced nicotine content, minimised spending and avoided exotic flavours.

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Failure of willpower and role performance (thrift as care) created addiction shame.

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Ensuring that vaping is cheaper than smoking is key to harm reduction.

The perceived causal structures of smoking: Smoker and non-smoker comparisons

Despite the detrimental impact of smoking on health, its prevalence remains high. Empirical research has provided insight into the many causes and effects of smoking, yet lay perceptions of smoking remain relatively understudied. This study used a form of network analysis to gain insight into the causal attributions for smoking of both smoking and non-smoking college students. The analyses resulted in highly endorsed, complex network diagrams that conveyed the perceived causal structures of smoking. Differences in smoker and non-smoker networks emerged with smokers attributing less negative consequences to smoking behaviors. Implications for intervention are discussed.

A Longitudinal Study of Adolescents' Optimistic Bias about Risks and Benefits of Cigarette Smoking

OBJECTIVES

Optimistic bias, a perception that one's own risks are lower than others', can help explain why adolescents smoke cigarettes despite knowing their risks. We examined the extent and changes over time of adolescents' optimistic bias for various smoking-related perceptions of risks and benefits on the aggregate and individual level.

METHODS

Longitudinal study (6 measurements over 3 years) of 395 adolescents (mean age 14 years, SD=0.4, at baseline) who rated the chance of occurrence of 19 short- and long-term heath risks, social risks, addiction, and benefits related to cigarette smoking for self and comparable others.

RESULTS

Optimistic bias was consistently found only for addiction (83% of comparisons; 37%- 60% of adolescents). Addiction-related optimistic bias decreased significantly with time for "still be smoking in 5 years" (β = -2.44, p < .001) and for "become addicted" (β = -1.71, p < .001). This reduction resulted from a greater decrease in perceived risks for others rather than an increase in the adolescent's own perceived risk. For other risks and benefits, adolescents were either realistic or pessimistically biased.

CONCLUSIONS

Smoking-related optimistic bias in adolescents was not as prevalent as past studies showed. Anti-smoking interventions targeting adolescents should emphasize the risk of addiction and personal relevance of addiction.

Exploring Factors Influencing Transcultural Caring Relationships in the Pediatric Stem Cell Transplant Setting: An Explorative Study

In the literature, there is evidence about the importance of ensuring a Family-Centered approach for foreign patients to provide culturally competent care. The Italian context shows a lack of studies concerning nurses' perceptions regarding factors that influence foreign patients' daily care. In addition, the number of pediatric patients coming to Italian hospitals to be cured has increased dramatically in the last few years. This study aims to investigate the pediatric nurses' perception of the factors influencing nursing care for foreign pediatric patients who have undergone a stem cell transplant (SCT) and their families. A qualitative approach is used. Semi-structured interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques for recurrent themes. Italian SCT pediatric nurses were interviewed until data saturation was achieved. Four themes emerged from the analysis: "Respect for other cultural traditions," "Different roles," "Communication," "Equal treatment and different opportunities." Communication was seen as a barrier in caring for foreign patients. Nurses perceived a lack in their training and knowledge when caring for foreign patients. The hospital supports nurses when caring for foreign patients. We found that pediatric nurses do not feel they are caring for foreign patients in the same way as they do for Italians, but adopt strategies to improve their relationships with them. Semi-structured interviews proved to be useful in highlighting the nurses' perceptions. These data were confirmed by the results of the audit conducted with the "Children and Young People's Audit Policy Tool," The tool suggests specific interventions when foreign patients are admitted.

The role of cognitive attributions for smoking in subsequent smoking progression and regression among adolescents in China

Previous studies have documented that cognitive attributions are correlated with adolescent smoking. The present study further explored whether cognitive attributions for smoking influenced adolescents' future smoking behaviors, especially transitions to more advanced stages of smoking. Participants were 12,382 middle and high school students (48.5% males and 51.5% females) in seven large cities in China. They completed two waves of surveys one year apart. Cognitive attributions for smoking and three smoking behavior outcomes (lifetime smoking, past 30-day smoking, and daily smoking) were assessed. Changes in smoking, including progression from lower stages to higher stages and regression from higher stages to lower stages, over a one-year period, were defined longitudinally. Polychotomous logistic regression was used to examine associations between cognitive attributions for smoking and changes in smoking status over one year, adjusting for demographic characteristics and other plausible confounders. Seven out of eight cognitive attributions for smoking were associated with subsequent smoking behaviors (p<0.05). Curiosity, autonomy, social image, social belonging, and coping influenced earlier stages of smoking, whereas mental enhancement and engagement influenced later stages of smoking. Curiosity, autonomy, social image, and mental enhancement preceded smoking progression; social belonging prevented smoking regression; and coping and engagement both preceded smoking progression and prevented smoking regression. This study demonstrates that different cognitive attributions influence smoking at different stages in different ways. These findings could inform smoking prevention and cessation programs targeting Chinese adolescents.

Do cognitive attributions for smoking predict subsequent smoking development?

To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals' cognitive attributions for smoking were associated with subsequent smoking development and through which pathways. Middle and high school students in seven large cities in China (N=12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008). Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity (β=0.11, p<0.001) and autonomy (β=0.08, p=0.019) were associated with smoking initiation among baseline non-smokers. Coping (β=0.07, p<0.001) and social image (β=0.10, p=<.0001) were associated with smoking progression among baseline lifetime smokers. Social image (β=0.05, p=0.043), engagement (β=0.07, p=0.003), and mental enhancement (β=0.15, p<0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%. This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.

Smoking among young children in Hong Kong: influence of parental smoking

AIMS

This paper is a report of a study comparing children with smoking parents and those with non-smoking parents, in terms of knowledge and attitude towards smoking and the influence of parents and peers on smoking initiation.

BACKGROUND

Adolescence is a developmental stage when smoking habits are likely to start. Adolescents are most influenced by the smoking habits of their parents and friends.

METHOD

A cross-section study was conducted with students aged 13-15 years in two schools in 2008, using a questionnaire that collected information on the smoking habits of their parents and peers, knowledge and attitude towards smoking, initiation and inclination towards smoking. Chi-square tests and binary logistic regression were used to analyse the data.

RESULTS

A total of 257 of 575 (44·7%) students had smoking parent(s), and 25·4% reported having peers who smoked. Children with non-smoking parents were more likely than those with smoking parents to consider 'smoking as disgusting' (67·3% vs. 45·9%), and to know that 'smoking is addictive' (80·5% vs. 70·4%) and 'harmful to health' (81·8% vs. 67·7%). More of those with smoking parents had tried smoking than those with non-smoking parents (13·2% vs. 3·8%).

CONCLUSION

Preventive programmes should involve smoking parents to increase their awareness of the impact their smoking has on their children. Interventions should include problem-solving skills for children to deal with daily stresses and thus eradicate the potential risk of smoking initiation.

Why do young adult smokers continue to smoke despite the health risks? A focus group study

The focus of this article is on constructions of health and illness in relation to smoking. Specifically, we were interested in how culturally embedded health promotion messages were discussed and understood by our young smokers-and how continued smoking was rationalised in the context of a thoroughgoing anti-smoking climate. To investigate accounts of smoking maintenance, we conducted focus group discussions (N = 22 groups) with young adults from both high school and university settings. Techniques from discourse analysis were used to identify significant patterns of talk around health and smoking, and three main repertoires were elicited. First, the health risks of smoking were downplayed in several ways (e.g. by citing other risky activities). Second, the putative health benefits of smoking were emphasised (e.g. stress relief). Third, smoking was construed as a temporary, youthful phenomenon, which would cease upon entering responsible adulthood. The implications of these three interlocking repertoires are discussed in relation to smoking maintenance, and suggestions for targeted health promotion are made.

Gender differences in smoking: A longitudinal study of beliefs predicting smoking in 11-15 year olds

This longitudinal study investigated differences in beliefs and perceived behavioural control between smokers and non-smokers in a large sample of adolescents. Positive and negative instrumental beliefs, normative beliefs, perceived behavioural control (PBC) and smoking status were assessed in the same participants at 11, 13 and 15 years of age. Prospective analyses among non-smokers revealed that for boys, negative instrumental beliefs in non-smokers at age 11 predicted smoking at age 15 years. For girls, normative beliefs and PBC in non-smokers at age 11 predicted smoking status at age 13; normative beliefs at age 11 predicted smoking at age 15; and positive instrumental beliefs and normative beliefs at age 13 predicted smoking status at age 15. Cross-sectional data revealed that smokers were significantly more likely than non-smokers to endorse positive instrumental beliefs, less likely to agree with negative instrumental belief items, more likely than non-smokers to perceive social pressure to smoke, and less likely to report control over smoking, and that female smokers reported less control over smoking and fewer negative instrumental beliefs than all other groups including male smokers at age 13. The need for belief-based preventative interventions that are age- and gender-relevant is discussed.

Cognitive attributions for smoking among adolescents in China

To design more effective health communication messages for smoking cessation and prevention, it is important to understand people's own perceptions of the factors that influence their decisions to smoke. Studies have examined cognitive attributions for smoking in Western countries but not in the Chinese cultural context. In a study of 14,434 Chinese adolescents, exploratory factor analysis grouped 17 cognitive attributions into 8 factors: curiosity, coping, social image, social belonging, engagement, autonomy, mental enhancement, and weight control. The factors were ranked based on the participants' self-reports of importance and by the strength of their associations with smoking behavior. Among all smokers, curiosity was the most frequently-ranked attribution factor at the early stages of smoking but not for daily smoking. Coping was highly-ranked across smoking stages. Social image and social belonging were more highly-ranked at earlier stages, whereas engagement and mental enhancement were ranked more highly at later stages of smoking. More attributions were associated with smoking among males than among females. This information could be useful for the development of evidence-based anti-smoking programs in China.

Using the Prototype/Willingness model to predict smoking behaviour among Norwegian adolescents

This paper examines cognitive antecedents of non-smoking among adolescents who reported smoking less than 1-2 times a week, and reported non-smoking intentions and willingness, in the framework of the Prototype/Willingness model. Two waves of data were obtained from a nation-wide sample of 760 Norwegian adolescents who responded to a school-based survey on smoking. Structural equation modelling was used to evaluate the predictive power of the social reaction pathway (prototype and willingness) of the P/W model, and in addition, the constructs from the Theory of Reasoned Action (subjective norm, attitude and intention). Results demonstrated the unique importance of the social reaction path when examining smoking behaviour among non-smoking adolescents. Implications of the findings and possible applications are discussed.

A Q-methodological Investigation into the Meanings of Cigarette Consumption

This Q-methodological study identified shared subjective explanations of smoking among non-smokers, current smokers and ex-smokers, to consider whether some representations were protective or facilitated quitting. Four factors were identified: named independent addiction; independent non-addiction; anti-smoking; and social addiction. The first two factors were dominated by current and ex-smokers, and the last two by non-smokers. Differences emerged on the use of the `addiction' concept, the use of smoking as a tool for affect management, the role of image manipulation and the general positive and negative perceptions of smoking. The functional use of the different shared smoking representations is discussed.

Adolescents report both positive and negative consequences of experimentation with cigarette use

OBJECTIVE

To examine the physiological and social consequences that 9th and 10th grade adolescents experience as a result of experimenting with cigarette use, and whether consequences vary by level of experimentation and gender.

METHOD

Data were collected between 2001 and 2004 from 395 adolescents attending two northern California public high schools. Analyses are limited to 155 adolescents who reported puffing on cigarettes or smoking whole cigarettes at any of four time points during the study.

RESULTS

The percentage of adolescents reporting consequences of smoking was as follows: any positive consequence (56%), felt relaxed (46%), looked cool (31%), looked grown-up (27%), became popular (17%), any negative consequence (56%), friends were upset (35%), trouble catching breath (29%), bad cough (26%), and got into trouble (23%). Ten percent of adolescents reported only experiencing negative consequences, 11% reported only positive consequences, 45% reported both negative and positive consequences, and 34% reported no consequences. Greater levels of experimentation were associated with greater likelihood of reporting positive or negative consequences. Few gender differences emerged.

CONCLUSION

Adolescents experience both positive and negative consequences of experimentation with cigarette use. Prevention and intervention efforts should acknowledge that positive consequences of smoking may occur and address how these consequences can be achieved through other behaviors.

Persistent impact of pubertal timing on trends in smoking, food choice, activity, and stress in adolescence

OBJECTIVES

a) To replicate the established association between early puberty and smoking; b) to see whether differences between early and late maturers narrowed with increasing age and differed by gender; and c) to determine whether other health behaviors (food choice, physical activity, sedentary behavior) and stress showed the same association with pubertal timing.

METHODS

The Health and Behaviour in Teenagers Study (HABITS) followed a cohort of 5863 adolescents from ages 11 to 12 years (UK year 7; US grade 6) for 5 years. Puberty was assessed with the Pubertal Development Scale. Three pubertal timing groups were created by identifying adolescents who reached midpuberty relatively early, average, or late, compared with their peers. Longitudinal trends in health behaviors and stress were compared between the three groups.

RESULTS

Smoking rates were higher throughout adolescence among early-maturing students, with no evidence that late-maturers "caught up" when they reached puberty, although group differences narrowed over time. Early-maturing students had higher rates of sedentary behaviors but also reported higher rates of vigorous activity than their "on-time" developing counterparts. Patterns in dietary behaviors and stress showed lower rates of daily breakfast and higher stress among early-maturing girls, but not boys. Overall, the effects were largest in early adolescence (ages 11-13 years) and became smaller at older ages (ages 14-16 years).

CONCLUSION

Early-maturing adolescents are at increased risk for unhealthy behaviors, especially smoking, and although differences attenuate during adolescence, they remain significant at age 16 years. This suggests that early maturation may be a cause of, or is at least a marker for, differences in lifestyle.

Prototype perception and smoking: are negative or positive social images more important in adolescence?

It is suggested that a more profound understanding of cigarette smoking among adolescents should include the social images they have of smokers. The main goal of the present study was to investigate the role of smoker prototypes in adolescents' smoking status and to compare the role of negative and positive smoker images. Data were collected from high school students in two counties of the Southern Plain Region of Hungary (N=548; ages between 14 and 21 years). The self-administered questionnaires contained items on sociodemographics, smoking occurrence, and smoker prototypes. Factor analysis revealed three smoker prototypes: a negative prototype (e.g., dull, childish), a positive social appearance prototype (e.g., cool, popular), and a positive individual competence prototype (such as smart, independent) all with satisfactory reliability. Odds ratios suggest that the role of the negative prototypes for nonsmokers is greater than the role of positive prototypes for smokers. For boys, positive individual competence prototype also seems to be important. Health promotion programs should focus on fostering negative social images in prevention.

What is addiction? Age-related differences in the meaning of addiction

In a sample of families from a midwestern community study of cigarette smoking, we examined adolescents' and adults' definitions of "addiction", and related these definitions to their perceived addictiveness of cigarette smoking. Both adolescents and adults viewed addiction as multi-faceted, including both appetitive aspects and compulsive aspects. However, for adolescents, the two dimensions were equally important to the overall meaning of addiction, whereas for adults, the compulsive dimension was more important than was the appetitive dimension. The two dimensions of addiction were related to the perceived addictiveness of smoking, but differently for adolescents and adults. For adolescents, the appetitive dimension was a significant predictor whereas, for adults, the compulsive dimension was significant (and appetitive scores were predictive only at high levels of endorsement of the compulsive factor). These findings have potential implications for prevention programs for adolescents. Adolescents may perceive messages about "addiction" as communicating that the behavior in question has appetitive value in addition to a potential for inducing loss of control, and this may weaken the effectiveness of these messages.

Children talking: emerging perspectives and experiences of cigarette smoking

Despite efforts to prevent the onset of smoking, the rate among older children remains high. In this article, the authors report on a longitudinal, qualitative study of 11 to 16-year-old children describing children's construction of what it means to be a smoker, the reasons given for children smoking, and their views of smoking behavior. Findings indicate that children adopt broad interpretations of what constitutes smoking behavior; although they strongly disapprove of children who smoke, they are less disapproving of older children or adult smokers and are increasingly tolerant of smoking behavior as they get older. Children's disapproval of smoking acts as a protective mechanism against smoking for younger participants. Participants' broad interpretation of what it means to be a cigarette smoker, their association of smoking with adulthood, and their increasing tolerance of and exposure to smoking behavior as they move into adolescence appears to increase susceptibility to becoming cigarette smokers.

Adolescents and tobacco use: systematic review of qualitative research methodologies and partial synthesis of findings

After a brief overview of adolescent tobacco control, methodological features and content areas of 78 qualitative studies of adolescent smoking published in English prior to September 2002 were assessed. Narrative syntheses of three content areas - peer influences, access/sales issues, and dependence/addiction - were also undertaken. Many studies failed to provide sufficient sampling and subject characterization details and more effort was required to demonstrate data validity and reliability. Syntheses of the content areas revealed important common themes. Relationships to quantitative research were informative and suggested other research questions. The review highlights the heuristic value of qualitative research on adolescent smoking. Funding was provided by The Cancer Council New South Wales and NSW Health/Hunter Medical Research Institute.

Early dating predicts smoking during adolescence: A prospective study

AIM

To examine the relationship between dating and smoking behaviour.

DESIGN

A 5-year prospective study.

SETTING

Thirty-six schools in South London, England.

PARTICIPANTS

A socio-economically and ethnically diverse sample of students (n = 4319 at baseline) took part in the study, providing annual assessments from age 11-16 years.

MEASUREMENTS

Questionnaire items assessed dating status, smoking status, friends and family smoking, psychological wellbeing, popularity and conduct, pubertal status, gender, ethnicity and deprivation. Cotinine assays provided biochemical verification of smoking status.

FINDINGS

At age 11-12, 18% [corrected] of girls and 29% [corrected] of boys reported having a boyfriend or girlfriend. Logistic regressions showed being an early 'dater' to be a strong predictor of later smoking uptake at each study year, with odds ratios ranging from 3.03 to 8.96 among girls and 1.87 to 5.85 among boys. These associations remained significant after controlling for potential confounding factors, including past smoking and pubertal stage. There was minimal evidence that having smoked by age 11-12 predicted later dating.

CONCLUSIONS

The association between early dating and later smoking is strong, and not explained by obvious confounders or dependent on the influence of past smoking experience. The use of smoking to maintain a popular image, and the link between both behaviours and aspirations towards maturity, are potential explanations for the effect. Identification of adolescents dating early could help to target prevention of later smoking uptake.

Smoking in film in New Zealand: measuring risk exposure

Background

Smoking in film is a risk factor for smoking uptake in adolescence. This study aimed to quantify exposure to smoking in film received by New Zealand audiences, and evaluate potential interventions to reduce the quantity and impact of this exposure.

Methods

The ten highest-grossing films in New Zealand for 2003 were each analysed independently by two viewers for smoking, smoking references and related imagery. Potential interventions were explored by reviewing relevant New Zealand legislation, and scientific literature.

Results

Seven of the ten films contained at least one tobacco reference, similar to larger film samples. The majority of the 38 tobacco references involved characters smoking, most of whom were male. Smoking was associated with positive character traits, notably rebellion (which may appeal to adolescents). There appeared to be a low threshold for including smoking in film. Legislative or censorship approaches to smoking in film are currently unlikely to succeed. Anti-smoking advertising before films has promise, but experimental research is required to demonstrate cost effectiveness.

Conclusion

Smoking in film warrants concern from public health advocates. In New Zealand, pre-film anti-smoking advertising appears to be the most promising immediate policy response.

Influence of the ice-hockey environment on taking up snuff: an interview study among young males

In Sweden, snuff-use is an established and accepted phenomenon in society, especially in connection with certain sports. The aim of this qualitative study was to analyze and describe the psychosocial environment influencing young male ice-hockey players into starting to use snuff. The study sample comprised 16 male participants between 15 and 32 years of age strategically selected for being active or having been active as ice-hockey players--snuff-users and non-users alike. A grounded theory design, including in-depth interviews, was used to generate a theory from data and thereby create theoretical concepts explaining social phenomena, human behavior, and process. An interview guide containing different themes was used to cover the study area. Five higher-order categories were developed and labeled: having a role model, residing in a consenting environment, experiencing performance demands, experiencing a sense of community and creating an image. Socialization in and through psychosocial norms of the ice-hockey environment was identified as a core category describing the central meaning of the informants' experiences of snuff in the ice-hockey environment. In the present study, the identified categories that integrate within the environment in which the young people reside and pursue their sports activities have been interpreted as factors enhancing the commencement of snuff-use. We suggest health promotion activities within the ice-hockey environment based on a health psychology model of planned behavior.

Smoking and peer groups: results from a longitudinal qualitative study of young people in Northern Ireland

Previous research has indicated that young people are under considerable social pressure to take up smoking. This study has therefore sought to explore and better understand the mechanisms through which peer-related social factors operate to encourage young people to smoke. Individual qualitative interviews were held with adolescent children aged 11-12 years (N = 102) within youth clubs based in economically deprived areas of Northern Ireland, and then followed up on two occasions during the subsequent 3 years (N = 51/39). The data implied that, although peers influence smoking uptake, this seldom happens through direct persuasion, but rather as the result of the young person striving to conform to the normative behaviour of the peer group with which they identify. The findings are consistent with social identity theory and self-categorization theory in that for both smoking and nonsmoking 14-year-olds smoking activity appears to provide a means through which to define social groups, to accentuate similarity within groups and differences between groups. In-group favouritism was expressed in the sharing of cigarettes within the in-group and in the negative stereotyping of out-group members. There was some evidence that group affiliation may be negotiated differently for boys and girls. These findings imply that successful intervention needs to reconsider the normative processes that encourage young people to smoke.

Iranian staff nurses' views of their productivity and human resource factors improving and impeding it: a qualitative study

BACKGROUND

Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses' perceptions and experiences of productivity and human resource factors improving or impeding it.

METHOD

A qualitative approach was used to obtain rich data; open, semi-structured interviews were also conducted. The sampling was based on the maximum variant approach; data analysis was carried out by content analysis, with the constant comparative method.

RESULTS

Participants indicated that human resources issues are the most important factor in promoting or impeding their productivity. They suggested that the factors influencing effectiveness of human resource elements include: systematic evaluation of staff numbers; a sound selection process based on verifiable criteria; provision of an adequate staffing level throughout the year; full involvement of the ward sister in the process of admitting patients; and sound communication within the care team. Paying attention to these factors creates a suitable background for improved productivity and decreases negative impacts of human resource shortages, whereas ignoring or interfering with them would result in lowering of nurses' productivity.

CONCLUSION

Participants maintained that satisfactory human resources can improve nurses' productivity and the quality of care they provide; thereby fulfilling the core objective of the health care system.

Adolescents' perspectives on addiction: Qualitative study

Given that the adolescence period is one of the most crucial stages of development during one's lifetime and adolescents are prone to engage in behaviors which may negatively impact their health, it is very important to have a clear and transparent understanding of adolescents' health needs and problems. A content analysis with a qualitative approach was conducted and 41 healthy adolescents were interviewed. The results of this study revealed the following themes: addiction causes and prevalence; unhealthy friendship and communication and increased rates of cigarette smoking; alcohol and drugs; barriers to and factors in addiction and health; family and addiction. The findings showed worrying attitudes of adolescents to addiction and its prevalence are alarming. It is concluded that exploring adolescents' perspectives is not only important but is useful for maintaining a healthy society, and thus policy makers should develop effective prevention and intervention programs based on these themes.

Alcohol consumption among 11-16 year olds: 'getting around' structural barriers?

This paper presents qualitative data from Irish children and adolescents on their experiences in relation to alcohol consumption. A sample of 78 participants (average age 11.5 years) was selected. A proportion of this initial sample were interviewed at intervals over a period of 3 years. The participants' consumption patterns were analyzed and four categories were generated: covert unsanctioned, overt unsanctioned, overt sanctioned, and peer unsanctioned. As the children got older, peer drinking became a stronger feature of the data; however, it mediated other patterns of behavior. Although the children displayed agency in circumventing adult rules relating to alcohol consumption, the participants were subjected to structural constraints by virtue of their status as children. Moreover, the agentic powers of the participants were procured through their social network rather than arising from an essentialist agency possessed by each individual child. The impact of childhood as a structural dimension weakened to some extent as the participants got older and had more freedom to circumvent adult-defined barriers to alcohol consumption.