Through the haze of cigarettes: teenage girls' stories about cigarette addiction

Adolescents' Experiences and Perceptions of E-Cigarettes and Nicotine Addiction

BACKGROUND

 E-cigarettes are the most-used tobacco product among US adolescents and are associated with nicotine addiction. This qualitative investigation aimed to understand adolescents' experiences and perceptions with nicotine addiction, and related influences of addiction, to inform product regulation, health communication, and cessation resource development.

METHODS

 Between May 2020 and December 2021, in-depth, semi-structured individual interviews were conducted with 47 California (United States) adolescents ages 13-17 who reported recent tobacco use (primarily e-cigarette use). The topic of addiction both arose organically and followed specific interviewer questions. Researchers used thematic analysis techniques to identify unifying themes related to addiction.

RESULTS

 Adolescents described e-cigarette addiction in ways that reflected a loss of control over their routines and activities and as physical symptoms, including reward and withdrawal. While some viewed addiction risk as a reason not to vape, others perceived it possible to use e-cigarettes and avoid or manage addiction. Specific characteristics of e-cigarette devices, particularly disposable nicotine-salt products, including flavors, "cool" designs, concealable size and odor, low price, and ease-of-use, were seen as enhancing addiction risk. Quit attempts were difficult and usually unsupported by adults or formal cessation aids.

CONCLUSIONS

 For many adolescents, addiction is a major component of their experience with e-cigarettes, often in ways that disrupt their routines and reduce their quality of life. Tobacco control or regulation could target e-cigarette product characteristics to decrease potential for addiction among adolescents. Needed are youth-targeted public communication about nicotine addiction and adolescent-tailored, evidence-based cessation support.

"I got a little addiction": Adolescent and young adult cigarillo users' self-perceptions of addiction

BACKGROUND

While prior research has informed how cigarette smokers understand and apply the term addiction, little is known about how this term is used by cigarillo smokers. This is an important area of study given the decline in cigarette use and increase in cigar product consumption.

PURPOSE/OBJECTIVES

This paper examines how cigarillo smokers self-identify in terms of addiction and the association of this identification with tobacco use, quitting experiences, and level of nicotine dependence.

METHODS

Transcripts from semi-structured interviews conducted in 2015-2016 with 57 participants (aged 14-28) about cigarillo use and beliefs were analyzed using a phenomenological approach to examine themes around addiction and cessation experiences. Analyses were limited to participants endorsing having a habit. Quantitative analyses were conducted to assess associations with demographics, tobacco use, addiction, cessation, and nicotine dependence for two groups: participants endorsing having an addiction to cigarillos and those who did not.

RESULTS

All participants described the term addiction similarly. Participants with an addiction had significantly higher nicotine dependence and self-rating of addiction than those without an addiction. Although most quitting experiences did not differ between the two groups, participants who did not identify as addicted felt that they could quit smoking cigarillos at any time.

CONCLUSIONS

Variations in identification with addiction are not associated with differences in definitions, use and quit experiences. Understanding self-perceptions of addiction can inform targeted communication to encourage cessation and the use of cessation resources.

Five decades of risk perception measurements of tobacco use: a review of literature

Perceptions of risk are beliefs about the likelihood of damage orloss. People make subjective judgments regarding the intensityand features of a danger. Smoking start and continuation areinfluenced by risk perception. Risk perception of tobacco useor smoking has always been controversial. Few studies foundthat risk perception is overestimated by smokers and tobaccousers, while other studies found that smokers underestimatethe risk of smoking. It has been observed that different authorshave been using different approaches to measure the risk perceptionof tobacco use. The present literature review is an ontologicalexploration of the process of calculating this constructand determining which method gives more holistic and robustinformation. A literature survey was carried out to understanddifferent ways in which risk perception can be measured. Fifty-seven studies were identified from 1970 to 2020 in which riskperception was calculated for any form of tobacco use. Theliterature review found that the researchers used two practicalapproaches to measure risk perception. In the first approach,the researchers tried to measure only the health risks of tobaccouse, and in the second, multiple dimensions of tobaccouse were measured. Most commonly perceived addictionand then the social risk of tobacco use was accessed. Thoughrecent literature is dominated by an approach where a singledimension, i.e., perceived health risk of tobacco use, is mostcommonly access, it is inferring from the available literature thattools that access multiple sizes of the perceived risk of tobaccouse give more comprehensive and robust information aboutthat construct which can be used further to create tobacco useprevention intervention.

Lessons on Addiction Messages From "The Real Cost" Campaign

INTRODUCTION

A key strategy in reducing the public health burden of cigarette smoking is preventing youth from ever becoming addicted to cigarettes in the first place. However, there is limited research exploring youth responses to addiction messages. This study assesses youths' responses to the U.S. Food and Drug Administration's "The Real Cost" campaign messaging depicting addiction as a "loss of control."

METHODS

Between 2013 and 2016, three focus group studies and four copy testing studies were conducted to assess reactions to advertising concepts and near-final videos. Participants were aged 12-17 years and ethnically and geographically diverse. Researchers conducted a thematic secondary analysis of focus group transcripts and open-ended survey questions from the copy testing studies. Data analysis for this study took place in 2017.

RESULTS

Youth responded favorably to loss of control messages showing real, often short-term, consequences of addiction, such as choosing to spend money on cigarettes instead of going to a movie, and depictions of scenarios that were relatable to youth. Youth also responded favorably to messages describing how nicotine changes the brain. A portion of youth remained skeptical, stating they felt the consequences depicted were unrealistic.

CONCLUSIONS

This study shows that by framing addiction as a loss of control and tying that loss of control to short-term health and social consequences, addiction becomes more concrete and understandable, and the consequences feel more relatable and relevant to youth.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

Smokers' Understandings of Addiction to Nicotine and Tobacco: A Systematic Review and Interpretive Synthesis of Quantitative and Qualitative Research

Background

Despite the centrality of addiction in academic accounts of smoking, there is little research on smokers' beliefs about addiction to smoking, and the role of nicotine in tobacco dependence. Smokers' perspectives on nicotine's role in addiction are important given the increasing prevalence of nontobacco nicotine products such as e-cigarettes. We conducted a systematic review of studies investigating smokers' understandings and lay beliefs about addiction to smoking and nicotine.

Method

We searched PubMed, Embase, CINAHL, and PsycINFO for studies investigating lay beliefs about addiction to smoking. Twenty-two quantitative and 24 qualitative studies met inclusion criteria. Critical interpretive synthesis was used to analyze the results.

Results

Very few studies asked about addiction to nicotine. Quantitative studies that asked about addiction to smoking showed that most smokers believe that cigarettes are an addictive product, and that they are addicted to smoking. Across qualitative studies, nicotine was not often mentioned by participants. Addiction to smoking was most often characterized as a feeling of "need" for cigarettes resulting from an interplay between physical, mental, and social processes. Overall, we found that understandings of smoking were more consistent with the biopsychosocial model of addiction than with more recent models that emphasize the biological aspects of addiction.

Conclusion

Researchers should not treat perceptions of addiction to smoking interchangeably with perceptions of addiction to nicotine. More research on lay beliefs about nicotine is required, particularly considering the increasing use of e-cigarettes and their potential for long-term nicotine maintenance for harm reduction.

Implications

Quantitative studies show that most smokers believe that smoking is addictive and that they are addicted. A feeling of "need" for cigarettes was central to qualitative accounts of addiction, but nicotine was not often discussed. Overall, smokers' understandings of addiction reflect a biopsychosocial model rather than a neurobiological one. Given the growing market for e-cigarettes and therapeutic nicotine, more research is required on lay beliefs about nicotine and addiction.

Boy Smokers' Rationalisations for Engaging in Potentially Fatal Behaviour: In-Depth Interviews in The Netherlands

Adolescent smokers engage in cognitive rationalisation processes that lower perceptions of personal vulnerability to the health consequences of smoking. There is, however, hardly any evidence that provides in-depth insights on adolescents’ recurring rationalisations. Therefore, we explored how boy smokers deal with the knowledge that they are engaging in potentially fatal behaviour. Interviews were held with 16 boy smokers aged 16 to 17 years old. The qualitative analysis focussed on combining boys’ reasons about why they think they will not experience severe health consequences into coherent rationalisations that recurred among interviewees. Three rationalisations emerged from the analysis. First, boys trivialize the immediate consequences and think these can be compensated for and are outweighed by the benefits of smoking. Second, boys assume that smoking will only take place during adolescence and they will, therefore, recover from the damage inflicted. Third, boys believe that they have control over the amount and frequency of smoking and, thereby, can ensure that they will not experience fatal consequences. Boys’ recurring rationalisations build on their view that they are supposed to have fun and will not become typical adult smokers. Interventions should address these rationalisations in order to increase adolescents’ perceptions of personal vulnerability, and thereby contribute to decreasing adolescent smoking.

Today's decisions, Tomorrow's outcomes: Does self-control explain the educational smoking gradient?

People with more education tend to have relatively healthy lifestyles. Among other things, they smoke less than those with less education. This link between education and smoking (known as the "educational gradient") is frequently interpreted as causal: many researchers argue that education develops skills, habits, and preferences that discourage smoking and other unhealthy behaviors. However, an alternative possibility is that these skills, habits, and preferences develop early in life and determine the likelihood of both attaining a high level of education and avoiding smoking. I test the latter possibility using data from the Longitudinal Study of Adolescent to Adult Health (Add Health). In particular, I assess the degree to which indicators of self-control in adolescence explain the association between educational attainment and smoking in adulthood. Results from a series of regression-based tests indicate that self-control is a significant predictor of both outcomes, even when controlling for a host of other risk factors. However, it does not appear to explain the educational gradient.

Young Australian women's accounts of smoking and quitting: a qualitative study using visual methods

Background

Although the overall rate of smoking in Australia continues to decline, the rate of decline has begun to slow. Rates of smoking among young women in Australia have been a particular concern, which has led to the development of targeted public health campaigns. Poststructuralist theory has successfully been used in research to explore the way in which young women experience smoking. However, there is an absence of poststructuralist analysis of young women’s experiences of quitting. This study aims to address this gap.

Methods

We carried out 27 interviews with young Australian women smokers and ex-smokers. Eighteen of those women then participated in a photography activity and follow-up interviews. A Foucauldian discourse analysis of the data was conducted.

Results

Through our analysis, we identified three discourses: ‘The irresponsibility of smoking: Quitting as responsible’, ‘The difficulties of quitting: Smoking as addictive’, and ‘Making a decision to quit: Smoking as a choice’. In relation to these discourses, participants took up contradictory positions of responsibility and resistance, addiction and agency. Taking up these positions had implications for young women’s subjectivity, and the way they engaged with tobacco controls and cessation support.

Conclusions

The analysis highlights the complex and contradictory nature of young women’s experiences with smoking and quitting. The study’s findings are considered in relation to the improvement of tobacco control policies and cessation support programmes targeted at young women.

"It doesn't seem to make sense for a company that sells cigarettes to help smokers stop using them": A case study of Philip Morris's involvement in smoking cessation

BACKGROUND

In the late 1990s, American tobacco companies began offering limited cessation assistance to smokers by posting links on their company websites to government-sponsored smoking cessation resources. Philip Morris USA (PM) went further, funding youth cessation programs and creating its own online cessation program, QuitAssist. We explore why PM entered the cessation arena, and describe the variety of options considered and how PM-supported cessation programs were evaluated and promoted.

METHODS

We retrieved and analyzed archival PM documents from 1998-2005. We supplemented information from the documents with scholarly articles assessing QuitAssist and archived versions of the PM and QuitAssist websites.

RESULTS

PM's Youth Smoking Prevention department began funding youth cessation projects and programs soon after its creation in 1998, motivated by the same issue that drove its interest in youth smoking prevention: regulatory threats posed by public and policymaker concern about youth smoking. The department took a similar approach to youth smoking cessation as it did with prevention, rejecting curricula with "anti-industry" themes. In 2002, a "cessation exploration team" examined a variety of rationales for and approaches to company support for adult smoking cessation. Ultimately, PM chose QuitAssist, a limited and less expensive option that nonetheless provided opportunities for engagement with a variety of public health and government officials. Independent research indicates that QuitAssist is not an effective cessation tool.

CONCLUSIONS

While the transformation of ambitious plans into a mundane final product is a recurring theme with PM's corporate responsibility efforts, it would be inappropriate to dismiss PM's smoking cessation endeavors as half-hearted attempts to appear responsible. Such endeavors have the potential to inflict real harm by competing with more effective programs and by helping to maintain a tobacco-favorable policy environment. If PM truly wanted to support cessation, it could drop legal and other challenges to public policies that discourage smoking.

Developmental cigarette smoke exposure II: Kidney proteome profile alterations in 6 month old adult offspring

Cigarette smoke exposure (CSE) during gestation and early development suppresses the growth trajectory in offspring. In prior studies utilizing a mouse model of 'active' developmental CSE (GD1-PD21), low birth weight induced by CSE persisted throughout the neonatal period and was present at the cessation of exposure at weaning with proportionally smaller kidney mass that was accompanied by impairment of carbohydrate metabolism. In the present study, littermates of those characterized in the prior study were maintained until 6 months of age at which time the impact of developmental CSE on the abundance of proteins associated with cellular metabolism in the kidney was examined. Kidney protein abundances were examined by 2D-SDS-PAGE based proteome profiling with statistical analysis by Partial Least Squares-Discriminant Analysis. Key findings of this study include a persistence of impact of developmental CSE past the original exposure period on the nucleic acid and carbohydrate metabolism networks and oxidant scavenging pathways.

Adolescent (Mis)Perceptions About Nicotine Addiction: Results From a Mixed-Methods Study

PURPOSE

Despite evidence that adolescents become addicted to nicotine even after limited use, adolescents believe they can experiment with or smoke cigarettes for a few years and easily quit. The goal of this study was to examine adolescents' understanding of the definition and process of nicotine addiction using a mixed-methods approach.Method A total of 367 adolescents with and without smoking experience rated the perceived risk for addiction, still being a smoker in 5 years, and ability to quit smoking. A subsample of adolescents (N= 41) were interviewed about their conceptualization and understanding of nicotine addiction. Within-participants analyses of variance were conducted to assess differences in perceptions of addiction across the three scenarios; thematic analyses of interviews were conducted to assess adolescents' understanding of addiction.Results Adolescents rated their perceived risk for addiction, still being a smoker in 5 years, and ability to quit as significantly different from one another for three different scenarios (F= 7.81, 47.78, and 70.27, respectively;p< .001). Seven themes describing how youth conceptualize and understand addiction emerged from the interview data, including skepticism and uncertainty about addiction, how smoking makes a person feel, and family and friends' experiences.

CONCLUSION

While adolescents have received the message that cigarettes are addictive, they are uncertain regarding the definition of addiction and have not recognized that addiction means experiencing difficulty quitting and continuing to smoke longer than expected. Findings suggest the need for comprehensive messaging regarding nicotine addiction in educational, clinical, and intervention settings and for product warning messages aimed at reducing and preventing tobacco use.

Smoker identity and its potential role in young adults' smoking behavior: A meta-ethnography

OBJECTIVE

Identity is an important influence on behavior. To identify potential targets for smoking cessation interventions in young adults, we synthesized findings from qualitative studies on smoker identity and potential influences on smoking and smoking cessation.

METHODS

A systematic search of 4 electronic databases up to September 19, 2013, was conducted to identify qualitative studies on smoker identity in smokers and ex-smokers aged 16-34. Key concepts were extracted from individual studies and synthesized into higher-order interpretations by following the principles of meta-ethnography.

RESULTS

Seventeen relevant papers were identified. At the highest level of interpretation, we identified 4 types of findings: (a) contributory factors to identity, (b) identity in relation to smoking, (c) contextual and temporal patterning, and (d) behavior in relation to smoking. Contributory factors included the desire to establish aspirational individual and social identities, enact a smoker identity appropriate to the momentary social context, and alter personal nonsmoking rules when consuming alcohol. Smoker identity was multifaceted and incorporated individuals' defensive rationalizations, and both positive and negative feelings attached to it. Smoker identities took time to develop, were subject to change, and were context dependent. Identity was found to play a role in quit attempts.

CONCLUSIONS

Qualitative research into the identity of young adult smokers has established it as a multifaceted phenomenon serving important functions but also involving conflict and defensive rationalizations. It develops over time and contextual factors influence its expression. The nature of a smoker's identity can play an important role in smoking cessation. (PsycINFO Database Record

The Influences of Health Beliefs and Identity on Adolescent Marijuana and Tobacco Co-Use

Among youth, the co-use of marijuana and tobacco is highly prevalent, yet a considerable gap remains in the drug-prevention literature pertaining to such co-use. In particular, the prevention field lacks research exploring how adolescents understand the health implications of smoking these two substances in combination. In this article, we draw on qualitative interviews with adolescents from three communities in British Columbia, Canada, and describe the health beliefs and social identities that they associated with smoking marijuana and tobacco. We argue that smoking prevention and cessation initiatives targeting adolescents must address both marijuana and tobacco. Such initiatives must also be designed to identify and address how adolescents frame the potential health harms associated with smoking these substances.

A qualitative study of smokers' responses to messages discouraging dual tobacco product use

Cigarette companies increasingly promote novel smokeless tobacco products to smokers, encouraging them to use smokeless tobacco in smoke-free environments. New messages may counteract this promotion. We developed 12 initial anti-smokeless message ideas and tested them in eight online focus groups with 75 US smokers. Those smokers who never tried smokeless tobacco were unaware of health risks of novel smokeless tobacco products, perceived scary messages as effective and acknowledged the addictive nature of nicotine. Smokers who had tried smokeless tobacco shared their personal (mainly negative) experiences with smokeless tobacco, were aware of health risks of novel smokeless tobacco products, but denied personal addiction, and misinterpreted or disregarded more threatening messages. Portraying women as smokeless tobacco users was perceived as unbelievable, and emphasizing the lack of appeal of novel smokeless tobacco products was perceived as encouraging continued smoking. Future ads should educate smokers about risks of novel smokeless tobacco products, but past users and never users may require different message strategies.

Quit intention as a predictor of quit attempts over time in adolescents with psychiatric disorders

BACKGROUND

Rates of smoking among adolescents with psychiatric comorbidity are high, despite the well-known health risks. The current longitudinal study examined patterns of quitting behavior in adolescent smokers with psychiatric comorbidity.

METHODS

The study evaluated 191 inpatient adolescents who had been enrolled in a randomized controlled trial of motivational interviewing versus brief advice for smoking cessation, and assessed their intentions to quit smoking.

RESULTS

Rates of quit attempts at post-hospital, 1-month, and 6-month assessments were 23%, 17%, and 17%, respectively. Adolescents who reported an intention to quit smoking (43%) were significantly more likely to report a quit attempt, regardless of psychiatric symptoms, cognitive factors, or substance use.

CONCLUSIONS

Intention to quit smoking appears to translate to substantial quit behavior, even in a high-risk adolescent population that may otherwise be viewed as uninterested in quitting, suggesting the need to proactively connect this population with adequate services and follow-up support. (Am J Addict 2013;XX:1-6).

Tobacco branding, plain packaging, pictorial warnings, and symbolic consumption

We use brand association and symbolic consumption theory to explore how plain cigarette packaging would influence the identities young adults cocreate with tobacco products. Group discussions and in-depth interviews with 86 young adult smokers and nonsmokers investigated how participants perceive tobacco branding and plain cigarette packaging with larger health warnings. We examined the transcript data using thematic analysis and explored how removing tobacco branding and replacing this with larger warnings would affect the symbolic status of tobacco brands and their social connotations. Smokers used tobacco brand imagery to define their social attributes and standing, and their connection with specific groups. Plain cigarette packaging usurped this process by undermining aspirational connotations and exposing tobacco products as toxic. Replacing tobacco branding with larger health warnings diminishes the cachet brand insignia creates, weakens the social benefits brands confer on users, and represents a potentially powerful policy measure.

Explorations of Self-Efficacy: Personal Narratives as Qualitative Data in the Analysis of Smoking Cessation Efforts

Research has found that an individual's perceived self-efficacy, supported by goals and the acceptance of potential obstacles, has the ability to assist in behaviour modification. By examining the narratives of cardiovascular patients undergoing smoking cessation counselling, this study highlights factors that individuals communicate in their narratives regarding changes to self-efficacy throughout the process of smoking cessation. Narrative analysis is used to establish those factors that cardiovascular patients assert to be the motivating or impeding factors in their smoking cessation efforts, particularly in relation to their initial readiness to quit smoking. The study's findings illustrate the social, physical and psychological barriers and motivating factors that exist for cardiovascular patients in the process of quitting smoking. The current study supplements past research illustrating that in-hospital programs are among the most influential smoking intervention strategies because they can be tailored to each patient's specific health problems and personal and social circumstances. The study concludes that the relationship formed between patients and intervention specialists can assist in raising an individual's self-efficacy to end an addictive behaviour.

Applying anthropology to eliminate tobacco-related health disparities

INTRODUCTION

Disparities in tobacco's harm persist. Declines in smoking among the general population have not been experienced to the same extent by vulnerable populations. Innovative strategies are required to diminish disparities in tobacco's harm. As novel tools, anthropological concepts and methods may be applied to improve the design and outcomes of tobacco cessation interventions.

METHODS

We reviewed over 60 articles published in peer-reviewed journals since 1995 for content on anthropology and smoking cessation. The specific questions framing the review were: (a) "How can lessons learned from anthropological studies of smoking improve the design and effectiveness of smoking cessation interventions?" (b) How can anthropology be applied to diminish disparities in smoking cessation? and (c) How can qualitative methods be used most effectively in smoking cessation intervention research?

RESULTS

Three specific disciplinary tools were identified and examined: (a) culture, (b) reflexivity, and (c) qualitative methods. Examining culture as a dynamic influence and understanding the utilities of smoking in a particular group is a precursor to promoting cessation. Reflexivity enables a deeper understanding of how smokers perceive quitting and smoking beyond addiction and individual health consequences. Qualitative methods may be used to elicit in-depth perspectives on quitting, insights to inform existing community-based strategies for making behavior changes, and detailed preferences for cessation treatment or programs.

CONCLUSIONS

Anthropological tools can be used to improve the effectiveness of intervention research studies targeting individuals from vulnerable groups. Synthesized applications of anthropological concepts can be used to facilitate translation of findings into clinical practice for providers addressing tobacco cessation in vulnerable populations.

Gender influences in tobacco use and cessation interventions

Smoking rates among and between men and women are in large part a reflection of the influence of gender and its intersections with other social factors including ethnicity, age, and social class that influence tobacco use and, ultimately, tobacco reduction and cessation. In this article, opportunities for developing and delivering gender-sensitive (programs addressing gender) and gender-specific (programs designed for men or women) interventions in the context of tobacco dependence treatment are discussed.

Does mother's smoking influence girls' smoking more than boys' smoking? A 20-year review of the literature using a sex- and gender-based analysis

A systematic literature review was conducted to examine whether mother's smoking influences girls' smoking more than boys' smoking. Fifty-seven studies, published between 1989 and 2009, were analyzed using a sex and gender lens. Results indicate that mother's prenatal and postnatal smoking influences girls' smoking more than boys' smoking. Despite evidence that sex and gender are important determinants of smoking among adolescents when examined in relation to mother's smoking, the theoretical understanding of why girls are more likely to smoke if prenatally and postnatally exposed to mother's smoking remains unclear. Implications for future research are discussed.

Youth's perspectives on the determinants of health

In this article, we discuss findings of an ethnographic exploring how Canadian youth frame health within the context of their life situations. Seventy-one youth (12 to 19 years of age) from diverse ethnic backgrounds and residing in a major city in western Canada took part in the study.We used traditional ethnographic methods of interviewing and fieldwork, as well as photovoice. Sociocultural themes emerging from the study indicate that even though youth have a broad understanding of health that includes acknowledging the many different types of health beyond physical health, lifestyle factors such as healthy eating and exercise nonetheless dominate the talk of health by youth. The results highlight that the concept of health normalized by academics and public policy experts-as being inclusive of the broader determinants of health-might not be congruent with how youth regard health.

Breast cancer messaging for younger women: gender, femininity, and risk

Evidence linking both active smoking and secondhand smoke exposure to premenopausal breast cancer makes the development of health messages specific to younger women a pressing priority. To determine how to communicate information about this modifiable breast cancer risk to young women, we analyzed a selection of 32 recent English-language breast cancer messages and campaigns that targeted young women. In addition, we obtained young women's responses to three breast cancer campaign images during focus group discussions. A visual analysis of messages points to an explicitly gendered discourse within contemporary campaigns, one that entails conflicting messages regarding breast cancer, health, feminine beauty, and risk. Although the intent might be to educate and empower young women to "fight" against breast cancer, paradoxically, the messages employ imagery that sexually objectifies young women's breasts and bodies. Recommendations are made for messaging about tobacco and breast cancer risk to avoid reproducing one-dimensional or stereotypical presentations of gender and femininity.

How adolescents experience smoking cessation

In this study we develop a model of how youth experience smoking cessation attempts. We followed 15 adolescent smokers twice monthly over three months. Through six semistructured interviews, we explored participants' subjective experiences of making a "quit" attempt. We analyzed transcript data using grounded theory procedures, beginning with open coding, axial coding, construction of matrices, and development of a preliminary theory or model of this phenomenon. We found that only emotionally compelling and inescapable quit reasons were truly motivating. Few parents actively supported their child during quit attempts; smoking friends and other peers undermined them. All successful quitters established new, nonsmoking friends and completely redefined themselves. The quit experience was physically uncomfortable, emotionally distressful, and socially isolating. Greater motivation, mature problem-solving skills, and a willingness to supplant their smoking friends characterized successful quitters. Further research is needed to test this model's efficacy in the adolescent population.

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.

Becoming a 'real' smoker: cultural capital in young women's accounts of smoking and other substance use

This paper draws from a qualitative study of tobacco use by young women in Toronto, Canada. Narrative interviews were used to understand the multiple roles and functions of smoking within the everyday lives of female adolescents. Guided by a Bourdieusian theoretical framework this study employed the core construct of cultural capital in order to position tobacco and other substance use as field-specific capital that young women accumulate while navigating the social worlds of adolescence. Departing from the psychosocial or peer-influence models that inform the majority of tobacco research with young people, this analysis provides a nuanced understanding of how smoking, drinking, using drugs are much more than simple forms of teenage experimentation or rebellion, but can also serve as key resources for defining the self, acquiring status and making social distinctions within adolescent social worlds. In this context it is also argued that initiation into substance use practices is a way that young women demonstrate and develop social and cultural competencies.

The adolescent perception of invincibility and its influence on teen acceptance of health promotion strategies

The purposes of this study were to explore the phenomenon of invincibility and to identify key factors contributing to risk behavior involvement in teens. Semistructured interviews revealed the following common themes: adolescence, a time of transition, the meaning of invincibility, learning the balance of taking chances and being safe, differences between risky and dangerous, and strategies for working with teens. Participants provided insights about intervention strategies that are most effective in working with teens. Their suggestions reinforce the critical importance of teen involvement in shaping, planning, and conducting health promotion interventions for this age-group.

Smoking cessation attempts among adolescent smokers: a systematic review of prevalence studies

OBJECTIVE

To synthesise estimates of the prevalence of cessation attempts among adolescent smokers generally, and according to age and level of cigarette consumption.

DATA SOURCES

PubMed, ERIC, and PsychInfo databases and Internet searches of central data collection agencies.

STUDY SELECTION

National population-based studies published in English between 1990 and 2005 reporting the prevalence, frequency and/or duration of cessation attempts among smokers aged >or=10 to <20 years.

DATA EXTRACTION

Five reviewers determined inclusion criteria for full-text reports. One reviewer extracted data on the design, population characteristics and results from the reports.

DATA SYNTHESIS

In total, 52 studies conformed to the inclusion criteria. The marked heterogeneity that characterised the study populations and survey questions precluded a meta-analysis. Among adolescent current smokers, the median 6-month, 12-month and lifetime cessation attempt prevalence was 58% (range: 22-73%), 68% (range 43-92%) and 71% (range 28-84%), respectively. More than half had made multiple attempts. Among smokers who had attempted cessation, the median prevalence of relapse was 34, 56, 89 and 92% within 1 week, 1 month, 6 months, and 1 year, respectively, following the longest attempt. Younger (age<16 years) and non-daily smokers experienced a similar or higher prevalence of cessation attempts compared with older (age >or=16 years) or daily smokers. Moreover, the prevalence of relapse by 6 months following the longest cessation attempt was similar across age and smoking frequency.

CONCLUSIONS

The high prevalence of cessation attempts and relapse among adolescent smokers extends to young adolescents and non-daily smokers. Cessation surveillance, research and program development should be more inclusive of these subgroups.

Female youths' perceptions of smoking in popular films

In this study, the authors used focus group interviews to explore how female adolescents in a Canadian high school interpreted and used tobacco imagery in films in their daily lives. Findings from interviews with 20 smokers led them to argue that smoking scenes in films might stimulate youth smoking and that cigarettes are an important symbol in youth peer groups with explicit social meanings and functions. Their analysis of interviews with 17 nonsmokers revealed that although the majority noticed smoking in movies, it did not detract from their viewing experience. Although both smokers and nonsmokers were aware that tobacco placements in films served as a form of product promotion, they typically focused on smoking's function as a dramatic device for character development rather than its promotional value. Overall, both groups appeared capable of critical readings of smoking in films but tended not to use these capabilities when viewing movies.

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.

Family heritage and depression guides: family and peer views influence adolescent attitudes about depression

While adolescents tend to under-use professional mental health services for depression, they informally seek health-related information from parents and peers. In this study, we interviewed 15 adolescents to examine how the views and behaviours of others influence teens' decisions about seeking care for depression. Using a grounded theory approach, we found that teens' families, peers, and siblings contributed uniquely to teens' decisions in seeking care for depression. Families may disclose a "heritage" of depression, and their choices about disclosing family mental health issues, previous treatment, and coping strategies affected teens' understanding of depression. Peer "depression guides," who had themselves experienced depression, provided teens with advice on recognizing depression, managing stigma, and seeking care. Siblings bridged the roles of peer and family, influencing teens' choices about accessing treatment. These findings suggest that family and peers should be included during teens' depression treatment.

Young women as smokers and nonsmokers: a qualitative social identity approach

The authors used a social identity perspective to explore young women's perceptions of smoking. They carried out 13 focus groups and 6 intercept interviews with women aged 16 to 28 years in regards to the social identities that might influence young women's smoking behavior. Three identities emerged: the cool smoker applied to the initiation of smoking; considerate smokers, who were older addicted smokers; and the actual and anticipated good mother identity, which applied to young women who quit smoking during pregnancy. These identities add to our understanding of the meaning of smoking within the lives of young women and might allow more focused initiatives with this group to prevent the progression to regular addicted smoking.

Image, context and transition: smoking in mid-to-late adolescence

This paper explores 16-19-year-old Scottish smokers' experiences and attitudes towards smoking and their understandings of the ways in which this transitional period impacts on their smoking behaviour. The study involved 49 qualitative interviews conducted mostly in friendship pairs. Interviewees also completed a brief smoking questionnaire. The paper highlights the salience of social context in smoking initiation and maintenance, and the role of smoking across a range of social spheres. Interviewees described how transitions from school to work, further education or un/employment, impacted on their smoking. Smoking was perceived to be an important 'lubricant' for social relations, and marker of an acceptable identity in familiar and new contexts which acted to reinforce and increase smoking. In contrast, smoking restrictions at home, work and/or educational settings were felt to moderate consumption. This has implications for cessation programmes for older adolescents who have been relatively ignored by tobacco control. The study also suggests that if smoke-free policies were extended to all workplaces, this would have a particular impact on smoking amongst older adolescents by hindering the transition from social to regular smoking.

“Social thinking” and cultural images: teenagers’ notions of tobacco use

The health hazards of tobacco use are well-known, and it is considered particularly important to prevent tobacco use among teenagers. New generations of teenagers still start using tobacco. To develop a more profound understanding of tobacco use among teenagers, the purpose of this study is to explore representations of tobacco use, smoking as well as snuffing, at the age when young people often start using tobacco. Focus-group interviews were carried out with 14-15 year olds in two schools in the Stockholm area. The analysis reveals that teenagers are well informed about the health-hazards of tobacco use. At the same time they hold complex and conflicting ideas concerning the relationship between tobacco use, risk, the body and "human nature". At the most general level of "social thinking" there is a dynamic relation between the three main representations of tobacco use related to: (1) notions of risk, (2) "human nature" and; (3) society's efforts to discipline its citizens, which together can be seen as the social representation of tobacco use. These representations of tobacco use are discussed as related to the teenagers' identity-work and gender identities.

Women and the global tobacco epidemic: nurses call to action

BACKGROUND

Tobacco consumption is increasing among women across the globe at alarming rates. Without effective intervention, the smoking prevalence among women will nearly triple over the next generation. These trends are potentially more threatening when considering how tobacco intersects women's lives, regardless if they use tobacco products or not.

AIM

A review and analysis of the literature is conducted to examine the scope of tobacco's global effect on the multiple dimensions of women's health.

METHOD

Medline (1990-2003), Cumulative Index to Nursing and Allied Health Literature (1990-2003) and World Health Organization databases were searched for related topics. Keywords for searches included global health, tobacco, women and nursing.

FINDINGS

The epidemiology and prevalence of tobacco use among women are presented and its impact on women globally. Using an ecological perspective, the consequences of tobacco are analysed within the contexts of health, social, environment, economic and policy as it relates to women, their families and their communities.

IMPLICATIONS

Nurses are in prime positions to empower individuals, families, communities and nations in the prevention and treatment of tobacco use. Health for all women continues to be a call for equity and social justice. Recommendations are provided for nursing practice, education, theory, research and policy to address this global health concern.

Tobacco dependence: adolescents' perspectives on the need to smoke

To address the need for a better understanding of the perspective of Canadian youths on tobacco dependence, a qualitative study using ethnographic techniques was conducted to describe the patterns of language that they use to describe tobacco dependence and the meaning that it has for them. The study was comprised of three inter-related phases: (1) A secondary analysis of 47 individual unstructured interviews with adolescents was completed to identify the words and phrases they use to explain tobacco dependence; (2) contrast and structural questions focusing on tobacco dependence were developed and used in open-ended interviews with 13 adolescents. Data analysis of the transcribed interviews resulted in a set of 60 key phrases that represented the primary ways youths describe the need to smoke; and (3) interviews were conducted with 14 adolescents that involved an open card sort using the set of 60 key phrases. All card sorts and transcribed interview data were analyzed to identify domains representing types of tobacco dependence and sub-types within each domain. From their descriptions about the need to smoke, five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional, and full-fledged. This study provides a step in elucidating the construct of tobacco dependence among the young. Further research is required to extend this understanding and to develop appropriate measures.

In conversation: high school students talk to students about tobacco use and prevention strategies

The purpose of this multi-site qualitative study is to explore how adolescents talk about tobacco use. Sixty-six students in four high schools became co-researchers and led focus group interviews with 205 fellow students. From the interviews, the authors develop a story line that reports how adolescents begin smoking, how smoking becomes a pervasive influence, how attitudes form about smoking, what it means to be a smoker, and, ultimately, student suggestions for tobacco use prevention. Embedded within this story line are complex questions and contradictions. We explore whether peers really are influential, if the media is important, whether smoking is a matter of personal choice, if schools actually promote tobacco use, and whether adolescents can quit smoking.