Adolescents’ Reasons for Smoking Irwin G. Sarason, Eric S. Mankowski, Arthur V. Peterson, jr., Khanh T. Dinh
ABSTRACT: Part of the Hutchinson Smoking Prevention Project. this study provides information on reasons reported by adolescents for their smoking behavior. A total of 1,615 10th grade students in 20 rural and suburban school districts in Washington state were asked why they currently smoke and why they first smoked. For beginning smoking, curiosity, social norms, and social pressure were the most frequently given reasons for smoking. For current smoking, pleasure and addiction were mentioned most often. A number of gender duferences occurred with 10th grade students beginning and current smoking. More females than males reported social norms and social pressure as reasons for beginning to smoke, whereas for currently smoking, pleasure was given as a reason more frequently by females than males. When developing interventions, smoking prevention programs need to consider students’ current and past smoking behavior, and the reasons they give for smoking. (J Sch Health. 1992;62(5):185-190)
S
ince the 1970s, smoking has declined somewhat among adolescent males, but not among adolescent females. Many adolescents continue to smoke despite exposure to prevention programs and knowledge of its adverse effects. I Most school-based smoking prevention programs have not produced consistent or long-term reductions in smoking One possible reason why smoking prevention programs have not been more successful is that these programs have not been sufficiently responsive to the reasons (motivations) for adolescents’ smoking. More information about the reasons children and adolescents give for their own smoking might strengthen the design and effectiveness of smoking prevention programs. While some research has been conducted on selfreported reasons for smoking, most of it has dealt with adults’ motivations to smoke. The main reasons adults give for smoking are social acceptance, addiction/habitual needs, pleasure, and b ~ r e d o m . It ~ - is ~ difficult to extract generalizations from studies with adults that often deal with special groups, such as highly committed, long-term smokers.’ Therefore, intervention researchers also need to investigate children’s reported reasons for smoking. Concerning research on self-reported reasons among adolescents, Zoller and Maymon9 found curiosity the most common reason reported for trying smoking in a sample of high school students, while LevittlO reported pleasure, improvement of emotion, and habit as the most common reasons 10th grade students gave for current smoking. Unfortunately, these findings were based on samples either gathered many years ago or with samples of Israeli, rather than American students. Information about why adolescents smoke is especially important in view of evidence that even infrequent smoking in adolescence significantly raises the risk for adult smoking. Regular (at least monthly) adolescent smoking increases the risk for adult smoking by ~~
Irwin G. Sarason. PhD; Arthur V. Peterson, Jr., PhD; and Khanh T. Dinh, Fred Hutchinson Cancer Research Center, Hutchinson Smoking Prevention Project, MP-603. Division of Public Health Sciences, 1124 Columbia St., Seattle, WA 98104-2092;and Eric S. Mankowski, Dept. of Psychology University of Illinois at Urbana, Urbana. IL 61801. This work was supported by National Cancer Institute Grant CA-38269. This article was submitted October 14, 1991. and revised and accepted for publication March 16, 1992.
a factor of 16 compared to non-smoking.l’ This research investigated adolescents’ motivations for tobacco use in a large group of adolescents. Reasons reported by 10th grade students were examined in relation with using and continuing to use tobacco and how the reported reasons are related to level of smoking, perceived ease of quitting, and intentions about tobacco use. Because certain motivations for tobacco use may be more common among children who progress to the final stage of regular smoking,‘ further investigations were completed on whether certain reasons are more prevalent among adolescents who went on to become regular smokers. METHOD Subjects. Subjects were 1,615 10th grade students in 1986 in 20 geographically and demographically diverse rural and suburban school districts in Washington state. These school districts, part of the Hutchinson Smoking Prevention Project (HSPP), an ongoing, randomized, controlled trial in school-based smoking prevention, are the third wave of a total of 40 school districts recruited into the HSPP trial from the 41 selected and invited to join based on HSPP eligibility criteria such as school size and distance from Hutchinson Research Center. The 1,615 students represented 93% of those eligible; of the 7% non-participating students, 6 % were absent on the day of data collection and 1% declined to participate. The 387 (24%) students who reported smoking at least once a month were used to investigate reasons for current smoking; the 1,126 (69.7%) students who reported ever trying a cigarette were used to investigate reasons for beginning smoking. Procedure. A tobacco use questionnaire was administered to 10th grade students by trained HSPP data collectors in the classroom during one class period. Through an informational letter to parents and by inclass procedures, parents and students were fully informed in advance and were given an opportunity to ask questions and to decline participation. Measures used to enhance accuracy of responses to the questionnaire items included 1) administration of the questionnaire on an unannounced date, 2) classroom procedures designed to maintain and demonstrate confidentiality, including the use of study identification numbers and the handling of questionnaires by project data collectors
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Figure 1 Reasons for Currently Smoklnp 'Z students reporting reason 60
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Figure 2 Reasons for SmOklnQ as a Function of Level of SmOklnQ
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only, 3) explanation and collection of saliva samples from all participating students concurrent with administration of the questionnaire, and 4) explanation of the data collection objectives and the important role of the students in achieving them. Two open-ended items were used to assess reasons for smoking: “Why did you smoke or try your first cigarette?” and “Why do you currently smoke?” Five items with a Likert-type response format were used to assess aspects of smoking history, current smoking, and intentions to smoke: “Have you ever smoked or tried a cigarette? ,” “How often do you currently smoke cigarettes?,” “How many cigarettes have you smoked in your life?,” “If you smoke, could you stop smoking easily?,” and “What are your plans about smoking cigarettes? ” In every case, responses to the open-ended items about reasons for smoking were legible to the coders. Reasons for students’ tobacco use were coded into 1 1 categories similar to those from a previous article;1° these categories and examples of responses so categorized were: 1) curiosity (“Just to try it”), 2) social norms (“a lot of my friends did”), 3) offers and/or pressures (“my friend asked me if I wanted to try”), 4) enhancement of self-image (“to look mature”), 5 ) pleasure and/ or reduction of negative affect (“it’s relaxing”), 6) preconceived expectations (“I thought it would be good”), 7) boredom (“there was nothing else to do”), 8) desire (“I wanted to”), 9) addictiodhabit (“out of habit”), 10)responses indicating a desire to quit tobacco use (“I want to quit”), and 11) don’t know (“don’t know why I smoke”). Coding was completed twice by two independent groups of trained staff. The reliability of coding the open-ended responses was very high. A random check of 104 surveys showed that only 3% of the reasons given were coded differently by the two groups. All differences were resolved during meetings among the coders. Statistical Analyses. The usual X test was used to test equality of proportions between two groups. The McNemar’s test was used to test equality of proportions from paired data. Logistic regression analyses were conducted to assess the contribution of several variables to the prediction of binary dependent variables, such as whether or not a particular reason was reported. The Wald Chi-square statistic, the square of the ratio of the regression coefficient to its standard error, was used to evaluate the contribution of a variable entered into a logistic regression model. In view of gender differences in the smoking acquisition p r o ~ e s s , ~all~ analyses J~ were performed separately for male and female students, and gender differences are reported when they are statistically significant.
RESULTS Reasonsfor Current Smoking. As shown in Figure 1, the most frequently reported reasons for smoking among current smokers who reported smoking at least once per month were pleasure/affect (males, 19070, females, 29%, overall 23%), addictiodhabit (males, 2290,females, 2290,overall 22%), and desire (males, 129’0,females, 13%, overall 12%). All other reasons were reported by fewer than 10% of the students. A
gender difference was found only for the pleasure/affect reason: significantly more females (29%) than males (19%) reported pleasure/affect as a reason for current smoking ( X = 4.36,p .05). Reasons reported for currently smoking were investigated by level of smoking: light (less than weekly), medium (less than daily), heavy (1-10cigarettes per day) and very heavy ( 10 cigarettes per day) use. As shown in Figure 2, the level of smoking is strongly related to the addiction/habit reason (Wald test statistic = 24.02,p c .001),with more than 50% of very heavy current users reporting addictiodhabit as a reason for their current smoking. Also, the level of smoking is positively related to the pleasure/affect reason (Wald test statistic = 3.79, p c .052). However, the relative frequency of other reasons did not significantly depend on the level of students’ smoking. Reasons reported for currently smoking were also investigated in relation to perceived difficulty of quitting. Among current smokers, 179 (46.3%) responded “yes, I could quit easily,” 79 (20.4%) reported that “no, I could not quit easily,” and 88 (22.7%) indicated they did not know if they could stop easily. As shown in Figure 3, the percentage of students reporting addiction/habit as a reason for smoking was only 8% among smokers who reported that they could quit easily, and 54% among those who reported that they could not quit easily. Addictiodhabit was positively related to perceived difficulty of quitting (Wald test statistic = 23.25, p .001). Students’ intentions to smoke were assessed by asking: “What are your plans about smoking cigarettes?” Four responses were pertinent to current smokers: “I plan to continue,” “I don’t know whether or not I will continue,” “I plan to quit eventually,” and “I plan to quit soon.” The third and fourth responses were combined to form an overall intention to quit category. Twenty-one (25.6%) of current once-a-month or more smokers intended to continue smoking, 142 (36.7%) intended to quit, and 146 (37.7%) were uncertain about their future plans. The findings showed that the response “don’t know why I smoke’’ was positively related to intention to quit (Wald test statistic = 3.13, p = .057).Other reasons were not significantly related to intentions.
Reasons for Beginning to Smoke. As shown in Figure 4, the most frequently reported reasons for beginning to smoke among the 1,126 students who reported ever trying at least one cigarette were curiosity (males 42%, females 46%, overall 45%), social norms (males 17%, females 31%, overall 23%), offers/pressure (males 9%, females IS%, overall 12%), and desire (males 1 1 Yo, females 1 1 To, overall 1 1 To). All other reasons were reported by fewer than 10% of the students. A gender difference was found only for social norms and offers/pressure reasons: significantly more females than males reported social norms (males 17%, females 31%; X = 29.75, p < .001), and offers/pressures (males 9%, females 15%; X = 9.41,p c .01)as reasons for beginning to smoke. However, significantly more males (7%) than females (3010) reported that they did not know why they began smoking (X = 4.08, p < .05).
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R r 8 o n 8 for Smoklng 18
Figure 3 a Functlon of R m l v o d B 8 0 of Qulttinp
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Reasons for beginning to smoke that might distinguish experimental smokers from those who develop regular smoking habits also were investigated. Students who had tried cigarettes were divided into two groups: those who became weekly or more frequent smokers (continuers, N = 434), and those who did not (non-continuers, N = 675). As shown in Figure 5 , curiosity (Wald test statistic = 18.82, p < .001) and offerdpressure (Wald test statistic = 3.72, p < .05) were negatively related to continuing smoking: only 24% male and 36% female continuers reported curiosity as a reason for starting to smoke, where 53% male and 55% female non-continuers did. Eight percent of male and 12% of female continuers reported offers/pressures as a reason for starting to smoke whereas 10% male and 18% female non-continuers did. Social norms (Wald test statistic = 8.94, p < .Ol), desire (Wald test statistic = 15.78, p .001),and pleasure/affect (Wald test statistic = 6.18, p < .05) were positively related to continuing smoking. Higher percentages of continuers than non-continuers reported respectively; social norms (males 22070, females 38% as compared with males 14%, females 26%), desire (males 21 Yo, females 17% as compared with males 6%, females 6Oi'o), and pleasure/affect (males 11'70, females 10% ascompared with males 2070, females 4%) as reasons for beginning tobacco use. The relative frequencies of other reasons were not significantly different for continuers and non-continuers. Only among continuers, a gender difference in rea-
sons for beginning to smoke was observed for curiosity (males 24%; females 36%). Female continuers reported curiosity more than male continuers and that was positively related to continuing smoking (Wald test statistic = 3.69, p < .055).
DISCUSSION The most frequently reported reasons for beginning smoking were curiosity (45%), social norms (23Oro), and offers/pressures (12%), while for current smoking, the main reasons were pleasure/affect (23 To), addiction/ habit (22%), and desire (12%). Curiosity was reported as a reason for beginning to smoke by about 45% of students, but was not reported as a reason for currently smoking. Social norms was reported by about 25% of students as a reason for beginning to smoke, but was reported by only slightly more than 5% of students as a reason for currently smoking. Almost 25% of students reported pleasure/affect as a reason for currently smoking but only 5 % of students reported this reason for beginning to smoke. More than 20% of students reported currently smoking because of addictiodhabit, while as expected, no students reported this reason for beginning to smoke. Thus, personal and social factors, such as curiosity, social norms, and offers/pressure, were frequently reported as reasons for beginning use of tobacco, whereas physiological or affective reasons were more frequently reported for current use of tobacco, such as pleasure/reduction of negative affect, and addiction/
Figure 5 Reasons for Beginning to Smoke Amonp Continuers and Non-Continuers
Z students reporting reason 60
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habit. These findings are consistent with previous eviden~e.~JO A number of gender differences were found: As a reason for current smoking, more females (29%) than males (19%) reported pleasure/affect, and for beginning smoking, females reported both social norms and offers/pressure as reasons more frequently than did males. Reasons reported for begining to smoke were associated with individuals’ subsequent smoking experience. Social norms, desire, and pleasure/affect were reported as reasons for beginning tobacco use more frequently among continuers than non-continuers, and curiosity less frequently. These reasons for beginning tobacco use might be interpreted as risk factors for subsequently becoming regular tobacco users. Among current smokers, the level of smoking was positively related to reported use of tobacco due to addictiodhabit and pleasure/affect. Perceptions about ability to quit were negatively related to addiction/habit as a reason for use. Adolescents’ reasons for smoking varied as a function of their smoking histories. Students who had only experimented with tobacco (non-continuers) reported more frequently curiosity and offers/pressure as reasons for beginning use than students who had experimented with tobacco and progressed to weekly or more frequent use (continuers). Though curiosity and offers/pressure were common reasons for begining use of tobacco, they did not appear to be important risk factors once regular use was adopted by adolescent smokers. Though the data reported here were gathered in 1986, the results seem applicable today. While there have been new tobacco advertising campaigns and some demographic changes, there is no basis for believing that reasons for smoking have changed among adolescents. In addition, since 1980, the trend in smoking prevalence among high school students has remained stable at about 19%. I ‘ This fact suggests information gathered in 1986 on adolescents’ reported reasons for beginning and current smoking is applicable to present-day smoking prevention research and intervention.
CONCLUSIONS Understanding which reasons for tobacco use that are most prevalent at various stages of the smoking onset process might be useful in designing prevention program components to address specific motivations for using tobacco at different stages of onset. This study reports adolescents’ reasons for beginning and current tobacco use as a function of smoking history, intentions about tobacco use, gender, and current use of tobacco. The significance of these variables suggests the complexity of adolescent smoking and its determinants. The often weak results of school-based smoking prevention programs may be due in part to their failure to take account of the heterogeneity of the adolescent population and to target certain high risk groups. Results from studies of reasons for tobacco use may help smoking prevention programs to develop effective strategies which can be targeted at children with “high risk” motivations who are prone to become regular smokers.
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While the predictive role that adolescents’ reasons for tobacco use plays in the smoking onset process requires longitudinal research designs, this cross-sectional analysis demonstrated that reasons for tobacco use are different for regular and experimental tobacco users and for males and females. Identifying reasons for tobacco use that are risk factors for continued use may be of great value in designing more successful prevention programs. Prevention programs may require new strategies for redirecting the motivations underlying these reasons t o other behaviors, and for challenging students’ perceptions and attitudes about tobacco that make them feel that smoking can serve some purpose, or that there is a reason to smoke.” For example, addiction was a frequently given reason for continued smoking. Perhaps smoking prevention programs need to make a stronger effort to make students aware of the addictive properties of tobacco and what addiction means in terms of social adjustment and difficulties in living. Social norms were frequently given as a reason for beginning to smoke. Intervention programs need to deal effectively with positive and negative features of social norms in children’s lives. This study demonstrates that children do have specific reasons for why they begin to smoke and continue to smoke and these reasons or motivations need to be addressed by smoking intervention programs. m References 1. Marwick C. Even “knowing better” about smoking, other
health risks, may not deter adolescents. JAMA. 1988;260:1512-1513. 2. Cleary PD, Hitchcock JL, Semmer N, Flinchbaugh LJ, Pinney JM. Adolescent smoking: Research and health policy. Milbank Q. 1988;66:137-171. 3. Flay BR. Psychosocial approaches to smoking prevention: A review of the findings. Health Psychol. 1985;4:449-488. 4. Leventhal H. Cleary PD. The smoking problem: A review of the research and theory in behavioral risk modification. Psychol Bull. 1980;88:370-405. 5. Coan RW. Personality variables associated with cigarette smoking. J Pers Soc Psychol. 1973;26:86-104. 6. Horn D, Waingrow S. Behavior and attitudes. Unpublished questionnaire. 1966. 7. Livson N, Leino EV. Cigarette smoking motives: Factorial structure and gender differences in a longitudinal study. In1 J Addict. 1988;23:535-544. 8. Tate JC, Stanton AL. Assessment of the validity of the Reasons for Smoking scale. Addicf Behav. 1990;15:129-135. 9. Zoller U, Maymon T. Smoking behavior of high school students in Israel. J Sch Health. 1983;53(10):613-617. 10. Levitt EE. Reasons for smoking and not smoking given by school children. J Sch Health. 1971;41(2):101-105. 1 1 . Chassin L. Presson CC, Sherman SJ, Edwards PA. The natural history of cigarette smoking: Predicting young adult smoking outcomes from adolescent smoking patterns. Healrh Psychol. 1990;9:701-716. 12. Clayton S. Gender differences in psychosocial determinants of adolescent smoking. J Sch Health. 1991;61(3):115-120. 13. Grunberg NE, Winders SE, Wewers ME. Gender differences in tobacco use. Health Psychol. 1991;19:143-153. 14. Reducing the Health Consequences of Smoking: 25 Years of progress. A report of the Surgeon General. Washington, DC: US Dept o f Health and Human Services publication (CDC) 89-841 I ; 1989. 15. Hirschman RS, Leventhal H. Preventing smoking behavior in school children: An initial test of a cognitive-developmental program. J Appl Soc Psychol. 1989;19:559-583.
ABSTRACT: Part of the Hutchinson Smoking Prevention Project. this study provides information on reasons reported by adolescents for their smoking behavior. A total of 1,615 10th grade students in 20 rural and suburban school districts in Washington state were asked why they currently smoke and why they first smoked. For beginning smoking, curiosity, social norms, and social pressure were the most frequently given reasons for smoking. For current smoking, pleasure and addiction were mentioned most often. A number of gender duferences occurred with 10th grade students beginning and current smoking. More females than males reported social norms and social pressure as reasons for beginning to smoke, whereas for currently smoking, pleasure was given as a reason more frequently by females than males. When developing interventions, smoking prevention programs need to consider students’ current and past smoking behavior, and the reasons they give for smoking. (J Sch Health. 1992;62(5):185-190)
S
ince the 1970s, smoking has declined somewhat among adolescent males, but not among adolescent females. Many adolescents continue to smoke despite exposure to prevention programs and knowledge of its adverse effects. I Most school-based smoking prevention programs have not produced consistent or long-term reductions in smoking One possible reason why smoking prevention programs have not been more successful is that these programs have not been sufficiently responsive to the reasons (motivations) for adolescents’ smoking. More information about the reasons children and adolescents give for their own smoking might strengthen the design and effectiveness of smoking prevention programs. While some research has been conducted on selfreported reasons for smoking, most of it has dealt with adults’ motivations to smoke. The main reasons adults give for smoking are social acceptance, addiction/habitual needs, pleasure, and b ~ r e d o m . It ~ - is ~ difficult to extract generalizations from studies with adults that often deal with special groups, such as highly committed, long-term smokers.’ Therefore, intervention researchers also need to investigate children’s reported reasons for smoking. Concerning research on self-reported reasons among adolescents, Zoller and Maymon9 found curiosity the most common reason reported for trying smoking in a sample of high school students, while LevittlO reported pleasure, improvement of emotion, and habit as the most common reasons 10th grade students gave for current smoking. Unfortunately, these findings were based on samples either gathered many years ago or with samples of Israeli, rather than American students. Information about why adolescents smoke is especially important in view of evidence that even infrequent smoking in adolescence significantly raises the risk for adult smoking. Regular (at least monthly) adolescent smoking increases the risk for adult smoking by ~~
Irwin G. Sarason. PhD; Arthur V. Peterson, Jr., PhD; and Khanh T. Dinh, Fred Hutchinson Cancer Research Center, Hutchinson Smoking Prevention Project, MP-603. Division of Public Health Sciences, 1124 Columbia St., Seattle, WA 98104-2092;and Eric S. Mankowski, Dept. of Psychology University of Illinois at Urbana, Urbana. IL 61801. This work was supported by National Cancer Institute Grant CA-38269. This article was submitted October 14, 1991. and revised and accepted for publication March 16, 1992.
a factor of 16 compared to non-smoking.l’ This research investigated adolescents’ motivations for tobacco use in a large group of adolescents. Reasons reported by 10th grade students were examined in relation with using and continuing to use tobacco and how the reported reasons are related to level of smoking, perceived ease of quitting, and intentions about tobacco use. Because certain motivations for tobacco use may be more common among children who progress to the final stage of regular smoking,‘ further investigations were completed on whether certain reasons are more prevalent among adolescents who went on to become regular smokers. METHOD Subjects. Subjects were 1,615 10th grade students in 1986 in 20 geographically and demographically diverse rural and suburban school districts in Washington state. These school districts, part of the Hutchinson Smoking Prevention Project (HSPP), an ongoing, randomized, controlled trial in school-based smoking prevention, are the third wave of a total of 40 school districts recruited into the HSPP trial from the 41 selected and invited to join based on HSPP eligibility criteria such as school size and distance from Hutchinson Research Center. The 1,615 students represented 93% of those eligible; of the 7% non-participating students, 6 % were absent on the day of data collection and 1% declined to participate. The 387 (24%) students who reported smoking at least once a month were used to investigate reasons for current smoking; the 1,126 (69.7%) students who reported ever trying a cigarette were used to investigate reasons for beginning smoking. Procedure. A tobacco use questionnaire was administered to 10th grade students by trained HSPP data collectors in the classroom during one class period. Through an informational letter to parents and by inclass procedures, parents and students were fully informed in advance and were given an opportunity to ask questions and to decline participation. Measures used to enhance accuracy of responses to the questionnaire items included 1) administration of the questionnaire on an unannounced date, 2) classroom procedures designed to maintain and demonstrate confidentiality, including the use of study identification numbers and the handling of questionnaires by project data collectors
Journal of School Health
M#y 1992, Vol. 62, No. 5
185
Figure 1 Reasons for Currently Smoklnp 'Z students reporting reason 60
50
40
30
20
10
0 soda1 norms
=
Molar
effrr/prrsnura
(N3174)
salf-image
Frmalar (N=ZlS)
'Z students reporting reason
drrlrr
ptrosurr/affect
oddlctlon/hablt
wontr net to
borrdom
Keason
Figure 2 Reasons for SmOklnQ as a Function of Level of SmOklnQ
60
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offar/prmrrura
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only, 3) explanation and collection of saliva samples from all participating students concurrent with administration of the questionnaire, and 4) explanation of the data collection objectives and the important role of the students in achieving them. Two open-ended items were used to assess reasons for smoking: “Why did you smoke or try your first cigarette?” and “Why do you currently smoke?” Five items with a Likert-type response format were used to assess aspects of smoking history, current smoking, and intentions to smoke: “Have you ever smoked or tried a cigarette? ,” “How often do you currently smoke cigarettes?,” “How many cigarettes have you smoked in your life?,” “If you smoke, could you stop smoking easily?,” and “What are your plans about smoking cigarettes? ” In every case, responses to the open-ended items about reasons for smoking were legible to the coders. Reasons for students’ tobacco use were coded into 1 1 categories similar to those from a previous article;1° these categories and examples of responses so categorized were: 1) curiosity (“Just to try it”), 2) social norms (“a lot of my friends did”), 3) offers and/or pressures (“my friend asked me if I wanted to try”), 4) enhancement of self-image (“to look mature”), 5 ) pleasure and/ or reduction of negative affect (“it’s relaxing”), 6) preconceived expectations (“I thought it would be good”), 7) boredom (“there was nothing else to do”), 8) desire (“I wanted to”), 9) addictiodhabit (“out of habit”), 10)responses indicating a desire to quit tobacco use (“I want to quit”), and 11) don’t know (“don’t know why I smoke”). Coding was completed twice by two independent groups of trained staff. The reliability of coding the open-ended responses was very high. A random check of 104 surveys showed that only 3% of the reasons given were coded differently by the two groups. All differences were resolved during meetings among the coders. Statistical Analyses. The usual X test was used to test equality of proportions between two groups. The McNemar’s test was used to test equality of proportions from paired data. Logistic regression analyses were conducted to assess the contribution of several variables to the prediction of binary dependent variables, such as whether or not a particular reason was reported. The Wald Chi-square statistic, the square of the ratio of the regression coefficient to its standard error, was used to evaluate the contribution of a variable entered into a logistic regression model. In view of gender differences in the smoking acquisition p r o ~ e s s , ~all~ analyses J~ were performed separately for male and female students, and gender differences are reported when they are statistically significant.
RESULTS Reasonsfor Current Smoking. As shown in Figure 1, the most frequently reported reasons for smoking among current smokers who reported smoking at least once per month were pleasure/affect (males, 19070, females, 29%, overall 23%), addictiodhabit (males, 2290,females, 2290,overall 22%), and desire (males, 129’0,females, 13%, overall 12%). All other reasons were reported by fewer than 10% of the students. A
gender difference was found only for the pleasure/affect reason: significantly more females (29%) than males (19%) reported pleasure/affect as a reason for current smoking ( X = 4.36,p .05). Reasons reported for currently smoking were investigated by level of smoking: light (less than weekly), medium (less than daily), heavy (1-10cigarettes per day) and very heavy ( 10 cigarettes per day) use. As shown in Figure 2, the level of smoking is strongly related to the addiction/habit reason (Wald test statistic = 24.02,p c .001),with more than 50% of very heavy current users reporting addictiodhabit as a reason for their current smoking. Also, the level of smoking is positively related to the pleasure/affect reason (Wald test statistic = 3.79, p c .052). However, the relative frequency of other reasons did not significantly depend on the level of students’ smoking. Reasons reported for currently smoking were also investigated in relation to perceived difficulty of quitting. Among current smokers, 179 (46.3%) responded “yes, I could quit easily,” 79 (20.4%) reported that “no, I could not quit easily,” and 88 (22.7%) indicated they did not know if they could stop easily. As shown in Figure 3, the percentage of students reporting addiction/habit as a reason for smoking was only 8% among smokers who reported that they could quit easily, and 54% among those who reported that they could not quit easily. Addictiodhabit was positively related to perceived difficulty of quitting (Wald test statistic = 23.25, p .001). Students’ intentions to smoke were assessed by asking: “What are your plans about smoking cigarettes?” Four responses were pertinent to current smokers: “I plan to continue,” “I don’t know whether or not I will continue,” “I plan to quit eventually,” and “I plan to quit soon.” The third and fourth responses were combined to form an overall intention to quit category. Twenty-one (25.6%) of current once-a-month or more smokers intended to continue smoking, 142 (36.7%) intended to quit, and 146 (37.7%) were uncertain about their future plans. The findings showed that the response “don’t know why I smoke’’ was positively related to intention to quit (Wald test statistic = 3.13, p = .057).Other reasons were not significantly related to intentions.
Reasons for Beginning to Smoke. As shown in Figure 4, the most frequently reported reasons for beginning to smoke among the 1,126 students who reported ever trying at least one cigarette were curiosity (males 42%, females 46%, overall 45%), social norms (males 17%, females 31%, overall 23%), offers/pressure (males 9%, females IS%, overall 12%), and desire (males 1 1 Yo, females 1 1 To, overall 1 1 To). All other reasons were reported by fewer than 10% of the students. A gender difference was found only for social norms and offers/pressure reasons: significantly more females than males reported social norms (males 17%, females 31%; X = 29.75, p < .001), and offers/pressures (males 9%, females 15%; X = 9.41,p c .01)as reasons for beginning to smoke. However, significantly more males (7%) than females (3010) reported that they did not know why they began smoking (X = 4.08, p < .05).
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Reasons for beginning to smoke that might distinguish experimental smokers from those who develop regular smoking habits also were investigated. Students who had tried cigarettes were divided into two groups: those who became weekly or more frequent smokers (continuers, N = 434), and those who did not (non-continuers, N = 675). As shown in Figure 5 , curiosity (Wald test statistic = 18.82, p < .001) and offerdpressure (Wald test statistic = 3.72, p < .05) were negatively related to continuing smoking: only 24% male and 36% female continuers reported curiosity as a reason for starting to smoke, where 53% male and 55% female non-continuers did. Eight percent of male and 12% of female continuers reported offers/pressures as a reason for starting to smoke whereas 10% male and 18% female non-continuers did. Social norms (Wald test statistic = 8.94, p < .Ol), desire (Wald test statistic = 15.78, p .001),and pleasure/affect (Wald test statistic = 6.18, p < .05) were positively related to continuing smoking. Higher percentages of continuers than non-continuers reported respectively; social norms (males 22070, females 38% as compared with males 14%, females 26%), desire (males 21 Yo, females 17% as compared with males 6%, females 6Oi'o), and pleasure/affect (males 11'70, females 10% ascompared with males 2070, females 4%) as reasons for beginning tobacco use. The relative frequencies of other reasons were not significantly different for continuers and non-continuers. Only among continuers, a gender difference in rea-
sons for beginning to smoke was observed for curiosity (males 24%; females 36%). Female continuers reported curiosity more than male continuers and that was positively related to continuing smoking (Wald test statistic = 3.69, p < .055).
DISCUSSION The most frequently reported reasons for beginning smoking were curiosity (45%), social norms (23Oro), and offers/pressures (12%), while for current smoking, the main reasons were pleasure/affect (23 To), addiction/ habit (22%), and desire (12%). Curiosity was reported as a reason for beginning to smoke by about 45% of students, but was not reported as a reason for currently smoking. Social norms was reported by about 25% of students as a reason for beginning to smoke, but was reported by only slightly more than 5% of students as a reason for currently smoking. Almost 25% of students reported pleasure/affect as a reason for currently smoking but only 5 % of students reported this reason for beginning to smoke. More than 20% of students reported currently smoking because of addictiodhabit, while as expected, no students reported this reason for beginning to smoke. Thus, personal and social factors, such as curiosity, social norms, and offers/pressure, were frequently reported as reasons for beginning use of tobacco, whereas physiological or affective reasons were more frequently reported for current use of tobacco, such as pleasure/reduction of negative affect, and addiction/
Figure 5 Reasons for Beginning to Smoke Amonp Continuers and Non-Continuers
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habit. These findings are consistent with previous eviden~e.~JO A number of gender differences were found: As a reason for current smoking, more females (29%) than males (19%) reported pleasure/affect, and for beginning smoking, females reported both social norms and offers/pressure as reasons more frequently than did males. Reasons reported for begining to smoke were associated with individuals’ subsequent smoking experience. Social norms, desire, and pleasure/affect were reported as reasons for beginning tobacco use more frequently among continuers than non-continuers, and curiosity less frequently. These reasons for beginning tobacco use might be interpreted as risk factors for subsequently becoming regular tobacco users. Among current smokers, the level of smoking was positively related to reported use of tobacco due to addictiodhabit and pleasure/affect. Perceptions about ability to quit were negatively related to addiction/habit as a reason for use. Adolescents’ reasons for smoking varied as a function of their smoking histories. Students who had only experimented with tobacco (non-continuers) reported more frequently curiosity and offers/pressure as reasons for beginning use than students who had experimented with tobacco and progressed to weekly or more frequent use (continuers). Though curiosity and offers/pressure were common reasons for begining use of tobacco, they did not appear to be important risk factors once regular use was adopted by adolescent smokers. Though the data reported here were gathered in 1986, the results seem applicable today. While there have been new tobacco advertising campaigns and some demographic changes, there is no basis for believing that reasons for smoking have changed among adolescents. In addition, since 1980, the trend in smoking prevalence among high school students has remained stable at about 19%. I ‘ This fact suggests information gathered in 1986 on adolescents’ reported reasons for beginning and current smoking is applicable to present-day smoking prevention research and intervention.
CONCLUSIONS Understanding which reasons for tobacco use that are most prevalent at various stages of the smoking onset process might be useful in designing prevention program components to address specific motivations for using tobacco at different stages of onset. This study reports adolescents’ reasons for beginning and current tobacco use as a function of smoking history, intentions about tobacco use, gender, and current use of tobacco. The significance of these variables suggests the complexity of adolescent smoking and its determinants. The often weak results of school-based smoking prevention programs may be due in part to their failure to take account of the heterogeneity of the adolescent population and to target certain high risk groups. Results from studies of reasons for tobacco use may help smoking prevention programs to develop effective strategies which can be targeted at children with “high risk” motivations who are prone to become regular smokers.
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While the predictive role that adolescents’ reasons for tobacco use plays in the smoking onset process requires longitudinal research designs, this cross-sectional analysis demonstrated that reasons for tobacco use are different for regular and experimental tobacco users and for males and females. Identifying reasons for tobacco use that are risk factors for continued use may be of great value in designing more successful prevention programs. Prevention programs may require new strategies for redirecting the motivations underlying these reasons t o other behaviors, and for challenging students’ perceptions and attitudes about tobacco that make them feel that smoking can serve some purpose, or that there is a reason to smoke.” For example, addiction was a frequently given reason for continued smoking. Perhaps smoking prevention programs need to make a stronger effort to make students aware of the addictive properties of tobacco and what addiction means in terms of social adjustment and difficulties in living. Social norms were frequently given as a reason for beginning to smoke. Intervention programs need to deal effectively with positive and negative features of social norms in children’s lives. This study demonstrates that children do have specific reasons for why they begin to smoke and continue to smoke and these reasons or motivations need to be addressed by smoking intervention programs. m References 1. Marwick C. Even “knowing better” about smoking, other
health risks, may not deter adolescents. JAMA. 1988;260:1512-1513. 2. Cleary PD, Hitchcock JL, Semmer N, Flinchbaugh LJ, Pinney JM. Adolescent smoking: Research and health policy. Milbank Q. 1988;66:137-171. 3. Flay BR. Psychosocial approaches to smoking prevention: A review of the findings. Health Psychol. 1985;4:449-488. 4. Leventhal H. Cleary PD. The smoking problem: A review of the research and theory in behavioral risk modification. Psychol Bull. 1980;88:370-405. 5. Coan RW. Personality variables associated with cigarette smoking. J Pers Soc Psychol. 1973;26:86-104. 6. Horn D, Waingrow S. Behavior and attitudes. Unpublished questionnaire. 1966. 7. Livson N, Leino EV. Cigarette smoking motives: Factorial structure and gender differences in a longitudinal study. In1 J Addict. 1988;23:535-544. 8. Tate JC, Stanton AL. Assessment of the validity of the Reasons for Smoking scale. Addicf Behav. 1990;15:129-135. 9. Zoller U, Maymon T. Smoking behavior of high school students in Israel. J Sch Health. 1983;53(10):613-617. 10. Levitt EE. Reasons for smoking and not smoking given by school children. J Sch Health. 1971;41(2):101-105. 1 1 . Chassin L. Presson CC, Sherman SJ, Edwards PA. The natural history of cigarette smoking: Predicting young adult smoking outcomes from adolescent smoking patterns. Healrh Psychol. 1990;9:701-716. 12. Clayton S. Gender differences in psychosocial determinants of adolescent smoking. J Sch Health. 1991;61(3):115-120. 13. Grunberg NE, Winders SE, Wewers ME. Gender differences in tobacco use. Health Psychol. 1991;19:143-153. 14. Reducing the Health Consequences of Smoking: 25 Years of progress. A report of the Surgeon General. Washington, DC: US Dept o f Health and Human Services publication (CDC) 89-841 I ; 1989. 15. Hirschman RS, Leventhal H. Preventing smoking behavior in school children: An initial test of a cognitive-developmental program. J Appl Soc Psychol. 1989;19:559-583.
