Gender differences in teenage smoking.

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Gender Differences in Teenage Smoking a

b

Ingrid Waldron PhD , Diane Lye PhD & Anastasia Brandon MA

c

a

Professor of Biology, University of Pennsylvania, Philadelphia, PA, 19104-6018 b

Assistant Professor, Department of Sociology, University of Washington c

graduate student, Population Studies Center, University of Pennsylvania Published online: 05 Nov 2010.

To cite this article: Ingrid Waldron PhD , Diane Lye PhD & Anastasia Brandon MA (1991) Gender Differences in Teenage Smoking, Women & Health, 17:2, 65-90, DOI: 10.1300/ J013v17n02_04 To link to this article: http://dx.doi.org/10.1300/J013v17n02_04

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Gender Differences in Teenage Smoking


I n g r i d W a l d r o n , PhD D i a n e Lye, PhD A n a s t a s i a Brandon, MA

ABSTRACT. This study analyzes the patterns and correlates of gender differences in cigarette smoking in a national sample of white high school seniors in 1985. More females than males were smokers, because females had higher rates for the early stages of smoking adoption. Specifically, females were more likely to have tried smoking at least once and, among those who had tried smoking, females were more likely to have smoked more than once or twice. Gender differences in smoking varied, depending on the students' characteristics. For example, the female excess in the early stages of smoking adoption was small or absent among rural students or very religious students, apparently because traditional values inhibit smoking adoption more among females than among males. We estimated the contributions of gender differences in students' characteristics to gender differences in smoking adoption. For example, males were more involved in sports, and this appears to be one reason why males had lower rates of smoking adoption than Ingrid Waldron is Professor of Biology at the Universiry of Pennsylvania, Philadelphia, PA 19104-6018. Diane Lye is Assistant Professor of Sociology at the University of Washington. Anastasia Brandon is a graduate studcnt at the Population Studies Center, University of Pennsylvania. The data utilized in this paper were collected by Lloyd D. Johnston, Jerald G. Bachman and Patrick M. O'Malley of the Survey Rcsearch Center, Institute for Social Research, University of Michigan, and the data were made available by the Inter-university Consortium for Political and Social Research. The research reported in this paper has been supported by funds from the John D. and Catherine T. MacArthur Foundation Network on the Determinants and Consequences of Health-damaging and Health-promoting Behavior. The authors thank Drs. Abba Krieger and Paul Rosenbaum for their statistical advice. None of these institutions or individuals bears any responsibility for the analyses or interpretations presented in this paper. The Technical Appendix and Supplementary Tables mentioned in this article are available from the first author upon request. Women & Health, Vol. 17(2) 1991 0 1991 by The Haworth Press, Inc. All rights resewed.

65

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WOMEN & HEALTH

females. On the other hand, males had more deviant behavior and attitudes, and this would be expected to contribute to greater smoking adoption by males. The findings of this study indicate important gender differences in the determinants of smoking adoption.


INTRODUCTZON For most Western and non-Western societies in most historical periods for which data are available, more males than females have smoked cigarettes and engaged in other forms of tobacco use (Waldron, 1988, 1990; Waldron et al., 1988). In contrast, recent data indicate that more females than males smoke cigarettes among teenagers in a number of contemporary Western countries, including the United States, Sweden, Great Britain and New Zealand (Goddard & Iken, 1987; Jarvis & Jackson, 1988; Johnston et al., 1989; Nordgren, 1981; Pirie et al., 1988; Stoto, 1988). Among high school seniors in the U. S., the female excess in cigarette smoking has been observed from the late 1970s through the mid-1980s (Johnston et al., 1989; National Institute of Education, 1979).' The female excess in smoking has been observed primarily among older teenagers and has generally been smaller or absent among younger teenagers or pre-teens (Goddard & Iken, 1987; Kegeles et al., 1989; National Institute of Education, 1979; Nordgren, 1981). There has been considerable public interest in this female excess in the prevalence of smoking among teenagers, but relatively little research effort has been devoted to analyzing this phenomenon. One basic approach to understanding gender differences in the prevalence of smoking is to evaluate gender differences in the various stages of smoking adoption and cessation. Recent data indicate that, among older teenagers in the U. S. and Great Britain, girls have been more likely than boys to have tried smoking at least one cigarette (Goddard & Iken, 1987; Johnston et al., 1989; Silverstein et al., 1980; but see Peterson et al., 1989). Additional evidence for one sample indicates that females were more likely than males to have proceeded from first use to tenth use of cigarettes and from tenth use to weekly use of cigarettes (Peterson et al., 1989). Gender differences in smoking cessation have been inconsistent in recent studies of teenagers in the U. S., Great Britain and New Zealand


Waldron, Lye, a d Brandon

67

(Goddard & Iken, 1987; Jarvis & Jackson, 1988; ~ohnstonet al., 1986; National Institute of Education, 1979; Stoto, 1988). The present study provides a systematic analysis of gender differences in the various stages of smoking adoption and smoking cessation for white high school seniors in the United States in 1985. A second useful approach to understanding why smoking is more prevalent among teenage girls than boys is to identify subgroups in which this gender difference is larger or smaller. Two observations suggest that the female excess in the prevalence of smoking is smaller or absent in regions which are more socially consewative. First, data for teenagers in Norway suggest that the female excess in smoking was smaller in regions in which people were more religious and more favorable toward temperance and prohibition movements (Aaro et al., 1981). Second, data for teenagers in Ontario indicate that more girls than boys were smokers in urban areas, but not in rural areas (Boyle & Offord, 1986). In the United States, it appears that gender differences in smoking vary by education. Data for 19 to 24 year olds in the 1980s indicate that, among those who were in college or had attended college, females were more likely than males to be smokers, while, among the less educated, gender differences were small and inconsistent (Johnston et al., 1989; Pierce et al., 1989). In the present study, we test whether gender differences in smoking vary by area of residence, educational goals, and a wide variety of additional variables. In contrast to most previous studies, we have tested the statistical significance of observed variations in gender differences in smoking. A third important approach to understanding gender differences in smoking is to identify characteristics which are associated with smoking and to estimate the possible contributions of gender differences in these characteristics to gender differences in smoking. Previous studies have identified a number of characteristics which predict smoking adoption or increased smoking, and current evidence indicates that many of these are more common among males, including rebelliousness, a tendency to deviance, and more negative attitudes toward school and religion (Brook et al., 1987; Gerber & Newman, 1989; Murray et al., 1983; National Institute of Education, 1979; Reynolds & Nichols, 1976; Waldron, 1990). One study


68

WOMEN & HEALTH

has shown that the observed gender differences in delinquent behavior, commitment to school and religion, and frequency of going out to bars and parties would be expected to result in more smoking among males than among females (Herzog et al., 1987). Thus, in order to account for females' higher rates of smoking adoption, there must be other factors which more than counterbalance the effects of males' more deviant, less conventional attitudes and behavior. In the present study we have estimated the possible contributions of gender differences in a broad array of characteristics to gender differences in smoking. SAMPLE AND METHODS The data for the present study are from the 1985 Monitoring the Future survey of high school seniors in the coterminous United States. Sampling methods and sample characteristics have been described previously (Johnston et al., 1986). Briefly, the sample was stratified by geographic area and by high school within geographic area. The response rate for students within sampled schools was about 84% (with most non-participation due to absence from school). In this sample, as in previous studies (U.S.Department of Health and Human Services, 1988), gender differences in smoking varied by race. Among the white high school seniors, more females than males were current smokers (34% vs. 28% had smoked in the past 30 days; p < .0001). In contrast, among the black high school seniors, equal proportions of females and males were current smokers (18% for males and for females). Unfortunately, we were not able to examine this racial difference, due to the relatively small number of blacks and methodological problems involved in racial comparisons in this sample (Johnston et al., 1986). The sample is less representative of blacks than of whites in the age range covered, particularly for males. This is due to higher dropout rates for blacks, and apparently also poorer school attendance and/or greater unwillingness to participate in the study. In addition, for many of the variables in the study, blacks had higher non-response rates. There also appear to be racial differences in response biases. These methodological problems cast doubt on the validity of racial com-


Waldron, Lye, and Brandon

69

parisons in this sumey, so we have excluded the black students from the analyses. We have also excluded the students of other races from the analyses, due to the heterogeneity and relatively small sample size of this group. In summary, the data analyzed in this study are for a large, representative sample of white high school seniors (6233 females and 5781 males, of whom 6158 females and 5689 males provided data on smoking). Data for dropouts and absentees are not included, but evidence from one study suggests that, for their almost entirely white sample, the inclusion of dropouts and absentees had a relatively modest and inconsistent effect on estimates of gender differences in smoking in this age range (Pirie et al., 1988). Five different questionnaire forms were administered, each to about one-fifth of the students. All five questionnaire forms contained a core set of items, including the smoking variables. Other items were included in only one of the five questionnaire forms. Obviously, if an analysis included an item found in only one of the questionnaire forms, then this analysis was necessarily restricted to the subsample of students who completed that specific questionnaire form (referred to herein as subsamples 1-5). Progression in the various stages of smoking adoption was assessed by a series of five dichotomous variables: whether a respondent had ever smoked a cigarette, had ever smoked more than twice, had smoked during the past 30 days, smoked daily, or smoked at least half a pack a day. Smoking cessation was also assessed by a dichotomous variable. (These variables were derived from items B01 and B02, listed in Johnston et al., 1986, which gives the wording and response distribution for each item in the survey.) For each of these smoking adoption or cessation variables, gender differences were tested in a bivariate logistic regression with the smoking variable as the dependent variable and gender as the independent variable. As discussed in the RESULTS section, these analyses show that females had higher rates only for the first two stages in the smoking adoption process and not for later stages of smoking adoption or for maintenance of smoking once smoking adoption had occurred. These findings imply that, in order to understand why more females than males smoke, it is necessary to understand the reasons for females' higher rates for the early stages of


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WOMEN & HEALTH

smoking adoption. Therefore, most of our analyses of the patterns and causes of gender differences in smoking utilize the dichotomous variable: ever smoked more than twice vs. never smoked a cigarette or smoked only once or twice. The validity of self-report measures of smoking appears to be quite high for the type of confidential, anonymous survey carried out in this study (O'Malley, 1984; Strecher et al., 1989). In addition, current evidence suggests no significant gender difference in errors in self-reports of cigarette smoking (Bauman & Koch, 1983; Coultas et al., 1983). Additional variables to be included in the analyses were selected on the basis of the following procedure. First, we chose items from the survey which we expected to be related to smoking, based on theoretical considerations and previous research. For each of these items, we used logistic regressions to test whether the dichotomous dependent variable, ever vs. never smoked more than twice, was significantly related to the item or to the interaction between the item and gender. If either of these effects was significant, then we included the item in our analyses, either as an individual item or as a component of a scale. Since there were a large number of items and many of the items measured similar characteristics, groups of related items were combined into scales which were derived on the basis of substantive considerations and factor analyses. A scale was utilized in this study only if the Cronbach alphas for the scale (calculated separately for males and females) averaged at least .60. These procedures resulted in 26 scales, as well as 52 individual items which were not included in any of the scales. These variables are described in detail in the Technical Appendk2 Among these variables, one item ind three scales are of special interest. Type of area where the respondent grew up (item CO.5) was one of the few variables that assessed an environmental characteristic that predated the initiation of smoking. We coded this variable so that it ranged from farm and rural areas, through cities of increasing size, to suburbs of cities of increasing size. Educational goals were assessed by a 5-item scale that included plans to graduate from a 4-year college, enrollment in an academic or college preparatory high school track, high school grades, and mother's and father's



71

education (items C08, C09, C15,C20 and C21D; Cronbach alphas, .73 for males and .69 for females). Sports and exercise habits were assessed by a 2-item scale that included frequency of participation in sports, athletics and exercise, and frequency of exercising vigorously (items A02H and E21D in Subsample 2; Cronbach alphas, .78 and .79). Good eating habits were assessed by a 3-item scale that included frequency of eating breakfast, green vegetables, and fruit (items E21A, B, and C in Subsample 2; Cronbach alphas, .77 and .70). To test whether gender differences in the early stages of smoking adoption varied depending on the students' characteristics, we estimated for each variable a logistic regression which assessed the relationship of having ever vs. never smoked more than twice to the variable, gender, and the interaction between the variable and gender. For each variable which showed a significant interaction with gender, we identified extreme categories of the response scale which contained at least 100 females and 100 males each, and calculated gender differences in the early stages of smoking adoption for the students in each of these extreme categories. Because these analyses were carried out for 78 different variables, the overall risk of Type I error is greater than the calculated significance levels. To take account of this problem, our discussion of the findings focuses on patterns of similar results obtained for a number of related variables or individual results with a high calculated level of significance (p S .001). With respect to the interpretation of the calculated significance levels, it should also be noted that the data were obtained from a stratified sample of students clustered within selected high schools, so the effective sample sizes for statistical tests are less than the actual sample sizes. Johnston et al., (1986) give general guidelines for correcting significance tests for this design effect. Our previous calculations for OLS (ordinary least squares) regressions for the various subsamples indicate that, when the probability uncorrected for the design effect is p = .01, the true probability, corrected for the design effect, is between .O1 and approximately .07 (Waldron & Lye, 1990a, b). Because the corrections for the design effect are impractical to compute for logistic regressions, the probabilities reported in this paper have not been corrected for the design effect. In


72

WOMEN & HE4 L TH

order to make allowance for the decrease in significance which results when corrections are made for the design effect, findings are designated statistically significant only if they have a p b .01. The final set of statistical analyses was designed to assess the possible contributions of various attitudinal and behavioral characteristics to gender differences in smoking.~ssentially,we made a series of comparisons between the observed gender difference in the early stages of smoking adoption and the predicted gender difference in smoking adoption in the absence of gender differences in a set of related attitudinal and/or behavioral characteristics. These predicted gender differences in smoking adoption were calculated on the basis of logistic regressions in which the dependent variable was ever vs. never smoked more than twice, and the independent variables were gender and a group of variables which assessed related characteristics and were available for the same subsample. The variables included in each of these regressions are listed in the Technical Appendix. Variables were included in these analyses only if they showed significant gender differences or significant interactions with gender in relation to the early stages of smoking adoption. Controls for socioeconomic status were not included in these or the previous regression analyses because there were essentially no gender differences in socioeconomic status and because there were no interactions between socioeconomic status and gender in relationship to smoking. We carried out two series of these logistic regressions for calculating predicted gender differences in smoking adoption in the absence of gender differences in various attitudinal or behavioral characteristics. One series of these logistic regressions included interaction terms between gender and the other independent variables, which allowed for gender differences in the relationships of smoking to the independent variables. The other series of these logistic regressions did not include interaction terms, so these analyses assumed no gender differences in the relationships between smoking and the independent variables. The results of these two sets of logistic regressions were generally similar, and only the results of the regressions without interaction terms are presented in this paper. It should be noted that the estimates from these analyses summarize the statistical associations observed in the data set, but


73

they do not necessarily indicate causal effects of the various characteristics on gender differences in smoking.


RESULTS Gender Differences in Specific Stages of Smoking Adoption and Cessation Among the white high school seniors in this sample, females were more likely than males to have ever smoked a cigarette (Table 1). Among those who had ever smoked, females were more likely to have smoked more than twice. However, females were not more likely to have progressed in the subsequent stages of smoking adoption, and, among current daily smokers, males were more likely to TABLE 1.

Gender Differences in Smoking Adoption and Cessation Gender

Smokina Ado~tionor Cessation Variable O

Females

nales

Dif f erencen

66;O

56.4

+9.7**.*

70.9

74.6

-3.7*

67.7

63.9

+3.8

60.7

72.3

-11.7***

31.6

29.0

6158

5689

who had ever smoked a cigarette (for all respondents) who had ever smoked more than twice (for those wbo had ever smoked)

I who had smoked during the past 30 days

,

(for those who had smoked more than twice) O who smoked daily

(for those who smoked in the past 30 days) % who smoked at least half a pack a day

(for those who smoked daily) I former smokera

+a.?

(for those who had ever smoked regularly) Number of subjects Gender differences are female minus male rates. due to rounding.

Slight discrepancies are


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WOMEN & HEALTH

smoke at least half a pack a day (Table 1). No significant gender difference was observed in the proportion of regular smokers who had quit. Thus, females had higher rates than males for the early stages of smoking adoption, but not for subsequent stages of smoking adoption or for maintenance of smoking once adoption had occurred. These observations imply that, in order to understand the causes of females' higher rates of smoking, it is necessary to understand the reasons why females had higher rates for the early stages of smoking adoption. To investigate the causes of gender differences in the early stages of smoking adoption, we have analyzed relationships for the dichotomous variable, ever smoked more than twice vs. never smoked or smoked only once or twice. The proportion who had ever smoked more than twice was 48% for females, compared to 38% for males (p S .0001). Variation in Gender Differences in Smoking

Gender differences in the early stages of smoking adoption varied depending on the students' characteristics (Table 2 and Supplementary Table 1A). For example, the female excess in the early stages of smoking adoption was largest for students who had grown up in suburban areas, intermediate for students who had grown up in urban areas, and smallest for students who had grown up in rural areas (Figure 1 and Table 2). For students who grew up on a farm, there was no gender difference in the early stages of smoking adoption. Gender differences in the early stages of smoking adoption were generally small among students who had more traditional or conventional attitudes and behavior (Table 2). For example, among students who were very religious, who liked school, or who did 15 or more hours of homework each week, there was little or no gender difference in the proportion who had ever smoked more than twice. In contrast, among students who were not religious, who did not like school, or who did little homework, females were substantially more likely than males to have ever smoked more than twice. The female excess in the early stages of smoking adoption was very large among students who frequently went to bars, taverns or night-


Waldron,

Lye, and Brandon

75

clubs, among students who had been in trouble with the police, and among students who had been involved in fights (Table 2). For both females and males, more traditional or conventional behavior and attitudes were associated with lower rates of having ever smoked more than twice, while deviant or antisocial behavior was associated with higher rates of having ever smoked more than twice. These relationships were stronger for females than for males, so feinales with non-traditional or deviant behavior and attitudes had particularly high rates for the early stages of smoking adoption (Table 2 and Supplementary Table I). Consequently, the female excess in the early stages of smoking adoption was large among students with non-traditional or deviant behavior and attitudes. The female excess in the early stages of smoking adoption was also large for students with certain favorable attitudes toward smoking or more friends who smoked (Table 2). As would be expected, students who had favorable attitudes toward smoking or more friends who smoked were more likely to have ever smoked more than twice. These associations tended to be stronger for females than for males, so females with favorable attitudes toward smoking or many friends who smoked tended to have particularly high rates of having ever smoked more than twice (Table 2 and Supplementary Table 1). Possible Contributions o f Gender Differences in Students' Characteristics to Gender Differences in Smoking

For many of the variables included in this study, the characteristics that were associated with smoking adoption were more common among males. For example, males reported more antisocial behavior such as stealing or getting in trouble with the police, males reported more differences of opinion with parents over issues such as how the respondent should behave, males reported more positive attitudes toward risk-taking, and males reported more negative attitudes and behavior with respect to school, including more truancy and cutting classes (Supplementary Table 2). Since each of these characteristics was associated with higher rates for the early stages of smoking adoption, the gender differences in these characteristics


&?

TABLE 2.

Variation in Gender Differences in the Early Stages Of Smoking Adoption depending on Students' Characteristics Who had Ever Smoked Hore Than Twice

Characteristicsa Residence Grew up on farm Grew up in suburb of very large city Religiosity Religion very important Religion unimportant School-related behavior and attitudes Does 15 or more hours of homeuork/week Does less than 5 hours of homeworklweek Likes school Doesn't like school Has not cut school or class in past month Bas cut school or class at least six tines Visits to bars Never goes to bars, taverns or night clubs Goes to bars, etc. at least once a week

Females

Males

Gender Difference

Nb


Antisocial behavior Has not stolen or shop-lifted in past year Aas stolen or shop-lifted more than tuice Bas not been in trouble with police in past year Bas been in trouble with police in past year Fiahting, conflicts and anger Not in physical fight in past year Fought more than once in past year Not angry or mad in recent months Angry or mad at least monthly Fatalism Strongly favors planning ahead Opposes planning ahead, since plans don't work Attitudes toward sex roles Agrees that husband, not wife, should achieve outside the home Disagrees with this traditional attitude


TABLE 2.

(Continued)

2

%

Characteristicsa

Who had Ever Smoked More Than Twice

Females

Males

Gender Difference

N

Friends' smoking None of friends smoke Host or all friends smoke Attitudes toward smokinp Very negative attitudes toward smokers and smoking Positive attitudes toward smokers and smoking

17.4 77.3

18.1 51.5

tO.7 +25.7***

2065

17.6 44.4

18.9 28.3

-1.3 +16.2**

2021

Harmful effects of cigarettes have not been 31.8 exaggerated Harmful effects of cigarettes have been exaggerated 10.9

26.3 47.3

t5.5 +23.6**

2068

Does mind being around smokers Does not mind being around smokers Teenage smoker looks like conformer Teenage smoker does not look like conformer

0

The pairs of characteristics listed indicate opposite extremes for the variables which had significant interactions with gender in relation to the early stages of smoking adoption (Supplementary Table 1).


79

FIGURE 1 . Relationships of females' and males' smoking to rural-urban-suburban residence. M = medium-sized; L = large; M. = very large; Sub = suburb of medium, large or very large city.

-Females

+Males


%who have e e r smoked more than tw~ce

60

r

would be expected to contribute to greater smoking adoption among males. As expected, our statistical analyses predict that, if there were no gender differences in these characteristics, the female excess in smoking adoption would be even greater than is currently observed (Table 3). In contrast, for a few of the characteristics assessed, the observed relationships suggest effects that may contribute to greater smoking adoption by females. For example, females reported less participation in sports and exercise and poorer eating and sleeping habits, and each of these poor health habits was associated with a greater likelihood of having ever smoked more than twice (Supplementary Table 2). As expected, the statistical analysis predicts that, in the absence of gender differences in sports, exercise, eating and sleeping habits, the female excess in the early stages of smoking adoption would be smaller (Table 3). Additional analyses indicate that this effect is largely due to the sports and exercise variable (data not shown).

WOMEN di HEALTH


DISCUSSION For this sample of white high school seniors, females were more likely than males to have experimented with cigarette smoking and to have progressed to smoking more than once or twice. However, females were not more likely than males to have progressed in subsequent stages of the smoking adoption process. Also, among those who had ever smoked, females were as likely as males to have quit smoking. Thus, the greater prevalence of smoking among females was due to gender differences in the early stages of smoking adoption. Our findings are in agreement with most, although not all, findings from previous studies (Johnston et al., 1989; National InTABLE 3.

Predicted Gender Differences in the Early Stages of Smoking Adoption in the Absence of Gender Differences in Various Attitudes and Psychosocial Characteristics

Characteristic for which an Absence of Gender Differences is Assumed in Uaking the Predictions Antisocial behavior LS2:7) Differences of opinion with parents (S4:4) Attitudes toward risk-taking (S2:l) School-related behavior and attitudes (S2:5) Attitudes toward school and schoolwork (Sl: 5 ) Attitudes toward cohabitation and sex (S4:2) Evenings out, bars, parties, and dates (S2:4) Fighting, conflicts and anger (S2:4) Attitudes toward sex roles ( S 3 : 2 ) Religiosity (TS:l)

Predicted Gender Difference in b Who had Ever Smoked More Than Twiceb

Predicted Increase or Decrease in Gender Difference=

N

Waldron, Lye, and Brandon Expectations concerning marriage and divorce (S2:l)

11.7

' 21%

2265

Independence from parents (TS:31

10.9

'118

11041

Dads should spend more time with children (S5:l)

10.8

+5%

2357

9.6

0%

10951

Self-esteem, social support and fatalism (S5:5)

10.1

-2%

2156

Proportion of friends who smoke (S2:l)

9.1 10.0

-6%

2215

Attitudes toward smoking (S5:51

7.7

-218

1998

Sports, exercise, eating and sleeping habits (S2:3)

1.1

-328

2109

Rural-urban-suburban residence (TS:l)


81

Eager to leave home (S5:l)

For each characteristic, the subsample number (or TS for total sample) and the number of variables included in the analysis are given in parentheses. b

This column gives predicted values of the female excess in the early stages of smoking adoption if there were no gender differences in the specified group of characteristics and no gender differences in the relationships between these characteristics and smoking. The logistic regressions used to calculate these predicted values are presented in Supplementary Table 2.

c

This column gives the predicted percent increase or decrease in the gender difference in smoking adoption if there were n o gender difference in the mean values or relationships for the specified characteristics. Specifically, the values given are the predicted minus observed gender difference in smoking adoption divided by the ohserved. (The observed gender difference varied slightly for the different subsamples included in the various analyses.)

stitute of Education, 1979; Peterson et al., 1989; Silverstein et al., 1980). Because females had higher rates for the early stages of smoking adoption, but not for later stages of smoking adoption nor for maintenance of smoking once adoption had occurred, our analyses have focussed on the correlates and possible causes of this female excess in the early stages of smoking adoption. Gender differences in smoking adoption varied depending on the students' characteristics. There was little or no female excess in the early stages of smoking adoption among students from rural areas or among students with a strong commitment to religion or school.


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WOMEN & HEALTH

These findings confirm and extend previous findings from other Western countries which have indicated that the female excess in teenage smoking has been small or absent in rural areas or more religious and socially conservative areas (Aaro et a]., 1981; Boyle & Offord, 1986). In addition, we found that the female excess in the early stages of smoking adoption was particularly large for students who had been involved in various kinds of deviant behavior. To understand the reasons for these variations in gender differences in smoking, it is useful to note the following underlying relationships. Smoking adoption was inversely related to commitment to religion and school, and this inverse association was stronger for females than for males. Thus smoking adoption rates were relatively low for women with strong commitment to religion or school, and the female excess in smoking adoption was smaller or absent among these more traditional and conventional students. Similarly, the correlation between deviance and smoking adoption was stronger for female than for males, so smoking adoption rates were particularly high for females who engaged in deviant behavior. These observations suggest that traditional values may inhibit smoking adoption more for females than for males, and a tendency toward deviance may increase smoking adoption more for females. It appears that there is more social disapproval of women's smoking than men's smoking, and this may contribute to a closer link between smoking and deviance or unconventionality for females. Historically, smoking was socially unacceptable for females, and females who smoked were considered deviant (Waldron, 1988). Several findings suggest that, even in the contemporary period, smoking may still be socially less acceptable for females than for males. In a recent study of British nursing and education students, many of the respondents described girls who smoke as "unladylike" and girls who don't smoke as "feminine" (Elkind, 1985). Pn our sample, both males and females attributed more negative characteristics to female smokers than to male smokers. Specifically, there was greater agreement with the opinion that, "When a girl my age is smoking a cigarette, it makes her look insecure" than with the same opinion for a "guy" (p s .0001, data not shown). Similarly, there was less agreement with the opinions that a girl who is smoking looks "cool, calm, in control," "independent," or "ma-



83

ture, sophisticated" than with the same opinions for a guy (p Q .0001, data not shown). The more negative attitudes towards girls, smoking may inhibit smoking adoption more among more conventional girls, which may explain why the excess of female over male smoking adoption is observed only among the less conventional, more deviant students. Our data also suggest that the female excess in the early stages of smoking adoption is larger for students with favorable attitudes toward smoking or many friends who smoke. The association between smoking adoption and favorable attitudes or friends' smoking was stronger for females, so smoking adoption rates were particularly high for females with favorable attitudes toward smoking or many friends who smoked. Some previous longitudinal evidence suggests that social influences on smoking may have a greater effect on females (Chassin et al., 1986), but much of the available longitudinal evidence suggests no gender differences in the strength of social influences on smoking (Ary & Biglan, 1988; Chassin et al., 1986; McNeill et al., 1988). In addition, one longitudinal study has found no gender differences in the strength of relationships between attitudes toward smoking and subsequent smoking adoption (McNeill et al., 1988). This longitudinal evidence suggests that the patterns observed in our cross-sectional data are not due to gender differences in the effects of attitudes or friends' smoking on the respondent's smoking. Instead, it may be that, among those who have adopted smoking, girls were more likely to shift to more favorable attitudes toward smoking and to acquire friends who smoked. This example illustrates the need for caution in making causal interpretations of cross-sectional data. Previous studies of college-age teenagers and young adults have found that the female excess in smoking was observed primarily or exclusively among those who were in college or had attended college (Johnston et al., 1989; Pierce et al., 1989). However, we found no evidence that the female excess in the early stages of smoking adoption was larger for students with higher educational aspirations or greater academic achievements. Previous studies of high-school-age teenagers have also not found consistent relationships between education-related variables and the magnitude of gender differences in smoking (National Institute of Education,


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1979; Pirie et a]., 1988). To account for the apparent discrepancy between the findings for college-age and high-school-age young people, we suggest the following hypothesis. During the period immediately after high school, the greatest increases in smoking may occur among non-college-bound males (Bachman et al., 1984), so the female excess in smoking may decrease for non-college-bound young people, but not for college-bound young people. Our attempt to identify possible causes of females' higher rates of smoking adoption had only very limited success. Indeed, many of the characteristics which were associated with a greater likelihood of smoking adoption were more common among males. For example, males were more likely to have engaged in antisocial behavior and males had more negative attitudes and behavior with respect to school. These characteristics were correlated with higher rates for the early stages of smoking adoption, and previous analysis of longitudinal data have shown that these chaiacteristics predict increased risk of smoking adoption (Brook et al., 1987; Gerber & Newman, 1989; Murray et al., 1983; Reynolds & Nichols, 1976). Thus, gender differences in these characteristics would, if anything, be expected to contribute to greater smoking adoption by males. This result is similar to the findings of Herzog and co-workers (1987). Our analyses did identify a few characteristics that may contribute to greater smoking adoption by females. Females were less likely to participate in sports, athletics and exercise and females had poorer eating and sleeping habits, and these characteristics were associated with higher rates for the early stages of smoking adoption. Our statistical analyses suggest that females' lesser participation in sports, athletics and exercise may be a particularly important predictor of females' higher rates of smoking adoption. Previous surveys have indicated that males more often than females mention possible damage to athletic ability and sports performance as a reason not to smoke (Hill & Gray, 1984; Palmer, 1970; Salber et al., 1963). Thus, the evidence from this and previous studies suggests that males' greater involvement in sports and athletics may contribute to their lower rates of smoking adoption. Previous studies have found that females more often mention weight control as a benefit of smoking, and it has been hypothe-



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sized that females' greater concern with being slim may contribute to their higher rates of smoking (Charlton, 1984; Klesges et al., 1989; Page & Gold, 1983; Waldron, 1990). Unfortunately, our data did not permit a direct test of this hypothesis. However, females' higher rates of smoking adoption were related to their poorer eating habits, which were due primarily to their tendency to skip breakfast, and females' tendency to skip breakfast may be linked to their high rates of dieting (Waldron, 1988). Our findings indicate that females had more favorable attitudes toward smoking than males, and this would be expected to contribute to greater smoking adoption by females. However, this finding must be interpreted with caution for two reasons. First, on the basis of our cross-sectional data, it is unclear whether gender differences in attitudes toward smoking are a cause or a consequence of gender differences in smoking. Second, gender differences in attitudes toward smoking were inconsistent. Females had more positive attitudes for three of eleven variables that assessed attitudes toward smoking, but more negative attitudes for one variable. No significant gender differences were observed for seven of the attitude variables, including the opinions that smokers enjoy life more and teenagers who smoke look cool, independent, mature and sophisticated (Supplementary Table 2 and Technical Appendi~).~ These findings provide little support for the hypothesis that cigarette advertising targeted toward females is a cause of greater smoking adoption by females (Gritz, 1984). The hypothesis that peer group influences might account for females' higher rates of smoking adoption also was not supported by our data. Our analyses suggest that gender differences in friends' smoking made only a very minor contribution to gender differences in smoking, and no gender differences were observed in friends' disapproval of smoking (Table 3 and Technical Appendix). It has also been hypothesized that feminist attitudes increase smoking among females, and consequently feminist attitudes contribute to the higher prevalence of smoking among females. However, of the 28 variables in this data set which assessed attitudes toward women's rights, sex roles, marriage and sexual behavior, 19 were not related to smoking adoption (Waldron & Lye, 1990a), 3 others were not related to gender (Technical Appendix), and the


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other 6 had relationships to smoking and gender that predicted more smoking among males (Table 3 and Supplementary Table 2). Thus, our evidence provides no support for the hypothesis that feminist attitudes contribute to females' higher rates of smoking. In a very recent paper, Swan and co-workers (1990) hypothesize that "because on average girls mature physically and emotionally earlier than boys," girls are more prone to "adopt what they see as adult behaviour patterns, such as smoking." This hypothesis is based on their findings that girls spend more time with friends of the opposite sex and are more involved in social activities such as dancing and youth clubs, and these differences would tend to result in greater smoking adoption by girls. Our data indicate that girls date more often than boys and this would tend to contribute to greater smoking adoption by girls, but this effect is more than counterbalanced by the effects of boys' greater frequency of going to parties, bars, and out for fun in the evenings (Table 3 and Supplementary Table 2). Similarly, we found that girls were more likely than boys to be engaged, married or formerly married and this would tend to contribute to greater smoking adoption by girls, but this effect is more than counter balanced by the effects of boys' greater independence from their parents as indicated by being employed and not living with their mothers. Our data suggest that girls' greater involvement with the opposite sex makes only a minor contribution to girls' higher rates of smoking adoption, at least for white high school seniors in the United States. These effects may be more important in the rather different social situation in England where Swan et al., carried out their study. Several additional hypotheses have been proposed to account for females' higher rate of smoking adoption, but most of these are not supported by the available evidence (Waldron, 1988, 1990). However, current evidence does suggest that females may be more likely to use smoking to cope with stress, and this may contribute to females' higher rates of smoking adoption (Brunswick & Messeri, 1984; Waldron, 1990; Wills, 1986). Unfortunately, we were not able to test this hypothesis because appropriate variables were not available in this data set. In future research to assess the causes of females' higher rates of smoking adoption, it will be important to include measures of all potentially important variables, including the motivation to use



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smoking for stress reduction or weight control. Analyses of longitudinal data would permit clarification of causal relationships. It may also be helpful to use qualitative data collection techniques, including open-ended interviews and participant observation, to identify additional hypotheses concerning the causes of females' higher rates of smoking adoption. In conclusion, our findings suggest important gender differences in the factors that influence smoking adoption. It appears that traditional or conventional values may have a stronger inhibitory influence on smoking adoption among females. Conversely, deviance or rebelliousness may be more closely linked to smoking adoption among females. However, deviance is more common among males than among females, and this would be expected to contribute to greater smoking adoption by males. One factor which may contribute to the lower rates of smoking adoption by males is their greater involvement in sports and athletics. Additional factors, such as the use of smoking in weight control, may contribute to females' higher rates of smoking. In future research it will be of interest to study further the multiple factors which influence gender differences in smoking adoption.

NOTES 1. It should be noted that very recent (1988) data for high school seniors in the U. S. indicate only a very small gender difference in smoking (Johnson et al., 1989). Similarly, Australian data suggest that the female excess in teenage smoking observed during the early 1980s may have reverted to a male excess by 1986 (Hill et al., 1988). 2. The Technical Appendix and Supplementary Tables are available from the first author upon request. 3. We also attempted to identify characteristics which may contribute to the variation in gender differences in smoking depending on area of residence. However, these analyses yielded only a few, scattered significant results which could well be due to chance variation, so the results of these analyses are not reported. 4. These findings illustrate a contrast between the results of the present analysis of gender differences in smoking and our previous analysis of the inverse association between parent's education and smoking or between educational aspirations and smoking (Waldron & Lye, 1990b). Both analyses were based on the same data set and included similar explanatory variables. However, the analysis of education-related differentials showed more consistent patterns of relationships, and the available variables were more successful in accounting for the inverse association between educational background or aspirations and smoking, in

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contrast to our limited success in accounting for gender differences in smoking. For example, students with less educated parents or lower educational aspirations consistently reported more favorable attitudes toward smoking, and statistical analyses suggested that these differences in attitudes could account for most of the inverse association between educational background or aspirations and smoking (Waldron & Lye, 1990b).

REFERENCES Aaro, L. E., Hauknes, A., & Berglund, E. Smoking among Norwegian schoolchildren 1975-1980. Scandinavian Journal of Psychology, 1981,22, 161-169. Ary, D. V., & Biglan, A. Longitudinal changes in adolescent cigarette smoking behavior: Onset and cessation. Journal of Behavioral Medicine, 1988, 11, 361-382.

Bachman, J. G., O'Malley, P. M., & Johnston, L. D. Drug use among young adults: The impacts of role status and social environment. Journal of Personulify & Social Psychology, 1984,47, 629-645. Bauman, K. E. & Koch, G. C. Validity of self-reports and descriptive and analytic conclusions: The case of cigarette smoking by adolescents and their mothers. American Journal of Epidemiology, 1983, 118, 90-98. Boyle, M. H. & Offord, D. R. Smoking, drinking and use of illicit drugs among adolescents in Ontario. Canadian Medical Associalion Journal, 1986, 135, 1113-1121.

Brook, I. S., Gordon, A. S., & Brook, D. W. Fathers and daughters: Their relationship and personality characteristics associated with the daughter's smoking behavior. Journal of Generic Psychology, 1987, 148, 31-44. Brunswick, A. F. & Messeri, P. A. Gender differences in the processes leading to cigarette smoking. Journal of Psychosocial Oncology, 1984, 2, 49-69. Charlton, A. Smoking and weight control in teenagers. Pubfic Health, London, 1984,98, 277-281.

Chassin, L., Presson, C. C., Sherman, S. J., Montello, D., & McGrew, J. Changes in peer and parent influence during adolescence: Longitudinal versus cross-sectional perspectives on smoking initiation. Developmental Psychology, 1986,22, 327-334. Coultas, D. B., Howard, S. A,, Peake, G. T., Skipper, B. I., & Samet, J. M. Discrepancies between self-reported and validated cigarette smoking in a community survey of New Mexico Hispanics. American Review of Respiratory Diseases, 1988, 137, 810-814. Elkind, A. K. The social definition of women's smoking behavior. SocialScience & Medicine, 1985, 20, 1269-1278. Gerber, R. W. & Newman, I. M. Predicting future smoking of adolescent experimental smokers. Journal of Youth &Adolescence, 1989, 18, 191-201. Goddard, E. & Ikin, C. Smoking among Seconda y School Children in 1986. London: Her Majesty's Stationery Office, 1987. Gritz, E. R. Cigarette smoking by adolescent females. Women & Health, 1984,9, 103-115.



89

Herzog, A. R., Bachman, J. G., Johnston, L. D., & O'Malley, P. M. Sex differences in adolescents' health-threatening behaviors: What accounts for it? Monitoring the Future Occasional Paper No. 22, Institute for Social Research, University of Michigan, Ann Arbor, MI, 1987. Hill, D. & Gray, N. Australian patterns of tobacco smoking and related health beliefs in 1983. Communiy Health Sfudies, 1984, 8, 307-316. Hill, D. J., White, V. M., &Gray, N. J. Measures of tobacco smoking in Australia 1974-1986 by means of a standard method. Medical Journal of Australia, 1988,149,lO-12. Jawis, M., & Jackson, P. Cigar and pipe smoking in Britain: Implications for smoking prevalence and cessation. Britith Journal of Addiction, 1988, 83, 323-330. Johnston, L. D., Bachman, J. G., & O'Malley, P. M. Monitoring the Fufure: Questionnaire Responses from the Nation's High School Seniors, 1985. Ann Arbor, MI: Institute for Social Research, University of Michigan, 1986. Johnston, L. D., O'Malley, P. M., & Bachman, J. G. Drug Use, Drinking, and Smoking: National Survey Resul~cfrom High School, College and Young Adult Populations, 1975-1988. Rockville, MD: National Institute on Drug Abuse, 1989. Kegeles, S. S., Burleson, J. A., & Mioua, J. Cigarette and smokeless tobacco use among Connecticut adolescents. American Journal of Public Health, 1989, 79, 1413-1414. Klesges, R. C., Meyers, A. W., Klesges, L. M., & La Vasque, M. E. Smoking, body weight, and their effects on smoking behavior. Psychological Bulletin, 1989,106, 204-230. McNeill, A. D., Jawis, M. J., Stapleton, J. A., Russell, M. A. H., Eiser, J. R., Gammage, P., & Gray, E. M. Prospective study of factors predicting uptake of smoking in adolescents. Joumal of Epidemiology and Community Health, 1988,43, 72-78. Murray, M., Swan, A. V., Johnson, M. R. D., & Bewley, B. R. Some factors associated with increased risk of smoking by children. Journal of Child Psychology and Psychiatry, 1983, 24, 223-232. National Institute of Education. Teenage Smoking: Immediate and Long-term Patterns. Washington, D. C., U. S. Department of Health, Education and Welfare, 1979. Nordgren, P. Sweden launches new anti-smoking offensive. Current Sweden, 1981, NO. 276, 2-10. O'Malley, P. M. Cigarette smoking among high schoal seniors: Did the rate decline? Preventive Medicine, 1984,13,421-426. Page, R. M., & Gold, R. S. Assessing gender differences in college cigarette smoking intenders and nonintenders. Journal of Student Health, 1983, 53, 531-535. Palmer, A. G. Some variables contributing to the onset of cigarette smoking among junior high school students. Social Science & Medicine, 1970, 4, 359366. Peterson, A. V., Marek, P. M. & Mann, S. L. Initiation and use of smokeless

WOMEN & HEALTH


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tobacco in relation to smoking. National Cancer Institute Monograph, 1989, 8, 63-69. Pierce, J. P., Fiore, M. C., Novotny, T. E., Hatziandreu,. E. J., &Davis, R. M. Trends in cigarette smoking in the United States. Journal of the American Medical Association, 1989,261, 56-60. Pirie, P. L., Murray, D. M., & Luepker, R. V. Smoking prevalence in a cohort of adolescents, including absentees, dropouts and transfers. American Journal of Public Health, 1988, 78, 176-178. Reynolds, C., & Nichols, R. Personality and behavioral correlates of cigarette smoking: One-year follow-up. Psychological Reports, 1976,38, 251-258. Salber, E. J., Welsh, B., &Taylor, S. V. Reasons for smoking given by secondary school children. Journal of Health and Human Behavior, 1963, 4, 118129.

Silverstein, B., Feld, S., & Kozlowski, L. T. The availability of low-nicotine cigarettes as a cause of cigarette smoking among teenage females. Journal of Health and Social Behavior, 1980,21,383-388. Stoto, M. A. Estimating age-specific transition rates for population sub-groups from successive surveys: Changes in adult rates of cigarette smoking. Population Studies, 1988, 42, 227-239. Strecher, V. J., Becker, M. H., Clark, N. M., Prasada-Rao, P. Using patients' descriptions of alcohol consumption, diet, medication compliance, and cigarette smoking: The validity of self-reports in research and practice. Journal of General Internal Medicine, 1989,4, 160-166. Swan, A. V., Creeser, R., & Murray, M. When and why children first start to smoke. International Journal of Epidemiology, 1990, 19, 323-330. US Department of Health and Human Services. The Health Conrequences of Smoking, Nicotine Addiction, A Report of the Surgeon General. (DHHS Publication No. (CDC) 88-8406) Rockville, MD: US Dept HHS, PHs, CDC, 1988. Waldron, I. Gender and health-related behavior. In Gochman, D. S., (ed.), Health Behavior: Emerging Research Perspectives. New York: Plenum Press, 1988. Waldron, I. Patterns and causes of gender differences in smoking. Social Science and Medicine (in press). Waldron, I., Bratelli, G., Carriker, L., Sung, W., Vogeli, C., & Waldman, E. Gender differences in tobacco use in Africa, Asia, the Pacific and Latin America. Social Science & Medicine, 1988,27,1269-75. Waldron, I . , & Lye, D. Relationships bemeen teenage smoking and attitudes toward women's rights, sex roles, marriage, sex and family. Women & Healrh, 1990a, 16, (314): 23-46. Waldron I. & Lye, D. Relationships of teenage smoking to educational aspirations and parents' education. Journal of Substance Abuse, 1990b, 2, 201-215. Wills, T. A. Stress and coping in early adolescence: Relationships to substance use in urban school samples. Health Psychology, 1986,5, 503-529.

Gender differences in negative reinforcement smoking expectancies.

Gender equality and smoking: a theory-driven approach to smoking gender differences in Spain.

Patterns and causes of gender differences in smoking.

gender differences in smoking cessation: A review.

Gender differences in psychosocial determinants of adolescent smoking.

Gender differences in smoking among U.S. working adults.

Gender differences in the structural connectome of the teenage brain revealed by generalized q-sampling MRI.

Gender differences in epilepsy.

Gender differences in the association between self-reported stress and cigarette smoking in Korean adolescents.

Gender differences in cigarette smoking and quitting in a cohort of young adults.

The impact of smoking on gender differences in life expectancy: more heterogeneous than often stated.

Gender differences in age of smoking initiation and its association with health.

Gender differences in the relationship between affect and adolescent smoking uptake.

Gender differences in crowd perception.

[Gender Differences in Lung Cancer].

Gender differences in cardiovascular reactivity.

Validity of the self-reported smoking status of schizophrenia patients, taking gender-related differences into consideration.

Regional versus urban differences in teenage alcohol use: Does parental disapproval account for these differences?

Gender differences in survival in old age.

Gender differences in corydaline pharmacokinetics in rats.

Gender differences in career paths in psychiatry.

Gender differences in psychological distress in Spain.

Gender differences in cognition in schizophrenia.

Analysis for gender differences needed.