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As a mother of two streetwise teenage daughters and as a committed tobacco control campaigner, I was excited at the prospect of reading this book. In the cover notes it beckons: “What factors influence adolescents to take up smoking? Why do more girls smoke than boys? In contrast to medical orthodoxy, Smoking in Adolescence looks at smoking from adolescents’ own point of view.” It adds that it will be of practical interest to teachers, youth workers, health professionals, and parents, as well as students of psychology. In fact a lot of the book is written in the sort of “lingo” used only by the last of these and is not exactly light reading for the parents and youth workers, let alone health professionals. There are some absolutely thrilling bits in it and I am really glad I read it. It has given me lots of food for thought, although it was hard going some of the time; rather like watching a very intense foreign film that has hard to read subtitles—you know you would enjoy it more if you could understand better what was going on. The first part of the book is the most impenetrable and could seriously put off the “lighter” reader. Here is a sample: “Results of their hierarchical confirmatory factor analyses indicate that the convergent and discriminant validity of the behaviour contructs was high and that method effects were low. By contrast a two factor, second order model which represented general drug use and other problem behaviours accounted for a larger proportion of variance in the lower-order factors compared with the traditional single factor model.”
But it is not all like that—the best is saved until last. The last two chapters, “Interventions” and “Breaking the mould”, are inspiring and packed with key information. Suddenly all is revealed, clearly and succinctly. These two chapters not only summarise the rest of the book’s contents but also explain how the findings can be applied practically to smoking education programmes—perhaps the best way to read the book would be to start with the last two chapters then visit and revisit the chapters and sections that you want to explore in depth.
The first chapter of the book looks at theories of risk and problem behaviour, and was the one I could not get to grips with. The next chapter is a review of what is known about adolescent smoking—each chapter is headed by an apt quotation, my favourite being: “A drug is neither moral nor immoral—it’s a chemical compound. The compound itself is not a menace to society until a human being treats it as if consumption bestowed a temporary licence to act like an asshole.” (Frank Zappa.)
Young people are grouped into five distinct smoking behaviour categories: never smokers; recent experimenter; old experimenter; regular light smoker; and daily smoker. Each is described in detail, and a brief resumé given of factors affecting adolescent smoking behaviour, which provides a useful guide to existing research.
The real purpose of the book is to present the findings of two empirical British studies which investigated the meaning of smoking to adolescents themselves. Both used quantitative and qualitative components and aimed at identifying factors that could prevent the uptake of smoking. The Sussex study set out to look at the construction of social identities about smoking and non-smoking, and to suggest interventions to reduce the number of adolescents (particularly girls) who smoke. A huge amount of detail is given on the methodology and prevalence results—then came the depressing results. The biggest predictor of children becoming smokers is parental breakup. Even worse is when the lone parent lives with a new partner. As a co-habiting single mum who desperately wants her daughters not to smoke, this finding really hit hard!
Subsequent chapters report back on the detailed findings of the impact of social environments on smoking, smoking and mood, smoking and image, and social identities of adolescent smokers.
Copious quotes give a very detailed and honest picture of adolescents’ thoughts about smoking. For example, a regular smoker’s account of her first cigarette: “But she’s very persistent and she goes, ‘Oh Ellen, have one’; I went, ‘No’ and she went ‘Have one! Go on!’ and I went ‘Oh alright.’”
The insight given by some of these interviews and findings have real significance for anyone involved in schools projects and other health education interventions.
Some of the messages that stood out for me in the book were:
Children do know a lot about the health effects of smoking.
Children from one-parent and step-families are far more likely to smoke.
Family set up is crucial and needs to be acknowledged in health education programmes.
Body image concerns are not important in the initiation of smoking for girls and young women—contrary to popular belief.
Smokers are seen by smokersand non-smokers to be more sociable, fun loving, party animals who are attractive to the opposite sex.
Non-smokers saw themselves as more mature than smokers but smokers rated themselves as more mature. Non-smokers defined maturity as personal responsibility and academic work but smokers saw maturity in terms of an adult social life—drink, parties, and popularity with the opposite sex!
Some of the social pressures to smoke or not operating within groups of young people are powerfully described. The message that most got to me is the challenge to tobacco control workers to come up with a way of shifting the universally held attributes of “fun loving”, “popular”, and “sociable” from smokers to non-smokers. Non-smokers are just too “sensible”.
This book is a mine of interesting findings and comments and provides some useful summaries of research. It is very detailed, and hard work to read but overall I would recommend it as essential reading for anyone wanting to tackle adolescent smoking. It takes a fresh approach and presents many of the contradictions and complexities of why young people continue to smoke in such large numbers.