Youth Smoking Research
Why Young People Start Smoking
An evidence-based approach to smoking policy amongst young people would begin with a clear understanding of the factors that reliably predict youth smoking and then attempt to address each of these. Proceeding in this fashion would provide a clear, evidence-based link between causes and remedies, as opposed to an approach based on speculation and disputed assumptions.
Below are a number of studies which provide evidence related to predictors of youth smoking. It is clear that packaging and branding is not one of them.
1. Liverpool Longitudinal Study on Smoking (*1)
One of the longest running longitudinal studies on smoking initiation is the Liverpool Longitudinal Study on Smoking (“LLSS”), which was established in 1994. The key aim of the LLSS was to answer the question, “Why do young people smoke?”
To answer this question, the study has followed a single birth cohort of children from the age of 5 to 16. In its most recent report, The Liverpool Longitudinal Study on Smoking: Experiences, beliefs and behaviour of adolescents in Secondary School 2002 to 2006, the study focuses on the key factors that lead to trial and experimental smoking by adolescents.
Central risk factors include living in areas of high social and economic deprivation. It notes that “between ages 14 to 16 those living in an area with a high deprivation score were 95 per cent more likely to try smoking.” It also reports that students served by poor schools had a significantly higher risk of trying smoking, with this predictor increasing the risk of trial by 95 per cent.
(*1) The Liverpool Longitudinal Study on Smoking, August 2008
2. Goddard 1990 Why children start smoking HMSO and 1992 Why children start smoking (*2)
This study by Eileen Goddard for the UK Office of Population Censuses and Surveys reports on secondary school children who were interviewed three times in 1986, 1987 and 1989 when they were at the beginning of their (then) second, third and fourth academic years. The goal of the survey was to “see which of a range of factors were most closely associated with children starting to smoke.” The surveys were, of course, undertaken prior to the ban on advertising of tobacco products.
Goddard identified seven factors:
- being a girl;
- having brothers or sisters who smoke;
- having parents who smoke;
- living with a lone parent;
- having relatively less negative views about smoking;
- not intending to stay on in full-time education after 16; and
- thinking that they might be a smoker in the future.
Several of these risk factors, particularly living with a single parent and not intending to remain in school, have been identified as crucially important to smoking uptake in other studies. All the risk factors, according to Goddard, are associated independently with smoking; none has any direct connection with tobacco branding and there is no single, simple explanation as to why adolescents begin to smoke. As Goddard notes:
“…the onset of smoking in young people is a complex process – no simple combination of a small number of factors can be put together to form a good explanation of why some children start to smoke at this age while others do not…”
Goddard notes a low correlation between the brands that were most recognised and brands most likely to be smoked. Indeed, she does not identify branding or even advertising that was then permitted as a cause of youth initiation and the survey data provides no support for the claim that children smoke because of branding.
(*2) Why Children Start Smoking by Eileen Goddard HMSO (and OPCS (Office of Population Censuses & Surveys), 17 December 1990
3. Conrad et al. 1992 Why Children Start Smoking Cigarettes: Predictors of Onset (*3)
The research of Conrad et al. echoes the conclusions of Goddard. These authors confined their analysis of the factors associated with youth smoking to longitudinal studies that were published from 1980 onwards. The age of the adolescents in the studies ranged from 10 to 17 with the median age being 12 to 13. The studies lasted from four months to two years and were conducted in the US, Europe and Australia. They provide data drawn from a diverse range of societies.
Conrad and her colleagues grouped their analysis of the “process of becoming a smoker” around five different categories of smoking predictors or risk factors:
- social bonding;
- social learning;
- intrapersonal/personal/self-image; and
- knowledge, attitudes, and behaviour predictors.
They then discussed the findings by examining the predictive reliability of each group of risk factors in terms of youth smoking.
Socio-demographic predictors such as socio-economic status, age and gender were consistent with theoretical expectations 76 per cent of the time, with the strongest predictors of starting to smoke being socio-economic status and age.
Social bonding predictors, including family and peer bonding and school influences, were consistent in predicting smoking initiation 71 per cent of the time.
Social learning predictors – family smoking, family approval of smoking, other adult influences (including tobacco advertisements), peer influences and the availability of tobacco were consistent 72 per cent of the time.
Intra-personal, personal and self-image predictors which included such things as tolerance of deviance, independence, rebelliousness, risk-taking, alienation and locus of control were consistent in 77 per cent of the cases. What is particularly important is that the most reliable predictor in this grouping of risk factors was rebelliousness/risk-taking.
Knowledge, attitude and behaviour predictors, including understanding of and beliefs about the physical consequences associated with smoking; “addiction”; expected utility from smoking; approval of cigarette advertisements; alcohol and substance use were predictive in 75 per cent of the cases. Approval of cigarette advertisements was predictive in one study and non-predictive of smoking initiation in another.
Finally, one of the strongest predictors of smoking initiation in all of the studies was rebelliousness and risk-taking. Given how strongly these characteristics are associated with initiation, plain packaging raises serious concerns about the potentially counter-productive impact of such measures.
(*3) Conrad et al., 1992 K.M. Conrad, B.R. Flay and D. Hill, Why children start smoking cigarettes: predictors of onset, Br. J. Addict. 87 (1992), pp. 1711–1724.
4. Lloyd and Lucas 1998 Smoking in Adolescence: Images and Identities (*4)
In 1998 two UK researchers – Barbara Lloyd and Kevin Lucas – published a significant work on youth smoking. Their research, commissioned by the DH but never subsequently cited by the Department, was based on a decade of interviews with London and Sussex adolescents about smoking. It argued that many of the traditional anti-smoking interventions, including school-based education programmes, needed to be re-evaluated as they failed to connect with the actual causes of youth smoking. Criticising the inadequate research methods and assumptions of studies such as those employed by the UK DH, they wrote that:
“Health promotion programmes for young people must be theory driven and also based on research that uses adequate, representative samples which are capable of rigorous objective analysis. The inadequacy of strategies based on myth and popular opinion has been illustrated by the failure of many intervention programmes to date. Moreover, a danger exists whereby the adoption and promulgation of such myths by health professionals results in their being accepted as fact and threaten to produce a self-fulfilling prophecy… Sound research may sometimes yield uncomfortable truths. Such truth is the accumulating evidence that many smokers enjoy smoking.”
Lloyd and Lucas also stress that the main reasons for adolescent smoking uptake are found in:
- the structures and functioning of families, and particularly the quality of parent-child relationships;
- the nature of school cultures and the academic success of children;
- the adolescent need for stress and mood control; and
- the fact that smoking provides considerable physical pleasure.
“There is now … compelling evidence to support the view that the quality of an adolescent’s home environment will impact on his or her health-related behaviour, including the likelihood of taking up cigarettes.”
“…poor family relationships predict teenage smoking independently of parental smoking behaviour.” Furthermore, it is not simply the quality of the home environment but the quality of “relationships within a family” which “also influences the likelihood of an adolescent becoming a smoker. Adolescents value open, communicative relationships with their parents. For some, such relationships obviated the need to use smoking as a symbol of rebellion.”
They observe that:
“Our evidence highlights the significance of individual school cultures. … The contribution of school culture to health-related values and behaviour cannot be underestimated…”
And finally, with regard to stress, they found that their subjects responded to this by using cathartic coping devices and viewed “smoking as a coping resource” for stress.
Their statistical analysis showed that:
“…adolescents who smoke perceive more stress in their lives; report making less use of problem-focused coping and more use of cathartic coping strategies; perceive smoking as a coping resource.”
(*4) Lloyd, Barbara, Kevin Lucas, Janet Holland, Sheena McGrellis and Sean Arnold; Smoking in adolescence: images and identities; Published by Routledge, 1998 (London).
5. Jessor 1977 Problem behaviour and psychosocial development: A longitudinal study of youth (*5) & 1995 Protective factors in adolescent problem behaviour (*6)
A further alternative account of smoking uptake is found in the work of Richard Jessor and his colleagues in the US. For Jessor, as for many researchers, smoking is part of a cluster of risk-taking behaviours, rather than a unique adolescent activity. Jessor has looked at a number of these behaviours, including alcohol use and smoking, delinquency and sexual precocity, in
order to identify the factors that serve to protect adolescents from engaging in them. He has identified seven protective factors as crucial:
- positive orientation towards school;
- positive orientation towards health;
- intolerant attitudes toward deviance;
- positive relations toward adults;
- strong perceived controls;
- friends who engage in conventional behaviours; and
- involvement in pro-social activities (e.g. volunteering).
Contrasting with these seven protective factors are six risk factors which, according to the author, increase the likelihood of problem behaviours:
- low expectations for success;
- low self-esteem;
- general sense of hopelessness;
- friends who engage in problem behaviours;
- a greater orientation towards friends than towards parents; and
- poor school achievement.
(*5) Jessor, R., & Jessor, S. L. (1977). Problem behaviour and psychosocial development: A longitudinal study of youth. New York: Academic Press
(*6) Jessor, R., Van Den Bos, J., Vanderryn, J., Costa, F.M., and Turbin, M.S. 1995. “Protective factors in adolescent problem behavior: Moderator effects and developmental change“. Developmental Psychology, 31, 923-933.