Health Education Research Advance Access originally published online on August 14, 2006
Health Education Research 2007 22(6):770-781; doi:10.1093/her/cyl075
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Young people, smoking and gender—a qualitative exploration
1 Public Health Sciences, Division of Community Health Sciences, Medical School, Edinburgh University, Teviot Place, Edinburgh EH8 9AG, UK
2 Bostock Consulting, Edinburgh, UK
* Correspondence to: A. Amos. E-mail: amanda.amos{at}ed.ac.uk
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Abstract |
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Smoking among young people has become increasingly gendered. In several countries, smoking among adolescent girls is now higher than among adolescent boys. However, we have only a limited understanding of the reasons behind these gender patterns. This paper reports the findings from a qualitative study which used single-sex focus groups to explore the gendered nature of the meaning and function of smoking among Scottish 15- to 16-year old smokers. The study found that young people were ambivalent about their smoking but that this was somewhat different for boys and girls. These differences related to their social worlds, pattern of social relationships, interests, activities and concerns, the meanings they attached to smoking and the role smoking played in dealing with the everyday experience of being a boy or girl in their mid-teens. For example, boys were concerned about the impact of smoking on their fitness and sport, whereas girls were more concerned about the negative aesthetic effects such as their clothes and bodies smelling of smoke. Of particular importance was how smoking related in different ways to the gendered ‘identity work’ that adolescents had to undertake to achieve a socially and culturally acceptable image. The implications for programmes aimed at reducing smoking among young people, particularly the need for more gender-sensitive approaches, are discussed.
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Introduction |
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Smoking is the most important preventable cause of pre-mature mortality and morbidity in the European Union, causing >650 000 deaths annually [1]. While smoking has declined among adults in Europe over recent years, there has been little decline among 11- to 15-year olds [1, 2]. In addition, smoking among young people has become increasingly gendered, with regular (weekly) smoking in girls being higher than boys in 19 out of 31 European countries [2, 3]. This gender gap, which ranges from 1 to 11%, is most pronounced in countries such as the United Kingdom which have the longest history of smoking. In Scotland in 2002, 24% of 15-year-old girls were regular (weekly) smokers compared with 16% of boys, and while regular smoking in boys had declined significantly from 20% in 1994, there was no decline in girls over this period [4]. It is now widely accepted that tobacco control strategies aimed at reducing smoking among young people need to adopt a more gender-sensitive approach [5–8], but their development is hampered by our limited understanding of the reasons behind gender differences in youth smoking.
A wide range of factors influence whether young people start and continue to smoke. These are related to young people's individual characteristics (e.g. attitudes, beliefs, self-esteem, risk-taking, age, educational attainment), their close personal environment (e.g. family and friends' smoking, school ethos) and their wider social and cultural environment (e.g. social norms, tobacco promotion, access to cigarettes) [9, 10]. Several, mostly US, studies have found gender differences in relation to some of these factors. These include differences relating to body image (girls are more concerned about body image and believe that smoking can control weight), affect control (girls more likely to smoke to ‘buffer’ negative feelings) and self-esteem (poor self-esteem being more influential in girls' smoking) [11]. However, for most of these factors research evidence on gender differences is unclear or inconsistent [11]. For example, quantitative studies have consistently found that a young adolescent is more likely to smoke if his/her friends smoke and/or they perceive that they do [9, 12]. Furthermore, peer influence increases in importance as they move through adolescence, become independent from their family, establish new peer networks and move into new social worlds with different attitudes towards smoking [12–14]. But studies which have explored peer influence and gender among young adolescents have produced conflicting results. Many studies found that the effect of peer smoking was similar for boys and girls, but others found differences with most reporting that girls were more influenced by peers' smoking [11].
A recent major review concluded that our understanding of how peers and gender influence smoking remains limited [9]. However, ethnographic research has started to produce important insights about the gendered nature of youth smoking. This research aims to generate contextualized understandings of the meanings that young people attach to smoking and how these may not only differ between genders but also how smoking may act as a marker of gender and identity [15]. Adolescence is a period of developmental change and transition during which young people engage in the active construction of their gendered adult identities. Active in that this involves decisions about not only who they want to become, as well as what is feasible and acceptable, but also how such an image can be projected or ‘performed’ in particular social contexts [16]. Qualitative research on self-image and identity in the United States, United Kingdom and New Zealand has revealed the importance for young adolescent smokers of smoking as a means of enhancing their social identity and status [16–19]. Where smoking status is central or salient to the social identity of a peer group, peers are likely to share similar smoking behaviours [9]. Furthermore, gender, smoker identity and peer group structure appear to interact [19–21]. A study of Scottish 11- and 13-year olds found that peer group structure, described by young people as hierarchical, was closely related to smoking behaviour and this was different for boys and girls [19]. Smoking was most common among ‘top’ girls who were described as ‘good-looking’, ‘popular’, ‘loud’ and ‘cool’ and used smoking as a marker of their membership of this group, and by ‘bottom’ girls who smoked to be like top girls and attain their status. In contrast, high-status boys were less vulnerable to smoking as it conflicted with their wish to be fit and they could secure a cool identity through other activities, notably sport. Similarly, research of Plumridge et al. [16] with 13- to 14-year olds in New Zealand found that for boys, but not girls, sport presented an alternative to ‘smoker coolness’. Girls by contrast did not describe alternative ways of achieving similar cool school-based identities.
Qualitative research in the United Kingdom and United States has also revealed that many young smokers are ambivalent about their smoking—articulating a tension between the perceived positive benefits (e.g. peer conformity/approval, self-image, affect control) and negative consequences in the immediate (e.g. financial costs, parental disapproval) and longer term (e.g. health) [20, 22, 23]. However, there has been little exploration of whether these tensions and concerns, their relative importance and meaning, are different for girls and boys. The study reported here aimed to explore in more depth the gendered nature of the meaning and function of smoking for 15-year-old boys and girls. It formed part of a larger study of gender differences in adolescent smoking in five European countries which involved secondary analysis of survey data and focus groups [11].
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Methods |
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Sample
The study involved eight single-sex focus groups with 24 females and 22 males 15- and 16-year old smokers living in Edinburgh. Participants were recruited by a market research recruiter who gained written consent from parents, who had a child in this age group, to invite their child to attend a focus group discussing health issues including smoking. Young people who agreed to be involved and who reported that they had smoked at least one cigarette in the preceding week were invited to attend a focus group. They were then informed that they would be given a record voucher (£15) at the end of the group, to encourage attendance. Half the groups came from middle class (ABC1) and half from working class (C2DE) homes, based on the head of household's occupation. All but one participant was still at school, most in fourth year. Each group had participants from at least two schools. The groups had four to seven participants. The research complied with British Sociological Association guidelines on ethical practise and the principles of informed consent. Confidentiality and anonymity were assured.
Focus groups
The focus groups, conducted in 2002, were carried out by one of the authors with the other present to take notes. They took place in the market recruiter's home to provide an informal environment and each lasted 
90 min. A topic guide was used to generate discussion around several themes including social activities, smoking history, current smoking patterns, the role and meaning of smoking, positive and negative aspects of smoking, future intentions, perceptions of significant others' attitudes to smoking, gender and smoking. Permission to record the discussion was gained from the participants at the beginning of each group, and they also agreed that all discussion would remain confidential within the group.
Analysis
The groups were tape recorded and transcribed. The transcripts were analysed thematically. In the first stage, descriptive analysis was undertaken where emergent themes were identified and the data indexed in terms of similarity and contrast of content. In the second stage, these themes were shared with researchers undertaking the same study in four other European countries and the themes from the five countries refined to take into account their initial analyses and to identify more robust analytical thematic categories [11]. The third stage involved further analysis by the authors of the Scottish data where the conditions and circumstances in which smokers deployed these formulations were compared and contrasted. In the results section, extracts from the transcripts are used to illustrate key themes around smoking and gender. ‘M’ refers to male and ‘F’ to female participants, and ‘Int’ to the interviewer. The first part briefly reports smoking-related issues which were common to both the genders. The second considers in more depth gender-related issues.
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Results |
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Gender similarities
The participants had varied social lives that included spending time with friends in a range of different settings. Smoking and drinking often formed an important part of socializing. The contexts in which they smoked were diverse including pubs, clubs, school grounds, parks, parties, their bedrooms and on the way to school. Most smoked more at weekends with friends, particularly when drinking alcohol. The importance of peers was a key theme running through accounts of starting to smoke and relapse. For example, the failure of quit attempts was in hindsight often viewed as inevitable as most of their friends smoked.
Most were ambivalent about their smoking. Many talked about the benefits of smoking in their daily lives, for example, peer group acceptance or fitting in (‘everyone in my group smokes’), enjoyment (‘having fun’) and affect control (‘cope with stress’, ‘calm you down’), but these were counterpoised with concerns about finance, addiction and long-term health effects. Thus, while none intended to quit in the near future, most said they had attempted to previously and hoped not to be permanent smokers.
Gender differences
Gender differences emerged in their discussions around four themes—the tension between sport and smoking, smoking to deal with negative emotions, smoking and being part of a group and smoking and body image.
Sport and fitness
The most notable gender difference in participants' social lives was that most boys played sport, and keeping fit was important to them, whereas few girls were interested in sport or involved to any major extent. Boys talked about playing a range of team and individual sports, most notably football, in and out of school. Some were or had been in school teams and two had tried to become professional footballers. One group played football several times a week, as much for gambling as the sport and exercise. With sport being so important in their lives, the discussions quickly turned, unprompted, to the impact of smoking on their fitness. Smoking was widely regarded as negatively affecting fitness, a view drawn mostly from their own experience. Internal comparisons related to their levels of fitness when they had not smoked and/or had been more involved in competitive sports:
M: Before I started smoking quite a lot I was more fit.M: Me and another boy in the swimming team started smoking and I am not saying it was just because of smoking but we got absolutely hammered. After we started smoking we were never as fast. I think it does affect your fitness. We trained just the same amount of times.
External comparisons included comparing their fitness levels to non-smoking peers who were generally fitter and more successful sportsmen:
M: But I canny keep up with the rest of them, eh, they're all like whippets.M: Aye, they're a lot fitter.
M: They can run around a lot more.
M: Aye, they dinny cough as much.
M: The people who don't smoke are more into fitness and that. I play football and I'm the only person who smokes on my football team.
Given their interest in sport, being a smoker could conflict with their desire to be fit and successful. In the discussions, participants used three different strategies to deal with this tension—denial, conditional acceptance and substitution.
First, a minority denied or discounted the effect that smoking had on fitness, drawing on their own experience, arguing that training or ‘innate’ fitness could counteract any negative effects. For example, in one group considerable debate was triggered by ‘Mike’, who had tried to be a professional footballer, who argued that smoking had not affected his fitness. This view was countered by others who drew on their ‘expert’ knowledge of the scientific ‘facts’, as well as experience of negative impacts on their fitness:
M: It does have an effect.Int: Adam says it does have an effect.
M: It was covered on my course, I know what I'm talking about.
Int: What have you done at college?
M: I'm going to do health and fitness. But I know that it does have an effect on reducing lung capacity and stuff like that. You cannae be as fit and be a smoker.
Int: So Adam's saying you can't be fit and be a smoker.
M: Yeah. That's a fact.
Int: Mike's saying it doesn't make any difference.
M: It does. Cos I go to Canada in three weeks time with the rugby team and recently we've been doing training on a Tuesday and I didn't go for like the last four or five training sessions and I went on Tuesday. I went running and I was dead. I was out of it.
Int: What about the other guys that weren't smoking?
M: They were running round fit. The people that were smoking were collapsing all over the place. So it is true, it does affect you.
In trying to make sense of Mike's view, participants considered that it might depend on the sport, team position or not knowing what your fitness would have been if you had not smoked. However, Mike remained adamant that in his experience smoking had had no effect on good players like himself.
In contrast, the majority of male participants accepted, largely through their own experience, that smoking had affected their fitness. Rather than denying these effects they seemed to have adopted a strategy of conditional acceptance. Conditional in that several described how fitness concerns had motivated quit attempts in the past or would motivate future attempts:
M: I think I'll do it [quit] because I want to keep fit, especially in sport. I want to do well in sport.Int: And that's going to drive you?
M: Aye. If I never do it I will think how good I could be, if I was still smoking, if I hadn't started smoking. If I'm still smoking I can be good, but if I give up I'll play better.
The third strategy used by some also included acceptance but here regret was tempered by statements that they were now less involved in sports. They described how recently their social activities and interests had changed and, in contrast to sport, smoking in these contexts was less problematic and even desirable:
M: A lot of the people who didn't smoke were more into fitness have now started smoking as well, cos they're going to more parties and that than they used to.
In contrast, there was little discussion about sport in the girls' groups. Few were involved in sport outside school, and school sport had declined since they were younger. Few expressed concerns about the impact of smoking on their fitness. The few personal examples they gave related to non-sporting activities such as getting out of breath when climbing stairs or running for a bus, and were given less weight than boys' discussions around fitness.
Belonging to a group—sharing cigarettes
For both boys and girls, sharing the same experience with friends, and enjoying sharing this, was part of smoking. However, they tended to talk about and express their experience and feelings differently. For girls, sharing the experience went beyond simply smoking together. Their accounts revealed how smoking was woven into female relationships—the way they interacted with one another, did favours for one another and helped each other out. Sharing and being willing to reciprocate was a function of friendship. Social smokers described how they would share a packet of cigarettes, usually at weekends:
Int: So you get a packet—who keeps the packet if you go halvers?F: Probably my pal. Sometimes I keep it, cos sometimes they can be even worse at smoking than I can, and they end up smoking my half.
F: Or we end up splitting it there and then, and if one of us has an empty fag packet we end up putting half of them into the one packet.
Sharing individual cigarettes was also part of this behaviour. Someone would ask for a ‘left-on’ or be left the ‘beef’ (end of the cigarette). This was different from passing a cigarette around. It was about handing over the cigarette when most of it had been smoked:
F: You can share it if you want but normally I just—if someone's maybe not got any, then you just say ‘I'll leave you on’.F: Yeah. Just when ‘I'll leave you a draw’.
Sharing played a role in controlling consumption, maintaining one's status as a social smoker and reinforcing this identity for the group. Being willing to give friends cigarettes when they had none was also important, particularly when they ran out of money. Girls, who were more likely than boys to have a part-time job (but also more demands on their limited resources such as clothes and entry to clubs) had to wait until pay day. Being able to ‘crash’ a cigarette from a friend was vital in tiding them over. By providing a safety net, this system appeared to reinforce the social cohesion of the group, as they needed trust that their friends would return the favour when needed.
Boys in contrast discussed this aspect of their smoking in far less depth, although they did make reference to the need to feel part of a group:
M: You feel equal.M: [not smoking] you feel left out.
Int: You feel left out. Is it equal when you're all smoking?
M: You feel normal.
M: You're not smoking you're the odd one out.
They were also less likely to talk about crashing cigarettes. This difference appeared to be explained, in part, by several boys' involvement in more ‘extreme’ measures to ensure that they had money to buy cigarettes, including selling unwanted items and even stealing cigarettes or other goods to sell. ‘Going halvers’ was mentioned, but only one group referred to sharing, though most said girls did. While some described ‘chipping in’ to buy cigarettes when out at the weekend, others, in contrast to girls, expressed distaste at the idea of sharing the same cigarette:
M: I'll leave someone a draw if they don't have their own ... I won't take one. I would leave someone one.Int: Why is that?
M: Cos it's been in their lips. It's like the scraps.
M: Aye, the bit you don't want at the end.
Belonging to the group—smoking and drinking
Although one group of boys (mostly cannabis smokers) reported that they did not drink, most boys and girls regarded smoking as being inextricably linked with drinking and increased when drinking. However, they differed in the way they talked about this. For boys, it seemed just natural to drink and smoke together. Boys described smoking when they were out with their mates, ‘on the pull’, out at the pub. It was boring to just drink and there was an expressed need to smoke:
M: You can't just drink. It's boring. You need to do something else.M: I don't really like drinking unless I'm smoking, I just need to have a fag when I'm having a drink.
When girls talked about drinking and smoking, the two were often more explicitly associated with having a good time, being with their friends and feeling really good about it:
F: What was it we said one night? We were drinking. We were happy cos we were like, what was it we said? ‘I've got a drink, I've got a fag and I've got my friends’.F: You've got a drink in one hand, a fag in the other. You're in your element. It's just like ‘this is the life’!
That the girls were with their friends and having fun came over strongly. Drinking was fun, as was getting drunk ‘very, very drunk’. In several of the girls' groups, going out drinking with friends was focussed on as much as a key leisure activity as the boys focused on sport. Girls in two groups talked about their enjoyment of drinking and smoking as a marker of their group's identity:
F: We're usually the bad guys.And later when discussing different peer groups:
Int: And girls who smoke and drink, how do you see?F: We're fun.
Dealing with feelings and emotions
Boys and girls described how they smoked more when stressed or bored. For example, when reflecting on recent school exams they said they had smoked more:
M: Definitely during exams. You're more stressed.F: If you've got an exam or you're just nervous about something. A cigarette calms me down.
They also described how they would smoke when they were upset. However, differences emerged in the kind of problems they talked about as being upsetting and the view that boys (unlike girls) had alternative strategies for dealing with negative emotions, especially anger and frustration.
Girls tended to be specific about the problems they were referring to. Boys, and the way they were treated by them, were often a cause of upset:
Int: What kind of things do you get stressed out about, besides exams?F: Boys
Int: Why do boys stress you out?
F: Dunno, they're all just users
Int: They're all just users? In what way?
F: Dunno, they just always cheat on you and that.
One girl described how her boyfriend would buy her cigarettes because he did not like her ‘bad moods’ and that smoking would help deal with them. Splitting up with a boyfriend was also upsetting:
F: When I'm upset, I want a fag.F: Aye, when I'm upset as well.
F: Like when my boyfriend finished with me, I got 10 in my mouth.
Some boys also described how problems with boys could be reasons for girls' smoking. One believed that he was able to assess this simply by the way they smoked:
M: Well, just the way they take a draw of their fag. You know like, you can tell they're no' happy about some thing. It's usually the, well the ones I know, they like to be with the boys a lot. And 'cause I think it's either they're not getting it, or it's like they're being used.
In contrast, none of the boys said that they smoked because of problems with girls. Rather they said that smoking helped them deal with situations when they were angry, to help them calm down and avoid fights:
M: If I'm edgy, then just the point of having a fag, I don't know but it makes me feel a lot calmer.M: Like if you've been arguing with someone and you've just about got in a fight or something and you're all agitated and shaky and you have one and then you feel a lot more relaxed.
M: Well if I've got in to an argument with anyone, and like just before it comes to blows somebody'll sit you down and then they'll just go ‘Aye here, take that, smoke it’, and then you'll smoke it and then you'll feel better.
Others described feeling angry at school when teachers shouted at them. Situations that had they happened outside school would have provoked violence. One boy described having had problems at school from getting into fights and, in an effort to control his anger, taught himself to meditate. This had been somewhat effective but:
M: It was a lot easier just grabbin' a fag and lighting up.
In contrast to the girls, violence or the risk of violence, often fuelled by alcohol, was described as a common experience in boys' lives and male youth street culture. Staying out of trouble and avoiding aggressive behaviour was paramount. Smoking was perceived as a way of dealing with such feelings, as was smoking cannabis for some since consumption was generally private, ‘chilling’ with friends at home rather than being on the streets. Boys also discussed how sport could be an outlet for pent-up emotions. For some, having ‘something to do’ and actively releasing frustrations was seen as preferable to and/or more effective than smoking a cigarette, though this could involve violence:
M: I think that things like boxing and all that are better for relieving stress.In contrast, girls did not present any concrete alternative ways of dealing with negative emotions:M: If you're doing things, you're no thinking about it, you're like exercising, doing something.
M: After doing boxing, you cannae just do it and sit back for minutes. You need you're mind set on something all the time.
Int: So you're doing things.
M: Constantly.
Int: Does rugby not relieve stress?
M: Yeah, it does. If you see a guy's head on the ground and he's looking up at you. That really does de-stress you if you put a boot in his face. Mainly if the guy does it to me ... I'd rather do that than have a cigarette.
F: If you just smoke for stress and you want to give up smoking, then if you wanted to give it up that much then you'd find a way of coping with it.
Body image and appearance
Boys and girls talked about the difficulties of concealing their smoking from adults, notably parents, when they could smell smoke on them. Girls also raised this when discussing negative aspects of smoking. While boys focused on the effects on fitness, girls were more concerned about the aesthetic effects, particularly the smell on their clothes and bodies:
Int: Any other bad things about smoking you've noticed?F: Smell.
Int: What?
F: Your fingers smell.
F: Your clothes smell.
F: Your hair smells.
One group did discuss a positive aspect in relation to body image, smoking and weight control. For one girl this had been a reason for starting to smoke:
Int: You were 13 and you think you did it to?F: Be slim.
Int: Did you?
F: Yeah because it was coming up for the summer holidays. And we started chatting about losing weight and she said smoking helps.
Several in this group described how they used smoking to keep slim by smoking when they were hungry and buying cigarettes instead of food:
F: Every time I was hungry I started having one.Int: So it depends on when you were hungry?
F: A lot of people do that.
F: Instead of going to buy a bar of chocolate you buy fags.
F: If you stop smoking you bloat out.
F: No I can't stop, keep going.
Int: If you stop smoking, you bloat out?
F: Yeah, because you get hungry.
For these girls, stopping smoking was risky because they thought they would gain weight. In contrast, the only group of boys who raised this issue had the opposite view, related to the impact on fitness:
Int: Why else do you want to stop, or do you think you'll stop?M: I don't want to turn out fat and lazy basically, that's my worst nightmare.
Int: Your worst nightmare is being fat and lazy. So why do cigarettes make you fat and lazy?
M: It makes you less fit which makes you more lazy. You haven't got the energy into the body, which if you dinny use that energy up ‘cause you’re unfit, it comes out as starch and gets stored as fat.
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionConflict of interest statementAcknowledgementsReferences |
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Young people are ambivalent about their smoking and the findings from this study indicate that this differs somewhat for boys and girls. These differences relate to the social worlds which they inhabit, their social relationships, interests, activities and concerns, and the role smoking played in dealing with the everyday experience of being a boy or girl in their mid-teens. Of particular importance was what Stjerna et al. [24] have called the gendered ‘identity work’ that adolescents undertake to achieve a socially and culturally acceptable image.
A picture emerged of boy's lives where sport was an important interest and activity at school and in their leisure time. As has been found in previous studies [16, 19], being involved in sport was a marker of masculine identity and status, reflected in talk about being in school and national teams, trying out for professional football teams and regret at any loss of fitness. Sport was enjoyable, kept them fit and provided an opportunity to meet with friends in an environment where they could also safely let off steam, an important consideration for many who wished to avoid the violent aspects of the male street culture where they lived [25]. Smoking was perceived as having a positive role in their social lives and dealing with negative emotions, but most recognized it jeopardized their fitness. Some hoped this tension would eventually be resolved through quitting smoking, and this had motivated quit attempts, but many reluctantly accepted that they would continue to smoke in the immediate future and have to accept the consequences. Also other social activities were becoming increasingly important in their lives, and, as has been found with older adolescents [26], smoking in these contexts was less problematic and even desirable. Thus, while being involved in sport was perceived to deter smoking among adolescent boys, this might attenuate as they move into adulthood. Indeed, it is notable that in recent years gender differences in smoking among British 20- to 24-year olds have disappeared [27].
No similar clear marker of female gender identity emerged. Rather several of the girls drew on behaviours traditionally viewed as male—smoking, drinking and getting drunk with friends—to symbolize an alternative fun loving, rebellious female lifestyle and identity [28]. For these girls, unlike for the boys, their smoking did not challenge their gender identity but was central to its construction as they used it to reject a more traditional ‘good girl’ identity [29, 30], by being ‘the bad guys’. Thus, while young people may still hold traditional stereotypical views of gender and smoking, these cultural images can be drawn on differently to allow for alternative ways of expressing gender identities such as the ‘troublesome’ or ‘tarty’ female smoker [24]. Accounts around smoking, drinking and getting drunk were also important. This may reflect recent increases in adolescent girls' drinking and the lifting of social and cultural gender constraints which allow them to choose lifestyles once unacceptable for adolescent girls [31]. 15-year-old Scottish girls have one of the highest drinking levels in Europe and report similar drinking levels as their male peers [3]. While some boys talked about going out drinking with their friends, this was neither given the same attention nor used as a marker of their identity. This is not to deny that boys might also use smoking and alcohol to create a rebellious social identity, as has been found in other studies [19, 26], but that this may be more important for girls who seem to have fewer alternatives with which to construct a desirable social image [32]. For example, Scottish boys report higher levels of enjoyment and confidence in relation to physical activity than girls, more local opportunities for physical activity and feeling safe when taking part in physical activity locally [33]. Thus, while reversing the decline in girls' physical activity could positively impact on their smoking, this would involve addressing the range of psychological, social and environmental factors that hinder girls' greater involvement.
Both boys and girls highlighted the importance of smoking in their social relationships and dealing with negative feelings. However, they differed in the way that they talked about this. For girls, smoking helped when they were ‘upset’ often about their relationships with boys such as breaking up. In contrast, boys talked about dealing with feelings of anger and frustration and trying to ‘calm down’ to avoid fights. This difference could reflect gender differences around what it is acceptable to talk about in single-sex groups and the type of language that is used. A study of Scottish adolescents' perceptions of mental health found that while it was normal for boys to see aggression as a way of resolving anger and talked openly about this, girls did not talk about it but wrote about aggressive behaviour in self-completion forms [34]. However, this may also reflect their experience of the gendered social worlds in which they live. Scottish 15-year-old boys are three times more likely than girls to report having been in three or more fights in the previous year [35]. Girls also are more likely to focus on friends, people being nice to them and romance as making them happy whereas boys relate happiness mainly to sporting success [36]. Similarly, previous Scottish research with this age group found that girl's friendships were closer and more intense than boys', being exemplified by trust and loyalty [37]. This may also be reflected in the ways the girls used sharing cigarettes not only to fit in with the group but also to indicate trust and reciprocity, thereby reinforcing social bonds.
15-year-old girls are also more likely to be in a steady sexual relationship and to have had sex [38, 39] and thus their concerns about body image and achieving the desired stereotype of the aesthetically attractive female [22, 24, 40]. Though this may also relate to concerns about how they are perceived by their female friends [37]. While many disliked their bodies and clothes smelling of smoke, this was counterbalanced by the perceived benefits of smoking. For some this included weight control, but for most related to their social identity, relationships and affect control.
In conclusion, tobacco control programmes need to be developed within broader gender-sensitive approaches to health promotion which are congruent with adolescent boys' and girls' experiences of smoking and their wider social worlds. This is best achieved by involving young people in the development and evaluation of such programmes. It is also important that such interventions occur before smoking (and being a smoker) becomes fully integrated into young people's notions of self [41]. It has been argued that attempting to change the social meanings that invested in smoking is likely to be doomed to failure [16]. But recent research on the impact of smoke-free legislation in public places in the United States indicates that this view may be overly pessimistic. It found that there was a decline in the progression to regular smoking among young people, reflecting the impact of the legislation not only on adult behaviour but also on young people's perceptions of social norms and attitudes around smoking [42, 43]. There is also a need to go beyond focusing solely on smoking to address the diverse challenges which young people face as they move through adolescence. This would involve not only helping them to develop their confidence, self-esteem and less health damaging coping skills but also creating desirable alternatives for identity construction (particularly for girls) and more supportive social environments, including smoke-free environments [44]. The development and implementation of young-person-centred health promotion initiatives, such as National Health Service Health Scotland's ‘Teenage Transitions’ programme which takes an holistic life-course approach to supporting young people through teenage transitions, should be encouraged. But there is also a need to ensure that they incorporate a gender-sensitive approach.
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Conflict of interest statement |
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TopAbstractIntroductionMethodsResultsDiscussionConflict of interest statementAcknowledgementsReferences |
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None declared.
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Acknowledgements |
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TopAbstractIntroductionMethodsResultsDiscussionConflict of interest statementAcknowledgementsReferences |
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We would like to thank those who participated in this study. Gratitude is also expressed to our colleagues from the four other European countries who were involved in the larger study, particularly the co-ordinator Marleen Lambert. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the funding body. The research was funded by the European Commission and administered through the European Network on Young People and Tobacco.
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References |
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Received on June 8, 2006; accepted on June 8, 2006
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