Smoking Decisions from a Teen Perspective: A Narrative Study

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TUGAS REVIEW JURNAL MATAKULIAH TEORI KEPRIBADIAN

(Dosen Pengampu: R. Mahendra Wijaya Santoso, M.Psi., Psikolog)

Oleh:

NAMA MAHASISWA NO MAHASISWA

PROGRAM SARJANA PSIKOLOGI FAKULTAS BISNIS DAN HUMANIORA UNIVERSITAS TEKNOLOGI YOGYAKARTA

2023

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SMOKING DECISIONS FROM A TEEN PERSPECTIVE: A NARRATIVE STUDY Lynne Baillie, Chris Y. Lovato, Joy L. Johnson, dan Cecilia Kalaw

A. INTRODUCTION

Meskipun tempaknya terdapat penurunan dalam prevalensi rokok yang dilakukan oleh remaja, pencegahan perilaku merokok merupakan tetap menjadi hal yang penting di Amerika Utara. Pencegahan tersebut dapat meningkatkan kesehatan masyarakat Amerika Utara. Negara Kanada terdapat 23% remaja yang merokok berusia antara 15-19 tahun.

Negara Amerika Serikat terdapat 30% remaja yang merokok, 21% siswa kelas 10, dan 8%

dari siswa kelas 8. Penelitian sebelumnya melaporkan bahwa efektivitas pencegahan perilaku merokok berbasis program sekolah menunjukkan hasil yang beragam. Hal tersebut menunjukkan masih dibutuhkan pendekatan yang efektif untuk mencegah perilaku merokok pada remaja.

Tekanan untuk merokok pada remaja banyak dipengaruhi oleh kelompok sebaya mereka. Penelitian lain juga menunjukkan kecenderungan remaja yang merokok memiliki dampak negatif pada kesehatan mereka. Masa remaja digambarkan sebagai fase dimana individu mulai memperoleh otonomi, memperluas keterampilan sosial, dan pencarian identitas. Individu yang berhasil melewati tahap perkembangan ini membutuhkan dukungan dari kelompok yang menyediakan rasa aman akan identitas. Perkembangan remaja sering dipandang sebagai tahap perkembangan yang ditentukan oleh kelompok sosial, dimana penerimaan dan toleransi kelompok menjadi penentu dalam pengambilan keputusan individu. Pengaruh dari kelompok teman sebaya tetap menjadi faktor penting pada perilaku merokok remaja. Namun, pada penelitian terbaru menunjukkan bahwa pengaruh kelompok teman sebaya mempunyai andil besar dalam perilaku penggunaan obat dan perilaku kenakalan remaja. Meskipun tidak terdapat korelasi yang pasti antara perilaku merokok pada remaja yang mempunyai kelompok teman sebaya yang mempunyai perilaku merokok.

Sebuah program pengembangan remaja yang pernah dilakukan di Amerika Serikat sebagai usaha pencegahan perilaku merokok tidak menunjukkan hasil yang signifikan.

Program tersebut memberikan informasi kepada remaja yang merokok tentang bahaya yang

diakibatkan dari perilaku merokok. Remaja pada zaman sekarang bisa dibilang sangat

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mengerti akan hal tersebut, dan remaja bisa mencari informasi dari berbagai sumber mengenai dampak perilaku merokok.

Pada penelitian ini, fokus peneliti adalah konsep dan pengaruh dari kelompok teman sebaya terhadap perilaku merokok remaja. Peneliti menganalisa konsep tersebut dengan respon narasi yang disampaikan oleh responden. Peneliti mencoba untuk menentukan karakteristik kelompok teman sebaya yang mempengaruhi perilaku merokok remaja.

B. METHOD

Penelitian ini menggunakan narrative study untuk mengumpulkan data tentang interaksi antara teman sebaya dan perilaku merokok remaja. Pendekatan narrative study merupakan salah satu cara untuk memahami pengaruh lingkungan terhadap perilaku individu, baik untuk dirinya sendiri maupun untuk orang lain. Responden yang berpartisipasi dalam penelitian ini menyampaikan informasi yang spesifik tentang insiden yang terjadi selama perilaku merokok mereka. Responden juga menyampaikan bagaimana mereka membuat insiden-insiden tersebut menjadi berarti. Penelitian ini menggunakan wawancara semi- terstruktur selama 45-60 menit dan menggunakan bantuan alat perekam suara.

Pertanyaan wawancara dalam penelitian ini untuk mengungkapkan sejarah merokok dan mendorong responden untuk merenungkan faktor-faktor yang menyebabkan perilaku merokok.

Responden dalam penelitian ini berjumlah 35 orang yang terdiri dari 17 perempuan dan 18 laki-laki, yang berusia antara 14-18 tahun. Pemilihan responden berasal dari komunitas-komunitas, sekolah, dan suatu tempat kerja. Responden dalam penelitian ini terdiri dari 26 orang berkulit putih, 7 orang etnis Aborigin, dan 2 orang dari etnis lainnya.

Pengumpulan data dilakukan di pusat perkotaan dan pinggiran perkotaan di British Columbia, Kanada. Peneliti menggunakan purposive sampling untuk mengidentidikasi pengalaman perilaku merokok pada remaja.

Peneliti melakukan analisis data tidak hanya tanggapan dari responden seputar perilaku merokok saja, akan tetapi peneliti juga melakukan analisis dari konteks pribadi responden yang lebih luas lagi. Peneliti melakukan analisis data secara mandiri, kemudian mengidentifikasi tema dan dikembangkan secara kolaboratif dengan seluruh anggota tim penelitian. Analisis naratif dilakukan dengan 4 tahapan, tahap pertama setelah data diubah menjadi narasi, peneliti kemudian membuat kategori yang relevan dengan topik penelitian.

Tahap kedua, peneliti kemudian membaca data yang sudah dinarasikan tersebut secara

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berulang-ulang dan melakukan refleksi, sehingga peneiti menemukan hubungan dari data dengan tema-tema yang ada. Tahap ketiga, peneliti berusaha mencapai konsistensi internal dengan memverifikasi kembali tema dan pola yang muncul dan mengkonfirmasi tidak ada pengalaman lain responden yang bertentangan dengan tema. Tahap terakhir adalah memberikan penjelasan hasil dari penyamaan pemahaman peneliti dan responden.

C. RESULT

Berdasarkan data yang diperoleh peneliti, pengalaman merokok responden adalah sebagai alat sosial yang disengaja untuk berinteraksi dengan lingkungan sosial. Responden melakukan perilaku merokok untuk memenuhi kebutuhan sosialnya. Beberapa responden juga mengatakan tekanan dari teman sebaya sangat berpengaruh terhadap perilaku merokok mereka, melebihi pengetahuan mereka terhadap dampak negative bagi kesehatan. Keputusan responden untuk merokok tampaknya tidak didominasi oleh pengaruh paksaan dari teman sebaya atau ketidaktahuan responden mengenai dampak merokok bagi kesehatan.

D. TANGGAPAN DARI REVIWER

Tanggapan yang ingin saya sampaikan adalah penelitian ini sebenarnya bukan penelitian narrative study. Hal tersebut dikarenakan saya tidak menemukan metode penelitian narrative study dalam penelitian ini. Menurut saya penelitian ini cenderung lebih cocok disebut dengan penelitian phenomenology, karena dalam penelitian ini peneliti membahas suatu fenomena perilaku merokok remaja di Kanada yang dipengaruhi oleh kelompok teman sebaya. Peneliti membahas perilaku merokok pada 35 responden, bukan membahas perilaku merokok dari satu responden yang dilihat dari responden yang lain.

Hal tersebut sangatlah berlawanan dengan metode penelitian narrative study.

Penelitian narrative study adalah penelitian yang membahas pengalaman dari satu individu yang dikaji atau dilihat dari tanggapan dari beberapa individu lain. Pengalaman yang menarik dari individu tersebut bisa dikaji dari sudut pandang individu yang bersangkutan atau bahkan bisa dikaji dari sudut pandang individu lain. Menurut Creswell (2007) penelitian narrative study dibagi menjadi tiga yaitu biographical study, oral history, dan life history.

Penelitian ini tidak termasuk kedalam ketiga jenis pendekatan penelitian narrative study

seperti yang diungkapkan oleh Creswell (2007) tersebut. Menurut saya dalam penelitian ini

lebih cocok bila dikatan sebagai penelitian hermeneutic phenomenology. Hermeneutic

phenomenology adalah salah satu jenis dari pendekatan phenomenology yang

mendeskripsikan pengalaman

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kehidupan dari beberapa responden yang mempunyai pengalaman menarik dan peneliti melakukan interpretasi kedalam sebuah teks. Menurut Creswell (2007) juga mengatakan bahwa analisis dari narrative study adalah restoring (menceritakan kembali), namun dalam penelitian ini peneliti melakukan analisis dengan membuat kategori dari tema-tema yang muncul.

Penelitian ini menggunakan wawancara dan observasi sebagai alat pengumpulan data. Wawancara yang digunakan dalam penelitian ini adalah semi-terstruktur selama 45-60 menit. Menurut saya penelitian narrative study seharusnya menggunakan wawancara tidak terstruktur karena tujuan dari penelitian narrative study adalah mengeksplorasi kehidupan responden. Hal tersebut perlu untuk dilakukan oleh peneliti untuk memunculkan respon yang luas dari responden, sehingga nantinya peneliti akan mendapatkan data yang kaya.

Penelitian narrative study seharusnya menggunakan analisis dokumen pendukung untuk memperkaya data penelitian. Namun dalam penelitian ini tidak menggunakan analisis dokumen, tapi menggunakan wawancara dan observasi saja.

DAFTAR PUSTAKA

Baillie, L., Lovato, C. Y., Johnson, J. L., & Kalaw, C. (2005). Smoking Decisions from a Teen

Perspective: A Narrative Study. American Journal of Health Behavior Vol. 29, Issue 2,

99- 106.

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Am J Health Behav. 2005;29(2):99-106 99

Smoking Decisions from a Teen Perspective: A Narrative Study

Lynne Baillie, PhD; Chris Y. Lovato, PhD; Joy L. Johnson, PhD; Cecilia Kalaw, MA

Objective: To explore the transi-

tional phase between experimen- tal and regular smoking from the perspective of teens. Method: Nar- rative analysis of semistructured, individual interviews. Results: The need to belong and immediate social gain are major themes in- fluencing teen smoking decisions.

Conclusions: Our findings have

significance for public health workers planning and implement- ing tobacco-use prevention pro-

lthough there appears to be a de- cline in the prevalence of cigarette use by teens, smoking prevention remains an important public health goal in North America. For example, in Canada, 23% of adolescents between the ages of 15 and 19 reported they were current smokers.¹ Prevalence in the United States is similar, with 30% of 12^th- graders reporting they are current smokers, 21% of 10^th-graders, and 12% of 8^th- graders.² Outcome studies regarding the effectiveness of school-based prevention programs report mixed results,^3,4and there remains a pressing need to identify effec-

Lynne Baillie, Prevention Coordinator, British Columbia Cancer Agency, Centre for the South- ern Interior, Kelowna, BC, Canada. Chris Y.

Lovato, Associate Professor, Department of Health Care and Epidemiology; Joy L. Johnson, Profes- sor and CIHR/NHRDP Health Research Scholar, School of Nursing; Cecilia Kalaw, Project Director, Nursing and Health Behaviour Research Unit, School of Nursing, University of British Colum- bia, Kelowna, BC, Canada.

Address correspondence to Dr Baillie, British Columbia Cancer Agency, Centre for the South- ern Interior, 399 Royal Avenue, Kelowna, BC, Canada V1Y 5L3. E-mail: l [email protected]

grams aimed at teens whose smok- ing behaviors are not yet deter- mined by nicotine addiction. How such programs have been tradi- tionally framed and the ways in which peer influence and risk be- haviors have been addressed may be largely irrelevant to the ratio- nale of the adolescents them- selves.

Key words: teens, smoking, nar-

rative inquiry, tobacco control

Am J Health Behav. 2005;29(2):99-106 tive approaches to preventing adolescent tobacco-use.

The pressure to smoke exerted upon adolescents by the peer group and the adolescent tendency towards high-risk health behaviors traditionally are cited as being major influences on smoking activity during this time.^5,6Adolescence is often described as a phase in which individuals gradually acquire autonomy, expand social skills, and develop stable identities.⁷ Successfully accomplishing these developmental tasks requires group membership, which “provides the secu- rity of a provisional identity.”⁸ Conse- quently, the progression from child to adult is seen as being a socially deter- mined process, one in which the acceptance and tolerance of the group become the guiding factors in decision making.

Even with the emergence of a broad- ened awareness of complex adolescent smoking patterns, the social influence of peers remains one of the primary factors associated with tobacco use in adolescence.^9,10 However, other recent research into negative behaviors, such as drug abuse and delinquency, indicates that peer influence is overestimated.¹¹ Indeed, Unger¹²suggests, “It may be the adults,

A

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Smoking Decisions

not teens, whose description of events is reflected in the term “peer pressure” (p 168).

Although there appears to be a strong relationship between having friends who smoke and cigarette use, the genesis of that connection remains uncertain. The ways in which it features in terms of the attitudes and behaviors regarding the decisions made around smoking are also less than clear.^13,14

Within a youth development approach, adolescence is also seen as being a time in which risk-taking behaviors are pur- posefully adopted in order to gain group acceptance.⁶ However, Wyn and White¹⁵ take issue with this approach and chal- lenge its suitability as a vehicle for the adult interpretation of adolescent actions and beliefs, claiming “it is far too simplis- tic to characterize risky behavior as an inevitable part of growing up” (p 70).

They offer an alternative understanding by suggesting that what adults categorize as risks are, for the young people themselves, “simply a conventional response to a complex situation” (p 70).

If, as Wyn and White suggest, the adult concepts of risk and risk taking do not match those of the adolescent, then prevention programs guided by such an adult framework reduce the likelihood of suc- cessful intervention in risk-taking behaviors, such as smoking. To maximize the impact of prevention and intervention, the programs offered must be imme- diately relevant to the adolescents for whom they are intended.

At this point in the history of tobacco control, the argument cannot be made that adolescents are unaware of the health costs of lighting up. Today’s teens are arguably the most well-informed genera- tion regarding the health risks associated with tobacco use. Finding, then, how adolescents interpret and apply (or ignore) that information should be central to how we talk to them about the health risks of smoking.

In this qualitative study, we focus on the concepts of peer influence and risk taking as presented to us by adolescents themselves. We examine how these concepts occur within their own accounts of smoking experiences. By remaining within the configurations of meaning provided by the narratives of our respon- dents, we attempt to locate the defining characteristics of peer influence and risk

taking as they occur within adolescent ex- perience. In our discussion, we question whether the traditional representations of health risk and peer influence as found in prevention programs might not be re- interpreted to become more congruent with the ways in which adolescents themselves approach and define smoking in their own lives. The research presented in this paper is part of a larger 4-year study into the transitions from experimentation to regular smoking among adolescents.

METHODS

We used narrative inquiry to glean insight into the interplay between meaning and interpretation of cigarette use as created by adolescents living within their personal context. It has long been ac- cepted that we live storied lives and that narrative is the thread that we use to understand our experiences, as well as to share those experiences with others.^16-20 Further, not only do our narratives serve to interpret our past and articulate our present but they also guide the unfolding reality of what is to come.

Narrative is the way we make sense of our surroundings and our actions, to our- selves and to others, and the narrative framework that we use is the lens through which we approach the world.¹⁷The adolescents who participated in this study relayed information not only about spe- cific incidents in their smoking history, but also about how they themselves made—

and continue to make—these incidents meaningful.

Participants

We recruited 35 participants (17 female and 18 males), between 14 and 18 years of age, through community centers, schools, and youth workers. Mean age of the participants was 16 years (range 14-18 years of age). The ethnic break- down was 26 white, 7 Aboriginal, and 2 “other.” Data collection took place in ur- ban and rural settings in British Colum- bia, Canada.

We used a purposeful sampling strat- egy to identify a range of adolescent accounts regarding their tobacco-use experiences. The study included 11 former experimenters (had smoked more than one but fewer than 100 cigarettes in lifetime, but had not smoked in past 30 days), 14 daily smokers (had smoked more

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Am J Health Behav. 2005;29(2):99-106 101 than 100 cigarettes in lifetime and smoked every day over the past 30 days), 6 occasional smokers (had smoked more than 100 cigarettes in lifetime, but had not smoked every day in the past 30 days), and 2 former smokers (had smoked more than 100 cigarettes in lifetime, but had not smoked any cigarettes in the past 30 days). Teens, rather than younger children still at the experimental phase, were selected as we required a retrospective smoking narrative.

Flyers and posters describing the study were distributed in community centers, youth organizations, and schools in different neighborhoods. Adolescents who expressed interest were screened for eli- gibility through a brief telephone inter- view. Participants were remunerated ($25) for their contribution to this research in order to attract a wider range of respon- dents.

Following a brief description of the purpose of the study, participants were asked to sign a consent form in accordance with University of British Columbia Human Subjects Committee Guidelines. In order to insure confidentiality, parents were informed only that the study focused on attitudes towards tobacco use, and teens were assured that their parents would not receive information about their smoking. Interviews, which were conducted one-to-one, lasted 45-60 minutes and were audio-recorded. Participants were then invited to talk about their smoking history and encouraged to reflect upon the factors that may have contributed to their becoming smokers or nonsmokers.

In order to allow narrative responses to emerge, interviews were semistructured, using prompts.

Data Analysis

In keeping with the purpose of a narrative approach, we analyzed participants’

interviews for not only the responses they gave in relation to their cigarette use, but also the wider personal context of what they said. All members of the research team analyzed data independently.

Themes were then identified and devel- oped collaboratively at team meetings.

Analysis of the narratives adhered to the 4 steps outlined by Muller.¹⁸

After entering the text and becoming completely familiar with the narrative in its entirety, we identified the categories most relevant to our guiding research

question, by compiling the reasons and contexts provided by participants to account for smoking occurrence. Next, through successive readings and critical reflection, connections and relationships within the data were identified and themes and patterns established. That is, we examined these relevant categories for similar narrative structures across participants – were they telling us similar stories? In the third step, we sought to achieve internal consistency of interpretation by verifying emerging themes and patterns and by confirming the absence of negative cases and the inadequacy of alternative constructions.

We did this by continually returning to our larger research group for critical ex- amination of our interpretations. Each of these 3 steps is part of an iterative process. We continually considered new information or insight as it became available to the research process, trying “to keep intact, as much as possible, the context of each story, its sequential and structural features, and the consequences of events for each individual.”¹⁸The final step, representing an account, namely bringing together participants’ stories and researchers’ understandings, constitutes this paper.

RESULTS

Among these stories of smoking experience there appears the notion of smoking as a deliberate social tool used to personal advantage. Many of the young smokers to whom we talked were simi- larly utilizing the activities surrounding smoking to satisfy personal social needs, and although some young smokers mentioned peer pressure, this expressed sat- isfaction far superceded any considerations of physical harm. Their decisions to smoke did not appear predominantly to be driven either by the coercion of peer influence or by the ignorance of the serious health risks involved. That is not say that these elements were not present in some of their stories. However, even when specifically mentioned, these elements did not play the leading roles as portrayed in the interventions presented to young people. Instead, adolescents talked about the ways in which they themselves used smoking and, in doing so, provided reasons that went beyond the understanding contained in the conventional concep- tions of peer influence and risk taking. In

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the following sections, we discuss these findings and place them against the conventional concepts

surrounding adolescent

tobacco use.

Quotes contain the

ver- batim

responses of participants and are followed by the pseudonyms (chosen by each participant) and their age in years.

One Little Common

Thread: Peer Pressure vs Need to Belong

In these

narratives, the relationship

between smoking behaviors and having peers who smoked did not appear to equate with “pressure” as it is conventionally

portrayed in

prevention

programs. In fact, although there were exceptions, it was more usually the case that these others either did whatever they could to dis- suade participants from taking up smoking or were completely

apathetic towards it. That is, rarely did they report that others actively engaged them in the act of smoking or exerted any expectation of smoking behaviors.

Many participants also commented that peers were

not seen as

influencing the decision to smoke;

in fact, some told us that friends were more likely to accept their decision not to smoke.

Yeah, no one pushes them on you. Then it’s like, “Oh, come on, just keep me company”

and I’d be like,

“No, I really don’t think I should,” and they’d be like,

“Okay.” So most of my friends are really understanding about that.

(Sandy: 17yrs) They [friends]

all smoked at the time [of her quitting] … There wasn’t a big reaction, … and I never really bothered them about smoking, and they never bothered me about not smoking. (Cindy:

17yrs)

It’s not like,

“Come on try this. It’s good.”

It’s not like that anymore. It’s just, you know,

what you

choose is fine with everyone.

(Shannon: 18yrs) Within many of these narratives, smoking is described

functionally as a tool with which to negotiate the social

world: It provides these young people with a script with which to enter into social situations and to begin the

process of

communica- tion.

Not only do adolescents view cigarette use as a means to meet and interact

with others, but they are also

quite so-

phisticated in their awareness of this. The following quote

provides an

example of the deliberate and selective nature of cigarette use among

adolescents:

I’m thinking (of smoking) as more as an accessory

to me

having fun

… It's just sort of there inside my closet that I take out once in a while to wear out when I’m going out somewhere

…(Sandy: 17yrs)

The metaphor of cigarettes as an elec- tive fashion accessory reveals that, for this young woman, smoking is some- thing having a distinct social function

and quite

deliberately used to that end; she does not “wear”

cigarettes to school. This kind of conscious application of smoking moves cigarette use far

beyond the

definitions of peer pressure and risk behavior as currently

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Am J Health Behav. 2005;29(2):99-106 103 represented in

prevention initiatives.

Using the already

available social pro- tocols offered by a common and identifi- able activity

provides adolescents with a map to group

membership and relating to others that they

may not

otherwise be able to achieve:

I probably wouldn’t know the people I know …

‘cause you know you kind of, everyone crowds outside in

a ball

when it’s cold out and, “Oh, can I bum a smoke,

can I

borrow a lighter?”

and you just kind of meet people and start talking withpeople. So,

I met

people that way.

(Yvette: 16yrs)

I think nonsmokers don’t always have a group … It’s always like one little common thread between every smoker is the fact that they’re smoking … you always have the common way to start conversatio ns … it’s almost like a com- fort knowing that you have those few people that are gonna be there.

(Shannon:

18yrs) These narratives

contain a

personal social purpose beyond appearing “cool”

or following the herd. It must be included in the considerations about adolescent smoking, that, for these young people, the contexts of smoking carry a definite social benefit.

When peer

influence is considered as being a central

factor in the smoking equation, then the core of prevention is

avoidance and management strategies,

resulting, for example, in the

resistance approaches

favored by many interventions. If, however, external

pressure is

reconceived as purposeful

decision carry- ing a definite benefit, then such strate-

gies become

completely inappropriate.

Indeed, it would appear that health edu- cators and adolescents are

working from

totally different

scripts. If

cigarettes are seen advantageously as a social lubricant, why would teens then want to say, “No” to smoking?

They Haven’t Collapsed and Died, You Know:

Future Health Risk vs Immediate Social Gains Without

exception, the adolescents who shared their stories were aware of the dangers of smoking. However, although they easily could recite all the harmful

effects and

dangers inherent in tobacco use, most of them did not relate these to their own smoking and provided us with several reasons why such factors would not apply to them, the most common be-

ing that they would be able to stop long before their health was in any danger.

I have friends who have been smoking for 4 years, 5 years, and they’re still smoking – nothing’s happened to them. They haven’t collapsed and

died, you

know? So, I still think I have some years to go before I stop.

(Sandy: 17yrs) My dad, he’s been smoking since he was like about 14, and he’s 38 now, and he doesn’t have no cancer or any- thing.

(Nathan: 16yrs) Yeah, there’s pretty gross stuff (in an- titobacco video), and it tells you all about

emphysema … but all the people they show are like 40 and 50. I won’t die from smoking for a while.

(Greg: 16yrs) Although these teens could lessen the immediacy and relevance of their knowl- edge of tobacco-related health risks by

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erecting the barrier of time, they did not do so when considering the risks involved

for others.

Distancing and diminishing health risks appear to be relevant only to

the teen smokers themselves. It was not uncommon for teen smokers to express deep concern for others who might become smokers due to their own inadvert- ent influence.

I’m not

allowed to smoke in front of my sisters, and even if I was, I wouldn’t, just ‘cause it’s being that much more closer to a smoker, right?

(John: 16yrs)

I hate

smoking when little kids are around. I can’t stand it

‘cause I don’t want them to see it … I cringe when I see like the little grade 7’s smoking.

I just want to tell them, rip it out of their mouths and be like,

"Don’t do that. It’s stupid!"

(Cheryl: 16yrs) One teen who had spoken at length of the social benefits he enjoyed from smoking in terms of “bonding with friends” and smoking being

“like a secret

club” also told us that he would definitely stop smoking when he had his own children.

Why would I stop if I have a kid? Just for health reasons, I wouldn’t want to like, force any secondhand smoke on my child.

(Richard: 18yrs) antitobaccoThe messages

designed to

impact upon young smokers are further diluted by this attitude that they, some- how, are not the ones at risk; therefore, they are not part of the intended target audience.

I always read the package, and it says like,

“Smoking can kill you,”

“Smoking

can damage your unborn baby.” But, I

mean, I

wasn’t pregnant and I was young and healthy, so I thought like, it’s not going to bother me.(Cindy: 17yrs)

Rather than citing themselves as smokers, adolescents talk

of using

cigarettes as a social lubricant, much as adults will use alcohol;

and, just as adults rational- ize their alcohol

consumption (“I’m only a social drinker”), so, too, do adolescents justify their

smoking by

classification.

Accordingly, adolescents typically described

themselves to us as being “recre- ational,”

“occasional,”

“social,”and

“experimental” in their use

of cigarettes:

Rarely did they refer to themselves simply as being

“smokers.”

I don’t

consider

myself a

smoker, just a

once in

awhile kind of thing.

(Karen: 15yrs)

I ain’t saying that I’m a smoker, right?

Because you can’t say you’re a smoker if you smoke like once a week … I’d say

I’m a

nonsmoker except when I drink. (Donna:

18yrs)

The methods used by teens to distance

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Am J Health Behav. 2005;29(2):99-106 105 themselves from

the prevention and

cessation

messages that they see all around them every day are both effective and resistant.

Minimizing the

amount of

smoking they do and emphasizing the social benefits not only distance adolescents from

the negative

aspects of smoking, but also remove them from the impact of the

health risk

messages to which they are exposed.

This makes it

possible to

acknowledge the veracity of antito- bacco information while continuing to use cigarettes.

By placing the gulf of time between their present smoking and the probable health consequences, by not finding any personal relevance

in preven-

tion/cessation messages, and by not cast- ing themselves as outright “smokers”

per se, then clearly such messages are not really intended for them. It then becomes easier to ignore these interventions than it is to reassess their smoking behavior, which is currently

providing them with desirable advantages.

DISCUSSION

In electing to join smokers, adolescents are using the act of smoking to satisfy personal social needs versus sub- mitting to peer pressure in order to fit the desired group’s requirements for acceptance. Our results suggest that most adolescents did not identify peer pressure as being the primary influence in their decisions to smoke or not to smoke. Rather, they tend toward other reasons for their decision to smoke. In many cases, adolescents told us that choices regarding tobacco use are freely made.

Further,

adolescents do not appear to consider their own tobacco use as being a serious health-risk behavior. In fact, the perceived

psychosocial

advantages of smoking more than

outweigh any

consid-

ered physiological danger.

For the

adolescents in our study, it appears that the act of smoking has much less relevance than thepsychosocial benefits imparted by cigarette use.

Conse- quently, the dissonance between “smoking” (as defined by prevention

and inter-

vention

initiatives) and

“cigarette use”

(asinterpreted by adolescents) can emerge.

This may be another reason

why the

adolescents we listened to had such difficulty defining

themselves as outright

“smokers.” To be a smoker and to be seen as such do not appear to be the prime purpose behind their cigarette use.

If we take the stories that were told to us

by the

adolescents in this study and maintain these as our frame of refer- ence, then many of the observations held by adults concerning adolescent peer pressure and risk behaviors

become open to reinterpretation.

For example, the youth

development model operates within a discourse that focuses upon adolescence as a time of risk-taking behaviors and vul- nerability, and has been instrumental

in guiding

research and program development in the field of adolescent tobacco

control.^19,20 This approach creates the possibility

for simply

categorizing adolescent

behavior as being

“risky,” irrational, and in some way markedly different from “nor- mal”

adult responses.

If, however, this

view is

challenged, then it becomes pos-

sible to

reinterpret

“adolescent risk behaviors” as a social process.¹⁵ Further, if identity is about forging social connections – belonging or not belonging – then adolescents are faced with the tasks of negotiating an identity and choosing how they belong in a variety of settings.

It may be, therefore, that adolescents use

smoking to

accomplish these adolescent

(13)

106

tasks. That is, they may be using

cigarettes in shaping, defining, and characterizing who they are and what their personal

relationships will look like – both through the social acts clustered around smoking (accessing, buying, sharing, lighting up, finding places to smoke, etc) and in creating and sharing

narratives about smoking.

What are

these adolescents telling us? In creating their

“smoking

narratives,” what is it that they both want to believe and want us to know?

From these

narratives, it can be surmised that the responses would include the following:

· That

nonaddicted smoking is not al-

ways a

spontaneous act – in many in- stances, it is quite deliberate;

· That adolescent smoking

behaviors occur within a complex matrix of socially defined meanings that cannot be readily isolated;

· That the

consideration of

health risk

inherent in

smoking is not

usually a

determining factor.

This may not sound like a revelation.

However, when the term cigarette use is substituted for smoking, the shift in interpretation makes possible a much wider range of understanding having immediate implications

for the design and implementation of interventions.

It is hard to imagine that there could be a young person who is not aware that a link exists between

tobacco and

disease; they have been exposed to this message since infancy. Why, then, do adolescents initiate and continue a behavior that they clearly know to be harmful?

On the basis of the narratives we heard in this study, there are several possible answers to this question.

The predomi- nant possibility to consider is that,

from an

adolescent

perspective, there is little or no connection

between their using cigarettes as

a social mediator

and their

consideration of smoking as a health- risk behavior. It would appear that adolescents are not so much smoking as they are using cigarettes as a social accessory, and to them, the contextual activities

surrounding cigarette use are far removed from the acts of

smoking as

portrayed in prevention and cessation

initiatives and consequently rendered

harmless. Wyn and White¹⁵make the point that “the very idea of risk implies a rational assessment of the chances of ‘getting away with it’” (p 68, original quo- tation marks). In other words, a behavior can be perceived as being

“risky” only if the full implications of the potential consequences have been considered.

Most of the adolescents in our research did not

appear to

approach smoking in this way.

Although they did not deny the rationality of smoking as a high health risk, they refuted that their own behaviors fell un- der that same rubric. Quite simply, these young people do

not consider the way that they use cigarettes

constitutes a personal health-risk behavior.

Another

consideration is that, to the adolescent mind, cigarette use offers definite and immediate

benefits that out-

(14)

Am J Health Behav. 2005;29(2):99-106 107 weigh any potential

and distant harm, in that it facilitates

“the identity project” in that it can provide a sense of belonging.⁶There are several important implications to be considered from this study:

The underlying assumption that

teens are

pressured into smoking by peers con- tinues to pervade

cessation/preven tion initiatives and fails to take into account the possibility that decisions made by adolescents regarding

smoking are both freely made and have – for the adolescents themselves - positive

psychosocial results. Thus, the relevance to youth of existing intervention models requires further

investigation.

Further, it would appear from our findings that youth typically feel in control of their smoking behaviors and that some preaddicted youth go to great

lengths to

monitor their cigarette use carefully.

However, both influence and risk models imply a loss of control,

and many

prevention programs center

upon developing and practicing skills to overcome external

persuasion and operating within a discourse that focuses on the interpretation of cigarette use as an isolated health risk quite apart

from the

psychosocial needs of the adolescent. How valuable can resistance initiatives be if these aspects are not even a factor in adolescent

considerations?

The primary focus of many adolescent

prevention

interventions has been guided by the health profession’s concept of peer influence and health risk. Yet we know little

about how

adolescents themselves

experience the influence of peers or how they determine risk and the ways in which their perceptions of these behaviors differ during the initial sampling

and early

experimentation phases of cigarette smoking. A consequence of this is that the dialogue around the development and evaluation of adolescent tobacco-prevention initiatives tends to be a very one-

sided

conversation with the voice of the adult researcher, teacher, or parent encouraging a shift in individual attitudes and behaviors.²¹

How youth

smoking comes to be conceptualized in prevention programs

primarily involves the processes

derived from adult observa- tion and interpretation of adolescent behaviors. Although youth may be recruited in the

design and

implementation of such initiatives, they tend to be guided by re- ceived wisdom rather than their

own lived

experience.¹⁰ We propose that

the ensuing

mismatch between the theoretical assumptions guiding adolescent tobacco control design and the practical reality of teen life raises serious questions about the efficacy or relevance of these messages. Acknowl-

edging this

distinction may allow public health workers to continue fuelling the momentum that has been gained in tobacco control over the last several de- cades. Indeed, we would argue that

the tobacco

industry is already not only aware of this distinction, but has been making use if it for some time.

We fail

adolescents by clinging tena- ciously to an intervention paradigm that typically

represents teen smoking as a foolhardy activity brought about through pressure

exacted by equally foolhardy peers and cured by isolation and educa- tion, a paradigm that interprets adolescents as readily accepting but deliberately defying this rationale. The information obtained from these adolescent narratives of smoking emphasizes the ur- gent need to shift intervention

research and

development to a social perspective that gives adolescent needs and interests central focus, one

that can

accommodate the subtle and complex ecology that con- tinues to allow our youth to consider cigarette use as an answer for their needs.

Acknowledgment This research was supported by a grant from the National Cancer Institute of Canada.



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