The purpose of this multi-site qualitative study is to explore how adolescents talk about tobacco use. Sixty-six students in four high schools became co-researchers and led focus group interviews with 205 fellow students. From the interviews, the authors develop a story line that reports how adolescents begin smoking, how smoking becomes a pervasive influence, how attitudes form about smoking, what it means to be a smoker, and, ultimately, student suggestions for tobacco use prevention. Embedded within this story line are complex questions and contradictions. We explore whether peers really are influential, if the media is important, whether smoking is a matter of personal choice, if schools actually promote tobacco use, and whether adolescents can quit smoking.
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References
1.
Aloise-Young, P. A. , Graham, J. W., & Hansen, W. B. (1994). Peer influence on smoking initiation during early adolescence: A comparison of group members and group outsiders. Journal of Applied Psychology, 79, 281-287.
2.
Ashley, M. J. , Northrup, D. A., & Ferrence, R. (1998). The Ontario ban on smoking on school property: Issues and challenges in enforcement. Canadian Journal of Public Health, 89, 229-232.
3.
Aveyard, P. , Cheng, K. K., Almond, J., Sherratt, E., Lancashire, R., Lawrence, T., et al. (1999). Cluster randomized controlled trial of expert system based on the transtheoretical (“stages of change”) model for smoking prevention and cessation in schools. British Medical Journal, 319, 948-953.
4.
Balch, G. I. (1998). Exploring perceptions of smoking cessation among high school smokers: Input and feedback from focus groups. Preventive Medicine, 27, A55-A63.
5.
Biglan, A. , Duncan, T. E., Ary, D. V., & Smolkowski, K. (1995). Peer and parental influences on adolescent tobacco use. Journal of Behavioral Medicine, 18, 315-330.
6.
Bowen, D. J. , Kinne, S., & Orlandi, M. (1995). School policy in COMMIT: A promising strategy to reduce smoking by youth. Journal of School Health, 65, 140-144.
7.
Brown, B. R., Jr. , & Butterfield, S. A. (1992). Coaches: A missing link in the health care system. American Journal of Diseases of Children, 146, 211-217.
8.
Bruvold, W. H. (1993). A meta-analysis of adolescent smoking prevention programs. American Journal of Public Health, 83, 872-880.
9.
Bunch, W. H. (1990). Are your local schools healthy?Journal of the Florida Medical Association, 77, 45-46.
10.
Burton, D. (1994). Tobacco cessation programs for adolescents. Interventions for smokers: An international perspective. Baltimore, MD: Williams & Wilkins.
11.
Centers for Disease Control . (1994). Guidelines for school health programs to prevent tobacco use and addiction. Journal of School Health, 64, 353-360.
12.
Centers for Disease Control . (1996). Tobacco use among high school students—United States. Morbidity and Mortality Weekly Report, 47, 229-233.
13.
Centers for Disease Control . (1998a). Incidence of initiation of cigarette smoking—United States, 1995-1996. Morbidity and Mortality Weekly Report, 47, 837-840.
14.
Centers for Disease Control . (1998b). Selected cigarette smoking initiation and quitting behaviors among high school students—United States, 1997. Morbidity and Mortality Weekly Report, 47, 386-389.
15.
Centers for Disease Control . (1998c). State specific prevalence among adults of current cigarette smoking and smokeless tobacco use and per capita tax paid sales of cigarettes—United States, 1997. Morbidity and Mortality Weekly Report, 47, 922-926.
16.
Centers for Disease Control . (2001). Youth tobacco surveillance—United States, 2000. Morbidity and Mortality Weekly Report, 50, 1-45.
17.
Colby, S. M. , Tiffany, S. T., Shiffman, S., & Niaura, R. S. (2000). Are adolescent smokers dependent on nicotine? A review of the evidence. Drug and Alcohol Dependence, 59(Suppl. 1), S83-S95.
18.
Creswell, J. W. (1998) Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.
19.
Creswell, J. W. (2002). Educational research: Planning, conducting, and evaluating quantitative and qualitative approaches. Upper Saddle River, NJ: Merrill/Pearson.
20.
Engels, R. C. , Knibbe, R. A., Drop, M. J., & de Haan, Y. T. (1997). Homogeneity of cigarette smoking within peer groups: Influence or selection?Health Education and Behavior, 24, 801-811.
21.
Ennett, S. T. , & Bauman, K. E. (1993). Peer group structure and adolescent cigarette smoking: Asocial network analysis. Journal of Health and Social Behavior, 34, 226-236.
22.
Fibkins, W. L. (1993). Combating student tobacco addiction in secondary schools. NASSP Bulletin, 77, 51-59.
23.
Gibbons, F. X. , & Eggleston, T. J. (1996). Smoker networks and the “typical smoker”: A prospective analysis of smoking cessation. Health Psychology, 15, 469-477.
24.
Ginsburg, K. R. (1996). Searching for solutions: The importance of including teenagers in the research process. Journal of Developmental and Behavioral Pediatrics, 17, 255-257.
25.
Graham, J. W. , Marks, G., & Hansen, W. B. (1991). Social influence processes affecting adolescent substance use. Journal of Applied Psychology, 76, 291-298.
26.
Hansen, W. B. , Johnson, C. A., Flay, B. R., Graham, J. W., & Sobel, J. (1988). Affective and social influences—approaches to the prevention of multiple substance abuse among seventh grade students: Results from project SMART. Preventive Medicine, 17, 135-154.
27.
Heishman, S. J. , Balfour, D. J. K., Benowitz, N. L., Hatsukami, D. K., Lindstrom, J. M., & Ockene, J. K. (1997). Society for research on nicotine and tobacco. Addiction, 92, 615-633.
28.
Kolbe, L. J. , Kann, L., Collins, J. L., Small, M. L., Pateman, B. C., & Warren, C. W. (1995). The school health policies and programs study (SHPPS): Context, methods, general findings, and future efforts. Journal of School Health, 65, 339-343.
29.
Larsen, M. D. , & Christiansen, E. H. (1994). Values and opinions of comprehensive school health education in U.S. public schools: Adolescents, parents, and school district administrators. Atlanta, GA: American Cancer Society.
30.
Marshall, C. , & Rossman, G. B. (1995). Designing qualitative research (2nd ed.). Thousand Oaks, CA: Sage.
31.
Martin, M. W. , Levin, S., & Saunders, R. (1999). Secondary school tobacco policy and prevention curricula in South Carolina. Nicotine & Tobacco Research, 1, 341-347.
32.
McCool, J. P. , Cameron, L. D., & Petrie, K. J. (2001). Adolescent perceptions of smoking imagery in film. Social Science and Medicine, 52, 1577-1587.
33.
McGinnis, J. , & Foege, W. (1993). Actual causes of death in the United States. Journal of the American Medical Association, 270, 2207-2212.
34.
McVea, K. , Harter, L., McEntarffer, R., & Creswell, J. (1999). A phenomenological study of student experiences with tobacco use at city high school. High School Journal, 82, 209-222.
35.
Miles, M. B. , & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage.
36.
Miller, D. L. , McVea, K., Creswell, J. W., Harter, L., Mickelson, W., McEntarffer, R., et al. (2000). Engaging high school students as co-researchers in qualitative research: Logistical, methodological, and ethical issues. Manuscript submitted for publication.
37.
Moffat, B. M. , & Johnson, J. L. (2001). Through the haze of cigarettes: Teenage girls’stories about cigarette addiction. Qualitative Health Research, 11, 668-681.
38.
Mosbach, P. , & Leventhal, H. (1988). Peer group identification and smoking: Implications for intervention. Journal of Abnormal Psychology, 97, 238-245.
39.
Murray, M. , Kiryluk, S., & Swan, A. (1984). School characteristics and adolescent smoking. Journal of Epidemiology and Community Health, 38, 167-172.
40.
Northrup, D. A. , Ashley, M. J., & Ferrence, R. (1998). The Ontario ban on smoking on school property: Perceived impact on smoking. Canadian Journal of Public Health, 89, 224-228.
41.
Pallonen, U. E. (1998). Transtheoretical measures for adolescent and adult smokers: Similarities and differences. Preventive Medicine, 27, A29-A38.
42.
Pallonen, U. E. , Prochaska, J. O., Velicer, W. F., Prokhorov, A. V., & Smith, N. F. (1998). Stages of acquisition and cessation for adolescent smoking: An empirical integration. Addictive Behaviors, 20, 303-324.
43.
Pallonen, U. E. , Velicer, W. F., Prochaska, J. O., Rossi, J. S., Bellis, J. M., Tsoh, J. Y., et al. (1998). Computer-based smoking cessation interventions in adolescents: Description, feasibility, and six-month follow-up findings. Substance Use & Misuse, 33, 935-965.
44.
Peyton, C. G. (2001). Reflections on the experience of beginning smoking: A narrative analysis. Unpublished doctoral dissertation, University of Nebraska-Lincoln.
45.
Pickett, W. , Northrup, D. A., & Ashley, M. J. (1999). Factors influencing implementation of the legislated smoking ban on school property in Ontario. Preventive Medicine, 29, 157-164.
46.
Prochaska, J. O. , Velicer, W. F., Rossi, J. S., Goldstein, M. G., Marcus, B. H., Rakowski, W., et al. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13, 39-46.
47.
Prokhorov, A. V. , Hudmon, K. S., de Moor, C. A., Kelder, S. H., Conroy, J. L., & Ordway, N. (2001). Nicotine dependence, withdrawal symptoms, and adolescents’readiness to quit smoking. Nicotine and Tobacco Research, 3, 151-156.
48.
Ross, J. G. , Einhaus, K. E., Hohenemser, L. K., Greene, B. Z., & Gold, R. S. (1995). School health policies prohibiting tobacco use, alcohol and other drug use, and violence. Journal of School Health, 65, 333-338.
49.
Sarason, I. G. , Mankowski, E. S., Peterson, A.V., Jr., & Dinh, K. T. (1992). Adolescents’reasons for smoking. Journal of School Health, 62, 185-190.
50.
Siqueira, L. M. , Rolnitzky, L. M., & Rickert, V. I. (2001). Smoking cessation in adolescents: The role of nicotine dependence, stress, and coping methods. Archives of Pediatrics and Adolescent Medicine, 155, 489-495.
51.
Sussman, S. (2001, May). Effects of sixty-six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting. Prepared for the Youth Tobacco Cessation Collaborative Best Practices Workshop with support from the Canadian Tobacco Control Research Initiative, Chicago.
52.
Sussman, S. , Dent, C. W., Burton, D., Stacy, A. W., & Flay, B. R. (1995). Developing school-based tobacco use prevention and cessation programs. Thousand Oaks, CA: Sage.
53.
Sussman, S. , Dent, C. W., Stacy, A. W., Burciaga, C., Raynor, A., Turner, G. E., et al. (1990). Peer-group association and adolescent tobacco use. Journal of Abnormal Psychology, 99, 349-352.
54.
Tesch, R. (1990). Qualitative research: Analysis types and software tools. Bristol, PA: Falmer.
55.
Tompkins, N. O. , Dino, G. A., Zedosky, L. K., Harman, M., & Shaler, G. (1999). A collaborative partnership to enhance school-based tobacco control policies in West Virginia. American Journal of Preventive Medicine, 16, 29-34.
56.
United States Department of Health and Human Services . (2000). Healthy People 2010. Retrieved July 9, 2002, from http://hp2010.nhlbihin.net/
57.
van Roosmalen, E. H. , & McDaniel, S. A. (1989). Peer group influence as a factor in smoking behavior of adolescents. Adolescence, 24, 801-816.
58.
Villani, S. (2001). Impact of media on children and adolescents: A10-year review of the research. Journal-American Academy of Child and Adolescent Psychiatry, 40, 392-401.
59.
Wakefield, M. A. , Chaloupka, F. J., Kaufman, N. J., Orleans, C. T., Barker, D. C., & Ruel, E. E. (2000). Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: Cross sectional study. British Medical Journal, 321, 333-337.
