Factors associated with smoking behavior in adolescent girls

Addic,rit,c Belmviors,

Printed

in the USA.

Vol. 13, pp. 139145, All rights reserved.

FACTORS

1988 Copyright

ASSOCIATED WITH SMOKING ADOLESCENT GIRLS SUSAN

Counseling

and Consultancy

LISA University

0306-4603188 $3.00 + .OO 0 1988 Pergamon Press plc

BEHAVIOR

IN

J. HOVER Services,

ROSENTHAL of Queensland,

Brisbane,

Austrdha

GAFFNEY St. Lucia,

Australia

Abstract - This study investigated the relationship between smoking in adolescent girls and levels of social skills, parental smoking, peer smoking and academic achievement. A Smoking Data Survey was administered to 143 girls aged between I2 and 16 to distinguish smokers and nonsmokers and to gain information about parents’ smoking behavior, peers’ smoking behavior, and the subjects’ academic achievement. A second questionnaire, the Problem Inventory for Adolescent Girls. was also administered to determine subjects’ levels of social skills. A multiple discriminate analysis was performed on the variables of social skills score, socioeconimic status, mothers’ smoking behavior, fathers’ smoking behavior, number of peers who smoke and average school grade achieved. Results demonstrated significant differences between the two groups, smokers and nonsmokers, p < .OOOl. A series of univariate F tests showed significant group differences between smokers and nonsmokers on the variables of social skills score, mothers’ smoking behavior, number of peers who smoke, and average school grade achieved. Smokers, compared to nonsmokers, had lower social skills scores, a higher percentage of them had mothers and friends who smoke, and they achieved lower grades overall than nonsmokers.

The association between cigarette smoking, premature mortality and chronic ill health is well documented. When the connection between smoking and related diseases was initially established there was a general tendency for smoking to decrease. In 1965 in the United States, an estimated 41.7% of all adults were smokers but by 1978 this number had decreased to approximately 33.2% of the adult population (Department of Health, Education and Welfare [HEW], 1979). Similarly in Australia, a survey conducted by the National Heart Foundation in 1980 found that 3% of men were ‘current’ smokers and 27% were ‘ex-smokers’ and 26% of women were ‘current’ smokers and 15% were ‘ex-smokers’ (National Heart Foundation [Australia], 1980). The figures indicating a general decrease in smoking are not applicable to the adolescent population, where an actual increase in smoking behavior has occurred, particularly in the case of females. Four studies by the United States National Institute of Health (1976) indicate that in 1968 approximately 12% of adolescents aged twelve to eighteen were smokers, whereas by 1974, 16% of adolescents in this age group were smokers. Although overall smoking has increased, from 1970 to 1974 male adolescent smoking actually decreased, but this decrease was offset by a marked increase in female adolescent smoking. Male smokers in the twelve to eighteen year range increased from 14.7% in 1968 to 18.5% in 1970, but then decreased to 15.8% in 1974. By contrast, the percentage of adolescent female smokers significantly increased. From 1968 to 1974 the percentage of female smokers in the twelve to eighteen year range increased from 8.4% to 15.3%. Requests Australia

for reprints

should

be sent to Susan

J. Hover,

139

37 Rinora

Street.

Corinda,

Queensland

4075.

140

SUSAN J. HOVER and LISA ROSENTHAL

GAFFNEY

In view of the inherent dangers of smoking and the overall increase in adolescent smoking, it is apparent that the most effective way to deal with the problem is to persuade adolescents and younger children not to start smoking. In order to accomplish this it is necessary to identify the influencing factors that lead adolescents into smoking. While it is most probable that all the influences have not been identified, three specific areas have been defined and explored. These areas are (a) peer group pressure, (b) parental smoking habits and (c) the adolescents’ academic achievement levels (HEW, 1979). Prrr group prrssurr. Peer group pressure has been largely accepted as a significant factor in the initiation of smoking, with many teenagers smoking because they perceive it as giving them status and group acceptance (Newman, 1970). Levitt and Edwards (1970) reported that the best predictor of smoking in children from the fifth to the twelfth grade was whether they had a best friend or group of friends who smoked. Hill (1971) and Aitken (1980) also confirmed that adolescent smokers have more friends who smoke than do nonsmokers and they both suggested that peer group pressure could be a crucial factor in the onset of smoking behavior. Parentcrl smoking habits. A consistent finding in the literature has been that parental smoking influences the adoption of smoking by adolescents (Allegrante, O’Rourke, & Tuncalp, 1978; Borland & Rudolph, 197.5; Palmer, 1970; Williams, 1973; Wohlford, 1970). It is suggested that parents who smoke act as role models for their children and also provide easy accessibility to smoking supplies. Studies in this area have found that smoking is more frequent in cases where both parents smoke. Academic ochicvrmcnt. Several studies have now determined that there is a relationship between academic achievement during adolescence and the acquisition of the smoking habit. Matarazzo and Saslow (1960) indicated that although smokers generally do not differ from nonsmokers in terms of IQ, smokers gain lower grades on average than nonsmokers. Creswell, Huffman and Stone (1970) and Laoye, Creswell and Stone (1972) found a relationship between adolescents’ educational expectations and their smoking behavior. Adolescents who smoke see themselves and others who smoke as less successful academically and see nonsmokers as being academically successful. These findings which indicate a relationship between smoking and peer group pressure, parental smoking, and academic achievement, have had important implications for antismoking campaigns directed at adolescents and younger children. Until 1971. most of the education programs were directed at providing adolescents with facts concerning the health risks involved in smoking. Briney (1967) however, found that knowledge of the health risks involved with smoking had no significant effect on the smoking behavior of high school seniors. At the Second World Conference on Smoking and Health in 1971, it was recognized that supplying facts alone about the health risks involved in smoking was not enough (Bynner, 1971). As a consequence of this, new educational approaches have been designed. In several of the long term school programs, an attempt was made to incorporate social skills training into programs that were teaching the health risks associated with smoking. Specifically, skill training centered on teaching teenagers how to resist peer pressures to smoke (e.g.. Evans, 1983; Perry, Telch, Killen, Burke, & Maccoby, 1983). However, while the use of a skills training component in anti-smoking programs has been associated with a decrease in smoking behavior. there is little empirical evi-

Smoking and associated factors

141

dence to show a relationship between lower levels of social skills and higher frequencies of smoking behavior in teenagers. The main purpose of the present study is to establish such a relationship. In addition, the study will attempt to replicate earlier work showing that parental smoking, peer smoking, and academic achievement are related to the smoking behavior of female adolescents. METHOD

Subjects

The subjects were 143 female high school students in grades eight through ten from two city high schools. The subjects ranged in age from 12 to 16 years. Materials

Two questionnaires were used, the Smoking Data Survey and the multiple choice version of the Problem Inventory for Adolescent Girls (Gaffney, 1984; Gaffney & McFall, 1981). The Smoking Data Survey was used to gather biographical data and to determine the smoking behavior of the subjects, their parents and friends. The Problem Inventory for Adolescent Girls was used to rate subjects on their levels of social skills. Smoking

data survey

This questionnaire consisted of two sections. The first section was used to determine the subjects’ ages and their parents’ occupations. Socioeconomic status was determined by scoring parental occupations on the Hollingshead Index of Social Position (Hollingshead, 1975). Scores ranged from one (unskilled laborers) through to nine (professionals and senior executives). Six items included in the second section were designed to ascertain whether subjects were smokers or nonsmokers, how much their parents smoked, how many of their friends smoked, and their reported average grade obtained on examinations. Problem

inventory

for adolescent

girls

This inventory consisted of 52 items which had been selected to reflect a wide range of problematic situations for adolescent girls. Each item describes a troublesome situation involving teachers, parents or peers in which the subject is called upon to make a response. For example, the troublesome situation may be presented as a teacher accusing a girl of cheating on an exam, or a friend asking the girl to shoplift. There are five possible responses to each item representing solutions ranging from very competent to very incompetent. Subjects are asked to select the response closest to what they would say or do in that situation. Subjects receive a score of either five, four, three, two or one, with a very competent response scoring five and a very incompetent response scoring one. Scores on all the items were added together and then divided by 52 to get a mean item score for each subject. Procedure No names were requested

on the questionnaires to allow for more honest selfreports. Subjects were tested in two groups - one group at each school. In order to control for differences in reading ability, all questions and possible responses were either read aloud by the experimenter or presented on audio tape. RESULTS

A multiple discriminate analysis was performed on the six variables of social skills

SUSAN

n

50 45

and LISA

ROSENTHAL

GAFFNEY

Smokers

ON

1

.I. HOVER

onsmokers

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25 20

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‘51 10

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1.751.99

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SUBJECT< Fig. 1. Distribution Adolescent Girls.

2.502.7L

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MEAN

of subjects according

Ji

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SOCIAL

3.253.1s

SKILLS

3.503.7L

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&. L.

J e

RATINGS

to their mean ratings on the Problem

Inventory

for

score, socioeconomic status, mothers’ smoking behavior, fathers’ smoking behavior, number of peers who smoke and average school grade achieved. The results of the discriminate analysis revealed significant group differences between smokers and nonsmokers, Wilks Lambda = 0.329, F(6, 136) = 46.16, p < .OOOl. The chi-square associated with Root 1 is 154.38 (6), p < .OOOl. In addition univariate F tests showed significant group differences on the four variables of social skills score, F( I, 141) = 93.17,~ < .OOOl; mothers’ smoking behavior, F(1, 141) = 10.61,~ < .0018; number of peers who smoke, F(l, 141) = 211.58, p < .OOOl; and average school grade achieved, F(1, 141) =19.98, p < .OOOl. No significant group differences were indicated for the variables of socioeconomic status, F(1, 141) = .897, and fathers’ smoking behavior, F( 1, 141) = 2.78. Social skills. Smokers had a mean social skills score of 2.96 compared with a mean social skills score for nonsmokers of 3.78. Figure 1 displays the distribution of subjects according to their mean ratings on the Problem Inventory for Adolescent Girls. Using a score of three as the cutoff point between competent and incompetent responses, 41% of smokers were in the incompetent range of performance while only 6% of the nonsmokers scores in this range. No smokers scored in the competent to very competent range of performance, designated by a score of four or more, whereas 38% of nonsmokers received scores in this range. The mean number of cigarettes smoked per day by the Mothers’ smoking. mothers of smokers was 10.9 compared to 4.7 cigarettes per day smoked by mothers of nonsmokers. Fifty-three percent of smokers’ mothers smoked compared to 35% of nonsmokers’ mothers who smoked. Peer smoking. For smokers, the mean number of close friends who smoked was 3.8 whereas for nonsmokers the mean was 1.04. Figure 2 illustrates the distribution

143

Smoking and associated factors

100

c

n UN

L 0

Smokers onsmokers

60

NUMBER

OF

SUBJECTS’

CLOSE

FRIENDS

WHO

SMOKE

Fig. 2. Distribution of subjects according to the number of close friends of the subject who

of subjects according to the number of close friends who smoked. While smokers did not have any close friends who did not smoke, 5% of nonsmokers reported none of their close friends smoked. Ninety-one percent of smokers had more than three friends who smoked compared to 13% of nonsmokers who had more than three friends who smoked. School grades. Figure 3 depicts the distribution of subjects according to the schooi grades they reported to have achieved. For smokers, 39.7% received a grade of A or B while 62.7% of nonsmokers received these grades. Fifteen percent of smokers received D or E grades but there were no nonsmokers who received a grade lower than C. Socioeconomic status andfuthrrs’ smoking. The two variables which were not significant were socioeconomic status and fathers’ smoking. Smokers had a mean of 3.5 for socioeconomic status and nonsmokers had a mean of 3.8 for this variable. The mean number of cigarettes smoked per day for fathers of smokers was 11.8 and for nonsmokers was 7.9.

DISCUSSION

Significant results have established the relationship between lower levels of social skills and smoking behavior in teenage girls. Many smokers had social skills levels in the incompetent range and none of the smokers attained a level of social skills equivalent to the competent to very competent range. These results indicate that less socially competent adolescents lack the skills necessary to resist social pressures and particularly peer pressure to smoke, thereby providing empirical support for antismoking campaigns which have incorporated social skills training programs.

SUSAN

50 L5

n

Smokers

0

Nonsmokers

J. HOVER

and LISA

ROSENTHAL

I

r

LC [

GAFFNEY

35’

3ot 27 20 15p 10 1 50[

r

1

-.A-

D

A

USUAL Fig. 3. Distribution

GRADES

of subjects

ACHIEVED according

BY

to school

_I E

SUBJECTS grades

achieved

Training in social skills could assist adolescents to resist the influence that leads to the initiation of the smoking habit and to help those who are already smoking give it “P. The present study showed that peer smoking, mothers’ smoking and low grade achievement are related to female adolescent smoking behavior. The findings related to peer smoking support previous research that has indicated that smokers have more friends who smoke than do nonsmokers. This suggests that peer pressure may be a major factor in the initiation and maintenance of the smoking habit and is consistent with findings from other studies (Aitken, 1980; Hill, 1981). The data also are in agreement with results from other studies (Allegrante et al., 1978; Williams. 1973; Wohlford, 1970) that indicate a positive relationship between parental smoking and the adolescent’s smoking. The present study suggests that the mothers’ smoking behavior is more important than the fathers’ in relation to their daughters developing the smoking habit. This research supports the hypothesized relationship between smoking and lower grade achievement for smokers. This corresponds to work by Borland and Rudolph (1975) which suggested that smoking may be used by low grade achievers as a defense against a derogated self-image, but does not necessarily suggest that smoking leads to lower grade achievement. Smoking cigarettes may be used as a symbol of toughness, maturity or independence by low grade achievers in an attempt to enhance their self-image. The absence of a significant association beween social class and smoking behavior is in agreement with findings reported by Bewley and Bland (1977), and Aitken (1980), but conflicts with other research. Williams (1973) found that lower family socioeconomic status was associated with smoking behavior among adolescents. Borland and Rudolph (1975) determined that socioeconomic status had some relationship with high school students whereby adolescents in lower socioeconomic

Smoking

and associated

factors

145

levels were more likely to smoke, but they also found that socioeconomic status correlated less with smoking than parental smoking or lower grade achievement. Work is needed to determine whether the relationships detailed in the present study, particularly that of social skills and smoking, are present among adolescent boys. Future research is needed to determine whether a social skills inventory, together with data about peer and family smoking habits and academic performance could predict future “at risk” smokers. These teenagers would be helped most by prevention programs. REFERENCES Aitken, P.O. (1980). Peer group pressures, parental controls and cigarette smoking among ten to fourteen year olds. British Journal of Social and Clinicul Psychology, 19, 141-146. Allegrante, J.P., O’Rourke, T.W.. & Tuncalp, S. (1978). A multivariate analysis of selected psychosocial variables of the development of subsequent youth smoking behavior. Journal of Drug Educution, 7, 237-248. Bewley, R.B., & Bland, J.M. (1977). Academic performance and social factors related to cigarette smoking by schoolchildren. British Journal of Preventatirv crnd Social Medicine. 31, 18-24. Borland. B.L., & Rudolph, J.P. (1975). Relative effects of low socioeconomic statsu, parental smoking and poor scholastic performance on smoking among high school students. .Soc?a/ Science and Mcdicirw, 9, 27-30. Briney, K.L. (1967). Relation of knowledge of effects of cigarette smoking to the practice of smoking among high school seniors. Studies and issws in smoking hrhalior (pp. 53-55). Tucson: University of Arizona Press. Bynner, J.M. (1971). The dilemma facing health educators. The Second World Conf?rrnce on .rrnoking crnd health: Proceedings of (I conjbrrncr organized by the Health Education Council at Impc~riul Collcgr, London, September 20-24, 1971 (pp. 81-84). London: Pittman Medical. Creswell. W.H., Jr., Huffman, W.J.. & Stone, D.B. (1970). Youth smoking behavior characteristics and their educational implications. A report ofthe University of’ Illinois antismoking educution study, Champaign: University of Illinois. National institute of Health (1976). Teenage smoking. national pattrrns of cigcwette smoking. trges I2 through 18, in 1972 and 1974. Department o.f Heulth, Educcrtion and We&we Publication No. lNIH) 76-93 1. Evans, R.I. (1983). Deterring smoking in adolescents: Evolution of a research program in applied social psychology. Internutionnl Review of Applied Psychology, 32, 71-83. Gaffney, L.R. (1984). A multiple-choice test to measure social skills in delinquent and nondelinquent adolescent girls. Journrrl ofConsulting und Cliniwl Psychology 52, 91 l-912. Gaffney, L.R.. & McFall, R.M. (1981). A comparison of social skills in delinquent and nondelinquent adolescent girls using a behavioural role-playing inventory. Journal ofConsulting trnd Clinical Psyc~hology, 49, 959-967. Hill, D. (1971). Peer group conformity in adolescent smoking and its relationship to affiliation and autonomy needs. Australicrn Journal of Psychology, 23, 189-199. Hollingshead, A.B. (1975). Four-j&or index ofsociulposition. Unpublished manuscript. Yale University. Laoye, J.A.. Creswell, W.H., Jr., & Stone, D.B. (1972). A cohort study of 1,205 secondary school smokers. Journal ofSchool Health. 42, 47-52. Levitt. E.E., & Edwards, J.A. (1970). A multivariate study of correlative factors in youthful cigarette smoking. Dr~~elopmentrrl Psychology, 2, 5-I 1. Matarazzo, J.D. & Saslow, G. (1960). Psychological and related characteristics of smokers and nonsmokers. Psycho/o&n/ BtdIctin. 57, 493-513. National Heart Foundation [Australia] (1981). Smoking and heart disease. Community information paper No. IX. Department of Health. Education and Welfare (1979). Smoking und health. Washington. DC: United States Government Printing Office. Newman, I.M. (1970). Status configurations and cigarette smoking in a junior high school. Jorrrntrl of School Hralth. 40, 2%3 1. Palmer, A.B. (1970). Some variables contributing to the onset of cigarette smoking among junior high school students. Social Science and Medicine. 4, 359-366. Perry, C.L., Telch, M.J., Killen. J., Burke, A., & Maccoby, N. (1983). High school smoking prevention: The relative efftcacy of varied treatments and instructors. Ado/e.scencc, 18, 561-566. Williams. A.F. (1973). Personality and other characteristics associated with cigarette smoking among young teenagers. Journal ofHealth and Socirrl Behnvior. 14, 374-380. Wohlford, P. (1970). Initiation of cigarette smoking. Is it related to parental behavior? Journal of Consrtlting crnd Clinical Psychology. 34, 146151.