Starting to smoke: a qualitative study of the experiences of Australian indigenous youth

Abstract

BackgroundAdult smoking has its roots in adolescence. If individuals do not initiate smoking during this period it is unlikely they ever will. In high income countries, smoking rates among Indigenous youth are disproportionately high. However, despite a wealth of literature in other populations, there is less evidence on the determinants of smoking initiation among Indigenous youth. The aim of this study was to explore the determinants of smoking among Australian Indigenous young people with a particular emphasis on the social and cultural processes that underlie tobacco use patterns among this group.MethodsThis project was undertaken in northern Australia. We undertook group interviews with 65 participants and individual in-depth interviews with 11 youth aged 13–20 years led by trained youth ‘peer researchers.’ We also used visual methods (photo-elicitation) with individual interviewees to investigate the social context in which young people do or do not smoke. Included in the sample were a smaller number of non-Indigenous youth to explore any significant differences between ethnic groups in determinants of early smoking experiences. The theory of triadic influence, an ecological model of health behaviour, was used as an organising theory for analysis.ResultsFamily and peer influences play a central role in smoking uptake among Indigenous youth. Social influences to smoke are similar between Indigenous and non-Indigenous youth but are more pervasive (especially in the family domain) among Indigenous youth. While Indigenous youth report high levels of exposure to smoking role models and smoking socialisation practices among their family and social networks, this study provides some indication of a progressive denormalisation of smoking among some Indigenous youth.ConclusionsFuture initiatives aimed at preventing smoking uptake in this population need to focus on changing social normative beliefs around smoking, both at a population level and within young peoples’ immediate social environment. Such interventions could be effectively delivered in both the school and family environments. Specifically, health practitioners in contact with Indigenous families should be promoting smoke free homes and other anti-smoking socialisation behaviours.

Targets for primary prevention: Cultural, social and intrapersonal factors associated with co-occurring health-related behaviours

“…Another reason could be the underrepresentation of ultimate factors from the cultural stream in our study (also see below, the paragraph on limitations). Similar to our results, a large influence of factors from the social stream (family and peer networks) was found to be important in smoking initiation and progression among Australian young people (Johnston et al, 2012). Lippke et al focused mainly on the clustering of health-related behaviours, and therefore was less comparable.…”

“…Furthermore, for all three behaviour clusters, the distal factors only partly mediated the role of the ultimate factors, by showing approximately one-third of shared variance-accounted-for. Several previous studies also used the TTI (Donath et al, 2012;Johnston, Westphal, Earnshaw, & Thomas, 2012;Lippke et al, 2012). Many of our operationalisations of the ultimate and distal factors (see Supplementary material, Table 1) correspond roughly to those of Donath et al (2012).…”

“…Some of these factors have been included in previous studies (e.g. Donath et al, 2012;Johnston et al, 2012).…”

Family Role towards Smoking Behaviour among Children in Jakarta

“…Smoking behaviour is a learning process from higher level status in vertical level social context, from parents to a kid, whilst they unconsciously give an example to children on cigarette use during smoking. 6,13 However, Sirirassamee, et al 11 and Kim, et al 12 studies did not include the smoking status of father and mother separately. Since the prevalence of children with a father who smoked was high, children were more likely familiar with male smokers than female smokers.…”

In their own voices: Iranian adolescent girls' views about smoking

“…Some researchers thus consider tobacco use in girls a means of social identification. [28] Dependence and attachment to peer group's forms over time by receiving open (articulated) and hidden (heard or seen) messages from the group. [29] The important point is that peer socialization is dominantly imposed by an indirect peer pressure rather than the direct offering of a smoke from friends.…”