5.2 Stages in the uptake of smoking

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5.1 Introduction

5.2 Stages in the uptake of smoking

5.3 Factors influencing uptake by young people—overview

5.4 Physiological aspects

5.5 Individual personality traits and psychiatric influences

5.6 Intentions, attitudes and beliefs

5.7 The home environment

5.8 The smoking behaviour of peers, and peer attitudes and norms

5.9 The educational environment: achievements, aspirations and 'school connectedness'

5.10 Other drug use

5.11 Accessibility of tobacco products to young smokers

5.12 Affordability of tobacco products

5.13 Opportunity to smoke

5.14 Cultural background

5.15 Tobacco advertising and promotion targeted at young people

5.16 Products and packaging created to appeal to new users

5.17 Factors influencing uptake of smoking later in life

5.18 Uptake—a concluding note

5.19 What is meant by prevention?

5.20 Approaches to youth smoking prevention

5.21 Mass media strategies/campaigns

5.22 Interactive technology and multimedia

5.23 School-based interventions

5.24 Peer influence and education

5.25 Parent/family/home targeted interventions

5.26 Reducing tobacco access and supply

5.27 Reducing product appeal

5.28 Promotion and visibility of tobacco

5.29 Denormalising smoking

5.30 Taxation and pricing of tobacco products

5.31 Harnessing predictors of uptake to prevent smoking

5.32 Preventing smoking in more 'at risk' groups

Acknowledgments

References

The process of taking up smoking may be conceptualised as a progression through a number of stages in a continuum, during which external influences and individual characteristics interact. These stages may be broadly summarised as:1, 6

Precontemplation—the individual has no desire to start smoking in the near future. These adolescents do not view smoking positively, and are oblivious to, disregard, or resist pressure to smoke. Never-smokers do not proceed beyond this stage.6

Contemplation and preparation—development of positive beliefs and attitudes about cigarettes, shaped by influences such as family, peer group and the media.

Initiation—trying the first few cigarettes, usually with friends providing the greatest influence on behaviour. Factors such as boosting self-image and wishing for peer group approval are associated with this stage.

Experimentation—marked by a gradual increase in frequency of smoking and the contexts in which it occurs. Smoking is still viewed positively, even if its initial physiological effects feel unpleasant. Uncommitted smokers at this stage tend to give up, but others will persist, become adept at smoking, and develop a self-image as a smoker. Being part of a family where others smoke assists with ongoing access to cigarettes.

Regular smoking—the behaviour is no longer sporadic. Teenagers may smoke on the weekends, at parties, or on the way between home and school. Most smokers are not, at this stage, smoking daily, or consuming many cigarettes. Not all smokers who have reached this stage will proceed to the next stage.

Established/daily smoking—at this stage the smoker is addicted, and tobacco use is perceived to fulfil a range of psychological and physiological functions.

The process of smoking acquisition usually occurs during adolescence, for some rapidly escalating into dependence, while for others becoming established more gradually.7 In any individual, transit through the pathway outlined above may halt, reverse, or recommence, depending on a range of influences,8 including biological factors.6

Not all individuals who try smoking become committed smokers and identifying the causes of different behavioural trajectories is an important theme for further research.7