5.3 Factors influencing uptake by young people—overview

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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

A range of sociodemographic, environmental, behavioural and personal indicators predict the likelihood of adopting or rejecting smoking, particularly in early adolescence. Detailed literature reviews have been published in the US Surgeon General's Reports of 1994,1 20009 and 2001,10 and in journal articles (for example Conrad,11 Sargent,4 Turner,7 and Moolchan12).

The factors discussed in the following sections are ordered according to the Theory of Triadic Influence, a model for integrating and understanding the interrelated influences on youth uptake of smoking developed by Flay.7, 13, 14 This model encompasses the 'big picture' of personal, social and environmental effects on behaviour, dividing them into three separate but interconnected streams:

1. Biology and personality (intrinsic factors), which includes individual demographic, physiological and psychological factors. These influences lead to self-efficacy, which may be broadly defined as individual's sense of self, social competence, and self-determination.


2. Social context (extrinsic factors), relating to the influence of family and friends through their behaviour and attitudes, resulting in the development of a perception of what is normative behaviour.


3. Broader environment, taking in cultural contexts, the information environment, and legislative and policy issues that affect pricing and availability of tobacco. The broader environment influences knowledge, expectancies, values and evaluations, leading to attitudes.

The combined effect of the personal, social and wider environment leads to an individual's intentions and ultimate decision about whether or not to smoke. Different factors may be expected to have a greater or lesser influence on behaviour at different stages in a person's life. A decision to smoke leads to trialling the behaviour, and the resulting experience is mediated by each of the three major streams of influence—the personal, the social setting and broader expectancies and attitudes.13 This is illustrated in Figure 5.1.15