5.6 Intentions, attitudes and beliefs

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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

5.6.1 Perceived benefits and disadvantages in smoking

Not surprisingly, having a positive attitude to smoking is associated with a greater likelihood of adopting smoking.4, 10, 44, 53 Believing that smoking will confer benefits, such as by enhancing popularity and social bonding, or improving mood, for example by reducing anxiety, alleviating boredom or relieving depression, increase the likelihood of taking up smoking.1, 4, 10 Conversely, believing that smoking offers negative social consequences (such as causing bad breath and smelling bad) and has immediate short-term effects on health and fitness is associated with a lower risk of smoking.1, 44, 54, 55 Young people who believe that most of their peers smoke, and that their peer group will approve if they start smoking is also significantly associated with uptake of smoking (see Section 5.7).10

A national survey of smoking and other drug use in English secondary school students aged 11–15 found that although most pupils were aware of the health effects of smoking, 65% of children thought that smoking helped people relax, and about 20% thought that smoking made you slimmer, gave you confidence, or was not dangerous. Children who had smoked in the previous week were far more likely to regard smoking positively, especially in the younger age groups.56

As with adults,57 research has shown that adolescents have misconceptions about the health implications of using 'light' (low emission) cigarettes. A study of teenagers in California showed that they thought that light cigarettes were less likely to cause diseases, were less addictive, and easier to quit smoking. The authors of this study comment that beliefs of this nature may encourage children to take up smoking and discourage them from quitting, in the misguided belief that light cigarettes offer a safer alternative to standard cigarettes[2].58

There is also some evidence that the belief that smoking will help with weight reduction is also an influence on uptake, especially among girls. This is discussed further in Section 5.8.1.1 below.

5.6.2 Future intention to be a smoker or a non-smoker

Assessing an individual's intention (whether adult or adolescent) to smoke in the future is a useful predictor of smoking behaviour.59, 60 Individuals who express the conviction that they are not going to take up smoking are much less susceptible to starting smoking than those who have not made any firm decision.10 Assessing susceptibility in this way may be a stronger predictor of future behaviour than other important factors such as proximity to smokers in the immediate social environment.10 Wakefield et al have shown that senior school students who expressed a firm intention not to be smoking in five years' time were less likely to be smoking at follow up, regardless of their level of involvement with smoking at the commencement of the study.59

The 2005 Australian Secondary Students' Alcohol and Drug Survey2 asked participants (students aged between 12–17) 'Do you think you will be smoking this time next year?' Students were invited to choose one of five statements which matched their intention. Seventy percent of all respondents stated that they were 'certain not to smoke;' 18% replied that they were 'very unlikely or unlikely to smoke,' 6% were 'undecided,' 4% thought that they were 'likely or very likely to smoke,' and 1% said that they were 'certain to smoke.' Younger students are more likely to state that they will not become smokers than older students: 84% of 12 year olds said they were certain not to smoke, but this dropped to 63% by age 17, suggesting that almost 40% of 17-year-old students could still be open to experimentation with tobacco.2

Findings for future intentions among current and daily smokers are summarised in Table 5.1. About one quarter of current smokers (defined as children who had smoked in the past week) reported that they would not be smoking, or were unlikely to be smoking, in a year's time. Another third of current smokers were undecided about their intentions to continue smoking, and 13% expressed the intention to keep smoking. In contrast, 11% daily smokers thought they would not be smoking, or were unlikely to be smoking, in a year's time and two-thirds of daily smokers thought it certain or likely that they would still be smoking in a year. Older daily smokers were more inclined to intend to quit, to say that they would be unlikely to smoke, or to be undecided about their smoking future than younger daily smokers. Combining the 'undecided' smokers with the 'very unlikely or unlikely' to be smoking in a year's time, almost one half of current smokers and one third of daily smokers may be considered susceptible to encouragement to quit.2 [3]

5.6.3 Perceived acceptability of smoking

Australian data show that although many teenagers aged 14–19 are aware that smoking is the leading cause of drug deaths, adult tobacco use still receives considerable personal approval.3

The National Drug Strategy Household Survey (2004)[4] asked respondents about their opinions and perceptions about drug use. Forty-two percent of teenage boys and girls aged between 14–19 recognised that tobacco is the leading cause of drug death in Australia. A similar proportion (46% of boys and 43% of girls) personally approved of its use in adulthood.3 Alcohol had a higher approval rating than tobacco (85% of boys and 76% of girls giving it personal approval). Of all age groups, teenagers were most likely to nominate tobacco as the form of drug use of most serious concern for the general community (26% of boys aged 14–19 and 29% of girls), whereas older age groups nominated alcohol. Illicit drugs (especially cannabis and heroin) and alcohol are substantially more likely to be associated with a 'drug problem' than tobacco by all age groups.3

Adults agree that tobacco is a topic of concern that should be discussed with children, but that it is not the most important health-related subject. A Perth-based survey in 2002 showed that although the vast majority of parents (93%) felt that smoking was important, it ranked lower than sun protection, exercise, good nutrition and illegal drugs in order of concern. Only 2% of parents surveyed felt that tobacco was the single most important health issue, compared with 34% who ranked illegal drugs as most important. Most parents (94% of non-smokers and 85% of smokers) strongly agreed with the statement that they did not want their children to take up smoking.61