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

Last updated:  October 2020  

Suggested citation: Wood, L., Greenhalgh, EM., Vittiglia, A & Hanley-Jones, S. 5.8 The smoking behaviour of peers, and peer attitudes and norms. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020. Available from: https://www.tobaccoinaustralia.org.au/chapter-5-uptake/5-8-the-smoking-behaviour-of-peers-and-peer-attitu

 

Smoking during adolescence is primarily a social activity,1 and research has consistently identified peer group influences as a significant factor in uptake of smoking.2-7 Peer influence is important in future smoking intentions among adolescent smokers and non-smokers,8, 9 as well as in the development of nicotine dependence in adolescent smokers.10 Peer groups may variously be defined as best friendships, romantic attachments, small social ‘networks’ and larger social ‘crowds’. 11 Each of these types of peer group may influence the decision to smoke or not.11

Individual and population level dynamics play an important role in the strength of peer influence.12 A meta-analysis of peer influence on adolescent smoking initiation and continued smoking suggests that smoking initiation is positively associated with peers’ smoking when there is high interpersonal closeness.12 The analysis also suggests that both smoking initiation and continuation was positively associated with peers’ smoking when adolescents were from peer groups that emphasised the needs and goals of the group over individual needs.

A review of peer group influences on adolescent smoking based on longitudinal studies explored the extent to which peer smoking predicts adolescent smoking.13 Almost all studies reported positive associations between peer smoking at baseline and adolescent smoking at follow-up. The review also highlighted the variation of peer influence on adolescent smoking by socio-demographic characteristics, including gender differences (said to be well established, with girls more strongly influenced by peer smoking than boys; see Section 5.8.1), and less clear effects of age group and ethnicity. Social bonds (e.g. with school and family) and individual characteristics such as genetics and personal attributes were also found to moderate peer smoking.13

Peer pressure is one aspect of peer socialisation, in which adolescents are influenced by their friends.13 Some commentators have argued that the importance of peer influence has been overestimated, and that the clustering of smoking behaviour within peer groups could be because adolescents seek out friendships with individuals who share similar interests, of which smoking may be just one signifier,14, 15, 16 (i.e. ‘selection’).13 In a review of peer influence and smoking behaviour,17 the author concluded that the effect of peer pressure as an influence on adolescent health behaviour is not proven, and is in practice very complex to decipher.17 It is important to understand that young people are not a homogeneous group, and that there are distinct peer clusters who smoke and do so for different reasons.17 It is probable that peer influences both interact with and are compounded by a host of other predictive factors:18 selection and socialisation processes can operate independently, but may also have reciprocal effects. Studies have found support for an important role of either and/or both processes, but their relative importance is strongly debated.13 Based on a review of 13 studies, researchers concluded that while both socialisation and selection processes contribute to peer group homogeneity in terms of smoking behaviour, evidence from studies using more advanced research designs suggested the influence of selection was somewhat greater.13

It is likely that the nature of peer influences on smoking changes over time and across social and cultural groupings.17 While some research suggests that peer influences may vary in importance at differing points along the adolescent continuum, with the influence of close friends’ smoking having most impact in earlier adolescence,1 there is evidence suggesting that parental and sibling smoking behaviour may be more important earlier.19 Research among New Zealand high school students found that the influence of smoking by parents and best friends varied with stage of adolescent tobacco smoking, progressively increasing with smoking frequency.20 There is also some evidence that peer influence on smoking behaviour or intentions may vary with adolescents’ previous smoking experience, whereby peer influence to smoke is stronger for adolescents with pre-existing smoking experience.9

Some features of adolescent social networks may have long-lasting associations with longer term smoking behaviour.21 A longitudinal analysis of US adolescents22 estimated that a 10% increase in the proportion of classmates who smoke will increase the likelihood of smoking by more than 3%, while an increase in smoking rates of 10% among an individual’s close friends will increase the likelihood of smoking by 5%. They concluded that peer effects are significant determinants of smoking, which persist into adulthood.22 Similarly, an analysis of European school data estimated that, on average across countries, a one percentage point increase in the proportion of smoking classmates is associated with an increase of 0.31% to 0.38% in the probability that a ‘typical’ adolescent smokes, a range that varied between countries.23

The common perception that ‘peer group pressure’ equates to open coercion is not necessarily the case: most of the evidence indicates that socialisation is mainly a normative process and not one of overt peer pressure.13 Initiating smoking may arise as a response to more subtle influences, such as being a means of facilitating acceptance and bonding, and avoiding exclusion from peer groups.7, 11 Qualitative research from Western Australia found that some adolescent experimenters and smokers saw trying a cigarette in the spirit of ‘joining in’ or ‘giving it a go’. However, the same research found that young people of Indigenous or lower socio-economic status background were much more likely to describe overt peer pressure or inducement to try smoking.24, 25

Socialising processes that facilitate smoking can also discourage use.13 For example, being ‘cool’ is important to teenagers,26 although what is deemed to be cool also changes across time, peer groups and social contexts. Smoking has traditionally been viewed as one of the badges of ‘coolness’ among teenagers.27 While ‘coolness’ is still identified by young people as one of the reasons why some of their peers smoke,28 research undertaken in Western Australia suggests that the inverse is increasingly true, with those who smoke often regarded as ‘losers’ or ‘trying too hard to be cool’.25 Refusing an offer of cigarettes or declaring that ‘I don’t smoke’ is increasingly socially acceptable and normative among many youth cohorts.25 Among groups with a negative prevailing attitude to smoking, peer influence may deter uptake of smoking.1, 11, 13

Smoking behaviour of the most popular students within the school context has also shown to have the ability to either influence or deter smoking uptake for other students. When those who smoke are among the most popular students within the school context, then uptake the following year can increase by up to 18%. Conversely, when those who smoke are among the least popular within the school context, uptake the following year is not statistically significant.29

British research has found that dating at an earlier age is a predictor for becoming a smoker later, independent of other possible confounding factors. The authors speculate that dating and smoking behaviours may be connected by a desire to appear to be more grown up,30 which is consistent with tobacco industry advertising linking its products with sex appeal and popularity.31 Research also suggests that young people who are lesbian, gay, bisexual, transgender or intersex (LGBTI) have a higher risk of taking up smoking.32, 33 The National Drug Strategy Household Survey for 2016 found daily tobacco smoking to be higher among people who identified as homosexual/bisexual than heterosexual.34

Qualitative research identified three main motivations for tobacco uptake among the LGBTI community—image building, socialisation and stress. Smoking was used as a tool for building an image of one’s self or to attain a certain persona. In the LGBTI smoking aids socialisation with some fearing loss of friends if they were to quit. Lastly, smoking was reported by the LGBTI community as a coping mechanism for stresses cause by the intersectionality of race, ethnicity and sexuality.35 As well as this, the LGBTI population has also been specifically targeted in  tobacco advertising.32

Social norms need only to be perceived to influence behaviour:13 young smokers tend to congregate together, and also to overestimate the extent of smoking in their own age group, giving them a distorted sense of what is normal behaviour.6, 13, 36

The English National Survey39 conducted in 2016 investigated pupils’ perceptions of smoking prevalence within their age group. While all respondents overestimated the prevalence of smoking in their peer groups, smokers were far more likely to do so. For example, 81% of regular smokers aged 15 thought that half or more of their age group were smokers, whereas in reality 6% of boys and 7% of girls aged 15 years smoked regularly at that time.39  

5.8.1 Influence of gender

A large number of studies have examined whether boys and girls are similarly affected by the various factors that influence smoking behaviour. In a major review of the literature, the US Surgeon General’s report for 2001 (Women and Smoking) concluded that ‘Most risk factors for smoking initiation appear to be similar among girls and boys’ (p477.36) However, the review did find that girls may be more likely to be influenced by positive images of smoking, perceptions about smoking and weight control, and improvement of mood. There was also some evidence that girls are more likely to smoke than boys out of rebelliousness, rejection of conventional values, lack of religious conviction, poor self-esteem and emotional distress. Dutch research found gender differences in the association between pre-adolescent smoking initiation and emotional or behavioural problems, with relationships between smoking and problem behaviour (attention problems, thought problems and delinquent behaviour) observed in girls, but not in boys.40

Other research has proposed that boys are more likely to smoke as a result of ‘psychosocial’ factors (such as risk taking, rebelliousness, self-esteem and coping ability), whereas girls tended more to be influenced by ‘environmental’ factors such as parental smoking habits, peer group attitudes and behaviours.41 A social network analysis of adolescent smoking in Finland, however, found that both adolescent boy and girl  smokers were influenced by parental smoking behaviour and tended to select other smokers as friends, while only adolescent girls were influenced to smoke by their peer group.42 The strength of the relative influence of psychosocial and environmental factors is likely to change during teenage years.41 It has been found that psychosocial factors are more closely associated with smoking in young teenage girls than in older girls, who are more influenced by attitude variables (including beliefs about smoking), while younger boys are less susceptible to the influences of both psychosocial factors and environmental variables than older boys.

Australian studies have reported that uptake of smoking in adolescent girls is strongly related to a desire to adopt and reinforce their reputation among a specific peer group,43 and that strength of self-concept in girls (defined as how an individual perceives her physical presentation and appearance to others) is more closely connected with increased likelihood of smoking than in boys.44 Environmental pressures on adolescent girls to be self-confident, socially aggressive and sexually precocious may lead to cigarette smoking, in an effort to boost physical self-concept.44

5.8.1.1 Do concerns about body weight influence the uptake of smoking?

The misperception that smoking depresses appetite, hence assisting with weight control, has long been considered a possible enticement for smoking, especially among females. Over many decades the tobacco industry has overtly targeted the female market with brands and imagery connecting cigarettes with a slim and shapely female form.36, 45, 46

Many studies have investigated the relationship between adolescent smoking and body weight. A review,47 analysing 55 studies published between 1980 and 2003, concluded there was some evidence that:

  • young smokers were more likely to perceive they were overweight
  • some adolescents smoked because they thought it would help with weight control
  • adolescent smokers were more likely to have engaged in dieting, the evidence being strongest for girls.

Research from Western Australia25 has shown that young people (both smokers and non-smokers) cite ‘to be thin’ as a reason for smoking. Recent evidence links smoking among young females with body shape concerns and eating disorder symptoms,48, 49 including extreme dieting (e.g. fasting or use of laxatives or diet pills).50

There are several US studies linking increased smoking over time with weight issues among young females. For example, research found increases in smoking prevalence during high school among young females to be associated with self-perceptions of overweight,51 in another study smoking patterns were predicted by the severity of one’s weight concerns, perceived weight status, and BMI percentiles among young females,52 while a twins study found both underweight and overweight/obesity to be positively associated with the transition from experimentation to regular smoking among females aged 18–29 years.53

Analyses of data from a large longitudinal US adolescent survey suggest that for females aged 11–23 years, being overweight—based on measured body mass index (BMI) in 1996—was associated with frequent/heavy smoking five years later.54

Other research links body weight, dietary behaviours and smoking among young males and females. For example, a Canadian study found that girls who perceived themselves to be overweight and boys with higher self-reported BMI at two time points during high school were more likely to be smokers as young adults.55

Extreme dieting has been linked with current smoking regardless of gender and weight status.50 The association between smoking and weight control may be becoming more pervasive over time: while some of the extreme dieting behaviours were not associated with smoking in the years 1999–2003, all of the extreme behaviours were associated with smoking from 2005, regardless of gender and weight.50 While the magnitude of the association between smoking and extreme dieting became smaller among adolescents in later survey years, it remained unchanged among non-overweight girls over that same time period. The authors speculate that this might reflect the stubborn nature of smoking behaviour in this group and therefore that it would be more difficult to implement smoking cessation intervention for female extreme dieters than for other groups.50 Research examining the association between restrained eating and smoking among young female smokers, found those who attempted to control what they ate—after a being exposed to temptation—were quicker to smoke in order to prevent more food consumption than non-restrainers.56 This held true even when alternative distractors, such as a computer tablet, were available.57

In a 2009 Dutch study, depressive symptoms were related to smoking among adolescent boys and girls similarly, but the effect for depression became non-significant for girls when controlling for the effect of weight concerns and dieting. Researchers therefore proposed that smoking prevention programs for girls with depression might be enhanced by challenging the idea of smoking as a diet strategy and incorporating a focus on healthy weight regulation.58

The relationship between smoking uptake and mental health problems such as depressive symptoms is explored further in Section 5.5.2.

 

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated May 2021)

 

References

1. Turner L, Mermelstein R, and Flay B. Individual and contextual influences on adolescent smoking. Annals of the New York Academy of Sciences, 2004; 1021:175–97. Available from: https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1196/annals.1308.023

2. Conrad K, Flay B, and Hill D. Why children start smoking cigarettes: Predictors of onset. British Journal of Addiction, 1992; 87(12):1711–24. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1992.tb02684.x

3. US Department of Health and Human Services. Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2012/.

4. US Department of Health and Human Services. Reducing tobacco use: A report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. Available from: https://www.cdc.gov/tobacco/data_statistics/sgr/2000/index.htm.

5. Wang M, Fitzhugh E, Westerfield R, and Eddy J. Family and peer influences on smoking behaviour among American adolescents: An age trend. Journal of Adolescent Health, 1995; 16:200–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7779829

6. Tyas S and Pederson L. Psychosocial factors related to adolescent smoking: A critical review of the literature. Tobacco Control, 1999; 7(4):409–20. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/7/4/409

7. Walsh R and Tzelepis F. Adolescents and tobacco use: Systematic review of qualitative research methodologies and partial synthesis of findings. Substance Use and Misuse, 2007; 42(8):1269–321. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/10826080701204904

8. Ling PM and Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: Evidence from industry documents. American Journal of Public Health, 2002; 92(6):908–16. Available from: http://www.ajph.org/cgi/content/full/92/6/908

9. Vitória P, Salgueiro M, Silva S, and De Vries H. The impact of social influence on adolescent intention to smoke: Combining types and referents of influence. British Journal of Health Psychology, 2009; 14(Pt 4):681–99. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19288976

10. de Leeuw R, Engels R, Vermulst A, and Scholte R. Relative risks of exposure to different smoking models on the development of nicotine dependence during adolescence: A five-wave longitudinal study. Journal of Adolescent Health, 2009; 45(2):171–8. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19628144

11. Kobus K. Peers and adolescent smoking. Addiction, 2003; 98(suppl.1):i37–55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12752361

12. Liu J, Zhao S, Chen X, Falk E, and Albarracin D. The influence of peer behavior as a function of social and cultural closeness: A meta-analysis of normative influence on adolescent smoking initiation and continuation. Psychological Bulletin, 2017. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28771020

13. Simons-Morton B and Farhat T. Recent findings on peer group influences on adolescent smoking. Journal of Primary Prevention, 2010; 31(4):191–208. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20614184

14. Urberg K, Degirmencioglu M, and Pilgrim C. Close friend and group influence on adolescent cigarette smoking and alcohol use. Developmental Psychology, 1997; 33:834–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9300216

15. de Vries H, Candel M, Engels R, and Mercken L. Challenges to the peer influence paradigm: Results for 12-13 year olds from six European countries from the European smoking prevention framework approach study. Tobacco Control, 2006; 15(2):83–9. Available from: http://tc.bmjjournals.com/cgi/content/abstract/15/2/83

16. Mercken L, Candel M, van Osch L, and de Vries H. No smoke without fire: The impact of future friends on adolescent smoking behaviour. British Journal of Health Psychology, 2011; 16(1):170–88. Available from: http://www.ingentaconnect.com/content/bpsoc/bjhp/pre-prints/bjhp924

17. Michell L. Loud, sad or bad: Young people's perceptions of peer groups and smoking. Health Education Research, 1997; 12:1–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10166897

18. Holliday J, Rothwell H, and Moore L. The relative importance of different measures of peer smoking on adolescent smoking behavior: Cross-sectional and longitudinal analyses of a large British cohort. Journal of Adolescent Health, 2010; 47(1):58–66. Available from: http://www.jahonline.org/article/PIIS1054139X09007046/fulltext

19. Mercken L, Candel M, Willems P, and de Vries H. Social influence and selection effects in the context of smoking behavior: Changes during early and mid adolescence. Health Psychology, 2009; 28(1):73–82. Available from: http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=2009-00026-014

20. Scragg R, Glover M, Paynter J, Wong G, and McCool J. Association of parent and best friend smoking with stage of adolescent tobacco smoking. The New Zealand Medical Journal, 2010; 123(1326). Available from: http://www.nzma.org.nz/journal/123-1326/4440/

21. Pollard MS, Tucker JS, Green HD, Kennedy D, and Go M-H. Friendship networks and trajectories of adolescent tobacco use. Addictive Behaviors, 2010; 35(7):678–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20332061

22. Ali M and Dwyer D. Estimating peer effects in adolescent smoking behavior: A longitudinal analysis. Journal of Adolescent Health, 2009; 45(4):402–8. Available from: http://www.jahonline.org/article/PIIS1054139X09001001/fulltext

23. McVicar D. Estimates of peer effects in adolescent smoking across twenty six European countries. Social Science and Medicine, 2011; 73(8):1186–93. Available from: http://www.sciencedirect.com/science/article/pii/S027795361100493X

24. Leavy J, Wood L, Rosenberg M, and Phillips F. Try and try again: Qualitative insights into adolescent smoking experimentation and notions of addiction. Health Promotion Journal of Australia, 2010; 21(3):208–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21118068

25. Wood L, Lang A, and Coase P. Smarter than smoking qualitative research. A research report. West Perth, Australia: TNS Social Research, 2005.

26. Watson N, Clarkson J, Donovan R, and Giles-Corti B. Filthy or fashionable? Young people’s perceptions of smoking in the media. Health Education Research, 2003; 18:554–67. Available from: http://her.oxfordjournals.org/content/18/5/554.full.pdf+html

27. Danesi M, Cool: Signs and meanings of adolescence.  Toronto: University of Toronto Press; 1994.

28. Eureka Strategic Research, Youth tobacco prevention research project. Undertaken for the Australian government department of health and ageing.  Canberra: Department of Health and Ageing; 2005. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-tobacco-literature-cnt.htm.

29. Robalino JD and Macy M. Peer effects on adolescent smoking: Are popular teens more influential? PLoS ONE, 2018; 13(7):e0189360. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30001357

30. Fidler J, West R, Jarvis M, and Wardle J. Early dating predicts smoking during adolescence: A prospective study. Addiction, 2006; 101:1805–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17156180

31. DiFranza J and Wellman R. Early dating and smoking initiation: Some thoughts about a common cause [editorial]. Addiction, 2006; 101:1682–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17156163

32. Tang H, Greenwood G, Cowling D, Lloyd J, Roeseler A, et al. Cigarette smoking among lesbians, gays, and bisexuals: How serious a problem? (United States). Cancer Causes and Control, 2004; 15:797–803. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15456993

33. Easton A, Jackson K, Mowery P, Corneau D, and Sell R. Adolescent same-sex and both-sex romantic attractions and relationships: Implications for smoking. American Journal of Public Health, 2008; 98:462–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18235075

34. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2016: Detailed findings. Drug Statistics series no. 31., AIHW Cat. no. PHE 214.Canberra: AIHW, 2017. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents.

35. Jannat-Khah DP, Dill LJ, Reynolds SA, and Joseph MA. Stress, socializing, and other motivations for smoking among the lesbian, gay, bisexual, transgender, and queer community in New York City. American Journal of Health Promotion, 2017:890117117694449. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28318307

36. US Department of Health and Human Services. Women and smoking: A report of the US Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44303/.

37. Australian Institute of Health and Welfare. 2004 National Drug Strategy Household Survey: Detailed findings. Drug statistics series no.16, AIHW cat. no. PHE 66.Canberra: AIHW, 2005. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/2004-ndshs-detailed-findings 

38. Sargent J and DiFranza J. Tobacco control for clinicians who treat adolescents. CA A Cancer Journal for Clinicians, 2003; 53(2):102–23. Available from: https://onlinelibrary.wiley.com/doi/full/10.3322/canjclin.53.2.102

39. Niblett P. Smoking, drinking and drug use among young people in England - 2016. NHS Digital, England 2017. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2016.

40. de Meer G, Crone M, and Reijneveld S. Gender differences in the association between pre-adolescent smoking initiation and emotional or behavioural problems. BMC Public Health, 2010; 10(1):615. Available from: http://www.biomedcentral.com/1471-2458/10/615

41. Koval J, Pederson L, and Chan S. Psychosocial variables in a cohort of students in grades 8 and 11: A comparison of current and never smokers. Preventive Medicine, 2004; 39:1017–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15475037

42. Mercken L, Snijders T, Steglich C, Vertiainen E, and de Vries H. Smoking-based selection and influence in gender-segregated friendship networks: A social network analysis of adolescent smoking. Addiction, 2010; 105(7):1280–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20456296

43. Snow P and Bruce D. Cigarette smoking in teenage girls: Exploring the role of peer reputations, self-concept and coping. Health Education Research, 2003; 18:439–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12939126

44. Thornton W, Douglas G, and Houghton S. Transition through stages of smoking: The effect of gender and self-concept on adolescent smoking behavior. Journal of Adolescent Health, 1999; 25:284–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10505846

45. Ernster V. Mixed messages for women. A social history of cigarette smoking and advertising. NY State Journal of Medicine, 1985; 85:335–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3900827

46. Amos A and Haglund M. From social taboo to 'torch of freedom': The marketing of cigarettes to women. Tobacco Control, 2000; 9:3–8. Available from: http://tobaccocontrol.bmj.com/content/9/1/3.full?sid=14378807-5d29-45f6-927c-40b199822b0b

47. Potter B, Pederson L, Chan S, Aubut J-A, and Koval J. Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender. Nicotine and Tobacco Research, 2004; 6:397–425. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15203775

48. Groth S and Morrison-Beedy D. Smoking, substance use, and mental health correlates in urban adolescent girls. Journal of Community Health, 2010; 36(4):552–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21107998

49. Kendzor D, Adams C, Stewart D, Baillie L, and Copeland A. Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females. Eating Behaviors, 2009; 10(1):56–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19171320

50. Seo DC and Jiang N. Associations between smoking and extreme dieting among adolescents. Journal of Youth and Adolescence, 2009; 38(10):1364–73. Available from: https://link.springer.com/article/10.1007/s10964-009-9421-0 

51. Hong T, Rice J, and Johnson C. Social environmental and individual factors associated with smoking among a panel of adolescent girls. Women and Health, 2011; 51(3):187–203. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21547857

52. Lange K, Thamotharan S, Racine M, Hirko C, and Fields S. The relationship between weight and smoking in a national sample of adolescents: Role of gender. J Health Psychol, 2014. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24423576

53. Duncan A, Lessov-Schlaggar C, Nelson E, Pergadia M, Madden P, et al. Body mass index and regular smoking in young adult women. Addictive Behaviors, 2010; 35(11):983–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20634004

54. Rees D and Sabia J. Body weight and smoking initiation: Evidence from add health. Journal of Health Economics, 2010; 29(5):774–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20708283

55. Koval J, Pederson L, Zhang X, Mowery P, and McKenna M. Can young adult smoking status be predicted from concern about body weight and self-reported bmi among adolescents? Results from a ten-year cohort study. Nicotine and Tobacco Research, 2008 10(9):1449–55. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/14622200802239140

56. Kovacs MA, Correa JB, and Brandon TH. Smoking as alternative to eating among restrained eaters: Effect of food prime on young adult female smokers. Health Psychology, 2014; 33(10):1174–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25243718

57. Kovacs MA, Palmer AM, Correa JB, and Brandon TH. Smoking by young women with restrained eating following a food prime in the context of an alternative distractor. Experimental and Clinical Psychopharmacology, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29431452

58. Larsen J, Otten R, and Engels R. Adolescent depressive symptoms and smoking behavior: The gender-specific role of weight concern and dieting. Journal of Psychosomatic Research, 2009; 66(4):305–8. Available from: https://www.sciencedirect.com/science/article/pii/S0022399908004868