The Application of Reference Group Theory in Chinese Adolescent Smoking

Monday, 30 October 2017: 1:55 PM

Han-Yi Tsai, MS
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
Tzu-I Tsai Sr., PhD, RN
School of Nursing, National Yang Ming University, Taipei, Taiwan

Background: Since 2009 the enforcement of Tobacco Hazards Prevention Act in Taiwan, smoking prevalence rate has substantial declined in adults but not in adolescents. As adolescents are on the process of socialization, reference groups are key attributes for adolescent smoking.

Study purpose: We used the reference group theory to explore the main reference group and the type of influence impact adolescent smoking most.

Method: Modified Q methodology and cart sorting were adapted to this study design. 44 cards for reference groups and reference group influences were used according to the focus groups of students and school faculties.Total 297 participants were enrolled in this study. This research was conducted in north, middle, west, and east Taiwan cities. Classmates from four senior high schools, four vocational high schools and four evening high schools were selected as our study samples. Descriptive statistics and chi-square test and adjusted residual analysis were used for data analysis.

Results: The result showed that there was no difference between gender (p=0.083), but among school systems (p<0.001) and cities (p=0.027). Smoking status of parents (p=0.03), older siblings (p<0.01), best friends (p<0.01), colleagues (p=0.01) and art folk participants (p<0.001) positively and significantly influenced adolescent smoking status. As for card sorting, “Peer or friend” (59.7%) was the most important reference group forthe intention of current smokers. “Parent” (59.6%), especially “Father” (43.8%) was the main reference group for the non-smoking intention of previous and non-smokers. In addition, participating in traditional art folk was also a key factor for adolescents’smoking. Furthermore, normative social influence (69%) was referred more important than informational social influence whatever the smoking status was.

Conclusion: The results of this study suggest that smoking prevention for non-smokers and previous smokers can be aim at enforcing normative policy on parents. Smoking cessation for current smokers should address peers or friends influences. Also, traditional art folk can be also transferred into other performing types instead of making smoking sub-groups for teenagers. Taken together, our findings indicate that creating positive normative social influences will be an effective smoking intervention for adolescents.