Friday, September 27, 2002

This presentation is part of : Research in Smoking Influences and Cessation

“Needing to Smoke”: Constructing a Typology of Youth Tobacco Dependence

Joan L. Bottorff, RN, PhD, professor1, Joy L. Johnson, PhD, associate professor1, Barbara Moffat, MSN, project coordinator1, Pamela A. Ratner, PhD, associate professor1, Jean A. Shoveller, PhD, assistant professor2, and Chris Y. Lovato, PhD, associate professor2. (1) School of Nursing, The University of British Columbia, Vancouver, BC, Canada, (2) Health Care and Epidemiology, The University of British Columbia, Vancouver, BC, Canada

OBJECTIVES: Although youths that smoke demonstrate some of the characteristics of dependence observed in adults, it remains unclear how dependence develops, manifests, and is accurately measured in youth. If measures of tobacco dependence are to be developed that are relevant to youth they must be based on the lives and experiences of youth and be reflective of the language they use and the way they understand the world. The purpose of this study was to describe the patterns of language that youth use to describe tobacco dependence and the meaning that tobacco dependence holds for youth.

DESIGN: A descriptive study using ethnoscience techniques was conduced to explore youths’ perspectives regarding tobacco dependence and to elicit implicit and explicit culturally patterned beliefs. This method allows researchers to explore informants’ ideas and beliefs to discover the meanings of social behavior that are often taken for granted and only indirectly expressed through language and action.

METHODS: This study consisted of three phases. In the first phase, key words and phrases used to explain tobacco dependence were identified in a secondary analysis of 47 unstructured interviews with adolescents on the topic of smoking to provide a basis for primary data collection in second and third phases of the study. Both boys and girls, ranging in age from 13-19 years, were recruited for the next phases of the study. All had experimented with tobacco: some were regular smokers and others were ex-smokers. In the second phase, 13 interviews were conducted with teens focusing specifically on tobacco dependence. Open-ended questions were followed by prepared contrast and structural questions to explore similarities and differences among the ways that adolescents talked about dependence. In the final phase, we conducted 14 interviews with adolescents that involved open card sorts, using a set of 60 key phases derived from interview data. Card sorts were compared and contrasted and transcribed data was coded to facilitate retrieval and detailed analysis of the data.

FINDINGS: Although adolescents did not spontaneously use the term “dependence” in their discussions of needing cigarettes, the manner in which they spoke about being “controlled by cigarettes,” “needing to smoke” and “being addicted” to cigarettes revealed that their experiences and understanding of dependence extended well beyond the need for nicotine. From adolescents’ descriptions about the need to smoke five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional and full-fledged. The adolescents suggested that the first four aspects were “weaker” forms of dependence in which one “starts to get addicted.” Although these aspects were perceived to be less serious, some youths recognized that the need to smoke in particular situations was powerful regardless of how infrequent or irregular. The fifth aspect, full-fledged dependence, was recognized as the most serious form of dependence in which smoking is incorporated into everyday life. Each of the aspects of dependence is supported by detailed descriptions and direct quotations from the youth to illustrate their thinking.

CONCLUSIONS: Youths’ understanding and experiences of tobacco dependence extend beyond nicotine addiction. Furthermore, the findings suggest that youths’ experiences of tobacco dependence may be qualitatively different from that of adults. The five aspects of dependence identified in this study provide an important step in defining the construct of youth tobacco dependence. Some forms of tobacco dependence may exist among youth smokers who could be classified as “light” or “irregular” smokers.

IMPLICATIONS: The typology described in this study provides direction for the development of a measure of tobacco dependence that is sensitive to “emerging” or early tobacco dependence. A full understanding of emerging dependence may assist health professionals including nurses help youths who believe they are experimenting with cigarettes to begin to recognize early signs of dependence.

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