Social and Behavioral Sciences for Tobacco Use Bonnie L. Halpern-Felsher, Ph.D., FSAHM Professor Division of Adolescent Medicine Department of Pediatrics
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Racial/Ethnic and Age Differences in Smoking Rates White and Hispanic adolescents smoke at greater rates than Asian and African- American adolescents. African-American young adults are more likely to begin smoking than other ethnic groups.
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Adolescents report both positive and negative consequences of experimentation with cigarette use Percent Reporting 60 56 56 46 45 30 31 27 26 29 23 35 17 15 0 (Brady, Song, & Halpern-Felsher, 2008, Preventive Medicine)
Peer Pressure 45% of ever smokers and less than 5% of never smokers promoted smoking among friends. Positive consequences of smoking predicted attempts to promote smoking (OR=4.37, p<.05) 70% of ever smokers and 40% of never smokers deterred smoking. Negative consequences of smoking predicted attempts to deter smoking (OR=2.60, p<.08). Journal of Adolescent Health, 2013
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Exposure to Marketing and Pro- Tobacco Messages Exposure to cigarette use in movies and other media linked to tobacco use initiation Exposure to marketing influences perceptions IOM, 2007
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Acceptability and Norms Social norms: Extent to which you think (similar) others are using tobacco Extent to which you think (similar) others are accepting of tobacco use Perceptions of social norms is a critical component of perceptions and behavior
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Personal Influences on Perceptions Compared to non-smokers, smokers Estimated their chance of experiencing a negative outcome as less likely Reported their chance of addiction as less likely Perceived their chance of experiencing a benefit as more likely Perceptions of lower risk and greater benefit promote smoking initiation among adolescents Health Psychology, 2010
Perceptions Predict Smoking Initiation Lowest perceptions of short-term risk: 2.7 times more likely to start smoking Lowest perceptions of long-term risk: 3.6 times more likely to start smoking Highest perceptions of benefits: 3.3 times more likely to start smoking American Journal of Public Health, 2009
Perceptions of Addiction Adolescents don t understand addiction Don t understand the definition and causes of addiction Think they can smoke for a short period of time and easily quit Health Psychology, 2010
Peer Smoking Having 6 or more friends who smoke predicted lower perceptions of short-term risk, but not long-term risk Adolescents may not observe their friends experiencing negative short-term consequences of smoking Health Psychology, 2010
Parental Smoking Parental smoking did not predict perceptions of risks or benefits Perhaps parental smoking does not affect teen smoking via perceptions of risks and benefits Health Psychology, 2010
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Tobacco Decision-Making Theoretical Framework Demographic Variables Age Gender Race/Ethnicity SES Perceived Acceptability Social norms Perceived prevalence of tobacco use Perceived acceptability of tobacco use Perceived peer pressure Marketing/Anti- Tobacco Messaging Exposure Pro-tobacco (e.g. POS, movies, internet) Anti-tobacco (e.g., warning labels) Intentions Behavior Past Tobacco Experiences Use of tobacco products Positive and negative experiences from tobacco product use Peer and Parent use Tobacco-Related Perceptions Disease risk Death risk Addiction Benefits
Demographic Differences in Decision-Making Age/developmental differences/similarities Racial/ethnic differences/similarities SES differences/similarities