Smokin Relationship

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I kissed my first girl and smoked my first
cigarette on the same day. I havent had time
for tobacco since.
-- Arturo Toscanini
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Smokin Relationship

• Gabriel Garcia
• gabrieljmgarcia_at_yahoo.com
• February 13, 2004

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Did you know
when people started smoking?
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A little history on smoking
Circa first century B.C. the oldest existing
illustration of a smoker is a Mayan god
Proctor, Nature Rev, 2001
Circa 800-1000 A.D. Maya priest smoking
Gately, Tobacco, 2001
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A little history on smoking
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Smoking Around the World
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Why do people smoke?
What motivates people to smoke?What motivates
people not to smoke?
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Smoking is not like
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The physiologic reactions felt when one first try
smoking
DIZZY
COUGH
SICK
Friedman et al., Addict Behav, 1985 Nichter et
al., Tob Control, 1997
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However...

• A third of the male adult global population
  smokes
• 80,000-100,000 children worldwide start smoking
  everyday
• 10 million cigarettes are sold every minute

World Health Organization, Smoking Statistics,
Available online, accessed July 2005
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Smoking as a ritual among Native Americans

• Communicate to the spirit
• Promote peace, bind agreements
• Puberty rite
• Medicinal purposes

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Are we any different from the indigenous peoples?
Ones smoking behavior is related to culture and
relationships.
Nichter, Addiction, 2003
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Authoritative style of parenting among African
Americans protect their children from smoking.
Clarak et al., J Adol Hlth, 1999
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Smooth interpersonal relationship, pakikisama,
valued by many Filipinos encourages smoking
uptake among non-smoking individuals in order to
please their smoking peers.
Nichter, Addiction, 2003
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Queen Latifah Story
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Despite the importance of relationship, current
research on cigarette use have not elaborated
much on this.
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If we are to develop a more effective smoking
prevention campaign, it is necessary to take a
much closer look at peer relationship dynamics
and the influences therein.
Kobus, Addiction, 2003
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Purpose

• To investigate these relationship dynamics and
  how they impact smoking behavior, both at the
  level of initiation and cessation.

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Thesis

• Peoples motive to smoke and not to smoke is
  primarily to create or sustain important
  relationships.

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What are these relationships?
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Theoretical Framework

• Fiskes Relational Models Theory
• Authority Ranking
• Communal Sharing
• Equality Matching
• Market Pricing

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Authority Ranking
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Communal Sharing
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Equality Matching
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Market Pricing
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Methodology Analysis

• Reviewed mostly qualitative research studies on
  smoking.
• Why qualitative?
• They provide a richer data, allowing for a more
  meaningful interpretation and analysis.

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What motivates a person to smoke?
What motivates a person not to smoke?
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Authority Ranking Relationship Motivation to
smoke
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Smoking is cool for women

• Nichter et al., Tob Con, 1997
• Ethnographic study among adolescent girls in
  Arizona
• When youre doing it, I guess, I admit I used to
  feel just cool holding a cigarette, sitting there
  you feel cool.
• Lennon et al., Qual Hlt Rsrch, 2005
• Interviewed women 16-28 y.o. in Australia
• When I hit high school and saw people were
  smoking and it was generally I thought was cool
  people doing it, I thought, to be with them
  thats what I have got to do

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Smoking is cool for men

• Plumridge et al.,Hlth Edu Rsrch, 2002
• Focus group of 13-14 y.o. students in New
  Zealand
• Well if you want to be cool basically you just,
  you just smoke.
• The other day there was this guy computer nerd
  type and he suddenly changed started to do all
  the cool things low-ride, do your hair and then
  he suddenly started smoking its amazing how
  people change.

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Smoking is power, being grown-up, being a man,
being a woman

• Rugkasa et al., Hlth Edu Rsrch, 2001
• Interview pre-adolescents in Northern Ireland
• Just try to be big man, to try to look big. They
  want to boss people around and all that, said a
  male respondent.
• I thought that if I started to smoke Id be all
  big and that I could make myself older if I
  smoked, said a female respondent.
• Mishra et al., Hlth Edu Beh, 2005
• Interview young adolescents in India
• We see elders in the family and neighborhood
  doing it Its like a rite of passage, said an
  8th grade student.

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Authority Ranking Relationship Motivation not
to smoke
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Smoking is un-cool

• Plano-Clark et al., Qual Hlth Rsrch, 2002
• Interview of high school students in Nebraska
• At CHS, smoking is portrayed as a way to
  stratify students and many nonsmoking students
  lack tolerance for student smokers. For example
  one student comments, I have a rule that I will
  never date anybody who smokes Some CHS
  non-smokers not only describe their dislike for
  smoking but also have derogatory terms for
  smokers, such as individuals who are pathetic,
  dumb, and stupid.

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Smoking is powerless

• Clark et al., J Adol Hlth, 1999
• Interview of Caucasian and African-American
  parents
• He knows what would happen if I caught him
  smokingHe would be grounded for life, said an
  African-American parent.

• Mullen, Drug Alc Dep, 1987
• Interview of middle-age men from U.K.
• If you are a smoker you are a minority. It is
  very unusual for people to smoke now I find
  amongst my circle, I dont know many people that
  smoke. So it has become an anti-social habit.
  There is a lot of times I dont smoke because I
  would be the only one smoking and nowadays to
  smoke is a sign of weakness, a sign of
  ill-health.

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Communal Sharing RelationshipMotivation to smoke
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Smoking is sharing bonding

• Pavis Cunningham-Burley,Hlth Edu Rsrch, 1999
• Ethnographic study of male youth street culture
  in Scotland
• Cigarettes were nearly always shared. Within
  the core participant group when one person lit a
  cigarette it was very common for the others to
  shout seconds and thirds in order to claim
  draws or drags Smoking had become something
  that the young men shared, and this way of
  stacking up draws or drags involved reciprocal
  relationships that strengthened their social
  bonds and bound them together.

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Smoking is sharing bonding

• Tu et al., As Am Pac Isl J Hlth, 2000
• Interview of Chinese-American men in Seattle
• In China, the first thing at the first meeting
  between travelers and political officers, between
  subordinates and their superiors, or between
  friends is to offer a cigarette to the other
  party. It seems that the most important thing is
  to offer a cigarette to the other party
  Cigarette plays a role of courtesy or politeness
  between people or, you know, at different social
  activities. If you take out cigarette out of
  your pocket and you smoke by yourself, it seems
  that you look down on other people.

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Communal Sharing RelationshipMotivation not to
smoke
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Smoking is dis-bonding

• Kreuter et al., Community Health Promotion Ideas
  that Work, 1998
• Anti-Smoking Intervention in China Children
  wrote letters to their parents who smoke
• After 210 days, 11 of 7,000 fathers surveyed
  quit smoking.

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Childs Letter
Dear Father, This letter comes from the
bottom of my heart. I have been learning
about the harm of smoking in school and my heart
is heavy. Science shows us that smoking can
cause lung cancer and heart disease and cause
death before people get old. Also, the smoke
from others can harm those who do not smoke.
It worries me to see you smoke. As I grow
up, I will need your love and wisdom to help me.
Tomorrow is World No-Tobacco Day wont you
please consider giving up smoking? The day
after tomorrow is Childrens Day. The best
present I can get is not a toy but a promise that
you will try to stop smoking. I love you,
Father.
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Market Pricing RelationshipMotivation to smoke
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Smoking is money

• Wiltshire et al., J Adoles, 2005
• Interview of 16-19 y.o. Scottish college
  students
• I was just really starting to smoke when I left
  school. When I started working I just smoked
  more, I started getting money so I was buying
  them. So they werent hard to get then.
• Alechnowicz Chapman, Tob Con, 2004
• Gave evidence that tobacco companies provide
  donations to government officials in the
  Philippines in exchange for favorable economic
  policies.

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Market Pricing RelationshipMotivation not to
smoke
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Tax smoking, decrease smoking

• Highland et al., Am J Pub Hlth, 2005
• Those with access to lower taxed cigarettes are
  50 less likely to quit smoking as compared to
  those without access to lower taxed cigarettes.

• Segiure et al., Hlth Prom Intl, 2000
• Interview of adolescent girls in Canada.
• Respondent who are smokers expressed that they
  regretted smoking because of the financial burden
  it brings them.

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Equality Matching RelationshipMotivation to
smoke
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You smoke, I smoke

• Wiltshire et al., J Adol, 2005
• Interview of mid to late adolescents in U.K.
• When we all go out, all my mateshave
  cigarettes and light up, and when they light up,
  I get a wee bit of a temptation to light up.
  Cigarettes are handed out in a group and I just
  take one and smoke it.

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Equality Matching RelationshipMotivation not to
smoke
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You dont smoke, I dont smoke

• Thompson et al., Hlth Edu Rsrch, 2004
• Interview pregnant women smoker in U.K.
• I think if my partner stops smoking then I
  might be able to try wee bit harder to stop.

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Conclusions
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What did we learn?

• Smoking and non-smoking behaviors have relational
  motivations.
• Relational models theory can help us begin to
  understand the mechanism involved in smoking and
  non-smoking behaviors.
• Relational models theory may be helpful in
  understanding other health behaviors.
• For more info on the theory and studies using
  this theory, go to www.rmt.ucla.edu

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Strengths Limitations
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Strengths

• Relational models theory may have some predictive
  and prescriptive value.
• The theory has cross-cultural applications.
• It has the potential to be applied to other
  health behaviors.

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Limitations

• Relational models theory does not explain what
  type of relational model will have a stronger
  effect on ones decision to smoke or not.
• The theory does not explain when and which type
  of relational model will be employed.
• Given that culture and motivations are dynamic,
  it is difficult to predict which type of
  relational models will manifest, as one ages, for
  example.

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Implications
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What do we do next?

• Future research studies should address the
  theoretical shortcomings.
• Future studies should further explore how to
  measure relational motivations, quantitatively,
  with reliability and validity.
• A better understanding of relational models have
  important policy and practical implicationsnot
  just for smoking but other health behaviors.