This is one of the first studies to employ mixed methodology to investigate how adolescents define different smoker types using multiple smoking indicators of smoking behaviors, including frequency, amount, place, and length of smoking, and whether differences exist by individual smoking experience. The results of this study add to the body of literature on how adolescents perceive and define a smoker and the associated characteristics of various other smoker types. This information can be used to maximize the effectiveness of health messages targeted to youth smoking prevention and cessation efforts.
Results from this study found that adolescents generally agreed that a high frequency of smoking was required in order to be considered a smoker (i.e., smoke a couple times a week or everyday), whereas research-based classifications agree that a smoker is an individual who smokes cigarettes, regardless of the frequency. Youth smoking behavior tends to be characterized by nondaily and low amounts of cigarette use (Hassmiller et al., 2003
; Wortley et al., 2003
), which may explain why some adolescents who smoke do not identify themselves as a smoker. Also, the appearance of subsets of nondaily smoking behavior, such as social smoking, may be contributing to these inconsistent self-identifications of smoking status. The majority of adolescents in our study sample (73.3%) defined social smoking as smoking primarily in social contexts (i.e., at parties only). Evidence has shown that social smokers tend to categorize themselves as nonsmokers when asked by family, friends, or health care providers (Schane, Glantz, & Ling, 2009
). As a result, general health messages that are used to target youth smokers may be ineffective if they contain terms such as “smoker” because these individuals do not view their smoking behavior as a marker of such behavior (Gilpin, White, & Pierce, 2005
; Moran et al., 2004
) and may not perceive the messages as applicable.
The concept of nicotine addiction among adolescents raises particular concern as our findings suggest that adolescents may be unaware or not comprehend that they can experience symptoms of nicotine dependence with a lower frequency and amount of cigarette smoking compared with adults. This was shown in both the quantitative and the qualitative data. Previous research has shown that symptoms of nicotine dependence among adolescents often develop soon after smoking initiation and generally before the onset of daily smoking (Colby, Tiffany, Shiffman, & Niaura, 2000
; O’Loughlin, Kishchuk, DiFranza, Tremblay, & Paradis, 2002
; O’Loughlin, Tarasuk, DiFranza, & Paradis, 2002
) and that loss of autonomy can be prompted with smoking just one cigarette (DiFranza et al., 2011
; Scragg, Wellman, Laugesen, & DiFranza, 2008
). In our study, approximately three quarters of the participants (74.3%) characterized an addicted smoker as having smoked for a few years or more. Additionally, overlap in definitions between addicted smoker and heavy smoker was observed, which suggests that the adolescents in our sample tended to associate nicotine addiction with a high frequency and amount of cigarette use. These findings suggest that youth smoking prevention programs should include a discussion of nicotine addiction, including how quickly and from just a few cigarettes an adolescent can become addicted.
This study found differences in how adolescents characterized some smoker types based on individual smoking experience. While the majority of adolescents agreed that a nonsmoker never smokes, adolescent ever-smokers were more likely to assign some frequency of smoking to a nonsmoker. On the opposite end of the spectrum, adolescent never-smokers were more likely to characterize a heavy smoker with a greater length of smoking compared with ever-smokers. These results suggest that ever-smokers may have a greater flexibility in determining what constitutes nonsmoking and heavy smoking, while never-smokers may have much more narrower definitions. Although this study did not specifically investigate perceptions of smoking risk, our findings may contribute to future studies on risk perceptions among adolescent smokers and nonsmokers, which have found that adolescent smokers believe that health risks of smoking are lower for themselves than for other smokers their own age (Halpern-Felsher et al., 2004
), and that perceptions predict smoking initiation (Song et al., 2009
). These findings may be related to this flexibility in defining what smoking is and is not in this particular group.
Gender differences in how adolescents characterized different smoker types were detected. We found that males were more likely to characterize some smoker types more broadly than females, although this was not found to be consistent for all smoker types and characteristics. Previous studies have found gender differences in smoking identities among adolescent boys and girls (Lloyd, Lucas, & Fernbach, 1997
; Okoli, Torchalla, Ratner, & Johnson, 2011
), which suggests that there may be potential differences in how adolescents characterize different smoker types, regardless of their own smoking identity. Future research should examine these gender differences in order to develop more effective and tailored smoking prevention and cessation messages.
Our study also found a considerable amount of overlap in definitions between different smoker types. For example, adolescents’ characterizations of smoker and regular smoker showed a great deal of overlap in terms of the frequency, amount, and place of smoking. This was also reflected in the qualitative interview data. Other smoker types that showed overlap included the addicted smoker–heavy smoker and casual smoker–social smoker pairs. The amount of similarities and overlap between definitions is cause for concern, especially if adolescents are indiscriminately and interchangeably using different smoker types, as the accuracy of research often depends on consistency across participants (Rubinstein et al., 2003
). Future youth smoking prevention efforts and communication strategies should make efforts to provide clear definitions of what is meant by smoking and offer concrete explanations of different smoker types in order to avoid confusion and misinterpretation.
There are some limitations to this study. First, the participants were given specific smoking categories (i.e., regular smoker, addicted smoker) rather than given the option of providing their own categories, which may have resulted in confusion if adolescents were not familiar with such terms or categories. Related to this, participants were not given the option to identify their own perceived smoker type or classification according to the categories provided. Finally, the generalizability of the study findings may be limited as the smoking experience among adolescents in California does not necessarily reflect national trends.
Health communication strategies for youth smoking prevention need to address the wide variability and overlap in how adolescents define different smoker types. Greater attention should be directed to understanding the nuances of how both never smoking and ever smoking adolescents define smoking in order to maximize the effectiveness of youth-centered smoking prevention and cessation messages. As adolescent smoking is generally characterized by nondaily and low amounts of cigarette use, health messages may need to be reframed in order to capture what smoking adolescents consider relevant to them.