Ambivalence and uncertainty: experiences of and attitudes towards addiction and smoking cessation in the mid-to-late teens.

The late teens is an important transitional period as adolescents move into new social worlds which support or challenge their smoking. This paper draws on research with 99 Scottish 16- to 19-year olds which explored their understanding of their smoking and attitudes towards quitting and cessation support. The study involved qualitative interviews mostly with friendship pairs. Interviewees also completed a brief smoking questionnaire. Most regarded themselves as smokers but few thought they were addicted. Many were interested in quitting but this was not a priority. Perceived barriers to quitting related primarily to habitual and social aspects of dependence including friends' smoking, the smoking culture at work or college, stress and boredom. Few were interested in nicotine replacement therapy or cessation services, which they felt belonged to the world of older addicted smokers. The most effective quitting strategy was thought to be will-power. Traditional cessation services are therefore in their current form unlikely to appeal to older adolescents. Services aimed at this age group need to be grounded in their understandings of smoking and the social factors which support smoking. Young smokers should also be helped to understand how support may increase quitting success and how encourage quitting before smoking becomes entrenched in their daily routines.

Image, context and transition: smoking in mid-to-late adolescence.

This paper explores 16-19-year-old Scottish smokers' experiences and attitudes towards smoking and their understandings of the ways in which this transitional period impacts on their smoking behaviour. The study involved 49 qualitative interviews conducted mostly in friendship pairs. Interviewees also completed a brief smoking questionnaire. The paper highlights the salience of social context in smoking initiation and maintenance, and the role of smoking across a range of social spheres. Interviewees described how transitions from school to work, further education or un/employment, impacted on their smoking. Smoking was perceived to be an important 'lubricant' for social relations, and marker of an acceptable identity in familiar and new contexts which acted to reinforce and increase smoking. In contrast, smoking restrictions at home, work and/or educational settings were felt to moderate consumption. This has implications for cessation programmes for older adolescents who have been relatively ignored by tobacco control. The study also suggests that if smoke-free policies were extended to all workplaces, this would have a particular impact on smoking amongst older adolescents by hindering the transition from social to regular smoking.

'You can't go without a fag...you need it for your hash'--a qualitative exploration of smoking, cannabis and young people.

AIMS: To examine the relationship between smoking tobacco and cannabis use among smokers in their mid-to-late teens. DESIGN AND PARTICIPANTS: Two qualitative studies in Scotland. One study used semistructured paired interviews involving 99 16-19-year-old smokers, the other comprised eight focus groups involving 46 15-16-year-old smokers. MEASUREMENT: The interviews and focus groups explored the role and meaning of smoking in the participants' lives, smoking histories and future cessation intentions and how these related to other aspects of their lives, particularly cannabis use. FINDINGS: Cannabis use was regarded as an important and enjoyable aspect of many of the participants' lives. Importantly, cannabis use and cigarette smoking were linked inextricably. Several reported how smoking joints had been a 'gateway' to smoking cigarettes. While most wanted to quit smoking cigarettes, cannabis use reinforced their cigarette smoking and few wanted to stop using cannabis. CONCLUSION: National studies need to be conducted to examine how widespread the problem identified is and tobacco control initiatives and smoking cessation treatment services need to consider urgently how to overcome the barrier that a desire on the part of young people to continue cannabis smoking poses to achieving a reduction in tobacco use.

'I came back here and started smoking again': perceptions and experiences of quitting among disadvantaged smokers.

This paper draws upon qualitative research with 100 smokers (50 male and 50 female) in two Scottish areas of disadvantage to investigate their perceptions and experiences of quitting. The fieldwork took place between 1999 and 2000, with data collected through in-depth individual interviews and the completion of a smoking day grid. While many interviewees wanted to quit, they drew on their understandings of habit and addiction to illustrate the difficulties which quitting posed. Addiction was referenced through accounts of actual and anticipated unpleasant withdrawal symptoms, while accounts of the difficulties associated with quitting drew primarily upon habitual usage and routine aspects of their lives. Interviewees reported interacting frequently with other smokers. They also highlighted how stressful aspects of their lives perpetuated habitual smoking and prompted relapse following periods of cessation. Although the contexts inhabited by the interviewees were crucial in inhibiting successful quitting attempts, these factors acted in conjunction with and exacerbated feelings of physiological dependence on tobacco. Interviewees were sceptical about the effectiveness of nicotine replacement therapy (NRT) other than in the immediate or short term. For the most part, interviewees felt that NRT could not address aspects of their lives that appeared to support and sustain smoking in the long term. The paper concludes that in order to facilitate and sustain smoking cessation, tobacco control interventions need to tackle both nicotine addiction and the material circumstances experienced by disadvantaged smokers.

"It's like an addiction first thing...afterwards it's like a habit": daily smoking behaviour among people living in areas of deprivation.

The paper draws on qualitative interviews with a sample of male and female smokers who live in areas of disadvantage in Edinburgh, Scotland, to examine their perceptions of habit and addiction and the implications for smoking behaviour. The paper shows how smokers have a sophisticated understanding of these concepts and the way in which they affected their smoking behaviour across the course of a 'typical' day. The paper argues that daily contexts which smokers inhabit either constrain or facilitate smoking and as such play a central role in the way in which they smoke. In contexts where smoking was constrained (by externally or self-imposed restrictions) smokers described how they employed various strategies to achieve and maintain what they perceived to be a desirable level of nicotine intake, such as by anticipatory smoking. Where restrictions on smoking were absent, men's and women's smoking appeared remarkably similar. However, for the most part, the contexts which men and women inhabited over the course of the day differed, with women assuming the largest share of domestic and child care responsibilities. Apparent gender differences in smoking behaviour appeared to be related to the different daily contexts which men and women inhabited. Crucially, the influences on smoking described by respondents in this study were closely related to circumstances of socio-economic deprivation.