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I’m a Non Smoker Surrounded by Smokers. How Did This Resistance
Happen?
Abstract
Prior studies have focused on why adolescent’s smoke and research exploring the links
between family and peer influences on smoking have been at the forefront. Very few studies
have focused on nonsmokers, especially as to how one becomes a nonsmoker while
constantly being surrounded by smokers. This paper explores nonsmoking Fijian adolescents’
attitudes towards smoking through focus group study. The research highlighted the
importance of the social context of smoking amongst adolescents. Insight into understanding
a non-smokers identify and resistance to smoking will assist social marketers in
understanding an holistic overview towards smoking thus developing effective prevention
programs.
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Introduction
Smoking is the single most preventable cause of mortality and morbidity in today’s society,
yet approximately 3,900 young people between the ages of 12 and 17 begin smoking every
day (Greene and Banerjee, 2008). Given the potential long-term harm from smoking, it is
crucial that interventions are targeted at early-onset smoking with the aim of preventing these
adolescents from becoming smokers in adulthood. Qualitative research examining adolescent
views on smoking is important because it provides contextual understanding of smoking
behavior (Haines et al., 2009). In this study focus groups were used to explore nonsmoker’s
attitudes and intentions towards smoking and explore the research question: How is
resistance developed towards smoking by nonsmokers? Six focus groups were conducted
with 72 high school students aged 13 to 18 years in Fiji Islands. The study resulted in a
deeper understanding of how nonsmokers are able to develop resistance towards smoking
while constantly being surrounded by smokers in their community, family and amongst peers.
Theoretical perspective
In 1951, when Wiebe asked, ‘Can brotherhood be sold like soap?’ he paved the way for
researchers and practitioners to adapt commercial marketing tools to solve health and social
problems. Andreasen (1995) described social marketing as the application of marketing
techniques to influence people’s behavior in a manner that is beneficial to the community,
defining it as:
‘the application of commercial marketing technologies to the analysis,
planning, execution and evaluation of programs designed to influence the
voluntary behavior of target audiences in order to improve their personal
welfare and that of society’. (p. 7)
This definition emphasizes that the core of social marketing is behavior change.
The key purpose of social marketing is to benefit the individuals, who are the target of the
campaign, not the organizations responsible for the campaign. The focus should be on the
target audience, which has a primary role in the process (Weinreich, 1999). The challenge for
policy makers is to brand positive health behaviors. Adolescents often make decisions and
choices which are detrimental to their health and society at large, even though they are aware
of the consequences of their actions. Sometimes this is an expression of adolescent rebellion.
Yet amongst this same age group are adolescents that are aware of the consequences of their
action and are able to develop resistance towards choices that are detrimental to their health
which became the driving force for this study.
Research setting
The setting of this study is the Republic of Fiji (known as Fiji Islands) , a nation consisting of
more than 300 small islands in the South Pacific. The estimated population is 854 000, of
which 52 percent are ethnic Fijians, 44 percent are Indians and the remainder are mostly
Asians and other Pacific Islanders (Fiji Bureau of Statistics, Fiji Household Survey, 2009).
One of the biggest impediments to economic growth is the ethnic tension between the two
main population groups: indigenous Fijians and Indo-Fijians (De Vries, 2002). Fiji Islands
was the first country in the Western Pacific Region and the first developing country to ratify
the WHO Framework Convention for Tobacco Control (FCTC) on 3 October 2003. The
FCTC is seen as a major catalyst for strengthening national tobacco legislation and control
programs. The tobacco industry in Fiji is dominated by British American Tobacco (BAT).
BAT Fiji is the country’s largest single taxpayer, contributing in excess of F$40 million in
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2000. In 1998, the Fiji Government introduced legislation to restrict smoking in public
places, advertising and sponsorships. In 2010, this was named as Tobacco Control Decree.
Despite these measures the prevalence of smoking in Fiji in 2009 was 37 percent, with 22
percent of young smokers starting before the age of 18 (Fiji National Health Promotion
Council, 2010).
Method
The study was based on focus group interviews because they offer the advantage of being
socially oriented (Marshall and Rossman, 1999) and we felt this format would increase the
comfort level of the adolescent participants (Creswell, 2002). Semi-structured questions were
used to guide the groups, providing a platform for the participants to share their experiences,
beliefs and understanding of environmental influences, such as parents and peers, on smoking
(Strauss and Corbin, 1998). The topics discussed are shown in Table 1. The main themes
included: first thoughts on smoking, resistance towards smoking, smoking as a health issue,
smoking as a social issue and current tobacco control measures. All participants have selfdeclared themselves as nonsmokers. Three focus groups had all participants who had taken a
puff or had some level of experimentation with smoking but did not take up smoking
regularly while the remaining three focus groups had all participants who had not even taken
a puff as shown in Table 2. Using Nvivo software (QSR International, 2010) an inductive
approach was used to code responses and themes discussed by the majority of participants
were noted.
Analysis and discussion
The results are organized into two sections – themes related to the influence of families and
peers on resistance towards adolescent smoking and themes related to adolescent reactions
towards nonsmoking with the use of participant quotes as supporting evidence. Participant’s
names have been changed. Table 3 provides an overview of the strength of the discussions in
each group of the key themes.
First Thoughts on Smoking
It was important to obtain the adolescents’ views on smoking. To elicit this, groups were
asked to say the first thing that came to mind when someone says ‘smoking’. Across all
groups the dominant themes were that smoking causes cancer, affects teeth and lungs. There
was a stronger theme of smoking affecting studies and leading to other vices amongst the
focus group consisting of those who had not experimented with smoking.
My first puff
We asked the participants in the first three focus groups to discuss their first experience with
smoking. All groups groups described their environment as enabling and enhancing social
acceptance of smoking which led to a perception that smoking was a part of daily life as they
had one-two family members and close friends as regular smokers. The following quotes
illustrate this:
Family and Peer Influences and Reactions
My dad smokes everyday so I decided to take his cigarette and try it to see what it would
feel like to smoke. I didn’t feel good at all, it was yucky!(David)
My best friend smokes so she gave me one. I took one puff for the thrill of it to do
something new. Later I realized it was wrong to smoke after I saw how my friend’s teeth
were starting to discolor. I never smoked since then. (Mary)
My cousin gave me my first cigarette. I took it because I felt I can’t say no, his my
cousin. I took one puff and gave it back (Sam)
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In addition, these participants were asked to explore why they did not take up
smoking regularly.
David: It was the taste of it ,I didn’t like it at all.
Mary: I didn’t want to get teeth like my friends. I want a log and healthy life.
Sam: I decided to be leader not a follower of what everyone was doing around me.
Modeling of Non Smoking Behavior
Consistently across all six focus groups, the participants were aware of the health effects of
smoking but did not see smoking as “evil”. Since family and peers were smoking, there was a
social acceptance of smoking amongst the environment the participants were surrounded in.
This led to discussions as to how adolescents develop a resistance towards smoking, as
illustrated by these quotes:
I have friends who smoke. We go clubbing and they smoke there also. It is their choice
what they want to do. I don’t question whether it’s right or wrong. I’m responsible for
my actions and I don’t want to smoke. (Lucy)
I will like my dad to not smoke. I have seen the way his health is declining. He didn’t
have money to buy me toys but he had money for his packet of cigarette. I don’t want to
be that person when I have kids so I don’t smoke (David).
My friends smoke because they think it’s cool. I don’t see why one has to smoke to be
cool. Even though they offered me a cigarette, I have never taken one puff at all. A few
of my friends have distance themselves from me since we don’t have much in common.
As if! I learnt that day who my true friends are. A cigarette should not be basis of
friendship.
I choose not to smoke. My cousins choose to smoke. It’s all about choice. For me it’s
important to study, get good grades and not get caught up in smoking. I have seen
people smoking, later drinking alcohol and moving to drugs. That’s not for me. Plus my
parents will kill me. Smoking is a big no in my family. (Jan).
The perception that smoking is cool and a way to gain acceptance by peers was discussed by
all six focus groups and smoking was seen as a social activity undertaken with friends and a
form of acceptance by peer groups. Yet these participants were able to resist smoking.
Participants in all groups were asked to identify words with resistance towards smoking as
shown in Figure 1.
True friends
support
Smoking is
“un-cool”
Healthy
lifestyle
Resistance
Family rules
no smoking
Be a leader
not a follower
Can lead to
other vices
Personal
choice
Figure 1: Word
Associations with
resistance to Smoking
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Conclusion and Implications
For adolescents, identity is often linked to membership of a social group (Okoli et al., 2008).
This is consistent with focus groups conducted with American Indians who reported high
acceptability of smoking due to the presence of smokers in their culture (Burgess et al.,
2009). Having family members and peers who smoke provided social opportunities for
adolescents to smoke. Yet the focus groups participants were able to resist becoming regular
smokers though they constantly are being surrounded by smokers. The driving factors in
developing this resistance were the personal choice that participants felt everyone had to
make to choose whether to smoke or not. Participants also expressed a desire for healthier
lifestyle which smoking did not provide.
The upside of smoking—the fun, the togetherness and sense of social identity—is reiterated
in countless tobacco advertisements and marketing campaigns but largely ignored in social
marketing campaigns, which seem to discount the wider social elements which frame the
smoking environment. Referring back to the key research question of this study, the research
emphasizes the need for social marketers to re-focus on the target audience because smoking
isn’t an individual issue, it is influenced by various stakeholders and marketing agents in the
environment. Yet there are nonsmokers who are able to develop their own self resistance
towards smoking. Tapping into the nuances of these nonsmokers resistance gives an insight
as to how future anti-smoking programs should be developed with focus not only on fear and
shame but on positive behaviors such as personal choice and wellbeing. Tag lines such as “be
a leader not a follower” are one starting point. Future research should explore designing
these anti-smoking advertisements and testing adolescents’ responses to them.
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References:
Andreasen, A. (1995), Marketing social change: Changing behavior to promote health,
social development, and the environment, Jossey-Bass, San Francisco, CA.
Burgess, D.J., Fu, S.S. and van Ryn, M. (2009), “Potential unintended consequences of
tobacco-control policies on mothers who smoke: A review of the literature”, American
Journal of Preventive Medicine, Vol. 37 No. 2, Supplement, pp. s151–s158.
De Vries, R.E. (2002), “Ethnic tension in paradise: Explaining ethnic supremacy aspirations
in Fiji”, International Journal of Intercultural Relations 26: 311–327.
Fiji Islands Bureau of Statistics (2009), Household survey, Fiji Government, Fiji Islands
Fiji National Health Promotion Council (2010), Annual survey 2009, Fiji Government Printery,
Fiji Islands.
Greene, K. and Banerjee, S.C. (2008), “Adolescents’ responses to peer smoking offers: The
role of sensation seeking and self-esteem”, Journal of Health Communication, Vol. 13 No. 3,
pp. 267–286.
Haines R., Poland B., Johnson J. (2009), “Becoming a ‘real’ smoker: Cultural capital in
young women’s accounts of smoking and other substance use”, Sociology of Health and
Illness, Vol. 31 No. 1, pp. 66–80.
Marshall, C. and Rossman, G. (1999), Designing qualitative research, 3rd edn, Sage,
Thousand Oaks, CA.
NVivo qualitative data analysis software; QSR International Pty Ltd. Version 9, 2010.
Okoli, C.T., Richardson, C.G., Ratner, P.A. and Johnson, J.L. (2008), “Adolescents’ selfdefined tobacco use status, marijuana use, and tobacco dependence”, Addictive Behaviors,
Vol. 33 No. 11, pp. 1491–1499
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for developing grounded theory, Sage, Newbury Park, CA.
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Oaks, CA.
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Appendix:
Table 1. Discussion guide
Themes
Sample questions
First thoughts on
• Discuss your first thoughts about smoking.
smoking
• How, if at all, is it part of your life, friends, and family?
• When are you around it, how does it make you feel?
Influences on
nonsmoking
•
•
•
•
Smoking as a health
issue
•
•
Smoking as a social
issue
•
•
•
•
Current tobacco control
measures
•
•
•
•
Discuss your first puff.
Who gave you your first cigarette?
Do significant others, family, siblings and friends smoke?
How often does your friend, family or someone close to
you offer you cigarettes or say ‘just have a puff’?
What are your attitudes towards smoking and health?
Do you think smoking is harmful? Can you name three
health related problems from smoking?
What are your attitudes to smoking as a social issue?
What do your friends and family think about smoking?
How does smoking compare to other vices such as
alcohol or partying?
Do different groups within the community perceive
smoking differently?
Packaging: do you remember any warning signs? Which
ones?
Does the price of tobacco affect whether people smoke?
Is it easy to buy cigarettes or have access to cigarettes?
Do you remember any anti-smoking advertisements?
Which ones and why? What would you change and why?
Table 2. Demographic data for focus group participants
Focus Group
Group 1
Group 2
Group 3
Group 4
12
12
12
12
# Participants
16.8
16.4
16.0
16.3
Average age
(years)
0%
100%
100%
Experimented 100%
with smoking*
50%
40%
40%
60%
% Male
*Self reported
Group 5
12
16
Group 6
12
16.5
0%
0%
50%
50%
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Table 3. Themes Related to Attitudes towards Smoking by Groups
Topic and
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Theme
Smoking seen
as uncool
M
W
W
S
M
M
Smoking seen
as a form of
acceptance by
peers
M
M
W
M
W
W
Smoking
perceived to be
accepted by
family
M
S
M
W
W
W
Awareness of
negative health
effects of
smoking
S
M
M
S
S
S
Awareness of
anti-smoking
programs
W
W
W
M
M
W
Note: S = strong; M=medium and W= weak