How Normal Is Smoking? Teens Don't Know, But Their Guesses Affect Their Habits

The study identifies three distinct ways to measure “normative beliefs” involving smoking, each of which it found to be significantly related to adolescents’ likelihoodof smoking. According to the study:

• The more an adolescent perceived that successful and elite people smoke cigarettes, the more likely that adolescent was to smoke.
• The more strongly an adolescent perceived that his or her parents or peers disapproved of smoking, the less likely that adolescent was to smoke.
• The more an adolescent overestimated the percentage of smokers in the general population, the more likely that adolescent was to smoke.

According to the study, nine out of 10 (93 percent) high school students overestimate the percentage of people who smoke in the United States. On average, they believe over half (56 percent) of Americans are smokers, while the actual figure is less than half that.

“These findings are of value to those who devote themselves to smoking intervention programs geared to teenage audiences,” said lead author, Brian Primack, M.D., Ed.M., assistant professor of medicine and pediatrics at the University of Pittsburgh School of Medicine. “Smoking remains the leading cause of preventable death in the U.S., so any new information is welcome. Adolescents have important misconceptions about cigarette smoking that can place them at increased risk for smoking.”

More than 1,200 high school students who participated in the study were assigned normative beliefs scores based on their responses to survey items. Studentsresponded whether they agreed or disagreed with statements such as:

• “Most successful business people smoke cigarettes at least once a month.”
• “ In general, more ‘cool’ people smoke cigarettes than ‘uncool’ people.”
• “ Wealthy people are more likely to smoke cigarettes than poor people.”
• “ My favorite celebrities probably smoke cigarettes at least once a month.”

The students also responded to “perceived disapproval” statements, such as:

• “According to my parents, it is very important for me not to smoke cigarettes.”
• “ According to my friends, it is very important for me not to smoke cigarettes.”
• “ According to most people my age, it is very important for me not to smoke cigarettes.”

Finally, students were asked what percent of high school students and adults in the United States they thought smoked at least once each month.

Other study authors include Galen E. Switzer, Ph.D., also of the University of Pittsburgh, and Madeline A. Dalton, Ph.D., of the Dartmouth Medical School. The study was funded by the Maurice Falk Foundation and Tobacco-Free Allegheny. Dr. Primack is currently supported by the National Cancer Institute and the Robert Wood Johnson Foundation.