Addicted to Nicotine
A National Research Forum

Section II: Nicotine-Individual Risk Factors for Initiation
Richard R. Clayton, Ph.D., Chair

ETHNICITY, GENDER, AND RISK FACTORS FOR SMOKING INITIATION

Robin Mermelstein, Ph.D.
Health Research and Policy Center
University of Illinois at Chicago

Introduction

The prevalence of cigarette smoking has increased significantly among youth over the past several years. In 1991, 27.5 percent of high school students smoked cigarettes, compared with 36.4 percent in 1997. These overall rates mask important racial/ethnic and gender differences, however. Smoking is more common among white students (39.7 percent) than among Hispanic (34.0 percent) and black students (22.7 percent). The racial/ethnic differences are particularly striking among females; more than two times as many white females currently smoke (39.9 percent) as black females (17.4 percent), and almost five times as many white females are frequent smokers (20.1 percent) compared with black females (4.3 percent). Earlier data have shown high prevalence rates among American Indians and low prevalence rates among Asian-American and Pacific Islander youth, especially females. Smoking among black youth has shown the greatest increase since 1991, almost doubling from 12.6 percent in 1991 to 22.7 percent in 1997.

What might explain these ethnic and gender differences? What accounts for the relative resiliency of black and Asian-American females, and how do they differ from white females? This paper presents highlights of racial/ethnic and gender differences in risk factors for smoking and identifies questions for researchers to address.

What We Know

Although there is a plethora of studies on risk factors for initiation, the majority focus almost exclusively on white youth, and as a result, we know much less about how risk factors for smoking may differ among the racial/ethnic and gender subgroups. Generalizing findings from the studies of white youth may be inappropriate, and few studies have specifically compared racial/ethnic and gender subgroups. There are, however, some hints at important differences across the subgroups.

• The Relative Role of Family Versus Peer Influences. Peer smoking and peer-group identification are consistently strong predictors of smoking among white adolescents, but are far less consistent predictors of smoking among other adolescents, especially among African Americans. Among whites, parent and family factors play a much less important role in predicting onset. Cultural differences in the importance of family and value on family messages may moderate the power of peer influence. Data from qualitative studies of several ethnic groups found that nonwhite youth reported stronger antismoking messages and perceived consequences for smoking from parents than did white youth. Youth who were not white reported the strong belief that youth smoking was disrespectful to parents, and there was a strong value placed on not "shaming" the family (especially among females).

• Perceived Negative Consequences of Smoking. Although the majority of youth acknowledge the health consequences of smoking, survey data show that American Indian students are less likely to agree with such statements. Asian-American female students are more likely than other groups to agree that there is strong social disapproval of smoking. Racial/ethnic and gender subgroups may also differ dramatically in the perceived negative consequences of smoking that are not health related. Qualitative data indicate that African-American girls are unique in their view of smoking as "risky." For African-American girls, smoking may be seen as the first step "down a slippery slope" and incompatible with a promising, successful, and healthy future.

• Societal/Cultural Expectations. Such expectations may place white female adolescents at increased risk and may be protective of females in other ethnic groups: White females may be at increased risk for smoking because of smoking-related expectations that are reinforced through broader sociocultural attitudes of the mainstream society. These include beliefs that smoking helps to (1) control weight, and thinness is desirable; (2) control mood, notably anger, stress, and depression, for which white females may be at increased risk; and (3) enhance one's image of being independent and sophisticated, characteristics that are idealized in cigarette advertisements targeted to females and that might uniquely apply to white female adolescents.

  Identification with mainstream, white society may influence how much youth from other ethnic groups endorse these beliefs as well. In contrast, strong cultural antismoking norms for females may protect some ethnic minority femalesÑnotably Asian-Americans and Pacific Islanders and, to some extent, less acculturated Hispanic females. There is a strong sentiment among these groups that smoking is not appropriate for girls, is "unladylike," and ruins a girl's reputation.

• Popular Media/Entertainment. Celebrities and other public figures may influence the appeal of smoking and be differentially relevant to racial/ethnic and gender subgroups. Messages about smoking appear everywhere to youth, notably in entertainment outlets (music, television, movies) that may appeal to youth. Qualitative data suggest that youth are very aware of the smoking status of public personalities (e.g., music and entertainment figures) and often cite that appealing personalities have positive smoking messages (through image, behavior, in music). The prevalence of smoking in the entertainment media may have increased during recent years.

What We Need To Know More About

• More Specific Examination of Ethnic and Gender Effects. The relationship between smoking and certain risk factors may vary by racial/ethnic and gender subgroups, and the prevalence and relative importance of risk factors may vary as well. We need to identify and compare more specifically predictors of smoking and protective factors among the racial/ethnic and gender subgroups.

• More About Parental/Familial Influence. Qualitative data suggest that parental messages about smoking matter, although quantitative data may suggest that parental influences wear off over time, primarily for white youth. We do not know, though, how parental smoking and verbal messages about smoking interact and are interpreted by youth from different subgroups. We need to know more about the consistency and strength of parental messages, how they vary developmentally with the youth, how they interact with other risk factors, and how these can be enhanced to inhibit youth smoking.

• More About How Youth Cope With Negative Moods. Mood management is a primary reason for smoking across all youth subgroups. We need to know more about why some youth choose to cope with negative moods by smoking, whereas others might choose other substances, behaviors, or coping strategies and whether these vary by gender and ethnicity.

• Investigation Into Whether Factors That Protect Youth in Some Subgroups Can Be Diffused to Others. We need to explore whether some of the strong "countermandates" against smoking that exist for African-American and Asian-American females can be diffused to other subgroups or whether these protective factors are truly culture specific.

Recommended Reading

Bachman, J.G.; Wallace, J.M., Jr.; O'Malley, P.M.; Johnston, L.D.; Kurth, C.L.; and Neighbors, H.W. Racial/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors. Am J Public Health 81(3):372-377, 1991.

Centers for Disease Control and Prevention. Tobacco use among high school studentsÑUnited States, 1997. MMWR Morb Mortal Wkly Rep 47:229-233, 1998.

Conrad, K.; Flay, B.R.; and Hill, D. Why children start smoking cigarettes: Predictors of onset. Br J Addict 87:1711-1724, 1992.

Flay, B.R.; Hu, F.; Siddiqui, O.; Day, L.E.; Hedeker, D.; Petraitis, J.; Richardson, J.; and Sussman, S. Differential influence of parental smoking and friends' smoking on adolescent initiation and escalation of smoking. J Health Soc Behav 35:248-265, 1994.