Youth Research

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING
June, 2005
Project number 3032
YOUTH TOBACCO
PREVENTION RESEARCH
PROJECT
Table of contents
Executive summary
Research context
2.1 Background
2.2 Research objectives
Research design
3.1
3.2
3.3
3.4
3.5
Qualitative methodology
Sample structure for young people
Sample structure for parents
Indigenous research component
Conduct of the qualitative research
Research findings
4.1
4.2
4.3
4.4
4.5
Knowledge and attitudes

Youth smoking pathways
Cannabis
Parents
Reactions to current interventions
Conclusions and recommendations

5.1 Interventions
5.2 Campaign themes
Appendix A
Discussion guide (young people)
Discussion guide (parents)
6
9
11
11
11
19
21
24
26
26
35
52
61
70
76
76
81
87
87
101

YOUTH TOBACCO PREVENTION
1
Executive summary
This report is based on an extensive national program of qualitative research conducted with
young people aged 12-24 and their parents. It was preceded by a literature review, which is
reported separately.
Background and
objectives
It is estimated that one in five teenagers between the ages of 14 and 19

years smoke and that smoking prevalence among 20-29 year is more than
a quarter. Research shows that most smokers commence smoking before
the age of 18 years, with the median age of initiation at 15 years.

The Australian Government Department of Health and Ageing identified a need for a
comprehensive understanding of youth smoking behaviours, clarifying the processes of uptake,
addiction and cessation. This research was commissioned to serve as a resource upon which all
governments may draw, enabling them to promote policies and fund targeted spending
initiatives on the basis of sound evidence for their effectiveness. The findings will also form
useful input into the Commonwealths foreshadowed action on youth smoking.
Methodology
A total of 30 group discussions, 39 affinity pairs, and 36 depth interviews

were conducted with young people aged 12-24 years. In addition, 14
group discussions were conducted with parents who have children under 18 years of age. The
research included a dedicated component to explore the views of Indigenous young people and
parents. The research was conducted in eight locations across Australia, including metropolitan,
regional and rural areas.
Attitudes towards Early high school students and non-smokers often held negative attitudes
smoking
towards smoking. As development progresses and young people start to
experiment with smoking, they begin to develop positive associations,

despite still acknowledging numerous negative aspects of smoking.

Perceived
prevalence
A striking finding was participants estimates of the prevalence of tobacco

smoking. Particularly among those who smoked (or who had tried
cigarettes), there was generally an over-estimation of the prevalence of
smoking.
For example, young adult females who smoked tended to estimate smoking
prevalence to be at least 50% among people their age. Likewise, younger smokers often
assumed that half to three quarters of adults smoked. This systematic over-estimation of
smoking rates among adults contributes to the perception of smoking as being a relatively
normal, adult behaviour and thus as a symbol of maturity, much like driving a car, using licensed
premises or becoming sexually active.
Interventions that address misconceptions about
prevalence thus have some potential.

Moreover, the findings from the research suggest that there is considerable potential for teachers
to discuss tobacco control as a factual, non-judgemental social science phenomenon. This
would include discussing why tobacco control efforts exist and the success of strategies
employed to date, enabling communication about the reduction in the prevalence of smoking to
much lower levels than typically assumed by young people. Such an approach could also include
compassionate discussion of examples of where (and why) tobacco control efforts have been
less successful (such as among the mentally ill, poor, Indigenous and certain migrant
communities), which would include thinking about what needs to be done.
Similar results were found in respect of cannabis, with young people giving very high estimates
of prevalence and thinking of cannabis trial as a relatively normal and low risk activity, not unlike
experimentation with alcohol.
Short-term
effects
The short-term effects of smoking were reasonably salient to young

people, including coughing, reduced fitness and triggering asthma. Even
so, it would not seem prudent to base a communications campaign on
these short-term health effects. Among some female smokers in particular, there is a risk that
the general loss of fitness may be interpreted positively as providing weight loss benefits.
The impact of smoking on ones appearance (e.g. bad skin, wrinkles and yellow teeth) was also
salient, although young people often over-estimated the impact of smoking on ones physical
appearance. In addition, the smell of smoking was both salient and off-putting for many.
Overall, the results suggest that there is potential to leverage the desire to be sexually attractive
and position smoking as the antithesis of this.
2

Long-term effects All participants were aware that smoking has a negative impact upon
health and were able to articulate a range of long-term health effects.

There is no real denial of these risks for regular, heavy (addicted) smokers, although very few
perceived themselves as such. Knowledge of these risks acts as a deterrent for some. However,
most see these health risks as long-term and thus irrelevant. For most, it is a perceived low
personal susceptibility (to becoming a long-term smoker) rather than a lack of knowledge, which
makes health risks an insufficient deterrent.
Understanding
addiction
A key reason why most young smokers disassociate themselves from the
long-term consequences of smoking is that they have a poor
understanding of addiction.
Participants showed limited knowledge
about the signs that someone is becoming addicted and typically underestimated their own level
of dependence, with recognition occurring only in hindsight. Furthermore, many young people
(including some who are already addicted) believe they are unlikely to become addicted to
smoking and, among teenagers who smoke, there is generally a belief that quitting would not be
that difficult for them. Even among parents, knowledge about the process of addiction was
limited. There is no recognition that addiction can be contextual and that addiction typically
occurs situation by situation, rather than cigarette by cigarette.
Interventions that seek to impart knowledge about the addictive process thus have some
potential. A greater focus in early to mid high school on the addiction process might give them
greater insight into their own behaviours and motivate cessation at an earlier stage of
experimentation
Taking up
smoking
Overall, it is generally perceived (by young people themselves) as

inevitable that most will try smoking at some stage. It is clear that many
young peoples initial experiences with smoking are not enjoyable, and
such negative experiences appear related to an increased delay between initiation and subsequent
experimentation with smoking, making interventions that seek to limit or eliminate the use of
flavour-enhancers worth investigating. Decreasing the palatability of cigarettes (by limiting the
use of flavour-enhancers) may reduce significantly the prevalence of youth smoking.
The transition to more regular use typically occurs gradually, yet young people rarely expect (or
want) to become addicted to cigarettes. Knowledge of the long-term health risks of tobacco use
is not an effective barrier to trial, except in those cases where the young person perceived the
3

likelihood of addiction to be greater. The report discusses motivators and barriers to both trial
and continuance in some detail.
Cessation
Most young smokers appear to assume that cessation will be easy.

Indeed, they typically expect to quit at a relatively young age and very few
expect to smoke through to their late twenties. In terms of cessation strategies, going cold
turkey is often championed as the most effective option available to young smokers, who
perceive that there are few if any interventions that are relevant to them, since people under 18
are not supposed to smoke and most of the messages they receive relate more to prevention
than cessation. In particular, nicotine replacement therapy and the Quitline are seen as being for
older, more long-term smokers who have reached a level of desperation, having lacked the
willpower to quit unassisted.
Cannabis
A sharp distinction is drawn by young people between frequent cannabis

users, on the one hand, and non-users and occasional users on the other.
Young peoples attitudes towards occasional, in-control cannabis use were reasonably
favourable. In comparison to both tobacco and other illicit drugs, cannabis use is typically
perceived as not particularly addictive and as relatively safe, except for a few susceptible
individuals.
Compared to tobacco, young people report considerably less focus on cannabis within school
based education. In the absence of school education, young people indicated that they learnt
about cannabis from their peers or from older, more experienced friends.
Tobacco and
cannabis
The research provided some evidence that smoking tobacco does help to
develop certain smoking skills that reduce some of the barriers to
cannabis trial. This suggests that preventing use of tobacco could have
some impact on preventing, or more likely delaying, the trial of cannabis and some impact on
the likelihood of further use after trial.
The role of
parents
Most parents neither wanted nor expected their children to become longterm smokers. However, they generally felt that there was little they could
do to prevent this and that they were already doing all that they
reasonably could. Most agreed that not smoking themselves is the most influential thing they
could do to reduce the likelihood of their children becoming smokers. Most non-smoking
4

parents also reported subtly communicating anti-smoking messages to their children from early
childhood. Parental disapproval of smoking is cited by young people as a barrier to uptake,
although parents often feel that they lack influence and that their opinions count for little.
However, young people also perceive parental disapproval as a barrier to talking to their parents
about smoking. Both parents and young people suggested television commercials can act as
useful conversation starters for sensitive topics.
Some parents mentioned they would like to know more about what their children learn in
school about smoking, enabling them to reinforce these messages at home.
Social marketing
The report discusses a number of possible social marketing interventions

designed to reduce tobacco use among young people that, on the basis of
the research findings, warrant more detailed investigation.

2
Research context
This section outlines the background to the project, and specifies the research objectives.
2.1 Background
Tobacco smoking is the leading cause of premature death and hospitalisation among
Australians. It has been estimated to be the cause of 15% of all deaths, typically through chronic
health conditions resulting from long-term smoking across an individuals life course.1 Not only
do smokers die prematurely, they also suffer more disease and disability before they die. This
impacts negatively not only on the health system, but also on businesses, families and the wider
community. The total estimated social cost of tobacco use was estimated in 1998-9 to be over
$21 billion, accounting for 61% of the total social cost of all drug use (including alcohol and
illicit drugs).2 Further, it is clear that tobacco use is an effect of, and a contributor to, social
inequality, because the greater burden of tobacco-related costs falls on the more disadvantaged.
Smoking and
young people
While levels of smoking in Australia have reduced significantly over

recent decades, smoking rates for young people and, in particular, young
women, have been resistant to change. The 2001 National Drug Strategy
Household Survey found that one in five teenagers between the ages of 14 and 19 years were
smokers and that smoking prevalence peaked in the 20-29 year age group (at 26%). 3
Ridolfo B, & Stevenson C. (2001) The Quantification of Drug-caused Mortality and Morbidity in Australia, 1998. Cat.
No. PHE 29. Canberra: Australian Institute of Health and Welfare.
Collins, D. J. & Lapsley, H. M. (2002) Counting the cost: estimates of the social costs of drug abuse in Australia in
1998-9. National Drug Strategy Monograph No. 49. Canberra: AGPS.
Australian Institute of Health and Welfare 2002. 2001 National Drug Strategy Household Survey: First results. AIHW
cat. no. PHE 35. Canberra: AIHW (Drug Statistics Series No. 9)
http://www.aihw.gov.au/publications/phe/ndshs01/ndshs01-020717.pdf

Further, tobacco use in adolescence has been found to predict later dependence on tobacco and
daily smoking. Research shows that most smokers commence smoking before the age of 18
years, with the median age of initiation at 15 years.4 Together with the addictive nature of
tobacco smoking, this has the important implication that most smokers cannot be said to have
made an adult choice to be a smoker.
Tobacco use in adolescence has been found to increase the risk of health problems in early
adulthood, and the earlier that young people begin smoking, the more likely they are to suffer
from smoking related disease. Tobacco use also has acute effects in young people that are often
overlooked, from the long-established links to increased incidence and severity of respiratory
problems to more recently identified links to the development of depression. 5
Smoking and
cannabis use
In addition to the risks of dependence and tobacco-related illness,

evidence from the United States also suggests that adolescent tobacco use
can lead to cannabis use. After adjusting for other factors, tobacco use at
age 15 was shown in two studies to predict cannabis use at around ages 17 to 18.6
Cannabis is the most widely used illicit drug in Australia and regular heavy usage carries the risk
of dependence and conditions such as lung disease, as well as the impairment of cognitive
functioning. Cannabis, often in interaction with other drugs, poses extra short-term safety risks
(e.g. for drink-driving). It can also exacerbate symptoms of mental health problems and a
number of recent studies have documented some evidence of a relationship between adolescent
cannabis use and later mental health problems.
The National Drug Research Centre & the Centre for Adolescent Health. (2004) The Prevention of Substance Use, Risk
and Harm in Australia: a review of the evidence, Canberra: Ausinfo.
McGee R, Williams S, Poulton R, Moffitt T. A longitudinal study of cannabis use and mental health from adolescence
to early adulthood. Addiction 2000; 95(4):491503. Coffey C, Lynskey M, Wolfe R, Patton G. Initiation and progression
of cannabis use in a population-based Australian adolescent longitudinal study. Addiction 2000; 95(11):16791690.
See The National Drug Research Centre & the Centre for Adolescent Health. (2004) The Prevention of Substance Use,
Risk and Harm in Australia: a review of the evidence, Canberra: Ausinfo. See also VicHealth Centre for Tobacco Control
(2001). Tobacco Control: A Blue Chip Investment in Public Health. Melbourne: The Cancer Council of Victoria.
The National Drug Research Centre & the Centre for Adolescent Health. (2004) The Prevention of Substance Use, Risk
and Harm in Australia: a review of the evidence, Canberra: Ausinfo.

th
National Tobacco On the 12 November 2004, the Ministerial Council on Drug Strategy
Strategy
endorsed the second National Tobacco Strategy, covering the period
from 2004 to 2009. The overall goal of the National Tobacco Strategy is
to improve health significantly and to reduce the social costs caused by, and the inequity
exacerbated by, tobacco in all its forms. Two key objectives of the current Strategy are:
to reduce the uptake of tobacco use in non-smokers; and
to increase cessation, by encouraging and assisting as many smokers as possible to

quit as soon as possible.
The majority of tobacco control efforts have been focused on the latter of these objectives, and
have been aimed particularly at adult smokers. While this remains an important and successful
approach, effectively addressing the issue of youth smoking is vital to reducing further the longterm smoking rates in the community and diminishing the burden of tobacco-related illness and
disease on the community. This is made abundantly clear in the Strategy by the three outcome
indicators associated with the objective of reducing uptake. They are:
fewer young people smoking regularly;
substantially fewer young people making the transition to established patterns of

smoking; and
fewer young adults making the transition to dependent patterns of smoking.
The need for

research
In order to provide policy leadership, the Australian Government

Department of Health and Ageing identified a need for a comprehensive
understanding of youth smoking behaviours, clarifying the processes of
uptake, addiction and cessation and the mediating role played by various risk factors and
protective factors. In accordance with best practice, this research is a resource upon which all
governments may draw, enabling them to promote policies and fund targeted spending
initiatives on the basis of sound evidence for their effectiveness.

2.2 Research objectives

Overall, the aim of this research was to address the current gaps in knowledge of youth smoking
behaviour, for use in the development of anti-smoking campaigns and programs targeted at
young people aged 12 to 24 years.
The research explored five topic areas:
1.
Current attitudes of young people towards smoking
To improve understanding of:
young peoples knowledge of the health risks of tobacco use;
young peoples attitudes towards interventions for the prevention of tobacco use;
and
2.
attitudes of young people towards smoking.
The impact of parental attitudes on uptake of smoking by young people.
To provide:
a better understanding of typical parental attitudes to smoking, youth smoking and

their own children smoking;
insight into the impact of parental attitudes on uptake of tobacco by young people;
and
insight into successful methods of delivering anti-smoking messages to parents for

their use in discouraging the uptake of tobacco by their children.
3.
Available interventions to halt the move from youth at risk of tobacco experimentation
to dependence.
With a particular focus on youth viewed as at risk, to investigate:
the factors behind the move from experimentation with tobacco to dependence
leading to continued smoking in adulthood; and

identification of good practice early intervention models to halt the move from
experimentation to addiction.
4.
Strategies employed by young people to reduce or cease smoking
To investigate:
young peoples beliefs around the addictiveness or otherwise of tobacco products

and the impact on the desirability of smoking;
barriers and motivations to quit;
young peoples attitudes to stopping or reducing amount of tobacco use;
successful or unsuccessful strategies employed by young people to achieve

reduction or cessation of tobacco use (including any school-based support or
education programs); and
5.
young peoples beliefs about strategies that could help them to quit smoking.
An understanding of the association between youth smoking and cannabis
To investigate:
young peoples attitudes to cannabis use and if it differs from their attitude to
tobacco use;
the impact of cannabis use on uptake, increase or maintenance of tobacco use,

particularly given that both cannabis and tobacco are usually inhaled and cannabis is
often inhaled with tobacco; and
whether there is a potential causal link between youth tobacco smoking and the
uptake of cannabis
The research program undertaken to meet the research objectives and explore these issues
of interest is outlined in the following section.
10

3
Research design
Prior to conducting the primary research, Eureka Strategic Research carried out an analytical
review of the available evidence relating to youth smoking. The literature review methodology
and findings are reported in a separate document.7 This review phase assisted in refining the
sample structure and key research questions pertaining to the subsequent qualitative research
program.
This section provides details of the research methodology for the primary qualitative research
component.
3.1 Qualitative methodology

Qualitative research is exploratory, allowing for a detailed and flexible examination of the nature
of young peoples perceptions and their decision-making. It was therefore an appropriate
vehicle for uncovering and identifying issues relating to uptake and cessation among young
people.
The research used a
mix of different qualitative techniques,
because different lines of
investigation and subject matters are best suited to different qualitative techniques. Thus, a
combination of individual depth interviews, affinity paired interviews and group discussions
(both mini-groups and standard size) were employed.
3.2 Sample structure for young people

A total of 30 group discussions (including six mini-groups with Indigenous young people), 39
affinity pair interviews and 36 in-depth interviews with young people were conducted. The
Eureka Strategic Research, Youth tobacco literature review, June 2005.
11

research also involved 14 group discussions with parents of adolescents aged 12-18 years, details
of which are provided in section 3.3.
Sample structure
With young people in the general community, 24 group discussions, 36

depth interviews and 36 affinity paired interviews were conducted. The
sample structure for the group discussions, depth interviews and affinity pairs with young people
from the general community is shown in the following table.
12

School year/age
Years 7-8
Tobacco smoking/trial status
15-17 yrs
Years 11-12
(non-students)
18-21 yrs
Non-trialists
Not smoked in last
Not smoked in last
Ceased smoking
week
1 group discussion week
1 group discussion
1 group discussion
1 group discussion
(Busselton)
(Adelaide)
(Brisbane)
(Sydney)
1 depth interview
1 depth interview
1 depth interview 1 depth interview
(Adelaide)
(Dubbo)
(Brisbane)
1 affinity pair (Coffs (Coffs Harbour)
1 affinity pair (Sydney)
Not
1 affinity pair (Brisbane 1 affinity pair
Harbour)
smoked
(Busselton)
Non-trialists
Non-trialists
Not smoked in last
Ceased smoking
in last
1 depth interview 1 group discussion
week
1 group discussion 1 group discussion
(Bendigo)
(Coffs Harbour)
(Adelaide)
1 group discussion
(Bendigo)
week
1 affinity pair (Adelaid 1 depth interview
(Bendigo)
1 depth interview
1 depth interview
1 depth interview
(Brisbane)
(Dubbo)
(Adelaide)
Ceased
(Sydney)
1 affinity pair
1 affinity pair
1 affinity pair
(Bendigo)
(Dubbo)
smoking
(Dubbo)
Trialists
Trialists
Smoked in last week Smoked in last week Smoked in last week
1 group discussion 1 group discussion 1 group discussion
(Dubbo)
(Sydney) tried
(Bendigo)
(Busselton)
(Sydney)
smoking, but not smoke 1 depth interview
1 depth interview
in last week
(Sydney)
(Adelaide)
(Dubbo)
(Brisbane)
1 group discussion 1 affinity pair
1 affinity pair
1 affinity pair
1 affinity pair
Trialists
(Dubbo) tried and (Sydney)
(Busselton)
(Brisbane)
(Bendigo)
has continued
and/or
1 depth interview
smoking
(Sydney)
tried but
1 depth interview
1 affinity pair (Coffs
not
(Sydney)
Harbour)
1 affinity pair
continued
(Adelaide)
smoking Trialists
Trialists
Smoked in last week
Smoked in last week
1 group discussion
1 group discussion
(Brisbane)
(Coffs Harbour) (Sydney)
(Sydney)
tried smoking, but 1 depth interview
1 depth interview
1 depth interview
Smoked
not smoked in last
(Bendigo)
(Busselton)
(Coffs Harbour)
1 affinity pair (Brisbane week
1 affinity pair (Adelaid
in last
1 group discussion
week
(Brisbane) tried and
has continued smoking
1 depth interview
(Sydney)
1 affinity pair
(Bendigo)
Used cannabis in last Used cannabis in last Used cannabis in last
Tried cannabis
Ever tried 1 depth interview (Sydney)
6 months
3 months
3 months
1 depth interview
cannabis 1 affinity pair (Brisbane)
(Sydney)
(Bendigo)
(Bendigo)
1 depth interview (Brisbane)
1 affinity pair
1 affinity pair (Brisbane 1 affinity pair
1 affinity pair (Bendigo)
(Dubbo)
(Sydney)
Nontrialists
Cannabis smoking
status
Years 9-10
Used
cannabis
in last 3
or 6
months
Male
Non-trialists
1 group discussion
(Sydney)
1 depth interview
(Dubbo)
1 affinity pair (Adelaid
Tried cannabis
1 depth interview (Sydney)
1 depth interview (Coffs Harbour)
Female
Used cannabis in last

6 months
1 depth interview
(Busselton)
1 affinity pair (Coffs
Harbour)
Used cannabis in last Used cannabis in last

three months
3 months
1 depth interview
1 depth interview
(Sydney)
(Brisbane)
1 affinity pair (Coffs 1 affinity pair (Coffs
Harbour)
Harbour)
22-24 yrs
Ceased smoking
1 group discussion
(Coffs Harbour)
1 depth interview
(Sydney)
1 affinity pair
(Adelaide)
Ceased smoking
1 group discussion
(Brisbane)
1 depth interview
(Busselton)
1 affinity pair
(Brisbane)
Smoked in last week
1 group discussion
(Adelaide)
1 depth interview
(Bendigo)
Smoked in last week

1 group discussion
(Dubbo)
1 depth interview
(Adelaide)
1 affinity pair
(Busselton)

3 months
1 depth interview
(Adelaide)
1 affinity pair (Busselton
3 months
1 depth interview (Coffs
Harbour)
1 affinity pair
(Adelaide)
Mixed
Note: Italics in above table means med-high SES
13

There are many variables that could potentially impact upon young peoples interests, attitudes
towards and perceptions of smoking.
A number of these issues, and how they were
incorporated into the research design, is detailed below.

Smoking/trial
status
Young people who have made different choices regarding smoking tend
to old different attitudes and perceptions about this issue. The role of
policies, programs and interventions will differ according to ones
smoking status (for example, anti-smoking campaigns may assist in preventing uptake among
non-smokers, or motivating cessation among smokers). To fully understand the stages of
uptake, from trial to adoption, as well as young peoples attitudes towards and experiences with
cessation, it was critical that the research include smoking (or trial) status in the sample structure.
Importantly, the sample was divided on the basis of smoking/trail status, rather than merely
ensuring that the total sample included young people with different experiences with respect to
smoking. This provided an environment in which participants could feel able to express their
views freely.
Although we recognise that there are more detailed theories of stages of uptake and cessation,
we have illustrated the stages using a broad conceptual framework in the following diagram, to
help illustrate the way the sample was structured.
Never tried
smoking
(Non-trialist)
Trial
Tobacco smoking status -
Have tried
smoking
(Trialist)
Adoption
Recent smoker
(Have smoked Cessation
in last week)
Ceased
smoking
For younger students (school years 7 to 10), smoking status was
determined by whether or not the individual has ever tried smoking. Those who had tried
smoking were assigned to the positive trialing groups/interviews; those who have never tried
smoking were assigned to the negative trialing groups/interviews.
Years 9 and 10 at school is an age at which trial to initiation is a critically important issue. As
shown in the table above, the mainstream component of this research comprised six groups
with those in Years 9 and 10, as follows:
two group discussions with non-trialists;
14

two group discussions with those who had tried, but had not taken up, smoking, and
two group discussions with those who had tried and continued smoking.
The key advantage of this approach was that it allowed the process of uptake to be examined in
more detail. It also meant that, among this age group, those who had tried, but rejected
smoking, were not mixed with those who had tried and continued smoking. This provided
more comfortable group dynamics, which is particularly important for this age band, and
allowed potentially different attitudes towards smoking to be examined.
For older students (school years 11 to 12) and for non-students aged 15-17 years, smoking status
was determined by whether or not they have smoked in the last week. Thus, the positive
smoking/trialing groups/interviews consisted of individuals who had either trialed smoking
recently (rather than ever) or were current smokers. Individuals who have either tried smoking
longer ago but do not currently smoke, or who have never tried smoking, made up the negative
smoking/trialing group.
For those aged 18-24 years, the sample was divided into those who had ceased tobacco smoking
(including those who used to be social smokers, as well as people who used to smoke every
day) and those who currently smoke every day, allowing exploration of the motivators and
barriers to quitting among current and ex-smokers in this age group. Never-smokers were not
included among this age group, given that more than 90% of adult smokers in Australia
commenced as teenagers8, and so there was likely to be little gained from speaking to neversmokers in this age group.
This structure allowed the research to shed light on the stages of tobacco smoking uptake, by
disentangling the views of those who have never smoked, from those who have tried it, and
those who have formed a habit.
Cannabis smoking status
- To explore cannabis use and how this relates to tobacco smoking
among young people, depth interviews and affinity pairs were conducted with those who had
ever tried cannabis and/or had smoked cannabis in the last three or six months. Specifically,
8 Australian National Tobacco Strategy, 2004-2009: The Strategy. Ministerial Council on Drug Strategy, November 2004,
p9
15

ever tried cannabis was the criterion for those in years 7-10 at school, used cannabis in last
six months was the criterion used for Years 11-12 school students, and used cannabis in last
three months was the criterion used for 15-17 year old non-students, and for those aged 18
years and over.
Attitudes towards cannabis were explored in all group discussions and interviews, not just with
cannabis trialists / users.
Age/School year
As the teenage years are a time of rapid personal and social development,
the groups were separated by developmental stage.
In addition to
reasonably narrow age bands, participants who attend school were segmented by school year,
rather than by age, since school year is more likely than age to influence school students
interests, attitudes, and social environment.
As specified in the National Tobacco Strategy, 2004-2009,9 connectedness to school is an
important protective factor against smoking. Among non-school students aged 15 to 17 years
(corresponding to school years 10 to 12), given their similarity in life situation, this age range was
considered to be sufficiently narrow to ensure cohesion in the group discussions.
Hence, the sample was separated into the following bands:
Years 7-8
Years 9-10
Years 11-12
Non-school students (15-17 years)
18-21 years
22-24 years
9 Australian National Tobacco Strategy, 2004-2009: The Strategy. Ministerial Council on Drug Strategy, November 2004,
p17
16

Among those young people aged 18 to 24 years, there was a mixture of those engaged in fulltime study, and those who are not.
Since males and females in early adolescence tend to interact uneasily with
Gender
each other on a social basis and may bring different perspectives to

tobacco use, it was useful to conduct single-gender groups and affinity pairs among the younger
age categories.
There are also gender differences in the acquisition of social skills and
confidence that needed to be taken into account. Therefore, to promote uninhibited discussion,
single-gender groups and affinity pairs were used for the discussions with students in school
years 7 to 10.
Given the different levels of smoking among males and females in the older age bands, as well
as the potential sensitivity of the discussion (e.g. concern for weight as a barrier to cessation), the
views of males and females aged 18-24 years were explored separately as well.
Socio-economic
status
Research indicates that smoking is much more prevalent among the less
educated, blue-collar workers and the unemployed.
To ensure
participants from different socio-economic backgrounds were included,

the sample was counter-balanced on the basis of low-medium or medium-high SES.
Participants were screened during the recruitment process to ensure that they fell into the target
group. A small set of questions was used to assess SES, covering the occupation type of the
main income earner in the household, their highest education level attained, and the household
income category. Participants parents were asked to provide answers to these screening
questions. For younger participants (those of school age), parental permission to participate in
the research was also sought at this time.
Geographic
location
Smoking rates differ with location, with rates in other metropolitan

centres being significantly higher than the rates in capital cities (30.6% vs
24.6% in 1995).10
10
Smokers in rural and remote regions have been
1995, ABS National Health Survey.
17

identified under the National Tobacco Strategy, 2004-2009,11 as a disadvantaged group for which
tailored messages and support will be required. Hence, it was important to ensure geographic
diversity in the locations selected for the research.
The mainstream component of the research was conducted in seven different locations:
Adelaide
Bendigo
Brisbane
Busselton
Coffs Harbour
Dubbo
Sydney
This ensured that metropolitan, regional and rural areas were included in the research.
CALDG
The literature reports that the prevalence of smoking among secondary

students from a non-English speaking background has been consistently
lower than other secondary students. These lower rates of adolescent smoking apply particularly
to Vietnamese and Arabic-speaking adolescents, despite high adult smoking prevalence in these
communities.
Further, as highlighted in the literature review, prominent researchers in this area argue against
specifically ethnic-oriented interventions.
The group discussions and interviews with
mainstream Australians therefore included representation from a range of cultural and linguistic
backgrounds, in accordance with recommendations of researchers in the field.
Smoking rates among
Aboriginal and Torres Strait Islanders
are typically twice the national
averages, although there is wide variation in the smoking prevalence among Aboriginal and
11
Australian National Tobacco Strategy, 2004-2009: The Strategy. Ministerial Council on Drug Strategy, November 2004.
18

Torres Strait Islander peoples. In some communities, the rate is as high as 80%.12 Prevalence
data show that adolescent smoking is also significantly higher among Indigenous communities,
as detailed in the literature review. Hence, a dedicated research component was conducted with
Indigenous young people, as detailed in section 3.4.
3.3 Sample structure for parents

To understand the impact of parental attitudes on smoking among young people, we propose to
conduct 12 with parents from the general community. (As reported in section 3.4, two minigroup discussions were also conducted with Indigenous parents.) The sample structure for the
group discussions with parents from the general community is shown in the following table.
Age of child
Parental tobacco smoking status
not living with another

caregiver
Smoker
living with another caregiver

who smokes
who doesnt smoke
not living with another
caregiver
Non-smoker

who smokes
who doesnt smoke
Years 7-9
Years 10-12
female
low-med SES
Sydney
mixed gender
med-high SES
Adelaide
mixed gender
low-med SES
Coffs Harbour
female
med-high SES
Dubbo
mixed gender
low-med SES
Busselton
mixed gender
med-high SES
Sydney
female
med-high SES
Coffs Harbour
mixed gender
low-med SES
Busselton
mixed gender
med-high SES
Brisbane
female
low-med SES
Adelaide
mixed gender
med-high SES
Brisbane
mixed gender
low-med SES
Bendigo
The variables which were incorporated into this sample structure are discussed under the
following headings.
12 Cited in the National Tobacco Strategy, 2004-2009: The Strategy. Ministerial Council on Drug Strategy, November
2004, p18
19

Age of child
The research involved speaking to parents of children in high school.

Parents of young adults and those who had left school were not included,
because parents tend to have less influence over the behaviour of their adult children than they
do when their children are younger.
Age of the child was used to structure the sample, being a more useful analysis variable than the
age of the parent. Similar to the research with young people themselves, this was based on
school year, rather than on the actual age of the child. Parents qualified for a particular group if
they had one or more children within the school year bracket specified. Of course, there was
some overlap, with some parents having children across more than one of the specified school
year bands.
Tobacco smoking Parents own behaviour can significantly impact on the behaviour of their
status of parent
children. For example, there is evidence that teenagers whose parents
have quit are much less likely to take up tobacco smoking than teenagers
with a parent who still smokes.13 Furthermore, rates of smoking uptake are lower for children
who live in smokefree homes.14
Therefore, it was important to explore the views of parents who are themselves tobacco
smokers, and those who are not. Half of the group discussions were conducted with smokers
and half with non-smokers.
Household
structure
Although the parent included in the research was themselves either a

tobacco smoker or a non-smoker, other parental figures within the
household can represent significant sources of influence. Hence, the
tobacco smoking status of the caregivers in the household was included as a variable in the
research design.
13 Farkas A, Distefan J, Choi W, Gilpin E, and Pierce J. (1999). Does parental smoking cessation discourage adolescent
smoking? Prev. Med.; 28: 213-8.
14 Wakefield M, Chaloupka F, Kaufman J, Orleans C, Barker D, and Ruel E. Effect of restrictions on smoking at home, at
school, and in public places on teenage smoking: cross sectional study. Br Med J. 2000; 321: 333-337.
20

In addition to households where there are two caregivers, it was ensured that single parents were
also included in the research. There is a disproportionate rate of tobacco smoking among this
group.
Gender
The roles adopted by males and females as parents can be quite divergent.
Despite these differences, there was no reason to believe that either sex
would self-censor in front of the other while discussing smoking or their attitudes towards their
childrens smoking. Hence, the group discussions were mixed in gender, where feasible. For
those group discussions held with parents not living with another caregiver, these were
conducted with females, given females represent the greatest proportion (87%) of single parents
with primary custody.
Socio-economic
status
As with the research with young people themselves, half the groups were
conducted with parents from low to medium socio-economic
backgrounds, and the other half were conducted with those from medium
to high socio-economic backgrounds. Participants were categorised on occupation type, highest

education level attained and household income category.
Location
The same locations used for the research with young people were selected
for this component of the research. This delivered comprehensive, yet
efficient coverage across metropolitan, regional and rural areas.

One research
participant per
household
It was ensured that only one participant per family participated in the
research, for a number of methodological and logistical reasons which
were detailed in Eurekas research proposal.
3.4 Indigenous research component

Given that there is relatively little known about youth smoking among Indigenous Australians,
coupled with the fact that there is a relatively high prevalence of smoking (tobacco and cannabis)
among young Indigenous Australians, it was important to include these populations in the
research design. Ideally, a sufficient number of separate group discussions and depth interviews
should be included to allow the researchers to draw meaningful, separate conclusions about
smoking among Indigenous youth from the research. The budgetary and timing constraints
prohibited a comprehensive Indigenous research component. However, a reasonable number
21

of specific group discussions and interviews offered an opportunity for valuable exploratory
learning.
It was valuable to conduct paired interviews with Indigenous young people who have tried or
currently use cannabis. This is because the prevalence of cannabis use has been found to be
higher among Indigenous young people than non-Indigenous young people in Australia, and
also because of evidence that cannabis use often precedes tobacco initiation among Indigenous
populations.
The influential role of the social context on young Indigenous peoples smoking, and the
consequent importance of tobacco control in the broader Indigenous community, suggested
that the research would benefit from including components with some or all of Indigenous
parents, elders and health workers. Given the research objectives for this project specifically
include exploring parental attitudes towards smoking, it was valuable to include the views of
Indigenous parents.
For all these reasons, a small component of the research was dedicated to exploring the view of
Indigenous young people and parents.
Indigenous young
people
A total of 6 mini-group discussions, and three affinity-paired interviews,

were conducted with Indigenous young people, as summarised in the
following table.
22

Cannabis
Tobacco
Age
Years 7-9
Years 10-12
or 15-17 yrs
18-24 years
Non-trialists
1 mini-group
males
Perth
Not smoked in
last week
1 mini-group
females
Sydney
Ceased
smoking
1 mini-group
mixed gender
Perth
Trialists
1 mini-group
females
Perth
Smoked in last
week
1 mini-group
males
Dubbo
Smoked in last
week
1 mini-group
mixed gender
Sydney
Tried cannabis
1 affinity pair
females
Sydney
Used cannabis
in last three
months
1 affinity pair
males
Perth
Tried cannabis
1 affinity pair
males
Perth
The middle age band in the sample structure illustrated above was defined as school students
in years 10, 11 or 12 at school and/or non-school students aged 15-17 years.
Research with
Indigenous
parents
Two mini-group discussions were conducted with Indigenous parents, as

illustrated below. Each group comprised a mix of smokers and nonsmokers.
Age of child (at least one child within age band)
Years 7-10
Years 9-12 / 15-17 yrs
1 mini-group
mixed gender
Dubbo
1 mini-group
mixed gender
Sydney
23

Conduct of
Indigenous group
discussions and
interviews
A specialist Indigenous facilitator was engaged to conduct four of the

mini-group discussions and the paired interviews, while two of the minigroup discussions (including one with Indigenous parents) were
conducted by Eurekas project team.
3.5 Conduct of the qualitative research

Research tools
Comprehensive discussion guides for the discussions with young people

and parents were developed in consultation with the Department (see
Appendix A.)
The use of projective and enabling techniques can be particularly valuable for research with
young people. For example, word association tasks, sentence completion exercises are both
useful methods of indirect inquiry and were usefully employed in this research. They also made
the proceedings more varied and interesting for the participants.
Individual notepads were used in group discussions where this was appropriate and where
literacy levels permitted this. The notepad exercise can help to minimise any group leader
effects that can otherwise swamp the contribution of less confident participants, particularly in a
situation involving adolescents.
Duration and field
dates
Group discussions were between 1 and 2 hours. Depth interviews ran

for approximately 45 minutes to 1 hour each.
Fieldwork was conducted between 18th April and 31st May.

Number of
respondents per
group
Groups of around 7-9 participants were used for all group discussions
with adults in the mainstream component of the research.
With
teenagers, larger groups can overwhelm and nullify the contribution of
quieter respondents, so the mainstream component with those under 18 years involved 6-7
participants per group. All mini-group discussions involved between 3 and 5 participants.
Recruitment
Parental permission was sought for all participants still at school (even
though the ASMRS Code of Professional Behaviour only requires this for
those under 16 years of age).
24

During recruitment, any persons who work for a tobacco company (or, among young people,
whose parents work for a tobacco company) were excluded. Likewise, those who work within
tobacco control or in the treatment of tobacco-related illness, and who may be overly
knowledgeable, were also screened out.
Incentives
$30 gift vouchers (CD vouchers or Coles/Myer vouchers, depending on

what retail outlets existed in the locations used for the research) were used
as incentives for school students.

Where appropriate, younger participants who were relying on their parents to drop them off and
pick them up from a group discussion or interview were provided with an additional $15
Coles/Myer voucher as a token incentive for their parents. This helped to compensate parents
for their time and travel expenses associated with taking their children to participate in the
research, and helped to increase participation among the younger age bands.
For participants who had left school and/or were aged 18 years and over, including parents, a
cash incentive of $60 was used.
25

4
Research findings
4.1 Knowledge and attitudes
At the outset of the discussion about smoking, research participants were
Perceived norms
asked what words or images came to mind when they thought about
smoking. For many participants in early high school and for most non-smokers, their stated
views of smoking were almost exclusively negative. They viewed smoking as a smelly, repulsive
habit and tended to focus on its health effects. Adolescents who had tried smoking also
expressed mostly negative views, but some also held some positive attitudes towards smoking.
For older adolescents and young adults, smoking had several positive associations with
socialising, consumption of alcohol and routines (like smoking after a meal). Even so, these
participants also perceived negative aspects of smoking. This range of attitudes is illustrated in
the following diagram.
Smell in hair
/ clothes
Coughing
Dessert
Temporary
release
Yellow teeth
De-stress
Illness
Gross
Cost
Peer
pressure
Look cool
Company
Image
Lung
cancer
Alcohol
Smoking
Coffee
Not kissable
Happy
Yuck
Health
Bad breath
Disgusting
Addiction
Headspins
Relax
Break
26

There was evidence that adult smokers (especially parents) increasingly see themselves as a
marginalised minority, as illustrated in the following quotes.
Weve been put into a category in the same way as some people look at criminals
or ex-cons, or junkies we get looked at the same way. [Female parent, smoker]
The amount of looks I got and people craning their necks to see who that
disgusting smoker is. It annoys me. I went two hours without one in that shopping
centre for you guys. [Female parent, smoker]
This was largely seen as a result of heightened awareness about the impact of passive smoking,
the rights of non-smokers and increasing smoke-free legislation. These factors, and continual
emphasis on the health effects of smoking, appear to be changing societal norms (among adults)
and leading to smoking being seen as more of a marginal activity.
A few young people, usually from higher socio-economic backgrounds, appeared to recognise
that smoking is increasingly concentrated among lower socio-economic groups.
Its a dero thing to do. [Male non-smoker, yr 11-12]

Homeless people you constantly see them smoking, and I associate smoking
with dirty, its a dirty habit. [Female non-smoker, yr 9-10]
More, like, lower class people smoke. [Male non-smoker, yr 11-12]
However, these comments were relatively rare, and most young people seem to perceive
smoking as much more mainstream (among their peers and among adults) than is actually the
case.
Indeed, when young people were asked to estimate roughly how many people their age smoke,
many (particularly those who had tried smoking or currently smoked) over-estimated the
proportion. For example, young adults often estimated that at least 50% of people their age
smoked. This finding is illustrated in the quotes below.
A lot of people smoke. Its everywhere. [Male smoker, 22-24]

I reckon most teenagers smoke now. [Female smoker, 15-17, Indigenous]
27

About half. I think there would be about 20 percent of our group of friends that
dont smoke. [Female smoker, 18-21]
Similarly, they tended to over-estimate smoking prevalence among adults, often inferring the
percentage of adults that smoke from their perceptions of the number of smokers among their
peers or people in their school year.
Id say about two-thirds of the people my age would be smokers by now. Its
certainly about two-thirds of people I know are smokers. I dont really know for
adults, but Id guess it would be around two-thirds as well. [Male smoker, yr 9-10]
There was also a tendency among young people to over-estimate how often and how many
cigarettes an average smoker would smoke.
Consistent with these findings, many see trialling cigarettes as almost ubiquitous. This was less
common among younger non-trialists. However, many young people saw trying a cigarette as
part of the developmental process a curiosity that needed to be satisfied at some stage, or a
rite of passage to adulthood. Furthermore, most teenagers believed that the number of
people smoking increases throughout teenage years, becoming much more common among
those in older year groups and very widespread among adults.
These findings indicate that many young people do
not
see smoking as the minority
phenomenon that it is. As reported in more detail in section 4.2, the desire to be seen as adult
(or at least as older and more mature) is a particularly strong motivator for smoking. The
systematic over-estimation of smoking in society clearly contributes to the perception of
smoking as being a relatively normal, adult behaviour
and thus as a symbol of maturity,
much like driving a car, going to licensed premises or becoming/appearing sexually active.
Knowledge of
long-term effects
of smoking
There was universal awareness that smoking in the long term can be
harmful. Most mentioned cancer (especially lung cancer) and several
mentioned heart problems, although understanding of the specific
details or range of effects was generally weak.

It is clear that school interventions have been successful in imparting the knowledge that longterm smoking is harmful. Most young people report learning about the long-term consequences
28

of smoking during primary school as part of their basic health education (such as Healthy
Harold). These messages are reinforced in early high school through PD / Health / PE classes,
where students learn further details on the health consequences of smoking.
Schools were reported to be an important source of information for young people on the longterm effects of smoking. Other information sources, including interventions targeting adults,
also serve to teach young people about the effects of smoking, and/or to reinforce those
messages. For example, there was widespread awareness of the National Tobacco Campaign
television commercials, particularly the advertisement showing the lung dissection and the
advertisement featuring the aorta.15 Research participants, especially males, evinced a certain
appetite for shocking or gory messages like those used in the National Tobacco Campaign.
Health warnings on cigarette packets, restrictions on smoking in licensed premises and the
presence of no-smoking rules in private homes were also reported as communicating the health
effects of smoking to society, including young people themselves. In addition, illness and death
among relatives, especially in Indigenous communities where families and extended families can
be particularly close, highlight the health effects of long-term smoking and serve as salient
reminders of its risks. All these things were mentioned by participants in the research.
Although young people know that long-term smoking is dangerous, most young smokers
appeared to dissociate themselves from these consequences. The severe health effects of
smoking are believed to affect only long-term, regular smokers, and few expect either to become
addicted or to smoke in the long term. Even among those who do see themselves smoking
when they are older, they do not focus on the long-term consequences of smoking, believing
them to be too far away to worry about, and instead focus on their quality of life in the short
term. This was particularly so among some young Indigenous people, where several competing
challenges were seen as more pressing and/or severe than the potential consequences of
smoking. As one participant said
For a lot of smokers, thats not the worst thing theyve done. Its stopping them
from going back to doing the bad things. So theyre going yeah but I could be off
my face right now, just be happy that Im smoking. You say thats going to kill me
15 Few young people recognised the organ as an aorta, or absorbed the message that smoking causes heart disease, but the
advertisement was clearly successful at conveying a repulsive image of the health effects of smoking.
29

but if I wasnt doing this Id probably be dead by now anyway. [Female,

Indigenous smoker, 22-24]
Were all going to die anyway. By the time it hits us, we probably cant even walk
by then. [Male smoker, 18-21]
Long-term effects no one thinks about it. Everyone lives for today. [Male
smoker, 22-24]
We dont really think about it until our hands start falling off and stuff. [Male
smoker, 18-21]
It was also common for young people to hold self-exempting beliefs where they believed that
such consequences were unlikely to happen to them personally.
It happens to some people and not others. [Male smoker, 18-21]

These types of beliefs were often fuelled by counterexamples, with young people relaying stories
of how someone they knew smoked all their life, and either suffers no health consequences or
died of unrelated causes. Importantly, such counterexamples were not used as a way of
suggesting that smoking is not unhealthy (a phenomenon sometimes seen in adults). Rather,
they were used as a basis for arguing that there was a possibility that one could beat the odds.
Short-term
effects of
smoking
There was high awareness of various short-term effects of smoking, both

health and aesthetic. Some (particularly young adults) felt that they had
already experienced some of the respiratory effects of smoking, such as
coughing, reduced fitness or aggravation of existing asthma.
Ive given up sport because Im just so unfit [from smoking]. [Female smoker, yr
11-12]
Others had not noticed any impact on their health. It is possible that, in some cases,
maturational development can mask some of these effects (e.g. one can normally run faster as
one physically grows and develops, and so any reduction in fitness that may be attributed to
smoking goes unnoticed). Reduced fitness appeared to be more of a concern among males than
females, especially young Indigenous males.
30

I wish I didnt start smoking. Im addicted now cant give it up. I used to be
good at football but now I cant run as good and Im real lazy. [Male smoker, yr 910, Indigenous]
There was some mention of the cost associated with smoking, although young people tended to
focus on the immediate financial effects. Few extrapolated the financial effects to the medium
term (for example, being able to save up to buy a car, or go on a holiday) or the long term (for
example, ability to buy a home).
The impact of smoking on ones physical appearance (including yellow fingers, stained teeth,
bad skin and wrinkles) was reasonably salient among many young people, although it appeared
to be more of a concern among females. Often, the impact of smoking on ones physical
appearance was expected to be earlier and more severe than it is in reality.
The unpleasant and penetrating smell associated with smoking was particularly salient. Many
commented on the repulsive smell that lingered on ones hair, breath and in ones clothes.
There does appear to be potential to leverage young peoples desire to be sexually attractive
against this unpleasant outcome, directly undermining the link between smoking and
perceptions of sexual maturity. Many young people noted the negative impact that smoking can
have on ones sexual appeal, as illustrated in the following quotes.
I lie down next to him and it will be the mushiest moment and he smells my hair
when youre smoking, your hair does not smell good, and if you have long hair it
reeks of the stuff. [Female smoker, 18-21]
When you hear a guy youre interested in saying smoking is disgusting and its the
biggest turn-off, you think oh, okay. You hear that most guys think its a turn-off
and it really hits home. [Female smoker, 18-21]
The main reason I gave up was because my girlfriend at the time was really against
it. [Male ceased smoking, 22-24]
Addiction
There was evidence that, for a small number of young people, addiction
holds a certain adult mystique. There were other cases where young
people noted that their smoking peers loved to dramatise and exaggerate their desire to smoke.
31

They all go Oh, I just cant wait to get to the end of class so I can have a
cigarette! [Female non-smoker, year 10]
It was common for those who had never tried smoking to believe that their smoking peers were
not addicted, and only smoked for appearances sake.
Some of them could be but others are always saying how they need a smoke.
They think they cant go one minute without a smoke. [Female, 15-17 years,
Indigenous non-smoker]
The following quotes highlight a similar view.
I reckon people talk crap when they say theyre stressing for a smoke
People our age that only smoke when theyre around friends, I dont believe that
they can be addicted. Like I think its just the fact that they want to look good in
front of their friends [Female non-smokers, Yr 11-12]
In general, however, young people viewed long-term addiction to, or dependence on, tobacco as
undesirable.
Overall, it was clear that
addiction to tobacco was a poorly-understood concept
and there
was limited knowledge about when someone is actually addicted. There was a tendency to
believe that someone was only addicted if they experienced strong cravings, needed to smoke all
day, or found quitting very difficult. Certainly, some young people felt that they would not
become addicted if they only smoked occasionally. Frequent interruptions to smoking in home
and school environments (where parental disapproval or school rules prohibit smoking) also
reinforce the view that one is not, and will not become, addicted.
When asked how easily someone can become addicted to smoking, young people were often
uncertain about the speed of addiction and their expectations varied. A common response was
that it would depend on the individual, and that some people with addictive personalities
would become addicted more easily. This notion of an addictive personality was usually seen to
apply to others, rather than oneself. Some young people pay lip service to the notion that one
can get addicted to tobacco fairly easily, although most significantly under-estimate just how
32

easily, particularly in relation to themselves. In general, there was limited knowledge of the ease
with which one can become addicted.
As illustrated in the following diagram, many young smokers distance themselves from their
perception of what constitutes addiction. They see addicted smokers as people who need to
smoke to cope or, in more extreme cases, who need to smoke frequently to avoid withdrawal.
In contrast, they view their own behaviour as little more than a mild desire to have a cigarette.
In reality, they are often much more addicted than they realise.
I wouldnt mind
a smoke
Believe I am here
I feel I need a
smoke to manage
Many actually here
I have to keep
smoking or Ill get
withdrawals
See addiction as
here
This common view is captured in the following quote:
I dont think Im totally addicted but I do need to have a cigarette every once in a
while because [otherwise] I might get a bit angry. [Female smoker, 15-17]
Most adolescents who smoke appear to become addicted well before they realise. That is, the
realisation of addiction lags behind actual addiction or comes only in hindsight. Young people
falsely believe that they are able to stay in control, that they would be able to recognise early
signs of addiction (even though they already evince them) and quit relatively easily.
I remember when we first started smoking at 15 or something and we all said to

each other that once we start to feel ourselves getting addicted, then well stop.
[Female smoker, 18-21.]
When you get to your early 20s, you sort of go why am I smoking, I should stop,
its not good for me. But then its hard to stop if youve been smoking since
you were a teenager. [Female smoker, 22-24]
It keeps going as a social thing until you need one by yourself thats when you
know youre addicted. [Female smoker, yr 11-12]
33

It wasnt until I tried to quit a couple of months ago that I actually realised that I
was addicted. I thought I was in control. [Female smoker, 22-24]
The contextual nature of addiction was an extremely notable gap in young peoples knowledge.
Adolescents are not aware of the contextual nature of addiction, believing that because they
do not smoke in all settings, they are not addicted. Habits, such as having something in ones
hands, or usually smoking at parties or while drinking alcohol, were usually seen as unrelated to
addiction. Indeed, social smoking was often viewed as the opposite of addiction, because of
the perceived contrast between infrequent smoking and regular, daily smoking. Using smoking
as a way of dealing with short-term stresses (such as exams and work) was also seen to be
unrelated to addiction.
Few young smokers believe or acknowledge that they are currently addicted, and many are
confident that they are unlikely to become addicted in future (including some who are already
addicted in certain contexts). Fuelling this belief is their conviction that quitting would be easy
for them. Several consider that their success with stopping or cutting back for short periods is
proof that they are not addicted.
It was that easy for me [to stop smoking] I went out and drank, I put myself
under every test there was, and I quit [for a while] and I didnt want it and I didnt
need it. So I know Im not addicted. [Male smoker, 22-24]
Even failed attempts to quit smoking are often seen as evidence of lacking sufficient motivation,
rather than a signal of addiction.
Although there is recognition of the long-term health effects of smoking, most expect to have
given up in their twenties. Indeed, several describe smoking as a phase and when asked
whether they believe they will smoke all their life, many report that they can see themselves
giving up when they settle down, have children or get a full-time job.
Its a phase. You go out clubbing, out with friends. At a certain point in your 20s,
half the people have stopped. Thats what I can see me doing too. [Female
smoker, 18-21]
34

I definitely dont want to be smoking when Im 25. I dont want to be smoking

when Ive got a family or something. [Male smoker, yr 11-12]
In summary, young people lack knowledge of the addictive process and they perceive a greater
degree of control than they possess.
4.2 Youth smoking pathways

Overview
The research discussions covered all key (potential) stages pertaining to

tobacco uptake, from pre-trial to cessation (as appropriate to the smoking
status and experience of individual participants). These stages are represented diagrammatically
below.
Cessation
Pre-trial
Initiation
Experimentation
/ Infrequent use
Regular use
Cannabis initiation
The research found that in cases where cannabis use was initiated, this could have occurred at
any stage throughout the pathway of tobacco uptake. However, it was most likely that cannabis
initiation would occur at later stages along the tobacco uptake pathway (if at all), most typically
after tobacco initiation or more regular use. Issues relating to cannabis use re discussed in detail
in Section 4.3.
Pre-trial beliefs
and experiences
Exploration of the pre-trial stage focussed on participants pre-existing

knowledge, attitudes, beliefs and experiences prior to initiation of tobacco
use.
This included the views of non-trialists, as well as trialists
recollections of their pre-trial situation.

35

Pre-trial
Many of those who had never tried a cigarette indicated that they feel it is unlikely that they
would become smokers in the future, often simply because they feel they have no particular
reason or incentive to do so. Some reported that smoking seems stupid and pointless.
Even so, several are unwilling to rule out trying smoking, yet typically reject the idea that they
will ever become a smoker per se. There is a widespread belief that almost all young people
will try a cigarette at some stage in their life, although non-trialists are much less likely than
trialists to perceive initiation as inevitable among young people.
Trialists often reported having multiple opportunities for trial prior to initiation, and some nontrialists also stated that they could have tried by now if they had wanted. Other trialists reported
having initiated at the first opportunity. Some young people perceive these opportunities or
direct offers (particularly where persistent) as pressure to smoke. At the same time, a number of
participants have experienced pressure
not
to smoke, most commonly from teachers, parents,
non-smoking friends and even anti-smoking advertising. Whereas the anti-smoking messages
conveyed by teachers and advertising are seen as direct, parental pressure is often more implicit
than explicit. That is, many young people simply know their parents would disapprove of
them trying smoking, without their parents having directly told them not to smoke. Pressure
(either to smoke or not smoke) seems to become less material as young people develop greater
self-confidence and a sense of independence. Perceived pressure also appears to be less relevant
as young people become older and authority figures increasingly come under question.
The belief that addiction to cigarettes might develop quickly is an important barrier to trial
among some non-trialists. As reported in section 4.1, there is a widespread belief among young
people that it is easy to get addicted (even though many under-estimate how easily and
generally lack a good understanding of the addiction process). However, when opportunities for
trial arise, pressure to smoke (either direct or indirect) often outweighs the desire to not become
addicted. Further, as detailed in section 4.1, most do not recognise when they are addicted. So,
young peoples beliefs about how easy it is to become addicted often prove unfounded
following initiation and further experimentation, because they do not recognise the signs of
addiction.
36

Initiation: drivers
Initiation of tobacco use was discussed with all participants, with trialists
focussing on their own experiences and non-trialists sharing their
opinions regarding what might encourage or discourage young people from trying smoking.
Initiation
The main drivers or motivations for trial, as revealed by this research, are similar to those
identified in previous research and literature. One commonly cited reason for trying a cigarette
is curiosity - often to find out what cigarettes taste like, what positive effects they have, and to
understand why other people do it. Similarly, a number of young people reported that they tried
their first cigarette simply because it was there and there were no particular barriers to trying
one.
Another motivator that is consistently strong among young people is the desire to be seen as
cool and adult (or, at least, older). The following quotations illustrate the strong association
perceived between smoking and being cool, and suggest that the desire to be cool can outweigh
other disadvantages of smoking.
Well, I didnt like the act of smoking. But I still thought yeah, smokings cool.
[Male ceased smoking, 22-24]
For young girls, its more of Im cool, I smoke sort of thing, young teenagers
anyway. [Female smoker, yr 11-12]
This particular driver is not always explicit at the time of trial, and often appears in different
manifestations (for example, depending on the age of the trialist). Among younger people this
motivation to seem older and cool is often expressed as the desire to appear independent and
different; that is, compared with people their own age.
For older people, on the other hand, this
motivator typically represents a desire to appear similar to others, namely to people their own
age and above.
For many young people, trying a cigarette is seen as something to add to ones collection of life
experiences. For some, there is clearly a degree of credibility believed to be earned from having
37

been there, done that, without requiring that an individual becomes a smoker, per se, as
indicated below.
I was like youve got to try it some time, theres no way I can go my whole life
without trying it. [Male, ceased smoking, 22-24]
Peer pressure also plays a significant role in smoking initiation, yet this pressure is more likely to
be implicit than explicit. This is often experienced as part of the pressure to appear cool and/or
adult. Some note that peer pressure becomes less of an issue with age; firstly, because as ones
friends mature they are less likely to apply pressure on an individual, and secondly, as the
individual matures they are typically better-equipped to deal with and resist unwanted pressure.
This point is illustrated below:
Peer pressure you sort of learn to deal with it a bit better as you get older, like
its sort of a bigger thing when youre younger, but then you realise that its not
that big a deal once you get older. Your mates are more understanding. They
didnt sort of push the issue like I thought they might. [Male non-smoker, yr 11-12]
Many participants like to think of their first experience as solely their decision and a personal
choice, attempting to negate the idea that they were responding to pressure of any sort. This is
illustrated in the following quotation:
It relates back to peer pressure then. Thats how people get into it. Like, not me,
but thats how people get into it. [Male smoker, yr 11-12]
Generally speaking, older (young adult) smokers have the benefit of hindsight and are more
likely to understand and discuss the role that their peers played in their trial of smoking. Overall,
insight into the underlying reasons for trying smoking typically comes later, with greater
maturity and opportunity for reflection.
With the benefit of hindsight, they realised that the
reasons that they smoked (such as wanting to fit in, or appear cool or independent) were
somewhat silly.
Some young people believe (or, at least, have heard) that smoking can relax people. The desire
to relax oneself is a particularly important driver among those who try their first cigarette during
38

a situation when they feel stressed. A number of participants, especially those whose parents
smoked, spontaneously recalled situations where a smoker had expressed their need for a
cigarette in order to calm down and, in some cases, returned from their cigarette break visibly
relaxed.
Generally speaking, young people seem to have an inherent need to appear mature. But why is
smoking perceived as a badge of adulthood and independence? The key reasons for this
perception is that society treats smoking as an adult activity in various ways; for example,
cigarettes are only legal for adults to buy and consume; adult smokers (and society in general)
typically tell young people not to smoke; and, although it appears that this association is likely to
weaken due to new legislation, smoking has been strongly associated with licensed premises,
which are only legally accessible to those over 18 years. In addition, young peoples perceptions
of smoking as a badge of adulthood and independence suggests that this is, in part, also driven
by exaggerated beliefs about the prevalence of smoking among the adult population (as detailed
in section 4.1).
Most tellingly, adolescents harbour the belief that anyone younger than they are (or for some,
the age they were when they began smoking) is too young to smoke. The idea of a very young
child smoking is as repugnant to young people as it is to adults or indeed to health authorities
because smoking is seen as something that is for adults.
Further evidence that young people see smoking as a mature thing to do is provided by the
widespread view that smoking by younger adolescents or children is wrong. Observations of
younger children smoking clearly offends the notion that smoking is for mature people (i.e.
oneself). It was clear from the way participants expressed disapproval of those younger than
them smoking that smoking is one way young people distance themselves from childhood.
Comments, such as the following, allow the young person to appear mature, by saying what an
adult would say in this situation.
Little kids are starting to get on them. Theyre wrecking their life already. Smoking
cigarettes. Primary school kids. [Male smoker, yr 7-10 Indigenous]
Another reason why smoking is seen as conveying maturity and independence relates to the use
of smoking in films and television to define on-screen personalities. Many participants noted
39

the appearance of smoking in the media, and observed that smoking was very common among
glamorous actresses in old movies. Some young females described smoking as sexy, noting
(and imitating) the stylistic repertoire of smokers. As one participant explained:
We used to roll up paper and smoke it. We used to act like people in the movies.
[Female smoker, yr 7-8]
Many participants use the act of smoking to help mask social awkwardness or immaturity, as it
reportedly makes them feel more cool and confident in situations where they know no one or
have nothing to say. Indeed, one participant described how she had begun smoking as an adult
after observing the dynamics among others in her course at college, and deciding that she would
make friends more easily if she started smoking. Smoking also becomes a shared topic of
discussion in some cases. The ability to use, and appear to be in control of, a dangerous
substance (such as tobacco) also conveys a sense of maturity.
Finally, it is evident that adult smoking role models have an influence on young peoples
perceptions of smoking as a grown-up activity. This is an important implication for Indigenous
young people, who may have fewer non-smoking adult role models, compared to the nonIndigenous community.
Initiation: barriers Despite the fact that one of the most commonly cited reasons among
non-trialists and non-smokers for not wanting to smoke are the long-term
health effects of smoking, the research suggests that long-term health is generally an insufficient
barrier, particularly for trial. At the point of initiation, most participants give little consideration
to the long term, or even whether or not they will smoke again, and a number assume that they
will not. At the time, few think that they will actually get addicted. They are therefore
unconcerned about the long-term health impact, which they typically associate with long-term
addicted smokers. Others simply do not care about the distant future, only concerning
themselves with their current situation, as illustrated in the quotation below.
I was aware [of the health risks], but I didnt see them as relevant, I suppose.
When I started I was like oh, I dont have to worry about lung cancer until Im
like 60, so why should I care? [Male, ceased smoking, 22-24]
40

The main barriers that seem more effective in delaying (or, occasionally, preventing) initiation
are outlined below. One key factor is not having any reason to smoke and the perception that
smoking is fairly pointless and has no immediate tangible benefits for the user, as the following
participant expresses.
I just think its pointless. You dont get anything out of it. Seriously, what does it
do besides fuck your lungs? [Female non-smoker, yr 11-12]
A number of non-trialists have never actually been offered a cigarette and have insufficient
reason or desire to actively seek access themselves. Many typically report that none (or very few)
of their close friends and family members smoke.
Other barriers relate to the general belief that smoking is risky as well as expectations regarding
parental disapproval and the fear of detection. The desire to avoid addiction also appears to be
an important barrier (as mentioned), for those where the risk of addiction is judged to be
reasonably high and immediate. In such cases, the risk of long-term health damage is more
likely to play a role in preventing trial. The smell of cigarettes, and of smokers themselves, can
be a sufficient deterrent in some cases, also because it has associated expectations regarding
taste. All these factors, however, appear to be more barriers to continuance than to initiation.
Non-trialists often cite the high cost of cigarettes as a key disadvantage of smoking (both the
cost of whole packets, and inflated schoolyard prices). Although trying a single cigarette is
typically not prohibitively costly and is most likely to be free, expectations regarding cost acted as
a potential deterrent to becoming a smoker, thereby sometimes reducing the incentive to try a
cigarette in the first place, although again having more effect as a barrier to continuance.
The rejection of smoking as such a transparent attempt to be cool, and the dismissal of the idea
that smoking is a way of being mature also help to discourage people from initiation. A small,
more sophisticated and, usually, more affluent group, perceive that there is a social stigma
relating to smoking, and feel that smokers are typically looked down upon.
Some non-trialists, in particular, have relatively strong opinions regarding not smoking and (in
some cases) a sense of personal commitment to not smoking. Typical reasons for this include
strong cultural, religious or moral beliefs, or having an older relative or family friend who
41

suffered (or had died) from a smoking-related illness. For many asthmatics, smoking is simply
not seen as an option, although there are some exceptions to this, particularly among those with
milder asthma. Many non-trialists seem to have no rebellious inclinations, typically seeing
themselves as relatively straight and surrounded by a straight (and non-smoking) circle of
friends. In peer networks where there is an absence of explicit pressure from ones smoking
friends, and a sense of mutual respect for other peoples decisions, there are often no drivers to
initiate smoking, other than curiosity.
The data on smoking prevalence among young people show that non-trialists tend to be
younger than trialists and, within the Indigenous community, non-trialists are likely to be very
young indeed (as noted in the literature review).
Despite this range of barriers to smoking initiation, overall, it seems that few, if any, of the
barriers noted above are sufficient to prevent initiation in the right circumstances. None can
be thought of as immunising young people against the possibility of initiation.
First experience
Those participants who had tried smoking at least once were asked to
recall their first experience. Almost all trialists reported having tried
smoking in the company of friends and, in most cases, at least one of their companions had
already tried smoking. Trialists were more likely to report having been offered a cigarette by
someone else, rather than actively requesting or seeking one out.
Most participants report that their first cigarette was an extremely unpleasant experience. The
available literature on this issue indicates that non-smokers are more likely than smokers to
report their first experience as a negative one. Participants cite various negative side-effects
from their first cigarette, ranging from the unpleasant smell and taste, to coughing and dizziness,
and occasionally vomiting. The following quotations illustrate some of these reactions.
We choked the whole time. [Female smoker, yr 11-12]

It made me sick as a dog. I spewed on the way home. [Female smoker, 22-24]
Some young people report a significant time lapse between initiation and additional
experimentation with smoking, particularly in those cases where the first experience is
overwhelmingly negative.
42

Conversely, some report experiencing positive effects when trying smoking for the first time. A
number of participants recall a rush, a sense of relaxation, feeling cool, or simply satisfaction
of their curiosity.
The first time, your heart starts racing, you can feel it going through your system
yeah, the first time I thought whoa, this is a nice feeling [Male, ceased smoking,
22-24]
The most typical reaction of friends to an individuals initiation of smoking appears to be no
reaction, typically regardless of the smoking status of these friends.
However, a few
participants said that some of their friends who held strong anti-smoking views reacted
negatively, while their smoking friends seemed happy at recruiting another smoker, as noted
below.
I guess they thought oh great, they got another one. [Male, ceased smoking, 2224]
Role of peers
The role of peers was explored in more detail in the transition from
initiation to further experimentation.
Initiation
Experimentation
/ Infrequent use
The current research provides support for the notion that peers often play a pivotal role in
influencing smoking initiation, in terms of accessibility, perceived norms, peer pressure and
various other factors. Yet this is not simply a one-way relationship. The research also suggests
that a young persons smoking status influences their choice of friends. Through these
reciprocal mechanisms, smoking and socialising become associated in the young persons mind,
contributing to the development of social habits. This relationship is expressed in the
following diagram:
43

Peers often influence initiation
Peers
(smoking status)
Self
(smoking status)
Smoking influences choice of friends
Smoking and socialising become associated
As one young person commented:
I started hanging out with all my friends and they were all smoking, so I got into it
as well. [Female smoker, 15-17, Indigenous]
The following quote is another example of smoking influencing friendship groups:
We had a big group, and half of them smoked, half of them didnt so they moved
out the back, because thats where the smokers sit, and we stayed where we
were and thats how we stopped being as close friends [Female non-smoker, yr
11-12]
Availability
Availability of tobacco products is clearly a necessary factor for initiation,

but becomes more important during the transition from initiation to
further experimentation with smoking, where more regular access to cigarettes is required.
Access to free cigarettes seems relatively easy for people under 18 years, and sources often
include other people under 18 years. Peers and older siblings are the most commonly cited
sources, and where young people report stealing cigarettes the most likely sources appear to be
family members. Older boyfriends are a common source of cigarettes for young females.
Indigenous participants report that the extended family is a particularly important way in which
they access cigarettes.
44

Individual cigarettes are widely reported to be sold at school, common prices being 50c or $1
per cigarette, as noted below.
I reckon I should start selling smokes. How much is a pack, $15? And youd sell
them for like $1 each, thats like $50 if you buy one of them Horizon ones!
[Female non-smoker, yr 11-12]
Younger teenagers, in particular, were more likely to report charging for individual cigarettes
rather than parting with them for free. This is most likely related to their lower disposable
incomes and the extent to which cigarettes are perceived as hard to come by. As young
people became closer to the legal age limit for purchasing cigarettes (i.e. 16-17 year olds), some
report that older family members (including parents) are more likely to be willing to buy a pack
of cigarettes on their behalf.
For others, it is not particularly difficult for them to buy their own cigarettes directly from retail
outlets. Some report deliberately approaching smaller dodgy-looking shops and a number
consider shop owners from non-English speaking backgrounds to be softer targets, more
willing to bend the rules to make money.16 In some cases, one could ask around to find out
which shops within the area (or neighbouring areas) offer the best chances of an uncomplicated
sale. Some young people feel that because they look older than they actually are, they are
generally not asked to provide ID. Overall, fear of rejection is relatively low, as refusal by one
shopkeeper simply means the person has to try elsewhere, and results in no serious
consequences.
Experimentation:
drivers
Motivations and barriers for continuing smoking on an infrequent basis

were subsequently discussed among those participants who had
experimented beyond the initial trial situation.
Experimentation
/ Infrequent use
A number of young people were unable to identify the reasons why they experimented further.
45

Im not sure how I started smoking. I just did. Picked it up somewhere. [Male
smoker, yr 11-12]
A few claimed simply that they kept smoking because they liked it. Others reported that they
continued smoking in the same context or situations in which they initiated smoking, often
among the same group of friends. Thus, they feel that their reasons for experimenting further
are largely the same as those for initiation, especially in those cases where there was little delay
between trial and subsequent use. Yet, as already noted, there was often long latency between
first cigarette and continuation, sometimes up to four years.
In some cases, young people reported that their first attempt at smoking was somewhat off the
mark and that this influenced their decision to experiment further. Potential reasons include
making up for coughing or embarrassing oneself the first time, hoping to refine ones smoking
skills and develop a more sophisticated smoking repertoire, or giving smoking a second try if
one did not experience the anticipated positive effects during initiations. This finding is
illustrated in the comment below:
I was like I want to try it again, see if I can do it right. I used to hold it wrong, so
someone corrected me on that. Second time it gets better. It gets better as you go
on. [Male smoker, yr 11-12]
Some participants feel that it became easier to smoke, both physically and socially, after their
initial experience. That is, there were fewer barriers to subsequent use compared with those
faced or expected in the context of initiation. As one participant commented:
I thought Ive crossed that line now. Its becoming more comfortable. [Male
smoker, 22-24]
Experimentation:
barriers
A key barrier that contributes to preventing (or delaying) further

experimentation with cigarettes is the fact that the first experience is
typically unpleasant. As stated earlier, young people are often discouraged
16 Conversely, the major supermarket chains were seen to have relatively strict protocols that make buying cigarettes more
difficult.
46

via their memories of the repulsive taste, the uncomfortable sensation of inhaling smoke,
coughing and/or feeling ill, as noted below.
It was pretty disgusting to be honest. [Male non-smoker, 18-21]

In addition, the sense that ones curiosity has been satisfied by trying a cigarette, or the rite of
passage has been completed, leaves some young people with no further incentive to smoke
again.
Further, many young people report that the same reasons which helped them want to resist
trying a cigarette were even more salient to them at the stage of experimentation. Overall, there
are a number of similarities between the factors influencing trial and those influencing
subsequent experimentation. This suggests that some of the same messages could serve to both
prevent and delay initiation as well as further experimentation.
Social smoking
The next phase in the youth smoking pathway relates to the progression
from early experimentation to more habitual or regular smoking.
Experimentation
/ Infrequent use
Regular use
It is evident from the current research (and, indeed, the broader literature in this area) that
movement of young people along this pathway is not always towards more frequent smoking.
Some participants report instances where they periodically reverted to less frequent use of
tobacco.
In addition, a number of young people identify as social smokers, that is, smoking only in
certain social situations. Those who perceive themselves to be a social smoker typically see this
as clearly differentiated from being a smoker, per se. Yet many more established smokers view
such claims with scepticism, as the following quotations illustrates.
In social situations like at parties, especially when people are drinking, there are a
lot of social smokers who say theyre not smokers. [Female smoker, yr 11-12]
47

Social smokers tend to smoke only in particular social contexts, such as when they are at parties,
pubs, clubs or bars, when they are drinking, and when they are socialising with certain peers.
Most social smokers report that they commonly binge smoke on these occasions when they
do smoke.
Such behaviour appears to represent contextual addiction, although it goes unrecognised as such
by social smokers themselves. Young people frequently reported that they started by smoking
socially and that this developed into more regular smoking. This, coupled with the fact that
smoking in the pub/club environment no doubt contributes to perceptions of smoking as
cool, glamorous and adult (since pubs and clubs are restricted to 18+ only), the potential
positive impact of smoke-free legislation in licensed premises is likely to be substantial.
Habitual / regular
smoking: drivers
The transition to more regular and habitual smoking (or dependence) is

often a gradual process that is largely unnoticed by young smokers
themselves. Some participants felt that they had no specific reasons for
increasing the frequency or regularity of their smoking behaviour.

Upon reflection, one key driver of this transition to regular smoking is perceived to have been
growing to enjoy the taste or sensation of smoking, as suggested by the quotation below.
Obviously by the time you realise that its stupid its too late because youve
started it and you like the taste. [Female smoker, yr 11-12]
Another important driver during this phase is that smoking often becomes associated with
recurring situations. For example, a number of young people report increasing reliance on
smoking to deal with times of stress or even boredom. The issue of weight control can also help
to reinforce more regular smoking, particularly (but not exclusively) for females.
Some young people have experienced cravings for cigarettes, thereby contributing to their
tendency to smoke more often. For example, a number of participants reported that they
became more likely to smoke alone than they were previously. This is often a cue for the young
smoker that their smoking habits are developing. However, the idea of nicotine itself as a main
driver of this transition is rarely stated explicitly.
48

Habitual / regular
smoking: barriers
A variety of factors appeared to play a role in delaying or halting the

progression from experimentation to more regular smoking. For some
younger smokers, an effective barrier at this stage was irregular access to
cigarettes or irregular income to pay for them, thus restricting their smoking behaviour.
For older smokers, growing insight and maturity seems to create new barriers (or at least make
them more salient where they are acknowledged during earlier phases of uptake). One such
barrier is the idea of not wanting to be a smoker, per se, and not wanting to be controlled by
smoking. This is related to another key factor, namely, increasing awareness and appreciation of
the negative social stigma associated with smoking. In addition, a number of young people
reported that the health messages they were exposed to began to take on increasing relevance.
One reason for this is that, by this later stage, young smokers often have greater personal
experience of the negative short-term health effects of smoking and that the future seems
somewhat closer than it did previously.
When youre young you think I dont want to live past 30. You get a bit older
and you think hang on, Ive got a whole life ahead of me. [Male, ceased smoking,
22-24]
Benefits and
disadvantages of
regular smoking
The current research also explored the perceived benefits and

disadvantages of regular use of cigarettes, focussing on the personal
experiences and beliefs of regular smokers themselves.
Regular use
Many current smokers or ex-smokers feel that satisfaction of ones cravings is really the only
positive of smoking. Others consider smoking to be generally relaxing. For example, young
people often reported that smoking helps them to feel more comfortable in social situations and
can make it easier to meet people. In addition, smoking can provide an excuse to take time
out and assists some young people to cope with stress. A number of participants noted the
role that regular smoking can play in terms of weight control, especially among females.
49

On the other hand, participants were readily able to point out various disadvantages of regular
smoking. Some experience of the negative short-term health effects of smoking appears
virtually universal among regular smokers or ex-smokers. These commonly include poor fitness,
coughing and generally feeling run down. The cost of maintaining a regular smoking habit is
also commonly seen as an immediate and important disadvantage. Older teenagers and young
adult smokers, in particular, are often self-critical or feel helpless for continuing to do something
that they no longer want to do. This is illustrated in the following quotation:
It is a big waste of money and it is bad for you. I am wasting money to kill myself
and I feel really stupid, but hey ... [Female smoker, yr 11-12]
Cessation
Finally, the current research examined attitudes and experiences relating

to cessation or quitting smoking, incorporating the views of young people
who had never tried to quit, those who had tried unsuccessfully and ex-smokers.
Cessation
It is evident that few young people intend or expect to still be smoking past their mid-twenties.
Many expect that the process of quitting will be relatively easy, especially quitting at a young age
(as most expect to do). Even so, young people feel that a firm decision to quit smoking is
required, and that a half-hearted attempt based on half-hearted desire or reasons will not suffice.
There are various reasons why young people might decide to cease smoking. One critical
perceived motivation for quitting is becoming more mature. AS mentioned in section 4.1, some
participants indicated that they perceive smoking as a phase they are going through while young;
a phase they plan to put an end to at an older age. Starting a family is seen as a key point in the
future when many young people, particularly females, expect to quit smoking.
As one
participant noted:
If I really wanted to, I could (quit). I think Ill stop smoking when I get older and a
bit more mature. [Female smoker, 15-17]
50

Another commonly cited reason for quitting is having a girlfriend or boyfriend who does not
like smoking, particularly in cases where they persistently encourage their partner to quit. Some
young people resent being addicted to cigarettes and report that they quit (or would like to quit)
because they no longer want to be controlled by cigarettes. Cost is also cited as a common
reason why young people want to quit smoking.
Avoiding short- and long-term health damage is an important motivation for quitting among
young adult smokers. By this stage, smokers are already likely to have experienced some
negative short-term effects (such as respiratory problems and reduced fitness), and the threat of
long-term health complications becomes more real for some. In addition, having a serious
commitment to a sport (especially at professional or relatively high levels) can be an incentive to
quit smoking in order to protect ones health and fitness. This may also involve pressure from
other people to quit, as noted below:
If I got really serious about rep footy, my coachd probably make me give it up.
[Male smoker, yr 9-10, Indigenous]
Overall, there are similarities throughout the later stages in the youth smoking pathway. In this
sense, it seems that there are certain messages that could prevent or, at least, delay the onset of
regular smoking as well as encouraging cessation among those who are already regular smokers.
Some young people who have tried to quit (particularly slightly older participants) are quick to
point out the difficulties involved in cessation and the potential for relapse. Common triggers
for relapse include times of increased stress, the influence of alcohol, being with smokers and in
situations strongly associated with smoking. It is often the case that these factors occur
simultaneously.
The first two weeks was hard, after that was fine, but when youre drinking on
Fridays and Saturdays, you just need a cigarette so its more weekends that kill
you. [Male smoker, yr 11-12]
Cessation aids
and assistance
Only a minority of participants who had tried to quit smoking had used
some form of cessation aid or external assistance. Generally speaking,
teenagers perceive that there are no cessation strategies that are
51

specifically designed for their needs. Even some young adult smokers feel that various cessation
strategies are more relevant to older smokers or are not accessible to younger smokers, as
discussed below.
Awareness of the Quitline was reasonably high. However, the Quitline was perceived as an
appropriate avenue for heavy, long-term, addicted adult smokers, who are repeatedly unable to
quit on their own. There is a lack of understanding among teenagers of what the Quitline offers,
and who would benefit from its services. Many assume that they would simply be given
information that they already know. In addition, a number of young people do not see
themselves as the type of person who would seek counselling.
There was also widespread awareness of certain types of products that come under the Nicotine
Replacement Therapy banner, particularly patches and gum. However, some viewed NRT as
excessively costly for young people. Other adolescents questioned whether the purchase of
NRT was legal for those under the age of 18, as noted below.
I dont know, can you buy them? If you cant buy cigarettes, you probably
shouldnt be able to buy patches because kids would start getting addicted to
patches. [Male smoker, yr 11-12]
Furthermore, NRT was often seen as ineffective or a placebo, with some young people recalling
instances where they failed to help someone else quit.
An unassisted cold turkey strategy is overwhelmingly believed to be the most successful
means of quitting. This belief is particularly strong among males, who are more likely to
perceive the adoption of other strategies or the need for external assistance as a sign of
weakness.
4.3 Cannabis
Norms and
attitudes
Prior to discussing cannabis use, participants were asked to list any terms
they knew that could be used to describe cannabis or its method of
consumption. Although there appeared to be some geographic variation,
52

the most commonly cited terms included pot, weed, dope, marijuana, mull, jani, greenery, joint,
bong, cone and cookies. The term marijuana is universally understood, while cannabis is
less widely known and used.
Cannabis use has various positive and negative associations in the minds of young people.
Positive associations generally related to the pleasurable psychoactive effects and social context
of cannabis usage.
Negative associations tended to relate to the potentially harmful
psychological effects of cannabis use.
Key words and images associated with the term
marijuana are presented below.

Paranoia
Green
Memory
loss
Kills
motivation
Not worrying
Natural
Illegal
Rebels
Laughter
Costs
money
Marijuana
Risk-takers
Parties
Nonsensical
ravings
Dregs
Boredom /
nothing to do
High
Tripping
Dealers
Ripped
Munchies
Young people tend to overestimate the prevalence of cannabis trial and usage, as for tobacco.
Trial of cannabis is often viewed as inevitable and a rite of passage into adulthood, particularly
among trialists or more frequent users. However, most participants felt that the prevalence of
cannabis trial and use was lower than that of tobacco.
In the minds of young people, a sharp distinction is made between frequent users, on the one
hand, and non-users and occasional users on the other. This is illustrated by the following
diagram and quotation:
53

Non-users
Occasional
users
Frequent
users
People who use it occasionally arent that different from those who dont use it.
But theres the real stoner group. [Female trialist, yr 9-10]
Young peoples attitudes towards occasional, in-control cannabis use were reasonably
favourable, often being seen as akin to the social consumption of alcohol. In comparison to
harder drug use (i.e. other illicit drugs), cannabis use is typically perceived as relatively safe.
Cannabis is positioned by some older young people as a teenage drug, for those with limited or
no access to the club drug scene. Others persist with cannabis use into adulthood, although it
is by no means an aspirational drug. Long-term, frequent users of cannabis were generally
described as losers and deros, by non-users and occasional users alike. Some felt that
frequent cannabis use was more likely to attract these types of people in the first place (to escape
their problems or because they lacked motivation to do anything else), as well as exacerbating
these characteristics, as suggested below.
I think it attracts people who are lazier and then they become less and less
motivated to do anything. [Female non-user, 18-21]
It was generally believed that males are more attracted to cannabis use than females, a view
consistent with prevalence rates in the literature. In the current research, cannabis use appeared
to be more socially acceptable in certain geographic locations (e.g. Adelaide, Coffs Harbour,
Dubbo and Busselton) compared with others in the study. However, such findings should be
considered in light of the fact that qualitative samples are unrepresentative and relatively small.
Short- and longterm effects
The most commonly mentioned effect of cannabis use was its perceived
impact on mood, motivation and psychological health. The positive
effects are particularly salient to young people, particularly the immediate
54

psychoactive responses to cannabis use, such as feeling high, relaxing or being able to escape
from lifes problems. This is in contrast with tobacco use, which was seen as conveying
relatively few benefits.
Id rather smoke pot than tobacco. At least it does something for you! [Female
user, 15-17, Indigenous]
Consistent with this finding, few cannabis users expressed a strong desire to quit.
Some young people (such as the participant quoted below) believed that cannabis was
occasionally used, and considered acceptable for, medicinal purposes and was sometimes
sanctioned by medical professionals.
I know someone whose Dad took it for back problems. [Female trialist, yr 11-12]
There were also suggestions by some users that smoking cannabis can lead to higher levels of
creativity or intellectual activity, as highlighted below.
Thats what some people used to say, you become real creative. [Female trialist, yr
11-12]
It makes you think a lot I know a few people who are really smart and Ive seen
them have it they have all these little theories about things. [Male use, yr 11-12]
Participants perceived a number of negative factors relating to cannabis use. These included
various short-term effects, such as feeling ill (greening out) and coming down from the high.
However, the medium- or long-term effects of cannabis are more salient and appear to act as
stronger barriers to cannabis use. These include general, lingering effects on motivation,
concentration and mental agility, as well as perceived associations with more severe
psychological problems such as paranoia, schizophrenia, psychosis and depression. A number
of participants cited examples of friends or family members whose mental health was affected
by prolonged cannabis use.
In this sense, long-term cannabis use is viewed as socially
maladaptive, impinging on users capacity to interact normally with others. These views are
illustrated by the following quotations:
55

I think a lot of times marijuana is something that sparks off depression and stuff in
younger people. [Female non-user, 18-21]
You used to be able to laugh with him, have a conversation now you cant even
talk to him. [Female trialist, yr 11-12]
It can cause problems with relationships with other people when their behaviour
changes because theyre moody and paranoid. [Female non-user, 18-21]
During the discussions, there was limited mention of the physical health effects of cannabis use.
Very few noted the higher tar content of cannabis compared with tobacco. The harm associated
with the most common mode of administration of cannabis (that is, smoking) is less salient than
for tobacco. Again, this may be due to the fact that persistent heavy use is seen as less likely for
cannabis than tobacco.
Cannabis is widely considered less addictive than tobacco. Indeed, a few young people thought
cannabis was not addictive at all.
I dont think its physically addictive, but its psychologically addictive. [Female
non-user, yr 11-12]
I dont think its addictive. I think its a habitual drug. You get into the habit of
smoking. [Male ex-user, 22-24]
Cannabis addiction is often attributed to the user rather than the drug itself. Young people seem
to view addiction to tobacco and cannabis differently, in that being addicted to the positive high
of cannabis is seen to be distinct from the more negative, physical dependence on the nicotine in
cigarettes.
There was a degree of recognition that use of a tobacco-cannabis mixture could lead to a higher
likelihood of addiction. The following quotes highlight these issues.
I know people that smoke marijuana and I think they are addicted to the cigarette
that they put in their marijuana. A lot of them are [tobacco] smokers anyway and
you do get a hit from smoking mixed with tobacco. [Male ex-user, 22-24]
When I gave up smoking pot, I wasnt smoking cigarettes then, but little did I
know Id chuck a spinner in every mix I had. I went through the maddest
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withdrawals, and it didnt hit me until I took up smoking, that I was actually
addicted to the nicotine, not the marijuana. [Female user, 22-24]
Typically, cannabis use is only considered problematic for certain types of people. These include
heavy users (i.e. using cannabis several times a week), people with addictive personalities who
are less able to control their usage, those whose mental health is already marginal, and/or people
with significant problems in their life. Therefore, occasional or party use was generally
considered safer (for most people) than tobacco use.
Some young people felt that school education focused on that fact that cannabis is illegal, rather
than explaining its health effects, in part accounting for the limited understanding of the effects
of regular, long-term cannabis use.
Its more its illegal, dont use it, but they dont tell you the health risks generally.
[Female non-user, 18-21]
Comparison with
tobacco
Tobacco and cannabis are perceived to have a few core similarities. For
example, young people note that the most common mode of cannabis
intake (that is, inhaling smoke) is the same as tobacco. Furthermore, both
tobacco and cannabis are viewed as social substances, with most people considering it
preferable to smoke around others.
One participant highlighted the desirable social aspects as follows:
Its like something that weve been through together. We treat it like its an event.
[Male user, 22-24]
In contrast, the use of cannabis on ones own was often perceived as an indication of
problematic use, perhaps more so than for tobacco.
Despite certain perceived similarities, tobacco and cannabis are generally seen as distinct
substances. The most commonly cited differences were the reported feelings and sensations of
cannabis use, with the high from cannabis use seen as offering more of an escape than tobacco.
In addition, as noted previously, cannabis was widely considered to be less addictive than
tobacco. Although occasional cannabis use was viewed relatively favourably, there was a greater
57

social stigma associated with being a frequent, heavy cannabis user (a stoner, for example)
compared with being a frequent tobacco smoker. These views are captured in the following
comments:
[Heavy use] is very much a social outcast thing. It starts to have an affect on them.
They change ... [Female (tobacco) smoker, yr 11-12]
Another key perceived difference is that cannabis use is more likely to involve rituals and to be a
planned social event, compared with tobacco use. This point is illustrated below:
Its like a gathering. Its fun to chop up the weed, all of that. Its part of the
enjoyment as much as the effects. [Male user, 18-21]
Participants were divided over which of the two substances they thought was more harmful, and
comparisons were complicated by expectations regarding the likely frequency of use. Some
considered cannabis to be more dangerous, in light of its potential effects on ones mental
health, lifestyle (e.g. social relationships and work life), and the risk of putting oneself in
compromising situations while under the influence of cannabis. Others felt that tobacco is more
dangerous in terms of its impact on ones physical health, given beliefs about the likelihood of
more frequent use. Cannabis was often considered a more natural and unadulterated substance
to smoke than cigarettes, which were understood to contain various chemicals. Indeed, a few
participants felt cannabis was not physically damaging at all. As one person commented:
Definitely tobacco is worse, but its going to bring on different health effects than
smoking marijuana, which is more going to be like a psychological effect. [Female
user, 22-24]
An obvious difference which was noted by many young people is that cannabis use is illegal,
while cigarettes are legal for adults. In many cases, cannabis was perceived as less readily
accessible than cigarettes, yet this was location-dependent.
(For example, participants in
Adelaide felt that cannabis was very easy to obtain.) Overall, cannabis was still fairly easy to
access, particularly for older teenagers.
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Its probably harder [to obtain marijuana than cigarettes], but if they ask someone,
they probably could get some. [Female non-user, yr 9-10]
I reckon anyone, even if they are quiet people, I reckon if they wanted it theyd get
it. [Female trialist, yr 11-12]
Pathways and
associations
Consistent with the literature, the research found that it was much more
common for people to have already tried tobacco before trying cannabis.
There was sometimes a latency period of a year or more from tobacco
trial to cannabis trial, such that the average trial age for cannabis was slightly higher than that for
tobacco.
Young people themselves often believed that someone who has smoked tobacco is more likely
than others to try or use cannabis, although they were uncertain about any possible causal
relationship. There were, however, some exceptions to this temporal sequence. In some cases,
people had tried or used cannabis, but had never (or only later) tried tobacco. There is some
evidence from the literature that this pattern is more common among Indigenous populations.
As noted in the literature, there is currently no consensus on the question of whether tobacco
use actually leads to, or causes, cannabis use. Some authors suggest that tobacco use is a
gateway to cannabis use, and results in an increased attraction to cannabis. These theorists
argue that, after tobacco use, individual norms, peer associations and even biochemical
properties of the brain become more receptive to cannabis use. However, others contend that
the association between the two substances is a result of commonly-shared underlying factors
(such as rebelliousness, or a generally positive attitude toward drug use), and that tobacco
initiation does not lead to a higher likelihood of cannabis use per se. On balance, the literature
suggests that the two theories are complementary, and that while common factors behind the
use of tobacco and cannabis account for most of the association between the use of each
substance, tobacco initiation itself may make cannabis use more likely.
The primary qualitative research provided some evidence that smoking tobacco does provide
certain skills that reduce some of the barriers to cannabis trial. For example, some cannabis
users felt that being used to the method and sensation of inhaling smoke can reduce ones fear
of embarrassment from coughing in front of peers during cannabis trial, as illustrated below.
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Well, theyre used to smoking and its just another type of smoke theres
probably a level of embarrassment when they first try it too, you know, they cough
and all that kind of stuff. But if you are a smoker, itd be easier to smoke
marijuana. [Male ex-user, 22-24]
Therefore, this removes one of the perceived barriers to trial of cannabis. This suggests that
preventing use of tobacco could have some impact on preventing, or more likely delaying, the
trial of cannabis and some impact on the likelihood of further use after trial.
Although the research found some evidence that use of tobacco can function to remove some
of the barriers to trial of cannabis, there was little evidence to support the hypothesis that
tobacco trial increases peoples motivation to try cannabis. The research identified some
common motivators for trial or use of both substances, such as curiosity, rebelliousness,
independence, sensation-seeking and boredom.
Similarly, broadly unfavourable attitudes
towards drugs in general can act as a common barrier to use of either substance, as suggested
below.
It just depends on the persons attitudes. If they hate drugs, theyre not going to try
[cannabis] and mostly, if theyre against drugs, theyre against cigarettes. [Male
user, yr 11-12]
Despite these common motivators for trial, tobacco and cannabis are typically perceived as
distinct drugs with different associated risks and benefits. As one participant said:
Being a smoker will not necessarily make you smoke pot. I think youre looking at
a different drug with a different effect on every person. [Female user, 22-24]
There was some evidence (among a few heavier users of cannabis) of substitutability of tobacco
for cannabis. Some participants, albeit only among heavier cannabis users, reported using
tobacco to assist in reducing their cannabis usage levels. A few young people reported using
tobacco to supplement their cannabis supplies, often because this was cheaper or to provide an
increased hit. However, this was fairly limited and bears more on the question of whether
cannabis use increases tobacco use, rather than whether tobacco use can lead to cannabis use.
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4.4 Parents
This sub-section reports parents attitudes towards smoking, their attitudes towards young
peoples smoking and perceptions of their potential influence on whether or not their child will
smoke. Findings that relate to communication with parents and their information needs are also
included in this sub-section.
Attitudes towards Parents hold largely negative views with respect to smoking. The words
smoking
and images participants associated with smoking (shown in the diagram
below) were often pejorative in nature.
Smell in hair
/ clothes
Illness
Stress
Yellow teeth
Lungs
Addiction
Coughing
Death
Social
outcast
Calming
Drinking
Smelly
ashtrays
Smoking
Cancer
Premature
ageing
Dangerous
Stinks
Anti-social
Isolated
Disgusting
Cost
Relaxation
Desperation
Several parents report that they enjoy smoking, despite recognising its short- and long-term
effects. Some view smoking as one of their few sources of pleasure.
I enjoy smoking. Theres not much that we can enjoy in our situations. I didnt
want to be a single mother. I didnt want to be unemployable. [Female smoker]
Even so, most smoking parents expressed a desire to quit smoking, and many had previously
tried quitting with varying levels of success.
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I think smoking is the worst thing in the world. I have tried a few times to give it
up. [Female smoker, Indigenous]
I wish I could give up but Im not strong enough. Its too addictive. If I could get
hypnotised or something ... [Female smoker]
Attitudes towards In general, parents indicated that they would be disappointed if their
youth smoking
children took up smoking. However, they generally expressed more
concern about other, more immediate or severe risks to their children.

These included:
illicit drugs
underage sex
binge drinking
road safety
bullying
psychological problems (e.g. insecurity / depression / anorexia)
These views are illustrated by the following quotes.
I think if my daughter came home and said she was pregnant at 14 or 15 or was
trying drugs, I think that smoking would be the lesser evil. [Female smoker]
I dont think it is as important as alcohol. You can have a cigarette and still be in
control. [Male non-smoker]
Some parents perceive tobacco use as a sign that the young person may go on to try other drugs.
Parents did not necessarily indicate that tobacco use would cause experimentation with other
drugs per se. Instead, these parents viewed tobacco use as more of an indication of the childs
personality. In this way, some felt that tobacco use may represent a marker of potential antisocial behaviour and risk-taking.
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To me, smoking cigarettes was a warning sign. Youll try other things, too. [Female
smoker]
Perceived ease of Like young people themselves, parents believe that young people have
access
minimal trouble (if any) in accessing cigarettes. They suggested multiple
potential sources through which cigarettes could be accessed, including:
asking older friends to purchase them,
pooling the funds of several young people together,
stealing from parents or older siblings who smoke, and
purchasing from vendors who do not check ID, including buying them from their peers
and friends who work in retail outlets.
Lots of kids work in supermarkets or have friends behind the counter. [Female
non-smoker]
These assumptions were largely consistent with the methods reported by young people. One
notable exception was parents belief that young people could obtain cigarettes from major retail
outlets, like Coles and Woolworths. Young people themselves thought that these outlets
typically had strict protocols preventing the sale of cigarettes to minors.
Experimentation
and initiation
Parents generally thought that young people would start to experiment

with cigarettes in early to mid high school. They identified 14 - 15 years
old as the typical age when most people tried their first cigarette. Parents
suggested the following reasons why young people might try cigarettes at this time:
Independence.
This is the age when some young people are first employed in casual
jobs and start to earn their own money. They spend increasing amounts of time with
their friends, often in the absence of parents or adult supervision. They also start to
attend unsupervised parties (which is a common setting for tobacco experimentation).
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Developing sexuality.
At this age, attraction to the opposite (or same) sex begins to
develop. Young people may smoke to convey a sense that they are older, more mature
or as a sign of their sexual availability.
Concern for their image.
There is a perception that, during the early to mid teens,
young people experience greater pressure to fit in with social groups and to forge or
convey an identity. Parents believe that smoking is often seen as cool, and that
movies, television programs and celebrities help to perpetuate this notion. As one
parent said:
You should see him smoking - he thinks hes so bloody cool. [Female smoker]
Experimentation with smoking is thus viewed as a result of adolescents increased concern
for their image and their desire to fit in socially.
Self-confidence.
At this age, some young people are becoming more self-confident.
They want to be able to express their maturity and expanding ability to make their own
decisions. Smoking allows them to assert themselves in this way. Furthermore,
smoking is seen as a defiant or even rebellious action, and this was identified by parents
as a reason for trying cigarettes.
Parents recognise that simply knowing the health effects caused by smoking is often an
inadequate deterrent to prevent young people from trying cigarettes. A typical comment from
parents was that young people see themselves as invincible and are focused on the present.
The impact of available spending money was sometimes underestimated by parents. Most
reasoned that there are so many things that adolescents wish to purchase, that whether or not
they chose to spend it on cigarettes depended on their attitudes towards smoking. In general,
available spending money is not seen to have any real impact on whether a young person
smokes. However, there was a view that, among those who do smoke, available spending
money may determine how frequently a young person smokes.
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When asked why young people may smoke, the reasons that parents put forward often
paralleled their own experience. Indeed, parents show insight into the motivations for smoking
that young people themselves may only develop in hindsight.
Although most parents say that it is easy for young people to become addicted, they tend to
underestimate how easily this occurs. It is often assumed that reasonably long periods (e.g. six
months) of regular smoking (e.g. at least a few each day) are required to develop an addiction.
Infrequent smoking is assumed to not constitute, or put smokers at risk of, addiction.
As was the case among young people, parents often referred to the notion of an addictive
personality. They inferred that some people were more susceptible to addiction than others.
In addition, it was thought that the accessibility of cigarettes influenced how quickly adolescents
could become addicted, and that if cigarettes were hard to come by, it would take longer to
become addicted. As highlighted in the following quote, parents believe that young people do
not realise when they are addicted or even that they are at risk of becoming addicted.
It hasnt sunk into them yet how addictive it is. [Female smoker, Indigenous]
Most parents assume that, at some point, their child will try smoking. However, in the absence
of any evidence, most confidently assume their child has not yet tried smoking.
Nearly all parents say that they would be disappointed if child took up regular smoking, but
there is a widespread belief that their own children will not become regular smokers. The
following reasons lead parents to this conclusion:
they voice strong anti-smoking opinions,
they complain about their parents smoking, or
they are very involved in sport or concerned with maintaining a healthy lifestyle.
So, although most assume that their child will try smoking at some point, parents commonly
believe that their children will not become regular smokers. This reflects a poor understanding
of the addiction process, with many parents failing to recognise any connection between
experimentation and long-term smoking.
65

Parental
influence
Parents believe that they have some degree of influence over whether or
not their child becomes a smoker. Despite this, they feel that other
influences are more powerful and influential (in particular, their childs
friends). Many feel that, to the extent that they have influence, they are already doing all they
can.
I dont think youve ever had any real control over what the kids do ultimately. All
we can do is provide a foundation for them to make the decision. [Female smoker]
It was thought that parental smoking increased the availability of cigarettes to young people.
Indeed, some parents reported that their children had taken cigarettes from them. Many
believed that the impact of modeling was very strong, as illustrated by the following quotes.
Were doing it in front of them, and theyre children, were showing them. You
cant blame them. [Female smoker]
I just thought about how many times did I give the impression that Im going to
feel better once I have a cigarette or I look like Im enjoying a cigarette. [Female
smoker]
Most parents recognised the importance of setting an example for their children to follow with
respect to smoking. Most agreed that their actions spoke louder than their words. They
acknowledged that it was hypocritical to oppose their children doing something they do
themselves.
Theres nothing worse than telling your child not to do something youre doing
yourself. [Female smoker]
Furthermore, parents who smoke reported feeling guilty about their behaviour. Some tried to
hide their habit by not smoking in front of their children, and bans on smoking within the home
were reasonably widespread. Other parents told their children how little they enjoyed smoking.
Some parents who smoke argued that they had more credibility than parents who had never
smoked, based on their first hand experience of being a smoker.
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I just think it would be very hard to tell anybody not to do something unless
youve tried it yourself. [Female smoker]
Even so, nearly all parents who smoke agreed that quitting is the most influential thing they
could do to prevent their children from becoming smokers. That said, most believed it would
only have a limited effect on their childrens behaviour because they believed that other factors
would have a greater influence on their children. They also raised doubts about their own ability
to quit and expressed anxiety about failing in their attempts to do so.
I love it. Its my best friend. I know its not good for the kids. I know all these
things. [Male smoker]
They were also unsure what effect relapsing would have on their children, and what message this
would send.
Parents were able to suggest multiple ways to discourage their child from taking up smoking.
Other than quitting smoking themselves, parents identified that the main way to prevent their
children smoking was to talk to them and give them advice. Potential topics for conversation
included;
the health effects of smoking,
highlighting the disadvantages of smoking for sporty, active children,
discussing the possibility and unpleasantness of addiction,
encouraging them to lead a healthy lifestyle,
recalling their own experiences and mistakes,
emphasising the costs and what they could buy instead with the money, and
reinforcing decision-making skills and bolstering their self-esteem.
Some parents were aware that their child smoked or actually discovered them smoking.
Generally this scenario prompted confusion about how to deal with the situation and the best
67

course of action. There was concern that an outright ban or punishment would damage their
relationship, yet others believed that children need (and expect) to be punished and taught to
respect the rules.
Young peoples
view
Young people consider the disapproval of their parents as an important

reason for delaying smoking initiation.
They also are aware of the
influence that parental smoking has on their own behaviour. When young
people who smoke were asked why they believe that they started smoking, they often reported
that their parents smoking was an important influence.
Young people expect that their parents will disapprove of their smoking. They also anticipate
that their parents will initiate a discussion (or more commonly, one-way communication or a
lecture) on the issue. In general, young people perceive parental disapproval as a barrier to
talking to their parents about smoking.
If Id have mentioned it, my mum would have gotten on her high horse and
lectured me so there was never a point. [Male non-smoker, 18-21]
There are certain things you dont want to talk to your parents about. [Male
smoker, 18-21]
Despite a general reluctance among young people to talk openly to their parents about smoking,
females appear slightly more open to this idea.
Cannabis
Parents believed that cannabis use was reasonably widespread, and similar
to tobacco usage in its extent. Many assumed their children would try
cannabis at some stage. Most parents were only mildly concerned by the idea that their children
may try cannabis, although there were some notable exceptions, and reactions to their childrens
trialing cannabis also depended on the age of the child. Most saw frequent use as concerning,
although, as was the case with tobacco, very few parents believe that their children would
become regular users.
Those concerns that were expressed centred around its illegality per se, and their childs
behaviour when high. Parents were concerned about their childrens loss of self control and
disinhibition resulting from cannabis use, in particular that it might lead to inappropriate or ill-
68

considered sexual behaviour. Many raised concerns about the potential impact on their childs
personality, and the mental health risks. These psychological risks were more salient than the
other potential risks associated with cannabis use.
Most parents believed that cannabis is addictive, but generally it was seen as less addictive than
tobacco. As with tobacco smoking, most feel they have inadequate control over their teenagers
actions, and that their influence is overshadowed by that of their peers and friends.
Communication
and information
needs
Most parents believe they have the skills and knowledge to communicate
with their children about tobacco smoking. They believe they know and
can explain the potential health risks of tobacco smoking, and they that
they understand the reasons why young people smoke, often based on their own youthful
experiences with smoking. Parents also generally believe they have a good relationship with
their children, enabling them to discuss smoking with their children easily. By and large,
smoking was identified as an easier topic to talk about than some others (e.g. sex). There
appeared to be a minority who said that they felt uninformed about the health risks of cannabis,
suggesting a willingness to benefit from any educative interventions about cannabis.
Most reported subtly communicating anti-smoking messages to their children from early
childhood. For example, some participants described how they had pointed out peoples
smoking to their infants, describing the habit as yucky and dirty. Some parents have had
specific talks with their children about smoking. These discussions often go hand in hand with
the drugs talk and usually take place when their child starts going out with friends.
Conversely, many teenagers report feeling uncomfortable discussing their own smoking
behaviour and experiences with their parents. Both parents and young people suggested
television commercials can act as useful conversation starters for sensitive topics.
Some mentioned they would like to know more about what their children learn in school about
smoking, enabling them to reinforce these messages at home. That said,
parents feel they do not need further information.
the majority of
They believe their influence is limited and
that, given this, they know all that they need to know.
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4.5 Reactions to current interventions

Young people were asked about the types of anti-smoking lessons they had been involved in at
school, as well as their experience with any other interventions in which they may have been
involved. In addition, reactions to any anti-smoking advertising which they could recall were
explored. The results are reported in this sub-section.
School education
Most young people reported learning about smoking and its effects while
at school. Commonly mentioned school based anti-smoking programs
included:
Life Education (Healthy Harold);
Personal Development/Health/Physical Education courses; and
one-off lectures.
Given young peoples knowledge of the long-term risks of smoking, and where young people
report learning this information, school-based interventions appeared to have been successful in
communicating that long-term tobacco use carries serious health risks.
However, given
misconceptions regarding the nature of addiction, it seems that insufficient attention is given to
the addictive process with regard to tobacco smoking. Compared to tobacco, young people
report considerably less focus on cannabis within school based education. In the absence of
school education, young people indicated that they learnt about cannabis from their peers or
from older, more experienced friends.
Some students indicated that they received anti-smoking education on a regular basis (i.e. it was
part of the syllabus every year), while others took part in one-off education programs. While
some students complained of repetition, they generally felt that reinforcement was necessary and
that hearing information only once was ineffective.
Its a waste of time because they dont reinforce it. [Female smoker, yr 11-12]
One-off lectures conducted by people from outside the school, such as police and health
professionals, appear to provide a useful means of introducing variation into the presentation of
70

such material. Young people report being particularly receptive to real life examples and many
thought that showing documentaries and hearing other peoples stories would be effective.
They also thought that confronting material was appropriate and would be more likely to have
the desired impact.
They should bring in people who have lost their arms and legs to cancer. [Male
smoker, 18-21]
Young people reported resenting being told not to smoke as part of anti-smoking programs. As
many participants explained, they feel that they go to school to learn facts and skills, not to be
told what to do. Many believed that only one side of the argument is being presented in school
education and that there is no opportunity to take part in a balanced discussion on smoking. As
a result, many students feel that they are being preached to, rather than educated.
Furthermore, some young people felt that the non-smoking message was more likely to make
them want to go out and smoke rather than its intended effect. These young people indicated
that they resent being told what to do and deliberately rebel by doing the opposite of what they
are told.
When youre told not to do something, you go out and do it. There is a rebellious
element to it. [Male non-smoker, 18-21]
You can tell people but when theyre told not to do it, of course theyre going
to do it. [Male non-smoker, 18-21]
Especially amongst older adolescents, there was a view that students should be presented with
all of the available information, allowing them to make a properly informed decision for
themselves. It was important to students that they felt trusted enough to make decisions
themselves, and failure to give any attention to the other side of the debate seemed both
patronising and out of touch with the reality of youth smoking. These views are illustrated in
the following quotes:
The best way would be to let them make their own decision about it, but still
inform them what would happen. [Female smoker, 15-17]
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They keep saying its bad and all that. They should just say its more your choice.
It is your choice. [Male smoker, 18-21]
While young people said that they were comfortable with teachers presenting health
information, they doubted teachers credibility on moral or fashion issues. There was clear
evidence that messages delivered at school which directly challenge the perception of smoking
as being cool are rejected outright.
Listening to a teacher say it doesnt really have an effect. [Female smoker, 15-17]
They try to get across the message of the health effects first, and then they stuff it
up by saying Oh, you dont have to smoke to be cool. I get the feeling that if they
tried to improve it, theyd get it wrong again. [Male non-smoker, yr 9-10]
I think that the Education Department goes about it, like, really the wrong way,
with the anti-smoking campaigns. Those educational videos that they show in PD
and stuff, theyre just too clichd and annoying. [Male non-smoker, yr 9-10]
In some cases, students knew that the teachers delivering the anti-smoking message were in
fact smokers themselves, which often served to undermine the message they were trying to
communicate.
In other cases, given that young people tend to over-estimate smoking
prevalence among adults, it seems that young people assume that a majority of teachers smoke,
leading them to doubt the credibility of their teachers in delivering anti-smoking messages.
Students were asked their opinions of peer education campaigns. Some considered that they
would be effective.
Older peers were seen as people you could trust companions. Its easier to talk
to someone like that you cant talk to your teachers on that level. [Male nonsmoker, 18-21]
However, significant practical difficulties were identified. Some felt that it was important that
the peer delivering the message had had some experience with smoking, and that they no longer
smoked. Otherwise they were perceived to lack credibility.
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If they tell us not to do something and they havent done it themselves, then they
seem really nave. [Female non-smoker, yr 7-10]
More generally, it was suggested that it would be ineffective to get teachers to select the peer
leader, as they had little idea about who was considered cool. Nor would the teacher be likely
to know whether or not the student smoked. Young people generally expected that teachers
would select students that other students would see as straight, goody two shoes, teachers
pet types.
The above material on education has concentrated on school programs. A few young people
had been involved in anti-smoking programs run by other organisations, such as youth groups
or local churches. While these programs were seen as benefiting from a more supportive, less
hierarchical environment, they are seen as broadly similar to the school programs, and students
identified some of the same problems (e.g. not presenting a balanced view and being preached
at, rather than educated).
Cessation
Few participants could think of any formal assistance available to young

people who wanted to quit. In general, young people perceive that there
are no cessation strategies designed with them in mind. There is an expectation that, if a young
person wanted assistance to quit smoking, he or she would be frowned upon. For example,
many young people said that they believed that if a young person sought assistance, a likely
response from adults, would be well, you shouldnt have started smoking in the first place!
Although they were often aware of nicotine replacement therapies, most young people did not
see these as options for people their age. There was a common perception that young people
would not be able to purchase patches or gum. Young people tended to infer that, because
sale of cigarettes to minors was illegal, nicotine replacement therapy could also not be purchased
by those under 18 years. In addition, the cost of NRT was often seen as prohibitive and the
therapy was seen as being only for those who had exhausted other methods. There was very
limited awareness of any other method of pharmacotherapy.
Students felt that, while their schools will tell them not to smoke, there is little assistance offered
for those who do smoke. Based on feedback from the research participants, it does appear that
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few schools provided any assistance with cessation. There was evidence that such programs
would be attractive to some smokers.
I would have done them [cessation programs], but there were none to do. [Male
smoker, 15-17, Indigenous]
Even among young adult smokers, there was a feeling among some that smoking cessation
strategies are either less relevant to them than to older smokers, or that some methods (such as
nicotine replacement therapies) are not particularly accessible to them (primarily because of
cost). In particular, there is very limited understanding of what the Quitline actually offers, or
who would benefit from using it. Participants typically saw the Quitline as a service for heavy,
long term, addicted adult smokers who lacked the willpower to quit on their own. Young
people tend to believe that the Quitline would only tell them what they already knew. Further,
many do not see themselves as the sort of person who would seek help via telephone
counselling.
If young people need assistance, they appear more likely to rely on informal support from
friends. This was identified as an important factor in successful attempts to quit.
Itd be pointless if I tried to give up on my own. [Male smoker, yr 7-10,

Indigenous]
My friends are pretty good. They would help [me to quit]. [Female smoker, yr 910]
There was a widespread belief that success came down to willpower and if someone had
sufficient motivation to quit, then they would. Overwhelmingly, young people believed that
cold turkey was likely to be the most successful strategy for someone who wanted to quit.
I think if you quit, its just cold turkey. I dont believe in counselling. I think its
just mind over matter. [Male smoker, 18-21]
These findings suggest that the absence of any cessation programs targeted at young people acts
as prima facie evidence of it being unnecessary, leading young people to believe that quitting
would be easy (and can thus be postponed) and more generally that quitting is something that is
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only relevant to adults. The absence of cessation-based interventions also excludes current
smokers from (largely prevention-oriented) initiatives undertaken in the school system.
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5
Conclusions and recommendations
This section discusses the implications of the research findings for interventions targeting young
people, including a discussion of the merits and disadvantages of potential themes for a youth
anti-smoking campaign.
5.1 Interventions
School education
Well-developed and carefully implemented school education interventions

have a crucial role to play in preventing youth smoking. Particular
attention is required from the later years of primary school to the early years of high school
because it is then that many of those young people who go on to be smokers report first trialling
and experimenting with cigarettes. This is particularly important for Indigenous populations,
because trial and experimentation have been found to occur at younger ages among Indigenous
young people.
It is clear that current school education interventions are successfully communicating that longterm smoking has serious negative health effects. Unfortunately, on its own, this message is
unlikely to have behavioural implications (and the evidence from the literature supports this
conclusion). Few young smokers expect to be long-term smokers, most obviously because they
greatly underestimate and misunderstand the addictive nature of smoking. This suggests that
helping young people to understand the process of addiction and to recognise the early
signs of addiction
would be useful. A greater focus in early to mid high school on the
addiction process might give them greater insight into their own behaviours and motivate
cessation at an earlier stage of experimentation. Very few, if any, young people want to become
long-term addicted smokers and most would therefore welcome information on how to avoid
this. They know the risk associated with long-term smoking but there is limited understanding
of the risk of becoming a long-term smoker. Providing this information is important in
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leveraging the already good knowledge of the health effects of smoking on those who become
addicted.
Furthermore, the findings from the research suggest that there is great potential for teachers to
discuss tobacco control as social science phenomenon,
prefiguring it in primary school and
then covering it more thoroughly in high school. This would include discussing:
why tobacco control efforts exist;
the strategies employed to date and their success;
the reduction in the prevalence of smoking to much lower levels than typically assumed
by young people;
the high proportion of adult smokers who wish they did not smoke and want to quit
(thereby positioning it as a non-adult activity); and
the high proportion of adults smokers who, in hindsight, acknowledged they were
addicted before the age of 18.
It could also include compassionate discussion of examples of where (and why) tobacco control
efforts have been less successful (such as among the mentally ill, poor, Indigenous and certain
migrant communities), which would include thinking about what needs to be done.
The advantages of such an approach are that it:
helps engage students in thinking about the reasons why people smoke;
frames smoking as a marker of social disadvantage, rather than adulthood; and
indicates that society should address the needs of these (disadvantaged) groups.
It should be noted that some, more sophisticated, young people already perceive tobacco use in
these terms, and associate smoking with lower SES status, poorer people and the homeless.
Even some in the very communities in which prevalence is high will be motivated to own the
problem of tobacco use and see it as something that is holding them back, if the strategy is
executed in an empowering way.
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Such an approach would be inherently more objective, and less didactic or patronising,
encouraging students to draw their own conclusions about smoking, rather than being told what
to think. It would also enable teachers to talk authoritatively about smoking and its successful
reduction as a factual societal phenomenon, rather than as a moral or fashion issue, on which
teachers in general have less perceived credibility. This approach may represent an effective
avenue for positioning smoking as something that is the very antithesis of maturity and glamour,
without this ever being an explicit or didactic message. The evidence from this research suggests
the case for including tobacco control in the syllabus is sufficiently strong to warrant further
research or a trial program.
How such lessons about tobacco control could be integrated into the syllabus is an important
consideration for their success. Rather than including this particular material as part of health
and personal development lessons (with which some young people report not engaging), such
content might be more effectively included as part of social science subjects or the like. There is
also potential to integrate these themes into the wider syllabus, to maximise the potential reach
and relevance of these messages. (For example, junior high school mathematics, where students
could analyse a line chart and calculate the change in the proportion of smokers between Year X
and Year Y).
Role of parents
The discussions with young people themselves revealed that parental

disapproval is a key reason for delaying cigarette trial and slows the
progression along the pathway.
However, the research found that
underestimate their influence on their children with regard to smoking.
parents often
While they believe
they have some influence, they see this as relatively limited compared to other factors (such as
peer influence) which may influence whether or not their children will become smokers.
Among those parents who do smoke, they do acknowledge that quitting would be the best thing
that they could do to prevent their child from becoming a smoker. That said, they often
underestimate the impact of their own behaviour on the potential for their children to become
smokers. They report that their children often complain about their parents smoking, and
therefore parents are normally convinced of their childrens negative views of smoking and
perceive this almost as some form of immunity to the development of smoking habits. (Of
course, the literature suggests that parental smoking is an important predictor of uptake of
smoking, both through modelling smoking and increasing the availability of cigarettes.)
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Interestingly, when young people who smoke are asked why they believe that they started
smoking, they often report that their parents smoking was an important influence. Parental
cessation is thus clearly the key positive influence that smoking parents can have on young
people, and its impact is larger than most realise. This is particularly the case in indigenous
communities, where positive non-smoking role models within and outside the extended family
unit could play an important role in preventing tobacco uptake and help to address the
prevailing view among young people that smoking is a normal adult behaviour.
Both parents and young people agree that a television commercial can act as a useful
conversation starter on the sensitive topic of smoking. This will be worth bearing in mind for
the foreshadowed Commonwealth action on youth smoking.
Parents would welcome knowing what their children learn at school
about tobacco and
other drugs, to assist them in reinforcing these messages at home. This is especially appreciated
if new content is introduced as suggested by this research (namely material on addiction or
tobacco control strategies). Were this to be included in school education programs, then parents
would also like to be informed about and reinforce these messages. Therefore, there is some
support for a smoking information pack to be made available to interested parents.
To enlist parents in the reduction of youth smoking, or impart further information, it will be
necessary to
make them believe they have more influence than they currently realise.
Given that many parents do smoke and have difficulty in quitting, this message (that parents can
make a difference) should not just relate to the fact that one of the best ways to ensure that
children do not start smoking is for parents to give up themselves, although this would
necessarily be a major message.
Cessation
Given the data on prevalence of smoking among young people, it is clear

that messages and other interventions about smoking should not assume
that young people do not smoke or have not smoked. There is also
relevant assistance for young smokers.
a need for dedicated,
Non-judgmental information about different
cessation methods and available support would be relevant and useful to many young people.
The existence of such assistance would normalise quitting and make it relevant to young people.
Further, if implemented, the teaching of tobacco control as a phenomenon is likely to increase
the demand for cessation interventions.
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A number of cessation interventions are worthy of further investigation and possible trial.
Consideration should be given to involving young people in peer support schemes, especially for
Indigenous young people.
The research found that many young female smokers intend not to smoke while pregnant, with
some also intending not to smoke while breastfeeding. However, not all young mothers we
spoke to had succeeded in doing so, and even among those who had, some had begun smoking
again later. It seems likely that this intention to stop smoking when starting a family could be
leveraged by targeted cessation interventions for young women who are pregnant or who are
planning to start a family.
Finally, the research provides some support for interventions which target the family and/or
wider community. These include:
smoke-free home initiatives;
encouraging quitting with a friend; and
initiatives targeting sporting teams, possibly leveraging positive role models within those
teams.
These interventions appear particularly promising for Indigenous young people, given the higher
prevalence of smoking among Indigenous people and the stronger family and community
connections of Indigenous young people. This family structure, in which older family members
have a degree of respect, may provide an opportunity for interventions that target parents or
even grandparents as initiators of change.
Reducing
palatability
Prior to trying a cigarette, many young people report being deterred by

the belief that the smoking experience will be aversive. The majority of
trialists found the initial experience of smoking to be unpleasant, strongly
reducing the motivation for further trial. In some cases, there were reports of significant
amounts of time lapsing between first and second trial, often due to the initial unpleasantness of
cigarettes. Furthermore, the literature shows that non-smokers are much more likely than
smokers to report that their first cigarette was an unpleasant experience. Finally, while some
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regular smokers report having grown to like the flavour, others continue to consider the flavour
unpleasant.
This is the situation now, when cigarette manufacturers are allowed to add flavour-enhancers to
cigarettes. This strongly suggests that policy measures which decrease the palatability of
cigarettes (by limiting the use of flavour-enhancers and of menthol in particular) may reduce
significantly the prevalence of youth smoking.
Legislative
restrictions
Despite legislation relating to sales to minors, young people report little

difficultly in accessing cigarettes. Cigarettes appear to be readily available
to under 18s through older friends, family members and small or
struggling retailers. The research suggests that access restrictions are not a barrier to cigarette
trial, though they may represent more of a barrier to adoption in that they may slow or delay the
progression towards addiction, allowing other interventions time to take effect.
It is likely that the recent smoke-free legislation in licensed premises in many jurisdictions will
have a substantial positive impact on the attitudes of young people towards smoking. Reduction
(and eventually cessation) of smoking inside pubs and clubs will help to minimise young
peoples perception of smoking as cool, glamorous and adult. In addition, it will remove the
opportunity for binge smoking in these settings and lessen the association between cigarettes
and alcohol, which is a key motivator for continuing smoking and is acknowledged as such by
most young smokers.
5.2 Campaign themes

General
considerations
Young people, including Indigenous people, need to feel they are (part of)
the target audience for interventions and commercials. As one participant
indicated:
The anti-smoking ads dont have the same impact as the drug ads because theyre
mainly about old people. [Female smoker, yr 11-12]
In discussions about TVCs and anti-smoking interventions in schools, it was also evident that
young people reacted negatively to concepts that:
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characterised them as children;
used a parent to child communication style, which talked down to them; or
were didactic or moralistic.
Such approaches contribute to perceptions of smoking as adult by arguing that smoking is

not for children.
The reasons for uptake suggest that anti-smoking messages that are doctrinaire in style are likely
to be counter-productive. It is likely that more effective interventions will be those that
stimulate thought and invite young people to draw their own conclusions about why taking up
smoking is undesirable and unwise (or better still, un-adult). There is a possible role here for
self-diagnostic quizzes in teen magazines, or on the web (as subject-led interventions).
From considerations of the findings in this research, conclusions are drawn on the following five
possible campaign themes:
Smoking is
harmful
Addiction
happens
Smoking is
(increasingly)
uncommon
Smoking is
unfashionable
Smoking is a
turn-off
Each of these is discussed in turn under the following headings.

Smoking is
harmful
There is widespread awareness of the negative health and aesthetic effects

of smoking.
For some young people, knowledge of these effects is an effective deterrent to smoking.
However, most serious risks (e.g. cancer and heart disease) are seen to affect only long-term
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smokers and most young people do not see themselves as becoming long-term smokers. Thus,
it is their perceived low personal susceptibility, rather than their lack of knowledge, which makes
the negative effects of smoking an insufficient deterrent to smoking.
Young people feel themselves more susceptible to the short-term health effects. However,
these effects are already less severe and slower to appear than young people expect. Although
reduced fitness appears to be a motivator for cessation among some young people (mostly
males), running a campaign that focuses on the short-term health effects of smoking risks
misfiring. As noted, fear of weight gain is an important barrier to cessation for some females.
Reduced fitness could well be associated with being less muscular and slight a physique to
which young men generally do not aspire. In contrast, this may actually appeal to many young
women who would prefer to be slim, rather than bulky and muscular.
While there is some scope to leverage the medium-term financial costs of the decision to smoke,
it does not seem likely that this theme is sufficient to sustain a campaign. Rather, it is a
subsidiary message which may be able to be included in supporting material for whatever
campaign is launched.
In sum, it is safe to conclude that there is little potential for a separate youth-oriented media
campaign based on the harmful effects of smoking, given that general community-wide
messages on this subject appear to be reaching young people effectively.
Addiction
happens
Young people know that smoking is a deadly habit for long-term,

addicted, heavy smokers. However, most simply do not believe they will
ever belong to this group. For example, few smokers think they will still
be smoking in their late 20s.

Very few, if any, young people want to become long-term, addicted smokers. There is limited
understanding of the risk of becoming a long-term smoker. This leads to limited control over
the habit. Most would welcome information on how to avoid this situation. Providing this
information is important in leveraging the already good knowledge of the health effects of
smoking on those who become addicted.
It may be useful to utilise self-administered magazine or web quizzes to allow people to
determine their own level of addiction, and then to direct them towards the appropriate
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resources.
A greater focus on the addiction process might prevent regular use among
experimenters or motivate cessation among regular users. This approach could also strengthen
the barriers to cigarette trial.
The focus on addiction also works to negate the notion of smoking as adult. Instead, it links
smoking with decreasing power (the inverse of the concept of adulthood) and it positions the
behaviour of adult smokers as involuntary.
This campaign theme clearly warrants further investigation. However, care is required to handle
this approach subtly, to defuse any self-exempting beliefs about the recipient not being an
addictive personality.
For instance, it is worth noting that a message like Its easy to become addicted could be
ineffective, because it would fail to dispel many young peoples current beliefs. Young people
and parents acknowledge that it is easy to become addicted, but they under-estimate
how
easily. Further, care should be taken not to excessively raise young peoples expectations
regarding the speed of addiction, to avoid invoking self-exempting beliefs regarding addiction.
Messages should therefore aim to educate young people about the nature of the addictive
process, and the early signs of addiction. Further, messages could be directed towards helping
young people to recognise and respond to the first signs of addiction, to motivate early quit
attempts.
Finally, as mentioned, addiction is not well understood by adults. Therefore, should this
campaign theme be used, it will be important to provide appropriate resources for teachers and
parents.
Smoking is
unfashionable
Young people in the research strongly rejected the idea of any one
overarching youth culture. It is clear that it is not meaningful to talk
about youth culture as if it were a widely shared set of ideas or fashions.
What is fashionable among sub-groups of young people is diverse and in constant flux. Further,
school or health authorities are not respected by young people as arbiters of fashion. Therefore,
any effective long-term communication on the subject of smoking that leverages fashion seems
near impossible.
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Rejection of idea of a
dominant fashion
Fluidity in fashion
School or health
authorities not arbiters of
fashion
Direct communication on fashionability near impossible, with potential to backfire.

Any fashionability, self-image conclusion must be drawn unaided.
Given the considerations outlined above, the classical idea of the necessity of appearing to speak
from within the culture becomes problematic. With fragmentation, messages invoking any
particular element of fashion have the potential to backfire, alienating all but a few.
It may, however, be possible to devise a message which is not didactic, and which leaves young
people to draw an appropriate conclusion about the fashionability of smoking or its impact on
their impact.
Smoking is
(increasingly)
uncommon
It is clear from the literature and this research that perceived social norms
are of great importance in attitude formation. It is equally clear that
young people are considerably over-estimating the prevalence of smoking
both among young people and the adult population, which thereby encourages the notion of
smoking as an adult behaviour.
It is therefore, worth informing young people about:
the relatively low proportion of young people who take up smoking;
the relatively low proportion of adults who smoke; and
the concentration of smoking among disadvantaged groups.
Consequently, this campaign theme warrants further investigation, particularly whether it is

strong enough to stand alone in a campaign and whether and how it can be combined with the
other campaign themes under consideration.
Smoking is a
turn-off
With developing sexuality, young people becoming increasing interested

in the issue of their sexual attractiveness. Becoming sexually mature is the
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pre-eminent badge of adulthood. Given this, it may be possible to associate non-smoking with
apparent sexual maturity or sexual success, by leveraging the perception that the smell is
unattractive. For example, it may be worth revisiting the kiss a non-smoker, taste the
difference campaign, but targeting it directly at young people.
It may also be worth
investigating the similar slogan kissing a smoker is like licking an ashtray. Consideration
should be given to more subtle and less expensive means of conveying this messages, such as
embedding the notion in more general self-administered quizzes (e.g. Are you a great kisser?,
with the results incorporating smoking status).
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Appendix A
Discussion guide (young people)
Introduction
Thank for coming along

Introduction to market research (focus groups / interviews / paired interviews)
Facilitators role: to raise topics and issues and then for you to tell me what you think
No right or wrong answers, your opinion that counts. Please be honest
Group rules: one person speaks at a time / feel free to disagree
Audio / video taping, mirror. Reassure confidentiality, anonymity
Session will finish at [FINISH TIME]
Topic: Your thoughts about, and experiences with smoking
Hand out incentives (sign and check contents of envelope)
Refreshments, toilet facilities, please turn off mobile phones
Participants introduce themselves (ask them what they like to do in spare time etc)
Smoking status
Clarify that discussion will first be about smoking cigarettes (tobacco).
Notepad exercise 1
Please tick the things that are true about you

I am a regular smoker
I smoke sometimes
I have tried smoking once or twice
I used to smoke, but I dont anymore
I have never tried smoking, but I might try it in the future
I dont think Ill ever try smoking
(Ask questions appropriate for group) Has anyone ever tried smoking?
o [If yes] Does anyone still smoke?
1. [If yes] How often do you typically smoke? How much do you typically
smoke?
2.
[If no] So has anyone smoked in the past, but doesnt smoke any more?
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Perceptions of smoking and smokers
What do you believe are some of the most important issues affecting young people
today? [Note any mention of tobacco or marijuana use.] Compared to other issues, how
important an issue is young peoples smoking? Why? Why do [dont] you see
smoking as an issue?
Notepad exercise 2
When I see someone my age smoking, I think
Explore connotations of smoking using a group brainstorm exercise on butchers paper. What
words and images come to mind when you think about smoking?
Do you think of smoking as something that is good or bad, or a bit of both? In

what ways?
o Are there any good things about smoking / any benefits of smoking?
What?
o Are there any bad things about smoking / any disadvantages of smoking?
What?
[Discuss responses to notepad exercise 2]
Thinking about people around your age who smoke, do you think that they are any
different from people around your age who dont smoke? In what ways? Explore
any perceived differences fully (e.g. character/personality - are they popular / unpopular? Good at
school / successful / strugglers? Trend setters / slaves?
Do you think of yourself as a smoker? / as someone who would smoke?

Why/why not?
Roughly how many people your age do you think smoke? And how often do you
think they smoke?
[Younger groups] Thinking about people your age, how many of them do you
think consider that its OK to smoke? What makes you think that?
[Younger groups] Do you think that you used to have a different opinion of
smoking? [If yes] In what ways has it changed? Why do you think that this has
happened?
[Older groups] Do you think that societys attitudes towards smoking have
changed at all over time? [If yes] In what ways? Why do you think that this has
happened?
[Older groups] Do you think that your attitudes towards smoking have changed at
all over time? [If yes] In what ways? Why do you think this has happened?
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Smoking behaviour and attitudes
[YOUNGER - HAVE NOT TRIED SMOKING]
Have any of your friends or other people you know tried smoking or taken up
smoking? Who? (e.g. friends, acquaintances, siblings, family?) Older or younger?
Why do you think these people tried or took up smoking?
Have you ever thought about trying smoking? What do you think has stopped you
from trying it?
Do you think you will try smoking in the future? Why/why not? (If appropriate)
What things have helped you to decide that you [do/dont] want to smoke?
(Explore factors that create commitment to being a non-smoker.)
Have you ever been offered a cigarette? By whom? Can you describe what
happened? What did you say? How did the person who offered you the cigarettes
react? What do you think your other friends thought of your decision to not try it?
Have you ever felt any pressure from anyone to smoke? Who from? When? How
have people pressured you? Can you tell me what you did? How did you feel
about it?
Have you ever felt any pressure from anyone to not smoke? From who? How
have you responded? How did you feel about it?
[HAVE TRIED SMOKING / SMOKED IN LAST WEEK]

Id now like you to think back to the first time you tried a cigarette
Can you describe for me the first time you tried a cigarette? When was it? Who
were you with? (e.g. friends, acquaintances, siblings, family?) Where were you?
Were you offered a cigarette, or did you ask for one? How did you feel at the time?
Explore perceptions of palatability of cigarette, any physical discomfort etc. And what did you
think of the cigarette? Did you enjoy it, or did you hate it? How would you
describe the taste and the experience?
Why do you think you decided to try a cigarette?
Were many of your friends/family members already smoking?

situations/types of places were they smoking in?
How did your friends react when you tried smoking for the first time? (Explore
reactions among smokers and non-smokers.) Did your family know? What was
their reaction?
Which
89

about it?
Would you ever, or have you ever, encouraged anyone to try smoking? Who?
Why? (If appropriate) What happened?
Did you continue to smoke after youd tried it initially?

o [If yes] What were the reasons why you smoked again? What influenced
you?
o
[If no] Why do you think you didnt smoke again? What influenced you?
Was there pressure to keep smoking once youd tried it? Who from? How did you
feel about it?
Have you ever felt any pressure from anyone to not smoke? From who? How
have you responded? How did you feel about it?
Did/do you feel any benefits from trying or taking up smoking? What? (e.g. social
involvement, relaxation/stress release, time out, physical/psychological
gratification)
Did/do you feel any negative effects from trying or taking up smoking? Has it
affected your health in any way? Anything else?
[If continued smoking] Have you ever tried to stop smoking or cut down on the
number of cigarettes you smoke? Why/why not?
o What sort of things (would) make you want to give up/ what would you see
as the benefits? What sort of things (would) stand in your way? How
difficult was it/would it be?
[If tried to stop / stopped] What was the reaction of your friends when you tried to
quit smoking? Explore reactions of smokers and non-smokers.
If someone your age wanted to quit smoking, what sort of things can they do? Is
there any assistance available to young people who want to quit smoking? What?
o Is this relevant for people like you?
o How might this be useful? What would be the benefits? Are there any
disadvantages? Do you think this would be effective? Why/why not?
o What would be the best ways for young people to find out about assistance
in quitting? (e.g. advertising/marketing) Why?
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[If tried to stop / stopped] How did you try to stop or cut down? Was there anything
that made it easier for you to stop smoking? What? (e.g. encouragement from
friends/family, school-based education/support programs, lower mg, cold turkey,
avoid smokers/smoking situations, etc)
o Did this help at all? Why/why not? What would help?
Has anyone tried to quit or cut down, but then taken up smoking again?
o Why do you think it didnt work / your attempt to quit wasnt successful?
o How did this make you feel?
o What would encourage you to try to quit again?
For those of you who no longer smoke, how long have you been smoke-free?
o What motivated you to maintain your decision to quit?
[If not stopped] Do you see yourself stopping at some stage in the future? [If yes]
When might that be? Why do you want to stop?
[OLDER - HAVE NOT SMOKED IN LAST WEEK]
Have any of your friends or other people you know tried smoking or taken up
smoking? Who? (e.g. friends, acquaintances, siblings, family?) Older or younger?
Why do you think these people tried or took up smoking?
Have you ever been offered a cigarette? By whom? Can you describe what
happened? What did you say? How did you feel?
[If tried a cigarette] Explore perceptions of palatability of cigarette, any physical discomfort etc.
And what did you think of the cigarette? Did you enjoy it, or did you hate it?
What did you think of the taste?
[If tried a cigarette] How did your friends react when you tried smoking for the first
time? (Explore different reactions among smokers and non-smokers.) Did your
family know? What was their reaction?
[If tried a cigarette] Why do you think you decided to try a cigarette?
[If tried a cigarette] Did you continue to smoke after youd tried it initially?
o [If yes] What were the reasons why you smoked again? What influenced
you?
o
[If no] Why do you think you didnt smoke again? What influenced you?
91

Do you think you will smoke in the future? Why/why not? (If appropriate) What
things have helped you to decide that you dont want to smoke? (Explore factors that
create commitment to being a non-smoker.)
about it?
Have you felt any pressure from anyone to not smoke? Who? How have you
responded?
[If tried] Did you feel any benefits from smoking? (e.g. social involvement,
relaxation/stress release, time out, physical/psychological gratification)
[If tried] Did you feel any negative effects from smoking? Has it affected your
health in any way? Anything else?
[If continued smoking] Did you ever try to stop smoking or cut down on the number
of cigarettes you smoke? Why/why not?
o What sort of things made you want to give up/ what did you see as the
benefits? What sort of things stood in your way?
[If tried to stop] What was the reaction of your friends when you tried to quit
smoking? Explore reactions of smokers and non-smokers.
If someone your age wanted to quit smoking, what sort of things can they do? Is
there any assistance available to young people who want to quit smoking? What?
o Is this relevant for people like you?
o How might this be useful? What would be the benefits? Are there any
disadvantages? Do you think this would be effective? Why/why not?
in quitting? (e.g. advertising/marketing) Why?
[If tried to stop / stopped] How did you try to stop or cut down? Was there anything
that made it easier for you to stop smoking? What? (e.g. encouragement from
friends/family, school-based education/support programs, lower mg, cold turkey,
avoid smokers/smoking situations, etc)
o Did this help at all? Why/why not? What would help?
For those of you who no longer smoke, how long have you been smoke-free?
o What motivated you to maintain your decision to quit?
[If not completely stopped] Do you see yourself stopping at some stage in the future? [If
yes] When might that be? Why do you want to stop?
92

[OLDER - HAVE CEASED SMOKING]
Can you describe for me the first time you tried smoking? Who were you with?
(e.g. friends, acquaintances, siblings, family?) Where were you? Why do you think
you decided to try a cigarette?
Were many of your friends or family members already smoking?

situations/types of places were they smoking in?
How did your friends react when you tried smoking for the first time? Smokers
and non-smokers?
Have you felt any pressure from anyone to smoke? Who from? When? How have
people pressured you? What did you do? How did you feel about it?
Have you felt any pressure from anyone to not smoke? Who? How have you
responded? How did you feel about it?
Why did you continue to smoke after youd tried it initially? What influenced you
to keep smoking?
Was there pressure to keep smoking once youd tried it? Who from?
In what situations did you regularly smoke?
Did you feel any benefits from smoking? (e.g. social involvement, relaxation/stress
release, time out, physical/psychological gratification)
Did you feel any negative effects from smoking? Has it affected your health in any
way? Anything else?
How many times have you tried to stop or cut down smoking? When was this?
Which
o How difficult was it? What sort of things made you want to give up? What
sort of things stood in your way? How did you overcome these?
o How did you try to stop or cut down? Did you do anything to make it
easier for you to stop smoking? (e.g. lower mg/cold turkey, avoid
smokers/smoking situations, school-based education/support programs,
NRT etc)
Did this help at all? Why/why not? What would help?
What was the reaction of your friends? Smokers and non-smokers?
Did you feel any pressure to keep smoking or to give up? Who from?
Do you feel any benefits from stopping smoking? (e.g. health, cosmetic, social,
93

financial factors)
Has anyone tried to quit or cut down, but then taken up smoking again?
o What was your reason for trying to quit that time? And when was this?
o Why do you think it didnt work / Why do you think you relapsed this
time?
o How did this make you feel?
o Did you do anything differently the next time you tried to quit or cut down?
[If yes] Did this help? What encouraged you to try to quit again?
Can you think of any strategies or types of assistance for young people who want to
quit?
o Is this available for people like you? Is this relevant for people like you?
o How might this be useful? Perceived benefits/problems? Do you think
this would be effective? Why/why not?
in quitting? (e.g. advertising/marketing)
How long have you been smoke-free?

o What motivated you to maintain your decision to quit? How did that help?
Availability of cigarettes [under 18 years only]
How easy is it for people your age to get cigarettes? Why do you say that?
Where do you / did you / could you get your cigarettes from? Do you /did you/
could you buy them yourself? Do you /did you/ could you get someone else to
buy them for you? Why/why not?
Understanding of effects of tobacco smoking
What do you know about the health consequences of smoking / ways that smoking
might harm someone? (Explore knowledge of short and long-term consequences.)
How much and for how long would someone need to smoke for them to harm
themselves?
[For younger groups] What does it mean to be addicted to something? Is addiction

a good or a bad thing?
How easily can someone become addicted to (or dependent on) smoking? How
many cigarettes, and how often, would someone need to smoke to become
addicted? How does someone know that they are addicted?
94

[If does not smoke] Do you think you would become addicted if you tried smoking?
Why/why not? [If smokes] Do you think that you are addicted? Why/why not?
How hard do you think it would be to quit now / in the future? What makes you
think that? [If smoker] What about you personally?
In what ways might a smokers behaviour impact on others? (Explore knowledge of

risks of passive smoking.)
Where did you learn these things about the effects of smoking? [Prompt if necessary:
advertising, magazines, school, parents, friends etc]
(B) MARIJUANA / CANNABIS
Id now like to talk to you about marijuana.

Perceptions of marijuana
Does marijuana have any other names? What do you call it? [Probe as necessary.]
Notepad exercise 3 (for groups only)
Tick the answer that you think best describes you.

I dont think Ill try or use marijuana in the future
I think I probably will try or use marijuana in the future
Why do you think this?
Discuss responses to notepad exercise
What do you think of using marijuana? (Probe fully - note different attitudes towards
tobacco vs marijuana)
o Are there any good things about smoking marijuana? What?
o Are there any bad things about smoking marijuana? What?
How common do you think marijuana use is among young people? At what age do
you think young people might first try it? At what age might usage become more
frequent?
Why do you think some young people try marijuana? Why do you think some go
on to use it more regularly?
Thinking about people around your age who use marijuana, do you think that they
are any different from people around your age who dont? In what ways? Explore
any perceived differences fully (e.g. character/personality - are they popular / unpopular? Good at
school / successful / strugglers? Trend setters / slaves
95

In your opinion, what are the similarities and the differences between smoking
cigarettes (tobacco) and smoking marijuana? [Explore perceived differences in risk, social
acceptability, legality]
If someone smokes cigarettes (tobacco), do you think this would make them more
or less likely to try marijuana, or would it make no difference? What makes you
think that?
Marijuana usage behaviour and attitudes (INTERVIEWS ONLY WITH THOSE WHO
HAVE TRIED CANNABIS)
Can you describe for me the first time you tried marijuana? When was it? Who
were you with? (e.g. friends, acquaintances, siblings, family?) Where were you?
How did you feel at the time?
o How did you try it? (eg in a rolled cigarette, bong, food, other / mixed with
tobacco?)
o [If tried tobacco] Was this before of after you first tried tobacco, or at the
same time?
o [If tried tobacco and was separate occassion] And did you think that the
situation differed from when you first tried smoking cigarettes (tobacco)?
In what ways?
And what did you think of the marijuana the first time you tried it? Did you enjoy
it, or did you hate it? Why?
Why do you think you decided to try it?

o [If also tried tobacco] (Probe if different motivations for trying
marijuana/tobacco)
o Had many of your friends/family already tried/used it? Who? And who
knew that you had tried marijuana? How did they react?
Have you felt any pressure from anyone to use marijuana? Who from? Other
tobacco/ marijuana smokers? When? How have people pressured you? Can you
tell me what you did? How did you feel about it?
[If tried tobacco first] Did the fact that you had already tried tobacco influence your
decision to try marijuana?
o [If yes] In what way? (e.g. used to smoking/inhaling, seemed more
acceptable/less deviant than before, same people/context/access point,
more curious, logical progression?)
[If tried marijuana first] Did the fact that you had already tried marijuana influence
your decision to try tobacco?
96

o [If yes] In what way? (e.g. used to smoking/inhaling, seemed more

acceptable/less deviant at than marijuana, same people/context/access
point?)
[If use tobacco and marijuana together] Do you see yourself as a tobacco smoker?
Did you continue to use marijuana after youd tried it initially? Why/why not?
Was there pressure to keep using/smoking marijuana once youd tried it? Who
from?
Have you felt any pressure from anyone to not use/smoke marijuana? Who? How
have you responded?
[If still using] In what situations do you tend to use marijuana?
After trying marijuana, did you smoke less or more tobacco, or the same amount as
before? [If different amount] Why?
What would you do if cigarette prices increased or you couldnt access cigarettes
anymore? (e.g. Would you take up / smoke more / switch to marijuana?
Why?/Why not?)
In your mind, how close are tobacco cigarettes and marijuana? How interchangeable are they? Can you think of any circumstances under which youd start
using more marijuana instead of tobacco? If so, when? Why?
Did/do you feel any benefits from using marijuana? (e.g. social involvement,
relaxation/stress release, time out, physical/psychological gratification)
Did/do you feel any negative effects from using marijuana? Has it affected your
health in any way? Anything else?
Have you stopped using marijuana? Have you ever tried to stop?
o Why/why not? What sort of things would make you want to give up?
What sort of things would stand in your way?
o [If stopped / tried to stop] Did you stop using tobacco at the same time?
Why/why not?
[If stopped] What was the reaction of your friends? Smokers and non-smokers?
[If stopped] Did/do you feel any benefits from stopping? (e.g. health, cosmetic,
social, financial factors)
[If not stopped] Do you see yourself stopping at some stage in the future? [If yes]
When might that be? Why do you want to stop? Would you stop smoking tobacco
at the same time? Why/why not?
97

Availability of marijuana
How easy is it for people your age to get marijuana? Why do you say that?
Where do you / did you / could you get marijuana from?
Understanding of effects of marijuana use
In what ways can using marijuana affect people?

o Does it harm them? How? Is it more or less harmful than tobacco? What
about when people smoke tobacco and marijuana together?
o Can it benefit them? How?
Is marijuana addictive? Is it more or less addictive than tobacco? What about

when people smoke tobacco and marijuana together?
Do you think that when someone smokes marijuana they have an impact on other
people? (If yes) In what ways?
Where is it acceptable / not acceptable to smoke/use marijuana?
Where did you learn these things about the effects of using marijuana? [Prompt if
necessary: advertising, magazines, school, parents, friends etc]
(C) OTHER ISSUES

Parents and smoking
The next part of the discussion is about parents.
In general, what do your parents think about smoking? (Probe fully)

o Do either or both of your parents smoke? Have they ever smoked / Were
they ever smokers?
o Would they disapprove of you smoking (if you did)?
o Are there any rules at home about smoking? (By parents / yourself / others)
How easy is it to talk to your parents about these sorts of issues?

o What things make it hard to talk to your parents about smoking? What
could make it easier?
Communication campaigns
Id now like to ask you about advertising that you may have seen.
Can you describe any anti-smoking ads that you know of?
98

What do you think of that ad?

o What were your thoughts and feelings in response to that ad? Why is that?
o Was it relevant to people like you? Could you relate to it? Why / Why not?
(Note any impact of smoking status)
o What was it trying to say? Was it believable? Was it effective? Why / why
not?
Do you think the ad had any impact on your attitudes or behaviour? In what ways?
Attitudes towards other youth-oriented smoking interventions
Finally, I want to talk about your experiences with any programs that you might have
been involved in that aimed to prevent young people from smoking.
Have you ever been involved in any school-based health education lessons or
programs relating to smoking?
o [If yes] What did this involve? (e.g. information about risks / decisionmaking and self-esteem / ways to resist peer pressure) What were your
reactions? What was good/bad about it? How well did it work? What
makes you say that? Was it relevant to young people like you? How could
it have been improved?
o How interested are you in these sorts of programs? Why do you say that?
Have you ever been involved in any peer-led activities (vs teacher-led)?
o [If yes] About health and smoking, or something else? What did this
involve? What were your reactions? What was good/bad about peer-led
activities? How well did it work? Why? What makes a good peer leader?
How could this have been improved?
o How interested are you in these sorts of programs? Why do you say that?
Have any of these health education programs relating to smoking involved your
family?
o [If yes] What did this involve? What were your reactions? What was
good/bad about it? How well did it work? Why? Was it relevant to young
people like you? How could this sort of program be improved?
o How interested are you in these sorts of family-based programs? Why do
you say that?
Have any of these health education programs relating to smoking ever involved
other groups in the local community? (e.g. youth organisations, community groups,
churches, youth groups etc)
99

(Where appropriate) What sort of anti-smoking messages do you think should be

communicated to young people? In your opinion, what sorts of things work best /
appeal the most?
o Should the messages accept that many young people may smoke and
suggest ways to avoid getting hooked or to quit?
o Or should the messages encourage young people not to smoke at all?
Do you think its inevitable that young people will try smoking? Can you think of
any way of helping people to stop people from developing a smoking habit? Why
do you think that would help?
100

Discussion guide (parents)

Introduction
Thank for coming along

Introduction to market research / focus groups
Moderators role: to raise topics and issues and then for you to tell me what you think
No right or wrong answers, your opinion that counts. Please be honest
Group rules: one person speaks at a time / feel free to disagree
Audio / video taping, mirror. Reassure confidentiality, anonymity
Session will [INSERT EXPECTED FINISH TIME]
Topic: Smoking
Hand out incentives (sign and check contents of envelope)
Refreshments, toilet facilities, please turn off mobile phones
Participants introduce themselves
Parental attitudes to smoking in general
Explore connotations of smoking using a group brainstorm exercise on butchers paper. What
words and images come to mind when you think about smoking? How do you feel
about smoking?
Do you think that societys attitudes towards smoking have changed at all over
time? In what ways? Why do you think that this has happened?
Do you think that your attitudes towards smoking have changed at all over time?
In what ways? Why do you think this has happened?
Attitudes towards youth smoking
Id now like us to discuss young people. What do you believe are some of the most
important issues affecting young people today? Compared to other issues, how
important an issue is young peoples smoking? Why? Why do [dont] you see
smoking as an issue? (Explore as a health issue, a discipline issue etc)
When do you think young peoples smoking is a concern? Is experimentation a

problem? Is social smoking a problem? What about regular smoking?
What proportion of young people do you think would try a cigarette at some stage?
And how many do you think would become regular smokers?
Do you think that the number of children and young people who smoke has
changed over time? In what ways? Do you think that young people smoke more
or less than adults, or about the same?
At what age do you think most young people would try their first cigarette? Why
do you think this?
What do you think are the reasons why children or young people try smoking?
[Explore influence of friends, family, media etc]
101

And when do you think habits begin to form? How easy it is for people to become
addicted to cigarettes? Do you think young people know when they are addicted?
Why/why not?
How easy do you think it is for children / teenagers to obtain cigarettes? Why do
you think that? Where do you think children / teenagers get cigarettes from?
Do you think that the amount of money young people have influences their
smoking behaviour? In what ways?
Attitudes towards their own childrens smoking
Ask participants to primarily think of their child/children within the relevant age band when
answering the following questions.
Do you know whether your child has tried smoking?
How does this make you feel?
(If applicable) What did you do when you found out that your child smoked or had
tried smoking? What did you say? What actions did you take? Why did you do
these things?
How would you feel if you child tried smoking? Why? What do you think you
would do?
How likely do you think it is that they will continue to smoke if they try a cigarette?
Why?
How would you feel if your child took up smoking / continued to smoke? Why?
What do you think you would do?
Strategies for preventing youth smoking
Notepad exercise: sentence completion task. (Task completed individually.)

The things I can do to help prevent my children from becoming a smoker are
How much control do you think you have over whether or not your child will
become a smoker? Why do you think that? At what age do you think you have the
most control? Why?
What things do you think you can do to help prevent your child from becoming a
smoker? How effective do you think these things would be? Have you used any of
these? Can you describe what happened? If not raised, explore:
o Discussing health effects of smoking
o Discussing benefits of a healthy lifestyle
102

o Discussing social unacceptability of smoking

o Discussing reasons why children might try smoking
o Discussing potential for addiction
o Discussing tobacco companys strategies for marketing cigarettes,
sponsoring actors
o Discussing decision-making and refusal skills
o Setting rules relating to smoking and/or rewards for not smoking
o Being a good role model / not smoking yourself / partner being a good
role model
o Not smoking inside
o Restricting pocket money and/ or imposing rules on its usage
Parental communication with children about smoking
Is smoking something that you and your children have talked about? When? What
sort of things have you discussed?
Who initiated the conversation(s)? Have your children come to you with questions,
or have you raised the issue?
At what age do you think it is appropriate to talk to children about smoking? Is it

an issue that you think needs to be discussed again at different stages of your childs
development?
How comfortable do you feel talking about these issues with your children?
How knowledgeable do you feel you are about these issues? What information
would you like to have? What would be the best way for you to access this
information?
What do you think your children know about smoking and the associated health
risks?
From where do you think children and young people get information about
smoking? Which of these do you think have the biggest impact on your children?
Explore parents views on extent to which young people see these sources as
credible.
Parental attitudes and behaviour and their influence on youth smoking
Do you think your children know how you feel about smoking? In what ways do
you think that your opinion of smoking influences your childrens attitudes and
behaviours? What about that of your partner?
103

Do you change your smoking behaviour in any way if your children are around? In
what ways? Why?
In what ways do you think that your behaviour influences your childrens attitudes
and behaviours? What about that of your partner? (Explore smoking, nonsmoking and quitting.)
What do you think is more likely to have an impact on whether your child smokes
what you say to them about smoking / your advice, or whether you and/or your
partner smokes? Why?
Parental attitudes towards cannabis use among young people
How common do you think marijuana use is among young people? At what age do
you think young people might first try it? At what age might usage become more
frequent?
Why do you think some young people try marijuana? Why do you think some go
on to use it more regularly?
How likely do you think it is that your child might use marijuana, either now or in
the future? What makes you think this? How do you feel about this?
In your opinion, what are the similarities and the differences between tobacco
smoking and smoking marijuana?
Are you more concerned about your children smoking cigarettes (tobacco) or using
marijuana? Why? Which do you consider to be more hazardous? In what ways?
If your child tries or smokes cigarettes (tobacco), do you think this would make
them more or less likely to try marijuana, or would it make no difference? What
makes you think that?
Sign off
Explain purpose
Thank and close.
104

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AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

Knowledge and attitudes

Conclusions and recommendations

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

It is estimated that one in five teenagers between the ages of 14 and 19

the age of 18 years, with the median age of initiation at 15 years.

A total of 30 group discussions, 39 affinity pairs, and 36 depth interviews

experiment with smoking, they begin to develop positive associations,

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

A striking finding was participants estimates of the prevalence of tobacco

Interventions that address misconceptions about

prevalence thus have some potential.

The short-term effects of smoking were reasonably salient to young

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

health and were able to articulate a range of long-term health effects.

Participants showed limited knowledge

Overall, it is generally perceived (by young people themselves) as

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

Most young smokers appear to assume that cessation will be easy.

A sharp distinction is drawn by young people between frequent cannabis

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

The report discusses a number of possible social marketing interventions

the research findings, warrant more detailed investigation.

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

While levels of smoking in Australia have reduced significantly over

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

In addition to the risks of dependence and tobacco-related illness,

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

to reduce the uptake of tobacco use in non-smokers; and

to increase cessation, by encouraging and assisting as many smokers as possible to

fewer young people smoking regularly;

substantially fewer young people making the transition to established patterns of

fewer young adults making the transition to dependent patterns of smoking.

The need for

In order to provide policy leadership, the Australian Government

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

2.2 Research objectives

Current attitudes of young people towards smoking

To improve understanding of:

young peoples knowledge of the health risks of tobacco use;

attitudes of young people towards smoking.

The impact of parental attitudes on uptake of smoking by young people.

a better understanding of typical parental attitudes to smoking, youth smoking and

insight into successful methods of delivering anti-smoking messages to parents for

With a particular focus on youth viewed as at risk, to investigate:

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

Strategies employed by young people to reduce or cease smoking

young peoples beliefs around the addictiveness or otherwise of tobacco products

barriers and motivations to quit;

young peoples attitudes to stopping or reducing amount of tobacco use;

successful or unsuccessful strategies employed by young people to achieve

An understanding of the association between youth smoking and cannabis

the impact of cannabis use on uptake, increase or maintenance of tobacco use,

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING

3.1 Qualitative methodology

mix of different qualitative techniques,

because different lines of

3.2 Sample structure for young people

Eureka Strategic Research, Youth tobacco literature review, June 2005.