Why Women Smoke: Study Results Contradict Previous Findings
From 1997 to 1998, researchers at the University of Arizona, Tucson, contacted and re-interviewed young women who had participated in a 199092 longitudinal study on body image, dieting, and smoking.
The initial study, known as the Teen Lifestyle Project, funded by the federal National Institute of Child Health and Human Development, tracked 240 eighth- and ninth-grade girls in Tucson, Arizona, over three years.
Participants were primarily white and Mexican American.
Under the follow-up study, investigators interviewed 179 of these women during 199798 to determine their smoking and dieting status as well as any attempts they may have made to quit smoking.
- 25 percent of the women who smoked had started smoking after high school.
- 42 percent who had been casual smokers and 38 percent who had been habitual smokers in high school had quit smoking.
- 32 percent of casual smokers had smoked at higher levels previously but returned to being low-casual smokers.
- 12 percent of current smokers reported that they smoked as a way to control their weight.
- The investigators concluded, in contrast to previous studies, that women's smoking does not increase steadily over time. Rather, many young women intermittently take up and quit smoking.
- The investigators also concluded that most young women in this sample do not smoke as a dieting strategy.
The Robert Wood Johnson Foundation (RWJF) supported the study with a grant of $31,868 between July 1997 and August 1998.
This grant from The Robert Wood Johnson Foundation (RWJF) supported a project to re-contact and interview young women who had participated in a 199092 longitudinal study on body image, dieting, and smoking.
The initial study, known as the Teen Lifestyle Project, funded by the federal National Institute of Child Health and Human Development, tracked 240 eighth- and ninth-grade girls over three years. Participants came from two middle schools and two high schools in Tucson, Ariz., and were primarily white and Mexican American. Over 75 percent of the girls who remained in the longitudinal study in 1992 indicated that they would like to continue in the project.
The RWJF grant allowed the investigators to interview these young women by telephone during 199798 to determine their smoking and dieting status as well as any successful or unsuccessful attempts they may have made to quit smoking during the intervening years. By tracking patterns of smoking and dieting among young women over time, the investigators hoped to better understand the transition from smoking experimentation to dependence on nicotine.
The initial study indicated that few girls smoked to reduce or control their weight. Since this finding contrasted with that of other studies, the investigators also hoped to determine whether the girls had taken up or increased their smoking as a dieting strategy as they grew older.
Although the investigators initially planned to re-contact only the 160 girls who had voiced interest in future project participation, they decided to attempt to interview all the participants from the 199092 study in order to increase the size of their sample. Over a period of nine months during 199798, the investigators were able to locate 182 of the 240 women from the original study; 179 agreed to be interviewed by telephone.
The investigators also had intended to re-contact 50 African-American girls who had been part of a 1992 cross-sectional component of the original study, but initial attempts to locate these women were problematic. The investigators concluded that follow-up interviews with the African-American girls would have to be postponed until additional time and grant funds were available.
- There is not a steady and uninterrupted upward trajectory toward smoking dependence for young women. Several studies on tobacco use have suggested that smoking is a habit that usually starts early in life, becomes increasingly addictive, and then plateaus. The investigators instead found that, in response to social or emotional cues, many young women intermittently take up and quit smoking:
- 25 percent of the women who smoked said they had started smoking after high school.
- 42 percent who had been casual smokers in high school and 38 percent who had been habitual smokers in high school had quit smoking by the time of the follow-up interview.
- 32 percent of the women who were smoking less than one pack per week at follow-up had previously smoked at higher levels but returned to being low-level smokers.
- Dieting or weight control is not the main reason why most young women smoke. Earlier studies on tobacco use among women have consistently concluded that a high percentage of women smoke as a dieting strategy. In the follow-up interviews, however, just 12 percent of smokers reported that they had ever smoked as a way to control their weight.
- As girls get older, they are significantly more likely to say that they will quit smoking. In 1992, 66 percent of the girls who smoked thought they still would be smoking when they reached their senior year in high school. By the time of the follow-up interview five years later, only 17 percent of the young women who smoked thought they still would be smoking in another five years.
- Many people do not recall their earlier smoking history accurately. Investigators were able to compare the young women's answers to follow-up questions against the answers they had given in the 199092 study. They found that many did not accurately recall their smoking level during middle school and high school.
The investigators presented their findings at two poster sessions and in two papers given at national conferences. One presentation was part of the first-ever conference session at the international meeting of the Society for Applied Anthropology devoted exclusively to the topic of tobacco, according to the principal investigator, who organized the session. (See the Bibliography.)
- Interviewing participants from previous studies can be difficult and time-consuming. Many of the girls had moved, and most were either employed or full-time college students. The investigators initially thought it would take two telephone calls to schedule and complete each interview; instead, they found it took an average of 3.7 calls.
- Telephone interviews with young adults often need to be done in the evening hours. Because of time constraints related to jobs, classes, or parental responsibilities, most of the young women were only available for interviews in the evening. The investigators hadn't considered this when they made their initial staff hiring decisions and budget projections.
AFTER THE GRANT
In September 1998, the project received $14,000 from the Tobacco Etiology Research Network, an interdisciplinary group supported in part by RWJF, to fund it for an additional nine months. During this time, the investigators located and interviewed 12 of the 50 African-American girls who had participated in the 1992 cross-sectional study. They also re-contacted a subsample of the women who had reported during the RWJF-funded interviews that they smoked. As of August 1999, investigators were still reviewing the information from both sets of interviews and had not yet released their findings.
GRANT DETAILS & CONTACT INFORMATION
Follow-up Study on Adolescent Girls' Tobacco Use
University of Arizona (Tucson, AZ)
Dates: July 1997 to August 1998
Mark Nichter, Ph.D., M.P.H.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Presentations and Testimony
Mark Nichter and Mimi Nichter, "Who's Still Smoking? Follow-up of a Longitudinal Study of Smoking Among Adolescent Females," poster presentation at the Multidisciplinary Perspectives on Adolescent Health and Sexuality national conference, Arizona Prevention Center and the Institute for Youth and Families, University of Arizona, Tucson, Ariz., October 8, 1998.
Mark Nichter, "Youth Culture and Nicotine Addiction," at the quarterly meeting of the Tobacco Etiology Research Network, Brown University, Providence, R.I., October 29, 1998.
Mark Nichter and Mimi Nichter, "Qualitative and Quantitative Data from a Longitudinal Study on Adolescent Females," poster presentation at the Society for Nicotine and Tobacco Research national conference, San Diego, Calif., March 10, 1999.
Mimi Nichter, "Smoking Among Young Adult Women: Follow-up of a Longitudinal Study," at the international meeting of the Society for Applied Anthropology, Tucson, Ariz., April 20, 1999.
Report prepared by: Gregory Hall
Reviewed by: Richard Camer
Reviewed by: Robert Narus
Program Officer: C. Tracy Orleans