ARTICLE IN PRESS

Social Science & Medicine 59 (2004) 573–583

‘‘Social thinking’’ and cultural images: teenagers’ notions of tobacco use
Marie-Louise Stjernaa,*, Sonja Olin Lauritzena, Per Tillgrenb,c
b

Department of Education, University of Stockholm, Stockholm S-106 91, Sweden Department of Public Health Science, Division of Social Medicine, Karolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden c ( Sweden Department of Caring and Public Health Sciences, Malardalen University, Box 883, 721 23 Vaster as, . .

a

Abstract The health hazards of tobacco use are well-known, and it is considered particularly important to prevent tobacco use among teenagers. New generations of teenagers still start using tobacco. To develop a more profound understanding of tobacco use among teenagers, the purpose of this study is to explore representations of tobacco use, smoking as well as snuffing, at the age when young people often start using tobacco. Focus-group interviews were carried out with 14-15 year olds in two schools in the Stockholm area. The analysis reveals that teenagers are well informed about the healthhazards of tobacco use. At the same time they hold complex and conflicting ideas concerning the relationship between tobacco use, risk, the body and ‘‘human nature’’. At the most general level of ‘‘social thinking’’ there is a dynamic relation between the three main representations of tobacco use related to: (1) notions of risk, (2) ‘‘human nature’’ and; (3) society’s efforts to discipline its citizens, which together can be seen as the social representation of tobacco use. These representations of tobacco use are discussed as related to the teenagers’ identity-work and gender identities. r 2004 Elsevier Ltd. All rights reserved.
Keywords: Teenagers; Tobacco use; Social representations; Gender; Social identity; Focus-groups interviews

Introduction In contemporary society, efforts are made to restrict tobacco use and particularly to prevent tobacco use among teenagers. Despite preventive activities, health education about tobacco at school and the fact that health-hazards related to tobacco use are well-known, new generations of teenagers start using tobacco. In Sweden, as in several West European countries, cigarette smoking is more common among girls (Wold, Aasen, Aaro, & Samdal, 1995; WHO, 2000) while oral snuffing1 (smokeless tobacco) is almost exclusively a male habit.
*Corresponding author. Tel.: +46-8-16-31-58; fax: +46-815-83-54. E-mail address: marie-louise.stjerna@ped.su.se (M.-L. Stjerna). 1 Sweden has one of the highest prevalence of smokeless tobacco use (mainly moist snuff; snus) per capita in the world, whereas the sale of moist snuff is prohibited since 1992 in other countries in the European Union (Bolinder, 1997).

The prevalence of snuffing among teenagers has increased since the early 1970s, whereas smoking has decreased slightly during the last decade (Andersson, . Gronberg, & Hibell, 1999). Today, the prevalence of tobacco use is fairly equal in girls and boys: 38 percent of the boys and 36 percent of the girls, aged 14–15, used tobacco (smoking and/or snuff) in Sweden in 2000. Among the tobacco users 10 percent of the boys and 15 percent of the girls were daily smokers. 30 percent of the boys and 3 percent of the girls used snuff (CAN, 2001). In this study we address smoking as well as snuffing as both forms of tobacco use are addictive, and one can serve as an introduction to the other (Tillgren, Haglund, . 1996).2 A multi-disciplinary Lundberg, & Romelsjo,
2 In pre-adolescence (11–12 years) there is an earlier initiation of tobacco use among boys, and a more rapid transition to regular smokers among girls (Galanti et al., 2001). Of particular interest is that experimentation with snuffing among boys also marks the transition to cigarette smoking (ibid).

0277-9536/$ - see front matter r 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2003.11.003

and on the vital function of this ‘‘system of thinking’’ to both shape and maintain social identity (Jodelet. 1995). Gender is here primarily understood as what we do in interaction with other people.). 1991). Stjerna et al. not what we are (West & Zimmerman. 1991). Herzlich (1973) found that when people talked about health and illness. is thus characterised by conflict. at the same time as conflicting ideas can exist and be debated at a discursive level (Rose et al.-L. The focus is on human beings as social and cultural beings. Our point of departure is thus a gender perspective on teenagers’ search for an identity. 1995). their shared ideas and images. smoking helps the women to cope with caring for their families. Of particular interest is how tobacco use is described and dealt with in the local socio-cultural context. and the threat to the individual’s health emanating from ‘‘outside’’. as a young man or woman approaching adult hood. 2001). women. representations of health and illness relate biology to social life. Also. interest and behaviors. Today. Stockholm University (Stjerna. the individual can act in order to maintain his or her ‘‘natural’’ state of health. the young person’s attitudes towards tobacco use could be seen as a part of his or her identity-work. Daykin (1993) Social representation theory To explore teenagers’ notions of tobacco use. The search for an identity could thus be described as a central project. the . boys and girls are socially constructed and not considered simply ‘‘natural’’ or biological. notions of health and illness are ideological. As smoking is without doubt hazardous to health. but also how they feel they should think. which children are incorporated into when they learn to observe these differences regarding their own and other peoples’ behaviour (ibid. Gender is thus to be understood as an ongoing process in women’s and men’s lives. The meaning of smoking for young women has also been studied in relation to the transition between school and work life. Jones (1993) argues that young women no longer have to be viewed as socialised into ‘‘appropriate’’ gender roles. where cigarettes and snuff are consumer goods loaded with symbolic meanings. even if such choices are circumscribed by ideas of what is considered ‘‘feminine’’ in local socio-cultural contexts. The purpose of this paper is to explore teenagers’ notions of tobacco use. However. To actively strive for health has become an imperative (Lupton. At a cultural level these differences can be described as notions of ‘‘masculinity’’ and ‘‘femininity’’ and are reflected in ideas of typical ‘‘male’’ and ‘‘female’’ characteristics. In this sense. 2000) and the Department of Education. where social representations are defined as a ‘‘system of thinking’’ that affects our perceptions of and acting in the world (Moscovici. and consequently girls can take different positions in different situations. Cigarette smoking offered them a short break from the routines and strains of family life. Within a group of people. poverty and low social support. how these notions are reflected in their accounts about their own and other peoples’ tobacco use and also the ways understandings of tobacco use are related to the teenagers’ development of a gender identity. Illness is to a great extent understood as caused by the lifestyle of modern society. The understanding of people’s ideas of tobacco use can be informed by studies of social representations of health and illness.. Graham (1987) found that smoking serves a contradictory function in the women’s lives. Definitions of a healthy way of life include judgements and values and is therefore ideological. At the same time. 1988). Social representations are seen as socio-cultural phenomena which are formed in interaction between people and thus differ from a purely cognitive perspective. the youth of today have possibilities to choose as norms and traditions that put a pressure on former generations may have lost its meaning for generations of today (Holstein-Beck. / Social Science & Medicine 59 (2004) 573–583 project was carried out in collaboration between the Department of Public Health at the Karolinska Institutet (Stjerna. Earlier work on the meaning of tobacco use from a gender-perspective has addressed the meaning of smoking in motherhood and in the transition towards adultlife. In her study of English women’s experience of smoking in the context of motherhood. 1995). moral imperative to strive for health is of particular interest in relation to smoking. Tobacco use from a gender perspective The attitude teenagers adopt towards cigarette smoking and snuffing can be seen as related to the young person’s position in the social order. as Radley and Billig (1996) argue. & Tillgren. The relationship between health and illness. ‘‘Doing gender’’ means that differences between men. sometimes perceived as synonymous with success and fortune (Herzlich. and between the individual and society. As the question of taking up smoking or snuffing is most urgent during the teen years. their reflections were phrased in terms of the individuals’ relation to society. Marttila. but create their own positions in the social order. They are related to wider discourses in society that affect not only the way individuals think. we take our point of departure in social representations theory.ARTICLE IN PRESS 574 M. Although undermining their own and their children’s health. social representations contribute to a shared image of reality. cigarettes were often the only consumption women allowed solely to themselves. 1995). and young people find themselves right in the middle of ‘‘identity-work’’. the concept of health is imbued with far reaching implications.

with openness to new themes and sub-categories. 1995). Krueger. the teenagers’ talk about tobacco use was described according to the strategy of analytic induction or deviant case analysis (Frankland & Bloor. as they struggled for independence. To date. 1999). 1990. Tobacco users and non-tobacco users. in areas with an average socio-economic structure. and more knowledge is needed about contexts that promote smoking or non-smoking. . at school and in their leisure time. (4) media and tobacco use. and Plumridge. It is then possible to gain insight into conflicting views as well as consensus in the groups regarding a phenomenon. 14–15-year. and Fernbach (1997) and Moffat and Johnson (2001) have explored teenage girls’ smoking identities and the meaning of nicotine addiction. especially if participants know each other. and Abel (2002) looked at the implication of smoking refusal on personal identity. peers and adults as tobacco-users. Fitzgerald. the focus was on the 3 The majority of the 25 non-tobacco-users had tried smoking earlier. (3) school and tobacco use. Among the 18 tobacco users more girls than boys use tobacco on a daily basis. The analysis was conducted in three steps (Stjerna. (5) the aesthetics of tobacco use (6) the ‘‘pointless’’ tobacco use. Lloyd. First. as Farr points out: Group discussions is a useful way of sampling the stock of arguments available within a particular culture where the researcher is interested in the arguments produced rather than in the individuals producing the arguments (Farr. with a focus on what they saw as its advantages or disadvantages. were also placed in different groups to stimulate discussions and avoid a polarization between teenagers with different experiences of tobacco use: Table 1. according to their own presentation of their tobacco habits. in the process of including more material from all groups. as is recommended in studies of gender issues (Debus.. which also may have implications for health promotion as suggested by Frankowiak (1987). The second step was to identify notions of tobacco use which were shared among the teenagers. T-B T-B T-G T-G N-B N-B N-G N-G N-G Participants 5 3 4 6 6 4 6 5 4 43 Method To capture teenagers’ notions of tobacco use.-L. Starting with one interview. Stjerna et al. Lucas. At this level. (1) health and tobacco use. Frankland and Bloor (1999) argue that the method is particularly suitable in studies of group norms. 1994). at two schools in inner Stockholm. eight themes were identified. a qualitative approach with focus group interviews was used (Krueger. teenagers’ own notions should be explored to further the understanding of tobacco use in the teens. research on tobacco use from young peoples’ perspective is still limited (Allbutt.old. 2000). The focus was here directed towards conflicting views and concordances in the groups. which was the case in this study.S. Lunt and Livingstone (1996) argue that focus-group interviews stimulate everyday communication and thus allow for the analysis of social representations. 1 2 3 4 5 6 7 8 9 Total Tobacco habit Tobacco users Tobacco users Tobacco users Tobacco users Non-users Non-users Non-users Non-users Non-users Sex Boys Boys Girls Girls Boys Boys Girls Girls Girls Abbr. The non-tobacco users did not smoke or use snuff at all. Furthermore. The description of each theme was then modified. (2) the agelimit of tobacco purchase. 1995:6) Focus groups differ from individual interviews in that they capture the social interaction among participants and can provide knowledge about people’s shared understanding of everyday life (Krueger. Table 1 The number of participants in the focus groups Group no. / Social Science & Medicine 59 (2004) 573–583 575 found that for young women smoking could offer a symbolic adult status and serve the purpose of balancing their subordinated position both at home and at work. & Cunningham-Burley. Girls and boys were interviewed in separate groups.ARTICLE IN PRESS M. (7) presentation of self. 2001). (8) presentation of self and peers who do not use tobacco. 12 boys and one girl had tried snuffing. Michell and Amos (1997) have demonstrated the importance of the gendered peer-group structure for smoking. Nine focus groups were carried out with 43 ninthgrade students. (2) school (3) family (4) leisure time (5) advantages and disadvantages of tobacco use (6) media and (7) gender. However. The first author (M-L. 1994). and on how tobacco use is represented in the media. Tobacco use varied from occasional smoking/ snuffing to regular smoking of 10–20 cigarettes a day or snuffing on a daily basis. All nine groups were tape-recorded and transcribed verbatim. 1994). Amos.3 The discussions4 revolved around the teenagers’ views on boys’ and girls’ tobacco use at home. 4 A topic guide was used to stimulate to discussions among the focus groups participants and to cover certain topics of interest: tobacco use related to (1) the age-limit of tobacco purchase.) moderated all nine groups and another member of the research team made close observations of the discussions and interactions in the groups (Stjerna et al.

illness and ugliness. T-B) The meaning of these facts is sometimes renegotiated at the level of the individual. / Social Science & Medicine 59 (2004) 573–583 teenagers’ ways of understanding the world. Cigarette smoke smells and the snuffer looks ugly as the snuff changes the shape of the lip: * * And moist snuff is disgusting when it hangs outside the lip (laugh). and at the other. I can still do it just as well. (Group 5. but the teenagers sometimes wonder if information about smoking is exaggerated: * * Except. like. Smoking is related to negative social development. Tobacco use as risk The teenagers talk about the risk of tobacco use in relation to physical health and addiction to tobacco. but if you . there is a dynamic interplay between these notions. there are models who appear in magazines and tell you that smoking is bad. Most often you think that they only want to scare you and. For example.ARTICLE IN PRESS 576 M. A boy who smokes puts it this way: * I don’t feel the need to quit smoking. the information you get. Notions of the body as inner and outer. but if you wait. This indicates different notions of risk related to the young and the adult smoker as well as a risk dimension. making smoking or snuffing seem appropriate for some individuals. Stjerna et al. (Group 1. there is an idea that snuffing could have positive effects. are described in terms of how smoking ‘‘destroys’’ lungs and makes them ‘‘disgusting’’. N-B) Furthermore. all our parents who smoke. The final step was to identify the most general themes constituting the social representation of tobacco use and to develop a deeper understanding of the teenagers’ cultural repertoire of identities. primarily among non-users. look. It is not possible to smoke if you want to be a successful sportsman or woman. Among the boys. if you. like. but if one wants to avoid risk all together one should not use snuff. they don’t really have nice teeth’’. When talking about the outside of the body. That’s what I think they do. like. T-B) The teenagers assume that people ‘‘evaluate’’ what is important to them. Such facts are understood as valid on a general level. a boy who does not use tobacco (group 6) thinks that it is the ‘‘cells in the face’’ that will be destroyed by smoking and that a person ‘‘does not have to become ugly’’ provided he or she abstains from smoking. the adult who has been a smoker for almost a lifetime. the body. and to images of the ‘‘problematic’’ smoker. such as increasing their sports performance. This means that ill-health due to tobacco use does not have to be a reality until the distant future. But. I don’t know. The bodily processes are also Some of the aesthetic effects of tobacco use show immediately. ‘‘female’’. for example their assumptions about ‘‘male’’. (Group 2. There seems to be a close relationship between smoking. At one end of this continuum is the teenager who has been using tobacco for a short while. I don’t know why. The teenagers seldom question ‘‘tobacco facts’’. The teenagers stress that people differ in bodily constitution as well as values. ‘‘human nature’’ and society’s efforts to discipline its citizens. Some girls refer to tobacco information they have read in girls’ magazines: * * Like. However. Then when it is spit out there is some left between the teeth (laugh). spanning from almost no harm to serious danger. than I need to be. I still ride my skateboard and. Some people may never experience illness due to smoking. They describe that the invisible process inside the body. T-G) The social representation of tobacco use The analysis revealed that the teenagers’ shared understandings of tobacco use revolve around notions of risk. smoking will eventually lead to the breakdown of the whole body. will gradually be visible on the outside of the body. it most probably is. when smoking. To this degree snuffing is attributed a health value. I haven’t noticed that I’m less fit. Pictures of the smoker’s lungs which have been shown in tobacco education sessions at school. but more with the health and hygiene of the mouth. related to aesthetic values. a non-smoking girl (group 9) says: ‘‘Maybe they look good now (others of the same age who smoke). According to the teenagers. such as drug abuse. exaggerate about things.-L. because I don’t feel less fit. in the long run the smoker runs the risk of becoming seriously ill as a result of smoking. At the most general level of social thinking. you don’t really know if it’s true. the teenagers stress that it will take a long time before the more serious consequences of smoking occur (if they ever do). (Group 3. This implies a way of thinking of risk as a process. That it gives you a bad complexion and then you think y I’ll never be Miss Sweden. play floor ball and stuff like that. Then it is so damned disgusting when they laugh. or invisible and visible emerge in the ways the girls and boys talk about the absorption of oxygen and the functioning of lungs when smoking. Snuffing is not associated with illness and death the same way as smoking. generation and tobacco use. which also is related to a dimension of time.

an awful lot. She sat and smoked over her kid ‘‘ (Group 4. and peer pressure is about belonging to a certain group: ‘‘This thing with smoking. as adults are supposed to do what they want and are All but one of the smoking girls emphasise it was their own choice to smoke. 1995). two weeks. Among boys who smoke. N-G) * I think every one should do as they wish. according to teenagers. Yeah. I think.-L. You want to be cool’’ (Group 6. is because they are addicted to tobacco. (Group 4. The overwhelming reason why adults smoke. N-B). but everybody has the right to make one’s own choice: * * * * One person in our class is allowed to smoke at home. No one knew that you could get cancer then and the thing with nicotine. The peerpressure is then seen as the smoker’s desire to attain a certain image. like. Only if it doesn’t directly affect others. You know that it’s dangerous.ARTICLE IN PRESS M. T-B) Also. And that is. I know but then you don’t really have the need to smoke. These girls focus on the pleasure. the teenagers describe the meaning of peer-pressure differently according to their experiences of tobacco. TG). Parents should not smoke in front of their children or allow them to smoke: * considered more ‘‘responsible’’ than teenagers. but it wasn’t back then. but only if they try to stop. From this point of view smoking is seen as an ‘‘offer’’. Maybe. At the same time. when one is officially grown-up. T-G) Family life is thought to put adults under the obligation not to smoke. a health hazard. It’s just a status thing with wanting to belong to a group and stuff like that. an underlying dimension in their reasoning is the assumption that it is possible to be healthy and smoke. is lurking in the background. it looks bad if mothers smoke: ‘‘she sat with her little baby over her shoulder. Smoking is sometimes described as part of teenage lifestyle. . everything. Her dad lets her. smoking was a ‘‘fun thing’’ to do. Also there is the idea that some people are attracted to danger. and see a value in risk-taking. Yeah. At the same time a constant danger. which is one reason for them to choose to smoke. For example. for instance to achieve high status or belong to a social group. (Group 1. This is seen as a legitimate reason for adult smoking but less legitimate for teenagers. but ‘‘there isn’t much she can do about it’’. because you know that. Tobacco use and human nature The teenagers express the idea that ‘‘human nature’’ makes people susceptible to tobacco use. Some boys who use tobacco (group 1) say it is okay if their parents smoke. It you want to smoke. Less common are explicitly expressed worries about a smoking parent ‘‘He smokes lots and lots. Stjerna et al. Lupton (1995) refers to the function of cigarettes as an expression of beauty. The smokers’ caring for ones own health has been described as subordinated to other concerns (Graham. ‘‘going out’’ and enjoying oneself. who smoke just in order to be ‘‘cool’’: ‘‘It’s idiotic to start smoking now. The girls who smoke talk about growing older when they will quit smoking: * * * When you’re like 30 years old. When they started. I don’t think that is taking their responsibility as parents if they let their kids smoke a home. and smoking during teen years is not necessarily thought of as ‘‘turning away’’ from health.’’ (Group 8. you just sit at home and watch TV with your husband and kids (laugh). the ‘‘new’’ and the excitement of smoking.’’ (Group 6. no but heard. I do too. Smoking is thus seen as a symbol of adult life. there is an opinion that adults have limited possibilities of controlling teenagers. T-G). There is some acceptance of adult smoking. just the same in school’’ (Group 3. / Social Science & Medicine 59 (2004) 573–583 577 are just an ordinary jogger. What is indicated in this study is that tobacco use and health are not always seen as contradictory at the level of the individual. you just can’t quit later on. that he can get cancer and all that stuff. the issue of smoking is not as important. Lupton. they risk death even as they fulfil desire’’ (Lupton. a boy (group 2) says that his mum doesn’t approve of him smoking. The baby was like. However. The idea is that parents and grandparents started to smoke at a time when they didn’t know much about the health-hazards. possible to realise through friends who smoke. 1987. pleasure and death: ‘‘Cigarettes are ‘negative pleasure’. The non-users argue that smoking gives young people access to social life. noticed. smokers act in order to fulfil their needs. I guess that’s how it is with everything. God. what the risks are. I’m still noticed. you don’t go out with your friends in the same way. you can do it anyway. (Group 9. N-G). such as being together with friends. Susceptibility towards smoking could in this sense be understood as a deeply human need to belong to others. but thought of as loosing its attractiveness after the age of 18. When it comes to their own tobacco use. 1995:153). This idea is related to the view of the teens and is closely associated to teenagers’ identity work. You get so much information. and I become sad. But I think it isy That’s no good. As rational beings. N-B). that sounds boring. but stress they don’t smoke in order to be ‘‘cool’’: ‘‘if I don’t smoke or drink then I’m still cool. the credo is that it is wrong to expose others to pressure to smoke. The teenagers are thus informed about the risks of tobacco use. Everybody has a dream of being popular and some people do anything to achieve this.

actively or passively. T-B). then it was. ‘‘They (smokers) are a part of society. It’s nothing that affects anyone else. Tobacco use and society’s efforts to discipline its citizens The third theme in the representation of tobacco use is the role of society. there is a difference between smoking as a social act and being addicted to tobacco. they spend time together with friends during breaks in school or after school hours and at parties. that varies. So I mean. Oh no. is more at one’s own risk and is mostly related to aesthetic values: ‘‘But I think it’s better. in particular the ways tobacco use is perceived as ‘‘normal’’ or ‘‘not normal’’. exactly. Snuffing. The teenagers’ opinions about the role society ought to take. but snuffing is viewed as less hazardous to health than smoking: * * * But you smoke because it’s sociable. However. but I am not a smoker’’ (Moffat & Johnson’s. because it isn’t known whether it’s as harmful in that way (the boy is referring to the cancer risk). You * They should remove the sign (health information on snuff package). follow theirsy’’ (Group no 9. self confident and rebellious than their non-smoking peers (Clayton 1991. its eats away your lip. T-G) According to the teenagers. have the mental strength to resist the pressure to smoke. To conclude. so maybe some months pass by without thinking about it. Like. you can get cancer. When smoking. From this point of view. T-B). then you also breath it in and that affects you’’. The boys who do not smoke (group 6) suggest that to refuse smoking at their age ‘‘proves a certain maturity. I mean it’s not really anything you think about.-L. The teenagers who use tobacco argue that frequent smoking among adults makes it ‘‘normal’’. You’re not like others. / Social Science & Medicine 59 (2004) 573–583 This is in line with other studies suggesting that girls who smoke are more socially skilled. the underside of the lip. 1997). because the ones who use snuff just affect themselves. p. The teenagers’ stress that they do not know as much about snuffing compared to smoking. you can’t quit’’ (Group 1. . when I came to this class. At the same time it is perceived as risky to continue smoking: ‘‘But what I think is that I know that I can quit right now. which means that smoking functions both as an activity and a way to make friends: * * don’t have to be like others. They are everywhere so. like themselves. which makes it ‘‘not normal’’. At the same time there is an understanding that individuals are different. it is not ‘‘human nature’’. tobacco use is perceived as non-hygienic and causing illness. is most strongly articulated among the non-users. Teenagers differ from adults in terms of maturity. but actively choose to smoke.ARTICLE IN PRESS 578 M. The idea that tobacco use is an artificial need. Among non-users. You get cancer. This evidence is often presented as a moral imperative to abstain from tobacco. what would we otherwise have done? (Group 3. In this study. Michell & Amos. But if someone is standing smoking and blows smoke in your face. I got to know her just because we went out and smoke at recess. the human ability to deal with tobacco use is seen as related to the phases of the life-cycle. such as ‘‘cramps in the stomach’’. is related to their view on tobacco use and ‘‘human nature’’. however. like. N-G). and in the focus group discussions it is apparent that the responsibility for one’s own health and the responsibility towards others is closely associated to guilt. The smoking girls are not sure they want to give up smoking. it’s terrific. Stjerna et al. the teenagers present themselves as the ‘‘informed generation’’. which similar to Moffat and Johnson’s (2001) study of American girls. strength of character or self-confidence’’. which can be seen as a paradoxical standpoint ‘‘I smoke. Yeah. the susceptibility to tobacco use. who cares’’ (Group 2. the case of snuffing is less clear. that person is smoking. 673). who are well aware of the health hazards of smoking. but the individuals’ ability to handle the consequences. There is a strong consensus among boys and girls that there is no new information about smoking. the disposition to develop an addiction is also understood as a human weakness. the scientific evidence of the health hazards is used as a strong argument why society should act among both users and non-users. you make new friends. can stop a goodlooking guy in town and ask for light (laugh) Yeah. like. Both boys and girls who smoke stress that one reason they smoke is because it is a social thing to do. much. You don’t have to. addiction to tobacco is seen as the inevitable result of continuous use. (Group no 8. Smoking gives you pleasure (you don’t really want to quit) and at the same time it is ‘‘out of control’’ (it is difficult to quit). However. The boys who use tobacco say they are able to stop whenever they want to. The point is that girls who smoke are not unable to refuse cigarettes. then maybe suddenly. the girls present a smoking identity which recognises their addiction to tobacco. thus locating themselves in a phase of ‘‘invincibility’’. non-users. The nonsmoking girls argue that it feels good not to do as ‘‘everyone else’’: ‘‘I think is an advantage in being able to say that you don’t smoke. N-G). which determines their different abilities and obligations to take responsibility for their own and others’ behaviour. 2001. The only thing is that. but then maybe you keep on thinking that you’ve only just begun. Compared to the boys. Furthermore. like. For example. When they have tried to quit they get ‘‘irritated and in a bad mood’’ and some describe physical cravings for smoking. like.

A limited use of tobacco or alcohol could lead to positive changes in the relationship to peers. is that smokers are largely portrayed in a positive manner. the opportunities and obligations of society to intervene in this course of events. The non-users present a rival idea. teenage smoking and adult smoking are viewed as separate phenomena. in turn. because there isn’t any age limit or anything. Participation in sports activities and other interests. In our study. say something about values and ideals in our culture. on the one hand. notions of the susceptibility of human beings towards the risky smoking and on the other hand. according to the teenagers. more occasions when peers spent time with each other and increased experiences of having a central role in the circle of friends. like. 1995). it is also perceived as gender neutral: * * * But then these little kids who see the cool people standing back here smoking (at school). teenagers described their relations as formed within a hierarchic structure (Michell & Amos.’’ (Group 9. then you get to know everyone. were the ones smoking. N-B) The majority of teenagers who use tobacco argue that at 15–16. smoking during the teens could be described as ‘‘youthful foolishness’’. A cultural repertoire of identities To understand the gender aspects of tobacco use. Also. However. 1997). Then they think that it is okay. The identity of the young smoker. T-G). we examine developing a gender identity (Forna the meaning of collective identities that are used by the teenagers to develop an understanding of social life. you can’t just can’t just go ahead and allow it. and Pilgrim (1997) showed that when young people tried smoking or drinking alcohol. hash begins to be like this. The risks of using tobacco are thus seen as varying. I think that it’s probably those ones that start smoking. but are unable to. poor person. then you start drinking. smoking did not seem to have the same social significance. The teenagers’ attitudes towards society’s right to intervene are related to the question of whom the measures are directed to. like. they haven’t found that yet.’’ (Group 3. maybe. Stjerna et al. This is in line with other studies of the structure of young peoples social networks. that is stuck and has smoked their whole life. In addition. For boys with high social status. the teenager has attained the ‘‘awareness’’ to handle tobacco use. likey Smoking.ARTICLE IN PRESS M. Then no one talks about it. The teenagers think that most adults want to quit smoking. The idea of peer-pressure is intertwined with this positive image of those smoking. type of thing. as found in a study of German teenagers (Maggs & Hurrleman. Risk. seemed to ‘‘protect’’ them from smoking. like. such as computers and music. It’s just the ones who. However. Such cultural images. Or anyway. Children are considered incapable if taking responsibility for their actions and should therefore be protected from tobacco use.-L. Urberg. s. they often started to socialise with peers who smoked or drank alcohol. as teenagers are thought of as living here and now and also stretching rules. The age-limit of tobacco purchase (18 years) is worthwhile because it could prevent young children from smoking: * of tobacco use. we looked more closely into the different ‘‘cultural images’’ * I don’t think it matters if they are girls or boys. Part of identity-work consists of . the ‘‘teenagers nature’’ makes it difficult. the ones who are so-called popular and cool. To summarise. you can’t die from using snuff. right and then it just gets worse and worse. those who begin smoking widen their circle of friends: ‘‘But if you start smoking. a substantial proportion of the young Scottish female smokers also had sophisticated social skills. tobacco use is viewed as inconsistent with the idea of childhood. The teenagers’ representations of tobacco use can thus be seen as characterised by a dynamic relationship between. which makes the image of their smoking behaviour more complex. In a Scottish focus-group study. T-B) . snuffer and non-user One characteristic of teenage culture which emerges in this study. who were ‘‘cool’’ and ‘‘good-looking’’. the possibilities of society to intervene and to a certain degree the human nature is thought of as varying in relation to different phases of the life span. and smoking in middle age is thus described as a cul-de-sac: ‘‘Then I think (the girl is referring to adults who smoke) poor. The ‘‘popular ones’’ go to parties. it’s. (Group 6. Yeah. even though the psychologically mature teenager is able to decide about his or her own life. (Group1. These girls can be more vulnerable to smoking as they could use cigarettes to form a certain image of themselves. 1998): for example. I don’t think that you can. Then. we have seen that both girls and boys who use tobacco stress that it is a personal choice to start smoking. Degirmencioglu. N-B) Also. Although smoking has a gender loading towards the ‘‘feminine’’. drink alcohol and smoke. (Group 5. as in this study. N-G). It is the ‘‘cool ones’’ with high status in the teenagers’ hierarchy who smoke. The teenagers also stress the differences between smoking and snuffing. / Social Science & Medicine 59 (2004) 573–583 * 579 But it’s not like. there is an understanding that society has possibilities and obligations in the restriction of teenage use of tobacco. Girls at the ‘‘top’’. want to meet others instead of sit at home and study.

They try to avoid their fingers. the non-users present positive images of non-smokers and negative of their smoking peers. The conclusion is that there seem to be continuos ongoing ‘‘negotiations’’ concerning identity claims in the social space of teenagers. N-B). but boys and girls are thought of as having different ways of expressing themselves. it’s almost sad to think about. which means that nonsmoking teenagers are always faced with ‘‘the problem of accrediting themselves against superior smokers cool group’’ (2002 p. and they ask: Like. act differently in some respects. put forward by the non-smoking girls (group 9). Stjerna et al. how you look’’(Group 6. do I smell of smoke? When boys come into . based on the assumption that girls ‘‘learn’’ to pay great attention to their appearance. When they come into the classroom they breath more through their nose.ARTICLE IN PRESS 580 M. The dreary character of the ‘‘swot’’ also changes when the school is presented as an interest which prevents you from smoking. is that girls smoke in order to avoid eating candy and putting on weight. In that picture they didn’t know that they would begin smoking and drinking. which could be described as ‘‘rivals’’ to the positive image of the smoking teenager. but snuffing is possible for a ‘‘hockey or football guy’’. even if there are exceptions: * Girls are more discreet about smoking. This implies that smoking could always be understood as a topic of interest in the teenagers’ culture. the teenagers speak about non-smokers as associated with psychological strength and willpower to make one’s own choices. The non-smoker’s identity was rated more ‘‘sensible’’ than the smoker’s. 1997). it’s like. According to this view. Rather. 2002. but may be constructed differently as both groups claim to be ‘‘mature’’. In our study. In our study. on the other hand. no one is going to smoke. On the other hand. Those girls who were doing well at school and had positive aspirations for the future did not feel a pressure to smoke and were ‘‘safe’’ from smoking. / Social Science & Medicine 59 (2004) 573–583 According to Michell and Amos (1997) smoking does not seem to be an issue for girls positioned in the middle of the teenagers’ hierarchy. but lacks the power to ensure the claim’’ (Plumridge et al. For example. p. smoking is a little more like. which could be the breeding ground for smoking. Each has to make a claim to some identity. Also. being ‘‘mature’’ was desirable to smoking as well as non-smoking girls. If we assume that different groups of teenagers accept different ideals. The reason why girls and boys. their smoking peers can claim that those who do not smoke are ‘‘smart’’ or are ‘‘impressed’’ by their non-smoking status. respectively. Boys are also presented as anxious about their appearance. By the use of tobacco they take risks which could lead to drug abuse: * If I think back to when I was in elementary school. N-G) Images of female and male tobacco use The teenagers assume that girls and boys are brought up to a ‘‘female’’ and ‘‘male’’ identity. Girls who adopted this identity were likely to refer to girls who smoke as ‘‘stupid’’ (Lloyd et al. but have to do so under conditions of others readings of their competence. the smokers ‘‘hang around’’.. This is in line with Michell and Amos (1997) findings that an interest in sports or computers can ‘‘protect’’ from a ‘‘meaningless life’’. there they stand with a cigarette in their hand or lying somewhere in a ditch drunk. Then.. these images could be understood as a repertoire of different values and ideals among teenagers. 169). argue that smoking as well as smoking refusal are important identity statements. At times. 1997). Plumridge et al. smoking alone is no guarantee for being accepted as ‘‘cool’’. Such little children: you sit and you look at the pictures. Although images of smoking and non-smoking youths seem to circulate in teenager culture. as found in a British study where the non-smoker was portrayed as interested in school life. And it’s like. is associated with different ideals and the different expectations they are confronted with: ‘‘I think that girls are more into their appearance and stuff like that. consume alcohol and are potential troublemakers.-L. this can be problematic for the non-smokers as well as the smokers. the appearance like. It’s like. whereas the smoker’s identity was rated more ‘‘fun-loving’’. when you look at the photos: everyone was so little. The entertainment business is given a prominent role in this process. but also different ideals (Lloyd et al. Boys and girls deal with smoking in different ways. with implications for smoking uptake or refusal. upbringing in the family and the commercial market are important socialising agents. the ‘‘right’’ clothes and being seen with the ‘‘right’’ people was just as important (ibid). Smoking is also understood as an attribute that girls can use in order to create a special image of themselves. (Group 9. 167). Because they are more used to that role. they put on makeup and stuff like that. However. One idea. This reasoning gets some support in a British focus group study of girls’ construction of non-smoking and smoking identities which demonstrated that girls not only have different tobacco habits. ‘‘Individuals are not free to ‘fashion’ their identity as they choose. (2002). as a ‘‘creator’’ of images. by nonsmoker as well as smokers. the non-users talk about tobacco use as problematic behaviour.. The boys who represents themselves as ‘‘athletes’’ (group 6) say it is a ‘‘natural’’ thing not to smoke. this does not necessarily mean that the non-smoking individual always will find him or herself having to struggle against their ‘‘inferior’’ status compared to peers who smoke.

A girl who snuffs could be viewed as ‘‘mannish’’. like with checkered shirts. football. hunting and construction work: * * * * Snuff. Further. T-B). if boys smoke. boys who snuff can be ‘‘friendly’’ and ‘‘very sweet’’. These images could be related to smoking women earlier in the 1900s. smoking is consistent with a ‘‘feminine’’ style: ‘‘Yeah. take Maria. T-B). * * when we saw a movie at the cinema. At the level of the individual the teenager can draw on these cultural images in different ways in different social contexts. A boy who smokes in a ‘‘feminine’’ manner runs the risk of being seen as ‘‘sissy’’. but like. which is ‘‘relaxed’’ and ‘‘cool’’. yeah. However. the If it is a ‘‘tough’’ cowboy who smokes. Consequently. which in turn are associated with different contexts. Different types of tobaccos have ‘‘male’’ or ‘‘female’’ connotations. as it does in other European studies (Michell & Amos. the ‘‘genderloading’’ is male. The girls who use tobacco (group 3) say that although snuffing is disgusting. To sum up. First. Who hunt. she doesn’t give a damn about anything. the ‘‘feminine’’ and ‘‘masculine’’ can be reflected in the way one smokes and holds the cigarette. no you can’t do that. N-G) When associated to ‘‘glamour’’. ‘‘male’’ and ‘‘youth’’ identities and behaviour are fairly stereotyped. Yeah. This male stereo! . The teenagers also reflect on smoking heroes (men) in action movies: * woman’’. ‘‘If girls smoke. But in any case boys shouldn’t snuff for aesthetic reasons: ‘‘I don’t think that boys should use snuff either. Like.-L. they (the boys is referring to girls his age). / Social Science & Medicine 59 (2004) 573–583 581 * * the classroom they couldn’t care less if they smell of smoke. Plumridge et al. I mean. there are several positions for a female subject. Snuffing is considered ‘‘male’’. However. (Group 3. contexts and cliche ‘‘female’’ or ‘‘male’’ significance. but never mind about that. They can smoke as much as they want to. like. Pipes and cigars are ‘‘male’’. The cultural images could thus be seen as ‘‘offers’’ and allow for different ways of expressing gender identities. But no snuffing. who were not considered ‘‘respectable’’ (Waldron. N-B) Conclusion What conclusions can be drawn from the analysis of the teenagers’ social representation of tobacco use? The fact that the notion of the ‘‘cool’’ smoker emerges in this study. 1991). no there is no difference. The teenagers usually do not explain gender differences in terms of biology. snuffing is associated to male fields such as hockey. However. Right (laugh)? That’s exactly right. for instance. The analysis shows that the teenagers’ cultural images of ‘‘female’’. men have for a long time practised the habit. they want to look so bloody good and go around with their cigarette trying to look glamorous. like making your face uglier’’.’’ (Group 1. As Jones (1993) argues. In it he smoked so damned much and he was really mean. a seductive and slightly dangerous ‘‘femme fatale’’. Snuffing is considered ‘‘un-feminine’’ and thus a typical male thing. 2002) indicates a more general notion of the tobacco user in Western teenage culture. the ways snuffing is ‘‘reserved’’ for men is not viewed as discrimination of women. Also.’’ (Group 2. construction workers. such as the ‘‘cool’’ or the ‘‘problematic’’ smoker. T-B) The teenagers argue that girls shouldn’t snuff. limited to urban Sweden. really shooting down every last person and stuff like that. It is more acceptable for a man to snuff. However. (Group 9. In the group of boys who use tobacco (group 2) suggest that it is alright if ‘‘tough birds’’ use moist snuff compared to ‘‘mini catch’’ which is seen as a more feminine snuff. to break norms can be risky. it’s manly or men in their 30s. it’s likey Yeah. the ‘‘strong’’ man.. but snuffing is a less clear case since it is considered to be a ‘‘male practice’’ given by nature. But. 1997.ARTICLE IN PRESS M. Most of themy Well. God. At the same time it is possible to break gender norms and expand conventional gender roles. This is how she is (the boys inhales and exhales) then she enters like this. just putting it in like that. because it’s so unattractive. ‘‘masculine’’ and the identity of the young smoker is continuously negotiated in different social situations. as well as the possibilities of crossing gender barriers and expanding traditional gender identities. the repertoire of possible identities to some extent reflects the cultural images that teenagers face and have to deal with as part of their identity-work. It starred Bruce Willis and what the hell he is calledy Die hard? No. they snuff in a more ‘‘tasteful’’ and ‘‘discrete’’ manner than boys. (Group no 6. They stress that it is not common for girls to snuff. T-G). Furthermore. girls can break into this male field if they do it in a way that is consistent with what is accepted as ‘‘feminine’’ in the culture. indicates that what should be considered ‘‘feminine’’. but if they do. The girls who smoke (group 4) think it is ‘‘charming’’ and ‘‘smart’’ if boys smoke in a certain manner. the ‘‘glamour type could be compared to a female cliche . The teenagers’ reasoning reflect roles and identities divided by gender. for the teenagers the meanings of ! s are associated with certain fields. Cigarettes are both ‘‘male’’ and ‘‘female’’ with domination towards the ‘‘female’’. the tension between different types of images. Stjerna et al. the analysis reveals a more complex pattern. (Group 2. as we want to.

. Tabeller med sammanfattande kommentarer. . market forces and society’s efforts to discipline its citizens. B. that to prevent smoking in girls. Daykin. At the same time. Results from a national study of grades 7 and 9. (Dissertation). The teenagers see the individual as shaping her own destiny. even if the correctness of these facts are discussed. (1997). A. The conclusion is that. mostly girls. CAN. 95–102. The individual has a responsibility for her own and others’ health. Gronberg. Skolelevers drogvanor 1998. 115–120. In these ways. 1991. Stockholm: Karolinska Institutet. and Kelly (1994) argument. such as upbringing in the family. Stockholm: CAN. we think it is important to take teenagers’ social representation of tobacco use as a point of departure. teenage culture. ( riksundersokningen ( Resultat fran i arskurs 7 och 9 1998. 8. The social image of smoking among young people in Scotland. We would also like to thank the anonymous referees for constructive comments on an earlier version on this paper. Health Promotion International. . The Swedish Council for Information on Alcohol and Other Drugs. the risk of tobacco use is reinterpreted at the individual level. risk. 443–454. 63). This pattern.-L. in turn. When confronted with the offer of tobacco use. 1997. Health Education Research. Long-term use of smokeless tobacco. Cardiovascular mortality and risk factors. Most importantly. To do this. Bolinder. and tobacco use in this phase is not necessarily thought of as ‘‘turning away from health’’. the teenagers’ notions of tobacco use forms a paradox. 1999). although well informed about the health-hazards. even if the ‘‘teenagers nature’’ creates a common platform for identity-work. G. Handbook for exellence in focus groups research. (1993). 1998). Acknowledgements We would like to thank the teenage girls and boys who participated in the focus groups discussions and Dulcinia Da Costa for her translations from Swedish of the teenagers’ vividly described views on smoking and snuffing. M. (1990). which can extend the repertoire of female identities beyond the traditional. Plumridge et al. S. reflecting the fundamental condition of modern man to be obliged to form an identity (Giddens. Wearing. Clayton. the teenagers challenge a more fundamental ‘‘imperative of health’’ (Lupton. the body and ‘‘human nature’’. 61. which is presented as less harmful than smoking and goes well with a traditional male identity. (1991). 1995) in contemporary Western societies. S. and the finding that teenagers separate the child’s nature from the teenagers’. Stjerna et al. Other researchers (Michell & Amos. although considered risky.. there are gendered solutions to the problem of being a nonsmoker. In other words. Journal of School Health. However. the teenagers are informed about tobacco facts and do not question the health hazards at a general level. smoking during teenage years and adult life are viewed as separate phenomena. . 2002:169) have stressed that girls seem to be more vulnerable to smoking uptake due to different peer pressure and have more limited possibilities of forming alternative identities to the ‘‘cool smoker’’.. Of particular importance are the ways images of tobacco use are intertwined with ideas of different identities that the teenager could strive for or try to avoid. Here. The teens are viewed as a phase in life characterised by certain conditions. We have seen that boys’ and girls’ tobacco use are described as related to different values and gender loadings. We agree with Wearing. weak or strong is seen as making a difference. Young women and smoking: Towards a sociological account. to be a boy or a girl. / Social Science & Medicine 59 (2004) 573–583 tradition of snuffing adds another dimension to tobacco use in Sweden. This takes place in a rapid stream of different influences. We would argue that teenagers’ notions of tobacco use should be understood within this context of identity-work. there is a need to provide enriching experiences in the leisure field. These results may have implications for preventing tobacco use among teenagers. & Hibell. but not ‘‘male’’ from ‘‘female’’. (Schoolchildren’s drug habits 1998. as well as the Swedish Cancer Society for funding the initial phase of this study. Report 2001. B. Tables and comments.. New York: Lexington. smoking is thought of as possible during the teenage years. This study has shown that the teenagers hold complex and conflicting ideas concerning the relationship between tobacco-use. Debus. & Cunningham-Burley. seems to be intertwined with certain youth and gender identities. N. Secondly. whereas boys seem to be more protected as they can establish themselves as ‘‘physical beings’’. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs. Smart. (1999). (1995). teenagers are thought to differ in psychical strength and capacity to ‘‘handle’’ this offer in the context of identity-work. as an individual acting within a social context. some teenagers. the notion of ‘‘human nature’’ is important. Amos. Andersson. K. (2001). since the most alarming dangers are attributed to the adult smoker. Part of this influence is the possibility of tobacco use. articulated an identity as smokers whereas others were more likely to view themselves as ‘‘social smokers’’. but this is open to be negotiated within the local socio-cultural contexts of teenage life.ARTICLE IN PRESS 582 M. Trends in alcohol and other drugs in Sweden. loaded with symbolic meaning. Also. H. 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