Smoker identity and its potential role in young adults' smoking behavior: A meta-ethnography

Ildiko Tombor, Lion Shahab, Aleksandra Herbec, Joanne Neale, Susan Michie, Robert West, Ildiko Tombor, Lion Shahab, Aleksandra Herbec, Joanne Neale, Susan Michie, Robert West

Abstract

Objective: Identity is an important influence on behavior. To identify potential targets for smoking cessation interventions in young adults, we synthesized findings from qualitative studies on smoker identity and potential influences on smoking and smoking cessation.

Methods: A systematic search of 4 electronic databases up to September 19, 2013, was conducted to identify qualitative studies on smoker identity in smokers and ex-smokers aged 16-34. Key concepts were extracted from individual studies and synthesized into higher-order interpretations by following the principles of meta-ethnography.

Results: Seventeen relevant papers were identified. At the highest level of interpretation, we identified 4 types of findings: (a) contributory factors to identity, (b) identity in relation to smoking, (c) contextual and temporal patterning, and (d) behavior in relation to smoking. Contributory factors included the desire to establish aspirational individual and social identities, enact a smoker identity appropriate to the momentary social context, and alter personal nonsmoking rules when consuming alcohol. Smoker identity was multifaceted and incorporated individuals' defensive rationalizations, and both positive and negative feelings attached to it. Smoker identities took time to develop, were subject to change, and were context dependent. Identity was found to play a role in quit attempts.

Conclusions: Qualitative research into the identity of young adult smokers has established it as a multifaceted phenomenon serving important functions but also involving conflict and defensive rationalizations. It develops over time and contextual factors influence its expression. The nature of a smoker's identity can play an important role in smoking cessation. (PsycINFO Database Record

(c) 2015 APA, all rights reserved).

Figures

Figure 1
Figure 1
Flow chart for paper selection.
Figure 2
Figure 2
Framework for the interpretation of smoker identity and identity change in young adults.

References

    1. Amos A., Wiltshire S., Haw S., & McNeill A. (2005). Ambivalence and uncertainty: Experiences of and attitudes towards addiction and smoking cessation in the mid-to-late teens. Health Education Research, 21, 181–191. 10.1093/her/cyh054
    1. Arnett J. J. (2000). Emerging adulthood. A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480. 10.1037/0003-066X.55.5.469
    1. Berg C. J., Lust K. A., Sanem J. R., Kirch M. A., Rudie M., Ehlinger E., et al. An L. C. (2009). Smoker self-identification versus recent smoking among college students. American Journal of Preventive Medicine, 36, 333–336. 10.1016/j.amepre.2008.11.010
    1. Berg C. J., Parelkar P. P., Lessard L., Escoffery C., Kegler M. C., Sterling K. L., & Ahluwalia J. S. (2010). Defining “smoker”: College student attitudes and related smoking characteristics. Nicotine & Tobacco Research, 12, 963–969. 10.1093/ntr/ntq123
    1. Brown A. E., Carpenter M. J., & Sutfin E. L. (2011). Occasional smoking in college: Who, what, when and why? Addictive Behaviors, 36, 1199–1204. 10.1016/j.addbeh.2011.07.024
    1. Campbell R., Pound P., Morgan M., Daker-White G., Britten N., Pill R., et al. Donovan J. (2011). Evaluating meta-ethnography: Systematic analysis and synthesis of qualitative research. Health Technology Assessment, 15, 1–164. 10.3310/hta15430
    1. Choi Y., Choi S. M., & Rifon N. (2010). “I smoke but I am not a smoker”: Phantom smokers and the discrepancy between self-identity and behavior. Journal of American College Health, 59, 117–125. 10.1080/07448481.2010.483704
    1. Dixon-Woods M., Fitzpatrick R., & Roberts K. (2001). Including qualitative research in systematic reviews: Opportunities and problems. Journal of Evaluation in Clinical Practice, 7, 125–133. 10.1046/j.1365-2753.2001.00257.x
    1. Doll R., Peto R., Boreham J., & Sutherland I. (2004). Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ: British Medical Journal, 328, 1519 10.1136/
    1. Dresler C. M., León M. E., Straif K., Baan R., & Secretan B. (2006). Reversal of risk upon quitting smoking. The Lancet, 368, 348–349. 10.1016/S0140-6736(06)69086-7
    1. Falomir J. M., & Invernizzi F. (1999). The role of social influence and smoker identity in resistance to smoking cessation. Swiss Journal of Psychology/Schweizerische Zeitschrift fur Psychologie/Revue Suisse de Psychologie, 58, 73–84.
    1. Festinger L. (1954). A theory of social comparison processes. Human Relations, 7, 117–140. 10.1177/001872675400700202
    1. Freeman M. A., Hennessy E. V., & Marzullo D. M. (2001). Defensive evaluation of antismoking messages among college-age smokers: The role of possible selves. Health Psychology, 20, 424–433. 10.1037/0278-6133.20.6.424
    1. Gilbert E. (2007). Constructing “fashionable” youth identities: Australian young women cigarette smokers. Journal of Youth Studies, 10, 1–15. 10.1080/13676260701196079
    1. Hertel A. W., & Mermelstein R. J. (2012). Smoker identity and smoking escalation among adolescents. Health Psychology, 31, 467–475. 10.1037/a0028923
    1. Hoek J., Hoek-Sims A., & Gendall P. (2013). A qualitative exploration of young adult smokers’ responses to novel tobacco warnings. BMC Public Health, 13, 609 10.1186/1471-2458-13-609
    1. Hoek J., Maubach N., Stevenson R., Gendall P., & Edwards R. (2013). Social smokers’ management of conflicted identities. Tobacco Control: An International Journal, 22, 261–265. 10.1136/tobaccocontrol-2011-050176
    1. Høie M., Moan I. S., & Rise J. (2010). An extended version of the theory of planned behavior: Prediction of intentions to quit smoking using past behavior as moderator. Addiction Research & Theory, 18, 572–585. 10.3109/16066350903474386
    1. Hubbard G., McLachlan K., Forbat L., & Munday D. (2012). Recognition by family members that relatives with neurodegenerative disease are likely to die within a year: A meta-ethnography. Palliative Medicine, 26, 108–122. 10.1177/0269216311402712
    1. Jia H., Zack M. M., Thompson W. W., & Dube S. R. (2013). Quality-adjusted life expectancy (QALE) loss due to smoking in the United States. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 22, 27–35. 10.1007/s11136-012-0118-6
    1. The Joanna Briggs Institute (2011). Joanna Briggs Institute reviewers’ manual: 2011 ed. South Australia: The Joanna Briggs Institute, The University of Adelaide.
    1. Johnson J. L., Lovato C. Y., Maggi S., Ratner P. A., Shoveller J., Baillie L., & Kalaw C. (2003). Smoking and adolescence: Narratives of identity. Research in Nursing & Health, 26, 387–397. 10.1002/nur.10102
    1. Kearney M. H., & O’Sullivan J. (2003). Identity shifts as turning points in health behavior change. Western Journal of Nursing Research, 25, 134–152. 10.1177/0193945902250032
    1. Kishchuk N., Tremblay M., Lapierre J., Heneman B., & O’Loughlin J. (2004). Qualitative investigation of young smokers’ and ex-smokers’ views on smoking cessation methods. Nicotine & Tobacco Research, 6, 491–500. 10.1080/14622200410001696565
    1. Lawson E. J. (1994). The role of smoking in the lives of low-income pregnant adolescents: A field study. Adolescence, 29, 61–79.
    1. Leas E. C., Zablocki R. W., Edland S. D., & Al-Delaimy W. K. (2014). Smokers who report smoking but do not consider themselves smokers: A phenomenon in need of further attention. Tobacco Control. Advance online publication.
    1. Lennon A., Gallois C., Owen N., & McDermott L. (2005). Young women as smokers and nonsmokers: A qualitative social identity approach. Qualitative Health Research, 15, 1345–1359. 10.1177/1049732305277844
    1. Levinson A. H., Campo S., Gascoigne J., Jolly O., Zakharyan A., & Tran Z. V. (2007). Smoking, but not smokers: Identity among college students who smoke cigarettes. Nicotine & Tobacco Research, 9, 845–852. 10.1080/14622200701484987
    1. MacFadyen L., Amos A., Hastings G., & Parkes E. (2003). “They look like my kind of people”—perceptions of smoking images in youth magazines. Social Science & Medicine, 56, 491–499. 10.1016/S0277-9536(02)00050-3
    1. Malpass A., Shaw A., Sharp D., Walter F., Feder G., Ridd M., & Kessler D. (2009). “Medication career” or “moral career”? The two sides of managing antidepressants: A meta-ethnography of patients’ experience of antidepressants. Social Science & Medicine, 68, 154–168. 10.1016/j.socscimed.2008.09.068
    1. Markus H., & Nurius P. (1986). Possible selves. American Psychologist, 41, 954–969. 10.1037/0003-066X.41.9.954
    1. Michie S., Richardson M., Johnston M., Abraham C., Francis J., Hardeman W., et al. Wood C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46, 81–95. 10.1007/s12160-013-9486-6
    1. Moan I. S., & Rise J. (2005). Quitting smoking: Applying and extended version of the theory of planned behavior to predict intention and behavior. Journal of Applied Biobehavioral Research, 10, 39–68. 10.1111/j.1751-9861.2005.tb00003.x
    1. Moffat B. M., & Johnson J. L. (2001). Through the haze of cigarettes: Teenage girls’ stories about cigarette addiction. Qualitative Health Research, 11, 668–681. 10.1177/104973201129119361
    1. National Institute for Health and Clinical Excellence (2009). Methods for the development of NICE public health guidance (2nd ed.). London: NHS National Institute for Health and Clinical Excellence.
    1. Noblit G. W., & Hare R. D. (1988). Meta-ethnography: Synthesizing qualitative studies. Newbury Park, CA: Sage.
    1. Oyserman D. (2007). Social identity and self-regulation In Kruglanski A. W. & Higgins T. E. (Eds.), Social psychology: Handbook of basic principles (2nd ed., pp. 432–453). New York, NY: Guilford Press.
    1. Oyserman D. (2009). Identity-based motivation: Implications for action-readiness, procedural readiness, and consumer behaviour. Journal of Consumer Psychology, 19, 250–260. 10.1016/j.jcps.2009.05.008
    1. Oyserman D., Fryberg S. A., & Yoder N. (2007). Identity-based motivation and health. Journal of Personality and Social Psychology, 93, 1011–1027. 10.1037/0022-3514.93.6.1011
    1. Pirie K., Peto R., Reeves G. K., Green J., Beral V., & the Million Women Study Collaborators (2013). The 21st century hazards of smoking and benefits of stopping: A prospective study of one million women in the UK. The Lancet, 381, 133–141. 10.1016/S0140-6736(12)61720-6
    1. Ridner S. L., Walker K. L., Hart J. L., & Myers J. A. (2010). Smoking identities and behavior: Evidence of discrepancies, issues for measurement and intervention. Western Journal of Nursing Research, 32, 434–446. 10.1177/0193945909354904
    1. Ring N., Jepson R., Hoskins G., Wilson C., Pinnock H., Sheikh A., & Wyke S. (2011). Understanding what helps or hinders asthma action plan use: A systematic review and synthesis of the qualitative literature. Patient Education and Counseling, 85, e131–e143. 10.1016/j.pec.2011.01.025
    1. Rooke C., Amos A., Highet G., & Hargreaves K. (2013). Smoking spaces and practices in pubs, bars and clubs: Young adults and the English smokefree legislation. Health & Place, 19, 108–115. 10.1016/j.healthplace.2012.10.009
    1. Scheffels J. (2008). A difference that makes a difference: Young adult smokers’ accounts of cigarette brands and package design. Tobacco Control: An International Journal, 17, 118–122. 10.1136/tc.2007.021592
    1. Scheffels J. (2009). Stigma, or sort of cool: Young adults’ accounts of smoking and identity. European Journal of Cultural Studies, 12, 469–486. 10.1177/1367549409342513
    1. Scheffels J., & Schou K. C. (2007). To be one who continues to smoke: Construction of legitimacy and meaning in young adults’ accounts of smoking. Addiction Research & Theory, 15, 161–176. 10.1080/16066350601179464
    1. Shadel W. G., Mermelstein R., & Borrelli B. (1996). Self-concept changes over time in cognitive-behavioral treatment for smoking cessation. Addictive Behaviors, 21, 659–663. 10.1016/0306-4603(95)00088-7
    1. Smith L. K., Pope C., & Botha J. L. (2005). Patients’ help-seeking experiences and delay in cancer presentation: A qualitative synthesis. The Lancet, 366, 825–831. 10.1016/S0140-6736(05)67030-4
    1. Song A. V., & Ling P. M. (2011). Social smoking among young adults: Investigation of intentions and attempts to quit. American Journal of Public Health, 101, 1291–1296. 10.2105/AJPH.2010.300012
    1. Tajfel H., & Turner J. C. (1986). The social identity theory of intergroup behaviour In Worchel S. & Austin W. G. (Eds.), The psychology of intergroup behaviour (pp. 7–24). Chicago, IL: Nelson Hall.
    1. Taylor G., McNeill A., Girling A., Farley A., Lindson-Hawley N., & Aveyard P. (2014). Change in mental health after smoking cessation: Systematic review and meta-analysis. BMJ: British Medical Journal, 348, g1151 10.1136/bmj.g1151
    1. Tombor I., Shahab L., Brown J., & West R. (2013). Positive smoker identity as a barrier to quitting smoking: Findings from a national survey of smokers in England. Drug and Alcohol Dependence, 133, 740–745. 10.1016/j.drugalcdep.2013.09.001
    1. Toye F., Seers K., Allcock N., Briggs M., Carr E., Andrews J., & Barker K. (2013). “Trying to pin down jelly”—Exploring intuitive processes in quality assessment for meta-ethnography. BMC Medical Research Methodology, 13, 46 10.1186/1471-2288-13-46
    1. Vignoles V. L. (2011). Identity motives In Schwartz S. J., Luyckx K., & Vignoles V. L. (Eds.), Handbook of identity. Theory and research (pp. 403–432). New York: Springer; 10.1007/978-1-4419-7988-9_18
    1. Vignoles V. L., Schwartz S. J., & Luyckx K. (2011). Introduction: Toward an integrative view of identity In Schwartz S. J., Luyckx K., & Vignoles V. L. (Eds.), Handbook of identity. Theory and research (pp. 1–27). New York: Springer; 10.1007/978-1-4419-7988-9_1
    1. Wee L. H., Shahab L., Bulgiba A., & West R. (2011). Conflict about quitting predicts the decision to stop smoking gradually or abruptly: Evidence from stop smoking clinics in Malaysia. Journal of Smoking Cessation, 6, 37–44. 10.1375/jsc.6.1.37
    1. West R. (2006). The theory of addiction. Oxford: Blackwells.
    1. West R., & Brown J. (2012). Smoking and smoking cessation in England 2011. Retrieved from
    1. West R., Walia A., Hyder N., Shahab L., & Michie S. (2010). Behaviour change techniques used by the English Stop Smoking Services and their associations with short-term quit outcomes. Nicotine & Tobacco Research, 12, 742–747.
    1. Wiltshire S., Amos A., Haw S., & McNeill A. (2005). Image, context and transition: Smoking in mid-to-late adolescence. Journal of Adolescence, 28, 603–617. 10.1016/j.adolescence.2004.12.005

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever