Growing Up With Girl Power (Mediated Youth) 
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Tobacco use is a learned and socially mediated behavior. Experimenting with tobacco is attractive to children and youths because of associations they learn to make between tobacco use and the kind of social identity they wish to establish. Repeated and ubiquitous messages reinforcing the positive attributes of tobacco use give youths the impression that tobacco use is pervasive, normative in many social contexts, and socially acceptable among people they aspire to be like. Youths are led to believe that tobacco consumption is a social norm among attractive, vital, successful people who seek to express their individuality, who enjoy life, and who are socially secure. Several factors are involved in maintaining this impression among youths and in fostering tobacco use as a social norm at a time when public health messages are calling attention to the serious health risks associated with tobacco consumption. These factors will be highlighted in this chapter, and attention will also be called to a growing, largely local, movement calling for the exercise of greater social responsibility in the reduction of environmental cues that reinforce tobacco use in public spaces frequented by children and youths. At issue is an ecology of representations, ideas, images, cues, and the like, that foster tobacco use as normative behavior.
The term "norms" has a broad range of meaning, with very specific connotations applied in the social sciences. In general, however, and for the purposes of discussion in this report, social norms are at once descriptive, that is, normative in a statistical sense denoting majority approval, and prescriptive, that is, guidelines for acceptable behavior associated with sociocultural values. Norms are maintained both by social reinforcements and social sanctions. A social learning analysis of tobacco use takes into account the different types of social reinforcement that coincide with the development of tobacco use from experimentation to initiation to maintenance of regular use. Experimentation typically occurs under conditions of peer reinforcement; usually the initial inhalation of smoke is aversive but eventually the youth develops a tolerance to it. In other words, the adolescent "learns" in a peer context that tobacco use is an acceptable or desirable behavior, despite initial negative physiological reactions. Continued use produces pharmacologic reinforcement to sustain the behavior independent of social reinforcement. The behavior then occurs in different situations, where new learning takes place. The young smoker discriminates between situations in which smoking is socially acceptable or unacceptable. At the same time, various environmental or situational cues, such as an ashtray, or an empty cigarette pack, or a party, not only can suggest acceptability but can also stimulate physiological responses that reinforce the addiction to nicotine.1 Hence, whereas the addictive power of nicotine drives a person to use tobacco regularly and to maintain that regular use, it is the power of these perceived social norms that persuades children and youths to experiment with and initiate use of tobacco.
In developing peer norms, adolescents look to the greater social environment for concepts of adult identity, particularly in the behavior of leaders, heroes, and film stars, and in the media. Messages, especially repeated messages. that associate behaviors with maturity, peer approval, and independence tend to be the most influential. An overabundance of such messages in relation to a given behavior can result in a youth's misperception of how pervasive the behavior actually is. Misperception of the pervasiveness of tobacco use can be a powerful influence on behavior.
Youths and adults alike want to quit using tobacco. A 1993 national Gallup poll reported that 76% of adult smokers have tried to quit smoking. Despite past failures, 73% believe that they will be nonsmokers within 5 years, and 30% were trying to quit at the time of the survey.10 Similarly, in a 1994 USA Today/CNN Gallup poll, 70% of smokers expressed interest in quitting; 48% had tried to do so but failed. About the same percentage (76%) of adolescent girls (smokers and ex-smokers) in the Teen Lifestyle Study had attempted to quit.11 Two large national surveys of teens also reveal that youths want to and try to quit. The 1989 TAPS (Teenage Attitudes and Practices Survey) data show that 74% of 12-through 18-year-old smokers had seriously thought about quitting; 64% had tried at some time to stop smoking and 49% had tried during the preceding 6 months (figure 3-1).12 The Monitoring the Future Project data show that nearly half of smokers who were seniors in high school between 1976 and 1989 wanted to quit, and about 40% had tried unsuccessfully to do so.13
What little information is available on the smoking habits of American-Indian groups shows large regional and tribal variations. For instance, one study found tobacco use to be very high among girls, and daily cigarette smoking higher among girls than among boys, after the seventh grade. Daily cigarette smoking rose from 8.9% for girls and 8.1 % for boys in junior high to 17.8% and 15.0%, respectively, for high school students. Elsewhere rates of about 20% were reported for regular smoking among American-Indian youths, and the rates seem to be increasing.16
Increasingly, through a variety of channels, the message is being conveyed that tobacco is not used by the majority of people and that it is not socially acceptable. The public health values underlying this tobacco-free norm are steadily growing stronger and are being articulated more emphatically. Nevertheless, youths do not perceive the norm to be tobacco-free; rather, they commonly overestimate the percentage of their peers and adults who use tobacco.
In an interview study of 895 urban children and youths, the respondents greatly overestimated the prevalence of adult and peer smoking. The mean estimate for adult smoking was 66% at a time when 30% of adults were cigarette smokers. Estimates of peer smoking were about double the real figure by students in high school and higher by students in grade school.29 Other studies show similar results. Findings from the 3-year (1990-1992) Teen Lifestyle Project reveal that, although only 5% of adolescent girls in a Tucson sample smoked regularly and another 20% smoked only occasionally or only at parties, 31% of their peers thought that 51-75% of girls at their school smoked and another 10% thought that 75-90% smoked. The estimates about percentages of boys who smoke were similar, as they were for adult men and women. For example, 28% thought that 51-75% of women were smokers and 15% thought that 75-90% were smokers.30 A study of over 200 adolescents in Michigan found that youths' perceptions of the prevalence of smoking were "highly inaccurate": 79% of the youths thought that over half of all adults smoke and 68% thought that over half of all teens smoke.31
The misperception of youths that the large majority of peers and adults use tobacco may well derive from the near-constant exposure youths experience to pro-tobacco messages and images, which make tobacco use seem common. (See chapter 4 on advertising for a full discussion.) Pro-tobacco messages are ubiquitous in the American environment. Children walking home from schools see billboards in their neighborhoods promoting tobacco products (figure 3-3). Children themselves become walking billboards by wearing t-shirts, caps, and other clothing items that display tobacco logos. Children watch film and sports stars smoke and chew tobacco products. They read magazines with ads that either directly or indirectly promote tobacco products. They eat in restaurants that permit tobacco use. They frequent and linger in shopping malls where tobacco use is permitted. Many even attend schools where smoking is permitted on the grounds and where teachers smoke even if the students are prohibited from smoking. Youths attend cultural events, such as music concerts, and sporting events, such as rodeos and car racing, either sponsored by the tobacco industry or where billboards, scoreboards, or contestants display tobacco logos. Furthermore, tobacco products are displayed in many stores frequented by youths and are easily purchased by youths. As a result, children learn early and erroneously that tobacco use is widespread and acceptable, especially as an adult behavior.
The belief that there are benefits to smoking was a major predictor of both susceptibility and smoking in the last month in the 1990 and 1992 surveys. The univariate statistics from the 1992 survey indicate that, of those who did not perceive any of these benefits, 24% were susceptible to smoking; of those who perceived one benefit, 38% were susceptible to smoking; of those who perceived two benefits, 41% were susceptible; and of those who perceived three or more benefits, 57% were susceptible. In cross-sectional analyses of the 1992 survey data, the proportion of susceptible youth who experimented with cigarettes rose dramatically with age (14% of 12-year-olds versus 90% of 19-year-olds) compared to experimentation among those not susceptible (5% of 12-year-olds versus about 25% of 19-year-olds). The investigators conclude that, "these data suggest that the susceptibility measure includes adolescents who may smoke in the future but have not yet tried a cigarette."37
In the Teen Lifestyle Study, about half of those adolescents who smoked said that they started smoking because they had stress in their lives and they thought that smoking would be relaxing. Over half of them smoke when they are with friends.38 In another study, to determine the power of image messages in reinforcing tobacco use, Pierce and colleagues related trends in smoking initiation to the sales of leading cigarette brands targeted to women in advertisements from 1944 through the mid-1980s. The analysis revealed gender-specific relationships with the tobacco advertising campaigns that targeted women and were launched in 1967.39 (See chapter 4 for details.) 2b1af7f3a8