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Cigarette smoking by adolescents : exploring a hypothesis of social marginalization Dovell, Ronald A.

Abstract

This study investigates the use of tobacco by young people. It compares the personal characteristics of adolescent smokers and non-smokers as well as their social context. The principal hypothesis is that young smokers tend to be marginalized from their home or school environments. Such psycho-social alienation creates conditions where attempts toward social bonding, particularly among peers, can include behaviour such as using tobacco. While the investigation is focused on smoking, it also considers other behaviour known to compromise health. The study quantifies the relative strength of the relationships among health-compromising behaviour and determines social variables associated with such behaviour. The hypothesis of a relationship among health-compromising behaviour is supported by Problem Behaviour Theory as developed by Jessor and Jessor, 1977. Additional theories and empirical evidence are used to place smoking and other risk behaviour within a broad social framework. The framework is intended to clarify important factors that exist when young people start to smoke. It is used to test the hypothesis that the uptake of smoking is associated with adolescents who provide indications of being socially marginalized. The project exploits a large database sponsored by the World Health Organization. The database, "Health Behaviours of School-Aged Children," contains information from adolescents of several countries, including Canada. The Canadian portion provides results from three national cross-sectional surveys conducted at three times during the past decade: 1989-90, 1993-94 and 1997- 98. Several questions used in the latter two surveys are nearly identical. The similarity makes them useful for temporal comparisons as well as merging into one database for modeling and testing hypotheses. The expanded dataset facilitates socio-demographic comparisons such as age, gender and socio-economic status. The analysis proceeds with the development of a marginalization model. The model is based on a synthesis of the literature including reports of the U.S. Surgeon General, Social Bonding Theory and Problem Behaviour Theory. The model delineates demographic variables as well as areas of marginalization that are important to adolescents. The important dimensions of adolescent lives include the home environment, school environment, peer groups and personal factors. Indicators for these dimensions were selected from the Health Behaviour surveys and subjected to a variety of statistical procedures. We assessed relationships between the demographic variables, dimensions of marginalization and behaviour. Due to the public health significance of smoking, the behaviour received a central focus during our analysis. We were unable to develop a composite indicator of socioeconomic status that would logically explain smoking status. The analysis of smoking status by age group found large increases in the proportion of smokers from the age of 11 to 15 years. The distribution of smoking status by age group was comparable to other national surveys. This project makes several contributions to public health, including: 1) Quantitative modeling to clarify the conditions that prevail during the uptake of smoking in Canada. 2) Testing of a hypothesis that adolescent smoking is associated with marginalization from formal social networks. 3) Insight into associations between smoking by young people and other risk behaviour that can compromise health. We have found that smoking is related to other behaviours that can compromise health. Smoking is associated with the use of illicit drugs, consumption of alcohol and failure to take safety precautions. Exercising and taking care of teeth were minimally associated with smoking. Relationships between the indicators of marginalization and smoking status were highly consistent. Relatively uniform increases in the proportion of smokers occurred as levels of Likert scales indicated greater marginalization. Each of the summary constructs of our marginalization model was able to differentiate current smokers and never smokers. A slight paramountcy of the home environment became evident from summary statistics using binary logistic regression and standardized scores of marginalization. Examination of the individual indicators illuminated the need for programs to assist interpersonal relations of adolescents. For example, to reduce the difficulties of marginalization programs need to assist with communication skills, building mutual trust and developing realistic expectations that are relevant to youth. The fact that marginalization differentiates smoking status in every domain that we identified as important to the lives of adolescents, tells us that theories and programs to prevent smoking must be comprehensive. The programs need to guide and support adolescents across these important domains in order to lower the burden of difficulties created by marginalization. Our research implies that benefits can accrue beyond the prevention of smoking. Additional research is required to investigate the full potential for enhancing population health by reducing marginalization and helping youth meet the challenges of marginalization.

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