Smoking Behaviors Among US Women Ages 18–30: A Research Proposal

Introduction

The issue of tobacco smoking is increasingly becoming an essential element of discussions about community and individual health. Smoking, along with all of its side effects and co-morbidities, represents the most preventable set of behaviors and diseases in the world (Bricker, Rajan, Andersen, & Peterson, 2005). The diseases and conditions directly associated with smoking are among the deadliest known, and yet young people continue to begin smoking at alarming rates (Munafò & Black, 2007). This work will specifically examine the identifiable social, cultural, and personal reasons why people — and specifically young women ages 18–30 in the US — begin smoking in the first place.

The work proposed will employ a mixed-methods research methodology that utilizes both qualitative and quantitative data. In general, most of the research related to cigarettes that has been conducted is quantitative in nature, relying on statistical analysis. While quantitative research is important for establishing smoking prevalence, smoking patterns, and smoking-related illness, it cannot alone capture the complex social, cultural, political, and economic aspects of cigarette use. Qualitative research has thus emerged as a way to improve understanding of some of the more elusive aspects of tobacco use, such as why women start and continue to smoke. Qualitative research also helps explain findings from quantitative research and provides data that can inform research questions in quantitative studies.

This work will take the form of a meta-analysis focused on smoking behaviors among women ages 18 to 30. The meta-analysis will examine both qualitative and quantitative research on the subject and include only those works that address all three factors: smoking behavior, female subjects, and the age group of 18–30. The research literature has been reported as lacking in information about gender differences in motivation for starting and stopping smoking; therefore, a meta-analysis constitutes a legitimate approach to exploring this hypothesis within the existing literature. Additionally, this research will draw from the available literature information provided by various study participants and will attempt to develop an argument for causal factors of smoking behaviors among women, who have been repeatedly reported as having different motivational as well as physical reasons for exhibiting risk-taking behaviors compared to men in the same age group (Berlin, Gasior, & Moolchan, 2007; Baker, Maes, Larsson, Lichtenstein, & Kendler, 2011; Kawai, Kang, & Metherate, 2011). The work will not compare men to women but will look specifically at women participants and draw from the evidence to support a more accurate conceptualization of smoking as a risk-taking behavior among women.

It has been theorized that because females tend to mature earlier — both physically and mentally — than boys, they are less likely than boys to begin smoking during adolescence. Additionally, some researchers detail the association between increased parental supervision among girls as another factor contributing to lower rates of smoking and other risk-taking behaviors among girls and young adult women during the adolescent risk period. The literature does not, however, support either of these assumptions. Many studies have indicated that there is only a minimal difference between the percentages of boys and girls regarding smoking behaviors beginning at around age 13, but that the pattern of initiation actually rose sharply among girls and more gradually among boys up to the age of 18 (Bernaards, Kemper, Twisk, van Mechelen, & Snel, 2001, pp. 640–641).

Review of Literature

One study found that a gender difference that can be established is that women, over time and through development, are far more likely than men to quit smoking (Munafò & Black, 2007, p. 397). Additionally, with regard to gender, it was found to be more likely for men to be heavy smokers than women, even if they did continue to smoke into adulthood (p. 400). This same study also found a strong link between two personality traits — extroversion and neuroticism — which appear to transcend gender and create a higher likelihood of initiating smoking and continuing to smoke into adulthood. Gender did not alter this trend, but the authors established a strong link between these personality traits and heritability, meaning these two traits are commonly passed from one generation to the next and presuppose a higher propensity for becoming a lifelong smoker (pp. 397–398).

Bell and Lee (2006) found that life transitions tend to affect smoking and other health-related behaviors for women, where stress served as an indicator for smoking behaviors and was triggered by disrupted life-stage transitions — such as moving from independence back to the parental home. Additionally, the work found that becoming mothers also had an effect on smoking behaviors. In a longitudinal study of women in Australia, the authors concluded that "young women's smoking patterns are significantly associated with the transitions of emerging adulthood. Specifically, both marriage and pregnancy were associated with smoking cessation, whereas young motherhood was associated with resuming smoking after cessation" (p. 266). Overall, the work indicated that if things proceeded along socially accepted pathways, young women were less likely to continue smoking even if they had begun in adolescence; however, if they deviated from the "normal" path, the stress associated with this disruption was a contributing factor to continued or recurrent smoking behaviors.

Peer and parental influence was examined by Brook, Pahl, and Ning (2006), who chose to look at minority girls and women (African American and Latina) in an attempt to understand the influence of environmental smoking on these populations. The literature review in that work highlighted some seminal findings by other researchers who contended that peer group smoking was a large factor in smoking risk behavior among girls — but not among boys (p. 261). Additionally, the work found that parental and peer smoking in both genders determined a greater likelihood of early initiation as well as persistence of smoking into adulthood (p. 261). This finding is significant because it implies that smoking cessation education for girls should include attempts to reduce exposure to peer smoking, much as people struggling with alcohol dependence are advised to break patterns by distancing themselves from drinking companions.

Along similar lines, Bricker, Rajan, Andersen, and Peterson (2005) demonstrated that children whose parents smoked were far more likely to quit smoking as young adults if their parent or parents quit while the children were still young. Conversely, they also found that children whose parents quit later in life did not show a higher likelihood of quitting themselves as young adults. This finding again emphasizes the need to alter peer or parental behavior and exposures at critical points in early life. Finally, socioeconomic status (SES) appears to be another factor related to both the initiation and continuation of smoking, as both boys and girls in families the researchers characterized as belonging to the manual labor class showed higher rates of smoking. This finding indicated that even adult children's own improvements in SES did not mitigate the lasting effects of smoking as a continuing behavior (Huurre, Aro, & Rahkonen, 2003).

Statement of Purpose: To explore the unique and common motivations for smoking behaviors among women ages 18–30 — both for starting and for persistence of smoking — through a literary meta-analysis.

Hypothesis: Female young adults will have characteristically and environmentally unique motivations for both beginning to smoke and continuing to smoke into adulthood.

This research proposal will use several academic research databases to collect a large subset of scholarly literature on the subjects of smoking, smoking cessation, gender or sex differences, or exclusively female study participants. Studies will be included if they utilize either a longitudinal method that encompasses the age group 18–30 or exclusive age-group research, and if they employ qualitative, quantitative, or mixed-methods designs. The databases to be used include Ebsco databases — Academic Search Complete, HealthSource Consumer Edition, HealthSource Nursing/Academic Edition, PsycArticles, and PsycInfo — as well as Biological Abstracts, CINAHL, and the Cochrane Library Databases.

Statement of Purpose and Hypothesis

After a comprehensive term search covering all categorical terms listed above, the researcher will review each article for topical relevance as well as academic merit and statistical accuracy. Once the initially large pool of articles has been narrowed to those of specific interest for this work — likely to approximately 100 articles — the researcher will conduct a term and data search across all retained works to identify thematic trends, comparing quantitative data where possible and drawing on qualitative transcription where applicable. The work will then be divided into two subsections: one addressing qualitative data and one addressing quantitative data interpretations. Finally, the work will be organized by dataset-specific information, and a thorough discussion of the findings will be compiled. Recommendations for future research, as well as any cessation and treatment trends that emerge as particularly effective in supporting women to quit smoking, will be addressed and discussed.