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Article Excerpt
This paper uses a hierarchical decision process model, uses of information, and a theory of consumption values as a strategic framework for evaluating the general failure of intervention strategies for teenage smoking initiation. Extremely high smoking consideration-to-trial rates and rapid cessation by occasional smokers provide narrow but unused strategic opportunities for intervention. Use of information sources varies by stage of model with interpersonal sources dominating consideration, trial, and cessation stages and mass media showing only a slightly increasing use in cessation compared to the earlier stages. The decision process model and consumption values are necessary for planning strategic interventions. Existing intervention programs are not appropriately targeted in the decision process. Programs should be developed to reduce the smoking consideration to trial rates in younger children and to encourage rapid cessation in older teenagers. The use of either print or broadcast mass media interventi on programs is not supported.
Continuing high levels of teenage tobacco use in the United States and elsewhere cast doubts on the success of public policy interventions and the efficacy of widely held teenage smoking beliefs. While levels of teenage smoking have recently shown a slight decrease, high-school smoking rates are more than one-fourth higher than in 1991, and the percentage of frequent high-school smokers has risen approximately 32% during the same time period (Brooks 2000). Surprisingly, little appears to have changed since 1988, when one group of researchers observed:
In spite of the attention, smoking behavior among adolescents has not decreased appreciably over the past five years, and the most intensive intervention efforts have been judged to be only of modest success (Cleary et al. 1988, p. 137).
In that time frame, teenage smoking prevention programs were described as "modest" and "fragile" and having unwarranted optimism about their potential impact (Cleary et al. 1988, p. 149). Other researchers then questioned government regulations and policies in terms of effectiveness in achieving desired objectives (McAuliffe 1988; Ringold and Calfee 1990; Calfee and Ringold 1992).
Today there is evidence that even total advertising bans may have only a limited effect on teenage smoking behavior (Langreth 1997). and attempts to limit youth access to tobacco have had limited, though not statistically significant, results (Forster et al. 1998). Seigel and Beiner (1997) reviewed two "successful" statewide anti-tobacco campaigns and found neither program reduced smoking initiation among adolescents. Advertising and antismoking information were found to be less important in predicting adolescent smoking levels than peer pressure and prior beliefs. Others have questioned the value of health warning labels for adolescents (Cecil, Evans, and Stanley 1996) and exposure to antismoking messages and advertisements, (Murray, Prokhorov, and Hardy 1994; Pechmann and Tatneshwar 1994). Even the impact of tobacco advertising campaigns such as "Joe Camel" on youth smoking has been recently questioned (Calfee, 2000; Cohen 2000). The ongoing tobacco company legal settlements and recent smoking discouragemen t strategies proposed by the tobacco industry (Beck 1996; Hwang 1995; Freedman and Hwang 1997) seem to be ineffectual as the teenage smoking situation is not improving.
Previous findings that adolescents were smoking at a higher rate led politicians to state that children were condemning themselves to a lifetime of pain and disease (Buckley 1995; Consumer Reports 1995; Hwang 1995), and were interpreted as a continuing and major public policy failure. Teenage tobacco use continues as a major source of preventable disease, a major social problem, and a major pediatric illness, as well as a major growth market for tobacco companies (Public Health Service 1990; Kessler 1995).
There are a number of ways to study teenage smoking behavior. One major direction has been to examine the underlying behavior in the context of a number of psychosocial, demographic, and cultural factors (Escobedo et al. 1990, 1993; Thorlindsson and Vilhjalmsson 1991; Bruvold 1993; Evans et al. 1995; Pechmann 1995; Pollay et al. 1996; Lloyd, Lucas, and Fernbach 1997; Thrush, Fife-Schaw, and Breakwell 1997). Other researchers have focused on initiation behavior as a part of the overall smoking process (Krosnick and Judd 1982; Friedman 1985; Headen 1991; Pierce 1994). In general, these research approaches aref criticized for not providing an adequate account of the behavior, for a continuing gap between empirical findings and theoretical formulations (Thorlindsson 1991), and for the possibility of inadvertently reinforcing undesirable behavior through antismoking promotional messages (Eckert 1983; Pechmann and Ratneshwar 1994).
Recently in this journal, Smith and Stutts (2000) researched predictor variables of adolescent smoking behavior, concluding that family smoking behavior, peer pressure, and prior beliefs were more important than advertising and antismoking information. This present study externally validates Smith and Stutts' basic consumption values analysis with a different sample, extending those findings with direct measures of uses of information sources in the framework of a hierarchical decision process model used as a basis for the evaluation of strategic intervention possibilities. Unlike Smith and Stutts (2000), the hierarchical decision process model is used to explore potential underlying reasons why the effectiveness of past and current interventions continues to be questioned. The model also serves as a setting for integrating underlying antecedents of behavior and existing behavioral theories (Thorlindsson 1991), as well as helping researchers better understand factors that account for smoking initiation (Escob edo 1990) and cessation in an attempt to better understand those processes in children. In addition, viewing smoking behavior as a decision process allows researchers to systematically study the phenomenon as a series of stages through which individuals progress over time. This enhances evaluation of different types of intervention processes such as effective forms of communication for respondents in different stages. Specifically, we assess information sources used by respondents during the smoking decision process (Calfee 1992).
The approach taken here represents an attempt to integrate the concepts of social or consumption values, the decision process leading to the behavior, and sources of information during the decision process. One might presume this approach not to be dissimilar from that of tobacco companies in their marketing planning processes. Under the assumption that children represent a major target market, what is their value structure relevant to the smoking decision process and how do they seek and acquire information during that process? This study further examines the relationship between five consumption values and consumer choice behavior as related to the decision of teenagers to use tobacco products. These consumption values were originally proposed by Sheth, Newman, and Gross (1991a, 1991b), who applied the theory they developed to the smoking behavior of adults.
CONCEPTUAL DEVELOPMENT
The Decision Model
While the teenage tobacco use literature contains multiple examples of research into behavioral theories and underlying factors, the few examples of decision models are either theoretical discussions without empirical testing, or are not directly used to plan or evaluate strategic intervention programs. Cleary (1988) presented a four-stage model (preparation, initiation, experimentation, maintenance) and called for further research into intervention programs that address different stages as well as other socioeconomic factors. Glynn (1987) also used a four-stage model (preparation, initiation, becoming, maintenance) with general consumption values or motives affecting each stage, noting that such models were not used to draw implications for prevention programs (see Leventhal 1980, p. 383). Others used a non-empirical, decision theory perspective to evaluate smoking behavior in terms of the net effects of smoking versus not smoking (Robbins and Kline 1991). Several researchers presented seven-stage addiction models without empirical testing (DePaul et al. 1987), or related cultural and demographic factors as antecedents to the decision model (Chassin et al. 1981; McCarthy 1987). Pallonen et al. (1998) used a complex nine-stage acquisition and cessation continuum emphasizing the pros and cons of smoking and an in-depth definition of levels of smoking behavior in a very limited sample of 10th and 11th graders. Intervention approaches and information sources are not evaluated in their model.
The present study uses a modified four-stage model with the inclusion of a final outcome stage (see Figure 1) focusing primarily on the child's initial smoking decision. The classification questions are shown at the bottom of Figure 1. The preparation stage is the set of events, activities, influences, and anticipations that lead a child to consider smoking as a behavior. Trial (initiation) is the initial act of smoking the first cigarette, leading to behavior that is either occasional (becoming, experimenting) or regular (maintenance, addiction) smoking. Note that in this model format, a smoker is defined as anybody who goes to trial. Nonsmokers are those who either do not consider, or consider but do not go to trial. Their final outcome is "never smoked." Thus this model could also be characterized as "never smoked" versus those who go to trial and become smokers. These smokers, either occasional or regular, can as a final outcome continue smoking, enter cessation, or fluctuate...
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