Title

Understanding health-related risk behaviors: A social causation approach to adolescent smoking transitions

Date of Completion

January 1999

Keywords

Psychology, Behavioral|Health Sciences, Public Health|Sociology, Individual and Family Studies|Sociology, Public and Social Welfare

Degree

Ph.D.

Abstract

Despite years of scientific research linking cigarette smoking to chronic disease and premature death as well as decades of explicit health warnings and prevention programs, millions of young Americans try smoking every year and an estimated 3,000 begin smoking regularly every day. Extant research has demonstrated that a wide array of psychosocial factors is associated with the likelihood that an adolescent takes up smoking. Research studies also document socioeconomic, racial, and gender differences in adolescent smoking. However, because youthful smoking is commonly understood as a peer group phenomena, few studies have examined how the broader social contexts within which adolescents live, interact, and make decisions may influence smoking outcomes. My project focused on the research question: How do social and economic factors influence the decisions that adolescents make regarding cigarette use? ^ I combined differential needs and resources theories with socialization and cognitive theories to better understand the complex relationships between multiple predictors of adolescent smoking. Using a social causation approach, I proposed that stratified social positions have significant effects on health that contribute to higher rates of risk-related health behaviors like smoking among disadvantaged groups of individuals. I further proposed that key intermediate factors more proximate to the individual mediate these distal effects on individual decision making. ^ I tested these proposals with longitudinal data from a national sample of American youth. Using hierarchical logistic models, I estimated both direct and mediated effects of family SES on adolescent patterns of smoking initiation, experimentation, and cessation. Variables hypothesized to mediate macro effects included psychological distress, family structure, peer interaction, and cognitive constructs such as intentions and beliefs. ^ Utilizing the contributions of needs/resources stratification theories and alternative theories of stress, socialization, and cognition places the analysis of adolescent smoking in a context of broad social arrangements that shape everyday decisions. Understanding relationships between multi-level factors and adolescent smoking outcomes has implications for the design and implementation of prevention programs that target adolescents at greatest risk of becoming chronic adult smokers. ^