Saying "no" to cigarettes: a reappraisal of adolescent refusal skills

The principles of social inoculation developed in the late 1940s and later presented as a theory combined with Bandura's self-efficacy construct in the 1970s led to a series of smoking-prevention programmes for young people based on refusal skills. The present study examines refusal skills developed by young people who have not been taught such a programme. The survey was carried out by self-completed questionnaires administered to whole classes of 11-15-year-olds in two secondary schools in northern England. Harter's Self-Perception Profile for Children was used. Responses from 743 (365 boys and 378 girls) were analysed. Smoking prevalence reflected the national prevalence pattern for the age group at the time of the survey. Girls were at greater risk than boys of being repeatedly offered a cigarette and more likely than boys to accept it after more than two offers. Girls with high self-perception scores for all domains except social competence were at lowest risk of being offered a cigarette. For boys this only applied in the context of behavioural conduct. However, the factor most strongly related to multiple offers of cigarettes was having a best friend who smoked. Never smokers were most likely to have simply said "No, thank you" to proffered cigarettes but most had used several responses, boys generally using more refusal mechanisms than girls did. Cigarette refusal among young people is a complex process and programmes must be variable in order to meet specific circumstances, such as refusing a cigarette from one's best friend.