Which reference groups matter for Taiwanese high school adolescent smoking? A card sorting study.

Area of Science:

• Adolescent Health
• Social Psychology
• Tobacco Control

Background:

• Adolescence is a critical period for smoking initiation.
• Family, peers, and social groups act as key reference groups influencing adolescent decisions.
• Limited research exists on how diverse reference groups impact adolescent smoking choices.

Purpose of the Study:

• To compare normative and informative influences from various reference groups on adolescent smoking decisions.
• To understand the differential impact of reference groups on smoking initiation and maintenance.

Main Methods:

• Applied reference group theory and card sorting technique with 297 Taiwanese 11th graders.
• Adolescents sorted cards representing reference groups and influences, constructing smoking-related cues.
• Ranked influences based on relevance to their smoking decision-making process.

Main Results:

• For current smokers, having a smoking best friend or colleague and participating in ceremonial dance performances significantly increased smoking likelihood.
• Peers provided more smoking-elicited cues for current smokers.
• Families provided the most smoking-inhibited cues for former and never smokers.
• Normative influences (e.g., encouraging smoking) were more impactful than informative influences (e.g., stress relief).

Conclusions:

• Adolescent smoking is driven by peer norms; non-smoking is linked to family norms.
• Tobacco prevention should prioritize family-level interventions to prevent initiation.
• Smoking cessation programs for current smokers must address peer pressure.
• Collaborative school and community efforts are needed for effective cessation, especially for high-risk groups like adolescents in ceremonial dance.