Attitudes toward smoking among college students in ...

Int. J. Behavioural and Healthcare Research, Vol. 3, No. 1, 2012

55

Attitudes toward smoking among college students in Poland and the USA Elzbieta Lepkowska-White* International Affairs, Department of Management and Business, Skidmore College, Saratoga Springs, NY 12866-1632, USA Fax: (518) 580-5118 E-mail: [email protected] *Corresponding author

Amy L. Parsons Department of Business and Management, McGowan School of Business, King’s College, Wilkes-Barre, PA 18711, USA Fax: (570) 208-208-5989 E-mail: [email protected]

Joanna Białkowska Department of Medical Studies, Warmińsko-Mazurski University Hospital, Rehabilitation in Hospital, ul. Michała Oczapowskiego 2, Olsztyn, Poland E-mail: [email protected] Abstract: In this article we analyse attitudes about smoking and motivations to smoke among college students in the USA and Poland. To provide the context for this discussion we first discuss historical changes in the economic, business, and legal environments in both countries since World War II. We follow with an empirical test of attitudes towards smoking and motivations to smoke using a survey distributed to 192 undergraduate students in the two countries. The results show that in both countries young people view smoking more negatively now than they did in the past, probably in response to the changing macro-environment. Overall motivations to smoke among young consumers in these two countries are similar, but differences exist and are explored in this study. Keywords: attitudes toward smoking; motivations to smoke; Poland; USA; undergraduate students; healthcare. Reference to this paper should be made as follows: Lepkowska-White, E., Parsons, A.L. and Białkowska, J. (2012) ‘Attitudes toward smoking among college students in Poland and the USA’, Int. J. Behavioural and Healthcare Research, Vol. 3, No. 1, pp.55–69. Copyright © 2012 Inderscience Enterprises Ltd.

56

E. Lepkowska-White Biographical notes: Elzbieta Lepkowska-White received her PhD in Marketing at the University of Massachusetts, Amherst. Her research on globalisation of advertising and sales management was published in the Journal of Advertising, Journal of Global Marketing, and Journal of Business Research. More recently She investigates marketing communication, education and public health issues and has published this work in the Journal of Marketing Management, Journal of Consumer Affairs, Journal of Consumer Marketing, Journal of Marketing Theory and Practice, Journal of East-West Business, Journal of Marketing Education, and Journal of the Academy of Business Education among other journals. She wrote several book chapters and presented her work at multiple national and international conferences. Amy L. Parsons received her PhD in Marketing from the University of Massachusetts, Amherst, her MBA from Syracuse University and her Bachelor’s degree from the University of California, Berkeley. Her recent research includes marketing education, integrated marketing communication, and advertising in print, internet, and social media. She has published articles in the Journal of Internet Commerce, Journal of Marketing Education, Journal of Consumer Affairs, Journal of the Academy of Business Education, Journal of Supply Chain Management, Journal of Advertising, Journal of Advertising Research, Academy of Marketing Studies Journal, and Health Marketing Quarterly. She has also presented papers at national and international conferences. Joanna Białkowska received her PhD at the Medical Academy in Poznań, Poland in 2000. Her research centres on rehabilitation and health problems of youth and adults. She published her work in Rehabilitation, Physiotherapy, Medical Review of Pediatric, and Sketches of Humanities and other medical journals. She has written book chapters and presented her work at multiple conferences.

1

Framework

Historically, smoking rates in Poland have been higher than in the USA (WHO, 2009; Zatoński, 2004). However, in recent years overall smoking rates in Poland have declined significantly as Polish citizens have become more aware of the dangers of smoking and new anti-smoking legislation was introduced. Yet despite these changes, college students in both countries still smoke. In this study we examine the attitudes and motivations of college students who smoke in both countries. It is important to examine the economic, business, and legal environments in both countries since World War II to understand the context for changes in smoking behaviour over time. It is also meaningful to examine the role of the government and healthcare industries in providing education about the consequences of tobacco use. College students are influenced by their parents and therefore it is essential to understand the environment that shaped both the parents’ and the students’ experiences relative to smoking. Once the historical perspective is examined we will discuss past research on the motivations for smoking among college students in both countries and present findings from scarce cross cultural research on smoking behaviour. Studies have shown that those who start smoking when they are young will have a harder time quitting so it is important to understand why young people smoke even though they are well educated about the negative consequences of smoking to their

Attitudes toward smoking among college students in Poland and the USA

57

health (Chassin et al., 2000; Fiore and Baker, 2009; Pierce and Gilpin, 1996). Finally, we will empirically test and compare smoking motivations in Poland and US today.

1.1 Historical background – Poland After World War II and prior to the democratisation of Poland in the early 1980s, smoking rates in Poland reached 62% among men and 30% among women and were among the highest in the world, especially among middle age men. This was a result of multiple factors. Information about the negative consequences of smoking was held back by the Polish government as the state owned the tobacco industry and derived profits from its sales (Zatoński, 2003). The government did not enforce existing anti-smoking regulation and paradoxically many Polish doctors were frequently heavy smokers. Free cigarettes were distributed to young Poles serving in the military regardless of whether they smoked. Cigarettes, like many other products, were rationed, but since everyone received a ration even if they did not smoke, more people started smoking (Zatoński, 2003). Cigarettes were also inexpensive and of low quality (high tar content) which made them very harmful to people’s health (Zatoński, 1995). Following the change of the economic and political systems after 1989 the tobacco industry was one of the first to be privatised and within a short period of time 90% of the Polish tobacco market was controlled by multinational corporations (WHO, 2009). Tobacco companies introduced Poles to novel forms of tobacco marketing and tried to influence antismoking regulations through aggressive lobbying activities (Zatoński, 2003). The Polish people now had more access to different brands of better quality cigarettes and were exposed to sophisticated forms of advertising and sales promotions that were unfamiliar to them. Cigarettes were also still inexpensive as taxes on cigarettes were among the lowest in the European Union (Cekiera, 2001). In the late 1980s and 1990s concerns over health issues related to smoking prompted the Polish government to take action (Mazur et al., 2000). Efforts were made to ban cigarette advertising, to include warnings on cigarette packs, to maintain minimum tar levels in cigarettes, to increase surcharges on cigarettes, to recognise the need for smoke-free public environments, to educate the public about the negative consequences of smoking, and to offer support for those who wanted to quit smoking (WHO, 2009). In 1995, a significant anti-smoking bill was passed. Some of the key changes that this bill recommended were a ban on smoking in health care establishments, a ban on the selling of tobacco products to those under 18, a ban on the selling of tobacco in vending machines, a ban on tobacco advertising on radio and television, and a requirement to include a warning on each pack of cigarettes that would occupy 30% of two of the largest sides of each pack (Zatoński et al., 2000). In 1999–2000 taxes on tobacco increased by 30% and that made cigarettes less attractive to price sensitive consumers (WHO, 2009; Zatoński, 2004). In 1999, a total ban on all tobacco advertising was passed and by 2000 tobacco advertising was completely removed (WHO, 2009). After 1989, in addition to legislation, anti-smoking educational programmes were launched, research on tobacco’s impact on human health was conducted, conferences were held, and debates started to emerge at schools, universities, hospitals and non-governmental organisations (WHO, 2009). For example, the Health Promotion Foundation was created to organise educational programmes and conferences, to support research, and to cooperate with international institutions to promote antismoking

58

E. Lepkowska-White

behaviour. Using the Great American Smoke-out campaign as a framework the first successful anti-smoking campaign in Poland was organised which now helps approximately 200,000–400,000 people to give up smoking annually (Zatoński, 2003). As a result of all these changes, reported smoking rates have decreased and the number of people who want to stop smoking has increased (Global Adult Tobacco Survey, 2010; Neubauer, 2005; WHO, 2009). According to the Global Adult Tobacco Survey (2010), currently 30.3% of Poles smoke which amounts to 9.8 million people. Poles are now more aware of the negative consequences of smoking and their attitudes toward smoking are more negative (Marmon and Flak, 2001). However, despite the government’s efforts, young people still smoke at relatively high rates in Poland even though they are aware of the negative health effects of smoking (Białkowska, 2008; Nowicka-Sauer et al., 2006; WHO, 2009).

1.2 Historical background – USA In the USA smoking rates have declined significantly from 42% in the 1960s to less than 20% today (Fiore and Baker, 2009). As in Poland, antismoking education and regulation and changes in the prices of cigarettes made a significant impact on smoking behaviour. In 1961, a Federal Commission was started to study the health consequences of smoking, followed by the creation of an Advisory Committee that issued a report in 1964 that reported that smoking is related to lung cancer and that overall “smoking is a health hazard of significant importance in the United States to warrant appropriate remedial action” [CDC, (1989), p.7]. Early responses to the content of the 1964 report included a Congressional mandate in 1966 requiring the appearance of a health warning on all cigarette packs but not in advertisements (CDC, 1989) and the launching of a two year national campaign against tobacco use in the late 1960s (Schroeder, 2004). Since the 1960s, a variety of educational programmes and marketing and public health campaigns, expanded access to treatment programmes, pricing and taxation strategies, and legislation have helped to educate people on the dangers of smoking (Fiore and Baker, 2009). In 1973 federal legislation required passenger airlines to establish separate smoking and non-smoking sections and today smoking is banned on all domestic flights and in most airports in the USA (Shipan and Volden, 2006). In 1989 on the 25 year anniversary of the forming of the Advisory Committee in 1964, the United States Surgeon General issued a report that found that smoking rates decreased from 40% of the population in 1965 to 29% in 1987. It is also reported that smoking begins primarily during childhood and adolescence and that the age of initiation (first exposure to smoking) has fallen over time from eighth grade to sixth grade, especially among females. The report also presented evidence that suggested that incentives related to the cost of tobacco may be effective in encouraging people to quit smoking (CDC, 1989). In 1998 the Master Settlement Agreement (MSA) was reached. This agreement was made between 46 states attorneys general and the four largest tobacco companies. Provisions of this agreement require tobacco companies to pay the states an average of $10 billion per year and the tobacco companies agreed to restrictions related to their advertising, marketing and lobbying practices (Daynard et al., 2001). Some specific areas covered in the MSA include prohibition on youth targeting, a ban on the use of cartoons in advertising, promotion, or packaging of tobacco products, a limitation on the use of tobacco brand name sponsorships of events such as concerts, events in which the


59

intended audience is comprised of a significant percentage of youth, events in which participants are youth or any athletic events in any football, basketball, baseball, soccer or hockey league, the elimination of outdoor advertising and transit advertising, a ban on tobacco brand name merchandise, and a ban on youth access to free tobacco samples (MSA, 1998). Evidence linking tobacco advertising to smoking has been mixed but there is evidence that substantial bans on tobacco advertising can have more of an effect on lowering smoking rates than limited bans on tobacco advertising (Saffer and Chaloupka, 2000). While the MSA has effectively restricted billboard advertising and sponsorships, there is concern that tobacco companies are still targeting youths through magazine advertising (Chung et al., 2002). Despite the MSA limitations on tobacco advertising, the overall dollars spent on cigarette advertising in the three years after the MSA went into effect increased 66% compared to the three years prior to the signing of the MSA (Krugman et al., 2005). Advertising in magazines from 1999–2002 showed that cigarette companies still advertised their products in magazines that reached a high percentage or number of youth readers (Krugman et al., 2005). After the 1998 Master Settlement Agreement tobacco prices substantially increased even in tobacco producing states due to increases in taxes. State cigarettes taxes increased from an average of $0.66 a pack in 2004 to an average of $1.34 per pack at the end of 2009. State excise taxes ranged from $.07 per pack to $3.46 per pack (CDC, 2010; Mendez and Warner, 2004). The increases in taxes provide state governments with a way to fund programmes geared towards preventing and controlling tobacco use and providing healthcare for people with smoking related illnesses (CDC, 2010). Many states (24 and the District of Columbia as of 2009) also impose minimum cigarette pricing laws (CDC, 2010). Another concern of lawmakers in recent years has been to promote policies restricting the practice of smoking in public places. Such policies have helped to reduce exposure to second hand smoke, to decrease cigarette consumption and to increase attempts by smokers to quit (Burns et al., 2000). Since 1986 policies governing smoke free indoor work environments have gone from covering 3% of employees to 77% of employees in 2003 (Osypuk and Acevedo-Garcia, 2010). An increased presence of smoking bans at home and at work has helped to lower smoking rates (Levy et al., 2004). In 1988 there were 320 local communities that had adopted laws restricting smoking in public places up from 90 communities in 1985 (CDC, 1989). In the 1990s, the rate of home and work smoking bans increased on both a national and individual state level (Levy et al., 2004). As of 2010, 31 states had some type of smoke-free legislation in place while seven states had no statewide smoke-free laws in place (CDC, 2010). There is not, however, any national legislation mandating smoke free environments. Smoke free policies are under the control of the individual states and in some states local governments can enact stricter legislation and in 12 states the state has the right to preempt more stringent local policies (MMWR, 2010). Smoking education and awareness programmes have helped to reduce smoking rates in many states. According to the CDC, research indicates that states that spend more on sustained comprehensive tobacco control programmes experience the greatest reduction in smoking rates and that the longer the states continue to invest in such programmes the impact will be stronger. For example, California has “the longest-running comprehensive tobacco control program (where) adult smoking rates declined from 22.7% in 1988 to 13.3% in 2006” [CDC, (2010), p.1]. On a national level, the MSA helped to fund the

60

E. Lepkowska-White

American Legacy Foundation’s ‘truth’ campaign which reduced smoking among young people to a 27 year low in 2001 (Mendez and Warner, 2004; Schroeder, 2004). Most recently, in 2009 Congress passed the Family Smoking Prevention and Control Act. This legislation gives the US Food and Drug Administration the authority to regulate tobacco products which includes regulating the marketing and promotion of tobacco products and setting performance standards for tobacco products to protect public health. Another stipulation of this legislation provides states and local communities the authority to impose restrictions that may be more stringent than FDA requirements such as specific bans on the time, place, and manner of cigarette advertising (CDC, 2010).

1.3 Smoking motivations Researchers identify a variety of reasons why people still smoke that may include smoking to reduce negative emotions, smoking to increase positive emotions, smoking because it is addictive, and smoking because it is habitual or routine (Fiala et al., 2010; Tomkins, 1966). Other studies focus on investigating specific characteristics of the individual, situations that motivate smokers such as stress reduction, or social settings, physical dependence and addiction or consequences of smoking.

1.4 Poland Stelmach et al. (2004) investigate the role of income, education, health status and self-rated health on lifestyle characteristics such as smoking, alcohol consumption, physical activity and diet on adults in Lódz, Poland. They find that “69% of the respondents have never smoked (and) that smokers were mostly men and divorced persons. There was relationship between smoking and education; in the present study smoking was more common among lower-educated people” (p.399). Nowicka-Sauer et al. (2006) examine smoking behaviour among 18 year old high school students in Gdansk and find that 34.1% of the students in the sample smoke every day or occasionally. Female students are the most frequent smokers and those enrolled in vocational schools are more likely to smoke than those enrolled in traditional or technical high schools. Very high percentages of both men (89.85%) and women (92.09%) are aware of the health threats associated with smoking but this knowledge does not stop them from smoking. Many of these students think smoking helps them to remain calm and to reduce stress. Ostaszewski and Pisarska (2008) report findings from a longitudinal study on alcohol and tobacco use conducted every four years from 1988–2004 using 15 year olds in Warsaw. While overall smoking rates increased from 1988-2000 they have declined somewhat since 2000. There are fewer boys and girls who occasionally smoke and fewer boys who smoke regularly, however, smoking rates are growing among girls in Warsaw. More recent studies show that many medical students continue smoking even though they have sufficient medical knowledge about the consequences of smoking (Kołłątaj et al., 2010). The study suggests that the high prices of cigarettes may deter young people from smoking more effectively than education. Other studies also show that in this group, family pressure, increasingly worsening physical condition, awareness of the impact of


61

smoking on health, and economic consequences of smoking tend to motivate subjects to quit (Walczak et al., 2004). Among adults who entered smoking cessation clinics, health related reasons were the greatest motivators to quit smoking among both men and women (Stokłosa, 2010).

1.5 USA Many US smokers smoke to cope with negative affect states. “Negative affect refers to a transient, aversive, emotional state that can be assessed by self-report as well as behavioral and psychophysiological measures” [Brandon, (1994), p.33]. Gregor et al. (2006) find that smokers who have a lower evaluation of their overall perceived health are more motivated to smoke to reduce negative affect and cope with emotional distress than those who evaluate their perceived health more highly. Smokers who smoke every day are more likely to report that cigarettes help them to alleviate negative affect than occasional smokers are (Brandon, 1994). A study by Gregor et al. (2007) confirms a predictive relationship between the motivation to smoke to reduce negative affect and the presence of anxiety and depression symptoms in young adult daily smokers. Smokers with high levels of the anxiety sensitivity personality trait, especially those with psychological concerns about the consequences of anxiety, are motivated to smoke to relieve aversive states or to achieve pleasurable states (Battista et al., 2008). Anxiety sensitivity is the relationship between fear of anxious emotions and the beliefs that the consequences of these emotions could be harmful (Battista et al., 2008). Tension reduction is an influential motive for smoking among college students (Fiala et al., 2010). Social context seems to be an important determinant of when young people in the US smoke (Moran et al., 2004; Waters et al., 2006). Among students there seems to be a strong correlation between smoking, alcohol consumption and attending social events (Moran et al., 2004; Nichter et al., 2010, 2006). Social smoking refers to “smoking more often with others than when alone” [Moran et al., (2004), p.1031]. Social smokers often do not consider themselves as smokers or have a desire to become ‘real’ smokers despite having smoked in the previous 30 days. They believe that they will quit smoking after they graduate from college and that their smoking is under control and they have more confidence in their ability to quit smoking (Berg et al., 2010; Moran et al., 2004; Nichter et al., 2010; Waters et al., 2006). The presence of other people, the presence of alcohol, and whether or not smoking is permitted influence college students’ decisions to smoke (Cronk and Piasecki, 2010). Smoking at parties seems to be different than smoking in other situations (Nichter et al., 2010). One reason that college students smoke is that it offers them pleasurable relaxation (Fiala et al., 2010). Smoking can facilitate social interaction and help to structure time and space at a party and being at a party reduces inhibitions related to smoking (Nichter et al., 2010). Ott et al. (2005) find that college student smokers and non-smokers have similar beliefs about commonly known health facts related to smoking even though the percentage of smokers among college students is higher than those in the general adult population. Smoking is also a way to keep awake at parties (Nichter et al., 2010).

62

E. Lepkowska-White

1.6 Cross cultural studies Few cross cultural studies exist that discuss smoking motivations across countries. Forgays et al. (1993) examines differences between Polish and US adolescent smokers in terms of personality dimensions and finds no significant differences between the two cultures. Smokers in both countries tend to be angry, anxious, impulsive and antisocial. Female smokers in both countries are more likely to be emotionally distressed. Piko et al. (2005) examines the relationships between adolescent smoking and various personal and social influences in four different countries (Hungary, Poland, Turkey and the USA) using survey data. They find that higher life satisfaction, academic achievement, and future orientedness relate positively to lower rates of smoking and the presence of friends who smoke was a strong influence on smoking rates in all four countries. Page et al. (2008) compares adolescent smoking behaviour and feelings of hopelessness and loneliness in Southeast Asian countries (Thailand, Taiwan, and the Philippines) and Central European countries (Hungary, Ukraine, Slovakia, Czech Republic, Romania and Poland). Their results show that overall Eastern European adolescents smoke more than Southeast Asian adolescents and that adolescents who smoke feel more hopeless than non-smokers. Southeast Asian female smokers are lonelier than non-smokers while Central European female smokers are less lonely than non-smokers. Helweg-Larsen and Nielsen (2009) measure risk perceptions about smoking in young adults in Denmark and the USA. Denmark is perceived to be a smoking-lenient culture and the USA is perceived to be a smoking prohibitive culture. Results show that Danish smokers do not think that their own personal risks of lung cancer are increased by smoking cigarettes and in general Danes have more positive attitudes towards smoking than Americans. In this study we focus on smoking motivations among young consumers in Poland and the USA. We examine why they start smoking and why they continue smoking over the years. We investigate the following research questions: •

Is there a difference in motivations to start smoking between Poland and the USA?

•

Is there a difference in motivations to continue smoking between Poland and the USA?

2

Methodology

To address our research questions we used a convenience sample of 192 undergraduate students (103 American and 89 Poles) ages 18 to 26. Based on past research on Polish and US consumers and a blog that asked Polish smokers to explain their reasons for smoking we developed a survey that examined motivations to start smoking, and motivations to continue smoking . We measured these motivations using a Likert scale (1 – strongly disagree, 5 – strongly agree) and present them in Tables 1 and 2.


3

63

Data discussion

The responses to the survey questions were analysed using a t-test. We present the results of this analysis in Tables 1 and 2. Table 1

Motivations to begin smoking

Why did you start to smoke?

Poland

USA

F

Sig.

4.23

2.84

54.12

0.00

1

Out of stupidity

2

Out of curiosity

3.90

3.79

0.63

n.s.

3

Because of stress, to relax

3.71

3.78

0.19

n.s.

4

Because I’m weak

3.48

1.83

89.16

0.00

5

Smoking brought interesting people together, made us special/different

3.45

3.51

0.14

n.s.

6

They tasted good, I liked to smoke

3.27

3.55

2.81

0.10

7

People I care about smoke (friends, family)

3.22

3.19

0.02

n.s.

8

Social pressure, ‘cool’ people smoked

3.00

3.07

0.14

n.s.

9

I did not realise the impact of smoking on my health

2.90

1.76

38.44

0.00

10

Cigarette occupied my hands when meeting new people; I had something to do

2.89

3.12

1.47

n.s.

11

To rebel, smoking was a ‘forbidden fruit’

2.36

2.37

0.01

n.s.

12

I was lonely; I was depressed

2.20

2.20

0.00

n.s.

13

To lose weight

1.74

1.68

0.17

n.s

Poland

USA

F

Sig.

Social pressure, ‘cool’ people smoke

3.53

3.25

2.96

0.10

Because I’m weak

3.53

1.93

79.60

0.00

They taste good, I like to smoke

3.50

3.66

0.86

n.s

Cigarette occupy my hands when I meet new people; I have something to do

3.07

3.47

4.05

0.05

Cigarettes help me when I’m lonely and/or depressed

2.97

2.48

5.82

0.01

Because of stress, to relax

2.75

3.07

1.23

n.s

People I care about smoke (friends, family)

2.56

3.07

2.57

n.s

I’m addicted

2.36

2.37

2.20

0.14

Smoking brings people together, makes us special/different

2.03

2.30

7.65

0.01

Table 2

Motivations to continue smoking

Why do you currently smoke?

If I give up smoking I’ll gain weight

1.97

1.58

5.27

0.05

To rebel, smoking is a ‘forbidden fruit’

1.88

1.92

0.07

n.s

To lose weight

1.76

1.65

0.48

n.s

Smoking does not affect my health

1.64

1.59

0.14

n.s

64

E. Lepkowska-White

The results in Table 1 show that Poles begin smoking because they feel that they are foolish (mean = 4.23), curious (mean = 3.9), and stressed (mean = 3.71). Interestingly, US students do not think that foolishness motivated them to start to smoke (mean = 2.84, p < 0.01), but their scores for curiosity and stress are equally high (means equal to 3.79 and 3.78 respectively). In contrast to the US students (mean = 1.83), Polish students begin smoking because they feel weak and unable to resist pressures to smoke (mean = 3.48, p < 0.01). Both groups believe that smoking brings interesting people together, and makes them special and different (means equal to 3.45 and 3.51 for Poles and Americans respectively). They also begin to smoke because they like the taste of cigarettes (meansPoles = 3.27; meansUS = 3.55) and are surrounded by friends and family who smoke (meansPoles =3.22; meansUS = 3.19). Many also feel social pressure to smoke (meansPoles =3.00; meansUS = 3.19). Poles also believe that they did not realise the impact of smoking on their health when they begin smoking which was not the case for the US students (meansPoles = 2.9; meansUS = 1.76, p < 0.01). Both groups feel that smoking helps them meet new people and gives them something to do with their hands when talking with others (meansPoles = 2.89; meansUS = 3.12). Rebellion, trying to fight depression, and trying to lose weight are not important. The results in Table 2 show that some motivations gain importance over time. Poles continue smoking because of social pressures (mean = 3.53) and because they feel that they are too weak to quit (mean = 3.53) and these means are significantly higher than for Americans (means equal to 3.25 and 1.93 respectively). Both groups smoke because they like the taste of cigarettes (meansPoles = 3.50; meansUS = 3.66). Cigarettes make Poles more comfortable when meeting new people as they occupy their hands and this result is significantly greater for Americans (meansPoles = 3.07; meansUS = 3.47, p < 0.05). The beliefs of Polish students that cigarettes help them when they are depressed are stronger than among the US students (meansPoles = 2.97; meansUS = 2.48, p < 0.01). Both groups smoke to relax (meansPoles = 2.75; meansUS = 3.07) and because people they care about smoke (meansPoles = 2.56; meansUS = 3.07). Other previously important motivations such as the feeling that cigarettes bring people together, make them different, rebellious, lose importance over time. It also seems that both groups do not believe that they are addicted and that smoking negatively affects their health.

4

Conclusions

Overall the historical overview of changes in Poland and the USA shows that antismoking legislation and education made a significant impact on smoking behaviour and attitudes toward smoking. In response to the greater availability of research on the consequences of smoking, exposure to antismoking programmes and education, bans on marketing and advertising of cigarettes and other anti-smoking legislation, the overall consumption of cigarettes in both countries decreased and the attitudes toward cigarettes became more negative over time. Overall the motivations toward smoking are similar among young consumers in Poland and the USA, although some differences exist. In contrast to US students, Poles believe that they began smoking because they were weak or foolish, and not fully aware of the consequences of smoking on their health. It seems that Poles believe that they are less in control and are less knowledgeable about the consequences of smoking than their US counterparts. Past studies suggest that internal locus of control may explain these


65

findings. Nowicka-Sauer et al. (2006, p148) write that “The person with more internal locus of control believes that he or she is responsible for his or her life, behavior and action and has an ability to control their life. Such a person is more disposed to positive health-related behaviors…”. Cross cultural studies show that Americans have a stronger internal locus of control and therefore they feel more in charge of their lives and decisions they make (Tobacyk and Tobacyk, 1992). On the other hand, Poles who have a higher external locus of control (and significantly lower internal locus of control) believe that external factors beyond their control influence their lives (Tobacyk, 1992). As a result when locus of control is applied to a smoking context, Poles feel more helpless and less capable to quit or to control their smoking habit than Americans do (Penar-Zadarko et al., 2009). Other motivations to start smoking are common across the two groups. Both groups begin smoking because they are curious and want to explore something new and exciting. They also begin to smoke to relax and release stress. Social reasons are also important. They feel that smoking creates a unique atmosphere that brings together special and different individuals. The mere fact that their loved ones and friends around them smoke motivates them to begin smoking. Students in both countries also are pressured by friends and relatives who smoke to try cigarettes and when they try them they often like the smell and taste of cigarettes. Our study also shows that motivations to continue smoking change over time. Over time social pressures gain importance and motivate both young Poles and Americans to keep on smoking. Past studies suggest that self-efficacy, defined as one’s beliefs concerning his or her ability to cope with problems and anticipation may play a role [Nowicka-Sauer et al., (2006), p.148]. Self-efficacy influences smoking behaviour as it affects how resistant young people are to social pressures. Individuals with low self efficacy are less able to resist social pressures to smoke (Holm et al., 2003) and this is why both Poles and Americans continue to smoke. Other findings from our study show that both groups continue smoking because they like the taste of cigarettes, they want to relax, and they feel surrounded by loved ones who smoke. There are however some differences between Poles and Americans. As was the case with first starting to smoke, Poles continue to smoke because they believe that they are too weak and cannot resist the habit. This was again not true for the Americans. Here again locus of control may explain these differences. Poles are also more likely to smoke to deal with negative emotions such as depression or loneliness which was less true for the Americans. Americans on the other hand, use cigarettes to reduce the awkwardness of meeting new people more than Poles. Other reasons such as lack of knowledge of the impact of cigarettes on human health and the feeling of having a special atmosphere by smokers lose on importance over time.

4.1 Directions for future research Future research should test how these motivations to smoke could be addressed through further education and legislation. Experimental studies could examine how specific types of anti-smoking messages influence smoking motivations in Poland versus in the USA by taking into consideration differences in external locus of control and other psychological variables that may influence smoking. This could perhaps allow for the development of global anti-smoking approaches. Stronger legislation that does not allow tobacco companies to target the young needs to be developed and implemented and its

66

E. Lepkowska-White

consequences monitored. A larger sample size could improve the generalisability of these findings. Since the consumption of cigarettes is still relatively high among the young and still growing among young females in both Poland and the US the research in this area needs to continue.

Acknowledgements The authors would like to thank anonymous reviewers for their comments and suggestions.

References Battista, S.R., Stewart, S.H., Fulton, H.G., Steeves, D., Darrdeau, C. and Gavric, D. (2008) ‘A further investigation of the relations of anxiety sensitivity to smoking motives’, Addictive Behaviors, Vol. 33, No. 11, pp.1402–1408. Berg, C.J., Parelkar, P.P., Lessard, L., Escoffery, C., Kegler, M.C., Sterling, K.L. and Ahluwalia, J.S. (2010) ‘Defining ‘smoker’: college student attitudes and related smoking characteristics’, Nicotine & Tobacco Research, Vol. 12, No. 9, pp.963–969. Białkowska, J. (2008) ‘Problem with nicotine addiction: research on students from Olsztyńska Szkoła Wyższa’, (in Polish) Szkice Humanistyczne, Vol. 16, No. 3, pp.121–129. Brandon, T.H. (1994) ‘Negative affect as motivation to smoke’, Current Directions in Psychological Science, Vol. 3, No. 2, pp.33–37. Burns, D.M., Shanks, T.G., Major, J.M., Gower, K.B. and Shopland, D.R. (2000) ‘Restrictions on smoking in the workplace’, in National Cancer Institute, Population Based Smoking Cessation, Bethesa, MD, pp.99–128. CDC (1989) US Department of Health and Human Services, Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General, US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, DHHS Publication No. (CDC) 89–8411. Cekiera, Cz.M. (2001) ‘Ethical and psychological effects of smoking among young people’, Soltysiak, T. and Karwowska, M. (Eds.): Polish Youth – Threats in Today’s Social Environment, pp.349–357, in Polish, Akademia Bydgoska, Bydgoszcz, Poland. Centers for Disease Control and Prevention (2010) Tobacco Control State Highlights, US Department for Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta. Chassin, L., Presson, C.C., Pitts, S.C. and Sherman, S.J. (2000) ‘The natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: multiple trajectories and their psychosocial correlates’, Health Psychology, Vol. 19, No. 3, pp.223–231. Chung, P.J., Garfield, C.F., Rathouz, P.J., Lauderdale, D.S., Best, D. and Lantos, J. (2002) ‘Youth targeting by tobacco manufacturers since the master settlement agreement’, Health Affairs, Vol. 21, No. 2, pp.254–263. Cronk, N.J. and Piasecki, T.M. (2010) ‘Contextual and subjective antecedents of smoking in a college student sample’, Nicotine & Tobacco Research, Vol. 12, No. 10, pp.997–1004. Daynard, R.A., Parmet, W., Kelder, G. and Davidson, P. (2001) ‘Implications for tobacco control of the multistate tobacco settlement’, American Journal of Public Health, Vol. 91, No. 12, pp.1967–1971.


67

Fiala, K.A., D’Abudno, M.L. and Marinaro, L.M. (2010) ‘Construct validity and reliability of college students’ responses to the reasons for smoking scale’, Journal of American College Health, Vol. 58, No. 6, pp.571–577. Fiore, M.C. and Baker, T.B. (2009) ‘Stealing a march in the 21st century: accelerating progress in the 100-year war against tobacco addiction in the United States’, American Journal of Public Health, Vol. 99, No. 7, pp.1170–1175. Forgays, D.G., Forgays, D.K., Wrzesniewski, K. and Bonaiutio, P. (1993) ‘Personality dimensions and cigarette smoking behavior in Polish and US adolescents’, Psychology and Health, Vol. 8, No. 2, pp.257–268. Global Adult Tobacco Survey (2010) Available at http://www.cdc.gov/tobacco/global/gats/ countries/eur/fact_sheets/poland/2009_2010/pdfs/poland_2009_2010.pdf (accessed on 1 July 2011). Gregor, K., Zvolensky, M.J., Bernstein, A., Marshall, E.C. and Yartz, A.W. (2007) ‘Smoking motives in the prediction of affective vulnerability among young adult daily smokers’, Behaviour Research and Therapy, Vol. 45, No. 3, pp.471–482. Gregor, K., Zvolensky, M.J., Leen-Feldner, E.W., Yartz, A.R. and Feldner, M.T. (2006) ‘Perceived health: A test of incremental validity in relation to smoking outcome expectancies, motivation to smoke and desire to quit Smoking’, Cognitive Behaviour Therapy, Vol. 35, No. 1, pp.28–42. Helweg-Larsen, M. and Nielsen, G.A. (2009) ‘Smoking cross-culturally: risk perceptions among young adults in Denmark and the United States’, Psychology and Health, Vol. 24, No. 1, pp.81–93. Holm, K., Kremens, S.P.J. and deVries, H. (2003) ‘Why do Danish adolescents take up smoking?’, European Journal of Public Health, Vol. 13, No. 1, pp.67–74. Kołłątaj, W., Kołłątaj, B., Karwat, I.D. and Piecewicz-Szczęsna, H. (2010) ‘Attitudes of students of Medical University of Lublin towards tobacco smoking’, Problemy Higieny i Epidemiologii, Vol. 91, No. 3, pp.495–500 Krugman, D.M., Quinn, W.H., Sung, Y. and Morrison, M. (2005) ‘Understanding the role of cigarette promotion and youth smoking in a changing marketing environment’, Journal of Health Communication, Vol. 10, No. 3, pp.261–278. Levy, D.T., Romano, E. and Mumford, E.A. (2004) ‘Recent trends in home and work Smoking Bans’, Tobacco Control, Vol. 13, No. 3, pp.258–263. Marmon, G. and Flak, E. (2000) ‘Fighting addictions among students based on anti-smoking programs’, in Polish, Health Promotion, Social and Medical Studies, Vol. 12, No. 19, pp.145–155. Master Settlement Agreement (MSA) (1998) Available at http://ag.ca.gov/tobacco/pdf/1msa.pdf/ (accessed on 26 April 2011). Mazur, J., Woynarowska, B. and Kowalewska, A. (2000) ‘Tobacco smoking: health of school aged children in Poland’, in Polish, Faculty of Psychology, University of Warsaw, Poland. Mendez, D. and Warner, K.E. (2004) ‘Adult cigarette smoking prevalence: declining as expected (not as desired)’, American Journal of Public Health, Vol. 94, No. 2, pp.251–252. Moran, S., Wechsler, H. and Rigotti, N.A. (2004) ‘Social smoking among US college students’, Pediatrics, Vol. 114, No. 4, pp.1028–1034. Neubauer, J. (2005) Young People and Cigarettes. The Use of Psycho-Active Substances among Students in the Eyes of Students that Study Teaching, translated, Malinowski, J.A. (Ed.), Educational Publishing Company Akapit, Torun, Poland. Nichter, M., Nichter, M., Carkoglu, A. and Lloyd-Richardson, E.E. (2010) ‘Smoking and drinking among college students: ‘It’s a package deal’’, Drug and Alcohol Dependence, Vol. 106, No. 1, pp.16–20.

68

E. Lepkowska-White

Nichter, M., Nichter, M., Lloyd-Richardson, E.E., Flaherty, B., Carkoglu, A. and Taylor, N. (2006) ‘Gendered dimensions of smoking among college students’, Journal of Adolescent Research, Vol. 21, No. 3, pp.216–243. Nowicka-Sauer, Ł., Sadlak-Nowicka, J. and Bochniak, A. (2006) ‘Tobacco smoking problem in a group of 18-year-old high school students in the city of Gdansk – finding causes and preventive methods’, Advances in Medical Research, Vol. 51, No. 1, pp.145–150. Ostaszewski, K. and Pisarska, A. (2008) ‘Trends in adolescent substance use: the Mokotów study 1988–2004’, Drugs: Education, Prevention & Policy, Vol. 15, No. 4, pp.378–394. Osypuk, T.L. and Acevedo-Garcia, D. (2010) ‘Support for smoke-free policies: a nationwide analysis of immigrants, US-born and other demographic groups, 1995–2003’, American Journal of Public Health, Vol. 100, No. 1, pp.171–181. Ott, C.H., Cashin, S.E. and Altekruse, M. (2005) ‘Development and validation of the college tobacco survey’, Journal of American College Health, Vol. 53, No. 5, pp.231–238. Page, R.M., Zarco, E.P.T., Ihasz, F., Suwanteerangkul, J., Uvacsek, M., Mei-Lee, C., Miao, N-F, Simonek, J., Klarova, R., Hantiu, I. and Kalabiska, I. (2008) ‘Cigarette smoking and indicators of psychological distress in southeast Asian and central-eastern European adolescents’, Journal of Drug Education, Vol. 38, No. 4, pp.307–328. Penar-Zadarko B, Zadarko, E., Binkowska-Bury, M. and Januszewicz, P. (2009) ‘Prevalence of tobacco smoking university students and health locus of control’, Przeglad Lekarski, Vol. 66, No. 10, pp.705–708. Pierce, J.P. and Gilpin, E. (1996) ‘How long will today’s new adolescent smoker be addicted to cigarettes?’, American Journal of Public Health, Vol. 86, No. 2, pp.253–253. Piko, B.F., Lusszczynska, A., F.X. Gibbons, F.X., and Tekozel, M. (2005) ‘A culture-based study of personal and social influences of adolescent smoking’, European Journal of Public Health, Vol. 15, No. 4, pp.393–398. Saffer, H. and Chaloupka, F. (2000) ‘The effect of tobacco advertising bans on tobacco consumption’, Journal of Health Economics, Vol. 19, No. 6, pp.1117–1137. Schroeder, S.A. (2004) ‘Tobacco control in the wake of the 1998 master settlement agreement’, The New England Journal of Medicine, Vol. 350, No. 3, pp.293–301. Shipan, C.R. and Volden, C. (2006) ‘Bottom-up federalism: The diffusion of anti-smoking policies from U.S. cities to states’, American Journal of Political Science, Vol. 50, No. 4, pp.825–843. State Preemption of Local Smoke-Free Laws in Government Work Sites, Private Work Sites, and Restaurants – United States, 2005–2009 (2010) MMWR Morbidity and Mortality Weekly Report, Vol. 59, No. 4, pp.105–108. Stelmach, W, Bielecki, W. and Drygas, W. (2004) ‘The impact of income, education and health on lifestyle in a large urban population of Poland (CINDI Programme)’, International Journal of Occupational Medicine & Environmental Health, Vol. 17, No. 3, pp.393–401. Stokłosa, A., Skoczylas, A., Rudnicka, A., Bednarek, M., Krzyżanowski, K. and Górecka, D. (2010) ‘Evaluation of motivation to quit smoking in outpatients attending smoking cessation clinic’, Pneumonologia and Alergologia Polska, Vol. 78, No. 3, pp.211–215. Tobacyk, J.J. (1992) ‘Changes in locus of control beliefs in Polish university students before and after democratization’, Journal of Social Psychology, Vol. 132, No. 2, pp.217–22. Tobacyk, J.J. and Tobacyk, Z. (1992) ‘Comparisons of belief-based personality constructs in Polish and American university students: paranormal beliefs, locus of control, irrational beliefs, and social interest’, Journal of Cross-Cultural Psychology, Vol. 23, No. 3, pp.311–25. Tomkins, S.S. (1966) ‘Psychological model for smoking behavior’, American Journal of Public Health, Vol. 56, No. 1, pp.17–20. Walczak, M., Brzeszczyńska, K. and Wawrzyniak, A. (2004) ‘Fifth- and sixth-year medical students and the problem of smoking. Assessment of the extent of addiction and motivation to stop smoking’, Polska Medycyna Rodzinna Vol. 6, No. 4, pp.1465–1471.


69

Waters, K., Harris, K., Hall, S., Nazar, N. and Waigandt, A. (2006) ‘Characteristics of social smoking among college students’, Journal of American College Health, Vol. 55, No. 3, pp.133–139. World Health Organization (WHO) (2009) The Current Status of the Tobacco Epidemic in Poland, WHO Regional Office for Europe, Copenhagen, Denmark, available at http://www.euro.who. int/__data/assets/pdf_file/0006/68064/E92470.pdf (accessed on 1 September 2011). Zatoński, W. (1995) ‘The health of the Polish population’, Public Health Review, Vol. 23, pp.139–156. Zatoński, W. (2004) ‘Tobacco smoking in central European countries’, in Boyle, P., Gray, N., Henningfiled, J. Seffrin, J. and Zatoński, W. (Eds.): Tobacco, Science Policy and Public Health, pp.235–252, Oxford University Press, Oxford. Zatoński, W. (2003) Democracy and Health: Tobacco Control in Poland, 97-121, available at http://siteresources.worldbank.org/INTPH/Resources/ch5.pdf (accessed on 20 January 2010). Zatoński, W., Przewoźniak, K. and Porębski, M. (2000) ‘Large cigarettes pack warnings change smoking behaviors in Poland’, in Workshop and Poster Session on Challenges to Tobacco Control for Eastern Europe in the 21st Century, 8 August, Eleventh World Conference on Tobacco and Health – Promoting a Future Without Tobacco, 6–11 August, Chicago IL, Abstract, No. 3, p.777.