Smoker identity and smoking escalation among adolescents

Cigarette smoking remains the most preventable cause of morbidity and mortality in the United States. Smoking typically begins and often escalates during adolescence. Among 12th graders in the 2010 Monitoring the Future Study, 42.2% reported having tried smoking and 10.7% reported smoking daily (Johnston, O'Malley, Bachman, & Schulenberg, 2010). Despite efforts to discourage adolescents from smoking, prevalence rates remain unacceptably high. Unfortunately, smoking during adolescence significantly raises the risk of smoking later in life (Chassin, Presson, Sherman, & Edwards, 1990). Achieving greater success in preventing adolescents from escalating from experimental to more frequent smoking is contingent, in part, on revealing more of the precursors of escalation. Adolescence is a time of pronounced self-concept development (Arnett, 2000; Barton, Chassin, Presson, & Sherman, 1982; Erikson, 1968), and self-concept regulation influences patterns of health behaviors (Shepperd, Rothman, & Klein, 2011). Not all adolescents who progress beyond initial smoking trials are nicotine dependent (Colby, Tiffany, Shiffman, & Niaura, 2000), and an emerging consensus is that escalation is also because of other factors, such as the self-concept (Baker, Brandon, & Chassin, 2004; Leventhal & Cleary, 1980; Mayhew, Flay, & Mott, 2000). As a result of experimental smoking, adolescents may develop a self-concept as a smoker and consequently smoke with more frequency. This article examines the longitudinal association between a smoker self-concept and smoking escalation. The self-concept is addressed in theoretical models applied to understand smoking and has increasingly been the focus of empirical efforts. According to the Prototype/Willingness Model (Gibbons & Gerrard, 1995), social behaviors, such as smoking, invoke self-image concerns via perceived image attributes (e.g., “cool”) of the prototypical person who engages in the behaviors. The more favorable the prototype, and the greater the perceived similarity to the prototype, the greater the likelihood of engaging in the behavior. Prototype perceptions are particularly likely to influence behavior if there is a comparison of the self to the prototype and if there is the belief that engaging in the behavior results in acquiring and/or expressing the prototype-image attributes. They are thought to influence willingness to engage in spontaneous, situational behaviors more so than planned, intentional behaviors. They are often evaluated against variables in the Theory of Planned Behavior (Ajzen, 1991). Adolescents are more likely to smoke if their perceptions of the prototypical smoker are favorable, independently of attitudes, subjective norms, and perceived behavioral control (Barton et al., 1982; Hukkelberg & Dykstra, 2009; Spijkerman, van den Eijnden, Vitale, & Engels, 2004), particularly if they perceive they are similar to the prototypical smoker (Gibbons & Gerrard, 1995), and if their self-image attributes match the smoker prototype-image attributes (Burton, Sussman, Hansen, Johnson, & Flay, 1989). Alternatively, behavior-specific self-identities are frequently investigated as an additional variable with independent effects in the Theory of Planned Behavior (Ajzen, 1991; Rise, Sheeran, & Hukkelberg, 2010). A person can develop an identity as someone who does a behavior, such that it is internalized as a defining aspect of that person (e.g., identity as an exerciser), regardless of whether it is evaluated positively or negatively. These identities develop gradually and through repeatedly engaging in a behavior (Charng, Piliavin, & Callero, 1988) and increase the likelihood of continuing the behavior. For example, college student and adult regular smokers have more intentions to quit smoking and are more likely to actually quit smoking the less they identify as smokers and the more they identify as quitters, independently of attitudes, subjective norms, and perceived behavioral control (Moan & Rise, 2005; van den Putte, Yzer, Willemsen, & de Bruijn, 2009). There is a strong positive bidirectional relation between a behavior-specific identity and behavior. However, identity is not the same as behavior and has several determinants. Thus, two people who engage equally in a behavior may differentially recognize it as part of their identity. It is interesting to note that adolescents who smoke may not identify as smokers unless they consider themselves nicotine dependent (Mermelstein, 1999). Identity perceptions are also likely bolstered by social factors, such as when the behavior is positively reinforced by others, considered socially desirable, publicly recognized, internally attributed, and considered a distinguishing characteristic. Identity perceptions may also be reinforced when individuals affiliate with others who engage in the behavior (Berg et al., 2010; McGuire & Padawer-Singer, 1976; Schlenker, 1986; Tice, 1994). Positive prototype perceptions and perceptions of similarity to the prototype also likely foster an identity (Gibbons & Gerrard, 1995). Both the Prototype/Willingness Model and the Theory of Planned Behavior, along with empirical efforts suggest that self-concept as a smoker uniquely influences escalation. However, the models do not specifically addresses escalation and the relation between smoker self-concept and escalation has not been investigated. Although smoker prototype perceptions have been shown to relate to initiation among adolescents, smoker identity may be more relevant for understanding escalation. First, escalation may be influenced more by internal than situational influences. Prototypes influence spontaneous, situational behaviors (Gibbons & Gerrard, 1995), and smoker prototypes have been shown to predict experimental smoking. Behavior-specific identities account for long-term behavioral outcomes (Charng et al., 1988; Rise et al., 2010). Smoker and abstainer identities have been shown to predict smoking cessation, even independently of nicotine dependence (Shadel & Mermelstein, 1996). Second, once a person has direct experiences with smoking, the prototype may be less relevant, and smoker identity may more readily capture the self-as-smoker. Prototypes may act like stereotypes, formed by those with minimal or no smoking experiences and consisting of beliefs thought to apply to all of the other, “smokers.” Having smoked, the self may become the referent. Beliefs about the smoker may be individuated, self-image attributes may be used to define the smoker (Dunning, Perie, & Story, 1991), and smoker prototype-image attributes may be adjusted to justify the behavior and the identity as well as thought to be situation-specific (Collins, Maguire, & O'Dell, 2002; Shadel, Cervone, Niaura, & Abrams, 2004).