Review
Stages in the development of adolescent smoking

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Abstract

Many researchers have conceptualized smoking uptake behavior in adolescence as progressing through a sequence of developmental stages. Multiple social, psychological, and biological factors influence this process, and may play different functions at different points in the progression, and play different roles for different people. The major objective of this paper is to review empirical studies of predictors of transitions in stages of smoking progression, and identify similarities and differences related to predictors of stages and transitions across studies. While a number of factors related to stage of progression replicated across studies, few variables uniquely predicted a particular stage or transition in smoking behavior. Subsequently, theoretical considerations related to stage conceptualization and measurement, inter-individual differences in intra-individual change, and the staged or continuous nature of smoking progression are discussed.

Introduction

Many authors have conceptualized smoking uptake behavior in adolescence as progressing through a sequence of developmental stages. A diversity of stage definitions reflects the involvement of multiple academic disciplines in smoking research (e.g. psychology, epidemiology, human development, behavioral medicine). Furthermore, multiple social, psychological, and biological factors influence this progression. In addition, different factors may play different functions at different points in the progression, and play different roles for different individuals (Flay et al., 1992). However, to date, no review of the literature has assessed whether specific factors (social, psychological, or biological) are associated with different stages of smoking progression. The major objective of this paper is to review empirical studies of predictors of transitions in stages of smoking progression, and identify similarities and differences related to predictors of stages across studies.

In the first section of this paper we provide an overview of the various stage definitions related to smoking behavior. In order to facilitate our analysis, we impose a re-labelling of stages based on our discussion of the theoretical stage definition of smoking. Second, we introduce a categorical classification scheme to facilitate an analysis of the predictors of stages found in empirical studies. For each category we discuss our findings of whether similar variables are related to specific stages across studies, and whether these variables differ according to stage of smoking or transition. Third, we discuss our empirical findings in light of theoretical assumptions. Fourth, we discuss and clarify issues related to ‘gaps’ in our knowledge about smoking uptake behavior and suggest directions for future research. These gaps include theoretical considerations related to stage conceptualizations, construct validity related to stage definitions, issues of developmental measurement, inter-individual differences in intra-individual change in the development of smoking behavior, and a discussion of the staged or continuous nature of smoking uptake behavior.

Section snippets

Overview of stage definitions of smoking

Leventhal and Cleary (1980) suggested that smoking has a complex ontogeny, and that the developmental history of a smoker moves through several stages. Flay et al. (1983) and Stern et al. (1987) essentially agreed with the basic premise of stages, and provided minor elaborations of the stages suggested by Leventhal and Cleary. The basic stages were described and summarized in Flay (1993) and the 1994 Surgeon General’s Report (USDHHS, 1994). Despite minor differences in terminology and stage

Classification scheme of studies of predictors of stages of smoking uptake

In this review paper an attempt was made to provide an exhaustive list of research studies that addressed stages of smoking during the adolescent years. No geographical limitations were imposed on the literature search. Articles in this review represent research from Canada, the United States, England, New Zealand, and Australia. Subsequently, generalizing these findings to other geographic locations should be made with these limitations in mind.

A large number of psychosocial risk factors have

Findings

Stages of smoking progression have been conceptualized based on previous research and observations leading to theoretical conceptualizations (Leventhal and Cleary, 1980, Flay et al., 1983, Prochaska and DiClemente, 1983). Partial support for the theoretical assumptions has been established in this review of the literature.

Category 1 studies were cross-sectional and revealed little regarding the developmental course and predictors or variables associated with smoking uptake behavior. However,

Conclusions

Observations of smoking behavior and previous research have informed theory construction related to the definition of stages (Leventhal and Cleary, 1980, Flay et al., 1983; Pierce et al., 1995; Wills et al., 1995), and suggested that different factors may be associated with different stages of smoking. However, this review of the literature does not provide any firm conclusions due to the lack of a consistent operational definition of smoking stages across research studies. The need for a valid

Acknowledgements

This work was supported by the Robert Wood Johnson Foundation through the Research Network on the Etiology of Tobacco Dependence (TERN) and the National Institutes of Health (NIDA grant # DA10306 and NIAAA grant # AA11266).

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