Factors That Influence Smoking in Adolescent Girls

Mary Ann Faucher, CNM, PhD


J Midwifery Womens Health. 2003;48(3) 

In This Article

Review of the Literature

Many of the factors that contribute to smoking initiation have been elucidated; the strongest appear to be peer smoking and parent smoking. In addition to external influences, factors within specific important relationships and factors internal to individual adolescents may be significant. This may be more important for girls than boys, and the influence of relationships and internal self-concept have not been directly analyzed with regard to their effect on smoking.

Peer Smoking

Peer smoking appears to be the most important factor influencing smoking initiation.[2] Susceptibility to peer pressure does appear to be influenced by race and gender.[8] Peer smoking significantly increased the likelihood of smoking, both experimental use and regular use, in both European American and African American youth, although the effect was less for African Americans (odds ratio [OR] = 2.87 versus 1.65).[8] Females (31%) are more likely than males (17%) to report social norms as a reason to initiate smoking.[9] Peer pressure and offers to smoke have been reported as reasons to initiate smoking more often by females (15%) than males (9%).[9] In addition, risk for lifelong continuation of smoking in females may be greater than in males because the reasons they begin smoking are associated with an increased likelihood of continued smoking.[9]

Role of Parent Smoking

In 1993 Rutter[10] reported that the family and school are the most important social contexts that influence adolescent risk behavior.

Parents who smoke are known to influence their children's smoking behaviors. In a study of families in which both parents smoke, 20.7% of girls were smokers, compared with 7.6% of girls from families where neither parent smoked.[11] Parental smoking appears to be more influential for girls than for boys;[9,12,13] this finding was particularly pronounced for the influence of smoking mothers on adolescent daughters.[13,14] The strong influence of parental smoking has been demonstrated for European American girls, as well as for African American girls, although the influence of parent behavior on African American girls is less pronounced (OR 3.07 versus 1.54, respectively).[8] An explanation for the greater influence of parental smoking on adolescent girls than on boys has been attributed to a greater need for intimacy and family ties.[15] Although adolescents seek independence and less oversight by parents, the need for guidance and support is critical.[16]


According to Chodorow,[4] females develop self-concept in the context of relationships with others, whereas males develop self-concept around the idea of the body as an instrument reinforced through physical capability and efficiency. Although body image is an integral aspect of self-concept, it varies according to cultural norms, contextual norms (i.e., body structure of family and friends), and social perceptions. For example, adolescent girls who had negative feelings about their body also had lower self-esteem, although the association between negative self-esteem and a negative body image is more often seen in white girls than in girls of other races/ethnicities.[17] In addition, Vinuesa[18] reported that body image dissatisfaction was negatively correlated with internal locus of control and autocratic interpersonal styles, whereas positively correlated with submissive styles of interpersonal behavior. The research findings relating less internal locus of control, less self-control, and strong desire for social approval with body image dissatisfaction are particularly important risk factors for smoking. Individually and cumulatively they increase susceptibility to both peer pressure and peer influence, both validated as important risk factors for smoking initiation in both adolescent girls and boys.

Parent Connectedness

Most of the literature on parental influence on adolescent behavior focuses on two aspects, relationship quality and parental monitoring.[19] McCord[20] found both aspects to be prognostic of adolescent delinquent behavior. Other aspects of parenting that have been studied for their effect on adolescent behavior include effective discipline and parental involvement with the youth.

Adolescents desire greater connectedness to parents, school, and community. Unfortunately, today's busy adults frequently relinquish responsibility and supervision of teens allowing them greater opportunities to participate in unhealthy behaviors.[21] When the adolescent is unable to meet her need for affirmation within the family, in this case the daughter with the mother, the affiliation with the peer group may be greater. Blos[22] agrees that, particularly for girls, normal passage through early adolescence is ultimately safeguarded by emotional availability of the parent. Allen et al.[23] revealed that optimal outcomes in adolescent' lives were associated with establishment of both autonomy and relatedness. Lamborn and Steinberg[24] found that adolescents who were high in emotional autonomy and low in parental support demonstrated problematic adjustment profiles more frequently. Resnick et al.[3] reported the protective influence that parent connectedness has in preventing the adolescent from engaging in risk behaviors, including smoking, although sex differences were not reported.


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