The fight against tobacco can reinforce social inequalities in smoking

This means that for every person who quits, another begins.

These figures are not surprising to Katherine Frohlich, Professor in the Department of Social and Preventive Medicine at the Université de Montréal and researcher at the Institut de recherche en santé publique publique at UdeM. “Among Quebecers aged 15 to 19 years, the smoking rate is 17%, which is among the highest in Canada,” she says.

Frohlich focuses on the social aspects of smoking and led a major research project to better understand why socially disadvantaged youth smoke more compared to their wealthier counterparts. A part of the study, which concerns the attitudes of tobacco control practitioners toward young smokers, has recently been published in the journal Sociology of Health & Illness.

Double stigma

“Intervention programs with young smokers tend to target the whole population regardless of social or economic conditions. There is a gap between the view of tobacco control practitioners and the reality of young smokers," says the professor.

Frohlich wanted to understand the point of view of these decision-makers and practitioners to better guide their actions. Twelve practitioners from Montreal and thirteen from Vancouver, where the proportion of smokers is among the lowest in the country, were interviewed by the researcher.

An unexpected result of the interviews showed that practitioners, regardless of where they are in Canada, often associated young smokers with people from lower socioeconomic backgrounds who are unable to curb their desires and who are irresponsible in terms of their decisions. Hidden therefore is the fact that there are also smokers from wealthy backgrounds and that the factors of tobacco use are not the same depending on social conditions.

“It is dangerous to attach a behaviour to a social class,” says the professor. “The danger is to create a double stigma: being poor and being a smoker because you lack self-control. Smokers are no longer seen only as those who use cigarettes, but as those who are biologically determined to smoke and socially conditioned by their environment.”

Young smokers are even associated with problem behaviours such as sexual promiscuity, school dropout, and general delinquency.

While assistance programs focusing on the development of self-esteem and the dangers of smoking to health have been mostly unsuccessful with young people, the failure of these programs is interpreted as a lack of reason and willingness on the part of these youth. “This moralizing discourse is quite present, and young people end up appropriating it,” says the researcher.

Different factors

According to Professor Frohlich, the reasons why young people from disadvantaged backgrounds start smoking are not the same as for a young person from a wealthier background. “In both Montreal and Vancouver, disadvantaged youth start smoking because the habit is already present in their milieu and because it is a way to manage social stress, economic stress, and sometimes the violence of their social or family environment,” she explains. “Youth from wealthy backgrounds do it because it’s ‘cool,’ to be accepted by their friends, or to defy their parents.”

Since the causes of smoking are not the same depending on social background, it makes sense that interventions aimed at the whole population are unsuccessful with groups dealing with specific problems. “Smoking is not only a psychological problem, and self-esteem workshops have minimal impact in helpinghe to break the habit,” says Frohlich.

The researcher has no doubt that practitioners seek the welfare of young people, but wants to highlight that such unfounded discourse may be counterproductive and further marginalize those the practitioners wish to help.

Frohlich even believes that interventions directly targeting smoking-related behaviour are largely ineffective with these less advantaged groups. It would be better, in her opinion, to improve living conditions and fight against social inequalities. Providing rewarding extra-curricular or social activities to help young people build strong identities other than through cigarette use and creating safe and enjoyable social environments seem to her more appropriate and promising in the longer term.