Smoking: what does culture have to do with it?

REVIEW

© 2003 Society for the Study of Addiction to Alcohol and Other Drugs

Addiction,

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(Suppl 1), 139–145

Blackwell Science, Ltd

Oxford, UK

ADDAddiction

1359-6357© 2003 Society for the Study of Addiction to Alcohol and Other Drugs

98

Supplement 1

Original Article

Smoking and cultureMark Nichter

Correspondence to:

Mark NichterDepartment of AnthropologyUniversity of ArizonaUSA

E-mail: [email protected]

RESEARCH REPORT

Smoking: what does culture have to do with it?

Mark Nichter

Department of Anthropology, University of Arizona, USA

ABSTRACT

In this commentary issues are raised relating to the role of ethnicity and ‘cul-ture’ as a context influencing adolescent smoking. A processual rendering ofculture is encouraged, as is an appreciation of intraethnic diversity. The ques-tion posed is ‘what is cultural about particular patterns, transitions and trajec-tories of smoking?’ Productive ways of investigating patterns of smoking whichattend to class, ethnicity, gender norms, modernity and popular culture arefocused upon as an ongoing project subject to both the identity needs of youthand the agenda of the tobacco industry. Promising areas of research are identi-fied, as are the potential contributions of ethnographies of tobacco use.

KEYWORDS

Class, culture, ethnicity, ethnography, gender, popular

culture, smoking.

A better understanding of tobacco uptake, trajectories ofuse, expressions of dependence and quitting attemptsrequires a careful consideration of the interactionbetween individual and contextual factors, the way inwhich nested social contexts interface and influence oneanother and an appreciation of risk and protective fac-tors. The study of nested contexts is challenging. A movefrom the study of additive to interactive factors influenc-ing tobacco use demands both a new vision of what typesof data need to be collected and new methods of dataanalysis. The papers in this special issue go a long waytowards summarizing what we know about family, peer,neighborhood, media, economic and political economicinfluences on tobacco use. Rather than revisit themesalready covered in the papers, I wish to raise a few addi-tional issues related to ethnicity and ‘culture’ as a contextinfluencing adolescent smoking. Ways will then be sug-gested in which ethnographic studies of smoking can addto our understanding of smoking behavior as a phenom-enon influenced by both structural locations whichbound subjective experience and cultural play whichinvolves experimentation with self-image and identity(Pavis

et al

. 1998).Let me comment first on the role of ‘culture’, a factor

influencing tobacco use that was raised by several of theauthors. When this volume was first discussed, ‘culture’was considered as a context meriting its own review.Given that a Surgeon General’s Report (US Department ofHealth & Human Resources, 1998) had recently summa-

rized ethnic differences in rates of smoking, it appearedredundant to restate what is already known and moreuseful to consider how cultural norms and institutions,gender roles and aesthetics played out in each of the othercontexts being addressed. I would urge future researchersinvestigating ‘culture’ and tobacco use to continue tolook at the interaction between culture and social andeconomic contexts, and to consider ‘culture’ on twofronts: (a) culture as it is commonly regarded in relationto ethnic differences, and (b) popular culture as an ongo-ing project subject to both the identity needs of youth andthe influence of an advertising industry that manipulatesthese needs to sell cigarettes and develop market niches.

Ethnicity and culture are terms that public healthresearchers need to differentiate and take seriously, espe-cially when studying adolescence (Fergerson 1998).

1

When using the term ‘ethnicity’ it is important to differ-entiate between an ethnic identity one assumes in con-text and an ethnic label that is imposed by others. One’sethnic identity is an identity one chooses to assume onthe basis of some sense of social and political affiliation.Far from being fixed or static, which would render ethnic-ity a reified construct (a ‘thing’), ethnic identity may beclaimed or distanced in particular contexts, at particulartimes, and for particular reasons. One’s sense of ethnicidentity is situational and changes in accord with

1

For a complementary discussion of the meaning of ‘race’, seeFreeman (1998).


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life-style, residence, etc. At its core, ethnic identity isbased on shared meanings that emerge from collectiveexperiences and as such it is produced and reproduced insocial interaction. An ethnic label, on the other hand, is astatic designation assigned to a person by someone else. Itis based on a set of criteria that distinguishes them fromothers in the eyes of whomever it is that controls the cat-egorization scheme. The history of ethnic categorizationin the United States has been politically motivated andhas been influenced by a changing agenda (Edmontson &Schultze 1994).

Ethnic labeling, whether by skin color, language orregion of origin, lumps people together who may have asmany differences as similarities. Lumping has diverseramifications. It can contribute to misleading and some-times disempowering stereotypes as well as provide anopportunity for those labeled to gain critical mass andmobilize forces toward particular ends. For example,diverse groups categorized as Hispanic may mobilize as acollective based on the common experience of oppressionand assume an ethnic identity as much for political ascultural reasons.

When ethnicity is employed as a category in publichealth, it is important to be clear about one’s assumptionsand how ethnic designation is going to be used in dataanalysis. Is an ethnic label being used to examine the pos-sible role of biological differences? Is ethnicity a proxy fora whole bundle of social and economic factors associatedwith the position a group of people has been forced toassume as a result of a history of discrimination oroppression (e.g. as a marker of social inequity and struc-tural violence)? Or is ethnicity being examined to deter-mine whether the distinctive characteristics of an ethnicgroups’ ‘culture’ are protecting or exposing this group toparticular types of risk? If the latter is the case, we mustbear in mind that ‘culture’ is one of the most highlydebated concepts in cultural anthropology (Sewell1999).

Culture is commonly thought of as an enduring set ofsocial norms and institutions that organize the life ofmembers of particular ethnic groups giving them a senseof continuity and community. It is often described rathervaguely as an all-encompassing associational field inwhich ethnicity is experienced. Numerous anthropolo-gists have discussed the limitations of such conceptual-ization of ‘culture’, especially in complex societies subjectto the forces of modernity. When ‘culture’ is thoughtabout in terms of consensus and as a template for idealbehavior, the positions of different stakeholders (definedby gender, generation, class, power relations, etc.) are for-gotten and heterogeneity is ignored. A processual render-ing of culture is more productive. Such an approachdirects attention to cultural dimensions of social transac-tions and asks what is cultural about particular types of

behavior in different contexts. Culture is treated more asan adjective than a noun (Appadurai 1996).

Why is a discussion of ethnicity and culture importantfor tobacco research? There has been mounting criticismof late about the way in which race/ethnicity has beenused in public health research as a set of pigeonholes, ifnot black boxes. This fosters an analysis of ‘difference’that focuses on individual and group traits rather thanthe contexts in which people live (Lillie-Blanton & LaVeist1996). Despite warnings against reading too much intoaggregate (e.g. state, national) data on smoking and eth-nicity, it is easy to overlook ethnic heterogeneity and seeethnicity as a risk factor rather than a risk marker. Aquestion often posed in debates about ethnicity andsmoking is the following: are cultural factors responsiblefor ethnic differences in levels of smoking (at differentages by gender), or is ethnicity merely a marker for mul-tiple social and economic factors predisposing one tosmoke or abstain from smoking? Adopting an ‘action is inthe interaction’ perspective, I would argue that there is amuch better way of framing this important issue. Twoquestions appear more relevant to ask:

1

Is smoking behavior in particular social and economiccontexts influenced by cultural norms and processesand if so, how?

2

What has smoking come to represent to those sharingan ethnic identity in an environment in which thetobacco industry often targets ethnic pride in market-ing campaigns?

I would argue that it is far more productive to look for cul-tural differences in smoking after first accounting forother factors known to predispose an individual to smoke,including education, social class, economic insecurity,stressors (e.g. discrimination), other drug use, etc. Follow-ing an analysis which pays credence to the shortcomingsof quantitative research—for example, that it often over-looks important differences between socio-economic indi-ces (King 1997)—ethnic differences should be examinedmore closely. At a minimum the following three issuesshould be addressed by ethnographic research. What isthe role that cultural institutions, values, and processesplay in: (1) protecting against smoking in the general pop-ulation, as well as particular patterns of smoking amongmales and females, (2) fostering smoking as a normativebehavior within particular gender and age cohorts and(3) affecting the distribution of particular smoking trajec-tories (e.g. early versus late onset of smoking, smokingcharacterized by rapid versus slow escalation, etc.). Thisethnographic analysis would serve as a complement toassessments by researchers who examine intraethnicgroup differences by examinations of social class, educa-tion, residence, racial segregation and acculturation.

What cultural factors might be productive to examinemore closely when researching smoking trajectories?

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Parenting styles and respect for elders are two variableshighlighted in the Surgeon General’s Report as importantfactors influencing smoking behavior. Beyond noting thatthese factors affect smoking uptake and age of initiation,we need to consider how and in what ways they affectyouth once they begin smoking. What verbal and non-verbal messages do youth receive from male and femaleparental figures in different ethnic communities at differ-ent points in their smoking trajectories? Once someonebecomes a smoker, are they urged to quit or is theirbehavior accepted? How does respect for elders influencewhen and where youth may smoke, and how does this dif-fer by not only age and gender, but by employment status?How do cultural sanctions influence patterns and levels ofsmoking?

The messages youth receive about smoking must notbe looked at in isolation. It is not just the content of themessage that makes a difference, but the meaning andsocial relations it evokes. Several publications have sug-gested that authoritarian parental messages protectAfrican American youth against higher rates of smok-ing (Koepke, Flay & Johnson 1990; Distefan, Gilpin

et al

.1998; Clark, Scarisbrick-Hauser

et al

. 1999). We need tounderstand youth response to these messages in terms oftheir relationships with the people delivering them as wellas other messages they receive. What protective role doassociated messages play such as those which emphasizemaintaining a positive self image in the face of adversityand messages which remind youth that one’s behaviorreflects not only on their person, but family and commu-nity? In what contexts do such messages matter and inwhat contexts do they fall on deaf ears? In contexts wheresuch messages matter, do they contribute to reported eth-nic differences in peer group influence (Unger

et al

. 2001)or are other factors involved? And, are there gender andage differences in the ways youth respond to both peerinfluence and the messages of elders?

2

In addition to examining the influence of family andpeers it might be useful to focus attention on the influenceof role models which include, but are not limited to thesetwo groups of people. For example, among AfricanAmerican families, senior women (mothers, grand-mothers, extended and fictive kin) often, but not always,act as effective role models for the young as providers andsurvivors. Their message about smoking has been fairlyconsistent and clear—it does not look good for youngAfrican American men or women to smoke and it doesnot reflect well on their family; but what happens, forexample, to the many African American men and womenwho join the armed forces when they turn 18 years of

age? What influence do older officers who smoke have onnew recruits in their units? Given high rates of smokinguptake and relapse in the military among young recruits(Bray

et al

. 1988, 1999), studying the influence of officersas role models would seem worthwhile.

Another issue worth considering is how core culturalvalues affect smoking behavior once uptake hasoccurred. For example, the importance accorded to socialexchange and reciprocity within different ethnic groupsmay be an important factor to investigate. Being offeredand accepting or refusing a cigarette within Filipino-American communities, for example, may carry a locusof meaning far different than within African American ormainstream Anglo communities, and this meaning maydiffer by gender (Nichter

et al

. 2002). Similarly, culturalvalues may influence peer group norms and boundarysetting related to tobacco use. For example, I haveobserved that peers sometimes play a dual role in bothencouraging smoking uptake and limiting where, whenand how much friends smoke; that is, they are at once arisk and a protective factor that may affect smoking tra-jectories (Nichter 1999). The role of peers in establishingboundaries for acceptable behavior has also been notedby Tessler 2000), Kobus (2003) and Maggs (1997) in herresearch on alcohol use. An issue worth exploring iswhether peer relations vary within different ethnicgroups such that friends are more or less likely to act asboundary setters circumscribing the behaviors of peers?For example, would Native American youth be less likelyto limit friends smoking behavior due to deep-seated cul-tural norms valuing autonomy than, for example, Mexi-can Americans?

Another important issue in need of investigation is themeaning that smoking assumes during socially con-structed life transitions. The study of smoking transitionsin particular ethnic communities would benefit from eth-nographies of what else is occurring at times when signif-icant shifts in smoking appear to be taking place. Suchresearch needs to pay special attention to cultural percep-tions of age appropriate behavior, normative transgres-sions and risk taking (Lightfoot 1997; Turbin, Jessor &Costa 2000; Burton

et al.

1996), and behaviors associ-ated with assuming greater adult responsibility. In orderto understand better the role that smoking plays as amarker of gender and age identity, we need to examinesocial constructions of adolescence as well as femininity/masculinity. Perceptions of when adolescence begins andends often differ by gender in accord with roles and expec-tations, the division of labor within the household and theavailability (political economy) of paid work outside thehome. While girls in some ethnic group contexts areexpected to bear the responsibilities of adult women early(e.g. become child-care providers if not mothers), in othergroups young women are encouraged to stay at school for

2

See for example the study by Simons-Morton

et al

. (2001),which suggests gender differences in the effect of ‘peer pressure’on smoking and drinking among younger adolescents.


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long periods of time; in some contexts, adolescence maybe much longer for boys than girls because transitions toemployment and marriage take place much later. Thepoint being made is that comparisons of male and femalesmoking within and across groups need to be contextu-alized and not merely be based on physical age.

Let me next draw attention to aesthetics and style asimportant cultural factors influencing smoking, becausethey are often associated with ethnic identity. At a recentconference I attended, one speaker cited as a reasonfor lower rates of African American smoking amongyouth was that smoking was a ‘white thing’. An AfricanAmerican woman in the audience corrected the speakerby stating, ‘Not acting white isn’t what our youth are allabout, it is being Black and being proud. Smoking is not a“Black thing”’.

3

The woman went on to suggest that thereason black youth did not take to smoking was ‘mostlybecause it wasn’t important to their styling’. Her wordsecho the findings of a multi-site study in the UnitedStates, where researchers found that black girls in com-parison to white girls were far more likely to think that‘not smoking’ enhanced their self image (Mermelstein1999). Smoking, put simply, was not equated with style.Ethnographies of African American perceptions ofbeauty and individual expression have drawn attentionto the importance of styling and cool pose to ethnic iden-tity as well as courtship rituals (Majors & Billson 1992;Parker

et al

. 1995).Styling can act as both a protective and risk factor for

smoking. A better appreciation of cultural aspects of styleand the way status is displayed in ethnic communitiesmight provide us with a better understanding of why cer-tain marketing pitches for cigarettes work well in thesecommunities and what kind of tobacco control messagesmight be best suited for them. It would also be wise tomonitor changes in perceptions of ‘smoking as stylish’ asa barometer of how well the advertising industry is doingin making smoking culturally acceptable in different eth-nic groups.

4

In this regard, it is important to bear in mindthat the advertising industry is in the business of position-ing products to enable people to position themselves aspart of an ongoing cultural project.

This brings me to the importance of studying popularculture and the way youth negotiate their identities in

consumer society. One of the primary ways we structuretime, define who we are and express social relations isthrough acts of consumption. Consumption events punc-tuate the flow of everyday life as we move from school orwork to leisure time. They help us to rekey our moods andstates of mind. Consumption practices also play a role infantasy and social performance, image experimentationand image management, social affiliation and the expres-sion of group and individual boundaries. In particular,cigarettes serve as symbols as well as props that allowpeople to imagine as well as act out constantly varyingroles on the stage of everyday life (Danesi 1999). Youthcreate, appropriate and assign meaning to smoking at thesame time as they are being primed to interpret smokingin particular ways.

There is nothing new in recognizing all of this. What iscalled for is a more sophisticated approach to studyingthe meaning of smoking in popular culture, an approachthat accounts for both the expression of agency and thesocial meaning of smoking performances. Here it is vitalto recognize that, although it may be possible to link cig-arettes with particular meanings among certain groupsand in certain situations, tobacco use is better conceivedas a form of imaginative play involving symbols andmutually understandable cues rather than discrete mes-sages sent through a code (Bateson 1972). While it is truethat smokers may send messages through their tobaccouse, most do not consciously or explicitly set out to sendparticular messages. The interaction of a smoker’s cogni-tive and emotional situation, their facility in performingsmoking routines and the widely distributed culturalimagery that they work off of is glossed over in an analysisof tobacco as a code of meaning (a semiotic). What isrequired are studies of tobacco use that attend to the stage(context) in which smoking occurs, cultural meaningsassociated with tobacco, and processes of self expressionwhich involve performance. Smoking is but one part ofimage management. For this reason it is important tostudy smoking as it is combined and contrasted withother expressive acts such as sports, substance use anddress in a constantly evolving fashion system. It is entireensembles of symbolic behavior that make cultural state-ments more often than single acts such as smoking a cig-arette. When one takes up or gives up smoking, they oftenmake shifts in an array of interrelated behaviors.

In this light we need to deepen our understanding ofthe importance of smoking in movies and community-based marketing strategies where youth are paid tosmoke in particular spaces. Most research on smoking inthe movies focuses attention on the number of timessmoking occurs, whether main characters smoke ciga-rettes and if smoking occurs in particularly memorablescenes. The assumption is that youth will want to imitateattractive main characters and that a transfer of positive

3

While it is important to recognize cultural aesthetics as anexpression of core values and improvisation, it is also importantto recognize that an ‘oppositional cultural frame of reference’(Cross 1995; Ogbu 1994) does affect choices in style and self-presentation. This may impact on smoking.

4

Conspicuous consumption among blacks is also an expressiveact having collective significance best understood against thebackdrop of a history of racism (Lamont & Molnar 2001). This istapped into and used as a marketing strategy to sell tobaccoproducts.

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arousal will occur from scenes to products. Anotherdimension of tobacco use may be just, if not more impor-tant. Background smoking as well as smoking featured inthe foreground of movies gives youth ideas about when,where and how to smoke in a manner which enables arange of social performances. At a time when smoking isincreasingly being regulated, the tobacco industry willneed to provide youth with new images of smoking inspaces and at times when it is feasible. Researchers mon-itoring smoking in the media need to look beyond the cig-arette to the context in which it is smoked and what issignaled by particular smoking gestures. Researchersmonitoring community-based tobacco strategies need,similarly, to pay more attention to where ‘paid smokers’are positioned and the spaces and times in which ciga-rettes, small cigars, and other tobacco products are beingfashioned to appear normative.

Let me turn briefly to a few other issues related tosmoking environments and how they may affect smokingtrajectories as well as expressions of tobacco dependence.The study of human geography investigates what behav-iors and forms of social interaction and identities areassociated with place. This discipline might have much tocontribute to studies of what types of smoking occur indifferent smoking environments. Such studies might pro-vide, for example, valuable insights into smoking topog-raphy. At a time when constraints on where and whenone may smoke are increasing, more attention needs tobe focused on the relaxed and pressured manner in whichpeople smoke in different spaces. Chapman, Haddad &Sunhusake (1997) have called our attention rightly tochanges in the depth of smoke inhalation and rates ofinhalation by those forced to smoke outside of work sites.Payne (2001) has noted further that women are morelikely than men to be employed in work sites where smok-ing bans lead smokers to smoke both harder and faster.She hypothesizes that gender differences in smokingtopography may affect trajectories of lung cancer.Whether or not this is the case, gender-sensitive studies ofthe way people smoke at different times and in differentplaces are worth doing. Given all the restrictions on youthsmoking, it might be valuable to investigate not only howmany cigarettes youth smoke a day, but also when youthengage in rushed and relaxed smoking. It is worth con-sidering more closely how smoking trajectories amongyouth are affected by access to times and spaces wheresmoking can occur in particular ways. For example, aresmoking transitions more likely to take place when youthhave access to relaxed smoking environment, such as in acar?

It is very important that we consider the impact ofsmoking opportunities and constraints on expressions ofdependence. Recent research suggests that it may be bet-ter to conceptualize tobacco dependence in terms of

degrees, not absolutes, and as multi-dimensional phe-nomena (Shadel

et al

. 2000). It is likely that youth andadult expressions of dependence differ or that the order inwhich signs of dependence appear may be different forsmokers of different ages (Nichter

et al

. 2002). It is rea-sonable to hypothesize that expressions of dependenceamong youth may be associated with smoking opportu-nities and constraints over the course of the day andweek. In order to test this hypothesis, measures of depen-dence sensitive to youth and their life world will need tobe developed (Nichter 2000). Such measures will have tobe sensitive to patterns of smoking, the plans youth maketo smoke, and the salience of particular cigarettes in theirday.

A last point I would like to raise is related to the waymodernity itself may be a context we need to consider inrelation to tobacco use. Today youth live in an age ofincreasing time compression, greater opportunities forarousal and diminishing tolerance for ‘boredom’, and theproliferation of products that promise instant gratifica-tion. Cigarettes have been engineered biologically to be afast and effective nicotine delivery device and engineeredsocially (advertised) to be an antidote for boredom. Theremay be biocultural reasons why nicotine, like caffeine, isappealing to youth in today’s world. Consider, for exam-ple, that a significant percentage of youth are placed in anenvironment where they are required to multi-task atschool when experiencing mild to moderate sleep depri-vation (Wahlstrom 1999). Youth today are going to bedlater than ever before because they have the opportunityand means to be in constant contact with their friendsthrough cell phones and instant messaging, have accessto hundreds of television programs thanks to cable tech-nology, are able to experiment with new identities at willin computer chat rooms, and they can spend hourssearching the web to complete school assignments. Yetthey are subject to early wake up times demanded byschool schedules more geared to the political economy ofadults than the lives of youth.

Does the pharmacology of nicotine make tobaccoattractive to youth given these conditions? Anthropolo-gists who have studied the history of substance use fromcoca leaves to sugar, coffee and tea have observed that‘food drugs’ tend to become popular when they match thebiocultural demands of work cycles as well as facilitate thepractice of ideologies at the site of the body, through trade,etc. (Mintz 1985 and 1997; Jankowiak & Bradburd 1996and 2003; Gladwell 2001; Wolf 1982). If such is the casefor tobacco, we need to reflect on both the appeal of tobaccoas a symptom of our times and the tobacco industry as thepurveyor of a form of ideology. This ideology is clearly aform of capitalism based on the promotion of dependence.Indeed, one could argue that tobacco is the best example ofa dependence industry affecting the world on multiple


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fronts ranging from the micro (cellular) to the macro (soci-ety, global relations). Nicotine delivery devices rendertobacco as addictive as possible, tobacco agriculturemakes farmers more dependent on fertilizers than almostany other crop and politicians and state governments eas-ily become addicted to tobacco generated revenues. Theideology of dependence propagated by the tobacco indus-try is an important political economic dimension of ‘cul-ture’ which we must not fail to appreciate.

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Smoking: what does culture have to do with it?