Snus user identity and addiction. A Swedish focus group study on adolescents

BMC Public Health

Lena Lendahls²  Göran Ejlertsson¹  Margareta Troein³  Ingrid Edvardsson² 

[1] School of Health and Society, Kristianstad University, Kristianstad, SE-291 88, Sweden;Unit for Research and Development, Kronoberg County Council, Box 1223, Växjö, SE-351 12, Sweden;Department of Clinical Sciences, Malmö, Family medicine, Lund University, Jan Waldenströms gata 35, Malmö, SE-205 02, Sweden

关键词: Identity;    Snus user;    Focus group;    Content analysis;    Addiction;    Adolescents;   

Others  :  1162845
DOI  :  10.1186/1471-2458-12-975

 received in 2012-03-01, accepted in 2012-11-07,  发布年份 2012

【 摘 要 】

Background

The teenage years are the years when adolescents seek their identity, and part of this involves experimenting with tobacco. The use of tobacco as such, and norms among their friends, is more important to the adolescents than the norms of parents when it comes to using tobacco or not. The aim was to explore the significance of using snus for adolescents, and attitudes to snus, as well as the reasons why they began using snus and what maintained and facilitated the use of snus.

Methods

Adolescents who use snus were interviewed in focus groups. The material was analysed using content analysis.

Results

Four groups of boys and one group of girls were interviewed, a total of 27 students from the upper secondary vocational program. Three themes related to the students’ opinions on and experiences of using snus were found: Circumstances pertaining to snus debut indicate what makes them start using snus. Upholding, which focuses on the problem of becoming addicted and development of identity, and approach, where the adolescents reflect on their snus habits in relation to those around them. A number of factors were described as relevant to behaviour and norm building for the development into becoming a snus user. Attitudes and actions from adults and friends as well as – for the boys – development of an identity as a man and a craftsman influenced behaviour.

Conclusions

The results showed that development of identity was of major importance when adolescents start using snus. The adolescents were initially unable to interpret the early symptoms of abstinence problems, but subsequently became well aware of being addicted. Once they were stuck in addiction and in the creation of an image and identity, it was difficult to stop using snus. These factors are important when considering interventions of normative changes and tobacco prevention in schools as well as among parents.

【 授权许可】

   
2012 Edvardsson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Edvardsson I, Lendahls L, Hakansson A: When do adolescents become smokers? Annual seven-year population-based follow-up of tobacco habits among 2000 Swedish pupils–an open cohort study. Scand J Prim Health Care 2009, 27(1):41-46.
• [2]Galanti MR, Rosendahl I, Wickholm S: The development of tobacco use in adolescence among "snus starters" and "cigarette starters": an analysis of the Swedish "BROMS" cohort. Nicotine Tob Res 2008, 10(2):315-323.
• [3]Henriksson C, Leifman H: Skolelevers drogvanor. Centralförbundet för alkohol- och narkotikaupplysning, Stockholm; 2011.
• [4]Hecht SS: Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nat Rev Cancer 2003, 3(10):733-744.
• [5]ARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Meeting (2004: Lyon France) International Agency for Research on Cancer., ebrary Inc: Smokeless tobacco and some tobacco-specific N-nitrosamines. IARC Monogr Eval Carcinog Risks Hum 2007, 89:1-592.
• [6]Salonen L, Axell T, Hellden L: Occurrence of oral mucosal lesions, the influence of tobacco habits and an estimate of treatment time in an adult Swedish population. J Oral Pathol Med 1990, 19(4):170-176.
• [7]Wickholm S, Soder PO, Galanti MR, Soder B, Klinge B: Periodontal disease in a group of Swedish adult snuff and cigarette users. Acta Odontol Scand 2004, 62(6):333-338.
• [8]Zendehdel K, Nyren O, Luo J, Dickman PW, Boffetta P, Englund A, Ye W: Risk of gastroesophageal cancer among smokers and users of Scandinavian moist snuff. Int J Cancer 2008, 122(5):1095-1099.
• [9]Hergens MP, Alfredsson L, Bolinder G, Lambe M, Pershagen G, Ye W: Long-term use of Swedish moist snuff and the risk of myocardial infarction amongst men. J Intern Med 2007, 262(3):351-359.
• [10]Hergens MP, Lambe M, Pershagen G, Terent A, Ye W: Smokeless tobacco and the risk of stroke. Epidemiology 2008, 19(6):794-799.
• [11]Wikstrom AK, Stephansson O, Cnattingius S: Tobacco use during pregnancy and preeclampsia risk: effects of cigarette smoking and snuff. Hypertension 2010, 55(5):1254-1259.
• [12]Wrangsjö B, Winberg Salomonsson M: Tonårstid: utveckling, problem och psykoterapeutisk behandling. 1st edition. Natur och Kultur, Stockholm; 2006.
• [13]Tajfel H, Turner JC: The social identity theory of inter-group behavior. Nelson-Hall: Psychology of Intergroup Relations. Chigago: Nelson-Hall, Chigago; 1986.
• [14]Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process 1991, 50(2):179-211.
• [15]McMillan B, Higgins AR, Conner M: Using an extended theory of planned behaviour to understand smoking amongst schoolchildren. Addict Res Theory 2005, 13(3):293-306.
• [16]DiFranza JR, Rigotti NA, McNeill AD, Ockene JK, Savageau JA, St Cyr D, Coleman M: Initial symptoms of nicotine dependence in adolescents. Tob Control 2000, 9(3):313-319.
• [17]Post A, Gilljam H, Rosendahl I, Bremberg S, Galanti MR: Symptoms of nicotine dependence in a cohort of Swedish youths: a comparison between smokers, smokeless tobacco users and dual tobacco users. Addiction 2010, 105(4):740-746.
• [18]Morgan DL: Focus groups as qualitative research. 2nd edition. Sage, Thousand Oaks; 1997.
• [19]Kreuger RA, Casey M, Focus Groups: A Practical Guide for Applied Research. 3rd ed. 3rd edition. California Sage Publications Inc, Thousand Oaks; 2000.
• [20]Edvardsson I, Lendahls L, Landstinget Kronoberg: Barns och ungdomars hälsa och levnadsvanor i Kronobergs län: en uppföljande enkätundersökning: en beskrivande rapport. Landstinget Kronoberg, Växjö; 2010:111-120.
• [21]Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004, 24(2):105-112.
• [22]Stewart-Knox BJ, Sittlington J, Rugkasa J, Harrisson S, Treacy M, Abaunza PS: Smoking and peer groups: results from a longitudinal qualitative study of young people in Northern Ireland. Br J Soc Psychol 2005, 44(Pt 3):397-414.
• [23]Harris JR: Where is the child's environment? A group socialization theory of development. Psychol Rev 1995, 102(3):458-489.
• [24]Tajfel H: Human groups and social categories: studies in social psychology. Cambridge U.P, Cambridge; 1981.
• [25]Noller P, Feeney JA, Peterson C: Personal relationships across the lifespan. Psychology Press, Hove; 2001.
• [26]Connell R: Masculinities. University of California Press, Berkeley; 1995.
• [27]Stjerna ML, Lauritzen SO, Tillgren P: "Social thinking" and cultural images: teenagers' notions of tobacco use. Soc Sci Med 2004, 59(3):573-583.
• [28]Ambjörnsson F: I en klass för sig: genus, klass och sexualitet bland gymnasietjejer. Ordfront, Stockholm; 2004.
• [29]Doubeni CA, Reed G, Difranza JR: Early course of nicotine dependence in adolescent smokers. Pediatrics 2010, 125(6):1127-1133.
• [30]Scragg R, Wellman RJ, Laugesen M, DiFranza JR: Diminished autonomy over tobacco can appear with the first cigarettes. Addict Behav 2008, 33(5):689-698.
• [31]Nilsson M, Emmelin M: "Immortal but frightened" - smoking adolescents' perceptions on smoking uptake and prevention. BMC Public Health 2010, 10(1):776. BioMed Central Full Text
• [32]Kitzinger J: The methodology of focus groups: the importance of interaction between research participants. Sociol Health Illn 1994, 16(1):103-121.