Lighting Up: The Rise of Social Smoking on College Campuses 9781479812523

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Lighting Up

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Lighting Up The Rise of Social Smoking on College Campuses

Mimi Nichter

a NEW YORK UNIVERSIT Y PRESS New York and London

NEW YORK UNIVERSITY PRESS New York and London www.nyupress.org © 2015 by New York University

All rights reserved References to Internet websites (URLs) were accurate at the time of writing. Neither the author nor New York University Press is responsible for URLs that may have expired or changed since the manuscript was prepared. Library of Congress Cataloging-in-Publication Data Nichter, Mimi. Lighting up : the rise of social smoking on college campuses / Mimi Nichter. pages cm Includes bibliographical references and index. ISBN 978-0-8147-5838-0 (hardback) — ISBN 978-0-8147-5839-7 (pb) 1. Smoking—United States. 2. College students—Tobacco use—United States. 3. College students—United States—Social life and customs. I. Title. HV5760.N53 2015 362.29’608420973—dc23 2014040542 New York University Press books are printed on acid-free paper, and their binding materials are chosen for strength and durability. We strive to use environmentally responsible suppliers and materials to the greatest extent possible in publishing our books. Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 1 Also available as an ebook

For Mark For your continued presence and your loving support

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Contents

Acknowledgments

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1. “It’s No Big Deal”

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2. Profiles and Progressions

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3. Smoking and Drinking: “It’s Like Milk and Cookies!”

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4. What’s Gender Got to Do with It?

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5. Reconsidering Smoking as a Weight-Control Strategy

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6. The Slippery Slope

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7. Tipping Points: Stress, Boredom, and Romance

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8. Quit Talk

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9. Looking Forward: Uncertain Trajectories

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Appendix: Methods

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Notes

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References

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Index

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About the Author

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Acknowledgments

I have many people to thank for their assistance in the writing of this book. First, I am grateful to have been a Faculty Scholar with the Tobacco Etiology Research Network (TERN), funded by the Robert Wood Johnson Foundation. The purpose of this network was to study from a transdisciplinary perspective the etiology of tobacco use and transitions from low-level use to dependency among youth. Four times each year for six years, I attended TERN meetings where I was immersed in an intense think tank, learning about tobacco research from a wide variety of perspectives, including psychopharmacology, behavioral genetics, neurobiology, animal studies, and epidemiology. As one of only two anthropologists in the research network (the other being Mark Nichter), I was often challenged to comprehend the research approaches to the study of tobacco from other disciplines, and I personally struggled to articulate the contributions of an anthropological approach to tobacco to this largely quantitative group. The Tobacco Etiology Research Network influenced my thinking and greatly expanded my understanding of the tobacco field. Network members included Richard Clayton (chair), David Abrams, Robert Balster, Linda Collins, Ronald Dahl, Brian Flay, Gary Giovino, Jack Henningfield, George Koob, Robert McMahon, Kathleen Merikangas, Mark Nichter, Saul Shiffman, Stephen Tiffany, Craig Colder, Lisa Dierker, Eric Donny, Lorah Dorn, Thomas Eissenberg, Brian Flaherty, Lan Liang, Elizabeth Lloyd-Richardson, William Shadel, and Laura Stroud. Some of the data for this book is drawn from studies that were conducted under the auspices of TERN. I am extremely thankful for the financial support from this group. Having an opportunity to work for so long with so many of our nation’s top tobacco researchers was truly an honor. >>

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his observations about “red cup culture,” smoking at parties, and life beyond college. And Starr Herr-Cardillo, a big thank you for taking the great photo that graces the cover of the book. My colleagues and friends Terry Woronov, Leticia Veloso, and Penelope Jacks also read some of my earlier chapters and talked with me about the work. To all of these people in my life who have put up with me through all this time that I was writing this book, my heartfelt appreciation. I couldn’t have done it without you. Early versions of some chapters appeared elsewhere in a different form and are reworked here by permission: Mimi Nichter, Mark Nichter, Asli Carkoglu, and Elizabeth Lloyd-Richardson, “Smoking and Drinking among College Students: ‘It’s a Package Deal,’” Drug and Alcohol Dependence 106 (2010). Mark Nichter, Mimi Nichter, and Asli Carkoglu, “Reconsidering Stress and Smoking: A Qualitative Study among College Students,” Tobacco Control 16 (2007). Mimi Nichter, Mark Nichter, Elizabeth Lloyd-Richardson, Brian Flaherty, Asli Carkoglu, and Nicole Taylor, “Gendered Dimensions of Smoking among College Students,” Journal of Adolescent Research 21 (2006). Mimi Nichter, Mark Nichter, Nancy Vuckovic, Laura Tesler, Shelly Adrian, and Cheryl Ritenbaugh, “Smoking as a Weight Control Strategy among Adolescent Girls and Young Women: A Reconsideration,” Medical Anthropology Quarterly 18 (2004).

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“It’s No Big Deal” It’s not like I’m going to do these things forever. I mean, I’m in college and everyone says it’s the time to let go. If I don’t do all these things now, when will I? Now’s the time to party hard with friends, stay up late, smoke and drink, and just enjoy myself. But it’s not like something I do all the time so it’s really not like a big deal. I mean, I’m sure I won’t be smoking when I’m done with college. —Blake, eighteen-year-old male

The quote above from this college freshman echoes prevalent ideas on college campuses about smoking. Tobacco, like alcohol, is a substance that “everyone” seemed to use, especially at parties. Few students on the campuses where I worked saw themselves as “real” smokers. They were party smokers, that is, people who mostly smoked socially. That’s why so many students referred to their occasional smoking almost as an afterthought, and talked about it as “no big deal.” Social smoking is common among young adults, particularly those who are in college. Social smokers tend to be lighter smokers who do not smoke on a daily basis. Their smoking is more related to the context in which they find themselves. In fact, it’s an umbrella term that can refer to different patterns. On the college campus, the term “social smoker” most commonly refers to a person who smokes with friends at parties when consuming alcohol. I resist assigning a number of cigarettes to define social smoking at parties, as it really depends on how much drinking is going on and who the individual is hanging out with on a particular night. Other patterns of social smoking also exist. A person on a break from work may smoke because his or her coworkers do, or a person who rarely smokes may have a cigarette with a troubled friend who is smoking as a way of bonding. Social smoking can >> 1

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to move farther into a distant ambiguous future, something that might be reconsidered at the next life milestone, such as getting a real job or starting a family. While this book is largely focused on the college campus, I also consider what happens after graduation. Many grads today are stepping into an uncertain future, where the prospect of finding a good job in a timely manner is unlikely. Their twenties may be characterized by multiple moves (in and out of their parents’ and friends’ homes) and compounded by multiple stressors, not the least of which is supporting oneself in a time of high unemployment and low wages. Moving into adulthood is now an elongated process, as markers of “settling down,” like marriage, edge upward toward one’s late twenties, if that. For those who have come to depend on the comfort of cigarettes during their college years, this array of life stressors may make cutting back or quitting more difficult, despite their intentions and understandings of the harms of tobacco. Added to this picture is the powerful tobacco industry, which has focused much of its multibillion-dollar campaigns on young adults— the youngest legal targets of its products. Slim, light, and additive-free cigarettes are marketed to young people who may think they are engaging in harm reduction through the promise of a “healthier” cigarette. Emerging products in the marketplace, like e-cigarettes, carry with them the lure of vaping (distinct from smoking), ostensibly without the harmful effects. Taking these myriad factors into account, one begins to recognize how social smoking is a behavior that may continue well beyond the college years. My analysis draws on a social ecology of health model, which postulates that in order to understand the meaning of health behavior in context, we need to critically examine multiple levels of influence, such as the individual, the social network, the community, and global systems. Applied to the study of smoking among young adults, the social ecological perspective prompts us to look beyond psychosocial models that privilege individual behavior to consider how social, cultural, and political-economic environments affect youth behavior and how youth behavior, in turn, may influence the environment. Moving from the micro (interpersonal) to the macro (community/societal) level with a focus on reciprocal and bidirectional interaction, the social ecological

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For many years, a widespread assumption in the public health field was that over 90 percent of those who became smokers would begin their habit before they reached age eighteen. The period of maximum vulnerability to initiation was considered to be during the middle or high school years.4 Recently the conventional wisdom about when youth start smoking has been challenged by findings that as many as 20 percent of smokers start smoking after age eighteen, a figure that represents a substantial increase from earlier years. Nationwide surveys reveal that it is increasingly common for college students to begin smoking after they arrive on campus, mostly in their freshman year. Over 30 percent of college students report that they smoked at least once in the past year, 25 percent report that they smoked at least one time in the previous month, and 12 percent smoke cigarettes daily.5 Some research has concluded that smoking behaviors acquired in older adolescence and early adulthood are more likely to persist through later life.6 There is evidence to suggest that more than half of those who smoke at low levels in their freshman year will still be smoking when they are seniors. And for those who began smoking prior to college, more than one-quarter become regular smokers during the college years.7 For some of these students, what began as social or occasional smoking will convert to daily smoking.8 Clearly, an established pattern of smoking on a daily basis will make it more difficult to quit. By all accounts, young adulthood is a pivotal time in the development of smoking behavior. Smoking patterns among college students are much more fluid than those of adults, whose smoking behaviors tend to be already established.9 In fact, studies suggest that “the number of individuals aged 18 and 19 years in the early stages of smoking initiation may be more than double that of established smokers aged 18 years.”10 Those who once detested smoking may take it up in college, those who smoke in social contexts may increase or decrease their use, and party smokers who once swore that they were somehow immune to addiction may become dependent smokers with little interest in quitting. Scientific understanding of how one becomes a smoker has changed over time. For many years, researchers believed that after a person initiated smoking, the progression to regular or daily use took several years, with established smoking as an endpoint that occurred in the twenties.

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being able to light up a cigarette wherever they wish, smokers need to find appropriate places, not only where it is legal for them to smoke but also where they will not offend others. Smoking has been increasingly stigmatized, and even when someone is smoking in a legal space— like outdoors—nonsmokers are often quick to show their annoyance. Restrictions on smoking are increasing on college campuses as well, and many colleges nationwide have enacted total smoking bans, meaning no smoking in campus buildings or outside. A second reason for the downward shift in cigarette consumption is cost. Taxation on cigarettes, which varies across states, has resulted in increased cost, which can serve as a factor limiting the number of cigarettes one smokes as well as one’s brand choice. Numerous studies have shown that young adults are particularly sensitive to cost.15 A third factor contributing to lower levels of smoking is a growing awareness of the harm of tobacco and secondhand smoke. To mitigate harm, many people are adopting harm-reduction practices, like cutting back on the number of cigarettes they smoke each day or trying to quit completely.

How Do College Students Describe Their Smoking? The short answer to this question is that college students view their smoking very differently than public health and psychology researchers who frequently report on their behavior. Most researchers use the term current smoker to classify those who report smoking part or all of a cigarette in the past thirty days.16 Some years back, I realized that this label was a total mismatch for how students talked about smoking. In interviews with high school girls about their recent smoking experiences, my colleagues and I had asked, “Would you call yourself a smoker now?” Most girls seemed annoyed by this question, and quickly clarified their own behavior with comments like “I smoke, but I’m not a smoker” or “I just smoke when I’m partying.” These comments made it clear that from the girls’ perspective, there was a distinction between those who “really” smoked and their own occasional behavior. Their image of a smoker was someone “who bought cigarettes and really had to have one.”17 On a survey we developed for that project, we incorporated the teen-generated descriptors, and found that while 30 percent of the girls

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were dependent on a number of factors, with youth engaging in comparative reasoning and evaluating their smoking in relation to others in their social network. In doing so, they were not relying on a simple count of how many cigarettes they had smoked to define themselves.

Does Defining Yourself as a Nonsmoker Matter? The answer to this is complex and multifaceted. Clearly, many of those who start smoking in their freshman year or who enter college having smoked a few times stop after a couple of months. Approximately 70 percent of all people try a cigarette at some point in their life, yet only a third continue smoking to the point of becoming dependent.21 At present, the differences between those who progress to high levels of smoking and those who experiment with smoking but do not transition to regular use are not well understood. Recent studies have shown, however, that intermittent smoking (i.e., non-daily smoking) among both adults and college students appears to be a stable category over time.22 In other words, those who smoke on a non-daily basis tend to do so for many years. Recent studies have also shown that symptoms of nicotine dependence can develop rapidly after the onset of occasional or intermittent smoking. That is, there is no minimum nicotine dose or duration of use that has been established as necessary for dependence. What this means is that nicotine dependence can begin for some smokers as early as their first few cigarettes.23 While this may seem surprising, for some students I spoke with, the transition from trying their first cigarette socially to becoming daily low-level smokers (one to two cigarettes a day) took about two months. It’s not just the possibility of becoming dependent on a substance that needs to be considered. From a biosocial perspective, we need to recognize that dependence may develop in a social context where one receives strong cues to engage in a particular behavior. College students who smoke occasionally and socially can become dependent or “addicted” to smoking at parties while drinking. In other words, the craving they describe—echoed repeatedly in the phrase “when I’m drinking I’ve got to be smoking”—may have as much of a social dimension as a purely biological one. In a similar way, a low-level smoker

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As noted earlier, most social and low-level smokers believe that they will quit long before they experience any harmful effects of tobacco. There is a growing body of evidence, however, to suggest that even social and low-level smokers have difficulty in quitting, despite their desire to do so. And among regular smokers, national survey data have shown that of the more than 50 percent who tried to quit during the previous year, only 6 percent reported successfully doing so. Relapse rates are notoriously high. It is well established that tobacco use has substantial health risks that begin almost immediately—even in adolescence and young adulthood. Although social or occasional smoking may be thought of by the lay population as less harmful than daily smoking, these patterns are also associated with poor health outcomes. Studies among college students find that even occasional smoking (at least five days in the previous thirty) increased the odds of experiencing shortness of breath and fatigue while doing regular activities.28 Compared to those who have never smoked, light and intermittent smokers are at increased risk for cardiovascular disease, lower respiratory tract infection, and compromised reproductive health, among other health conditions.29 With regard to cardiovascular disease, light and intermittent smoking carries nearly the same risk for heart attack and stroke as daily smoking.30 With regard to lung cancer, women aged thirty-five to forty-nine who smoke one to four cigarettes per day have five times the risk of developing lung cancer as nonsmokers; men have three times the risk.31 Over half of those who continue smoking will have a significant decrease in their life span—about thirteen years shorter than their nonsmoking peers.32 Another important point to consider is that light or intermittent smokers who think of themselves as nonsmokers are less likely than a regular smoker to be advised to quit or be offered cessation assistance from health professionals.33

Background to the Studies My research on tobacco has been ongoing over the past twenty years. In this book, much of my discussion is drawn from research I conducted over the past decade with tobacco research colleagues at two large public universities, one in the Southwest and the other in the Midwest. These

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appropriate for freshman college students, which we knew we would be able to use in the coming year.

Working with Students The method of naturalistic observation by undergraduates proved very valuable for my research because there were certain venues where I as an older faculty member could not easily fit in. Although I did not attend college parties myself, I did spend one year on campus as a faculty fellow assigned to a residence hall. About 90 percent of the students in the hall were freshmen, so I had ample opportunity to interact with them as they settled in to campus life, as well as to observe their behaviors over time. These informal observations and conversations with students across the freshman year also informed this research. As part of my university teaching, I regularly teach seminars at both the undergraduate and graduate level on the anthropology of youth. One of the foci of these seminars is drug use, including tobacco and alcohol, and I have assigned chapters of this book to my students as “member checks” to assess their continued relevance and to identify any changes occurring in consumption practices. Students have told me that my descriptions of student life and smoking and drinking on campus are quite accurate. Graduate students in adolescent health and medical anthropology seminars have also read and commented on versions of these chapters.

The University Project of the Tobacco Etiology Research Network The year after the freshman experience study, a yearlong study (known as UpTERN, or the University Project of TERN) of incoming freshmen was initiated at a midwestern university. The social psychologist Steve Tiffany, a TERN member, was the principal investigator of the study. The goal of this study was to generate detailed assessments of smoking and other behaviors through weekly web-based quantitative data collection as well as through qualitative interviews and focus groups. As a research network, we were particularly interested in identifying trajectories of smoking and improving our understanding of the emergence of tobacco dependence. While this yearlong study generated both

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also smoked on weekends. Some of these students were interviewed multiple times over the course of the year. Based on our pilot study findings and initial observations during the UpTERN study, we recognized the importance of fraternities and sororities in the social lives of freshmen. The Greek system was found to be a highly pervasive organization on both college campuses, with large memberships. During first semester of freshman year, both men and women commonly attend parties at fraternity houses. At both campuses, many (but not all) fraternity houses are important sites for tobacco and alcohol consumption. They are also “sites of socialization,” where incoming students observe the behavior of upperclassmen and learn what is normative on campus. Therefore, we decided to conduct focus groups in fraternity and sorority houses to learn about smoking and drinking behaviors in these contexts. Focus group participants were non-freshmen because we were interested in interviewing fraternity and sorority members (not incoming pledges). These groups were conducted to provide a forum for the emergence of natural speech and to allow participants to reflect on, and be reflexive about, smoking practices in social contexts, particularly with relation to gender. Focus group questions centered on issues such as the prevalence of smoking among house members, spoken and unspoken rules within the house concerning smoking as well as alcohol use; smoking at parties; and the monitoring of excessive drinking and smoking among house members. In all, we conducted eleven focus groups (four sororities; four fraternities; three mixed groups), including eighty students in total. We also conducted forty brief interviews during final exam time, which focused on “exam smoking,” a time hypothesized to be associated with stress. Thus, in all, over the course of the year we interviewed about 180 college students. Findings from the freshman experience study and the larger UpTERN study form the basis for several chapters of this book (chapters 3, 4, 6, and 7) and inform discussions about smoking and drinking, gendered dimensions of smoking, and transitions to higher levels of tobacco use. For the discussion on smoking as a weight-control strategy, I draw on a longitudinal study conducted with my colleagues Cheryl Ritenbaugh and Mark Nichter that followed a cohort of girls from the eighth and

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prerequisites to selling more and more goods, high-arousal products are easily available, and self-medication is condoned as a way of handling negative emotional states. Tobacco maintains its status as a recreational drug among college students because smoking has important utility functions in their social world and because cigarettes have been designed to become physiologically addictive long after their social utilities have diminished. Lens 1: Place: Studying Environments of Risk Throughout this book, I employ an anthropological set of lenses that have proven useful for my research. The first of these analytic lenses incorporates notions of “place,” defined as interactions associated with a particular space. Following notions of space and place discussed by humanistic geographers who study health, I adopt a relational perspective to place and health that considers place “on the ground” as dynamic and fluid, which “constitutes as well as contains social relations and physical resources.”35 A college party, for example, is a social context that offers insight into how one’s experience and perceptions of place impact health behavior. Considerations of place represent a departure from existing quantitative research, which has largely focused on smoking as a risk behavior, and which seeks to identity “predictors of risk,” “groups at risk,” or the “co-occurrence of risky behaviors.” As medical anthropologists, my colleagues and I have moved from a “groups at risk” approach to more closely examine environments of risk—namely, those places that may facilitate risk taking. Environments of risk, such as parties, bars, and nightclubs, can be viewed as “breeding sites” where smoking (in conjunction with consumption of other substances such as alcohol) may be initiated, fostered, and normalized. Rather than identifying individuals at risk for adopting unhealthy behaviors (e.g., smoking), I examine risk in context and examine how it is experienced and embodied. A college student enters a party scene, has a drink or two, and has an urge to smoke. What does smoking offer in that context? What social norms are associated with smoking there? Is smoking even perceived as risky by those who only smoke now and then? And are there some strategies—like working out or eating healthily—that are perceived to lessen or offset potential risk?

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events punctuate the flow of everyday life as we move from school or work to leisure time. Smoking was often described as a marker of the beginning or end of an event, when moving in and out of spaces. References to time were replete in interviews, with parties described as “time out of time,” or “not real time.” This perspective of “not being in real time” allowed normative rules of appropriate behavior to be suspended. Some described smoking as “good for filling time” or to “pass time” when there was nothing else going on. In fact, the idea of college not being “real time” is a thread that runs throughout the book. Young adults today live in an age of increasing time compression where there are greater opportunities for arousal (e.g., continuous connection to friends via Facebook, texting, and other social media) and diminishing tolerance for boredom. There is also a greater proliferation of products that promise instant gratification.40 Cigarettes have been engineered to be a fast and effective nicotine delivery device and socially engineered (i.e., advertised) to be an antidote for boredom. References to boredom and having nothing to do emerged frequently among some low-level smokers who reported that smoking “was a great way of killing time” or even among social smokers at parties for whom “smoking was a great way to kill time while sobering up a bit.” Lens 3: Identity Construction and Gender Cigarettes serve as symbols as well as props that allow people to temporarily assume a new role or a different identity on the stage of everyday life. Young adults create, appropriate, and assign meaning to smoking at the same time as they are being primed to interpret smoking in particular ways.41 Perhaps—and paradoxically—because of its stigmatization, the behavior has an increased allure for some college students. Smoking sends a signal that a person is willing to take risks with his or her health and that he or she is not too uptight. And there is a particular mystique to being seen smoking—doing something that “everyone” knows is really not good for you. While public health researchers have largely focused on the physical risks of smoking (i.e., the health-related risks), my research is attentive to the social risks of not smoking. What social

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(drinking and smoking; smoking cigarettes and marijuana use, etc.), this is an important oversight that requires consideration not only because nicotine addiction can occur among social, intermittent, and low-level smokers, but because co-substance use can impact one’s longterm smoking trajectory. Lens 6: Pleasure Even among novice smokers, I was often struck by the sheer sensuality of their experience with a cigarette, which included lighting it, holding it, and inhaling. What a person found pleasurable about smoking was dynamic and appeared to shift as he or she moved from occasional smoking while drinking to smoking with greater regularity. And having smoked throughout my own college career, I understood the lingering pleasure of smoking while drinking and the dissolving of daily stressors, if even for a few moments. At present, we have few narrative accounts of the pleasure of the smoking experience that, in addition to addiction, makes it so difficult to quit. As noted by Robin Bunton, “the relative neglect of pleasure in drug and alcohol research is part of a broader difficulty public-health research has with pleasure.”43 With regard to club drug use, anthropologists have described how young adults engage in a process of active negotiation balancing the potential risks against the anticipated pleasures.44 This is equally true for cigarette smokers. A deeper understanding of the pleasures of smoking may help inform the development of more sensitive cessation interventions that can contribute to the overall health of this population. Lens 7: Life Trajectories This period of life—the college years and beyond—has been termed by the psychologist Jeffrey Arnett as “emerging adulthood” to refer to the extended transitional years between adolescence and adulthood. As noted earlier, this age period (eighteen to twenty-five—and longer) has the highest prevalence of drug use and is a key time for transitioning to smoking. This life stage, Arnett notes, is defined by several key features, including a continued exploration of one’s identity; an intense focus on

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interviewed more than once, so I am able to offer some sense of change over time. Chapters 3 and 4 are companion chapters that bring the reader on to the college campus, and highlight the centrality of co-substance use. I explore and contrast the social utilities of smoking for women and men in relation to identity construction and social facilitation. Students who are presented in these chapters are largely from the group whom I refer to as party smokers, although some smoke daily at a very low level. In chapter 5, drawing on longitudinal data that followed a group of girls from middle school to young adulthood, I critically examine and challenge the widespread belief that many women begin and continue to smoke as a way to control their weight. In doing so, I explore other reasons why women continue to smoke over time. In chapter 6, I consider the process of becoming a smoker—the movement along a trajectory from party smoking to more regular smoking—and discuss the meanings of such terms as “habit” and “addiction.” I also discuss the moral implications of smoking, including self-judgment and explanations that people use to make sense of their behavior. In chapter 7, I turn to a discussion of how stress, boredom, and romance impact smoking. Chapter 8 explores the extent to which students want to quit smoking as they near college graduation and are about to enter the “real” world. I discuss the challenges faced by those who are interested in quitting, and the strategies they adopt. Finally, in chapter 9, I consider cessation efforts on campus and the movement at some colleges to ban smoking. I also discuss the growing popularity of the latest nicotine delivery device, e-cigarettes. Looking forward, I explore how uncertain times facing college graduates may contribute to a continuation of smoking following graduation. In conducting interviews with young adults largely on college campuses, I was often struck with how remarkably insightful they were in describing their experiences. This period of life is marked by an intense capacity for self-reflection, as evidenced by their thought-provoking commentaries on their own and their friends’ behavior. In the chapters that follow, we see how smoking weaves its way into the social life of young adults, and how this changes over time.

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Profiles and Progressions If I get really drunk, I’ll just want to get that head rush that you get when you smoke. Because I don’t smoke much, when I do have a cigarette, I really feel it. And because I’m drunk, it doesn’t taste really disgusting except when I get to the last few puffs and then it gets really nasty. .  .  . But last weekend when I got really drunk, I finished a cigarette and I wanted another one right away. That was the first time I ever felt that. —Ryan, eighteen-year-old male

Think for a moment about your group of friends when you were sixteen years old. Fast-forward to age eighteen, twenty, and then twenty-two. Probably some of the faces remain the same, while others have exited from your social network. Some of these friends may have experimented with smoking a few times and decided it was not for them, others smoked socially when they partied, some smoked intermittently depending on what was going on in their lives, and others moved on to increased levels of smoking, some to become regular daily smokers. Some, like Ryan, enjoy the head rush of smoking when drinking, and though they hate the taste of cigarettes at first, at some point it becomes an enjoyable experience that may continue through college and beyond. What accounts for these differences? Why do some people maintain smoking at low levels while others increase their use? How do particular experiences or social contexts facilitate different smoking trajectories? How do people describe their own smoking histories? Why do some people enjoy their smoking and not think about quitting, while others experience pangs of regret and wish they could quit? In this chapter, I introduce you to seven young adults, each of whom represents a different pattern of smoking, ranging from intermittent 24

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early attempts to patterns of smoking on a daily or near-daily basis. The group is diverse—they are four women and three men, range in age from eighteen to twenty-four, represent different ethnic groups, and come from different parts of the United States. Most, but not all, are college students. These individuals were not chosen to represent all persons whom I interviewed, nor are they representative of all patterns of smoking. Rather, they exemplify different points on the continuum of smoking, a range of uptake experiences, and divergent views on the meaning and practice of the behavior. My hope is that these stories will help unpack some of the pathways in the process of becoming a smoker and the social contexts in which this path unfolds. The first two people, Andrew and Carlos, can best be characterized as party smokers; most of their cigarette smoking takes place in the context of drinking at parties, although they do so at differing levels of intensity. The third person, Brittany, is beginning to extend her smoking outside parties to other social contexts. These stories reveal early experiences with tobacco, the prevalence of smoking and drinking at parties, and ideas about progression. The next three, Lisette, Josh, and Amber, have more established patterns of smoking, on a near-daily or daily basis, albeit at different levels of use. Their stories highlight both the pleasure of their daily experience with cigarettes and their frustrations with what they term their habit or addiction. Finally, Abbey’s story explores the experience of being a smoker while pregnant.

Andrew: “Trying It Out” Andrew, eighteen, had brown cropped hair and pale skin, and appeared preoccupied when we met at the student union at his university. He had just completed a challenging math test and I guessed he must have been up late studying. Even though it was only his second month on campus, he was already feeling stressed about exams and the pressures of completing his assignments. An engineering major, he had to maintain good grades to move ahead in the competitive program. Andrew hailed from a city about an hour from this rural university, and some of his friends from high school were also attending the school. His roommate was one of his close friends from home, and his sister was also on campus. Unlike many freshmen who feel alone when

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or that I couldn’t stop it.” He continued, “It was a conscious choice on my part to smoke. It wasn’t like anyone asked me to do it, and we were smoking outside on a dark porch so it wasn’t like I wanted people to see me. I don’t know if I inhaled, but it made me feel buzzed and relaxed. I think it was the heat of the moment that got me wanting to have those cigarettes.” I asked him how he felt about his smoking now that some time had gone by. The next morning, I kind of felt bad about smoking more than I had before. . . . I was just down on myself for smoking and being okay with it. You know, my mom is a nurse and she’s always on me about not smoking, like she’s told me a lot of information about the kind of stuff she’s seen happen to people who are smokers. And my dad was a smoker and she really was hard on him to quit. He smokes a lot less now but hasn’t quit completely. So I feel like I let myself down and her too.

After a pensive pause, he continued, “It was just kinda empty, shallow, like to be doing something like that, as harmful as it is just because you’re in a group of people and it’s the cool thing to do.” “If I call you in a month or six weeks from now,” I asked, “do you think you will have smoked again?” Given the regret and self-reflectiveness he had just expressed, I anticipated that he would tell me that he probably wouldn’t smoke in the future. I was surprised that after considering my question for a moment, he laughed and said, I hope not, but it might happen. I can’t guarantee you either way, but my preference would be not to smoke again. But if the situation, you know, came up and I’d been drinking a lot, I might do it. I’ve never been the addictive type, so even if I do smoke again, I don’t think it will get to be serious. It’s nothing I plan to do on a regular basis, that’s for sure.

Three months later, at our next interview, Andrew was still smoking socially every now and then, particularly when he was drinking alcohol. However, he still called himself a nonsmoker, despite his occasional weekend cigarette.

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“People who smoke in high school,” he said, “are more rebellious against their parents and they’re trying to get back at them because they’re not happy with their lives, their parents, their school, their life.” He felt it was different to smoke in college, since he was of legal age to buy cigarettes and more people were doing it around him. With more people smoking and easier access to cigarettes, “it becomes easier to get trapped into addiction. Like my roommates—they’re regular smokers. I never fed into it. I think it’s gross and stupid since you’re just cutting your time line short.” Despite smoking while drinking, Carlos exuded an air of confidence that he would not smoke at other times: I don’t worry about it. I know when I smoke one or two cigarettes in a night, I won’t smoke again for another couple of weeks or until I’m really drunk again, or even if it’s the next night, I know I’m not the type of person to pick up the habit. I’ve been going around with people, some of my best friends smoke, and it doesn’t really appeal to me. Once or twice, I’ve considered it, like maybe it would be cool to buy my own cigarettes and have a smoke. I don’t see it as that big a deal, I’m just sort of playing around with it for a while. I’m also surrounded by people who don’t smoke and I know the reasons they don’t do it and I agree with them. But even they would occasionally smoke a cigarette.

Given his expressed dislike of smoking while at the same time smoking occasionally, I asked how he would define himself in terms of his smoking behavior. “I guess I would say that I’m a sociable drinker and a sociable smoker. Because I’ve never smoked by myself and when I do smoke, it’s usually outside a party, or outside a bar. It’s just killing time while sobering up a little bit. I wouldn’t label myself as a smoker, not even an occasional smoker.” Carlos felt strongly that his smoking would end when he finished college and that no woman he got involved with would smoke. At our next interview, three months later, Carlos told me that he was in a relationship with a Mexican American woman who disliked smoking so intensely that when they went out together he didn’t smoke even if he was drinking. “But every week or two,” he laughed, “I go out with my buddies for a night out and get really hammered and smoke a cigarette or two.”

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more lenient, though—when he heard I smoked, he just asked me what brand!” Brittany had chosen to attend a large state university far from her home so she could “start over” in a place where no one knew her. She wanted to prove to herself and to others that she could do it, that she could succeed in college, all by herself. Since she had lived in one place all her life, she “didn’t know what it meant to meet people and make it count.” Since arriving on campus four months ago, she’s joined a sorority because she likes the social scene even though her sorority sisters are more “southern California valley girl types” who are much more concerned with appearance and labels than her high school friends. Her roommate at college also smokes when partying, and the two of them sometimes go outside with other floor mates to have a cigarette and talk. On the weekend before our interview, Brittany had to take her roommate to the hospital, as she had such serious alcohol poisoning that she needed an IV. “I always smoke when I drink,” Brittany told me, “and I always drink when I party.” Her preferred drink was vodka shots, and she could down five to eight of them in a night, “which is probably a lot, given how small I am!” Although some of her guy friends said that smoking makes a girl look trashy, she was not deterred. She enjoyed smoking while drinking and felt that it kept her a little more in control of herself than if she was only drinking alcohol. That was important, she explained, because girls needed to watch out for themselves and their friends. Comparing her smoking to when she first arrived on campus, Brittany expressed concern that it had increased: When I first got here, I was partying on the weekends and I smoked about ten cigarettes a week at parties. But for the past week or two, I’ve been dating this guy at a fraternity and I’ve been going over there during the week, having a drink, and smoking. He’s a smoker so every time he goes out for a smoke, I go with him. And my roommate, I’m hanging out with her a lot and we’ve been smoking together. She’s trying to lose weight so she’s smoking more nowadays. I mean I’m conscious of my smoking, I’ll like ask myself, “Oh, what am I doing?” But then I’ll think,

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I was in the library studying and needed a study break really bad. I went outside and saw a group of people smoking and it smelled so good that I bummed one. That’s when I started smoking again to relieve my stress. It was weird because I had learned in science class that smoking actually hypes up your system and makes your blood pressure go up, but psychologically for me it was like it calmed me down. It helped me focus, it was like a break between all the studying. So from then on, when I got really tense from studying or something, I’d have a cigarette and I’d feel better.

For Lisette, the process of becoming a smoker again was a gradual one, “one a day, and not even every day.” When I asked her how much she was smoking now, a year after she had started back up again, she told me it was up to three a day, except on the weekends, when she would smoke as many as five while drinking. I asked her whether any of her girlfriends smoked, and she told me that one of them would have a cigarette or two while drinking, but her other good friend never smoked. Lisette also never smoked around her coworkers at the bank because none of them were smokers and “they’re a really judgmental crowd. If they saw me smoking, they’d be on my case to quit.” Of late, Lisette bought at least one pack of Marlboro Menthol Lights a week, her brand of choice, but usually had another pack with her when she went out on the weekend with friends. When I asked her whether she felt addicted, she said she didn’t. “I like the feeling but I can do without it. It’s more like a habit. And I’ve quit before for almost a year and I was fine.” Her pattern was smoking at a low level at the same time each day. “I usually don’t smoke at all during the day. But when I’m driving home from work in the afternoon, I like to have a cigarette. Then at night I’ll have another two cigarettes, mostly as a break from my schoolwork.” So most of her smoking was alone, as a reward for work completed, or as a break from some work she was doing. Later in the conversation, Lisette mentioned that she had a boyfriend, whom she’d been seeing for the past few months. She told me he didn’t smoke, nor did he approve of her habit. “A lot of my Mexican American guy friends disapprove of girls’ smoking, even if they smoke themselves. They see it as unfeminine. They can go out and smoke and drink because that’s what guys do, but girls can’t.” “What do you and your friends think of that?” I asked.

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several times in the past two years. He had finally decided to major in graphic design. He seemed in no hurry to graduate. His tight, straightlegged black pants, fitted thrift shop vintage shirt, and large sunglasses all spoke to his artistic hipster side. We started out talking about his history of smoking. In high school, he had smoked a few times, but didn’t like the taste. He preferred smoking marijuana, which he did on the weekends with friends. In college, his smoking had little pattern or consistency; he described himself as a “fluctuating” smoker: “My first two years in college, I just smoked when I drank or sometimes when I smoked weed. Now I usually have anywhere between two and six cigarettes a day. And some days I won’t have a cigarette till seven at night.” During his junior year in college he had given up smoking completely for the year, since his girlfriend at the time disliked it. After their breakup, he resumed smoking within a month, a marker of his freedom and getting back to his “old self.” Because Josh smoked at a fluctuating level and was in a social network where many of his friends and his roommates were smokers, he did not feel the need to buy cigarettes or carry around packs. He enjoyed rolling his own from his roommates’ stash, or bumming from his friends, a pattern that worked for him. Once in a while I’ll buy a pack or I’ll buy a bag of tobacco and roll some cigarettes, but it’s not a problem for me if I don’t have cigarettes, like I have cravings, but I never freak out. And I don’t feel like I need a pack of cigarettes in my pocket. But that’s not saying that I’m not addicted to nicotine because I absolutely am, but I guess I haven’t had a consistent enough habit that, like, I absolutely need it, at the same time each and every day. It doesn’t work that way for me.

The reason he didn’t buy his own, he laughingly told me, was definitely not to “preserve some sort of image of myself as a nonsmoker” but to limit his smoking. “If I don’t have a pack of cigarettes I’m not going to be smoking as much. If I’m out with people who are having cigarettes, that’s going to make me want to have a cigarette, you know, that’s when it’s going to be more important for me to have one.” Josh was a half-time employee at an office supply store, where most of his coworkers were regular smokers and his boss was a “hard-core

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Josh so enjoyed this sensual side of rolling and holding a cigarette that when he was unable to smoke—like when he visited his nonsmoking parents, who were vehemently opposed to his smoking—he would “play with paper and just roll it up and hold it.” For him, the act of smoking a cigarette was an important component of the addiction. Beyond the sensuality of smoking, Josh also savored what he termed the “indulgence.” “You’re so blatantly ignoring the consequences of your actions, that you’re almost empowered by it. I definitely think smoking is empowering.” I was unclear what he meant by this comment, so I asked for clarification. It’s empowering because you shouldn’t be doing it, because of the health risks, but you’re smoking anyway. Then there’s the financial aspect of it, you’re spending a lot of money. Or you could think about how your girlfriend won’t kiss you because you smell of cigarettes and how other people are going to be critical and judge you for smoking. So doing it in the face of all that, it just empowers me.

I asked Josh whether he saw himself quitting at any time in the future. He laughed and told me his mother had just reminded him on the phone that he had promised to quit when he was a senior. “It’s kind of annoying when my parents bug me about smoking,” he said. “I enjoy it too much to quit right now. But I’ve always told myself that when I’m gonna have a family, like I’m settled down and have a wife and we’re pregnant, then I’ll definitely quit.” Six months later, at our next interview, Josh was working two nights a week as a DJ at a local club, which was an environment populated with smokers. As a result, his smoking level had increased, particularly when he was at his new job. He did not foresee quitting at any time in the near future.

Amber: “It Helps Me Cope” At twenty-four, Amber was a bit older than her classmates, as she had taken some time off from college to work and travel. A senior majoring in Latin American studies, she was in the process of applying to the Peace Corps as something to do post-graduation. An Irish American

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and the buzz from smoking while drinking. She also enjoyed what she termed her “angry afternoon cigarette,” which she described this way: It’s when you’re sitting outside the student union on a bench alone, being frustrated with all you have to do for your classes and for school and stuff. And when it’s your own time you can do whatever. You can just vent with your cigarette and be like, “I don’t care about anyone or anything right now except me and my cigarette.” I just really like that antisocial aspect of it, the F-U aspect of it that can be so satisfying. It’s like I’m telling the world, “Leave me alone, I want this time and my space, don’t come around me and my smoke.”

Amber also expressed a litany of things she disliked about smoking, including the cost, waking up in the morning and not being able to breathe, having respiratory infections, and the loss of control. She hated the feeling of needing a cigarette and that it had become a crutch for her, and that she no longer had a choice in whether to smoke or not; she had to. She also disliked the smell of cigarette smoke lingering on her hair and clothes. Amber hoped to quit soon after graduation. Like most of her friends, she didn’t see herself smoking for the rest of her life. “Maybe some people do, but I don’t think that’s the majority, so when they see a change coming, like the end of college or the start of a career or a family, they want to be in a healthy place, or as the person they envisioned themselves being. And generally, being a smoker is not a part of that.” Six months later, Amber had graduated from college and was still smoking three to five cigarettes on a regular day, but much more on the weekends, when she went out to the bars and was drinking. Basically, there had been no change in her smoking status. She was still waiting to hear about the Peace Corps and she believed that if she got the chance to go abroad, she would definitely quit before leaving.

Abbey: “I Need to Quit for My Baby” Abbey, nineteen, offered me a welcoming smile when I arrived at her parents’ house early on a hot summer morning. Dressed casually in an oversized T-shirt and baggy shorts, Abbey looked like she might have

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harmful for health. By the end of her first trimester, she had managed to cut back to one to three cigarettes a day, a strategy she also hoped would make her smoking “a little less harmful” for the baby. Making rules for herself, like not smoking outside her house or in her boyfriend’s car, was useful, but she found it difficult not to smoke around her coworkers, all of whom enjoyed smoking during breaks. As Abbey entered her second trimester and her pregnancy became more obvious, she experienced social pressure to quit. “People look at you like you’re doing something really bad. I feel so ashamed when I go into 7-11 to get a pack. It’s not like they say anything, but they just look at me like, ‘What are you doing?’” With social support from her mom, her stepdad (also a nonsmoker), and her boyfriend, Abbey made the decision to quit completely. She asked her friends at work to help by not smoking in her presence, as she knew the temptation would be too great for her to resist. “They all knew it was bad to smoke while I was pregnant. One of my friends had heard it was even worse for the baby than taking crack.” Abbey also announced her quitting to her girlfriends outside work, most of whom also smoked. “They helped by not letting their smoke get in my face when they had a cigarette near me.” By the beginning of her fifth month, Abbey had quit smoking completely and was clear that this is what she needed to do for herself and her baby. Her moral identity as a nonsmoker became more established as time went on. I had two more interviews with Abbey during her pregnancy, and she was proud that she was able to remain quit throughout. She attributed this to her own willpower and the continual encouragement and social support of those around her, especially during those times when she felt like she really needed a cigarette to get through the day. During her eighth month, her boyfriend moved in to her parents’ house, as they wanted to be together as a family and knew they couldn’t afford their own place. Abbey delivered a healthy baby girl, and at our postpartum interview, three months after her delivery, she had remained a nonsmoker. “I had just one slipup,” she told me. “I was out with girlfriends having a drink and when they went outside to smoke, I went with them. I had one cigarette but it didn’t taste as good as I remembered. If I were to start up smoking again, Jason and my family would be really angry

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as “just” a phase that they are moving through in college. After not smoking for almost her entire freshman year, Lisette moved into a regular pattern of low-level smoking after she experienced college-related stressors. She smoked three cigarettes a day at specific times and more when she was drinking. Amber’s trajectory to becoming a smoker was intense and nontraditional, as she moved from nonsmoker to smoker at age twenty-one and then rapidly progressed to regular daily smoking, albeit at low levels. Josh, self-described as a “fluctuating” smoker who could smoke between two and six cigarettes a day, had been able to quit for one year when he was with a girlfriend who did not approve of his smoking. His daily pattern of smoking was still highly influenced by his social network. For those who had a daily pattern, smoking did not only take place in a group setting, but was also enjoyed alone as a way of creating their own space, grappling with emotions, and helping to gain focus. There was almost an anarchistic appeal to being a smoker in today’s antismoking environment. This was rendered differently for each: for Lisette, as a Mexican American woman, smoking signaled defiance over the controlling male gaze; and for both her and Amber, smoking provided a personal space to regain a sense of balance while cutting off the rest of the world. Josh found empowerment in engagement with a substance that is addictive and looked down upon by others. Notably, even the four students who were addicted smokers smoked at relatively low levels, exemplifying a pattern of smoking representative of college youth. While Andrew, Carlos, and Brittany all felt that they were not addicted to nicotine, Lisette, Josh, and Amber all recognized to some extent that they were. As I listened to their narratives, it was clear that addiction was not only about obtaining the drug to lessen negative side effects; people depended on the cigarette for what it could deliver at certain times of the day (Amber) or for the emotional relief it offered in times of need (Lisette). A range of utility functions associated with smoking was cited by these emerging adults. And regardless of their smoking level, all of them believed they would no longer be smoking when they entered the working world or started families of their own. Abbey’s story, however, explores the difficulty of quitting when pregnant, and the desires and social pressures to resume smoking once the baby is delivered.

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binge levels. In fact, their main reason for drinking is to “get drunk.” Notably, the highest proportion of heavy drinkers and individuals with diagnosable alcohol use disorders and multiple substance dependencies are between the ages of eighteen and twenty-one.7 Although binge drinking is typically defined in the scientific literature as five drinks for men and four for women, many college students actually drink much more than this. One recent study among ten thousand college freshmen found that about 20 percent of men and 10 percent of women surveyed consumed two or more times the established binge threshold—meaning that men drank ten or more drinks in one occasion; women drank eight or more.8 In terms of how often they drink, recent data from the U.S. Centers for Disease Control and Prevention (CDC) show that nearly fourteen million U.S. women binge drink about three times a month, downing about six beverages per binge.9 Increases in drinking among women may be in part due to the targeted marketing of female-friendly alcohol products such as flavored vodkas, alcopops, Smirnoff Ice, and a host of others. Why should we be so concerned with drinking in a book about smoking? What is the relationship between alcohol consumption and smoking experimentation and initiation? Drinking appears to facilitate the transition to social smoking, even among high school youth. Studies have found that among high school students, those who engaged in binge drinking in the past month are five times more likely to smoke when compared to teens who do not report binge drinking.10 The relationship between these substances appears to be bidirectional, as teens who experiment with smoking in early adolescence are two to three times more likely to become heavy drinkers by their senior year in high school compared to those students who had never smoked. This is true even for those youth who had very low levels of cigarette use across the high school years. The relationship of co-substance use is consistent across age, gender, and ethnicity.11 And longitudinal studies with young adults have similarly shown that for some individuals, greater alcohol use prospectively predicts tobacco use, while for others, experimentation with smoking precedes the uptake of drinking.12 First-year college students who binge drink face substantially elevated odds of smoking, a pattern that is particularly apparent among young women.13 This pattern is substantiated by survey findings of more

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have classes, but not till twelve and then again at two, so I go to those and when I’m done, me and my friends usually go shopping or we do something, go somewhere. Friday night is pretty take-it-easy night. We still go out and party but it’s more like a smaller group or a really small house party. Friday nights aren’t that great. And then Saturday it’s a bigger party or some function. Saturdays are more like our Thursday nights, like with how much we drink and all.

With her weekend beginning on Thursday, Sarah had extended time to party and recover. Her comment about “pre-drinking” in the dorm indexes a common mechanism for getting high before going out, which is done in the safe environment of the residence hall. While illegal, it is difficult to monitor by resident hall staff. From the perspective of some students, it not only is a cost-cutting measure giving you a “head start,” but also puts you in the mood for the evening ahead. Sarah’s pattern of late-night partying meant that her weekend days were truncated as she slept till noon or later, and she then had to take naps to be up for the next night. Before coming to college, she anticipated this type of intense weekend experience; in fact, she confided that one of her reasons for attending this university was that it had a reputation as a party school. Unabashedly, she told me that she had been voted Miss Saturday Night at her high school, an identity she was clearly proud of and that she hoped to maintain in college. Like Sarah, other freshmen on both college campuses openly expressed that they had come to these large state universities “to party.” This weekday/weekend distinction that college students on both campuses spoke about turned out to be very important for our research, as it provided the intense social context for the rise of the social smoker. On the online survey that was completed by more than nine hundred students each week, we utilized a method known as time-line followback, in which students record how much they smoked on each day of the previous week. This method allowed our research group to detect in detail the weekday/weekend distinction. In contrast, typical survey questions such as “In the past 30 days, on how many days did you smoke?” or “On average, how many cigarettes did you smoke a day?” tend to obscure key differences between days of the week. Of course, responses by college students are also subject to “memory loss,”

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been increasingly stigmatized, party smokers differentiated themselves from “real” smokers, defined as people who smoked alone, smoked at high levels, or smoked in public places. In focus groups with fraternity members (mostly upperclassmen), we wanted to explore further the idea of a difference between “a person who just smoked at parties” and “a real smoker.” When asked whether many of their fraternity members smoked, Bryce, a junior, estimated that only about 10 percent of members were “real smokers,” a number that he believed had been declining. “It’s just not okay to smoke when you’re walking around campus,” he opined. “After all, everyone knows smoking is bad for health so you really shouldn’t do it. And you don’t when you’re sober. But when you’re drinking, your judgment is impaired so you really don’t care about stuff like that. I mean, you still know it’s bad for you, but you stop caring because you’re just trying to relax and have fun.” When asked about smoking at parties, Bryce and his fraternity brothers were quick to note that “60 to 70 percent of the people at our parties smoke.” They described how they might chastise a friend who smoked too much during the daytime, whereas at a party it was acceptable because “everybody’s doing it and since everyone’s drunk, they just don’t care.” “During the day,” Derek continued, “if you’re inside and someone is smoking a cigarette it’s like, ‘Oh, it smells, get out of here,’ but if it’s a party it’s all right.” Nodding vigorously and chuckling, Ben expanded on this theme: Smoking when you’re drinking has become almost a social aspect of drinking. If you’re pounding away cigarettes in the middle of the day, like having five or six in an hour’s span, people are going to be like, “What are you doing?” . . . But when it comes to drinking, seeing someone smoke six cigarettes in a two-hour time span, they’re like, whatever. I think that any time alcohol is involved it’s just an entirely different scenario, the alcohol just completely changes the game. It’s very different when you’re not drinking and you’re on campus meeting people. Then you’re a lot more concerned about first impressions.

In a focus group with sorority members, I asked for clarification on why so many women who seemed to dislike smoking would have no

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always outside, and you can’t just go out and do nothing, so usually you smoke.

Several students explained that smoking at a party made them feel or look like they were part of a group, especially when everyone around them was smoking. Having a cigarette together was described as building a connection with others, a shared practice that created a sense of community. In this context, they took their smoking cues from others at a party, smoking more or less depending on what their friends were doing. Cigarettes provided a connection even with those who were not in the same social network. Caitlin, a party smoker, recalled going to a party where she knew very few people. Several people were smoking, so when they offered her a cigarette she took it. “That was our connection, . . . then I could talk.” Smoking facilitated a rapid bond that eased the discomfort of talking to people she had not met before and with whom she might otherwise have little in common. Because of the frequency of meeting new people in the early months of freshman year, it is not difficult to see why alcohol and cigarettes were perceived to be helpful props in these party contexts. The cigarettes become a way of facilitating the esprit de corps with other smokers in a way that aids identity formation. I asked Dan, a freshman who smoked occasionally at parties, to explain how smoking made it easier to communicate with people. He responded, I think it’s like with drinking . . . you’ll find all these different people talking to each other drunk and you don’t care anymore who you’re hanging out with. You’re just having fun. For some reason, alcohol and cigarettes and stuff like that just breaks down the barriers of differences by giving everyone mutual ground to stand on. I think that’s where it comes from. Cigarettes, pot, alcohol are the things that do that. You get a bunch of people under the same influence and they’re much more likely to commune with each other.

For John, who rarely smoked if he was not drinking, lighting a cigarette was a conscious strategy for meeting girls:

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avoiding getting drunk yourselves. Given that several rounds of these games are played, getting drunk is somewhat inevitable. The psychologist Brian Borsari has studied the role of drinking games among college students and explains that these games, much like smoking, have several social advantages, including lowering inhibitions and facilitating camaraderie. Because they require one to chug alcohol at a fast pace, they provide a socially sanctioned way to get drunk quickly, which can be particularly useful for those who are shy.18 Being forced to drink quickly during a game can also be very helpful for those who do not like the taste of alcohol, much in the same way as smoking while drinking can be useful for those who have a strong dislike for the taste of cigarettes. Smoking in the context of a drinking game can also help you level off, meaning that it helps players sober up so they can continue to participate in the group activity.

The Comfort of Cigarettes At a party, there are times when one is unoccupied, with no one to hang out or dance with. This opens up the possibility of being bored at the party or worse yet, of being perceived as a person who is boring. At such times, lighting a cigarette can make it appear that you are self-engaged and occupied, rather than someone who is alone. David, a lanky freshman who was shy and sometimes uneasy in social settings, was careful to clarify what a cigarette did and did not provide. “It may seem strange to say that a cigarette is comforting,” he told me, “but it does seem to do that to me if I’m at a party where I don’t know a lot of people. If I’m smoking then I don’t have to be talking to people, you know, because I’m doing something else. I’m not just standing there holding a red cup. You know what I mean? It helps because it gives that feeling that I’m doing something.” For Nicole, not only did a cigarette provide a reason to be standing around, it also helped her to look like she fit in more, as if she had a purpose. “It’s not just that you’re there trying to meet new people that smoke cigarettes,” she told me. In her opinion, to do that would be too obvious and might brand you as a loser. Nicole echoed David’s rationale for smoking at parties, explaining how going to a party where she

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Smoking as Play Cigarette smoking among college students occurs in response to what can be thought of as social situations that are somehow set off from everyday life.19 In interviews, students frequently described their smoking as “play” and “not serious.” In fact, a few of the students we contacted to be interviewed (because they had reported on the survey that they had smoked in the past week) had little to say about smoking during the interview. When asked a series of questions about their smoking experiences, they remarked that they were not “really” smokers, that they had just smoked a couple of times. This raised a number of questions about who or what is a smoker. Melanie, a woman who smoked primarily at parties, offered this response to a question about whether she was concerned that she might become a smoker: I can’t believe how seriously you are taking this smoking a few cigarettes thing. .  .  . It’s not serious—that’s the point! No one is being serious. If someone is “seriously” smoking, like they’re upset or something and sitting and smoking a ton by themselves or with a friend, well, they have a problem, and that is a whole different thing. When I smoke it’s like whatever, it’s no big thing, nothing worth talking about really. I am just smoking a few cigarettes and having a few drinks, that’s all, . . . it’s just play time.

Her level of explicitness about smoking as play was somewhat unusual when compared to other students whom we interviewed. However, her assertion that cigarettes are an important part of having a good time is a sentiment that, as we have seen, is widely shared among party smokers. But while playing at being a smoker was okay, being a smoker was not. A telling analogy would be to a drama (a play), a staged event: as the actor is not the role she is playing, so the student smoking a cigarette is often not really herself—at least not as she normally sees herself. My colleague and co-researcher, the anthropologist Peter Stromberg, has written extensively on how drugs used for recreational purposes can be conceptualized as “play.” Stromberg draws on the seminal writing of the Dutch cultural historian Johan Huizinga, who wrote on the

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day-to-day identity, but become absorbed in a party space defined by possibility and performance as well as a suspension of normative rules— to some degree. Those who smoke (most often while drinking) as part of taking on a new party persona may easily get caught up in a party script where they are not only cued to smoke, but where they lose their inhibitions and resonate with others participating in the same activities. Many students noted that they smoked at parties not just to be like others (social influences), but to “experience” the party. Smoking was seen as an act of freedom and abandon—feelings that are often associated with play.22

Smoking as play is also attributable to the positive pharmacological benefits the smoker experiences. This relates to the purpose of social gatherings—enjoyment, interaction, indulgence. For those who smoke, cigarettes and alcohol accelerate the creation of the desirable collective mood and fulfill the purpose of the gathering. For college students, who are often still in a phase of experimentation with self-image, the cigarette facilitates the assumption of different roles, allowing them to play with different images. The following comment from Angela suggests this identity shift through smoking: I think that smoking looks really sensuous the way some people do it. Cigarettes may smell gross if you’re the only one doing it, but at a party if everyone is doing it, it can look really sexy. Sometimes I do it to kinda, you know, announce myself, like, “Hey, here I am.” I have fun with that— calling like a little attention to myself, not a lot . . . it’s like a whisper, not like talking loud . . . and when I do it for a few minutes, I feel different. . . . it makes me feel a little sexier.

Angela went on to describe how she was usually a shy person, but with a cigarette she felt bolder. Several other students also alluded to the idea that the person attending the party is “not the real me.” One young man explained how cigarettes helped him adopt a new persona and expand his social network: I started smoking just to watch and witness how being a smoker changed me into all these different groups and people. So I’d be a smoker . . . and

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It’s like subconsciously I think, “Okay, I should have one too.” And I don’t consider that really peer pressure or anything. I don’t think of myself as a follower, . . . I mean, I lead a lot of things. I guess I’m smoking because I feel like I should be smoking, because it’s what we’re all doing.

The two quotes above, although different in their tenor, raise important points. First, both speakers agree that they do not feel overt pressure or encouragement to smoke from others. As Catherine describes, the experience is more subtle, that is, that you feel like you stand out by not smoking. Kelley refers to curiosity and “seeing others doing it,” which makes you want to, while Catherine similarly remarks, “it’s what we’re all doing.” Both speakers acknowledge how others in their social network affect their own behavior. “It’s just being around it more,” another sorority member explained. “It’s not that I have to smoke to fit in, I just see it and want to do it.” These young women describe themselves as choosing to engage in social smoking as active agents. Given the frequency with which college students attend parties and the commonality of smoking in these contexts, smoking comes to be viewed as normal behavior, something “you just do when you drink.” From an analysis of the weekly survey data on smoking and drinking among college students, we found that over 90 percent of early smoking episodes (defined as the first five times one smoked on campus for those who had smoked fewer than fifteen cigarettes prior to college) occurred in the presence of other smokers.24 Eighty percent of these episodes occurred on campus at a party. Novice smokers did not buy their own cigarettes; rather, they “bummed” from others or shared cigarettes with others who were already smoking. Many young men and women said that they had not actively sought out the experience of smoking on their own, but that their smoking had “just occurred” when they were around smokers. As Scott explained, “My friend offered me one, so I just took it.” Rachel, an observant and self-defined “social butterfly,” explained how peer pressure differed from high school to college: I think it’s similar, like how much pressure there is from people offering and asking you to do stuff, but back in high school you didn’t really know who you were, you wanted to be in the group, whichever group

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in the early months on campus, not to smoke when others were doing so might send a signal that you were judging others, that you felt better than them. Not smoking when your friends did might result in not getting invited out in the future. This is what I refer to throughout the book as the social risk of not smoking. Although it was unusual to have a college student tell me that they were overtly encouraged to smoke by a friend, Lara, a freshman, was an exception. She described how she had gone to a party with her girlfriends, who were “all trying to hook up with guys,” but since she had a boyfriend back home, she was not trying to meet anyone. With regard to smoking, she explained, I was just trying to have a good time. These older girls, they were juniors, came in and we started talking. And after a few minutes they said, “Oh, you’re a cool freshman, come outside with us, have a cigarette.” And I was like, “I don’t smoke.” So they said, “Okay, well, just come out and talk with us then.” So I went out there and talked and they just kept trying to get me to smoke and finally I did because I was like, “Oh well, why not?”

In terms of her smoking history, Lara had tried smoking a few times in high school, although she hadn’t liked it much back then. But after she had consumed a few drinks and had been encouraged to smoke by others, it appeared to be a natural, appropriate behavior. An important factor to consider here is what researchers call selection effects, a term referring to the extent to which certain individual characteristics might lead a person to want to have certain experiences or join particular organizations or environments. For example, students who were heavy drinkers in high school may choose to join a particular Greek organization in college because it is known for partying and drinking. Another separate but relevant term is socialization effects, referring to how having a particular experience or joining an organization (like a fraternity or sorority) can affect a person’s behavior. Becoming a member of a fraternity in college, for example, might result in the student becoming an even heavier drinker than he was in high school as he becomes socialized into what is considered appropriate behavior for that context. Sean McCabe, a substance abuse researcher who has studied college students, explains that these two effects often work in conjunction

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you”), nonsmokers may be respected by their peers, and encouraged to remain that way.27 Another example of positive peer influence emerged in a mixed sorority-fraternity focus group where Suzanne, a party smoker, explained how she watched how much her friends were smoking and commented to them about their behavior: I think, like everyone else, that smoking has a long-term effect. But, you know, it’s not like you’re going to have one cigarette and you’re going to die. So that’s why people aren’t going to be all over you if you smoke with them and you’re not really a smoker. But at least for me, I care about my friends. I don’t want them to be unhealthy. So if they smoke too much, even my guy friends, I’ll tell them to stop smoking as a way of showing them that maybe they’re a little too much into it.

Suzanne’s comment exemplifies how some girlfriends monitor each other’s behavior to control them from smoking in excess. Her remark that she would “even tell my guy friends” is important, because monitoring is far more common within gender than across gender. Whereas men are encouraged to engage in excessive or extreme behaviors, women are not. This is particularly true for alcohol consumption, but is also the case for smoking.

Physical Dimensions of Smoking and Drinking Getting drunk lowers inhibitions sufficiently so that even a novice smoker can feel comfortable about engaging in a behavior that requires some skill (smoking without choking, holding a cigarette, etc.). For those who had little experience with smoking, one of the advantages of drinking and smoking was that after having a few drinks, smoking a cigarette was physically easier to do because they experienced fewer negative side effects like throat irritation and coughing. John, an infrequent smoker, explained that a benefit of smoking while drinking was that “alcohol just washes away the cigarette’s bad taste.” Concurrent alcohol and tobacco use may eclipse the subjective negative effects of the initial smoking episode.28

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likely to report inhaling (77 percent inhaled) than those who reported smoking less than one cigarette (44 percent inhaled). Approximately a third of these students reported smoking fewer than six puffs during these early episodes.30 From interviews, we knew that those who were smoking just a few puffs were sharing cigarettes with friends because they had arrived at the party with no intention to smoke. As noted earlier, our data confirmed that over two-thirds of early smoking episodes on campus occurred with concurrent alcohol use, particularly heavy use. Only 4 percent of the early smoking episodes occurred when students were alone, and the vast majority of these episodes (over 90 percent) occurred with other people who were also smoking. Similar findings were reported by the public health researcher Sherry McKee and her colleagues who surveyed college freshmen at a Canadian university.31 “Experimental smokers,” as these researchers called them, reported that they were more likely to smoke while under the influence of alcohol; in fact, 86 percent of experimenters’ smoking episodes occurred while drinking. Not only was smoking related to drinking, but it was particularly common during binge drinking. Comparing these experimental smokers with their earlier studies of occasional smokers in non-party contexts, McKee and her colleagues conclude that smoking while drinking is associated with positive reinforcement rather than negative consequences: “Overall, for both experimenters and smokers, the concurrent use of alcohol and tobacco was reported to be a pleasurable experience. . . . Moreover, the pattern of results suggests that pleasure and desire for cigarettes was greater than that for alcohol when smoking.”32 This heightened desire for cigarettes—particularly striking among party smokers after drinking—was replete in our interviews. Steven, who self-defined as a nonsmoker, recalled his first experience of smoking on campus: “It was getting kind of late and I had about ten beers. Someone came up to me and asked me if I wanted to smoke and I said, ‘Sure, what the heck?’” For students like Steven, smoking rarely preceded drinking, but rather was engaged in both during and after alcohol consumption. “The urge to smoke just comes when I’m drinking,” Logan commented. “Just as soon as I take the first puff, it feels like I need it or something, like when I drink I feel like I need a cigarette.”

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In high school, I used to not even smoke cigarettes, I used to just drink, and then I started smoking cigarettes at a college party and the first time I smoked was when I was really drunk so I don’t really know what happened. . . . I know if you are not used to smoking and then you smoke a cigarette, it kind of increases the buzz of alcohol more.

Beyond the buzz that she felt, Jaime could not remember or articulate much about her initial smoking episode. In many narratives, it seemed that being drunk facilitates the smoking experience by mitigating the negative side effects of early episode smoking that one might have otherwise experienced. This is significant as initial smoking episodes may be embodied as positive memories and may foster a desire to smoke again in a similar social context, that is, when drinking again. In fact, previous studies have shown that for some individuals, higher levels of current smoking are associated with positive experiences during their earliest smoking episodes.33 Some students found that as the night progressed and they became increasingly drunk, smoking a cigarette helped them to “to calm down,” “feel a little more sober,” and “evened you out.” As Ashley explained, “When I get pretty drunk, having a cigarette slows me down so that I don’t want to drink anymore.” Similarly, Emily commented that “smoking just puts you in a mellower mood, so it’s not like being drunk and falling all over the place, it’s more a mellow thing and you get some control.” The calming sensation that nicotine afforded was also described by Crystal, who told me that smoking helped her nurse a drink over the course of the evening: It just kind of settles me. At a party, I’m drinking all kinds of stuff. I’ll smoke after I have a mixed drink just to make sure I’m okay. The cigarette will bring me down a bit. . . . it kind of sobers me up. I don’t know why or how, but it does. And it’s like, okay, well let’s smoke this and then I’ll see how I feel. After a cigarette, I will sometimes want to get one more beer or something. But the moments with the cigarette really helps me collect my thoughts, and take a break from everything that’s going on.

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individuals can produce increased fatigue. These differences are in part due to whether alcohol is consumed during the ascending or descending “limb” of the blood alcohol curve (i.e., whether one has just begun to drink or has been drinking for a while), and also one’s individual sensitivity to the substance. Nicotine tends to attenuate the adverse effects of alcohol. Because nicotine seems to enhance or augment the initial stimulation of mood that alcohol provides, it appears to provide a good explanation for why there is increased smoking in response to alcohol consumption.36 Many college students talked about “just getting the urge to smoke after a few drinks,” an urge that might be explained as a positive body memory, an informational template from previous evenings of co-substance use, when “smoking a cigarette just brought on the buzz.” Seen from a scientific perspective, the nicotine is furthering the stimulation one receives during the ascending part of the blood alcohol curve. Recent experimental studies among very light nondependent smokers (defined as those who smoke one to five cigarettes on a few days per week) found that urges to smoke increased rapidly following heavy drinking.37 In the laboratory setting, the desire to smoke sharply increased within a half hour after drinking—when alcohol’s stimulant effects are usually observed. Among light smokers in a controlled lab setting, alcohol was found to have a profound effect on the desire to smoke, a significant and surprising finding given the participants’ relatively low level of smoking. These findings are particularly relevant for an understanding of the drinking-smoking connection among college students, because they reveal that the greater the alcohol consumption, the greater the urge to smoke. Equally significant is that these urges remain elevated even when the blood alcohol curve declines, so a person may be at increased risk for wanting to smoke for hours after drinking alcohol. This may in part explain relatively high levels of smoking among those who call themselves “just party smokers.” For some students, binge smoking seemed as common as binge drinking. Importantly, research has also shown that smoking is associated with the duration of a drinking episode. In one study, young adults aged twenty-one to twenty-five were asked to report—hour by hour— on their drinking and smoking behaviors. By the fourth hour of their drinking episode, almost 60 percent of those who smoked daily and

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night)—beginning with pre-partying and continuing through the party itself and beyond. The party scene, knowing where to go and what time to arrive and leave, is facilitated by social media, including texts from friends (about who’s at the bar or party) and Facebook. As the duration of party and drinking time expands for young adults, there are more opportunities for smoking to occur.

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What’s Gender Got to Do with It? I guess to a lot of people seeing a girl smoking is just automatically a negative thing. It’s just a complete turnoff. Maybe once they got to talking to her, they would either realize that she was just a social smoker or that, you know, although she did smoke, it shouldn’t affect how they felt about her. —Lyndsey, eighteen-year-old female

Perusing online Facebook albums, one can find multitudes of photos that show college women playing the role of the “consummate party girl,” surrounded by girlfriends who exhibit the same attributes. Alcohol is prominently displayed. Young women in low-cut black minidresses sip mixed drinks from oversized fishbowls or pose around a kitchen table heaped high with empty beer and liquor bottles affirming the excesses of the night. Other young women portray themselves and their friends doing a beer pong or jello shot, two of the “absolutely quickest ways to get wasted.” What is often absent from these Facebook albums is cigarettes.1 I wondered why women didn’t shoot their photos with cigarettes in hand. Was it because they might nurse a drink for an extended period of time but smoking a cigarette took only a few minutes? Or was there some other reason for this conspicuous absence? Did men’s Facebook pages show them drinking and smoking? While it might have been useful to compare men’s and women’s Facebook pages, I knew that men posted their adventures far less frequently than women.2 When guys did post—according to college women I spoke with—it was more likely to be some inappropriate joke, a link to a sports website, or something impersonal. Scrapbooking of one’s raucous adventures is a gendered activity, decidedly a “girl thing.” In interviews, I was interested in exploring whether there were gendered dimensions in 74

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patterns of tobacco use, such as where, when, and how much people smoke, particularly in the early stages of use. Was it equally acceptable for women and men to smoke? Our initial interviews indicated that it might not be. Examining survey findings from our Tobacco Etiology Research Network project, we did not find significant gender differences with regard to the average number of cigarettes smoked among college freshmen.3 Among the students we surveyed, smoking was occurring at relatively low levels, with a mean of five cigarettes on weekends for men and women, and three cigarettes on weekdays. These findings are similar to other studies on gender among college students, which report that smoking appears to be equally popular among young men and women.4 One study conducted at twenty colleges and universities in the Pacific Northwest found that men and women were similar in the number of days per month that they smoked (on average, twelve days), the number of cigarettes smoked per day (about four), and the age of initiation of smoking (around fifteen years).5 Results from the National College Health Risk Behavior Survey found that among the 70 percent of students who had ever tried smoking, women were as likely as men to report that they were current smokers. In fact, at all levels of smoking, women were equally as likely to smoke as men.6 In contrast to survey data, relatively few qualitative studies on college campuses have explored gendered dimensions of smoking, including norms and acceptability of smoking for women and men, ideas about smoking at different levels of amount and frequency, monitoring of one’s own and friends’ behavior, norms of sharing, and ways in which smoking is used to communicate concern and empathy for others. In addition, we know little about how smoking behavior changes over time for men and women as they have greater access to times and places where smoking can occur. In interviews, we asked a number of questions about whether students observed gender differences in smoking on campus. Surprisingly, we were told that despite party smoking being so common, smoking among women was considered to be inappropriate and unattractive. Even women who smoked at parties commented that it was “just not as cool for a girl to smoke as a guy.” Why then did they smoke, seemingly

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sorority herself but had ample time to observe these women, offered this remark: I know a girl who’s in a sorority and actually her sorority wouldn’t let her smoke, I totally didn’t even know she smoked at all, and one day I was outside on campus and I was smoking a cigarette and she was like, “Oh my god, can I have a puff?” And I was like, “You smoke? I’ve never even seen you smoke before.” And she’s like, “Yes, I’ve been smoking since blah blah blah, but I have to go across the street cause my sorority won’t let me.” So she hides it from them. I’m not sure that they make everyone do that, but she was like the treasurer of the house or something.

At issue is not just whether women follow these rules “to the letter,” but the extent to which gendered norms mediate behavior. Sorority rules reproduce gender ideals that may be broken by individuals in particular contexts, but may not be entirely rejected. As much of freshman partying in the early months at these universities occurs at fraternity houses, notions of appropriate behavior for women may be widely known. While fraternity members interviewed were well aware of the above-referenced “rules” for sorority members, fraternities in which alcohol was available at parties did not dictate these specific “rules” to their male members. Beyond sorority members, these negative stereotypes of female smokers were repeated across students, even among smokers. When I asked Brittany, a party smoker, what she thought about a woman who smoked a few cigarettes at a party, she replied, I probably wouldn’t judge her too much because I smoke too, but when I used to not smoke and I’d see girls smoking, I’d think it was disgusting and wonder why they would do that to themselves. It’s a bad image. Now when I see someone and they just have one or two, it’s more like, “Oh, they’re drinking, they’re in that environment, so they’re having a cigarette.” But if they’re going out a lot to have a cigarette throughout the night then I think it’s gross, like if I was a guy I’d think that was totally unattractive. . . . But if I know they don’t smoke on a regular basis, then I figure they’re in the same situation as me and they just feel like smoking

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express concern about their bodies, and to behave in particular ways in public spaces. Indeed, “women’s bodies are not solely their own, but are doubly determined bodies for others.” As such, Bourdieu asserts that women are “constantly exposed to the gaze and discourse of others.”9 In his perspective on gender, women not only internalize and accept male power and domination, but also reproduce it in a range of social settings.

Men’s Perceptions of Women’s Smoking Do men’s perceptions of women’s smoking differ from that expressed by women themselves? By and large, male smokers confirmed the perception that smoking among females was a “big turnoff.” Trevor, a low-level smoker, told me, “I really think it’s trashy. I wouldn’t want to be seen with a girl who smokes even though I’m a smoker. I know it’s a double standard but that’s how I feel.” He went on to explain that women were “just expected to have more control of themselves.” Similar negative perceptions about women smokers were described by Tom, a sophomore who observed that there is far more surveillance of women’s behavior than men’s: I think with women smoking, . . . it’s like our society as a whole, . . . there are way more societal norms placed on women, what’s acceptable and what’s not, than there are on men. If I smoke six cigarettes at a party and a girl smokes four or five, I’m going to be like, “Wow . . . what’s wrong with her?” If she has one or two, that’s way more acceptable. In a party situation, no one questions how many cigarettes a guy smokes, it’s the girls who have to watch it.

Carlos, a party smoker discussed in chapter 2, similarly described the double standard: When I see a girl who’s really hot and she’s smoking a cigarette, I may think she looks sexy but I’ll think to myself, “If I were around her, how would I handle that? Would I have to smoke to hang out with her?” I think how it would be really gross to kiss her. When girls smoke, it looks tacky and unhealthy. Even though I smoke when I drink, I hate it when girls do it.

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the jocks. Here at college, I’ve met a couple of guys who have told me that I shouldn’t smoke, that it’s not good for me, that there’s no point to smoking. They’ve just asked me point-blank, “What do you get from that? What are you doing right now?”

When I asked her what she did in response to their admonitions, she commented that even if guys were against her smoking, after a few drinks she was into a “just go for it” attitude. “By that time, I’m not really thinking about what a guy is going to think of me.” When I asked whether women commented to their male friends about smoking, I found that some did, but this was largely out of concern that it was bad for their friends’ health, not because it looked bad. There was some reluctance to comment on guys’ behavior because women do not want to be labeled nags, a label sometimes given to women who made demands on men. This was in contrast to many men who, more often than not, exhibited a sense of entitlement about telling women—even those they did not know—that they should stop smoking because it gave a bad impression. In her study of “hooking up,” the sociologist Kathleen Bogle describes a similar double standard in the context of romantic relationships. She describes how male college students chided women who slept with multiple guys, while for men, having multiple partners was highly admired, acceptable, and considered studly.10 Guys bragged about their conquests and felt free to comment on their own and others’ behavior. This inequality in what was considered appropriate behavior for men and women is also discussed by DeSantis: Women consistently highlighted the frustration and confusion of maintaining a paradoxical sexual identity. On the one hand, they are expected to be virginal, monogamous, chaste, and virtuous, and, on the other, they are encouraged to be sexual, inviting, provocative, and available. This double bind forces them to walk a thin line between acceptable and unacceptable behavior. To complicate things even more, the line between the trashy and the appropriate is constantly, and capriciously, shifting.11

Applying labels like “trashy” or “slutty”—whether it is because a woman has engaged in what is perceived to be unacceptable sexuality or

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are consumed with their image, . . . there’s this wanting to be accepted, a wanting to be part of a group. . . . It’s just so much more for females than for males.” Thus, despite norms dictating the inappropriateness of women’s smoking, parties were a context where one could let loose and behave in ways that would be considered inappropriate outside the party.12 These ideas were echoed in a women’s focus group. Mimi: Who do you think smokes more in social situations? Amy: Girls, girls definitely. If you have a party and people are just milling around, you see a lot more girls with cigarettes than guys. Sally: Yeah, just like pretending to smoke almost. Mimi: Pretend smokers? Sally: Kind of, it’s almost like back in high school, when we were freshmen or even younger than that, and we were trying to go to parties, kind of like that. Mimi: What purpose does it serve to be seen smoking? Sally: It’s like you’re trying to look like you belong somewhere, just to look like you’re part of a group, just look like you’re smoking. Amy: ’Cause when you’re smoking it gives you a purpose, you know? And maybe it’s comfortable in a potentially awkward situation. I don’t know if I would say that they’re pretend smokers, because I know some people who just smoke socially. They don’t smoke cigarettes outside, they don’t smoke by themselves, but they smoke in a group. They just want to smoke in certain situations.

Avoiding the Trashy Look The point raised in the focus group that smoking among women helps them to fit in better and to feel that they are part of a group was mentioned by several of the women I spoke with. In fact, smoking with a group of girlfriends was an explicit strategy for avoiding looking “trashy” when one smoked. This practice helped deflect attention away from being seen as a smoker. Smoking with friends allowed one to be seen as a part of a group—rather than an individual with a cigarette. Kevin referred to this in his interview as “groupthink”:

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sophisticated and aggressive marketing campaigns specifically appealing to female aspirations, desires, and stressors. Products project a psychological and social meaning to the consumer who buys them. Smokers and potential smokers who identify with projected images may purchase the brand as a means of “adopting” the behaviors or attributes portrayed in the ads. Themes seen in tobacco ads, such as glamour, romance, independence, and friendship, appeal to a person’s self-image and may affect her or his structuring of social reality. When a role, such as smoking, is unfamiliar, a person may rely on the social meaning of the product portrayed in advertising to guide how and when it is used.16 The idea of the acceptability of smoking in a group, for example, is featured in a Newport cigarette ad that shows women at a party with friends, smoking together and happily enjoying the experience (see figure 4.1). Although not all of them are shown with cigarettes, their proximity to one another suggests that they are all accepting of the behavior. Women make up about half of the smokers of the Newport brand. It is interesting that similar ads for Newport continue to appear in magazines, with a shift in demographic target.17 The importance of group smoking was described by several low-level smokers in a focus group discussion (also noted above) with women who were describing their observations of sorority girls. Sally: You see these girls at a party and they all belong to the same group, and to me and my friends each one might have their own identity, but they’re like this collective that looks the same, dresses the same, talks the same, and acts the same. Mimi: Are these the type of girls who you expect will smoke? Amy: Well, yeah. How it works is like this: . . . I can imagine that there’s one hard-ass cool sorority girl that, like, smokes on a regular basis, so whenever she’s in a group with her other little friends, they smoke along with her, ’cause with her it’s cool, ’cause she’s all hard-ass and cool.

Amy’s comment echoes Kevin’s comment above where he references “their little one-brain decision,” which he believes dictates how women act in public. In fact, women’s narratives reveal a multivocality—they

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of these young women resist social dictates and express their personal agency through smoking.

“It’s Good to Be a Little Bad” Beyond allowing one to fit in with the group, were there other benefits of smoking at parties for young women? One benefit articulated by several women was that it enabled them to change their image. As I discussed in the previous chapter, in the first few months of college, students are trying on “new selves” and crafting new identities. Smoking at a party not only helps to define who you are but also who you are not—contingent on where you smoke and with whom. As Jenny explained, “If you don’t smoke when your friends are, then others may think you’re uptight, . . . it’s like you look like a girl who just can’t loosen up. If you smoke . . . you project a more fun and outgoing image.” Her friend Lori, a party smoker, laughingly added that “it’s good to be a little bad”—that is, that smoking at a party called attention to you as a person who was not afraid to do something that others might look at with disapproval. Smoking was an expression of personal agency and a way of announcing that you were the type of person who was not afraid to take a risk. Jenny, who described herself as a serious student, told me, There’s like a little bit of a thrill, especially if a person is really a goody two-shoes or a “by the book” person. It’s like you smoke a cigarette, . . . you do something you’re not supposed to be doing, you know. It’s like bad for you, but it’s also like a simple little rebellion.

For Katrina, a low-level smoker, smoking at a party helped her to project “a mysterious dame look”: “If you’re smoking you look so much more of a badass, so much more deep down inside.” Evoking this image helped her appear intriguing, someone a guy might want to get to know better. Having a lit cigarette in your hand projected a sensual image and said, in a subtle way, “that there was really more to you than met the eye.” This element of surprise afforded by the cigarette had the added potential of catching someone you were attracted to off guard. Katrina continued:

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Smoking a cigarette can provide women a form of resistance to traditional and submissive images of femininity. Advertisements for Camel No. 9 are an example of a brand directed at young fashionable women. In some ads, only the black cigarette box was shown, which had a hot pink border and a pink Camel featured in the center. The pack was surrounded by pink flowers. The copy on the ad read, “Light and luscious”—as much a statement about the cigarettes as the type of woman who would smoke them. Another ad for Camel No. 9 100’s says, “Now available in stiletto,” featuring images of a slim, stylish black pack (see figure 4.3).

Figure 4.3. Camel No. 9 brings to mind the perfume (Chanel No. 19) and the song (“Love Potion No. 9”). It also indexes images of fashionable women “dressed to the nines.” Ads for “Stiletto” appeared in Glamour, Lucky, GQ, Cosmopolitan, and Vanity Fair. These ads were removed from the marketplace under pressure from tobacco control advocates, who felt they were too objectionable as they so blatantly glamorized and stylized smoking for women. The brand, however, is still available.

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Men, on the other hand, were expected to engage in excessive behaviors and were rarely stigmatized for such behavior. As Jackie offered, “Guys can do anything way more hard-core than girls do without anyone looking at them, . . . like they can drink or smoke a lot more than we can.” As a result, men did not monitor each other carefully unless a behavior was truly inappropriate. For example, men in a focus group reported that several top athletes at their university were smokers, but their friends would not comment negatively about it. “It’s their thing, they earned it. It’s like popular basketball players smoke cigars after the game, . . . you don’t get in their business unless it’s real destructive.” For college males, smoking seemed to reaffirm their identity as men, especially as their engagement with risk is an important element in their formation of an identity.20 In contrast to this flamboyant male behavior, women in a mixedgender focus group described how they took it upon themselves to watch their friends’ behavior. This is particularly true for alcohol consumption, but is also the case for tobacco. Monitoring of friends was related to the feeling of responsibility that women friends had for each other and the true dangers they recognized in their environment. As the focus group continued, this issue emerged: Stephanie: Girls are gonna go to a party and hang out with people they show up with, but they always have to make sure someone is not drinking. They’re responsible for watching over someone else. Mimi: And with guys? Andy: You just go out and party! If your guy friend gets a hookup, well good for him. If we want to leave, we’ll just go! It’s like let the guy do his thing. If a guy is acting wild, we’ll just say, “Hey that’s cool, man.” Thomas: Yeah, we’ll just say, “Let’s get out of here.” We don’t need to wait for him.

Women need to be continuously cautious of their behavior and need to protect themselves from potential damage to their self-image. In the party scene, contemporary heterosexual scripts are enacted and can be viewed as a site for the reproduction of gender inequality. While women’s movements are restricted, men are expected and encouraged to roam.

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that’s our bond.” Kylie similarly said, “Even though we are all smoking different cigarettes, it’s as if we’re all smoking the same cigarette, . . . you know what I mean?” In the quote above, when one of the college women exclaims that she feels “we’re all smoking the same cigarette,” this feeling may arise from her embodied sense that they are in synch in the topography of their smoking—their inhalation patterns, their frequency of puffs. It feels like an intimate bonding and sharing. Experimental studies have shown that this actually occurs—that people change their puff frequency when smoking with friends to be more in line with the other smoker’s puff patterns.21 Going outside to have a cigarette with friends was an opportunity to catch up on gossip. Not taking part in a shared smoking ritual might mean missing out on an important information exchange. Interestingly, many college women I spoke to described explicitly gendered ways of inviting friends for a smoke. Women tended to use inclusive pronouns (let’s, we’re), while males talked about themselves (I’m gonna). As Jena, a sophomore, explained, “Usually, the guys will say, . . . ‘I’m going to go smoke a cigarette.’ But it’s always I, not let’s go, or we’re going.” Kelly observed, “Whenever I go to the library with guy friends, I’ll usually be the one who says, ‘Let’s go smoke a cigarette.’ A guy would never come up to me and say, ‘Let’s go smoke a cigarette.’ I think girls tend to do that.”22 On the college campus, smoking outside the residence hall operated differently among men. As Gina observed, “you don’t really see guys herding up their friends to go outside, but girls will do that on the spot.” In interviews and from observations, however, we saw that men did smoke with friends. However, several men noted that they did not feel compelled to find someone to go smoke with them because “you can always find a smoker outside.” Unlike women, who were described (by men) as being able to “talk, talk, talk” without the need for any precipitating event to talk about, males were seen (by females) as needing an activity to bring them together. Being involved in a shared consumption event, like smoking or drinking, allowed men to feel comfortable with friends who were all engaged in a similar behavior. Doing something together both facilitated and replaced the need for talk. Smoking together sometimes filled in otherwise silent spaces. Men whom we discussed this with tended to agree with this characterization.

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person. For example, when a friend is experiencing a state of negative affect, smoking may be used as a somatic mode of attention, a means of attending to and with one’s body to another person’s state of consciousness and affect such that a sense of resonance occurs.23 Students reported that smoking a cigarette with a friend when they were down or upset facilitated talking about a problem and served as a means of creating a shared space of caring. Our research team had initially hypothesized that empathetic smoking might be more common among women than among men, since our pilot interviews suggested that females seemed to disclose more about their feelings to one another and tended to describe smoking with friends as a bonding experience. In quantitative analyses, we assessed gender differences in empathetic smoking by asking the following question at the end of the first semester: “A good friend who is upset and smoking offers you a cigarette when you sit down to talk with him/her. Would you accept the cigarette and smoke with them?” Of students who described themselves as either someone “who is not a smoker but smokes every once in a while” or “who smokes when I party,” males were significantly more likely than females to endorse empathetic smoking (74 percent of males, 54 percent of females). The analysis was intentionally limited to these smokers, as we assumed that higher-level smokers would be more likely to accept a cigarette from a friend at any time. Closer analysis of interview data provided some explanations for this counterintuitive gender difference. Among some young men, smoking with an angry or troubled friend who was also smoking allowed them to be present without dwelling on details or probing into the problem. Smoking together was a way of showing empathy and diffusing emotion without the need for many words—“if you smoke together, you’re just there for them.” In this sense, smoking served to dissipate what Bryce described as the “uncomfortable tension that might be in the air every second.” For other men, smoking with a troubled friend conferred a different type of benefit. Robert noted, “Smoking makes conversation a little more casual, .  .  . it adds a little comfort, .  .  . conversations just seem easier.” This issue of smoking as comforting and “loosening one up” was echoed in another male party smoker’s narrative: “It’s a question of

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Figure 4.4. Smoking cigarettes together can facilitate openness and sharing among men.

image of smokers surrounded by friends was contrasted to a negative image of smoking alone. As one young woman noted, “It’s kind of sadlooking to see someone smoking alone. I don’t know, it’s like they’re lonely, depressed, all they have is their cigarette as their friend.” On both campuses we observed that females who were smoking alone would commonly be talking on their cell phone, a practice that helped them appear as if they were not alone.

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weekly patterns of smoking behavior (days of the week). Such findings are important for an understanding of college smoking. Ethnographic research provides a more nuanced account of how male and female smoking patterns are perceived in particular social spaces, how smoking contributes to identity construction, how women smoke in particular ways, and other social reasons for smoking. The utility of methods triangulation lies in the possibility of highlighting different dimensions of behavior and knowledge production, as well as validating that data generated by one method are not an artifact of that method.25 Anthropologists have long pointed out that what people say they do and what they actually do may vary. This is why participant observation—observing the same people in different contexts— and narrative analysis sensitive to the subtleties and multivocality of language are the hallmarks of ethnography.26 In interviews, women presented themselves as gendered subjects and performed in ways consistent with this identity. They were particularly articulate about gendered dimensions of smoking, drawing attention to the fact that their behavior was under more scrutiny than that of males. This caused them to be more self-conscious about their smoking than males and to monitor both their own smoking and that of their friends. Although females reported that smoking made them look “slutty,” observations at parties revealed that they did smoke. This paradox was followed up in interviews where we queried the conditions under which smoking became more permissible. It was found that smoking in a group with other women who were smoking mitigated the negative perceptions of being a smoker. Gendered dimensions of smoking impact smoking trajectories and may change over time. Looking through a social ecology of health lens, we have observed how peers, along gendered lines, adopt similar behaviors. We can also consider how environmental changes, such as leaving college or graduating, may affect behavior. Young men may be at greater risk to escalate into regular tobacco use as their behavior is less monitored by other male friends than is the case for women. This observation supports longitudinal research among college students that has shown that men are more likely to progress in their smoking behavior than women, with male gender predicting the transition from experimentation to regular cigarette use.27

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directed at women. Women’s brands—distinguished by the long and slim shape of the cigarettes—are often advertised with the word “slims,” “super slims,” or “extra slims” in the names of brands and on packages, and use slender young women as models in their ads. Although current prohibitions in the United States restrict billboard advertisements and print ads (in some media), tobacco advertising that glamorizes smoking remains widespread on the Internet and through direct mail.5 Ads for slim cigarettes featuring ultra-thin models are increasingly used to market cigarettes to women around the globe, particularly in low- and middle-income countries. Booming sales in overseas markets attest to the “successful strategy” of linking cigarettes with a slim body.6 What does the academic literature tell us about smoking as a weightcontrol strategy? Several studies have found that adolescent girls who diet or who express more concern with their weight initiate smoking at higher rates than nondieters.7 Some researchers conclude that even contemplation of smoking is more pronounced among those girls who express weight concerns.8 Smoking is reported to be more common among girls who are overweight, and several studies find that adolescent females agree with the statement that smoking helps keep body weight down.9 Researchers have found that girls who engage in unhealthy weight-loss methods, such as vomiting, using laxatives, and taking diet pills, are more likely to be smokers than girls who do not engage in these behaviors.10 One study concluded that the teenaged girl who is most likely to be smoking for weight-control reasons is white, female, and a chronic dieter.11 Of note, at least one study concluded that weight concerns did not predict smoking initiation among teens. In this longitudinal study, the psychologist Joel Killen and his colleagues followed approximately two thousand girls across high school to examine the relationship between smoking onset and concerns about the body. Rather than weight concerns or body fat being a predictor of smoking, the likelihood of smoking was highest among girls with high sociability scores and those who had more friends who smoked.12 This confirms results of many studies that find that youth who have friends who smoke are more likely to be smokers themselves.13 Notably, this is one of the few studies on smoking and weight control that followed teens across time to see the impact of their smoking-related beliefs on their actual smoking behavior.

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and young adults. Much of the data collected to date have been generated by cross-sectional surveys, with few notable exceptions.26 In the majority of these studies, dieting and smoking attitudes and behaviors are assessed separately, and responses to these distinct sets of questions are then correlated. Positive correlations show that girls who smoke are more often those who diet or are those who are dissatisfied with their body. On these surveys, adolescents may be asked to agree or disagree with the statement “Smoking keeps your weight down.” Responses typically show greater endorsement of this statement among adolescent girls than boys of similar ages.27 Surprisingly, relatively few studies ask girls directly whether they smoke to control their weight, or whether they think that smoking is or might be an effective weight-management strategy. Even fewer studies follow the progression of girls’ dieting and smoking behavior over time, and no studies to date have investigated the specific strategies by which girls smoke to control their weight (e.g., timing, location, amount, etc.). To my knowledge, no other ethnographic studies have been conducted with adolescents or young adults on the topic of smoking as a weight-control strategy. Although the results of many studies suggest an association between smoking and weight control, several questions remain to be answered. Given that smoking is prohibited on school campuses and in the majority of homes, how do teenaged girls manage to smoke to control their weight? Among girls and young women who smoke, is weight control the main reason for their smoking, or are there other factors more closely associated with smoking initiation and continuation? Does smoking constitute a primary means of weight control, or is it combined with other weight-loss practices (e.g., exercising, reduced food consumption, etc.)? Do young women who adopt this practice feel it is a successful strategy? When we first began to interview girls, one of our main areas of interest was the extent to which they initiated and continued smoking as a way to control their weight. However, during the first round of ethnographic interviews with over 240 eighth and ninth graders, it became evident that while many girls expressed concern about their weight and talked about dieting, few made an association between dieting and smoking. In fact, so few girls had even heard of smoking being used as a weight-control strategy that we were concerned that we might

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of dieting. In addition, all but one of these girls drank alcohol regularly and consumed other drugs. The remaining girl, Hannah, was an excellent student and a nondrinker, who described herself as a “type A” personality. Smoking, she noted, helped her cope with the stress of school. So if most girls did not initiate smoking as a way to control their weight, what reasons did they give for starting? On the survey, response choices were given based on data collected during face-to-face interviews. We asked girls to respond to the question “I started smoking because . . .” (multiple responses allowed). Almost half of the girls who smoked reported that they started smoking because they had a lot of stress in their lives, while the other half reported that they began smoking because they thought it was fun and relaxing. Many of these girls explained that after they started inhaling, “It started to calm my nerves and make me relax.” Importantly, even girls who smoked rather infrequently articulated this benefit of smoking. This substantiates findings of previous studies that report on smoking as a coping mechanism for stress among teens.29 Forty percent of girls who smoked reported that they started smoking for social reasons, because their friends did. Just as with college students, narrative data revealed that smoking among high school students often went with drinking at parties. We analyzed responses to the question “Are you trying to change your weight now?” to ascertain whether girls who smoked were more likely to be trying to lose weight compared to nonsmokers. However, we found that there were no significant differences in dieting attempts between smokers and nonsmokers. We also assessed whether girls who smoked but who had not initiated smoking to control their weight had ever used smoking as a means of weight control. Accordingly, smokers were asked to complete the statement “When I’m trying to lose weight .  .  .” to ascertain whether they changed their smoking level while dieting. Almost 40 percent of smokers (twenty-one girls) reported that they did not try to lose weight. Twenty-one percent (seven girls) reported, “I stop smoking so I can exercise” during weight-loss attempts. This finding verified information gathered during interviews, in which some girls who smoked said that they preferred to increase their exercise when they wanted to lose weight. Since smoking interfered with their ability to exercise vigorously, these girls curtailed their smoking during weight-loss attempts.

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relationship to body weight in adult women, nor is it associated with sustained weight loss.30 Even among girls in our study, those who were regular smokers were heavier when compared to those who were occasional smokers.31 Similarly, studies among college students have found that current smokers had significantly higher body mass index when compared to nonsmokers.32 Girls’ statements about the media and their observations of others made it clear that they were active agents in an information-gathering process. Rather than simply incorporating media messages passively, girls interpret the contradictory information they glean from the media and environments in which they live. It seems simplistic to assume that because girls see slim women in cigarette ads or smoking in movies, they therefore believe that smoking makes you thin or that smoking is an effective dieting aid. Approximately 80 percent of nonsmokers, occasional smokers, and regular smokers disagreed with the statement “In general, I think people who smoke cigarettes are thinner than people who don’t smoke.”

Smoking and Weight Control: Ethnographic Findings As noted earlier, during interviews with eighth and ninth graders, we found that very few girls made an association between smoking and weight control. Given the structure of their school day, eighth- and ninth-grade girls had multiple constraints on both time and spaces where they would be able to smoke. For example, none of these girls were allowed off campus for lunch, and smoking was prohibited and closely monitored on school grounds. Few girls were allowed to smoke at home, so lighting up a cigarette as a way of finishing a meal or instead of having dessert was not a viable option. By the time these girls had reached eleventh grade, many of them experienced increased freedom (via access to cars) and increased income from part-time jobs. These factors were described in some girls’ narratives as contributing to their increased smoking frequency. As smoking frequency and duration increased, so did the recognition of smoking as a weight-control strategy. Some girls who smoked at higher levels (more than ten cigarettes per day) found that having a cigarette was a way to control their eating. As one eleventh grader remarked,

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Another high school smoker, when asked whether she had friends who smoked to control their weight, expressed concern about the effectiveness of the strategy: Well, I do know some people that smoke instead of having something to eat, and I don’t know, I guess I can see how that would kind of fill you up, just because after you eat, smoking makes you feel a little more complete. But it doesn’t really fill you up completely. It actually hurts my stomach if I smoke on an empty stomach. If I’m really hungry and I have a cigarette, I’ll drink something with it, like juice or a hot chocolate. If I don’t, it hurts my stomach, and it makes me feel sick for a while.

For this girl and three others, smoking was not a viable alternative to eating, as lighting up on an empty stomach made them feel queasy. Another girl explained, “When I’m hungry and I smoke, it’s like I’ve taken something into my body but really there’s nothing going into my stomach. It’s like a big myth that it will fill you up.” Among some girls who smoked, there was an overt concern about increasing their smoking that made it unattractive as a weight-control strategy. Several eleventh graders noted that they wouldn’t try it because they were well aware that smoking was bad for their health and to increase it seemed stupid. As one girl explained, “I don’t want to die that quick!”

Quit Attempts As girls began to engage in quit attempts, several described their experiences of weight gain. One eleventh grader who smoked about seven cigarettes a day (including at home with her mother) had tried to quit many times. As she noted, “It’s really difficult because last time I tried to quit smoking, I gained ten pounds and I didn’t want to gain more, so I said, ‘I’ll smoke.’” Although her weight gain was an important reason for her relapse, it was not the only reason. In her extended narrative, she described how she often experienced loneliness and how smoking when she was alone helped her, describing her cigarette “as a kind of substitute for someone else being there, . . . it’s like having a friend.”

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Young Adults: Perceptions of Smoking as a Dieting Strategy In telephone interviews, we asked current and ex-smokers (sixty-two women) a series of questions on dieting and smoking to assess whether this was a strategy that they had utilized, either initially or as part of their present behavior. In response to the question “Thinking back to when you first started smoking, would you say that you started smoking as a way to control your weight?” 92 percent (fifty-seven women) responded that they had not. All but one of the six young women who had reported that they initiated smoking to control their weight in the original study reconfirmed that response in the follow-up interviews. In response to the question “Did you ever smoke as a way to control your weight?” 85 percent (fifty-three women) replied “no.” We next asked, “Do you think smoking is an effective weight loss strategy?” Of the nine women who had utilized smoking for weight control, six said it was an effective strategy. Among the other fifty-three women, almost half believed that it would not be an effective strategy, and the other half responded that they did not know. We also tried to assess behavior on a follow-up survey. In response to the survey question “When I’m trying to lose weight . . . ,” three young women did report that they increased their smoking while trying to lose weight. However, further discussion revealed that these increases were not a part of a dieting strategy. Rather, as one woman explained, “When I was trying to lose weight, I used some stuff that makes you feel real jittery. I needed to do something with my hands, so I smoked. But I didn’t smoke more so I could control my appetite.” The other two women explained that they had increased their smoking while trying to lose weight because they were stressed out because their diets were not going as well as they had hoped. Smoking helped these unsuccessful dieters deal with the frustration of not being able to lose weight. Approximately 20 percent of the current smokers at follow-up said that when they dieted, they tried to stop or reduce their smoking so they could exercise. As one high-level smoker explained, “I’m gonna stop smoking so I can exercise. Then hopefully it’ll make me not want to smoke again, ’cause I won’t be able to breathe when I’m trying to exercise.”

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sort of like food. . . . At the beginning, I probably thought that smoking might have a nice little side effect, you know, like an added bonus, but that’s not how it is. . . . If I really thought instead of not eating I could have a cigarette, I would be like smoking a pack a day or something!

Another woman who was extremely overweight found the idea of smoking for weight-control purposes quite humorous. As she noted, “If it worked I’d be skinny! It doesn’t work!” In response to the question “Do/did you ever smoke at the end of a meal so you wouldn’t continue eating?” 97 percent (sixty women) replied “no.” One woman who smoked about eight cigarettes per day and expressed concern with her weight, described how she smoked when she finished eating. Although this might appear to be a weight-control strategy, she quickly explained, “Actually I smoke at the end of a meal because it feels good. It’s like a cherry on top, but it’s not so I’ll stop eating!” In response to the question “Do you smoke at times so you’ll be less hungry?” 80 percent (forty-two women) of current smokers responded “no.” Three of the women who answered “yes” explained how their use of cigarettes to curb hunger went beyond issues of weight. As one woman noted, “I do smoke sometimes so I’ll be less hungry, . . . it’s usually that I’ve run out of money because I have to buy cigarettes. I guess it’s very much of a choice, I could go buy food to eat, but instead I buy cigarettes.” Another young woman provided a similar explanation of her behavior: “I’ve used smoking as a substitute for food, not to lose weight, though. I mean it’s usually when I don’t have money, or I don’t have the time to eat, and it’s like, well, I’m really hungry but I’ve got to go in five minutes, . . . so I’ll just go and have a cigarette and that’ll make me feel better.”

Cultural Knowledge about Smoking for Weight Control Although relatively few smokers had utilized smoking as a weightcontrol strategy, by the time these women reached their twenties, cultural knowledge of the practice was commonplace. In response to the follow-up question “Have you ever heard that smoking helps a person control their weight?” 87 percent of smokers and ex-smokers (fiftyfour women) responded that they had. Some, however, were quick to note that although they had heard this, they had not experienced

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nerves.” For those who relapsed to smoking, it was stress-related factors and needing to smoke that emerged as more salient than issues of weight gain. In discussions of their struggles with quitting, three women described how they were tempted to smoke by cues in their environment from other people smoking. Descriptions of these quit attempts made it clear that cues to smoke do not arise solely from looking at one’s body in the mirror or one’s weight on a scale but from observations of other smokers as well. Several women recognized that gaining some weight after quitting was inevitable, since “whether you realize it or not, smoking speeds up your metabolism.” However, there were also benefits associated with quitting that counterbalanced the initial weight gain. One woman who was a chronic dieter and smoked about ten cigarettes a day explained, “I’ve tried to quit before and I’ve gained weight. But this time it doesn’t concern me like it did then. I mean, if I make the commitment to quit smoking and be healthy it would be more important to me than gaining weight.” Another woman similarly explained that stopping smoking was part of a lifestyle change, which she described as a shift in identity from her “smoking frame of mind” to her “nonsmoking frame.” Now that she had a full-time job, she was able to avoid smoking all day, as she didn’t want others to know that she smoked. When she came home, she would quickly change her clothes and go out to exercise. After exercising, she immediately showered, and feeling clean again made lighting up a cigarette unappealing. Though it was a struggle, she hoped that her focus on exercise and an identity shift to being a healthier person would result in a more successful quit attempt than previous ones. She also hoped that this strategy would help her avoid any weight gain. Similarly, other women’s narratives revealed an awareness of the possibility of weight gain following quitting. However, this was viewed as a short-term result that was overshadowed by the health benefits of quitting.

Summary: What Ethnography Adds What do the results of this study tell us that is different from the numerous surveys that have been done on smoking as a weight-control strategy? Previous research has concluded that many teenage girls and young women smoke to control their weight—or make a clear

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Previous research on fear of weight gain after quitting smoking has concluded that this fear is a primary deterrent to quitting among women and that weight gain is a major factor in smoking relapse. In our study, young women recognized that they might gain weight if they quit, but they emphasized that their motivation to quit was related to major lifestyle shifts. A desire to enact these shifts eclipsed weight concerns as individuals moved toward establishing a “healthier or different self.” Women who relapsed to smoking did so for a multitude of reasons, including cravings to smoke, stress related to family problems, economic difficulties in trying to manage on their own, and constantly being around friends or partners who smoked. During interviews, several young women directly challenged the idea that the primary reason women relapse to smoking is due to weight gain, noting that they found this idea demeaning. From initiation in high school to young adulthood, the primary reasons for smoking among these women was not to control weight but rather for social facilitation among friends, to manage the stress and difficulties of their everyday lives, and cravings related to nicotine dependence. Both researchers and the popular media have been complicit in propagating the idea that smoking is a commonly used weight-control strategy among young women in the United States. I challenge this impression and the simplistic notion that issues of weight are what drive smoking among women. Rather than focusing attention on what might be a small percentage of girls and young women who do practice this behavior, it might be far more productive for those involved in tobacco control to emphasize that smoking is not an effective weightloss strategy and that many women who smoke are overweight. There is a lesson to be learned here. Public health practitioners need to exert caution when presenting risk data to the public derived from surveys that query dieting behavior and smoking through general questions. Inadvertently, risk data may actually put a population at risk by making it appear that a behavior is more normative than it actually is in practice.

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The Slippery Slope Sure, I smoke at parties, but I just do it for fun. I’m not going to become a real smoker. That’s so nasty! —Rachel, nineteen-year-old female

As my research continued on college campuses, I became increasingly interested in the transition from “just” party smoking on weekends to more regular patterns of weekday smoking. The transition to being a smoker, a label that many students eschew, entailed smoking outside social events to include an increased number of spaces, places, and contexts. While many students told me that they didn’t want to become “real” or “regular” smokers, how did they desist? Were there intentional strategies or unconscious behaviors that some people adopted to prevent, delay, or avoid this transition? How and why did some people make this transition while many others did not? Before exploring perceptions of addiction and strategies to avoid nicotine dependence, we should review how this movement along a trajectory toward dependence is conceptualized in the research literature. First, the prevalence of dependence on a particular substance is typically found to be higher at higher levels of use. In other words, the more you use a substance (be it alcohol, marijuana, cocaine, or nicotine), the more likely it is that you may develop a dependence on it. Repeated or chronic use is a core feature in the phenomenology of substance use. However, as discussed earlier, some individuals appear to be dependent at low levels of use. In fact, relatively little is known about the processes that underlie changes in smoking that occur between early use, more regular patterns of use, and eventual addictive use.1 As we have seen throughout this book, many college students begin their smoking careers in delimited contexts, and smoking is something they see as deriving from personal choice, rather than need. They smoke to have 120

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fun, for the pleasure of it, because it goes “perfectly” with drinking, and to facilitate social interaction. Researchers interested in the emergence of nicotine dependence have attempted to capture this transition on nicotine dependence scales, although these measures have limitations when applied to youth smoking. Importantly, dependence criteria have been developed among adults who smoke daily at high levels. Thus, it has been difficult to establish the parameters of dependence among youth who may have non-daily patterns (for example, weekend smoking) or those who smoke daily but at very low levels. What has been established is that susceptibility to nicotine dependence varies greatly across individuals, with some experiencing symptoms of physical dependence, such as withdrawal and tolerance, far earlier than others.2 Results of a longitudinal study among early adolescents by the tobacco researcher Joseph DiFranza and his colleagues found that symptoms of nicotine dependence can appear within a matter of days or weeks after the onset of intermittent tobacco use.3 In their study, teenage girls appeared to be more vulnerable to addiction than boys, showing a higher prevalence of dependence at the same quantity smoked. There did not appear to be any minimum frequency of smoking or number of cigarettes required for symptoms of tobacco dependence to occur.4 Other researchers have found that while adolescents typically smoke fewer cigarettes than adults, they experience a higher prevalence of dependence at the same level of use.5 Indeed, a significant body of evidence suggests that the adolescent brain is particularly vulnerable to nicotine.6 Those who begin smoking as adolescents are more likely to become dependent, to progress to daily smoking, to smoke at higher levels as adults, and to smoke well into adulthood.7 Such findings are important because it had previously been assumed that moderate daily use of tobacco over an extended period of time was a prerequisite for nicotine dependence. Previous studies had shown that the time span from initiation to regular use was typically two to three years, although considerable variation was found to exist in individual trajectories.8 Teens aged fourteen to sixteen appeared to accelerate their uptake when compared to teens who were younger (aged ten to twelve), perhaps because of cost and increased opportunity to smoke. Clearly, nicotine dependence can be the result of multiple factors, including the

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is dependent on nicotine, these findings raise intriguing questions about the meaning of dependence and how it may differ across individuals. It also raises questions about how well the scales used to measure dependence map on to young adults’ experience of use. A recent longitudinal study among high schools students conducted by the psychologists Lisa Dierker and Robin Mermelstein examined the association between nicotine dependence and future smoking behavior in order to map the natural history of youth smoking. Their study found that reporting high levels of nicotine dependence (e.g., experiencing craving, withdrawal, etc.) at baseline (despite having smoked fewer than one hundred cigarettes lifetime) predicted continued smoking behavior two years later. These authors conclude that experiencing signs of nicotine dependence early on appears to be more important than how many cigarettes one smoked or how often one smoked at baseline.13 A review of dependence theories conducted by the social psychologist Steve Tiffany and his colleagues raises key issues about the nature of dependence.14 First, the authors emphasize that dependence needs to be understood as a dynamic, emergent process that implies transformations in behavior over time and over situations. Rather than being a state or static end product that develops following a history of regular smoking, dependence is a process that can change over time and— importantly to our discussion—over social contexts. Second, dependence has typically been discussed as an all-or-none condition, that is, either one is a dependent smoker or not. According to Tiffany and his colleagues, This categorical model of tobacco dependence assumes that dependence arises when a smoker reaches a threshold level of nicotine exposure sufficient to trigger dependence processes, which are conceptualized implicitly as qualitatively different from “normal” functioning. Once that threshold is reached the person is dependent on nicotine, and further exposure past that point will serve only to increase the severity of dependence.15

In contrast to this categorical and linear view of dependence, these researchers contend that dependence can best be conceived of on a

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advertised images extolling the social benefits of smoking. Consider, for a moment, health education messages on television, in magazines, or on school buses that feature fear-provoking images of “an addicted smoker” with blackened lungs, disfigurement of the mouth and jaw, a gaping hole (stoma) in the throat rendering him or her speechless, or prematurely wrinkled skin. In sharp contrast, the advertised image of a smoker promoted by the tobacco industry is a glamorous individual (or hip individual, depending on product placement) surrounded by friends in a happy, lively setting, smoking with no apparent health consequences, no mess, even no ashes.19 In a discussion of the semantics of addiction in contemporary U.S. culture, the medical anthropologists Gilbert Quintero and Mark Nichter note that in everyday speech, several terms are associated with addiction, including habit, dependence, abuse, and obsession, among others. They raise questions about differences between these terms for laypersons: Is having or feeding a habit more positive or less threatening than having an addiction? Is a habit something someone possesses while an addiction is something that possesses them? Is dependency the same as addiction or do the terms mark different points on a trajectory? Is one less stigmatized than the other and among whom?20

These authors note that such questions invite further inquiry into how laypersons utilize such words in terms of issues of responsibility, agency, and moral labeling. They also question the impact of the ubiquitous “addiction talk” in the media and ask how this has influenced people’s ideas of what constitutes addiction: How has the use of the term “addiction” for socially accepted substances like coffee and activities like computer games impacted on the meaning of addiction as applied to less acceptable substances or activities? With so many addictions about, is it considered normal these days to have at least one addiction? Does this attitude lead to comparative reasoning wherein one addiction is judged against others as being less harmful in a world where one is probably going to be addicted to something anyway?21

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the tobacco industry launched an attack, claiming that these findings were a “contradiction of common sense.”25 Unlike truly addictive drugs like heroin or cocaine, the tobacco industry argued, cigarettes did not impair a person’s judgment, nor did they affect an individual’s ability to make a decision about whether to quit or continue. The tobacco industry depicted decisions to smoke or quit as “personal choice”—thereby sidestepping entirely the question of addiction. This focus on an individual’s behavior effectively shifted the focus of responsibility away from the very real dangers of the product. Tobacco industry spokespersons claimed that comparisons of cigarettes to drugs “trivialized the serious narcotic and other drug problems faced by our country.”26 In other words, why focus on cigarettes when there were real—that is, more pressing and more serious—problems to face? Contrary to their argument, previously secret tobacco industry documents and industry whistle-blowers provided abundant evidence that the companies were well aware of the addictive effects of nicotine for several decades and had attempted to conceal and distort their own findings. Indeed, the argument of “personal choice” (that one chooses to smoke and to remain a smoker) has been critical to the industry, allowing it to fight against corporate responsibility for the mortality and morbidity from tobacco use. Despite industry claims, cigarettes have been engineered to be efficient nicotine delivery devices, with one industry memo describing a cigarette as “a dispenser for a dose unit for nicotine.”27

Moving from Party Smoking to Regular Smoking Returning to the college campus, how do students think and talk about addiction? In the sections that follow, I explore talk about dependence and addiction that indexes discussions of personal responsibility and agency as well as moral labeling of “the other.” College students invoke a range of differing ideologies and thinking about dependence and addiction, and concerns about their own trajectories. Do college students who smoke socially see it as a potential route to regular smoking? Not really. Most students I spoke with believed that they were at little risk of becoming dependent on cigarettes or alcohol. In fact, asking “party smokers” questions about dependence and

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By comparing herself to other members of her social circle who smoked at higher levels than she did, Amy was able to assuage concerns about her own smoking. Her comment “I’m not worried about it” allows her to dismiss the health risks of her behavior. Mirroring back to herself from regular smokers in her environment, she maintained a sense of confidence that she was not a smoker and she certainly did not need to think about addiction. The use of comparative reasoning to others in one’s social network was also expressed by Morgan, a freshman who returned from winter break to find that one of her roommates had moved from social smoking to suddenly “claiming” addiction. As Morgan recalled, It was just disgusting. There was no point in it, we’re all social smokers. I mean I know there’s really no point in smoking, but we all do it, so it’s like, whatever. But to hear her all of a sudden be like, “Oh, I’m stressed out, I need to go smoke,” just felt so fake. . . . She’s always been like Miss Perfect, and she started occasionally doing this thing like she needed to smoke. I just got so annoyed with her. It’s not like she was addicted, she was trying to act like she was, but she really wasn’t. . . . It just lasted a couple of weeks. Walking to class she’d be like, “I’m fighting the urge,” and I’d be like, “Shut up. You’re not fighting an urge.”

Morgan’s refusal to acknowledge that her roommate could actually be craving cigarettes, one of the hallmarks of dependence, is noteworthy. On one level, Morgan expresses annoyance that her roommate is acting like a “poser” who needs a cigarette. But Morgan’s commentary speaks to the belief that a person can control addiction.29 She may also assume that because her roommate typically smokes in party contexts, she can’t be addicted. As a social smoker, Morgan controlled her cigarettes and when she chose to have one; cigarettes did not control her. Why couldn’t her roommate do the same? Her observation that her friend’s cravings only lasted a few weeks speaks to the shifts that can occur on a smoking trajectory early on in the process and the contextual nature of dependence. This annoyance at someone “really needing a cigarette” was also expressed by Kate, a freshman social smoker, with reference to several women on her floor who smoked:

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her age cohort should be somehow less susceptible to this “hopeless” or “disgusting” condition. After all, shouldn’t college kids be able to party hard and bounce back, and be able to use substances at will but not really need them? Youth is marked by flexibility, the ability to do “whatever,” to act out of control when having fun. Addiction, on the other hand, connotes rigidity—those people who continue to smoke because they have to. Calley distances herself from what she sees as the irresponsible, amoral behavior of those who “have fallen so easily into a trap.” Her own smoking practice is controlled, and thus, she retains her moral identity. Recently, the researcher Janet Hoek and her colleagues conducted an interview study with social smokers, aged nineteen to twenty-five, who identified themselves as nonsmokers. Data analysis revealed a tension and paradox faced by these smokers: while they enjoyed the cachet and superior status that being a nonsmoker brings, they engaged in behavior that attracts stigma and social disapprobation and overtly undermines the desirable position they wish to occupy. Because social smokers rejected “smoker” labels and the negative connotations these have, they struggled to maintain mutually exclusive identities and could not ever fully adopt either since doing so would disbar them from the other. This ambiguous identity requires social smokers to sustain an inherently contradictory position; they cannot consider themselves as either addicted smokers or smoke free.30

Their depiction of their respondents’ “ambiguous identity” seems equally apt for the college students whom I interviewed, as many of them described themselves as somehow “above” addiction. These authors also note that one of the ways young people dealt with this cognitive dissonance was through the consumption of alcohol, which absolved them from responsibility for their behavior. After all, if you were drunk, you could hardly be responsible for keeping track of how many cigarettes you were smoking. For many party smokers whose smoking was confined to weekends, smoking cigarettes was not considered to be a very risky behavior, especially when compared to the use of illegal substances on campus. Other drugs, like cocaine or methamphetamines, were perceived to be more

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Mimi: Would you say your smoking is a habit or an addiction? Kayla: Well, that’s a hard question, because I don’t want to say it’s an addiction [laughs]. For me it’s kind of both. It’s an addiction when I’m in a bar and there is no way that I’m not going to go outside and have a smoke, . . . I totally have to have one. But otherwise, it’s a habit, because if I want one I’ll have one, if I don’t, well I can go through weeks without having one. So I guess it’s kind of both. It’s a habit [pause]. Well, gosh, . . . if it’s an addiction in one place, I guess it would have to be an addiction in another place [laughs]. Mimi: So what’s the difference between a habit and an addiction? Kayla: Well, I think with an addiction there’s a physical reaction when you don’t have it, from not having that substance, and a habit is just doing it because you want to.

Kayla’s reluctance to label herself addicted is not surprising. In her responses, she observes a potential incongruity in her self-description. How can she be addicted in one sphere of life (the bars) but not in another? To mitigate the incongruity, she laughs it off and returns to her depiction of her smoking as a habit. This example shows the difficulty of distinguishing between these two terms, even—or especially— for the user. Some people gauged whether their smoking was a habit or an addiction by the amount of time they could go without cigarettes. Yvonne, who typically smoked about thirty cigarettes a week, described her smoking as a habit but not an addiction: It’s a habit because I’m used to smoking regularly, but I’m not addicted because I can go maybe a week before I have to have a cigarette. You know, and then I’ll be like, “I’d better get a pack of cigarettes.” . . . I’m used to it. Like, you know, some people are used to biting their nails, they do that all the time. My habit is smoking, I’m used to it, and it’s something that I do. . . . But I can go a couple of days without a cigarette so I feel like I’m not addicted to it yet. . . . It’s not like, “Give me my cigarette now” [laughs]. I’m not scrounging for pennies and stuff like that.

In addition to the days she can go without smoking, Yvonne differentiates herself from an addicted smoker because she does not engage in

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smoking was not good but I really didn’t understand that it’s a bad idea to get into the habit of smoking cigarettes when you drink because some day you’re going to be so used to it that it will be hard not to do that anymore.

Although Anna does not elaborate on her observation that smoking “is way more psychological for girls,” it is an important point. Indeed, some research has addressed this issue. Clinical studies suggest that women are more sensitive than men to the rewarding effects of nicotine, and that women are more likely than men to report that smoking helps to reduce negative affect.31 In addition, women are more likely to express concerns about the difficulty they may face in managing their negative emotions after quitting.32 In a recent experimental study where negative affect was induced in both female and male smokers, female smokers began smoking more quickly following the negative mood induction.33 In other words, women turned to smoking as a resource when they experienced negative emotions.34 As women are more likely than men to experience sadness and depression, they may have “more opportunities to learn and strengthen a conditioned association between smoking and negative affect.”35 Other studies similarly report that smoking among women appears to be less reinforced by nicotine intake and more influenced by non-nicotine smoking-related stimuli.36 Women have been found to be more responsive than men to social and environmental cues to smoke.37

The Family Connection Among students who had family members who smoked, there was a range of attitudes toward becoming a smoker themselves. Some emerging adults who had grown up in smoking households had been vehemently antismoking as children, expressing concern about health risks and the harm of secondhand smoke even at a young age. They found the smell that permeated their household disgusting and would break their parents’ cigarettes or flush them down the toilet. However, by the time some of these youth were in college, they were open to experimenting with cigarettes themselves. Some children of smokers were cautious about how much they allowed themselves to smoke, fearing that they were predisposed to

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parental smoking status has sometimes been found to be a predictor of their child’s smoking, findings of interview data remind us that tacit, embodied observations may offer teens and young adults a false sense of protection at a time when they already do not acknowledge their vulnerability. This sense of protection can undermine other health behaviors. On the other hand, for those who felt they were at heightened risk, such observations could result in hypervigilance. Other students had family members who had smoked and quit, apparently without having much difficulty. Ryan told me proudly, “My dad was just able to quit cold turkey .  .  . and he’d been smoking for about thirty years!” Ryan assumed that he possessed the same type of willpower as his father, and used this observation to continue smoking. Alternatively, some informants remembered with great detail how difficult it was for their parents to quit—particularly how angry and frustrated they had become during that time. Kyle recalled, “When my mother was trying to quit, I would hide in my room, . . . I was about twelve years old and I was scared. She used to say that her cigarettes gave her patience and she could depend on them to make her feel better. When she didn’t have them she was really mean.” By smoking only in social contexts, Kyle believed that he could enjoy his cigarettes but avoid the potential problem that his mother had, of smoking to manage emotions.

Personal Rules Some party smokers described conscious strategies or personal rules they enforced to prevent themselves from moving to more regular patterns of smoking, such as limiting the number of cigarettes smoked in an evening. As George explained, “If I’ve smoked three, then I would feel really guilty about it. I just allow myself to smoke one clove or one cigarette so I won’t really worry about it at all.” Some youth purposefully smoked a brand or a type of cigarette (like Indian bidis or Indonesian cloves) because they disliked the taste and therefore believed they would be physically unable to increase the number they smoked. In this way, choosing a particular kind of cigarette was self-limiting behavior. Christine, a party smoker, expressed concern about becoming addicted as she had begun to experience cravings for cigarettes at times

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who lived in the residence hall told me, “Sure, I’ll smoke again, but you know, I’m like not going to sit on the porch and smoke a cigarette.” “Sitting on the porch” was a reference to women in her residence hall who needed to smoke, and who went outside regularly in a group to do so. By contrast, she saw herself smoking occasionally at parties with friends, but not outside that context.

“Bumming, Not Buying” Another overt strategy to limit one’s consumption and avoid becoming a regular smoker was to rely solely on borrowing cigarettes from others. As Corey succinctly noted, “I always bum, I never buy.” He explained, “I’ve seen the medical research and that’s enough to keep me from becoming a regular smoker. I just bum a couple at parties, and there’s only so many you can ask for from friends!” Even those who smoked daily used the bumming strategy as a way to limit their intake. Ted had been smoking one or two cigarettes a day for the past few months and told me that his brand of choice was Marlboro Menthols. This was a brand that nobody else on his floor smoked. Although he could have purchased them, he recognized that this would increase the level of his consumption: It really helps me as a strategy. I’m sure if I were to continually buy them myself then I’d smoke more, but bumming, .  .  . well, I know it’s kind of shady, but it’s a technique to limit the amount of cigarettes I smoke, because people get mad if you ask for too many. When I bum I mostly smoke Camels, which I really dislike.

Having to smoke a cigarette that did not taste good was a sure way of not smoking too much. The idea of bumming as a conscious strategy was also found among other low-level smokers—those who had established patterns of smoking on a near-daily basis. Josh, discussed in chapter 2 as a low-level smoker, explained that he had arrangements with a few of his friends “where they sort of just bum me cigarettes all the time, whenever I need them, and then like, you know, every two months or so I’ll buy them a pack of cigarettes or something.” He was able to do this because

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your lung capacity per se is not going to be any different than a nonsmoker’s. Mimi: Oh, so how does that work? Kaitlin: Well, it doesn’t cancel out all the damage, but it balances out your lung capacity . . . because if you’re a smoker, your lung capacity is smaller than a normal person’s, right? I mean that’s what I understand. I heard it from a friend who’s on the cross-country team. Mimi: So it’s been important for you to keep active while you smoke? Kaitlin: Yes, but when I was on a study abroad program last semester, I was smoking even more than I do now. I was running every other day or daily and I didn’t feel like my smoking was making it harder for me, because I felt like my lungs were the same size even though, yeah, they’re getting black and tar-coated and nasty . . . but I could still breathe at the same rate.

Kaitlin’s observations of her ability to breathe deeply provided her with an objective measure of how tobacco smoke was (or was not) affecting her body. While acknowledging that her lungs were being affected by smoking—“getting black and tar-coated and nasty”—Kaitlin positions herself as maintaining health in other ways. She minimizes her risk not only through her healthy practice of running but also by commenting on the apparent good health of “the best athlete on the team,” who smokes twice as much as she does. This harm-reduction strategy of being active also emerged in the narrative of Gabrielle, a junior who taught spinning classes at the campus recreation center. A low-level smoker, she felt that her intense level of working out probably balanced out her smoking habit. Between her spinning classes, she often took a smoking break. Like Kaitlin, she was confident that “smoking had not decreased [her] lung capacity,” which she carefully monitored in classes. She felt that as long as she smoked moderately (three a day) and continued with her present level of exercise, she would not experience harmful “side effects” of smoking. For Gabrielle, who sometimes heard caustic remarks about her smoking from coworkers, the stereotype of a smoker was a person who was “unathletic, self-indulgent, and almost a glutton.” “It’s particularly bad if you’re a woman who smokes,” she told me, “because women who smoke are viewed as unfeminine and not caring about their bodies or their

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Choosing the right brand helped smokers like Dara feel that they were lessening the potential harm of smoking. Taylor, who smoked about five American Spirits a day, explained that she smoked this brand because “it prevents you from feeling like really awful the next morning.” She continued, If you’re out drinking and you smoke like ten cigarettes one night, you’ll feel a lot better the next day if you’ve smoked American Spirits, compared to if you were smoking Marlboro Lights. In American Spirits there’s no chemicals, no additives, and they burn slower. They don’t have that special paper to burn quicker. They’re the honest cigarette, . . . ’cause all the other brands, . . . we can smoke them quicker and so we end up smoking more of them.

Not only was the product viewed as more healthful because it was additive-free and made with organic tobacco, but it was also an “honest” cigarette, evidenced by the fact that it did not contain special chemicals in the outer paper to make the cigarette burn more quickly. Even in the aftermath of a hard night out, switching to these cigarettes made Taylor feel somewhat better about what she was putting in her body.

The Tobacco Industry and Harm-Reduction Products Additive-free cigarettes like American Spirits are typically advertised as “natural,” consisting of whole leaf natural tobacco with no chemical additives, preservatives, or reconstituted tobacco. In one study that examined laypersons’ opinions about additive-free cigarettes, a majority of adolescents and approximately a quarter of adults surveyed believed that the advertisements implied that additive-free cigarettes are healthier and/or less addictive than conventional cigarettes.39 In reality, however, there is no evidence that additive-free cigarettes are safer than conventional cigarettes, and the Federal Trade Commission has ruled that such advertisements are deceptive.40 Indeed, one study that tested nicotine levels in both American Spirit and conventional unfiltered cigarettes found that American Spirit cigarettes deliver substantial amounts of nicotine—even more than unfiltered conventional cigarettes.41

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color and brand imagery. It is worth reasserting that smoking light cigarettes is not less harmful, and in fact may be more dangerous because some people inhale them more deeply than regular cigarettes.

Summary: Moving along the Trajectory Many of the students whom I interviewed believed that they were not addicted to cigarettes and that smoking was a habit that they engaged in when they chose to, at times that they and others deemed appropriate. During interviews, addiction talk often indexed context. Respondents might state that they felt compelled to smoke at a bar or party when drinking—social contexts that seemed to demand smoking—but not in other social spaces or at other times of the day. Being really addicted, defined as needing your cigarettes “wherever you are,” was associated with those who were weak of will or had real problems. In contrast, many college students saw themselves as needing to smoke but only in a limited number of contexts. Students often described themselves as “not the type to get addicted to cigarettes,” and claimed that cigarettes were something they used, but did not need. They separated themselves from real smokers, whom they had no desire to become. Three patterns emerged with relation to family history and perceived addiction. Some young people expressed concern that they were at high risk of addiction to smoking and drinking, so they had to be careful to smoke only one or two cigarettes and not consume too much alcohol. Others had memories of family members who had suffered from smoking-related diseases, but seemed to blow this off as if it had little personal significance. Still other respondents proudly acknowledged that they had “immunity” from smoking-related diseases because their family members who smoked never seemed to get sick. Tobacco prevention messages received in middle school, several years before many of these emerging adults had started smoking, were vaguely recalled by college students. Few students could relate to these early messages, or grasp the meaning of addiction at such an early age. From my observation of school-based prevention programs, it appeared that those children and youth who best understood the meaning of addiction were those who had parents who smoked and who had witnessed it firsthand. These youth had observed their parents’ anger

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at the same time is responding to a demand of people who want to continue to enjoy the pleasures of smoking but also want to feel good about themselves. Comments by social and occasional smokers such as “at least I’m not smoking cigarettes with chemicals” or “organic cigarettes are healthier for me” are enabled by an industry that has worked hard to popularize the idea that safe smoking is possible for an increasingly health-conscious population. As a result, a population of young adults is lulled into a false sense of security.

7

Tipping Points Stress, Boredom, and Romance I probably use smoking in two different ways, you know, like at parties it’s like a kind of pump me up or it goes along with my drinking. During the week, it’s more about stress release. To me, the party side seems more normal or healthy. I mean, I feel more comfortable using it as a social tool than like a coping tool. —Michael, nineteen-year-old male

During our interview, Michael describes himself as “someone who is not really a smoker but smokes every once in a while.” Despite his selfcategorization as an infrequent smoker, his narrative reveals that he smokes every evening. In fact, he averages about three cigarettes each day and more on the weekends. In the spring semester of freshman year, Michael often finds himself overwhelmed with homework assignments and class projects for his demanding economics major. Several times in the recent past, when the stress gets to him, he has come to “rely on” smoking to help him manage. And it’s not just about classwork. He shares a recent time—just last week—when he was experiencing “relationship stuff ” that resulted in his smoking four or five cigarettes a day—closer to what he’s smoking on the weekends when he’s partying. Not only is smoking a big part of his going out and socializing, but it has also become “a break or relief from stress or something.” Reflecting on the pattern of his smoking, Michael comments, “I guess I am more dependent on it now.” In this chapter, I explore three contexts that can be characterized as tipping points in smoking trajectories. Although there are undoubtedly other tipping points of importance, I highlight these as markers of change because of their salience to many college students. The 148

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most common of these tipping points is associated with stressful life events, such as class projects and exams, problematic social relationships, or identity issues. I draw particular attention to the social utility of smoking in contexts associated with stress, acknowledging that tobacco use also has psychological and physiological effects when used as a form of stress management and self-medication. I explore how students use smoking as a multifunctional tool for stress management and what motivates them to do this. I then turn to the tipping points of boredom and romance as two other triggers of change in smoking behavior. It is well established in the general population that increases in smoking are often precipitated by stressful events.1 Being stressed is a common and perhaps inevitable part of daily life. Some researchers define stress as an objectively identifiable event that requires adaptation, while others define it as an individual’s subjective appraisal of his/ her own ability to effectively cope with external demands.2 Whether it is an event that makes individuals feel stressed or their appraisal of a situation as beyond their ability to cope, a stressful experience elicits both emotional and physiological reactions. Use of substances to relieve stress is common, and both drinking and smoking are substances that people turn to when they need stress relief. Smokers typically report that they smoke more when they feel stressed, angry, anxious, or sad as they expect that smoking will alleviate their negative mood.3 Clinical studies suggest that women are more sensitive than men to the rewarding effects of nicotine. Self-reports of positive mood effects after smoking are higher in women compared to men smokers.4 The question of whether smoking and nicotine actually alleviate stress has yielded mixed results in the scientific literature. At the conclusion of an extensive review on the relationship between smoking, stress, and negative affect, the psychologists Jon Kassel, Laura Stroud, and Carol Paronis note, “although the field has predominantly asked ‘does it or doesn’t it’ questions with respect to whether nicotine possesses genuine mood-modulating effects (independently of withdrawal relief), we believe it wiser to reformulate questions into ones that take context into account.”5 As an anthropologist, I concur. To date, few studies have examined stress and smoking among college students and how different contexts affect use.6

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“to relieve stress before or after an exam” (51 percent); “as a brain break” (49 percent); and “because I was bored” (46 percent). We then asked them why they had selected these responses and to expand on how (and whether) their smoking had changed during finals. We found that just as in social situations, there were multiple functions served by smoking when under examination stress. One commonly voiced assertion was that smoking helped clear one’s mind when shifting from one subject to another and was an aid in alleviating anticipated stress. Steve, an engineering student who smoked one to two cigarettes a day, enjoyed smoking while walking from the residence hall to the library, where he did most of his studying. Smoking helped him relax and transition from the stressful events of the day to the serious concentration and focus he needed for his evenings in the library. He also enjoyed smoking when returning to the residence hall, as a way to transition to his living space. For Steve, smoking was mostly a solitary behavior. It is worth noting that engineering students were under a lot of stress in their freshman year as they needed high grades in their major to continue in the program. Another student, Nick, described himself as “easily annoyed in large freshman class environments,” and smoking helped him cope with his anticipated stress of being in the classroom. As he explained, “When I’m headed off to class, if I know I’m going to be stressed out, I try to beat myself to it, and calm myself down. Knowing that I’m going to be annoyed, I have a cigarette, which makes me feel better.” Students described a variety of ways cigarettes helped them refocus their thoughts during a study session, facilitating greater concentration. For example, Courtney, who smoked four cigarettes a day, explained how “even if I’m on a roll studying, I’ll just suddenly go blank.” To help her work through that, she takes a short break, and a cigarette provides her the opportunity to do that. For Courtney, smoking is a productive time, shared with friends, that helps to relieve the stress of excessive concentration. During this break, which lasts about three to four minutes, she disengages from her studies, calms down, and is recharged. The break is circumscribed, lasting as long as the cigarette. She then returns to her studying with a renewed focus. Other students echoed Brian’s observation that a smoking break helps him puzzle through an issue, allowing him to work more

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they want to give you time to study. So at night, you’re like, all right, all I have to do is study for this, and you end up just putting that off. I mean you have a lot of free time, so it’s like, “Hey, let’s go smoke a cigarette.”

Students also described using cigarettes to change their mood or frame of mind when transitioning from studying to “being social.” This might be analogized to an adult having a drink to help wind down after work, a behavior referred to in the alcohol literature as “re-keying.”11

Smoking before and after Exams Students described smoking to reduce the nervousness they experienced before taking a test. Matt, a low-level smoker, described how he had smoked earlier that day while walking to take an exam with his roommate, a behavior that was unusual for him. “My roommate smokes and he lit up a cigarette, so I thought I might as well too.” Some described smoking after an exam as a way to calm down, especially if the exam did not go too well. As Scott described, “After a test, I smoke to just try to get rid of knowing how bad I failed.” Another student similarly described smoking as an after-test relief: “I went in expecting that the test was not going to be that bad, and then it’s like nothing like what you’ve studied and I’m like, ‘Oh my god!’ So smoking just gives me a few minutes to let that soak in.” Some students reported changes in smoking topography, meaning the way they smoked a cigarette. Before an exam, students smoked their cigarettes quickly and inhaled deeply. After an exam, they smoked more slowly, to mellow out.

The Power of the Group Having a study partner who smoked or being in a study group with smokers was a trigger that provided opportunity for increased smoking, even among those who otherwise smoked occasionally at parties. I was surprised when Anthony, a freshman who described himself as someone “who always hated smoking, the smell, the taste, the whole concept of it,” told me that he had smoked a pack of cigarettes so far during finals.

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“You guys should not smoke.” I mean when it’s a habit it’s a totally different thing. They don’t want me to start smoking, but one of the guys finds smoking to be a really good stress reliever and he thinks he’ll probably do it through college and then quit. . . . I don’t want to be that way because even for four years that’s going to affect your health. Mimi: So where do you see it going? Anthony: To the end of this pack. I’m really done with it now, but I bought them, so I might as well finish them.

So why would a nonsmoker like Anthony embrace smoking as a stress relief strategy during finals? A potentially useful explanation for his behavior is to be found in the work of the researchers Nicholas Christakis and James Fowler, who suggest that our social networks shape virtually all aspects of our lives.12 In their purview, emotions spread from person to person because we are hardwired to mimic others outwardly, which impacts how we feel inwardly. In an interconnected group (i.e., a concentrated network like a study group), there is a kind of synchrony that develops (for smoking or quitting). This may be what Anthony experiences, what makes him feel like smoking even though it’s something he quite dislikes. Our brains practice doing behaviors that we observe in others; emotions and behaviors may be “contagious” in part because of the mirror neuron system in our brains.13 As we continued with the interview, the power of the group to influence behavior became more apparent. Anthony—an infrequent smoker—was unusual, but certainly not alone, in embracing smoking for stress relief. What really surprised me was that beyond smoking with his study group, he had also smoked half a pack alone. Toward the end of the interview, he related what had happened on his way to an exam that morning: “I wasn’t even stressed about the test, . . . I don’t know, . . . I just had a cigarette for no reason.”

From Stress to Distress Students also discussed the benefits of smoking when experiencing relationship-related stressors. For Stacy, having a cigarette was useful to help modulate or even out emotionally charged stressful states. As

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smoking entails the use of a cigarette as a tool to express solidarity with a friend. For example, one male student who typically smoked one or two cigarettes a day described how he sometimes smoked more when his roommate was feeling distressed. During such times, he smoked to keep his friend company, which he thought would make him feel better. A second pattern of behavior, overlapping with but distinct from empathetic smoking, is best described by the term secondhand stress, also described above in relation to studying during finals. Secondhand stress, found to be more common among women, occurred when the stress that one’s friend was experiencing actually became one’s own. Abigail, for example, explained how she often experienced the stress of her close friends: “When someone’s upset, like a really good friend, I’ll get upset also. If someone has hurt my friend’s feelings or done something intentionally to my friend to upset her, it makes me mad, so usually I’ll have a cigarette to cope with that.” She also explained that having a cigarette while listening to a friend’s problems helped her to simultaneously listen intently to what was being said and at the same time, provided distraction, which prevented her from “from soaking up all their problems along with my own.” Cigarettes helped Abigail manage the multiple stressors she encountered in her everyday relationships. I suspect that the notion of secondhand stress may be felt more acutely among women than men. Research among adolescents has found that young women perceive negative interpersonal events as more stressful than males do, and experience more negative affect both in the family and in the peer context. As discussed in the previous chapter, cigarettes appear to play an important role in managing emotions, particularly for women. During smoking abstinence, women show greater levels of anxiety, depression, and stress than men.15 This may be one reason why they have lower rates of quitting and lower rates of success with pharmacological therapies when compared with men.

Smoking and Boredom When I walk across campus at the university where I work, one of the most common sights I observe is students looking down at their phones as they meander back and forth to their classes. Agile thumbs shoot texts back and forth to friends; Facebook and Instagram provide visual

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effectively pursued with little engagement or input. Another situation in which a college student is likely to experience boredom is in breaks in the schedule: breaks between classes, vacation breaks, uneventful weekends. Derek, for example, described how his week was filled with classes but “the weekends, . . . sometimes you’re sitting around, doing nothing, you get bored, so you’re gonna go out and smoke. That happens three or four times a day, and then with meals, you’re gonna smoke more.” Smoking was a reason for Derek and one or two friends to go out of their room at a time when they were “just doing nothing.” Other students felt like smoking more when they went home on holidays because they didn’t have enough to keep them busy and they felt there was “nothing to do.” This proved problematic for those young adults whose parents were unaware that their son or daughter smoked. The association of cigarettes and the rhetoric of boredom is a notable characteristic of interviews with students who have started to use cigarettes in more established patterns and who are smoking more than in particular contexts like a party or outside the residence hall to catch up on gossip. Attentive to this shift in smoking status, we can identify changes in discourse about smoking that index times of boredom. Such times may occur across contexts, even at parties or when informants describe why they smoke when stressed or to relax: I’m not gonna smoke because I feel self-conscious. I’m not gonna smoke because I feel insecure, . . . I’m gonna smoke because I’m standing there bored, . . . kind of in limbo, you know what I mean? You’re standing there doing nothing so you might as well have a cigarette. That’s the thought process, I guess. Like, I’ll do something. And these cigarettes always make me feel a little better. I think, “Why don’t I just have one and I’ll be more relaxed?”

The link between having nothing to do and smoking is a frequently repeated theme in interviews among those who are establishing a pattern of regular smoking. Smoking cigarettes structures time that is otherwise unstructured. On the most basic level, smoking the cigarettes fills up a time of emptiness (passive boredom). The cigarette “takes up like three or four minutes of your time when there’s nothing going on.”

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of feeling somehow amiss without a connection to others, of needing to fill in time alone, comes to be recognized as a time for a cigarette.

Romantic Partners and Smoking A third tipping point in smoking trajectories was found to be within romantic relationships. The topic is obviously complex because it is not entirely clear what constitutes a romantic relationship on college campuses. What is clear is that relationships among young adults are often intense but short-lived. As Kathleen Bogle has written in Hooking Up, today’s college students do not date as much as have brief, limited encounters with others whom they may not see again.19 While this phase of life often marks the beginning of longer and more intimate romantic involvements, few studies have explored romantic partner influence on smoking behavior.20 Not surprisingly, even romantic relationships that last for a short time or are in their earliest stages can influence behavior. Previous research has shown that in a new relationship people want to project “the right image” and desire to appear compatible with a potential partner.21 Once a relationship is established, romantic partners tend to spend a lot of time together, potentially setting the stage for adopting similar behaviors—like smoking together. Indeed, as intimacy and closeness develop, attitudes and behaviors tend to converge over time.22 One study among young adults that explored how changes in relationship status affected substance use found that among smokers, entry into a relationship increased cigarette smoking compared with those who smoked but who remained single.23 This may well be the result of selection effects, as smokers may enter into a relationship with a partner who is also a smoker. This makes sense, as it has long been observed that smokers tend to be friends with fellow smokers. While interesting, this does not tell us enough about how and why relationships can affect one’s smoking status, and how this changes over time. Two colleagues from the Tobacco Etiology Research Network, Chris Agnew and Paul Etcheverry, conducted two different analyses on the UpTERN longitudinal data set on both romantic partner and friend influences on college student smoking. Study participants were asked whether they were currently in a romantic relationship once a month

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of smoking was predictive in new partner selection. Specifically, those who smoked at lower levels tended to associate with new partners who smoked less and approved of smoking less. Etcheverry and Agnew conclude that romantic partner selection is composed of several important components, including a participant’s own smoking level, smoker prototype, and approval of smoking.

A Case Study of Shifts in Smoking Brittany, an eighteen-year-old freshman whom I introduced in chapter 2, exemplified the shifts in smoking that can result from romantic relationships, although her friends also played a role in her behavior change. Brittany was interviewed several times during her freshman year. While she consistently described herself as a social smoker whose smoking was mostly limited to parties, her narratives (and charting on paper) reveal interesting shifts occurring when she entered new relationships, and later when ending them. In her first months on campus, Brittany smoked about ten cigarettes per week on the nights she partied—which were numerous. As schoolwork became more demanding midsemester, she partied and smoked less. Early in the school year, she dated one nonsmoker for about a month, which had little impact on her smoking as he (a nonsmoker) was not bothered about what she did. After Christmas break, she began a relationship with an active fraternity member who was a regular smoker. Brittany began spending several nights a week at the fraternity house. During this time, her drinking increased, even during the school week, as did her smoking, as she accompanied him each time he went out to smoke. Around this time, Brittany’s roommate in the residence hall (a daily smoker) was increasing her smoking in an effort to lose weight before their spring break bash at the beach. Brittany was concerned about her own smoking increase, and often chided herself as she headed out to join her boyfriend for a cigarette. “I’m smoking way too much. OK. I’ll just have one more.” But this strategy was highly ineffective, as at the end of each day, she would find that she had smoked more than she intended. By early March, Brittany ended the relationship and soon entered a new one with Jared, whom she described as being “just all around perfect” and as “Mr. Health Freak.” She explained,

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and welcomed his aversion to cigarettes because it made her cut back a bit. But she was comfortable with her own smoking and felt that she would not “cross the line,” which she defined as four or five cigarettes each party night. Brittany’s case study exemplifies shifts that occur in behavior as one moves in and out of romantic relationships over the course of the year. Depending on whom she was seeing, her smoking escalated or decreased across her first year of college. Her friends with whom she frequently parties also influence her behavior. What is noteworthy here is not only the number of shifts that occur over the course of the freshman year, but also the continuation of her smoking in an abundance of social contexts. She and her friends also engage in “vacation smoking,” a phenomenon I have witnessed across the globe. As “time out of time,” vacations are often spaces where young adults engage in reckless abandon, made possible in part by the lower cost of cigarettes and alcohol in these settings.

Breakups Another shift in smoking status was evident during breakups. At this time, smoking was a way of consoling oneself. One woman related the following story: My friend Erika called me one evening to tell me that she had just broken up with her boyfriend, who she’d been dating for three months. She was really upset about the whole thing and asked me if I could buy her a pack of Camel Lights and orange juice and come right over. I hated buying cigarettes for her but I felt like I had to because she was so upset and she wanted them. I mean, I had hardly ever seen her smoke before that evening, but I’ve smoked in front of her before. So I went over to her place and smoked just one of her cigarettes. It was my first and last of the day. She had about ten.

I found her recounting of this event disturbing, as it depicts an infrequent social smoker who smokes to relieve stress in a time of need. In this particular case, it seems that Erika had friends who smoked, so perhaps she had observed their use of cigarettes for self-medication. In

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Summary: Smoking as a Resource in Times of Need So how does qualitative research add to our understanding of tipping points in smoking trajectories among low-level college smokers? First, narrative data draw attention to the multifunctionality of cigarettes in students’ lives. Smoking cigarettes is a consumption event that facilitates both “time out” and “time bounded” social interaction. Smoking is also undertaken as a means of taking one’s mind off a stressful subject/event and an aid in focusing one’s thoughts. An invitation to smoke a cigarette with a friend creates an opportunity to interact that is stress-reducing. A social ecological assessment of smoking reveals multiple factors to explain why friends smoke together beyond just “socializing” with peers. I have drawn attention to empathetic smoking, smoking as a way of taking a study break, smoking as a way of celebrating the end of an exam, and smoking to cope with secondhand stress. A sensorial approach to smoking ethnography, attentive to pleasurable feelings associated with smoking and how and when people use products to enhance performance (e.g., concentration and focus), provides insights into the use of tobacco as a drug food for study purposes, as well as a form of self-medication used for the management of emotional and psychological states. Two other tipping points that impact youths’ smoking trajectories—times of boredom, where there is “nothing to do,” and shifts in romantic relationships—have also been explored. Considering the intense sociality of college life, it is not difficult to imagine other contexts that might also trigger upward (and downward) shifts in smoking behavior. But do these shifts really matter? There is some evidence that they do. Kimberly Caldeira and her colleagues administered a survey questionnaire annually to over 1,200 students to track their smoking and drinking behaviors across the four years of college.25 Their analyses revealed four broad trajectories of smoking, which they labeled infrequent intermittent smoking (smoking on one to three days in the past month); moderate intermittent smoking (smoking on four to thirteen days in the past month); frequent-intermittent smoking (smoking on fourteen to twentynine days in the past month); and daily (smoking on thirty days in the past month). They found that those who were moderate intermittent

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in harm reduction? Among those who do express interest in quitting, what are their motivations? How do they go about quitting and what challenges do they face?

“Everything Has Its Risks” Some students I interviewed had little interest in quitting, particularly those who mostly smoked socially. Since their smoking was not extreme or viewed as a problem, they saw little point or benefit in quitting. Pete expanded on this position: Most of the things we do in life have a risk. I mean, do you always wear sunscreen when you go outside? I know smoking has a strong association with cancer and emphysema, but I don’t think that the risk, especially if you smoke in moderation and don’t let yourself be a victim of addiction, . . . that smoking doesn’t present an unacceptable risk. Like anything else, you have to use it appropriately depending on the situation.

Pete did engage in what he saw as harm reduction and had recently cut back from a higher level (eight cigarettes a day) to his current level of two cigarettes a day. This provided a rationale for not needing to quit completely. His lower smoking level was not so much a conscious decision as it was a “natural” result of spending a lot of time in a new relationship with a woman who disliked smoking. In his mind, he was engaging in harm reduction and mitigating the long-term risks of smoking. Not quitting completely allowed him to still enjoy his cigarettes in social spaces where he hung out with friends who smoked. This was important to his identity, as it enabled him to “look like I’m supposed to be there, . . . like I fit in.” Given that he was now “smoking in moderation,” quitting during college or even after he graduated seemed unnecessary and unwarranted. Similar to Pete, other smokers engaged in harm-reduction strategies with the idea that only smoking at a certain level (typically more than five cigarettes a day) is harmful to one’s health. Several students had reduced their smoking level from seven or eight cigarettes a day to three or four, believing that this was much healthier. However, several “harm reducers” engaged in compensatory smoking (inhaling more

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Because once I graduate, I’ll have a forty-hour-a-week job and I’ll be more responsible in a way and not have the weekend partying, and I just don’t think it’s a part of me anymore. I guess it’s not who I want to be. I don’t want to be a smoker.

Lisette links her interest in quitting to her moral identity, which she sees as undergoing a big shift as soon as she enters the workforce. Working marks a new beginning, a time for her to change her errant ways. Part of her decision to quit may have also been the fact that she was moving back to her small border community, where smoking among women was less acceptable and more visible than it had been on a large college campus. And she’d be moving back in with her mom, who smoked occasionally for stress relief. She felt like she needed to be a good role model for her. I was curious whether Lisette had thought about how she would quit or whether she was concerned about whether she would be able to or not. In response to a direct question about this, she said she was “just going to do it”—that she was confident she could, because she had already quit two years back for a whole year. Her one concern was that it might be hard to maintain her nonsmoking routine when she got really stressed or emotional, as she relied on having a cigarette to calm down when she fought with her boyfriend. She hoped she would find some alternative to smoking after she quit for good. Other students also shared this idea about the inappropriateness of smoking in the “real world,” but were not as ready as Lisette to give it up right away. Travis, a senior majoring in creative writing, was one semester away from graduating—he hoped. He planned to travel a bit after graduation, but he was unclear about his future career or what type of job he might pursue. He had begun smoking in his sophomore year when he lived with a smoker. He typically smoked one or two cigarettes a day, but more on the weekend when alcohol was involved. He believed that he would need to quit around the time that he graduated: I think there’s a certain professionalism that goes into a serious career and if you’re taking cigarette breaks when you should be at work, . . . I think it comes across as unprofessional and almost like a lack of selfcontrol or a weakness of the will. If you’re at work you should be doing

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It’s just something you do with people when you’re on a break. But it also may depend on the structure of the relationships. I mean if they’re people that I have to oversee, I may want to look separate to maintain a certain level of distance and that goes along with authority, . . . but if I want to fit in and it would help me build a sense of camaraderie with my coworkers, then I would probably do whatever they do.

His narrative is very informative. It suggests that the fluctuations and shifts that are so characteristic of college smoking may well continue post-graduation, albeit for different reasons. Beyond the social spaces of college life, it also points to some potential “benefits” of smoking at one’s workplace. But this was not always the case. I interviewed one recent business grad who had just started working in an accounting firm. In his white-collar job, he was cautious never to smoke around his work colleagues (or to smoke in the clothes he wore at work) because he was afraid it projected an unprofessional image that might affect his advancement at the firm. In fact, since getting the job, he had been trying to quit with great difficulty. Another consideration in entering the “real world” was that one’s time would be much more limited. Whereas in college there was ample opportunity to be with friends and smoke and drink as one liked, having a job would leave only Friday or Saturday night to “seriously” hang out with friends before it was once again time to go “back to the real world.” Unlike college, this highly structured life would not allow much opportunity for drinking heavily and smoking. One participant noted, “I mean, everyone says college is like the last chance to get out and do whatever. So, for now, I’ll just do whatever. I know it won’t last.”

Aging Out: Be an Adult, Be Responsible A related but distinct idea about quitting was that an individual could “age out” of behaviors that were considered acceptable in one phase of life, but not in another. The medical anthropologist Gilbert Quintero has written about this process of aging out with regard to the drinking careers of Navajo men, who shift from heavy drinking to a “retirement phase.” Quintero views this aging out process through a life course perspective, emphasizing how individual behaviors can be shaped by

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the social situation he’s in, well, he likes it, but he’s like, “I just need to get out of here, I need to stop smoking cigarettes, I need to stop drinking,” and he thinks getting out of here will make it all change. I think that’s really true, . . . I mean, when we get to a certain age—that we’re almost out of college—you gotta stop.

Adam recognizes that his co-substance use is part of a college lifestyle that will soon be coming to a close. He views the three substances he has used in college (weed, cigarettes, and alcohol) in terms of a “hierarchy of risk,” with tobacco conceived of as the least risky.9 After quitting weed, Adam settles on cigarettes as the “lesser of evils” because of its utility in stress reduction. In his imagined future, he will no longer be using any substances. Chris, a senior who had been a ten-cigarette-a-day smoker since high school, predicted that he would soon reach a time when he would age out of smoking and quit: “I’m getting to an age where I don’t feel like it fits me anymore or fits the image I want to portray to other people. Which for me, I guess it was just another time and maybe I don’t want to be seen how I used to be.” What was of particular concern for him in this aging out narrative was that by continuing to smoke he might be promoting it as an acceptable and cool behavior to his younger brother, who looked up to him. Several male students echoed this perspective, leading me to the humorous conjecture that college graduation somehow activated a “role model gene,” perhaps because students were considering moving back home to their parents’ house. Consider twenty-one-year-old Blake’s comment: “I don’t want my younger brother or his friends to see me as a smoker. That’s why I’m going to quit soon. I mean if my little brother ever smoked I’d be like, ‘You’re an idiot.’ It starts out as something social and turns into addiction, obviously. I don’t want younger kids to see me smoking, kids who might look up to me.”

“But I Can’t Quit Right Now” Despite the recognition of the need to quit, there were several factors that arose at the end of college that made it difficult to firmly conceptualize a quit time. First, for many students, the end of college is a

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and “starting a family”—that were identified as the “perfect” time to quit. Not only did a serious relationship structure one’s imagined quit behavior, it also played a role in how one selected one’s life partner. For example, Benjamin, who smoked about three cigarettes a day, explained, As I get older I would never get in a serious relationship with a woman who smokes, just because I don’t want a smoker to raise my kids. It’s kind of disgusting, you know. I mean, I wouldn’t judge what they’re doing, but I know what I want for myself. By the time I settle down, I won’t smoke and she won’t either.

The idea that a serious relationship would be the clarion call to stop smoking was also discussed by Charlie, a college senior who had been smoking four cigarettes a day for the past year. He had successfully quit for two months earlier that year, but had started up again while on a road trip with friends. In his interview, he talked about his intense dislike of smoking, so I asked him whether he planned to quit again, and if so, what would motivate him to do so. He responded, It’s hard to say. I think the thing that would make me quit right now would be getting into a serious relationship. That would be something I would quit for. I mean, by the time I’m going to get married, that would be the point where I’d want to quit, at the very latest. So that could be a long time or a short time from now.

I also heard a common discourse about quitting when one got pregnant. One of the reasons behind quitting when you had children was the recognition “that it’s not just about you anymore.”10 But this was a time that was way down the road. As Victoria, an eight-cigarette-aday smoker, explained, “Some of my friends have said, ‘I want to quit smoking by the time I start having kids,’ and we’ve had that kind of conversation, but nothing specific. We just know that we should.” While there was recognition that smoking was bad for the health of the fetus and mother, my sense was that college women had a very generalized understanding of the harm of tobacco to women’s reproductive health and child health outcomes.11 Only one woman I spoke to directly addressed the importance of staying quit postpartum. The daughter of

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someone is telling me I’m living my life wrong, . . . that I should actually be living my life another way, . . . well, it’s like, fuck you!” Later in the interview, he returned to this issue: I don’t know, . . . anytime that you’re being aggressively lectured regarding something that you don’t have any interest in, you just turn off. It’s not going to provide you with more reasons to quit or inspiration or anything like that. It’s the same old stuff you always hear. I don’t think it has much of an impact on me. If it’s visceral, like you’re with a girl who tells you she can’t stand smoking, that’s going to have a lot more impact on what you choose to do.

His girlfriend’s admonishment to quit smoking was better received by him than the antismoking messages he regularly received at the student health center where he went for his asthma medicines. “The nurse thinks I’m an idiot for smoking,” he mused, “but all that chatter about the risks of cigarettes really doesn’t sink in to a smoker’s head. It’s not that we don’t know, we do know, but it’s really easy not to pay attention.” The importance of individual choice and personal decision making about smoking and quitting emerged as a key discourse among those interviewed. While most agreed that quitting at some point was desirable, there was a reluctance to say that you planned to quit. Alex, for example, had quit previously for one year and then started up again. At the time of our interview, she was hopeful that she might try to quit for good following graduation. When I asked her when she thought she would make this quit attempt, she became a bit defensive: I know for me personally, . . . like, I’m not going to set any limit or any boundary on myself . . . because it wouldn’t work, . . . I wouldn’t be like, “Oh, it’s Wednesday, May 19, 2014, this is the day I said I had to quit by or else,” . . . that’s just not my way. That wouldn’t work for me because I’d be like, “Oh, screw that.” . . . And I really don’t like any added pressure of somebody else . . . like my parents, when they were like, “Oh, you can’t smoke,” I was like, “Screw you guys.” So for me personally I think, and from what I’ve seen from other people, it’s like you have to do it 100 percent your own way!

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avoid this struggle by being “mostly quit,” except for times when she’s hanging out with friends or having a drink. While I find this an unlikely scenario, it is interesting that she feels that she can achieve and maintain this status of “part-time” quitter.

Experiences with Quitting Many students thought the best way to quit was to be spontaneous and to quit cold turkey, without much preparation. One college senior who had quit this way used his grandmother’s quit story as his inspiration. He recalled the famous family tale of how someone had offered his grandmother ten dollars—when that was a lot of money—to quit smoking then and there, and she had done it. This was a particularly admirable and memorable feat, as she was a two-pack-a-day smoker and had been for many years. Rob, her grandson, who smoked ten or more cigarettes a day, kept her in mind as he similarly cast away his cigarettes for good. Spontaneity in quitting sometimes came from people waking up after a hard night of binge drinking and binge smoking and feeling horrible, particularly if they were not accustomed to smoking that much. Students described feeling that they had overdosed on nicotine and that they had just crossed a threshold. Feelings of nausea, an excess of phlegm, and heaviness in the chest were “disgusting” and served as inspiration for some to “quit” smoking. I suspected that some of these attempts would be short-lived. Quitting, some felt, was something that one should be able to manage on one’s own, using willpower and inner strength. One student who smoked about four or five cigarettes a day felt assured that he would be able to quit when he wanted to. After all, his mom had quit cold turkey under pressure from his dad, and his best friend had quit in the same way when his girlfriend opposed his smelly habit. He said, “When I place more value on something above cigarettes, the cigarettes will just kind of go away. So I won’t need counseling or gum or the patch or anything like that.” For him and other low-level smokers, if you were totally committed to your reason for quitting, you could “just do it.” In fact, there seemed to be a tacit assumption that needing a product to be able to quit was admitting that you really were under the

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for quitting and relied mostly on social support from friends or family to help them quit.17 They also found that young adults rarely received advice to quit from health care providers. These findings resonate with my interview data, which revealed that social and low-level smokers often hide their smoking status in health care encounters in an effort to avoid “a boring lecture” or because they simply do not see themselves as smoking enough to make a difference.

Testing Your Willpower The notion of having sufficient willpower was important in the formation of some people’s smoking trajectories. For example, Austin, who smoked one to two cigarettes a day at the time of our interview, had a history of starting and stopping smoking over the course of his college career. He described his unusual entrée to smoking during his freshman year: I guess I was just feeling bored and wanted some kind of change. There’s a lot healthier ways of changing something in your life, but I just felt like picking up smoking. My friend suggested it to me because I turned eighteen before he did. He said, “You know, when I turn eighteen I think I’m going to pick up smoking just so I can eventually quit. Pick it up, become a smoker, then flat-out quit, just to show my willpower over a substance.” So that kind of inspired me, you know, to be able to exert some kind of willpower over something in your life. So I picked it up. I enjoy smoking, having a cigarette relaxes me. It gives me something to look forward to. Like I smoke for about two weeks to a month and then I’ll be like, “I’ll quit now.” And now I know that I can successfully quit when I want to . . . so I know that when I feel like smoking again, I can start up. Except now I’m sort of ignoring all of that and continuing to smoke.

Austin was unusual among low-level smokers in that he used quitting as a metaphor for asserting control over issues in his life that he was otherwise unable to control. Each time he quit, he did so with the understanding that it was a temporary break and that he would start up again shortly, because he enjoyed how empowered this made him feel.

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I don’t think there’s anything that could make me smoke again, just on the basis of how hard it was to quit, I don’t want to go through that again. That’s the main thing. That’s what my mom said. I was thinking I was going to relapse about two months ago and I called her, I was like, “I want a cigarette so bad,” and she said, “Do you remember the first week after you quit?” and I was like, “Yeah,” and she was like, “Do you want to have that week again?” and I was like, “No,” and she was like, “OK, don’t be stupid.” So what I think is if you quit, don’t even smoke one. That’s how I figure, because I know I’m not gonna smoke, I’m not gonna go back to smoking, ever.

Support from Friends One college senior who had successfully quit after smoking ten cigarettes a day for several years told me that he received a lot of positive reinforcement from his friends, who were “kind of taken aback by the fact that I quit.” He was particularly proud to share with me that one of his close buddies, someone who he never thought could quit smoking, had been so inspired by his quit that he was now also trying to quit. Interestingly, the friend hadn’t told him this directly. He explained, “We were all hanging out with our group of friends and somebody asked him for a cigarette and he said, ‘No, I haven’t smoked a cigarette for a week and a half.’ Then he nudged me and he was like, ‘Eh eh,’ and I’m like, ‘OK!’” I asked whether his friend was still quit. He hasn’t smoked a cigarette since then. He’s a pretty tough hombre. This isn’t somebody who’s easily influenced. He doesn’t run with the crowd kind of thing, he’s not gonna just do what I do or something like that. And everybody else has been like, “Damn, how’d you do that?” you know, they’re still sitting there, still puffing on their cigarettes, like, “How did you pull that off?”

Although I cannot speak to the commonality of this type of spread effect on college campuses, it is interesting to note that a few women I spoke with had made quit attempts along with other women friends— much in the same way as they may start diets together or indulge

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Standing One’s Ground as a Smoker In closing the chapter, I want to note that not all people were involved in or cared about quitting. Indeed, some responded negatively to changing social norms about smoking. They were particularly annoyed at being stigmatized and felt they had every right to choose their own poison. Stigma marked an individual as different from others and consequently not as good as others.21 This was a topic of some importance to students who smoked regularly, as they were often the recipients of stigmatizing looks and overt derogatory comments about their smoking. Some researchers have noted that public health “denormalization” strategies (campaigns that seek to reinforce the norm that tobacco is not a normative activity in society) have had the result of actively stigmatizing those who smoke.22 Two women graduate students, good friends with similar smoking habits, were interviewed together and discussed this topic. Mimi: Both of you are still enjoying your cigarettes. Is there anything about smoking that you don’t like? Tara: Being a smoker today is a terrible stigma. You get dirty looks. Sometimes it’s annoying. Sometimes I enjoy pissing people off, like I just feel like saying, “What’s it to you if I smoke?” Mimi: Who is giving you these dirty looks? Tara: Old people, people with kids, people who are judgmental. When you are standing in a place and you’re smoking and someone walks by and gives you a dirty look, it’s like, “Hey, I’m sorry for smoking but I was here first.” I mean, obviously it’s bad for you and obviously as a person in a social setting you need to be conscious of other people because they don’t like smoke and secondhand smoke is bad for you, but I think this whole judgment of people in a public sphere just gets a little absurd sometimes. In every era, there’s moral judgment of the other going on. Mimi: Yes, there’s often judgment based on how people look, how they dress. Danielle: Yes, it’s this attitude that “I’m better than this person” or whatever. I see that and I see that you are looking at me . . . like I’m the devil incarnate. But then I see you get into your twelve-mile-pergallon SUV with your kid and drive off, and which one is really more

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an SUV really any better than smoking a cigarette? What gave people on the street the right to judge them? Tara and Danielle faulted public health campaigns for the demonization of smokers. They recognized the need for smoke-free legislation. But why couldn’t they smoke outside? Given the cultural imperative to take care of one’s own health, smokers come to be viewed as individuals who are uncaring of their own bodies and irresponsible toward the greater environment. A smoker’s moral identity as a responsible being is challenged, as he or she is often viewed as a person who is making stupid choices and one who has failed to embrace commonsense health knowledge. The response of Tara and Danielle to their stigmatization was not unusual among low-level smokers who smoked in public places. Others similarly expressed outrage and at the same time a sense of defensiveness and rebellion in response to the critical gaze of others. Josh, discussed earlier, explained how despite the stigma that he felt smoking in some public spaces, he believed that smoking a cigarette displayed a sort of confidence . . . in the sense that despite all, you’re willing to be self-indulgent, . . . in the face of societal stigma or the health risks involved, you’re willing to do it. There’s something confident about that, I mean, as opposed to being seen as completely pathetic, which people might look at you as because you smoke.

Through this type of reasoning, Josh skillfully manages to minimize the stigmatization of smokers like himself, offering a positive spin and reinterpretation of the behavior. The issue of how college students deal with the potential stigma of their behavior has been discussed by the sociologist Katherine Sirles Vecitis in her research on young women’s accounts of their instrumental substance use and management of their bodies.24 She highlights the “accounts” that women provide to explain their behavior, meaning “statements made to explain untoward behavior and bridge the gap between actions and expectations.”25 College women whom Vecitis interviewed were engaged in the use of prescription drugs (e.g., Adderall, among others) and illicit substances (e.g., cocaine) for weight management. Similar to the smokers discussed above, these women neutralized the potential negative impacts of their behaviors by reinforcing the

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smoking in the face of societal restrictions and bans on smoking in public places. Using a social ecological lens, we can turn our focus here to macro factors relevant to a holistic analysis of tobacco use. On the societal level, tobacco control has embraced denormalization strategies, reinforcing an ideology that smoking is no longer acceptable as a normative behavior. This has been met in different ways by young adult smokers. On the public health side, denormalization campaigns have helped foster a growing interest in quitting—at some point—among many social and low-level smokers. Most recognized that it was just not okay to smoke when one entered the adult work world. On the personal liberty side, however, the cost of these denormalization strategies has been high for low-level smokers who continue to smoke in public spaces. Some young adults expressed anger for being stigmatized and marginalized for their behavior. They felt that their moral identity was under attack. This fostered a defensive posture and a determination to continue smoking. Within the purview of emerging adulthood, this developmental period is marked by an intense self-focus, when one is faced with many decisions about how to live one’s life on one’s own terms. As we turn to the concluding chapter, we see how the end of college and the period beyond—times marked by instability and frequent fluctuations in one’s everyday life—affect smoking trajectories.

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Looking Forward Uncertain Trajectories If I were to move to a new place after graduation, I would probably increase my cigarette smoking because it serves to accompany loneliness. I’m sort of ashamed to say it, but cigarettes are a friend. If I was in a new place and I didn’t know people, I would need to have cigarettes to depend on. I just don’t know if I could do it on my own. —Kyle, twenty-one-year-old male

The speaker of the above quote, Kyle, was one of the last interviews I conducted with college seniors about what their smoking might look like after graduation. Given that Kyle was a low-level smoker (about three a day), and that he had successfully quit a couple of times during college, I thought he might embrace quitting once again as he entered the “real world.” I was surprised, then, that he thought he would probably smoke more once he was on his own. Kyle’s sheepish and somewhat embarrassed response that his cigarettes were friends that he would need in a new place reinforced the point to me that it is not how many cigarettes you smoke but the meaning of cigarettes and the contexts in which you smoke that can make even the thought of quitting difficult. At some point after college—at least as the script was once written— you’re “supposed to” be transitioning toward adulthood, at which point you have a job, a stable living environment, maybe even a partner. But this scenario seems far afield from the reality of today’s graduates.1 In fact, for many young adults, this may be more like a lingering cultural myth. Consider that in 2011, more than half of all Americans under age twenty-five with a bachelor’s degree were either unemployed or underemployed. All across the country, college grads can be found working 194

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in coffee shops, waiting tables, being bartenders, and working behind the register at retail stores. Over a third of those in their twenties move to a new residence every year, and many will go through an average of seven jobs during this decade of life. In the face of so many uncertainties, it is clear that the march toward adulthood is indirect at best.2 If you continue “emerging” toward adulthood till age thirty (or beyond), what happens to smoking behavior? These twenty-somethings may not see a “need” to quit—in fact, their many stressors (including not getting appropriate work, having to pay their bills and repay loans, having to make new friends as they move from place to place, etc.) may well contribute to unstable and prolonged trajectories of tobacco use. Two other factors are also likely to contribute to the continuation of social and low-level smoking among young adults both in college and after graduation. First, the cost of purchasing cigarettes in many states is becoming prohibitive, making it difficult for young people on limited income to smoke too much. Second, the banning of smoking in public places has resulted in fewer places to smoke and increased stigmatization of smoking. In the face of these constraints, new nicotine delivery devices have arrived on the scene with a promise of making smoking both affordable and acceptable in public and private spaces. Let’s briefly explore what these are and consider how they may impact future smoking behavior.

The Appeal of E-Cigarettes and Hookah Bars As a new nicotine delivery device, e-cigarettes are designed to look and feel like traditional cigarettes and deliver a nicotine vapor to the user.3 Initially, they are titrated to the nicotine level a person is accustomed to, with the idea that one can continue to reduce over time, if one so desires. They are promoted as a healthier and safer alternative to cigarettes and an aid in quitting or in reducing the number of cigarettes smoked. Their popularity has been growing steadily. Having first entered the U.S. market in 2007, they have seen a doubling of sales every year since 2008.4 At present, e-cigarette sales account for only 1 percent of the $80 billion U.S. cigarette market, but this is projected to change and will reach $1 billion in the near future.5 They are aggressively advertised

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that comes out of it, it’s vapor, so you’re not smoking, you’re vaping.” Many vapors become members of a “community of practice” (either in person or online) where they share information about products, how to use them, different nicotine “juices,” flavorings, and a host of other advice provided between new and established users. In terms of identity, e-cigarettes convey a trendy as well as a techie image (“like something you would find at Brookstone”), allowing people to customize their look by the product they purchase (making “mods,” or personal modifications) and the type of nicotine “juice” used. Unlike cigarettes, which are smoked out of a standard pack, e-cigarettes are tailored to and by the user. Juice flavors are labeled with the youth palate in mind, with names such as Blue Melon, Kiwiberry Candy, and multitudes of other floral, sweet, and tropical possibilities. For those who prefer their e-cigarette to taste more like a regular cigarette, there are tobacco and menthol flavors, which mirror the flavor of traditional cigarettes. I was told by a young man who had worked in an e-cigarette store that it was mostly older people who purchased traditional flavors (like Marlboro or Menthols), while young adults favored fruity combinations. Some of the tropical flavors used in e-cigarettes bear similarity to the alcohol industry’s fruity drinks, which have particular appeal for youth, especially young women. One important appeal of e-cigarettes for current cigarette users— especially youth who are very cost-sensitive—is the economics of the product. One man I spoke with, a senior who had switched from cigarettes to e-cigs about six months back, explained that one of the reasons he preferred them was that “e-cigs were . . . exponentially cheaper, . . . a great deal.” When I asked for more details about the economic aspects, he explained, Well, the initial e-cig starter kits cost between $50 and $80, but the weekly cost is negligible, like less than $10. The liquid is like $4 a bottle and that lasts me about one week. So that’s $4 a week as opposed to $20 every three days, which is about what I was spending on cigarettes.

If one of the reasons for quitting was that smoking is viewed as a waste of money, switching to e-cigs makes the habit affordable. And unlike regular cigarettes, which are often described as “dirty and smelly,”

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cessation found that among a small sample of adults, about a third had quit smoking at the end of six months.11 In fact, dual use (of both e-cigarettes and regular cigarettes) is reported to be the most common pattern of use.12 E-cigarettes present a challenge for tobacco control. At this historical juncture, when tobacco control has made significant steps toward the denormalization of smoking in public places, e-cigarettes may pose a threat to this nonsmoking norm. “Vaping” opens up new spaces for once banned smokers. The use of this new nicotine delivery device may circumvent previous restrictions and legislation.13 And the world’s largest tobacco companies, including Lorillard (maker of Newports), Reynolds American (maker of Camels), and the Altria Group (maker of Marlboro), are in the process of launching their own e-cigarettes, or have already done so and are expanding distribution. These three Big Tobacco companies have several advantages over smaller companies: they have extensive distribution networks, databases of their customers who they can market to online, and very deep pockets.14 We can expect rapid expansion of their presence in the near future. Advertisements for e-cigarettes emphasize the freedom of taking back your space to control when and where you want to smoke (see figures 9.1, 9.2, and 9.3). In one advertisement for blu e-cigarettes, an attractive, wealthy woman appears to be traveling first-class, using her e-cig in the enclosed space of an airplane, a practice that was banned over twenty years ago. A second ad for iFill e-cigarettes features a tattooed young woman at the beach. Another blu e-cigarette ad with the tagline “Why quit?” makes it clear that one can (and should) continue smoking now that there is an e-cigarette alternative. Other ads emerging in popular magazines reinforce the connection to alcohol, welcoming smokers back inside bars to once again enjoy the pleasure of smoking and drinking.15 It will be important to monitor how e-cigarettes are being marketed, to whom, as well as who is adopting these products and for what purpose. Many questions beg further investigation. Are young people using e-cigarettes to help quit their smoking habit, or do they adopt them because they are cool and trendy and attract attention from others? For those who use them to help with quitting, how successful are they? If they do quit, how long does it take them to do so? Are there

Figure 9.1. The woman featured in this ad (a well-known DJ) enjoys the pleasures of her e-cigarette while traveling firstclass on an airplane.

Figure 9.2. This tattooed young woman holds a blue-colored e-cigarette that matches the blue tattoo on her chest. Other colors are also shown. In interviews, some young adults talked about matching their e-cigs to their outfits. 200

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Figure 9.3. This image, with its bold copy, “Why quit?,” emphasized the freedom one now has to continue smoking without indoor smoking restrictions. This ad appeared widely in magazines, including Esquire and Men’s Journal (2012).

gender differences in the use of these products? Are there times when people prefer a traditional cigarette, such as when drinking at a party? Do college students develop dual use patterns that sustain use of both traditional cigarettes and e-cigarettes? Will cigarette nonsmokers be attracted to e-cigarettes and will they function as a “new nicotine gateway”?16 Based on their research on e-cigarette awareness on a college campus, the researchers Craig Trumbo and Raquel Harper assert that while e-cigarettes may be of benefit to those who want to quit, “of far greater concern is the potential integration of e-cigarettes into the portfolio of substances accepted by college students.”17 In other words, e-cigarettes

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buildings. In keeping with guidelines provided by the American College Health Association (ACHA), almost all colleges and universities have implemented policies to ban smoking within twenty feet of public buildings on campus. For obvious reasons, it is often difficult to enforce these rulings, despite appropriate signage. On crowded campuses, it is sometimes hard to identity permissible spaces between buildings that cluster next to each other. At a growing number of college campuses—over seven hundred at the latest count—total bans on cigarettes and other tobacco products are being adopted, which prevent students from lighting a cigarette anywhere on campus, even in open spaces. Part of the motivation in doing this is not only to reduce exposure to secondhand smoke but also to encourage healthy lifestyles. Campus-wide bans send a message about what is acceptable in society. But such bans are difficult to enforce and are not without pushback from students, who may feel that as adults, they should have a right to choose whether they want to smoke outside or not. And e-cigarettes as a new non-tobacco, non-smoke-producing product may circumvent campus-wide bans—at least for now. What are colleges doing now in terms of providing cessation services, and to what extent do they meet the needs of students? It is important to reiterate that most students I talked with felt that they did not need any help in quitting, that they “wanted to do their own thing” and that “pretty much anyone can quit” if they had enough willpower. This reasoning has been substantiated in many other studies among college-age youth.20 The health researcher Amanda Amos and her colleagues concluded that youth in their mid-to-late teens differentiated their own need for cessation services from those of older adults who had longer smoking histories “and were therefore perceived as addicted and more in need of nicotine replacement therapy (NRT, such as nicotine gum and patches) and other support.” The respondents in Amos’s study recognized that such therapies were not directed at young people and probably were “not for them.”21 To my knowledge, there have been two meta-analyses of the efficacy of smoking cessation interventions for young adults. The first concluded that interventions geared specifically toward this group are ineffective; in contrast, a second and more recent analysis found that those interventions that worked for adults also seemed to work well for youth.22 The

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consumption facilitates the initiation and continuation of tobacco use, I could not identify health communication messages on campuses that directly address how these products are used together. For those in tobacco control, this is a missed opportunity. Other missed opportunities are informing students about the harm of low-level smoking, and discussion about low-level smoking and dependency. At present, students are exposed to only very general information about tobacco and feel that they already are well informed about the harms. But the harmful effects of smoking seem very intangible to them; perhaps too far down the road to have any real meaning in the present. I was continually struck by how nonchalantly they talked about habit and addiction, problems that might happen to someone else but not to them. And even those who felt they were addicted expressed confidence that they could quit on their own time, in their own way, when they were ready. The data tell us that while many young adults will be able to quit, as many as 60 percent of low-level smokers will still be smoking in their final year of college.

Final Considerations There is abundant literature that points to a shift in the patterns of smoking that are common among college students and more broadly among young adults in the United States. While there are still many young adults who smoke at higher levels, particularly among those with fewer years of education, the general trend seems to be toward smoking at lower levels. Importantly, while higher-level smoking is relatively stable, those who smoke socially and at lower levels (like college students) have more fluctuations in their smoking habits. Taking into account these upward and downward shifts in smoking that occur across the college years, and that quitting is a long-term not an immediate goal for many smokers, we have reason for concern about a continuation of smoking among twenty-somethings. Just as social context often dictates the process of becoming a smoker, social context also plays an important role in decisions to quit and in short- and long-term success in doing so. Clearly, some young people, particularly those who smoke socially and intermittently, will quit on their own at some point in time. Still others may quit but enjoy a cigarette every now and then. These are

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freshmen at this university. All UpTERN-related studies were approved by the Institutional Review Boards at the university. Qualitative Data Collection Students’ responses to smoking questions on the weekly web-based surveys were used to identify participants for the qualitative component of the study. Based on our pilot study findings, initial observations, and extant literature, we recognized that college students smoked at varying levels. In UpTERN, we were particularly interested in two groups of college students: those who smoked most of their cigarettes at parties and those who smoked at parties but also at low levels during the week. We were less interested in those who already had established patterns of smoking, and thus they are represented to a lesser degree in this book. Qualitative data are drawn from in-depth interviews with students whom we classified as “party smokers” and those whom we refer to as “low-level smokers.” Following extensive discussions among qualitative UpTERN team members (the medical anthropologist Mark Nichter, the clinical psychologist Elizabeth Lloyd-Richardson, the family studies researcher Asli Carkoglu, and myself) and preliminary quantitative data analyses (conducted by the methodologist Brian Flaherty), we determined the criteria upon which to classify students into these two groups. Party smokers were identified based upon the following criteria: (1) those who reported smoking on four or more of the weeks that they had completed the survey by the middle of their first semester on campus, and (2) greater than two-thirds of reported cigarette smoking took place in a party context. Following the UpTERN research design, half of the students who participated in the web-based surveys were accessible for the ethnographic component. This design ensured that half of the entire sample remained “clean” from potential bias or behavioral change that might be introduced through the interview(s). Once the criteria for “party smokers” were established, a random sample of students who met these criteria were selected for interviews (n = 91). We randomly selected forty of these students for interviews, and thirty-five agreed to participate (eighteen males and seventeen females). For the most part, those students who were selected on this basis turned out to be appropriate

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on the quantitative data collected on these early use episodes is available elsewhere.3 For this project, semi-structured interviews were conducted by a graduate or advanced undergraduate student who was part of our interviewing team. Interviewers and participants were matched by gender, and interviews lasted about forty-five to sixty minutes. Questions regarding their early use episodes included smoking expectations, the physical experience of smoking, the social context in which it occurred, and concurrent substance use. Participants were also given a set of adjective cards describing the smoking experience (e.g., pleasant, unpleasant, nausea, etc.), from which they were asked to select the three most relevant attribute cards and then to discuss why they had selected each of those. These subjective effect reports used the same items that had been asked in the web-based assessment. Almost all interviews were conducted within three weeks of the web-based assessments. Stress Interviews There were two broad sampling criteria for these interviews, findings of which are mostly discussed in chapter 7. The participants needed to (1) be among the 412 who were randomly selected for further contact by the ethnography team; and (2) have smoked at some level during the week of finals. All study participants who came to the project office to pick up their last check for completing the online surveys the previous week were approached while waiting on the line. After checking for inclusion in the ethnography pool, they were given two cards and were asked to pick the one that fit their situation. Cards read, “I have smoked during the finals week” and “I have NOT smoked during the finals week.” If they picked the smoking-positive card, they were invited to be interviewed shortly after they received their check. A total of 135 study participants were screened for these interviews; 95 students (57 males and 38 females) reported smoking during finals, and the first 40 who reported having smoked were interviewed. We were sensitive to the time demands of the school year, so these interviews were relatively short, highly structured, and geared specifically toward exploring the smoking experience of students during finals week. To facilitate the discussion, we gave participants a pile of cards

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writing interview notes—one- to two-page reports on each interview that detailed the content as well as the context of the interview. Interviewers were also given guidelines for writing structured observation reports on smoking on campus. All interviews took place on the college campus in a place that was convenient for the participant. Interviewer and participant were matched by gender to the extent possible. Interviews, on average, took one hour to complete and participants were paid fifteen dollars. Focus groups were conducted by Mimi Nichter, Mark Nichter, or Elizabeth Lloyd-Richardson and were typically longer, lasting one and a half to two hours. Focus group participants were also paid fifteen dollars. All interviews and focus groups were audio-recorded and later transcribed. My fellow research team members and I conducted ongoing observations of smoking on campus, including outside the residence halls and in party contexts, to better understand smoking on campus. Data Analysis All interviews and focus groups were transcribed verbatim and coded by one of the graduate students using the ATLAS.ti program. Graduate student coders were given a two-day training in the software, and inter-rater reliability was established. The coding scheme used for the data was developed based on the themes and concepts developed in the interviews and emergent from the data. The software program utilized for data analysis permits classification and retrieval of data from transcripts on the basis of themes, which facilitates comparison of discourse across participants. Themes were established by the research team on the basis of questions in the interview script as well as key themes that emerged as the cycle of interviews progressed. Although for my writing of this book I used a data analysis program that provided a synthesis of responses across informants (for example, on the theme of “smoking when bored”), I also read and reread the interview transcripts to place participants’ narratives in the larger context of their lives. I sometimes find that data analysis programs that provide data on particular themes or concepts, while helpful, do not provide sufficient data for the whole picture of a particular participant to emerge. Thus, I typically utilize both methods of analysis.

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which took place at the school and lasted approximately one hour. We conducted ethnographic research to enable us to gather data on the way girls discussed smoking and dieting. Through ongoing ethnography and analysis of girls’ discourse about dieting and smoking, the researchers were able to identify new variables for study and inclusion in the subsequent interviews and surveys over the three years. Each girl completed an annual 110-item survey questionnaire, which contained multiple questions on attitudes and behaviors regarding dieting and smoking. Interviews also provided an opportunity to clarify the meaning of survey responses. In the follow-up study, telephone interviews were conducted with 178 of the original study participants. Informants were located across the country, although the majority had remained in Arizona. After rapport had been reestablished with participants, a semi-structured questionnaire, composed of both open- and close-ended questions, was administered. Interviews ranged in length from forty-five minutes to two hours. During interviews, recent weight management and smoking histories of women were obtained as well as narrative accounts of quitting attempts and relapses for those who were smokers or quitters. Telephone interviews were tape recorded and later transcribed and coded for analysis. Once all telephone interviews were completed, a survey questionnaire was mailed to those young women who had identified themselves as smokers. Out of fifty-three current smokers, only thirtytwo mail-in responses were received.

Collecting Data about Quitting Interview data for chapter 8 were collected from twenty-five college seniors and five graduate students (equally divided by gender) who were recruited from a large southwestern university. Twenty-one students were white, six were Mexican American, and three were Asian American. To recruit students for this project, I put up flyers on campus, and made a few brief presentations to undergraduate classes populated by seniors in which I described the study. I also hung out in places where people smoked on campus (our campus is still not smoke-free), and sometimes handed people flyers directly. I did this to get a cross-section of students on campus, representing different majors. I also worked

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Final Notes I have tried throughout this book to protect the confidentiality of the women and men who were interviewed by changing their names, the intimate details of their lives, and other identifying characteristics that were revealed in their narratives. At the same time, I have sought to maintain the integrity of their stories. For the most part, the quotes have not been altered, unless I considered it necessary to change a word or two to enhance readability.

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Notes

Chapter 1. “It’s No Big Deal” 1. Husten 2009. 2. Mimi Nichter 2010. For a discussion on the social ecological perspective on health, see also McLeroy et al. 1988. 3. SAMHSA 2011. 4. Hammond 2005. 5. SAMHSA 2006; Johnston et al. 2006. 6. Johnston, O’Malley, and Bachman 2002; Green et al. 2007. 7. Wechsler et al. 1998; Rigotti, Lee, and Wechsler 2000; Lantz 2003. 8. Kenford et al. 2005. 9. Wetter et al. 2004; Trinidad et al. 2004. Depending on ethnicity, between 40 and 50 percent of regular adult smoking is initiated in young adulthood, marking it as a vulnerable period of life. 10. This is quoted in the surgeon general’s report (Surgeon General 2012, 138). For details, see U.S. Department of Health and Human Services, 2012. On this same topic, see also Ling and Glantz 2002; and Green et al. 2007. 11. Kandel and Logan 1984; Mayhew, Flay, and Mott 2000. 12. Shiffman 2009. 13. CDC 2003; Backinger 2008. 14. Repace and Lowrey 1980; see also Shiffman 2009. 15. Chaloupka and Wechsler 1997; Chaloupka et al. 2002; Ding 2003. 16. Giovino 2002. See also Ryan, Trosclair, and Gfroerer 2012. Ryan and her colleagues provide a discussion of the differing definitions for current smoking and how this impacts national smoking estimates. The National Survey on Drug Use and Health (NSDUH) provides information about the use of alcohol, tobacco, and illegal drugs in U.S. households. They ask, “Have you ever smoked part or all of a cigarette?”; those who answer “yes” are defined as ever smokers. They next ask, “During the past 30 days, have you smoked part or all of a cigarette?” Those who answer “yes” are classified as “current smokers.” Other national surveys, such as the National Health Interview Study (NHIS), ask, “Have you ever smoked 100 cigarettes in your entire life?”; if the respondent answers “yes,” he or she is asked, “Do you now smoke every day or some days?” If the latter response is “yes,” the person is a current smoker. Of note here is that some surveys include the hundred

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17.

18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.

29. 30. 31. 32. 33. 34. 35. 36. 37.

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Rigotti, Lee, and Wechsler 2000. Starace 2002. See also Stromberg, Nichter, and Nichter 2007. Mark Nichter 2003b. See also Amos et al. 2004. Bunton 2011. Hunt, Evans, and Kares 2007. Arnett 2004.

Chapter 2. Profiles and Progressions 1. Poland et al. 2006, 60. 2. Ibid. 3. Bourdieu 1986.

Chapter 3. Smoking and Drinking 1. Bachman et al. 1997; Schulenberg and Maggs 2002; Wechsler et al. 2002. 2. Gfroerer, Greenblatt, and Wright 1997; Johnston et al. 2004. 3. Numerous studies of college students over the past two decades have concluded that alcohol use is ubiquitous on campus. See Glindemann et al. 2006; Vander Ven 2011; Wechsler et al. 2000, 2002. For information on binge drinking, see also SAMHSA 2006. 4. Dawson et al. 2004; Harrison and McKee 2008; Task Force of the National Advisory Council on Alchohol Abuse and Alchoholism 2002; Wechsler et al. 2002. 5. Sher, Bartholow, and Nanda 2001. 6. Surveys were conducted on college campuses originally in 1993 and repeated in 1997, 1999, and again in 2001. The survey results are widely cited, as they reveal important patterns across time for alcohol consumption. Wechsler is well known as an alcohol researcher who developed the concept of binge drinking. 7. Grant 1997; O’Malley and Johnston 2002. 8. White et al. 2006. 9. Sifferlin 2013. 10. SAMHSA 1998. 11. See Dierker et al. 2006. 12. Jackson et al. 2002. 13. Wechsler et al. 2002. 14. Levinson et al. 2007. 15. McKee et al. 2004. 16. McKee and Weinberger 2013. 17. Glindemann et al. 1998. See also Glindemann and Geller 2003; and Glindemann et al. 2006. 18. Borsari 2004; Borsari, Bergen-Cico, and Carey 2003. 19. Stromberg, Nichter, and Nichter 2007. 20. Stromberg 2009; Huizinga 1955a. 21. See Huizinga 1955b.

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which may be another factor in the low smoking prevalence reported. By contrast, the UpTERN study described in this book found that 45 percent of students reported smoking in the past thirty days (for further details, see Tiffany et al. 2007). Findings of the National Survey on Drug Use and Health (NSDUH 2010) show that the overall percentage of young adults (aged eighteen to twenty-five) who are current smokers is 34 percent. The NSDUH sample includes both college and non-college-going young adults. The latter group typically has higher smoking rates than young adults who attend college. For a discussion of these data, see U.S. Department of Health and Human Services 2012. Everett et al. 1999. DeSantis 2007, 27. See also Robbins 2004. Describing sorority life, Alexandra Robbins describes in her book Pledged how girls in some houses are not allowed to cross their legs at chapter meetings—a behavior considered unladylike—unless they cross at their ankles. DeSantis 2007, 27. See Haines-Saah 2011, 192. In her article, she applies Bourdieu’s theory of gender to young women’s smoking behavior. One’s habitus, which entails dispositions and tastes, are an “embodied history, internalized as a second nature” (Bourdieu 1990). Gender identity is a “deeply rooted, bodily anchored dimension of a person’s habitus.” See also Adkins and Skeggs 2005; and Bourdieu 2001. Bogle 2008. DeSantis 2007, 73. Stromberg, Nichter, and Nichter 2007. Anderson, Glantz, and Ling 2005. For articles where I directly address the global marketing of tobacco to women, see Kaufman and Nichter 2001 (updated and reprinted in World Health Organization 2010); and Nichter et al. 2009. For a discussion of women, advertised images, and the effect on body image, see Nichter and Nichter 1991; and Nichter 2000. For an interesting analysis of how the tobacco companies have marketed their products to trendsetting hipsters, see Hendlin, Anderson, and Glantz 2010. For further discussion on advertising and tobacco to women, see World Health Organization 2010, 107. In addition to attracting new purchasers, advertising is used to reduce health fears by presenting figures on lower nicotine and tar content of particular brands, with the implications that these brands are better for health. For further reading on the topic of advertising to women and girls, see the report by the Campaign for Tobacco Free Kids entitled “Deadly in Pink,” available online at www.tobaccofreekids.org/deadlyinpink. This advertisement appeared in 2004 in Cosmopolitan and Maxim. This ad campaign often features African American couples, particularly when the product is menthol. This ad and others used in the text were obtained from www.trinketsandtrash.org, which has a searchable collection of tobacco-related advertisements. Nichter 2000.

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Kobus 2003. Lopez et al. 2008. Budd and Preston 2001; Zucker et al. 2001; Saules et al. 2004. Carroll et al. 2006. Findings from one cross-sectional study conducted with almost two thousand college students found that 22 percent of female smokers and 16 percent of male smokers believed that smoking kept their weight down. Researchers also asked students to report their primary reason for smoking, with response options “to control weight,” “habit,” “taste/feeling,” and “friends.” Habit and taste/feeling were the most common, with these options endorsed by about 40 percent of smokers. Weight control was cited the least, with just 4 percent of female smokers and 1 percent of male smokers selecting this as their primary motivation to smoke. Thus, smoking for weight control is a complex topic; an individual may have multiple reasons for smoking at any given time with weight issues as just one of them. See George and Johnson 2001. Cepeda-Benito, Reynoso, and Erath 2004. Klesges, Zwikowski, et al. 1998. Gritz, Nielsen, and Brooks 1996; Jarry et al. 1998; Klesges et al. 1989. Swan et al. 1993. Klesges, Elliott, and Robinson 1997. Filozof et al. 2004. Klesges, Zbibowski, et al. 1998; Klesges et al. 1998b. Killen et al. 1997; Perkins 1994. Austin and Gortmaker 2001; Honjo and Siegel 2003; Killen et al. 1997; Klesges, Ward, et al. 1998; Voorhees et al. 2002. Camp, Klesges, and Relyea 1993; Charlton 1984; Klesges, Elliott, and Robinson 1997. Nichter et al. 1997. The median number of cigarettes smoked by occasional smokers was one per week (mean = 4) as compared with a median of forty cigarettes per week (mean = 60) for girls described as regular smokers. The mean age of initiation for the occasional smokers was 13.7 years, as compared with a mean age of initiation for regular smokers of 11.5 years. This is consistent with national data that suggest that smoking levels escalate over time and that early initiation results in higher sustained levels of smoking. See Lloyd-Richardson et al. 2002. Quintero and Davis 2002; Revell, Warburtun, and Wesnes 1985; Wills 1986. Klesges, Ward, et al. 1998; Klesges, Zwibowski, et al. 1998. The mean BMI of those who were regular smokers was 22.93; that of occasional smokers was 21.37. Carroll et al. 2006. Arnett 2005; Wechsler 1998. Nichter 2000. Klesges, Zwibowski, et al. 1998. Nichter 2000; Nichter and Nichter 1991. Klesges, Ward, et al. 1998; Klesges, Zwibowski, et al. 1998.

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18. Tiffany et al. 2004, 83. 19. For an examination of the marketing of tobacco to women both in the United States and globally, see Kaufman and Nichter 2001; and World Health Organization 2010. See also Haines-Saah 2011 for an analysis of how various anti-tobacco advertising campaigns reinforce an imperative that “pretty girls don’t smoke” and how the advertised image has portrayed smoking as a behavior to be avoided because it compromises a woman’s perceived attractiveness. 20. Quintero and Nichter 1996, 222. 21. Ibid., 223. 22. Reith 2004, 286. 23. Ibid. 24. Brandt 2007, 338. 25. Ibid. 26. Ibid. 27. Ibid., 240. 28. Arnett 2005; Weinstein 1989. 29. See also Amos et al. 2006, who similarly found that the notion of control was important in defining whether one was addicted or not. 30. Hoek et al. 2013, 264. 31. Mendelsohn 2011; Perkins et al. 2012, 2013. 32. McKee et al. 2005. 33. Weinberger and McKee 2012. 34. Graham et al. 2006. 35. Weinberger and McKee 2012, 624. 36. Perkins, Donny, and Caggiula 1999. 37. Benowitz and Hatsukami 1998. See also Bancroft et al. 2003. 38. Bailey 2013. 39. Arnett 1999. 40. Federal Trade Commission 2000. 41. Malson et al. 2001. American Spirits have been found to have a higher nicotine content per stick and higher concentrations of nicotine (17.7 mg; 16.6 mg/g, respectively) than unfiltered conventional cigarettes (11.8 mg; 12.0 mg/g). Another study by Malson et al. 2002 found that after smoking unfiltered additive-free American Spirits, participants had plasma nicotine levels that were significantly higher than when they smoked their regular conventional cigarettes. The authors conclude that contrary to the belief of many consumers, additive-free cigarettes deliver substantial amounts of nicotine and other toxic components of tobacco smoke. 42. Mutti et al. 2011, 1173. 43. Wilson 2010. The quote is from Dr. Gregory Connolly, a well-known tobacco control researcher and professor at the Harvard School of Public Health. 44. Mutti et al. 2011, 1173.

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more discussion of this issue, see Rubinstein et al. 2009; and DiFranza and Wellman 2005. See, for example, Berg et al. 2009; Brown, Carpenter, and Sutfin 2011; Klein et al. 2013; Moran, Wechsler, and Rigotti 2004. McDermott et al. 2006. Shiffman et al. 2002. Slovic 2001; Nichter 2003a. Reducing the number of cigarettes smoked is a step in the right direction. While most young adults recognize lung cancer or emphysema as negative health outcomes of long-term smoking, this represents a limited understanding of the potential harm of tobacco. For example, prospective studies of over 40,000 men and women screened for cardiovascular disease risk factors over a thirty-year period found that in both sexes, smoking one to four cigarettes per day was associated with a higher risk of dying from ischaemic heart disease and from all other causes. The authors conclude that “smoking five cigarettes a day is not a threshold value . . . that must be exceeded before serious health consequences occur.” See Bjartveit and Tverdal 2005. Other studies have demonstrated the importance of quitting smoking before age thirty to avoid tobacco-related mortality. See Doll et al. 2004. Quintero 2000. Conners 1992. Stein 2013. Several recent media reports on millennials characterize them as “the me me me generation,” with a high incidence of narcissism. Nichter, Nichter, Muramoto, et al. 2006. Ibid.; Orleans et al. 2000. Kishchuk et al. 2004, 495. Food and Drug Administration 2001. Curry et al. 2007. Suls et al. 2012. See also Villanti et al. 2010; and Schroeder 2010. Curry et al. 2007. Christakis and Fowler 2008. Ibid., 2256. The reference to thetruth.com refers to the website of the truth campaign that produces anti-tobacco advertisements and materials targeted at youth. The campaign is run by the American Legacy Foundation, which was created following the Master Settlement Agreement between the U.S. tobacco companies and many of the states in the United States. Goffman 1963. Bell et al. 2010. See also Stuber, Galea, and Link 2008. The DARE program (Drug Abuse Resistance Education) is a school-based program that aims to prevent use of controlled drugs, avoid gang membership, and curb violent behavior. It is typically taught in middle schools by police officers

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24. Vander Ven 2011; see also Dowdall 2008. 25. Montez and Zajacova 2013. See also Tavernise 2013.

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Emerging adulthood, 21, 98, 193–95 Emotion, 2, 155 Empathetic smoking, 94–96, 156–57 Emphysema, 10 Empowerment, 37, 185 ENDS. See Electronic nicotine delivery systems Energy drinks, 70 Environments of risk, 17–18 Escalators, types of, 226n8 Etcheverry, Paul, 161–63 Exam smoking, 15, 33, 56, 150–54 Exam stress, 15, 25, 152, 154 Exercise, 107, 113–14, 117, 118, 140–42 Experimental smokers, 9, 24, 67, 226n8 Facebook, 74, 222n1 Family, 135–37, 145, 178–80, 183 “Fat talk,” 116 FDA. See Food and Drug Administration Federal Trade Commission (FTC), 143 Female smokers: adolescent, 90, 103, 106–7, 112, 121, 220n17; anti-tobacco advertising and, 227n19; empathetic smoking by, 95–96; female perceptions of, 77–79; group smoking by, 92–93; level of smoking of, 78; male perceptions of, 76, 79–82; motives of, 85–87; nicotine sensitivity of, 135; at parties, 82–83; predictors of, 103; “slutty” image of, 76, 78; social world of, 164; sorority perceptions of, 76–77; “trashy” image of, 76, 83–84 Femininity, 33, 89 Finals week, 152 First smoking experience, 26, 38, 42, 69, 72 Fitting in, 55, 60–63, 83, 87, 171 Flip cup, 54 Fluctuating smoker, 35 Focus, 151–52 Food and Drug Administration (FDA), 196

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Moderate intermittent smoking, 167 Monitoring, 65 Moral identity, 41, 131, 173, 192 Moral judgment, 190–91 Morning smoking, 130, 140, 186 Motherhood, 40–42 Moving, 173, 177, 206 Multivocality, 85, 99, 182 National Survey on Drug Use and Health, 208 Naturalistic observation, 13 NDSS. See Nicotine Dependence Syndrome Scale Negative affect, 94–95, 135, 157 Negative effects, of smoking, 140–43, 205 Neoliberal values, 126 Newport, 85, 86 Nichter, Mark, 125, 207, 213 Nicotine, 36; alcohol and, 70–72; dose of, 9; metabolism of, 122; sensitivity to, 122, 135; stress and, 149 Nicotine dependence. See Dependence Nicotine Dependence Syndrome Scale (NDSS), 122 Nicotine gum and nicotine patch, 184 Nicotine replacement therapy (NRT), 184, 230n11 Nightclubs, 18, 37 Nonsmokers, 9–11, 27, 29, 32, 41, 64–65, 180 Normalization, 17, 18, 84, 189, 193 Normative development cycle, 176 Novice smokers, 61, 65–67 NRT. See Nicotine replacement therapy Obesity, 104, 114, 184 Optimistic bias, 10 Outdoors, 52–53 Pall Mall (cigarette brand), 38 Paltrow, Gwyneth, 142

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Slim cigarettes, 103 Slippery slope, 128 “Slutty” image, 76, 78, 81, 99 Smoke break, 36, 174–75, 206 Smoke-Free Arizona Act, 230n19 Smoke-friendly environments, 18 Smoker: addicted, 6, 35, 125, 130–31, 145; college student, 4–5; current, 7, 219n16; early stable, 226n8; experimental, 9, 24, 67, 226n8; fluctuating, 35; “healthconscious,” 10; identity of, 8, 131; late stable, 226n8; light nondependent, 71; novice, 61, 65–67; “pretend,” 83; “real,” 1–2, 7–8, 51; stable light, 226n8; standing ground as, 189–92; typical, 162–63; weight of, 108–9. See also Female smokers; Nonsmokers Smoking: aging out of, 177; binge, 71–73, 166; boredom and, 157–61; chain, 156; classification of, 8; compensatory, 171–72; concern with, 32; conversational pace and, 54; cutting back, 7, 167, 171–72, 186, 195, 198, 229n7; daytime norms of, 50–51; difficulty with, 65; dislike for, 39; emotive states communicated by, 2; empathetic, 94–96, 156–57; escalation of, 5–6, 99, 124, 225n17, 226n8; exam-related, 15, 33, 56, 150–54; first experience with, 26, 38, 42, 69, 72; focus and, 151; in fraternities, 51; frequency and duration of, 71–73, 109–10, 167; gender and, 31, 33–34, 93; after graduation, 194; in groups, 85, 92–93, 153–55; in high school, 29–30, 32, 40, 106, 112, 118; in homes, 6; identity negotiation with, 2; intermittent, 9, 167, 220n28; “just,” 56; level of, 78–79; after meals, 115; morning, 130, 140, 186; negative effects of, 140–43, 205; outside, 52–53; patterns of, 1–2, 5–6, 24–25, 42–44, 50; as play, 57–60; pleasure from, 21; prevalence of, 4–5, 51, 75;

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Veteran partier, 82 Virginia Slims (cigarette brand), 101 Weekend, 48–50, 78 Weight, 104, 108–9, 111–13, 116–18 Weight control smoking, 2, 15–16, 23, 31, 101; adolescent perceptions of, 106; awareness of, 105–6, 110–11, 115–16, 225n17; maintenance of, 107–8; parents and, 110, 116; smoking frequency and duration and, 109; smoking initiation for, 105–6, 113; studies on, 103–5, 117–19, 214–15; young adult perceptions of, 113–14 Willpower, 137–38, 145, 183–86 Winston, 96, 97 Withdrawal, 130, 186 Women: advertising targeted at, 85; affective states of, 157; behavior surveillance of, 79; body dissatisfaction of, 104, 116; cigarette sharing by, 94; control over, 78–82; drinking by, 91; female smokers perceived by, 77–79; graduation of, 100; in groups, 83–84; as “nags,” 81; public identity management by, 90–91; quitting difficulty of, 104, 157; shared activity of, 93; smoking prevalence of, 75; stress and, 157. See also Female smokers Work, 26, 35–36, 172–75, 206. See also Coworkers Young adults: advertising targeted at, 220n37; exercise and, 142; independence of, 206; quitting by, 184–85, 228n2; smoking prevalence among, 4; weight control smoking and, 113–14 Youth, 131

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About the Author

Mimi Nichter is Professor of Anthropology at the University of Arizona, where she holds joint appointments in the Norton School of Family and Consumer Sciences and the College of Public Health. She is the author of Fat Talk: What Girls and Their Parents Say about Dieting and Anthropology and International Health: Asian Case Studies (with Mark Nichter).

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