Blackwell Science, LtdOxford, UKADDAddiction1359-6357 2003 Society for the Study of Addiction to Alcohol and Other Drugs98Supplement 1Original

ArticleSmoking and cultureMark Nichter

REVIEW

Smoking: what does culture have to do with it?

Mark Nichter
Department of Anthropology, University of Arizona, USA

Correspondence to: Mark Nichter Department of Anthropology University of Arizona USA E-mail: mnichter@u.arizona.edu

ABSTRACT In this commentary issues are raised relating to the role of ethnicity and culture as a context inuencing adolescent smoking. A processual rendering of culture is encouraged, as is an appreciation of intraethnic diversity. The question posed is what is cultural about particular patterns, transitions and trajectories of smoking? Productive ways of investigating patterns of smoking which attend to class, ethnicity, gender norms, modernity and popular culture are focused upon as an ongoing project subject to both the identity needs of youth and the agenda of the tobacco industry. Promising areas of research are identied, as are the potential contributions of ethnographies of tobacco use. KEYWORDS Class, culture, ethnicity, ethnography, gender, popular culture, smoking.

RESEARCH REPORT

A better understanding of tobacco uptake, trajectories of use, expressions of dependence and quitting attempts requires a careful consideration of the interaction between individual and contextual factors, the way in which nested social contexts interface and inuence one another and an appreciation of risk and protective factors. The study of nested contexts is challenging. A move from the study of additive to interactive factors inuencing tobacco use demands both a new vision of what types of data need to be collected and new methods of data analysis. The papers in this special issue go a long way towards summarizing what we know about family, peer, neighborhood, media, economic and political economic inuences on tobacco use. Rather than revisit themes already covered in the papers, I wish to raise a few additional issues related to ethnicity and culture as a context inuencing adolescent smoking. Ways will then be suggested in which ethnographic studies of smoking can add to our understanding of smoking behavior as a phenomenon inuenced by both structural locations which bound subjective experience and cultural play which involves experimentation with self-image and identity (Pavis et al. 1998). Let me comment rst on the role of culture, a factor inuencing tobacco use that was raised by several of the authors. When this volume was rst discussed, culture was considered as a context meriting its own review. Given that a Surgeon Generals Report (US Department of Health & Human Resources, 1998) had recently summa 2003 Society for the Study of Addiction to Alcohol and Other Drugs

rized ethnic differences in rates of smoking, it appeared redundant to restate what is already known and more useful to consider how cultural norms and institutions, gender roles and aesthetics played out in each of the other contexts being addressed. I would urge future researchers investigating culture and tobacco use to continue to look at the interaction between culture and social and economic contexts, and to consider culture on two fronts: (a) culture as it is commonly regarded in relation to ethnic differences, and (b) popular culture as an ongoing project subject to both the identity needs of youth and the inuence of an advertising industry that manipulates these needs to sell cigarettes and develop market niches. Ethnicity and culture are terms that public health researchers need to differentiate and take seriously, especially when studying adolescence (Fergerson 1998).1 When using the term ethnicity it is important to differentiate between an ethnic identity one assumes in context and an ethnic label that is imposed by others. Ones ethnic identity is an identity one chooses to assume on the basis of some sense of social and political afliation. Far from being xed or static, which would render ethnicity a reied construct (a thing), ethnic identity may be claimed or distanced in particular contexts, at particular times, and for particular reasons. Ones sense of ethnic identity is situational and changes in accord with
1

For a complementary discussion of the meaning of race, see Freeman (1998).

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life-style, residence, etc. At its core, ethnic identity is based on shared meanings that emerge from collective experiences and as such it is produced and reproduced in social interaction. An ethnic label, on the other hand, is a static designation assigned to a person by someone else. It is based on a set of criteria that distinguishes them from others in the eyes of whomever it is that controls the categorization scheme. The history of ethnic categorization in the United States has been politically motivated and has been inuenced by a changing agenda (Edmontson & Schultze 1994). Ethnic labeling, whether by skin color, language or region of origin, lumps people together who may have as many differences as similarities. Lumping has diverse ramications. It can contribute to misleading and sometimes disempowering stereotypes as well as provide an opportunity for those labeled to gain critical mass and mobilize forces toward particular ends. For example, diverse groups categorized as Hispanic may mobilize as a collective based on the common experience of oppression and assume an ethnic identity as much for political as cultural reasons. When ethnicity is employed as a category in public health, it is important to be clear about ones assumptions and how ethnic designation is going to be used in data analysis. Is an ethnic label being used to examine the possible role of biological differences? Is ethnicity a proxy for a whole bundle of social and economic factors associated with the position a group of people has been forced to assume as a result of a history of discrimination or oppression (e.g. as a marker of social inequity and structural violence)? Or is ethnicity being examined to determine whether the distinctive characteristics of an ethnic groups culture are protecting or exposing this group to particular types of risk? If the latter is the case, we must bear in mind that culture is one of the most highly debated concepts in cultural anthropology (Sewell 1999). Culture is commonly thought of as an enduring set of social norms and institutions that organize the life of members of particular ethnic groups giving them a sense of continuity and community. It is often described rather vaguely as an all-encompassing associational eld in which ethnicity is experienced. Numerous anthropologists have discussed the limitations of such conceptualization of culture, especially in complex societies subject to the forces of modernity. When culture is thought about in terms of consensus and as a template for ideal behavior, the positions of different stakeholders (dened by gender, generation, class, power relations, etc.) are forgotten and heterogeneity is ignored. A processual rendering of culture is more productive. Such an approach directs attention to cultural dimensions of social transactions and asks what is cultural about particular types of
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behavior in different contexts. Culture is treated more as an adjective than a noun (Appadurai 1996). Why is a discussion of ethnicity and culture important for tobacco research? There has been mounting criticism of late about the way in which race/ethnicity has been used in public health research as a set of pigeonholes, if not black boxes. This fosters an analysis of difference that focuses on individual and group traits rather than the contexts in which people live (Lillie-Blanton & LaVeist 1996). Despite warnings against reading too much into aggregate (e.g. state, national) data on smoking and ethnicity, it is easy to overlook ethnic heterogeneity and see ethnicity as a risk factor rather than a risk marker. A question often posed in debates about ethnicity and smoking is the following: are cultural factors responsible for ethnic differences in levels of smoking (at different ages by gender), or is ethnicity merely a marker for multiple social and economic factors predisposing one to smoke or abstain from smoking? Adopting an action is in the interaction perspective, I would argue that there is a much better way of framing this important issue. Two questions appear more relevant to ask: 1 Is smoking behavior in particular social and economic contexts inuenced by cultural norms and processes and if so, how? 2 What has smoking come to represent to those sharing an ethnic identity in an environment in which the tobacco industry often targets ethnic pride in marketing campaigns? I would argue that it is far more productive to look for cultural differences in smoking after rst accounting for other factors known to predispose an individual to smoke, including education, social class, economic insecurity, stressors (e.g. discrimination), other drug use, etc. Following an analysis which pays credence to the shortcomings of quantitative researchfor example, that it often overlooks important differences between socio-economic indices (King 1997)ethnic differences should be examined more closely. At a minimum the following three issues should be addressed by ethnographic research. What is the role that cultural institutions, values, and processes play in: (1) protecting against smoking in the general population, as well as particular patterns of smoking among males and females, (2) fostering smoking as a normative behavior within particular gender and age cohorts and (3) affecting the distribution of particular smoking trajectories (e.g. early versus late onset of smoking, smoking characterized by rapid versus slow escalation, etc.). This ethnographic analysis would serve as a complement to assessments by researchers who examine intraethnic group differences by examinations of social class, education, residence, racial segregation and acculturation. What cultural factors might be productive to examine more closely when researching smoking trajectories?
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Parenting styles and respect for elders are two variables highlighted in the Surgeon Generals Report as important factors inuencing smoking behavior. Beyond noting that these factors affect smoking uptake and age of initiation, we need to consider how and in what ways they affect youth once they begin smoking. What verbal and nonverbal messages do youth receive from male and female parental gures in different ethnic communities at different points in their smoking trajectories? Once someone becomes a smoker, are they urged to quit or is their behavior accepted? How does respect for elders inuence when and where youth may smoke, and how does this differ by not only age and gender, but by employment status? How do cultural sanctions inuence patterns and levels of smoking? The messages youth receive about smoking must not be looked at in isolation. It is not just the content of the message that makes a difference, but the meaning and social relations it evokes. Several publications have suggested that authoritarian parental messages protect African American youth against higher rates of smoking (Koepke, Flay & Johnson 1990; Distefan, Gilpin et al. 1998; Clark, Scarisbrick-Hauser et al. 1999). We need to understand youth response to these messages in terms of their relationships with the people delivering them as well as other messages they receive. What protective role do associated messages play such as those which emphasize maintaining a positive self image in the face of adversity and messages which remind youth that ones behavior reects not only on their person, but family and community? In what contexts do such messages matter and in what contexts do they fall on deaf ears? In contexts where such messages matter, do they contribute to reported ethnic differences in peer group inuence (Unger et al. 2001) or are other factors involved? And, are there gender and age differences in the ways youth respond to both peer inuence and the messages of elders?2 In addition to examining the inuence of family and peers it might be useful to focus attention on the inuence of role models which include, but are not limited to these two groups of people. For example, among African American families, senior women (mothers, grandmothers, extended and ctive kin) often, but not always, act as effective role models for the young as providers and survivors. Their message about smoking has been fairly consistent and clearit does not look good for young African American men or women to smoke and it does not reect well on their family; but what happens, for example, to the many African American men and women who join the armed forces when they turn 18 years of
2

See for example the study by Simons-Morton et al. (2001), which suggests gender differences in the effect of peer pressure on smoking and drinking among younger adolescents.

age? What inuence do older ofcers who smoke have on new recruits in their units? Given high rates of smoking uptake and relapse in the military among young recruits (Bray et al. 1988, 1999), studying the inuence of ofcers as role models would seem worthwhile. Another issue worth considering is how core cultural values affect smoking behavior once uptake has occurred. For example, the importance accorded to social exchange and reciprocity within different ethnic groups may be an important factor to investigate. Being offered and accepting or refusing a cigarette within FilipinoAmerican communities, for example, may carry a locus of meaning far different than within African American or mainstream Anglo communities, and this meaning may differ by gender (Nichter et al. 2002). Similarly, cultural values may inuence peer group norms and boundary setting related to tobacco use. For example, I have observed that peers sometimes play a dual role in both encouraging smoking uptake and limiting where, when and how much friends smoke; that is, they are at once a risk and a protective factor that may affect smoking trajectories (Nichter 1999). The role of peers in establishing boundaries for acceptable behavior has also been noted by Tessler 2000), Kobus (2003) and Maggs (1997) in her research on alcohol use. An issue worth exploring is whether peer relations vary within different ethnic groups such that friends are more or less likely to act as boundary setters circumscribing the behaviors of peers? For example, would Native American youth be less likely to limit friends smoking behavior due to deep-seated cultural norms valuing autonomy than, for example, Mexican Americans? Another important issue in need of investigation is the meaning that smoking assumes during socially constructed life transitions. The study of smoking transitions in particular ethnic communities would benet from ethnographies of what else is occurring at times when significant shifts in smoking appear to be taking place. Such research needs to pay special attention to cultural perceptions of age appropriate behavior, normative transgressions and risk taking (Lightfoot 1997; Turbin, Jessor & Costa 2000; Burton et al. 1996), and behaviors associated with assuming greater adult responsibility. In order to understand better the role that smoking plays as a marker of gender and age identity, we need to examine social constructions of adolescence as well as femininity/ masculinity. Perceptions of when adolescence begins and ends often differ by gender in accord with roles and expectations, the division of labor within the household and the availability (political economy) of paid work outside the home. While girls in some ethnic group contexts are expected to bear the responsibilities of adult women early (e.g. become child-care providers if not mothers), in other groups young women are encouraged to stay at school for
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long periods of time; in some contexts, adolescence may be much longer for boys than girls because transitions to employment and marriage take place much later. The point being made is that comparisons of male and female smoking within and across groups need to be contextualized and not merely be based on physical age. Let me next draw attention to aesthetics and style as important cultural factors inuencing smoking, because they are often associated with ethnic identity. At a recent conference I attended, one speaker cited as a reason for lower rates of African American smoking among youth was that smoking was a white thing. An African American woman in the audience corrected the speaker by stating, Not acting white isnt what our youth are all about, it is being Black and being proud. Smoking is not a Black thing.3 The woman went on to suggest that the reason black youth did not take to smoking was mostly because it wasnt important to their styling. Her words echo the ndings of a multi-site study in the United States, where researchers found that black girls in comparison to white girls were far more likely to think that not smoking enhanced their self image (Mermelstein 1999). Smoking, put simply, was not equated with style. Ethnographies of African American perceptions of beauty and individual expression have drawn attention to the importance of styling and cool pose to ethnic identity as well as courtship rituals (Majors & Billson 1992; Parker et al. 1995). Styling can act as both a protective and risk factor for smoking. A better appreciation of cultural aspects of style and the way status is displayed in ethnic communities might provide us with a better understanding of why certain marketing pitches for cigarettes work well in these communities and what kind of tobacco control messages might be best suited for them. It would also be wise to monitor changes in perceptions of smoking as stylish as a barometer of how well the advertising industry is doing in making smoking culturally acceptable in different ethnic groups.4 In this regard, it is important to bear in mind that the advertising industry is in the business of positioning products to enable people to position themselves as part of an ongoing cultural project. This brings me to the importance of studying popular culture and the way youth negotiate their identities in
While it is important to recognize cultural aesthetics as an expression of core values and improvisation, it is also important to recognize that an oppositional cultural frame of reference (Cross 1995; Ogbu 1994) does affect choices in style and selfpresentation. This may impact on smoking. 4 Conspicuous consumption among blacks is also an expressive act having collective signicance best understood against the backdrop of a history of racism (Lamont & Molnar 2001). This is tapped into and used as a marketing strategy to sell tobacco products.
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consumer society. One of the primary ways we structure time, dene who we are and express social relations is through acts of consumption. Consumption events punctuate the ow of everyday life as we move from school or work to leisure time. They help us to rekey our moods and states of mind. Consumption practices also play a role in fantasy and social performance, image experimentation and image management, social afliation and the expression of group and individual boundaries. In particular, cigarettes serve as symbols as well as props that allow people to imagine as well as act out constantly varying roles on the stage of everyday life (Danesi 1999). Youth create, appropriate and assign meaning to smoking at the same time as they are being primed to interpret smoking in particular ways. There is nothing new in recognizing all of this. What is called for is a more sophisticated approach to studying the meaning of smoking in popular culture, an approach that accounts for both the expression of agency and the social meaning of smoking performances. Here it is vital to recognize that, although it may be possible to link cigarettes with particular meanings among certain groups and in certain situations, tobacco use is better conceived as a form of imaginative play involving symbols and mutually understandable cues rather than discrete messages sent through a code (Bateson 1972). While it is true that smokers may send messages through their tobacco use, most do not consciously or explicitly set out to send particular messages. The interaction of a smokers cognitive and emotional situation, their facility in performing smoking routines and the widely distributed cultural imagery that they work off of is glossed over in an analysis of tobacco as a code of meaning (a semiotic). What is required are studies of tobacco use that attend to the stage (context) in which smoking occurs, cultural meanings associated with tobacco, and processes of self expression which involve performance. Smoking is but one part of image management. For this reason it is important to study smoking as it is combined and contrasted with other expressive acts such as sports, substance use and dress in a constantly evolving fashion system. It is entire ensembles of symbolic behavior that make cultural statements more often than single acts such as smoking a cigarette. When one takes up or gives up smoking, they often make shifts in an array of interrelated behaviors. In this light we need to deepen our understanding of the importance of smoking in movies and communitybased marketing strategies where youth are paid to smoke in particular spaces. Most research on smoking in the movies focuses attention on the number of times smoking occurs, whether main characters smoke cigarettes and if smoking occurs in particularly memorable scenes. The assumption is that youth will want to imitate attractive main characters and that a transfer of positive
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arousal will occur from scenes to products. Another dimension of tobacco use may be just, if not more important. Background smoking as well as smoking featured in the foreground of movies gives youth ideas about when, where and how to smoke in a manner which enables a range of social performances. At a time when smoking is increasingly being regulated, the tobacco industry will need to provide youth with new images of smoking in spaces and at times when it is feasible. Researchers monitoring smoking in the media need to look beyond the cigarette to the context in which it is smoked and what is signaled by particular smoking gestures. Researchers monitoring community-based tobacco strategies need, similarly, to pay more attention to where paid smokers are positioned and the spaces and times in which cigarettes, small cigars, and other tobacco products are being fashioned to appear normative. Let me turn briey to a few other issues related to smoking environments and how they may affect smoking trajectories as well as expressions of tobacco dependence. The study of human geography investigates what behaviors and forms of social interaction and identities are associated with place. This discipline might have much to contribute to studies of what types of smoking occur in different smoking environments. Such studies might provide, for example, valuable insights into smoking topography. At a time when constraints on where and when one may smoke are increasing, more attention needs to be focused on the relaxed and pressured manner in which people smoke in different spaces. Chapman, Haddad & Sunhusake (1997) have called our attention rightly to changes in the depth of smoke inhalation and rates of inhalation by those forced to smoke outside of work sites. Payne (2001) has noted further that women are more likely than men to be employed in work sites where smoking bans lead smokers to smoke both harder and faster. She hypothesizes that gender differences in smoking topography may affect trajectories of lung cancer. Whether or not this is the case, gender-sensitive studies of the way people smoke at different times and in different places are worth doing. Given all the restrictions on youth smoking, it might be valuable to investigate not only how many cigarettes youth smoke a day, but also when youth engage in rushed and relaxed smoking. It is worth considering more closely how smoking trajectories among youth are affected by access to times and spaces where smoking can occur in particular ways. For example, are smoking transitions more likely to take place when youth have access to relaxed smoking environment, such as in a car? It is very important that we consider the impact of smoking opportunities and constraints on expressions of dependence. Recent research suggests that it may be better to conceptualize tobacco dependence in terms of
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degrees, not absolutes, and as multi-dimensional phenomena (Shadel et al. 2000). It is likely that youth and adult expressions of dependence differ or that the order in which signs of dependence appear may be different for smokers of different ages (Nichter et al. 2002). It is reasonable to hypothesize that expressions of dependence among youth may be associated with smoking opportunities and constraints over the course of the day and week. In order to test this hypothesis, measures of dependence sensitive to youth and their life world will need to be developed (Nichter 2000). Such measures will have to be sensitive to patterns of smoking, the plans youth make to smoke, and the salience of particular cigarettes in their day. A last point I would like to raise is related to the way modernity itself may be a context we need to consider in relation to tobacco use. Today youth live in an age of increasing time compression, greater opportunities for arousal and diminishing tolerance for boredom, and the proliferation of products that promise instant gratication. Cigarettes have been engineered biologically to be a fast and effective nicotine delivery device and engineered socially (advertised) to be an antidote for boredom. There may be biocultural reasons why nicotine, like caffeine, is appealing to youth in todays world. Consider, for example, that a signicant percentage of youth are placed in an environment where they are required to multi-task at school when experiencing mild to moderate sleep deprivation (Wahlstrom 1999). Youth today are going to bed later than ever before because they have the opportunity and means to be in constant contact with their friends through cell phones and instant messaging, have access to hundreds of television programs thanks to cable technology, are able to experiment with new identities at will in computer chat rooms, and they can spend hours searching the web to complete school assignments. Yet they are subject to early wake up times demanded by school schedules more geared to the political economy of adults than the lives of youth. Does the pharmacology of nicotine make tobacco attractive to youth given these conditions? Anthropologists who have studied the history of substance use from coca leaves to sugar, coffee and tea have observed that food drugs tend to become popular when they match the biocultural demands of work cycles as well as facilitate the practice of ideologies at the site of the body, through trade, etc. (Mintz 1985 and 1997; Jankowiak & Bradburd 1996 and 2003; Gladwell 2001; Wolf 1982). If such is the case for tobacco, we need to reect on both the appeal of tobacco as a symptom of our times and the tobacco industry as the purveyor of a form of ideology. This ideology is clearly a form of capitalism based on the promotion of dependence. Indeed, one could argue that tobacco is the best example of a dependence industry affecting the world on multiple
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fronts ranging from the micro (cellular) to the macro (society, global relations). Nicotine delivery devices render tobacco as addictive as possible, tobacco agriculture makes farmers more dependent on fertilizers than almost any other crop and politicians and state governments easily become addicted to tobacco generated revenues. The ideology of dependence propagated by the tobacco industry is an important political economic dimension of culture which we must not fail to appreciate.

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