An exploration of transactional states and cessation-related social variables within adolescent smokers

UNLABELLED BACKGROUND Given the high rate of adolescent smoking, cessation remains a vital public health priority. This study explored archival data using a structured phenomenological framework known as Reversal Theory (RT). In order to better understand aspects of adolescent tobacco use we compared the transactional, psychological states described by RT to the factor structure of adolescents' self-reported social environment influencing tobacco use. METHODS In a two step analysis of questions about self-reported tobacco use cognitions, attitudes, and behaviors from youth enrolled during the 2003-2004 period in a Texas, state-wide, mandated tobacco cessation program (N=1807), four factors and 11 items were identified as significantly related to the influence of social context and adolescents' tobacco use. These first step results guided the items to be selected for further analysis. In step two the variables were subjected to a factor analysis using principal components extraction and varimax rotation. The resulting factor structure was compared and interpreted within the context of descriptions of RT transactional states. RESULTS The analysis indicated that four factors were closely aligned to descriptions of the Reversal Theory transactional states and could be reinterpreted from within the framework of RT. The first factor included feelings of self-efficacy for quitting (autic mastery). The second and third transactional factors diverged between one factor to quit, and an opposing transactional factor to continue to smoke. Both of these transactional states are variants of the autocentric state where one wants to experience feelings of gain with the help of others. The fourth factor could be interpreted as 'confidence' or 'optimism'. CONCLUSIONS This intra-individual conflict revealed by the opposition of factors two and three clarifies a paradoxical issue where an adolescent wants to quit smoking with social support in one setting yet in another social environment chooses to smoke to gain or retain peer acceptance. These data illustrate that adolescent' self-identified quit skills and social support structures are important to the quitting process. This exploratory investigation has important implications for addressing RT state reversals in youth cessation programming activities.