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Social Science & Medicine 59 (2004) 573583
Social thinking and cultural images: teenagers notions of
tobacco use
Marie-Louise Stjernaa,*, Sonja Olin Lauritzena, Per Tillgrenb,c
aDepartment of Education, University of Stockholm, Stockholm S-106 91, SwedenbDepartment of Public Health Science, Division of Social Medicine, Karolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden
cDepartment of Caring and Public Health Sciences, M.alardalen University, Box 883, 721 23 V.aster (as, Sweden
Abstract
The health hazards of tobacco use are well-known, and it is considered particularly important to prevent tobacco use
among teenagers. New generations of teenagers still start using tobacco. To develop a more profound understanding of
tobacco use among teenagers, the purpose of this study is to explore representations of tobacco use, smoking as well as
snuffing, at the age when young people often start using tobacco. Focus-group interviews were carried out with 14-15
year olds in two schools in the Stockholm area. The analysis reveals that teenagers are well informed about the health-
hazards of tobacco use. At the same time they hold complex and conflicting ideas concerning the relationship between
tobacco use, risk, the body and human nature. At the most general level of social thinking there is a dynamic
relation between the three main representations of tobacco use related to: (1) notions of risk, (2) human nature and;
(3) societys efforts to discipline its citizens, which together can be seen as the social representation of tobacco use. These
representations of tobacco use are discussed as related to the teenagers identity-work and gender identities.
r 2004 Elsevier Ltd. All rights reserved.
Keywords: Teenagers; Tobacco use; Social representations; Gender; Social identity; Focus-groups interviews
Introduction
In contemporary society, efforts are made to restrict
tobacco use and particularly to prevent tobacco use
among teenagers. Despite preventive activities, health
education about tobacco at school and the fact that
health-hazards related to tobacco use are well-known,
new generations of teenagers start using tobacco. InSweden, as in several West European countries, cigarette
smoking is more common among girls (Wold, Aasen,
Aaro,&Samdal, 1995;WHO, 2000) while oral snuffing1
(smokeless tobacco) is almost exclusively a male habit.
The prevalence of snuffing among teenagers has
increased since the early 1970s, whereas smoking has
decreased slightly during the last decade (Andersson,
Gr .onberg, & Hibell, 1999). Today, the prevalence of
tobacco use is fairly equal in girls and boys: 38 percent
of the boys and 36 percent of the girls, aged 1415, used
tobacco (smoking and/or snuff) in Sweden in 2000.
Among the tobacco users 10 percent of the boys and 15percent of the girls were daily smokers. 30 percent of the
boys and 3 percent of the girls used snuff ( CAN, 2001).
In this study we address smoking as well as snuffing as
both forms of tobacco use are addictive, and one can
serve as an introduction to the other (Tillgren, Haglund,
Lundberg, & Romelsj .o, 1996).2 A multi-disciplinary
ARTICLE IN PRESS
*Corresponding author. Tel.: +46-8-16-31-58; fax: +46-8-
15-83-54.
E-mail address: [email protected]
(M.-L. Stjerna).1Sweden has one of the highest prevalence of smokeless
tobacco use (mainly moist snuff; snus) per capita in the world,
whereas the sale of moist snuff is prohibited since 1992 in other
countries in the European Union (Bolinder, 1997).
2 In pre-adolescence (1112 years) there is an earlier initiation
of tobacco use among boys, and a more rapid transition to
regular smokers among girls (Galanti et al., 2001). Of particular
interest is that experimentation with snuffing among boys also
marks the transition to cigarette smoking (ibid).
0277-9536/$- see front matterr 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2003.11.003
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project was carried out in collaboration between the
Department of Public Health at the Karolinska In-
stitutet (Stjerna, Marttila, & Tillgren, 2000) and the
Department of Education, Stockholm University (Stjer-
na, 2001). Of particular interest is how tobacco use is
described and dealt with in the local socio-cultural
context, where cigarettes and snuff are consumer goodsloaded with symbolic meanings. The purpose of this
paper is to explore teenagers notions of tobacco use,
their shared ideas and images, how these notions are
reflected in their accounts about their own and other
peoples tobacco use and also the ways understandings
of tobacco use are related to the teenagers development
of a gender identity.
Social representation theory
To explore teenagers notions of tobacco use, we takeour point of departure in social representations theory,
where social representations are defined as a system of
thinking that affects our perceptions of and acting in
the world (Moscovici, 1988). Within a group of people,
social representations contribute to a shared image of
reality, at the same time as conflicting ideas can exist and
be debated at a discursive level (Rose et al., 1995). The
focus is on human beings as social and cultural beings,
and on the vital function of this system of thinking to
both shape and maintain social identity (Jodelet, 1991).
Social representations are seen as socio-cultural phe-
nomena which are formed in interaction between people
and thus differ from a purely cognitive perspective.
The understanding of peoples ideas of tobacco use
can be informed by studies of social representations of
health and illness. Herzlich (1973) found that when
people talked about health and illness, their reflections
were phrased in terms of the individuals relation to
society. Illness is to a great extent understood as caused
by the lifestyle of modern society, and the threat to the
individuals health emanating from outside. However,
the individual can act in order to maintain his or her
natural state of health. The relationship between
health and illness, and between the individual and
society, is thus characterised by conflict. In this sense,representations of health and illness relate biology to
social life. Today, the concept of health is imbued with
far reaching implications, sometimes perceived as
synonymous with success and fortune (Herzlich, 1995).
To actively strive for health has become an imperative
(Lupton, 1995). Also, asRadley and Billig (1996)argue,
notions of health and illness are ideological. They are
related to wider discourses in society that affect not only
the way individuals think, but also how they feel they
should think. Definitions of a healthy way of life include
judgements and values and is therefore ideological. As
smoking is without doubt hazardous to health, the
moral imperative to strive for health is of particular
interest in relation to smoking.
Tobacco use from a gender perspective
The attitude teenagers adopt towards cigarette smok-ing and snuffing can be seen as related to the young
persons position in the social order, as a young man or
woman approaching adult hood. Our point of departure
is thus a gender perspective on teenagers search for an
identity. Gender is here primarily understood as what we
do in interaction with other people, not what we are
(West & Zimmerman, 1991). Doing gender means
that differences between men, women, boys and girls are
socially constructed and not considered simply natur-
al or biological. Gender is thus to be understood as an
ongoing process in womens and mens lives, which
children are incorporated into when they learn toobserve these differences regarding their own and other
peoples behaviour (ibid.).
At a cultural level these differences can be described
as notions of masculinity and femininity and are
reflected in ideas of typical male and female
characteristics, interest and behaviors. At the same time,
the youth of today have possibilities to choose as norms
and traditions that put a pressure on former generations
may have lost its meaning for generations of today
(Holstein-Beck, 1995), even if such choices are circum-
scribed by ideas of what is considered feminine in
local socio-cultural contexts. Jones (1993) argues that
young women no longer have to be viewed as socialised
into appropriate gender roles, but create their own
positions in the social order, and consequently girls can
take different positions in different situations. The
search for an identity could thus be described as a
central project, and young people find themselves right
in the middle of identity-work. As the question of
taking up smoking or snuffing is most urgent during the
teen years, the young persons attitudes towards tobacco
use could be seen as a part of his or her identity-work.
Earlier work on the meaning of tobacco use from a
gender-perspective has addressed the meaning of smok-
ing in motherhood and in the transition towards adult-life. In her study of English womens experience of
smoking in the context of motherhood, poverty and low
social support, Graham (1987) found that smoking
serves a contradictory function in the womens lives.
Although undermining their own and their childrens
health, smoking helps the women to cope with caring for
their families. Cigarette smoking offered them a short
break from the routines and strains of family life,
cigarettes were often the only consumption women
allowed solely to themselves. The meaning of smoking
for young women has also been studied in relation to the
transition between school and work life. Daykin (1993)
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found that for young women smoking could offer a
symbolic adult status and serve the purpose of balancing
their subordinated position both at home and at work,
as they struggled for independence.
To date, research on tobacco use from young peoples
perspective is still limited (Allbutt, Amos, & Cunning-
ham-Burley, 1995), and more knowledge is neededabout contexts that promote smoking or non-smoking.
Michell and Amos (1997) have demonstrated the
importance of the gendered peer-group structure for
smoking. Lloyd, Lucas, and Fernbach (1997) and
Moffat and Johnson (2001)have explored teenage girls
smoking identities and the meaning of nicotine addic-
tion, andPlumridge, Fitzgerald, and Abel (2002)looked
at the implication of smoking refusal on personal
identity. However, teenagers own notions should be
explored to further the understanding of tobacco use in
the teens, which also may have implications for health
promotion as suggested by Frankowiak (1987).
Method
To capture teenagers notions of tobacco use, a
qualitative approach with focus group interviews was
used (Krueger, 1994). Lunt and Livingstone (1996)
argue that focus-group interviews stimulate everyday
communication and thus allow for the analysis of social
representations. Furthermore, as Farr points out:
Group discussions is a useful way of sampling thestock of arguments available within a particular
culture where the researcher is interested in the
arguments produced rather than in the individuals
producing the arguments (Farr, 1995:6)
Focus groups differ from individual interviews in that
they capture the social interaction among participants
and can provide knowledge about peoples shared
understanding of everyday life (Krueger, 1994). Frank-
land and Bloor (1999) argue that the method is
particularly suitable in studies of group norms, espe-
cially if participants know each other, which was the
case in this study. It is then possible to gain insight intoconflicting views as well as consensus in the groups
regarding a phenomenon.
Nine focus groups were carried out with 43 ninth-
grade students, 1415-year- old, at two schools in inner
Stockholm, in areas with an average socio-economic
structure. The first author (M-L.S.) moderated all nine
groups and another member of the research team made
close observations of the discussions and interactions in
the groups (Stjerna et al., 2000). Girls and boys were
interviewed in separate groups, as is recommended in
studies of gender issues (Debus, 1990; Krueger, 1994).
Tobacco users and non-tobacco users, according to their
own presentation of their tobacco habits, were also
placed in different groups to stimulate discussions and
avoid a polarization between teenagers with differentexperiences of tobacco use: Table 1.
The non-tobacco users did not smoke or use snuff at
all. Tobacco use varied from occasional smoking/
snuffing to regular smoking of 1020 cigarettes a day
or snuffing on a daily basis.3 The discussions4 revolved
around the teenagers views on boys and girls tobacco
use at home, at school and in their leisure time, and on
how tobacco use is represented in the media, with a
focus on what they saw as its advantages or disadvan-
tages. All nine groups were tape-recorded and tran-
scribed verbatim. The analysis was conducted in three
steps (Stjerna, 2001). First, the teenagers talk about
tobacco use was described according to the strategy of
analytic induction or deviant case analysis (Frankland&
Bloor, 1999). Starting with one interview, eight themes
were identified; (1) health and tobacco use, (2) the age-
limit of tobacco purchase, (3) school and tobacco use,
(4) media and tobacco use, (5) the aesthetics of tobacco
use (6) the pointless tobacco use, (7) presentation of
self, peers and adults as tobacco-users, (8) presentation
of self and peers who do not use tobacco. The
description of each theme was then modified, with
openness to new themes and sub-categories, in the
process of including more material from all groups. The
focus was here directed towards conflicting views andconcordances in the groups. The second step was to
identify notions of tobacco use which were shared
among the teenagers. At this level, the focus was on the
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Table 1
The number of participants in the focus groups
Group no. Tobacco habit Sex Abbr. Participants
1 Tobacco users Boys T-B 5
2 Tobacco users Boys T-B 3
3 Tobacco users Girls T-G 44 Tobacco users Girls T-G 6
5 Non-users Boys N-B 6
6 Non-users Boys N-B 4
7 Non-users Girls N-G 6
8 Non-users Girls N-G 5
9 Non-users Girls N-G 4
Total 43
3The majority of the 25 non-tobacco-users had tried smoking
earlier, 12 boys and one girl had tried snuffing. Among the 18
tobacco users more girls than boys use tobacco on a daily basis.4A topic guide was used to stimulate to discussions among
the focus groups participants and to cover certain topics of
interest: tobacco use related to (1) the age-limit of tobacco
purchase, (2) school (3) family (4) leisure time (5) advantages
and disadvantages of tobacco use (6) media and (7) gender.
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teenagers ways of understanding the world, for example
their assumptions about male, female, the body,
generation and tobacco use. The final step was to
identify the most general themes constituting the social
representation of tobacco use and to develop a deeper
understanding of the teenagers cultural repertoire of
identities.
The social representation of tobacco use
The analysis revealed that the teenagers shared
understandings of tobacco use revolve around notions
of risk, human nature and societys efforts to
discipline its citizens. At the most general level of social
thinking, there is a dynamic interplay between these
notions.
Tobacco use as risk
The teenagers talk about the risk of tobacco use in
relation to physical health and addiction to tobacco.
Smoking is related to negative social development, such
as drug abuse, primarily among non-users, and to
images of the problematic smoker. According to the
teenagers, smoking will eventually lead to the break-
down of the whole body. Notions of the body as inner
and outer, or invisible and visible emerge in the ways the
girls and boys talk about the absorption of oxygen and
the functioning of lungs when smoking. They describe
that the invisible process inside the body, when smoking,
will gradually be visible on the outside of the body. This
implies a way of thinking ofrisk as a process, which also
is related to a dimension of time. Pictures of the
smokers lungs which have been shown in tobacco
education sessions at school, are described in terms of
how smoking destroys lungs and makes them dis-
gusting. When talking about the outside of the body, a
non-smoking girl (group 9) says: Maybe they look
good now (others of the same age who smoke), but if
you wait, if you, like, look, all our parents who smoke,
they dont really have nice teeth.
Snuffing is not associated with illness and death thesame way as smoking, but more with the health and
hygiene of the mouth. Among the boys, there is an idea
that snuffing could have positive effects, such as
increasing their sports performance. To this degree
snuffing is attributed a health value, but if one wants to
avoid risk all together one should not use snuff. There
seems to be a close relationship between smoking, illness
and ugliness. For example, a boy who does not use
tobacco (group 6) thinks that it is the cells in the face
that will be destroyed by smoking and that a person
does not have to become ugly provided he or she
abstains from smoking. The bodily processes are also
related to aesthetic values. Some girls refer to tobacco
information they have read in girls magazines:
* Like, there are models who appear in magazines and
tell you that smoking is bad. That it gives you a bad
complexion and then you think y*
Ill never be Miss Sweden. (Group 3, T-G)
Some of the aesthetic effects of tobacco use show
immediately. Cigarette smoke smells and the snuffer
looks ugly as the snuff changes the shape of the lip:
* And moist snuff is disgusting when it hangs outside
the lip (laugh).* Then when it is spit out there is some left between the
teeth (laugh). Then it is so damned disgusting when
they laugh. (Group 5, N-B)
Furthermore, in the long run the smoker runs the risk
of becoming seriously ill as a result of smoking.However, the teenagers stress that it will take a long
time before the more serious consequences of smoking
occur (if they ever do). This means that ill-health due to
tobacco use does not have to be a reality until the distant
future. This indicates different notions of risk related to
the young and the adult smoker as well as a risk
dimension, spanning from almost no harm to serious
danger. At one end of this continuum is the teenager
who has been using tobacco for a short while, and at the
other, the adult who has been a smoker for almost a
lifetime.
The teenagers seldom question tobacco facts. Such
facts are understood as valid on a general level, but the
teenagers sometimes wonder if information about
smoking is exaggerated:
* Except, the information you get, you dont really
know if its true. But, it most probably is. I dont
know.* Most often you think that they only want to scare
you and, like, exaggerate about things. Thats what I
think they do. (Group 1, T-B)
The meaning of these facts is sometimes renegotiated
at thelevel of the individual, making smoking or snuffing
seem appropriate for some individuals. The teenagersstress that people differ in bodily constitution as well as
values. Some people may never experience illness due to
smoking. A boy who smokes puts it this way:
* I dont feel the need to quit smoking. I dont know
why. I havent noticed that Im less fit, than I need to
be, because I dont feel less fit. I still ride my
skateboard and, like, play floor ball and stuff like
that. I can still do it just as well. (Group 2, T-B)
The teenagers assume that people evaluate what is
important to them. It is not possible to smoke if you
want to be a successful sportsman or woman, but if you
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are just an ordinary jogger, the issue of smoking is not as
important. Also there is the idea that some people are
attracted to danger, and see a value in risk-taking, which
is one reason for them to choose to smoke. The
teenagers are thus informed about the risks of tobacco
use. However, an underlying dimension in their reason-
ing is the assumption that it is possible to be healthy andsmoke. At the same time a constant danger, a health
hazard, is lurking in the background. Lupton (1995)
refers to the function of cigarettes as an expression of
beauty, pleasure and death: Cigarettes are negative
pleasure; they risk death even as they fulfil desire
(Lupton, 1995:153). The smokers caring for ones own
health has been described as subordinated to other
concerns (Graham, 1987; Lupton, 1995). What is
indicated in this study is that tobacco use and health
are not always seen as contradictory at the level of the
individual, and smoking during teen years is not
necessarily thought of as turning away from health.
Tobacco use and human nature
The teenagers express the idea that human nature
makes people susceptible to tobacco use. This idea is
related to the view of the teens and is closely associated
to teenagers identity work. Smoking is sometimes
described as part of teenage lifestyle; such as being
together with friends, going out and enjoying oneself.
The girls who smoke talk about growing older when
they will quit smoking:
* When youre like 30 years old, you dont go out withyour friends in the same way. Maybe, you just sit at
home and watch TV with your husband and kids
(laugh).* God, that sounds boring.* Yeah, I know but then you dont really have the need
to smoke. (Group 4, T-G)
Family life is thought to put adults under the
obligation not to smoke. Parents should not smoke in
front of their children or allow them to smoke:
* One person in our class is allowed to smoke at home.
Her dad lets her. But I think it isy* Thats no good. I dont think that is taking their
responsibility as parents if they let their kids smoke a
home. (Group 9, N-G)
Also, it looks bad if mothers smoke: she sat with her
little baby over her shoulder. The baby was like, two
weeks. She sat and smoked over her kid (Group 4, T-
G). At the same time, there is an opinion that adults
have limited possibilities of controlling teenagers. For
example, a boy (group 2) says that his mum doesnt
approve of him smoking, but there isnt much she can
do about it. There is some acceptance ofadult smoking,
as adults are supposed to do what they want and are
considered more responsible than teenagers. Some
boys who use tobacco (group 1) say it is okay if their
parents smoke, but only if they try to stop. Less
common are explicitly expressed worries about a
smoking parent He smokes lots and lots, an awful
lot. And that is, like, and I become sad, because you
know that, what the risks are, that he can get cancer andall that stuff. (Group 8, N-G). The overwhelming
reason why adults smoke, according to teenagers, is
because they are addicted to tobacco. The idea is that
parents and grandparents started to smoke at a time
when they didnt know much about the health-hazards.
This is seen as a legitimate reason for adult smoking but
less legitimate for teenagers, who smoke just in order to
be cool: Its idiotic to start smoking now, but it
wasnt back then. No one knew that you could get
cancer then and the thing with nicotine, you just cant
quit later on. (Group 6, N-B).Smoking is thus seen as a
symbol of adult life, but thought of as loosing itsattractiveness after the age of 18, when one is officially
grown-up.
When it comes to their own tobacco use, the teenagers
describe the meaning of peer-pressuredifferently accord-
ing to their experiences of tobacco. The non-users argue
that smoking gives young people access to social life,
and peer pressure is about belonging to a certain group:
This thing with smoking. Its just a status thing with
wanting to belong to a group and stuff like that, I think.
You want to be cool (Group 6, N-B). The peer-
pressure is then seen as the smokers desire to attain a
certain image. Everybody has a dream of being popular
and some people do anything to achieve this. Suscept-
ibility towards smoking could in this sense be under-
stood as a deeply human need to belong to others. As
rational beings, smokers act in order to fulfil their needs,
for instance to achieve high status or belong to a social
group. Among boys who smoke, the credo is that it is
wrong to expose others to pressure to smoke, but
everybody has the right to make ones own choice:
* I think every one should do as they wish.* Yeah, I do too.* I guess thats how it is with everything. Only if it
doesnt directly affect others.* You get so much information. You know that its
dangerous. It you want to smoke, you can do it
anyway. (Group 1, T-B)
All but one of the smoking girls emphasise it was their
own choice to smoke. When they started, smoking was a
fun thing to do. These girls focus on the pleasure, the
new and the excitement of smoking, but stress they
dont smoke in order to be cool: if I dont smoke or
drink then Im still cool, Im still noticed, no but heard,
noticed, everything, just the same in school (Group 3,
T-G). From this point of view smoking is seen as an
offer, possible to realise through friends who smoke.
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This is in line with other studies suggesting that girls
who smoke are more socially skilled, self confident and
rebellious than their non-smoking peers (Clayton 1991;
Michell & Amos, 1997). The point is that girls who
smoke are not unable to refuse cigarettes, but actively
choose to smoke.
Both boys and girls who smoke stress that one reasonthey smoke is because it is a social thing to do. When
smoking, they spend time together with friends during
breaks in school or after school hours and at parties,
which means that smoking functions both as an activity
and a way to make friends:
* But you smoke because its sociable.* Yeah, you make new friends, can stop a good-
looking guy in town and ask for light (laugh)* Yeah, exactly, its terrific.* So I mean, when I came to this class, then it was, I
got to know her just because we went out and smoke
at recess, like. Like, what would we otherwise have
done? (Group 3, T-G)
According to the teenagers, there is a difference
between smoking as a social act and being addicted to
tobacco. The smoking girls are not sure they want to give
up smoking. When they have tried to quit they get
irritated and in a bad mood and some describe
physical cravings for smoking, such as cramps in the
stomach. The boys who use tobacco say they are able
to stop whenever they want to, thus locating themselves
in a phase of invincibility, which can be seen as a
paradoxical standpoint I smoke, but I am not a
smoker (Moffat & Johnsons, 2001, p. 673). At the
same time it is perceived as risky to continue smoking:
But what I think is that I know that I can quit right
now, but then maybe you keep on thinking that youve
only just begun, so maybe some months pass by without
thinking about it, then maybe suddenly, you cant quit
(Group 1, T-B). Compared to the boys, the girls present
a smoking identity which recognises their addiction to
tobacco, which similar to Moffat and Johnsons (2001)
study of American girls. Smoking gives you pleasure
(you dont really want to quit) and at the same time it is
out of control (it is difficult to quit). From this point
of view, addiction to tobacco is seen as the inevitableresult of continuous use.
Among non-users, the disposition to develop an
addiction is also understood as a human weakness. At
the same time there is an understanding that individuals
are different. For example, non-users, like themselves,
have the mental strength to resist the pressure to smoke.
The boys who do not smoke (group 6) suggest that to
refuse smoking at their age proves a certain maturity,
strength of character or self-confidence. The non-
smoking girls argue that it feels good not to do as
everyone else: I think is an advantage in being able
to say that you dont smoke. Youre not like others. You
dont have to be like others. You dont have to, like,
follow theirsy (Group no 9, N-G).
To conclude, it is not human nature, the suscept-
ibility to tobacco use, that varies, but the individuals
ability to handle the consequences. Furthermore, the
human ability to deal with tobacco use is seen as related
to the phases of the life-cycle. Teenagers differ fromadults in terms of maturity, which determines their
different abilities and obligations to take responsibility
for their own and others behaviour.
Tobacco use and societys efforts to discipline its citizens
The third theme in the representation of tobacco use is
the role of society. The teenagers opinions about the
role society ought to take, actively or passively, is related
to their view on tobacco use and human nature, in
particular the ways tobacco use is perceived as normal
or not normal. The teenagers who use tobacco arguethat frequent smoking among adults makes it normal.
They (smokers) are a part of society. They are
everywhere so, like, I mean its not really anything you
think about, much. Oh no, that person is smoking, who
cares (Group 2, T-B). The idea that tobacco use is an
artificial need, which makes it not normal, is most
strongly articulated among the non-users. However, the
scientific evidence of the health hazards is used as a
strong argument why society should act among both
users and non-users. This evidence is often presented as
a moral imperative to abstain from tobacco, and in the
focus group discussions it is apparent that the respon-sibility for ones own health and the responsibility
towards others is closely associated to guilt; tobacco
use is perceived as non-hygienic and causing illness.
Snuffing, however, is more at ones own risk and is
mostly related to aesthetic values: But I think its
better, because the ones who use snuff just affect
themselves. Its nothing that affects anyone else. But if
someone is standing smoking and blows smoke in your
face, then you also breath it in and that affects you.
(Group no 8, N-G).
In this study, the teenagers present themselves as the
informed generation, who are well aware of the health
hazards of smoking. There is a strong consensus amongboys and girls that there is no new information about
smoking. However, the case of snuffing is less clear. The
teenagers stress that they do not know as much about
snuffing compared to smoking, but snuffing is viewed as
less hazardous to health than smoking:
* They should remove the sign (health information on
snuff package), because it isnt known whether its as
harmful in that way (the boy is referring to the cancer
risk). The only thing is that, like, its eats away your
lip, the underside of the lip.*
You get cancer, you can get cancer.
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* But its not like, its, you cant die from using snuff. Or
anyway, they havent found that yet. (Group 5, N-B)
Also, there is an understanding that society has
possibilities and obligations in the restriction of teenage
use of tobacco. However, the teenagers nature makes
it difficult, as teenagers are thought of as living here andnow and also stretching rules. The teenagers attitudes
towards societys right to intervene are related to the
question of whom the measures are directed to. Children
are considered incapable if taking responsibility for their
actions and should therefore be protected from tobacco
use. In addition, tobacco use is viewed as inconsistent
with the idea of childhood. The age-limit of tobacco
purchase (18 years) is worthwhile because it could
prevent young children from smoking:
* But then these little kids who see the cool people
standing back here smoking (at school). Then they
think that it is okay, because there isnt any age limitor anything. Then no one talks about it. Then,
maybe, like, hash begins to be like this, likey* Smoking.* Yeah, right and then it just gets worse and worse. I
dont think that you can, you cant just cant just go
ahead and allow it. (Group 6, N-B)
The majority of teenagers who use tobacco argue that
at 1516, the teenager has attained the awareness to
handle tobacco use. The non-users present a rival idea;
smoking during the teens could be described as
youthful foolishness, even though the psychologically
mature teenager is able to decide about his or her own
life. The teenagers think that most adults want to quit
smoking, but are unable to, andsmoking in middle age is
thus described as a cul-de-sac: Then I think (the girl is
referring to adults who smoke) poor, poor person, like,
that is stuck and has smoked their whole life, type of
thing. (Group 3, T-G).To summarise, teenage smoking
and adult smoking are viewed as separate phenomena.
Risk, the possibilities of society to intervene and to a
certain degree the human nature is thought of as varying
in relation to different phases of the life span. The
teenagers also stress the differences between smoking
and snuffing. The risks of using tobacco are thus seen asvarying. The teenagers representations of tobacco use
can thus be seen as characterised by a dynamic relation-
ship between, on the one hand, notions of the suscept-
ibility of human beings towards the risky smoking and on
the other hand, the opportunities and obligations of
society to intervene in this course of events.
A cultural repertoire of identities
To understand the gender aspects of tobacco use, we
looked more closely into the different cultural images
of tobacco use. Part of identity-work consists of
developing a gender identity (Forn.as, 1995), we examine
the meaning of collective identities that are used by the
teenagers to develop an understanding of social life.
Such cultural images, in turn, say something about
values and ideals in our culture.
The identity of the young smoker, snuffer and non-user
One characteristic of teenage culture which emerges in
this study, is that smokers are largely portrayed in a
positive manner. It is the cool ones with high status in
the teenagers hierarchy who smoke. The popular
ones go to parties, drink alcohol and smoke. The idea
of peer-pressure is intertwined with this positive image
of those smoking. Also, according to the teenagers,
those who begin smoking widen their circle of friends:
But if you start smoking, then you start drinking, then
you get to know everyone, the ones who are so-called
popular and cool. (Group 9, N-G).This is in line with
other studies of the structure of young peoples social
networks. Urberg, Degirmencioglu, and Pilgrim (1997)
showed that when young people tried smoking or
drinking alcohol, they often started to socialise with
peers who smoked or drank alcohol. A limited use of
tobacco or alcohol could lead to positive changes in the
relationship to peers, as found in a study of German
teenagers (Maggs & Hurrleman, 1998): for example,
more occasions when peers spent time with each other
and increased experiences of having a central role in the
circle of friends.In a Scottish focus-group study, teenagers described
their relations as formed within a hierarchic structure
(Michell & Amos, 1997). Girls at the top, who were
cool and good-looking, were the ones smoking.
These girls can be more vulnerable to smoking as they
could use cigarettes to form a certain image of
themselves. For boys with high social status, smoking
did not seem to have the same social significance.
Participation in sports activities and other interests, such
as computers and music, seemed to protect them from
smoking, as in this study. However, a substantial
proportion of the young Scottish female smokers alsohad sophisticated social skills, which makes the image of
their smoking behaviour more complex. In our study, we
have seen that both girls and boys who use tobacco
stress that it is a personal choice to start smoking.
Although smoking has a gender loading towards the
feminine, it is also perceived as gender neutral:
* I dont think it matters if they are girls or boys. Its
just the ones who, like, want to meet others instead of
sit at home and study.* I think that its probably those ones that start
smoking. (Group1, T-B)
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According toMichell and Amos (1997)smoking does
not seem to be an issue for girls positioned in the middle
of the teenagers hierarchy. Those girls who were doing
well at school and had positive aspirations for the future
did not feel a pressure to smoke and were safe from
smoking. Plumridge et al. (2002), on the other hand,
argue that smoking as well as smoking refusal areimportant identity statements, which means that non-
smoking teenagers are always faced with the problem
of accrediting themselves against superior smokers cool
group (2002 p. 167). In our study, the non-users
present positive images of non-smokers and negative of
their smoking peers, which could be described as
rivals to the positive image of the smoking teenager.
This implies that smoking could always be understood
as a topic of interest in the teenagers culture. Although
images of smoking and non-smoking youths seem to
circulate in teenager culture, this does not necessarily
mean that the non-smoking individual always will findhim or herself having to struggle against their inferior
status compared to peers who smoke. Rather, these
images could be understood as a repertoire of different
values and ideals among teenagers, with implications for
smoking uptake or refusal.
This reasoning gets some support in a British focus
group study of girls construction of non-smoking and
smoking identities which demonstrated that girls not
only have different tobacco habits, but also different
ideals (Lloyd et al., 1997). The non-smokers identity
was rated more sensible than the smokers, by non-
smoker as well as smokers, whereas the smokers
identity was rated more fun-loving. On the other
hand, being mature was desirable to smoking as well
as non-smoking girls, but may be constructed differently
as both groups claim to be mature. If we assume that
different groups of teenagers accept different ideals, this
can be problematic for the non-smokers as well as the
smokers. Individuals are not free to fashion their
identity as they choose, but have to do so under
conditions of others readings of their competence. Each
has to make a claim to some identity, but lacks the
power to ensure the claim (Plumridge et al., 2002, p.
169). However, smoking alone is no guarantee for being
accepted as cool, the right clothes and being seenwith the right people was just as important (ibid). The
conclusion is that there seem to be continuos ongoing
negotiations concerning identity claims in the social
space of teenagers.
In our study, the teenagers speak about non-smokers
as associated with psychological strength and willpower
to make ones own choices. The boys who represents
themselves as athletes (group 6) say it is a natural
thing not to smoke, but snuffing is possible for a
hockey or football guy. Also, their smoking peers can
claim that those who do not smoke are smart or are
impressed by their non-smoking status. This is in line
with Michell and Amos (1997) findings that an interest
in sports or computers can protect from a mean-
ingless life, which could be the breeding ground for
smoking. The dreary character of the swot also
changes when the school is presented as an interest
which prevents you from smoking, as found in a British
study where the non-smoker was portrayed as interestedin school life. Girls who adopted this identity were likely
to refer to girls who smoke as stupid (Lloyd et al.,
1997). At times, the non-users talk about tobacco use as
problematic behaviour. For example, the smokers hang
around, consume alcohol and are potential trouble-
makers. By the use of tobacco they take risks which
could lead to drug abuse:
* If I think back to when I was in elementary school,
its like, when you look at the photos: everyone was
so little, no one is going to smoke. Then, there they
stand with a cigarette in their hand or lying some-where in a ditch drunk. Its like, its almost sad to
think about. Such little children: you sit and you look
at the pictures. In that picture they didnt know that
they would begin smoking and drinking. (Group 9,
N-G)
Images of female and male tobacco use
The teenagers assume that girls and boys are brought
u p t o a female and male identity, respectively.
According to this view, upbringing in the family and the
commercial market are important socialising agents.The reason why girls and boys, act differently in some
respects, is associated with different ideals and the
different expectationsthey are confronted with: I think
that girls are more into their appearance and stuff like
that. Because they are more used to that role, they put
on makeup and stuff like that. And its like, smoking is a
little more like, the appearance like, how you
look(Group 6, N-B). One idea, put forward by the
non-smoking girls (group 9), is that girls smoke in order
to avoid eating candy and putting on weight, based on
the assumption that girls learn to pay great attention
to their appearance. Smoking is also understood as an
attribute that girls can use in order to create a specialimage of themselves. The entertainment business is given
a prominent role in this process, as a creator of
images. Boys are also presented as anxious about their
appearance, but boys and girls are thought of as having
different ways of expressing themselves. Boys and girls
deal with smoking in different ways, even if there are
exceptions:
* Girls are more discreet about smoking. When they
come into the classroom they breath more through
their nose. They try to avoid their fingers, and they
ask: Like, do I smell of smoke? When boys come into
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the classroom they couldnt care less if they smell of
smoke. Right (laugh)?* Thats exactly right. Most of themy* Well, take Maria, for instance. This is how she is (the
boys inhales and exhales) then she enters like this.
But, like, she doesnt give a damn about anything.
(Group 2, T-B)
The teenagers argue that girls shouldnt snuff.
Snuffing is considered un-feminine and thus a typical
male thing; If girls smoke, if boys smoke, no there is no
difference. They can smoke as much as they want to, as
we want to. But no snuffing. (Group 1, T-B). They
stress that it is not common for girls to snuff, but if they
do, they snuff in a more tasteful and discrete
manner than boys. It is more acceptable for a man to
snuff. The girls who use tobacco (group 3) say that
although snuffing is disgusting, boys who snuff can be
friendly and very sweet. But in any case boys
shouldnt snuff for aesthetic reasons: I dont think that
boys should use snuff either, because its so unattractive.
I mean, God, just putting it in like that, no you cant do
that, like making your face uglier. (Group 3, T-G) .
Furthermore, for the teenagers the meanings of
certain fields, contexts and clich!es are associated with
female or male significance. Different types of
tobaccos have male or female connotations, which
in turn are associated with different contexts. Pipes and
cigars are male. Cigarettes are both male and
female with domination towards the female.
Snuffing is considered male. Further, snuffing is
associated to male fields such as hockey, football,hunting and construction work:
* Snuff, yeah, its likey* Yeah, its manly or men in their 30s.* Like, construction workers. Yeah, like with check-
ered shirts.* Who hunt. (Group 9, N-G)
When associated to glamour, smoking is consistent
with a feminine style: Yeah, but like, they (the boys
is referring to girls his age), they want to look so bloody
good and go around with their cigarette trying to look
glamorous. (Group 2, T-B). The teenagers also reflecton smoking heroes (men) in action movies:
* when we saw a movie at the cinema. It starred Bruce
Willis and what the hell he is calledy* Die hard?* No, but never mind about that. In it he smoked so
damned much and he was really mean, really
shooting down every last person and stuff like that.
(Group no 6, N-B)
If it is a tough cowboy who smokes, the gender-
loading is male, the strong man. This male stereo-
type could be compared to a female clich!
e; the glamour
woman, a seductive and slightly dangerous femme
fatale. These images could be related to smoking
women earlier in the 1900s, who were not considered
respectable (Waldron, 1991). Also, the feminine
and masculine can be reflected in the way one smokes
and holds the cigarette. The girls who smoke (group 4)
think it is charming and smart if boys smoke in acertain manner, which is relaxed and cool.
The teenagers reasoning reflect roles and identities
divided by gender. At the same time it is possible to
break gender norms and expand conventional gender
roles. AsJones (1993)argues, there are several positions
for a female subject. In the group of boys who use
tobacco (group 2) suggest that it is alright if tough
birds use moist snuff compared to mini catch which
is seen as a more feminine snuff. However, to break
norms can be risky. A boy who smokes in a feminine
manner runs the risk of being seen as sissy. A girl who
snuffs could be viewed as mannish. The teenagersusually do not explain gender differences in terms of
biology, but snuffing is a less clear case since it is
considered to be a male practice given by nature; men
have for a long time practised the habit. Consequently,
the ways snuffing is reserved for men is not viewed as
discrimination of women. However, girls can break into
this male field if they do it in a way that is consistent
with what is accepted as feminine in the culture.
To sum up, the repertoire of possible identities to
some extent reflects the cultural images that teenagers
face and have to deal with as part of their identity-work.
The analysis shows that the teenagers cultural images of
female, male and youth identities and behaviour
are fairly stereotyped. However, the tension between
different types of images, such as the cool or the
problematic smoker, as well as the possibilities of
crossing gender barriers and expanding traditional
gender identities, indicates that what should be con-
sidered feminine, masculine and the identity of the
young smoker is continuously negotiated in different
social situations. At the level of the individual the
teenager can draw on these cultural images in different
ways in different social contexts. The cultural images
could thus be seen as offers and allow for different
ways of expressing gender identities.
Conclusion
What conclusions can be drawn from the analysis of
the teenagers social representation of tobacco use? The
fact that the notion of the cool smoker emerges in this
study, limited to urban Sweden, as it does in other
European studies (Michell & Amos, 1997; Plumridge
et al., 2002) indicates a more general notion of the
tobacco user in Western teenage culture. However,
the analysis reveals a more complex pattern. First, the
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tradition of snuffing adds another dimension to tobacco
use in Sweden, which is presented as less harmful than
smoking and goes well with a traditional male identity.
Secondly, the teenagers are informed about tobacco
facts and do not question the health hazards at a general
level, even if the correctness of these facts are discussed.
At the same time, the risk of tobacco use is re-interpreted at the individual level. The individual has a
responsibility for her own and others health, but this is
open to be negotiated within the local socio-cultural
contexts of teenage life. Most importantly, smoking
during teenage years and adult life are viewed as
separate phenomena. The teens are viewed as a phase
in life characterised by certain conditions, and tobacco
use in this phase is not necessarily thought of as turning
away from health. In these ways, the teenagers
challenge a more fundamental imperative of health
(Lupton, 1995) and cultural understandings of health as
a symbol of happiness (Herzlich, 1995) in contemporaryWestern societies. The conclusion is that, although well
informed about the health-hazards, the teenagers
notions of tobacco use forms a paradox; although
considered risky, smoking is thought of as possible during
the teenage years, since the most alarming dangers are
attributed to the adult smoker.
This pattern, in turn, seems to be intertwined with
certain youth and gender identities. The teenagers see
the individual as shaping her own destiny, as an
individual acting within a social context. This takes
place in a rapid stream of different influences, such as
upbringing in the family, teenage culture, market forces
and societys efforts to discipline its citizens. Part of this
influence is the possibility of tobacco use. When
confronted with the offer of tobacco use, loaded with
symbolic meaning, teenagers are thought to differ in
psychical strength and capacity to handle this offer in
the context of identity-work. Here, the notion of
human nature is important, and the finding that
teenagers separate the childs nature from the teenagers,
but not male from female. However, even if the
teenagers nature creates a common platform for
identity-work, to be a boy or a girl, weak or strong is
seen as making a difference. We would argue that
teenagers notions of tobacco use should be understoodwithin this context of identity-work, reflecting the
fundamental condition of modern man to be obliged
to form an identity (Giddens, 1991;Smart, 1999).
This study has shown that the teenagers hold complex
and conflicting ideas concerning the relationship be-
tween tobacco-use, risk, the body and human nature.
These results may have implications for preventing
tobacco use among teenagers. Of particular importance
are the ways images of tobacco use are intertwined with
ideas of different identities that the teenager could strive
for or try to avoid. We have seen that boys and girls
tobacco use are described as related to different values
and gender loadings. Also, some teenagers, mostly girls,
articulated an identity as smokers whereas others were
more likely to view themselves as social smokers.
Other researchers (Michell & Amos, 1997, Plumridge
et al., 2002:169) have stressed that girls seem to be more
vulnerable to smoking uptake due to different peer
pressure and have more limited possibilities of formingalternative identities to the cool smoker, whereas boys
seem to be more protected as they can establish
themselves as physical beings. In other words, there
are gendered solutions to the problem of being a non-
smoker. We agree with Wearing, Wearing, and Kelly
(1994)argument, that to prevent smoking in girls, there
is a need to provide enriching experiences in the leisure
field, which can extend the repertoire of female identities
beyond the traditional. To do this, we think it is
important to take teenagers social representation of
tobacco use as a point of departure.
Acknowledgements
We would like to thank the teenage girls and boys
who participated in the focus groups discussions and
Dulcinia Da Costa for her translations from Swedish of
the teenagers vividly described views on smoking and
snuffing. We would also like to thank the anonymous
referees for constructive comments on an earlier version
on this paper, as well as the Swedish Cancer Society for
funding the initial phase of this study.
References
Allbutt, H., Amos, A., & Cunningham-Burley, S. (1995). The
social image of smoking among young people in Scotland.
Health Education Research, 10, 443454.
Andersson, B., Gr .onberg, K., & Hibell, B. (1999). Skolelevers
drogvanor 1998. Tabeller med sammanfattande kommentarer.
Resultat fr (an riksunders.okningen i (arskurs 7 och 9 1998.
(Schoolchildrens drug habits 1998. Tables and comments.
Results from a national study of grades 7 and 9, 1998).
Stockholm: The Swedish Council for Information on
Alcohol and Other Drugs.
Bolinder, G. (1997). Long-term use of smokeless tobacco.
Cardiovascular mortality and risk factors. Stockholm:
Karolinska Institutet. (Dissertation).
CAN. (2001). The Swedish Council for Information on Alcohol
and Other Drugs. Trends in alcohol and other drugs in
Sweden. Report 2001. Stockholm: CAN. (Report No. 63).
Clayton, S. (1991). Gender differences in psychosocial determi-
nants of adolescent smoking. Journal of School Health, 61,
115120.
Daykin, N. (1993). Young women and smoking: Towards a
sociological account. Health Promotion International, 8,
95102.
Debus, M. (1990). Handbook for exellence in focus groups
research. New York: Lexington.
ARTICLE IN PRESS
M.-L. Stjerna et al. / Social Science & Medicine 59 (2004) 573583582
8/13/2019 Tobacco Use Main
11/11
Farr, R. M. (1995). Representations of Health, Illness and
Handicap in the Mass Media of Communication: A
theoretical overview. In I. Markov !a, & R. M. Farr (Eds.),
Representations of health. illness and handicap. Singapore:
Harwood Academic Publishers.
Forn.as, J. (1995). Youth, culture and modernity. In J. Forn .as,
& G. Bolin (Eds.), Youth culture in late modernity. London:Sage.
Frankland, J., & Bloor, M. (1999). Some issues arising in the
systematic analysis of focus group materials. In R. S.
Barbour, & J. Kitzinger (Eds.), Developing focus group
research. politics, theory and practice. London: Sage.
Frankowiak, P. (1987). Risk-taking and adolescent develop-
ment. The functions of smoking and alcohol consumption in
adolescence and its consequences for prevention. Health
Promotion, 2, 5161.
Galanti, M. R., Rosendahl, I., Post, A., & Gilljam, H. (2001).
Early gender differences in adolescent tobacco usethe
experiences of a Swedish cohort. Scand J Public Health,29,
314317.
Giddens, A. (1991).Modernity and self-identity. Self and societyin late modern age. Cambridge: Polity Press.
Graham, H. (1987). Womens smoking and family health. Social
Science & Medicine, 25, 4756.
Herzlich, C. (1973). Health and illness: A social psychological
analysis. London: Academic Press.
Herzlich, C. (1995). Modern medicine and the quest for
meaning: Illness as a social signifier. In M. Aug!e, & C.
Herzlich (Eds.), The meaning of illness. antropology, history
and sociology. New York: Harwood Academic Publishers.
Holstein-Beck, S. (1995). Consistency and change in the
lifeworld of young women. In J. Forn.as, & G. Bolin
(Eds.),Youth culture in late modernity. London: Sage.
Jodelet, D. (1991). Madness and social representations. Hert-
fordshire: Harvester Wheatsheaf.
Jones, A. (1993). Becoming a girl: Post-structuralist sugges-
tions for educational research. Gender and education, 2,
157166.
Krueger, R. A. (1994). Focus groups: A practical guide for
applied research (2nd ed.). Thousand Oaks: Sage.
Lloyd, B., Lucas, K., & Fernbach, M. (1997). Adolescent girls
constructions of smoking identities: Implications for health
promotion. Journal of Adolescence, 20, 4356.
Lunt, P., & Livingstone, S. (1996). Rethinking the focus group
in media and communications research. Journal of Commu-
nication, 2, 7998.
Lupton, D. (1995).The imperative of health public health and the
regulated body. London: Sage.Maggs, J. L., & Hurrleman, K. (1998). Do substance use and
delinquency have differential associations with adolescents
peer relations? International Journal of Behavioural Devel-
opment, 2, 367388.
Michell, L., & Amos, A. (1997). Girls, pecking order and
smoking.Social Science & Medicine, 44, 18611869.
Moffat, B. M., & Johnson, J. L. (2001). Through the haze of
cigarettes: Teenage girls stories about cigarette addiction.
Qualitative Health Research, 11, 668681.
Moscovici, S. (1988). Notes towards a description of social
representations.European Journal of Social Psychology, 18,
211250.
Plumridge, E. W., Fitzgerald, L. J., & Abel, G. M. (2002).
Performing coolness: Smoking refusal and adolescent
identities. Health Education Research. Theory & Practice,
17, 167179.Radley, A., & Billig, M. (1996). Accounts of health and illness:
Dilemmas and representations. Sociology of Health and
Illness, 2, 220240.
Rose, D., Efraim, D., Gervais, M.-C., Joffe, H., Jovchelovitch,
S., & Morant, N. (1995). Questioning consensus in social
representations theory. Papers on Social Representations, 2,
150155.
Smart, B. (1999).Facing modernity. Ambivalence, reflexivity and
morality. London: Sage.
Stjerna, M-L. (2001). Det riskfyllda tobaksbruket, m .anniskans
natur och samh.allets disciplineringsstr .avanden. Ton(arigars
f.orest.allningar om tobaksbruk (Risk, the human nature
and social disciplinteenagers notions of tobacco use). Master
thesis (No. 50). University of Stockholm, Department of
Education.
Stjerna, M-L., Marttila, A., & Tillgren, P.(2000). R .okning
och snusning som en del i flickors och pojkars
livsstil och sociala identitetett genusperspektiv p (a ungdo-
mars tobaksvanor (Smoking and snuffing as part of teenage
girls and boys lifestyle and social identitya gender
perspective on the tobacco habits of young people).
Report KI 2000:11. Stockholm: Karolinska Institutet,
Department of Public Health Science, Division of Social
Medicine.
Tillgren, P., Haglund, B. J. A., Lundberg, M., & Romelsj .o, A.
(1996). The socio-demographic pattern of tobacco cessation
in the 1980s. Results from a panel study of living conditionsurveys in Sweden. Journal of Epidemiology and Community
Health, 50, 625630.
Urberg, K. A., Degirmencioglu, S. M., & Pilgrim, C. (1997).
Close friend and group influence on adolescent cigarette
smoking and alcohol use. Developmental Psychology, 5,
834849.
Waldron, I. (1991). Patterns and causes of gender differences in
smoking.Social Science & Medicine, 9, 9891005.
Wearing, B., Wearing, S., & Kelly, K. (1994). Adolescent
women, identity and smoking: Leisure experience as
resistance.Sociology of Health and Illness, 16, 626643.
West, C., & Zimmerman, D. (1991). Doing gender. In J.
Lorber, & S. A. Farrell (Eds.), The Social Construction ofGender. London: Sage.
WHO. (2000). Health and behaviour among young people.
WHO, Copenhagen. (WHO Policy Series: Health policy for
children and adolescents, Issue 1).
Wold, B., Aasen, H., Aaro, L.E., & Samdal, O. (1995).
Helse och livsstil bland barn og unge i Norge. (Health and
Life styles among children and youth in Norway) Hemil
Senteret, Universitetet i Bergen, Bergen. (Hemil-Rapport
No. 14).
ARTICLE IN PRESS
M.-L. Stjerna et al. / Social Science & Medicine 59 (2004) 573583 583
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