Tobacco control policy advocacy attitudes and self-efficacy among ethnically diverse high school students

Teens who feel that they can be effective anti-smoking spokespeople in their communities are less likely to be smokers themselves, according to a new survey of Texas high school students.

Students who had never smoked were the most likely to think that they could be good advocates for anti-smoking policies and that their efforts would make a difference in the community, say Amelie Ramirez of the Baylor College of Medicine and colleagues.

The study will be published in the August issue of the journal Health Education and Behavior.

Among those surveyed, black students were most likely to believe they could be good advocates for policies such as clean air laws, tobacco taxes and bans on tobacco advertising. Latino and white students were the least likely to think they could do things like write letters and collect petition signatures to support anti-smoking measures.

Ramirez says the study "suggests that feeling empowered to take action on behalf of tobacco control policies is related to remaining smoke-free."

Among the 9,177 students surveyed, smoking rates were highest among Latino and white teens. Nearly 20 percent of Latina girls, 25 percent of white girls and 30 percent of Latino and white boys said they were current smokers.

White students surveyed didn't always approve of tobacco control measures such as raising cigarette prices, "but they still felt capable of taking action to transform the system," Ramirez said. However, white students were also the least likely to believe their advocacy would change anything, she adds.

Latino students were the least likely to think they could advocate for tobacco laws and were skeptical that their advocacy would change policy, the researchers found. By contrast, black students were generally supportive of tobacco control policies, confident in their advocacy abilities and confident that their actions would make a difference.

"The favorable complex of attitudes and expectations of African-Americans and, to some extent, Asians is encouraging and bodes well for these communities," Ramirez said.

Programs that help teens learn how to advocate on behalf of health causes can promote healthy behaviors, says Marilyn Winkleby, a community health researcher at Stanford University School of Medicine.

In a study Winkleby and colleagues conducted in San Francisco schools in 2004, students who advocated for better controls on tobacco advertising in their community actually reduced their regular smoking.

The study taught the students to be advocates, and "we never said to them, ‘Don't smoke,' so it was surprising to me that their behavior changed," Winkleby says.

Winkleby says the program appeals to teens because it makes them "aware that their individual choices are highly influenced by outside forces" such as industry advertising.

"They start thinking, ‘Wow, have I been hoodwinked.' They become very astute and articulate and passionate spokespersons about these influences," she said.

Ramirez and colleagues say all teens need to learn more about the complex influences of industry and policy on their own health choices.

"Above all, they need to feel that they can bring about change when they are well-prepared, persistent and innovative," Ramirez says.

The study was supported by the National Cancer Institute.

By Becky Ham