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ot0s PHILIP MORRIS U.S.A. INTER -OFFICf CORRESPONDENCE 100 Park Avenue, New York, N.Y. 10017 we should have this information at our disposal, this document summarizes the data available, and cites references. Cliff Goldsmith's question on why people start to smoke. Because ~t.t- . , ~ . _ V At the end of last week I gave you some material intended to answer smoking tend to rely on the statistical work of Daniel Horn and the National Clearinghouse for Smoking and Health. Others offer opinions There are surprisingly few hard facts on the question of the initiation of smoking. Most of those who write on the subject of without sources or data to back them up. (1968). written widely on smoking. He is the primary author of the entry on smoking in The International Encyclopedia of the Social Sciences Joseph Di. Matarazzo, of the University of Oregon Medical School has The best summary of the situationimay be an entry by Matarazzo. - His summary of the factors involved in the initiation of smo'king is as follows: These studies consistently have identified pare_ntal smoking as one of the most important predisposing fac o i.n smo~~~ing 'among school-age children. As mentioned above, most smokers appear tolhave begun smoking between the ages of 10 and 18. .If both parents smoke, the probability that their children will begin to smoke is several times that of children with nonsmoking,parents. When only one parent smokes, the incidence of smoking among the offspring falls midway between that of the ~ The relationship of some other sociopersonal factors to initiation of the smoking,habit is less clear-cut. In general, the studies suggest that youngsters' beginning to smoke is related to: (a) . -curiosity about smoking; (b) conformity pressures among adolescent"s; (c) need for status among peers, including self-perceived failure to achieve peer-group status or satisfaction; (d) the need forr self-assurance; and' (e) striving,for adult status (see the revie0s `A by Hochbaum 1964; Horn 1'963). However, it is difficult to measure the strength,of suchineeds, as well as their relative influence, and therefore these relationships should be considered tentative. other two groups. Published data also suggest a higher frequency of smoking among children withiolder siblings who smoke.

The basis for his, and many other statements is a publication of The National Clearinghouse for Smoking,and Health (1972) whichi reported on two surveys of teenagers, numbering 4931 in 1968 and!2640 in 1972. Their conclusions are based largely on statistical inference. The report concludes: While there are many factors in the environment of the child that influence h~is taking up, or not taking up, the smokingg habit, the one that has by far the most influence is the smoking behavior of those around him ... In householdis where both parents are present, the teenager is much more likely to be a smoker if the parents smoke. In fact, if both parents smoke, the teenager has about twice the likeli- hood of being a smoker than if neither parent smokes; the rates are 18.4% and' 9.8% respectively. Those with one parent who smokes fall in between, with a rate of 13.8% ... We find'a striking relationship between the behavior of the older members of the family and that of the younger members. In homes where both parents are present, boys with an older brother or sister are twice as likely to smoke if one or more of the old'er siblings smoke than if none smoke (30.0% and 13.1%). The reliationship is even stronger among girls, with a four to one ratio;, 24.8% of girls with one or more smoking,older siblings are smokers while only 51.6% of those with older siblings, none of whom smoke, have takeniup the habit. Whenithe combined effect of smoking of parents andiolder siblings is considered', the concept of family patterns is reinforced. The lowest level of smoking is found among teenagers who live in house- holds where both parents are present and neither smokes, and who have older siblings, none of whom smoke. Less than one in twenty have become regular smokers (4.2%). This compares with one in four (24.9%) in families with at least one parent and one older sibling who smoke. The older sibling,, as would~be expected, is more likely to smoke if he has a parent who smokes. It is impossible to determine precisel'y what are the relative effects of parental andisibling smoking on the teenager. However, we do see that he is more likely to smoke if the older sibling smokes andithe parent does not than if the : parent smokes and the older sibling does not. We cannot discount the influence of either; they interact with each other, and as they do, the family pattern is established. t / : 2.

Harold S'. Diehl, M.D. (1969), of the American Cancer Society quotes liberally fromiDavid Horniof the National Clearinghouse for Smoking and Health. Much of what he says is stated authoritatively without source or supporting data. "For children who see their parents, teachers, other adults, / and older brothers and sisters smoking,, the desire to be like them, to be grown-up, constitutes a strong incentive to try it themselves. Studies show that children are much more likely to smoke if their parents smoke." (No source givern). v"Many boys and girls start smoking to show their independence, as a symbol of revolt against authority, to feel sophisticated and grown-up, to be "one of the crowd", to gain social status, to have something to do." (No source giveni) "The advertisers of cigarettes.exploit this urge by creating an image of a smoker as an outstanding athlete; a handsome, virile outdoor man; a nonchalant campus leader; a man who succeeds; a sophisticated, charming young woman." (No source given). "For some smokers the motions and movements associatedlwith smoking,seem to have a soothing, pleasurable effect, similar to the chewing of tasteless objects such as pencils, straws, or chewing gum after the flavor is gone. It alsolseems that some of the satisfaction derived from smoking - particularly of pipOs and cigars is related to watching the smoke. Few people enjioy smoking in the dark, and blind men rarely smoke. For persons who are self-conscious and insecure smoking provides an activity and something to do withitheir hands that takes their minds off themselves. Many accept the image creatediby cigarette advertisements of cigarette smoking as a symbol of poise, self- confidence, and'.social success. But once one becomes dependent upon cigarettes, habituation or addiction are impelling drives to continue." (No source given). Dr. Daniel Horn, Director of the National Clearinghouse for Smoking and Health:, says that people smoke cigarettes for one or more of the, following,reasons: (1) for stimulation, such as to get started in the morning; (2) because of addiction; this smoker "must have"'a cigarette after a certain amount of time has elapsed; (3') to reduce negative feelings, such as distress, anger, or fear; (4) out of habit - a behavior pattern followed almost involuntarily; (5)' for oral gratification - the satisfaction derived from something-in'the, mouth; and (6) for pleasurable relaxation - to enhance positive ' feelings, suchias after a good dinner. 3.

A paper by Meyer, Friedman and Lazarsfeld' (1972) given before the Conference on MotivationiMechanism of Cigarette Smoking provides some qualitative insight into the initiation of'smokimg which may be abstracted as follows: ,/Many smokers, particularly "tahite collar" started in rebellion against their parents. Another theme is that of emulating friends and relatives. Peers provide especially important role models to emulate and partners with whom to rebel. The theory is offered that wheniyoungsters of smokers start to smoke, they are helping to deny that their parents are in danger. Also, when offspring of smokers take up the practice themselves, they are striking back at their parents' hypocrisy, and at the same time, making a connection with them. The Encyclopedia Americana (1969) says that the way smoking begins is not fully understood, and then attempts to explain it: The beginning of smoking andithe processes by which it becomes a habit are complex and not fully understood. In large part, the habit stems from psychological and social drives; the individual smoker does what others around him do. Physiological and possibly constitutional' factors may play a lesser role. There is little doubt that the physiological effects strengthen the habit. Nicotine, one of the many substances pharmacologically active in tobacco smoke, exerts its effects on the heart and the nervous system in particular. Smoking of one or two cigarettes causes an increase in the heart rate and a slight rise in blood pressure. The effect oni the nervous system is predominantly tranquilizing and relaxing,. Relationships betweenismokirng and a number of psychosocial and economic variables are apparent, but no simple explanation is evident. It is obvious, however, that smoking as a behaviar has become interwoven with the complex culture andi environment of mo '~e n society. Start of the Habit. The smoking pattern is established'relatively early. Before 12 years of age less than 5 Fercent of boys and 1 percent of girls smoke, but soon thereafter a steady increase begins:. In the 12th grade, from.40 to 55 percent of children are ' smokers, and by the age of 25 years about 6C percent of men and 36 percent of women have acquired the habit. The increase in the percentage of smokers continues into the fourth decade of life; Among the reasons why children take up the habit are their desire , for adult status and their need t&confor;:r to sccial pressures exerted by other children. Inistriving for status and self-assurance, children y may imitate their parents or famous people. The association between the smoking,habits of parents and children is strong andi many-sided. More childrenismoke in families where both parents smoke than in families where-fieither parent smokes. In adolescent and adult life, 4.

5. similar factors involving,the individual's~need and' his environment appear to play a role in the beginning of smoking. Although no differences in intelligence between smoking,and nonsmoking children have been established, smokers are more frequent among those who fall behind in scholastic achievement. Personality and Other Factors. No clearly defined "smoker's personality" has been establishe . Furt ermore, no personality characteris ic is found'exc usively in either the smoker or the nonsmoker. Certain personality factors - among them extroversion, neuroticism, and'd increased psychosomatic complaints - have been found! to be slightly more common in smokers. Stressful situations occurring in an environment favorable to smoking may contribute to the starting of the smokinD, habit, as well as to its continuation. For instance, some men begin smoking in the tense days of their first job. Smokers consistently report that they tend to smoke more when under tension. Bothimore smokers andimore early starters are foundlin the unskilled working classes. White collas, professional, managerial, and technical occupations contain fewer smokers thanicraftsmen, sales persons, and laborers~. Smokers are reportedito change jobs more often than nonsmokers. Another socioeconomic factor, income does not seem to be as consistently and positively related to prevalence of smoking, as to the quantity of cigarettes consumed. A relationship does exist betweenismoking and educational level, but it seems likely that this relationship is really based on occupation, b2cause those occupations associated wiithihigher education usually show a smaller prevalence of smokers. 1/*1ocial pressures undoubtedly delayed the acquisition of the smoking habit by women. Increased cigarette consumption by women began in the 1920's, and the rate rose rapidly during and after World War II. Although the habit has been prevalent among women for a shorter period'~, the percentage of women who smoke ha~s been increasing,faster than the percentage of men who smoke. Kozlowski an based on 560 that the imp d ltarford (unpublished!) cite a 1959 Britishistudy by Bynner 1 adolescent sch©ol boys in Great Britain which concludes ortant influences that lead to the initiation of smoking are: r (1) number of friendis who smoke (2) anticipation of adult-hood (3) parentali permi,ssiveness toward smoking (4.): whether or not deterred froni smoking by dan;;er ~f lung cuncer . ~ J 0 0 0 ~ ±+ 0 % ~ ~..~

6. The Yankelovich organization (1976) undertook alstudy for the American Cancer Society by means of in depth interviews with 826 teenagers and young women. Their conclusions about the teen-age smoker suggest some correlates (though not exactly reasons) of the beginning of smoking. They say: The Profile of the Teen-age Girl Smoker: The profile of the teen-age girl smoker counters the image of alsocially i11-at-ease youngster turning to cigarettes as a means of being thought of as more sophisticated or as a needed prop for handl!ing social situations. Instead, it is the teen-age girl smoker who is at ease socially, very put together, and with full confidence in herself. Parties andisocial gather- ings are her metier. One measure of both her sophistication and her value structure is the fact that 31% have already had sl?xual relations. It is instead the nonsmoker who tends to be quiet,~r, far less self-assured, more involved with athletics, school activities rnd clubs -- but more likely in her spare time to be reading or watchinF; television. Rebelliousness and Smoking: Cigarette smoking,among teenage girls, however, does appear to be highly identified with an antiauthority rebelliou:, syndrome. Among teen-age girl!s who smoke 25% use marijuana regularly compared'. to 3% of the nonsmokers; 81'% of the smokers drink and'.3::% drink at times to get drunk compared to 42% of the nonsmokers who dirink or 4% who drink to get drunk. One out of four teenage girl smokers have run away from home eompared tol10a of the nonsmokers. Despite i.he widespread acceptance of cigarettes, and the acknowledgement of smoking by parents _ and school authorities, the old "wood'e shed"' image of cigarette smoking, lingers on -- while the concept of not smoking of nonconformity or rebellion against advertising, big business, society, has not yet caught on. Teen-age Girl Smokers an&Peer Relationships: Peer relationships, long,identified as a major factor in teen-age smoking, continue to operate as a dominant influence. Teen-age girl smokers flock together and have more respect for the opinions of their own peers than for authorities. There is, however, an opposite side to the story as well. For the current study indicates that all teen-age girl nonsmokers are not•. ; homogenous but rather divide into two almost equal groups. It is easy to explain why over half of the nonsmokers:(55%) do not smoke -- for they are not influenced'.by the new values, but are very traditional in their views and outlook. They are strongly religious and respectful of authority -- and they shy away from their peers~who smo'.e,, use marijuana and are part of the new values. The other group of nonsmoking teEn-agers are very'diife'rent -- for they share many of the same values as the smokers -- and are highly Jexposed to the total' smoking,environment. We call them the "Vulmerables" j for, on the surface, they appear to be ready candidates for the next wave ~ 0 ~ Lb ~ ~

f M of new smokers. one out of two of the "Vulnerables" report that half - or more of their male friends smoke; a third indicate that most of the girl friends smoke. A majority have one or more parents who smoke. They see more women smoking now than in the past. Yet they do not smoke. Instea&they have found consciously or unconsciously, some strong barriers to smoking. These are - the importance of being in control of one's own life; and emphasis on physical fitness and well-being; concern about the addictive nature of cigarettes, and perhaps most of all, by becoming militant antismokers - people who are angered by other smokers, upset by smoke filled rooms and ready for increase&regulation of smoking. In other words, they are finding a cause -- and a new peer identification. Information on the motivation that leads to a continuation of smoking comes from a special study done for Philip Morris (Brand, 19'71).Smokers first answered the question "4Thy do you smoke" with platitudes such as: -- gives me something to do with my hands -- relieves tensions -- goes well with a social drink -- settles my stomach after a heavy meal -- helps me to relax -- just an automatic habit -- keeps my weight down % < But on deeper prob•ing, the circumstances in•which smoking occurs may be generalized as follows: 1. As a narcotic, tranquilizer, or sedative. Smokers regularly use cigarettes at times of stress. At the beginning or ending of a basic activity. This wouldicover such activities as entering or leaving,a room, starting or finishing a job, going into a party or leaving one, starting,a telephone conversation or a personal visit. • 3. Automatic smoking behavior. Heavy smokers, particularly, light up at intervals without much thought, and often without realizing what they are doing. It should be noted' that there was scarcely any unprompted reference toismoking for "'taste", or "flavor", until it was suggested -- andl tl~ien everyone agreed that it was the major element in smoking satisfaction. =' L t~ . ?t • 0 ~,& ; AU:sw A. Udow 0 ~ cc: Messrs. T.A. Budne J H. Daniel N.B. Holbert M. Johnston ) Richmond ~ D. Mazzitellif 0 ~~. Q1

References Brand!, Gzuber Co.: The Perceptual Context of Smoking. October 1971 D3;ehl, Harold S, M.D.: Tobacco and Your Health, rlcGraw-Hill 1969 Encyclopedia Americana, 1968 edition International Encyclopedia of the Social Sciences, Macmillan, 1968 Kozlowski, Lynn~T and Harford, Margi: On the Significance of the Never User of a Drug, an Example from Cigarette Smoking (unpublished manuscript) hteyer, Alan, Friedtnan, Lucy and Lazarsfeld, Paul: Perceptions and' Receptions of the Anti-smoking campaign. A report to the Conference on the Motivation, .Sechanismiof Cigarette Smoking, 1972 National Clearinghouse for Smoking,and Health: Teenage Smoking Pub. 72-7508, 1972' Yankelovich, Skelly and!j,lhite Inc.: A Study about Cigarette Smoking Among Teenage Girls and Young Women