• Open Access

When you're desperate you'll ask anybody”: young people's social sources of tobacco

Authors


Correspondence to: Dr Louise Marsh, Cancer Society Social & Behavioural Research Unit, Preventive & Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand; e-mail: Louise.marsh@otago.ac.nz

Abstract

Objectives : This study sought to examine young New Zealand smokers’ access to social supplies of cigarettes.

Methods : A qualitative investigation using 10 focus groups with 66 current young smokers, aged between 15 and 17 years, was conducted throughout New Zealand, between October and December 2011. Transcripts from the focus groups were analysed using NVivo to code the data, from which common themes and critical issues were identified.

Results : Family was one of the main sources of tobacco for the young smokers in this study and parents were the leading source, often purchasing tobacco for their children to smoke. Sharing tobacco within groups of friends was also very common. Additional methods were used when young smokers were desperate, including stealing, ‘butt scabbing’ and asking strangers.

Conclusions : Both family and social networks continue to support smoking and supply tobacco to young people. While these networks operate, young people will continue to smoke, despite increased regulations on commercial sales to minors.

Implications : Restrictions on commercial sales of tobacco to minors are increasing; however, many young people use multiple sources of tobacco, including social sources. It is likely that young people will increasingly use these social sources in the future. Interventions other than purchase restrictions are important for reducing minors’ access to tobacco.

Over the past decade, many developed countries have increased restrictions on young people buying tobacco from commercial outlets, with some success in reducing adolescent purchases from commercial sources,1 but not in reducing smoking prevalence2–4 or perceived access to tobacco.5,6 As restrictions increase, young people develop complex approaches for acquiring and purchasing cigarettes through alternative sources, including social sources of tobacco.5,7–12 If these social sources of obtaining tobacco are common, then preventing access to tobacco through restrictions on commercial sales alone will not prevent young people acquiring tobacco.13

Social sources are usually the source of a young person's first cigarette and these may encourage smoking initiation.3 This first initiation through social sources is important for influencing early decision making about smoking.14 Social supply may also influence young smokers in moving from experimentation to addiction.14 As their consumption increases, young people often develop multiple sources of cigarettes to ensure they have a constant supply,8 including both commercial and social sources.7,11,15 This is similar to the situation with alcohol where it is rare for young people to rely only on social sources.16

Friends are the main social provider of cigarettes for young people. Quantitative research has found that 60% of 14–15 year olds in New Zealand (NZ) obtained their cigarettes from friends in 2008.17 Friends are usually the source of someone's first cigarette18 and for those young people smoking at least monthly, their last cigarette was likely to have come from a friend.11,19,20 Exchange of cigarettes with friends takes place through a ‘social market’ involving borrowing and reciprocal arrangements14,21 or a ‘commercial social market’ where young people sell cigarettes to other young people.22 In 2008, 30% of 14–15 year olds in NZ bought their cigarettes from someone else.17 These studies suggest that social sources may have more influence on young people's access to tobacco than commercial sources, and thereby have more influence on adolescent smoking.16

Family members, with or without their knowledge, also supply young people with tobacco.7,23,24 In NZ in 2008, young current smokers reported in a quantitative survey that nearly one-quarter of their supply of cigarettes came from a parent or caregiver.17 One-quarter of respondents also reported that they got them from another adult in the family or household; this was significantly higher for young Māori smokers, who have high rates of smoking25 compared with NZ Europeans.17 A situation of exchange may also occur where cigarettes are given in return for doing work at home or for buying cigarettes for their parents.21 Parental behaviours such as lack of home-smoking restrictions can provide an environment that allows and supports the social exchange of cigarettes.2,11

Asking an adult to purchase cigarettes for them, often called ‘proxy sales’, occurs more frequently among young people in areas of high enforcement of age restrictions.8 In NZ in 2008, 45% of young people reported someone else buying cigarettes for them.17 However, it is not clear who is buying these cigarettes for young people. Recent British research has found that this method of obtaining cigarettes is on the rise,26 and highlights other young adults as a significant source of tobacco for minors.27 In some cases the adult will receive payment in the form of money or cigarettes,26 or they will purchase the cigarettes for the young person for free.8

An infringement notice scheme was implemented in NZ in July 2012 to enforce the prohibition on the sale of tobacco to minors by Smokefree Enforcement Officers (SEO) within District Health Boards. The new scheme allows SEO to issue on the spot infringement notices rather than going through the court prosecution process, and increases the maximum individual fine for selling to minors from $2,000 to $5,000. Combined with annual 10% increases in tobacco tax each year for the next four years, this may give rise to a reduction in young people accessing commercial sources of cigarettes, and social sources may become an increasingly popular way for young people to source their cigarettes. Although no specific research has tested the hypothesis that increased restrictions on commercial supply leads to an increase in young people obtaining their tobacco from social sources, many researchers suggest that this is the case.5,7,28 Evidence shows that young people are price sensitive,29 and there is evidence to show a general increase in youth acquisition from social sources in the US.8,30,31 Although we have quantitative data on where young people are sourcing their tobacco from, little is known about these social exchanges of cigarettes in NZ in more detail, such as how young people go about sourcing their tobacco through each of these means. A better understanding of the social exchange of cigarettes is essential for developing approaches for reducing supply to young smokers. This study seeks to examine young NZ smokers’ access to social supplies of cigarettes.

Methods

Focus groups were used to generate qualitative data for a deeper understanding of the social supply of tobacco to young people. Previous quantitative research has shown that young people in NZ are very reliant on social sources;17 however, the focus groups in this research were designed to delve into more detail on how and why these young people use social sources. This methodology has been used to enhance knowledge of young people in several public health areas such as violence,32 smoking,33 sun protection34 and access to primary health care.35 Focus groups also constitute a way for youth to communicate experiences and perspectives in a more natural context.36–38 They acknowledge young people as experts and so have high face validity,39 especially where there is a gap in experience or age between the researcher and participants.40

Focus group discussions were held with participants who had pre-existing friendships with each other to facilitate discussion; the general consensus is that homogeneity in focus groups is best for the successful functioning of the focus group.39 Ten focus groups of between five and 10 participants – a total of 66 participants – were conducted with young people in urban areas and small towns throughout NZ; half in the South Island and the other half in the North Island. The number of groups was determined using the notion of ‘saturation’, i.e. no further groups were enrolled when later groups offered the same themes as earlier groups. The participants were young current smokers aged between 15 and 17 years. There were separate focus groups for boys and girls, reflecting the difference in prevalence of smoking among these groups and their sources of tobacco.

There is no easily accessible sampling frame from which to select young Māori and Pacific smokers at a national level. Consequently, participants were recruited through youth and training organisations within the identified geographic locations, particularly those with high Māori and Pacific young people. These training organisations were selected through whānau (extended family) of one of the authors (AD), some of whom worked with disadvantaged youth and were able to suggest appropriate contacts. This was supplemented by online searches, suggestions from a contact in the NZ Cancer Society, and face-to-face meetings with representatives of the organisations.

Māori and Pacific young people were specifically selected for the focus group work, as they have the highest rates of smoking in NZ, and were important for identifying the sources of tobacco for these high-risk groups. The organisations were given vouchers suitable for their organisation in appreciation for their assistance. Each participant received a retail voucher and a petrol voucher for travel. The study received ethical approval from the University of Otago Human Ethics Committee. The participants were required to complete an informed consent form; parental consent was not required as all the participants were 15 years or older.

The focus groups, which lasted a maximum of 60 minutes, took place between October 2011 and December 2011. They were moderated by one of the authors (AD), who is experienced at conducting focus group discussions and could converse in Te Reo Māori and English. Each focus group began with the moderator introducing herself, where she came from and the background to the study. This was followed by some simple ground rules and an ‘ice-breaker’ introductory game to allow the group to share a little about themselves prior to the discussion on social sources of tobacco. A short survey of participants was undertaken at the start of the focus groups to determine demographics such as age, gender and ethnicity, current smoking status and level of addiction. Personal details including names or contact details were not collected to preserve the anonymity of the participants, and survey data collected was aggregated on collection of data from each group.

In the first part of the focus group, the moderator asked participants to write about the first place or person that came to mind when they thought about where they got their tobacco from. They wrote their answer on a piece of paper, then folded their paper and passed it to the person beside them; this was repeated three times. Once completed, they shared their findings back to the group. This led into a larger discussion with the group about each of the main sources of tobacco they identified. The moderator then asked for more detail about each of these, specifically in relation to who they were, and how, when, where and why they got their tobacco from them. Five different coloured Post-it Notes allowed the participants to write their answers according to these headings. Their answers were placed around the room by the moderator and the participants shared what they had written in greater detail, and opened up about their experiences. Finally, the moderator thanked the participants for their time and ideas, and closed the session with handing out the vouchers.

The primary researchers are aware of their lenses in this work. These include an emerging researcher from a Māori background with a constructivist view, and a more experienced researcher from a positivist view. Combining these world views gives a holistic approach to this research project.

After the first two focus groups, one with boys and one with girls, the audio files were reviewed by LM and AD before subsequent focus groups were undertaken. Some changes were made to procedures and content. Literature on working with adolescent boys in a focus group situation with a female facilitator was examined to better understand how to interact with the boys, and to get the best responses from the groups. Further changes were made to the content in terms of the organisation of the physical props used to engage the participants in the topic.

The conversation in each focus group was audiotaped and the tapes transcribed. Initially the study used a deductive approach through the literature review, with questions and analysis being determined by the research objectives. Two of the researchers coded three of the 10 focus groups transcripts and compared coding, prior to the lead researcher (LM) coding the remainder of the transcripts. The general inductive approach was applied to the analysis facilitated by NVIVO software to: condense raw data into a summary format; establish clear links between the research objectives and the summary of findings; ensure these links were both transparent and secure; and develop a model about the underlying structure of the themes and experiences discussed.41 Each theme is described below, and comments or quotes have been provided which support each of the themes discussed.

Results

Participants

The 10 focus groups, five male and five female, had a total of 66 participants with an average of six to seven participants in each group. About half the participants were male (53.0%), with an average age of 16 years and four months. The majority of the participants were Māori (57.6%), one-third (31.8%) were NZ European and 10.6% were Pacific peoples. Most of the participants attended training organisations (62.1%), with the remainder enrolled at school (37.9%).

Most of the participants smoked daily (89.4%), with 4.6% smoking weekly and 6.1% smoking less than monthly. The majority (83.3%) had smoked more than 100 cigarettes in their lifetime, 10.6% had smoked between 11 and 100, and 6.1% had smoked fewer than 11 cigarettes in their lifetime. Many of the participants had a high level of addiction to tobacco at the time of the study, with 89.4% of participants stating that they always or sometimes felt like having a cigarette first thing in the morning.

Social sources of tobacco

Participants were asked to write down the four most common places or people they source their tobacco from. The results showed a consistent pattern of shops; family, including parents, siblings, and cousins; friends; stealing; picking up from the ground; and asking strangers. These sources were then asked about in more detail, and the results are reported below. The ‘G’ or ‘B’ in brackets after each quote indicates whether it was from a girls’ or boys’ group, and the number represents geographic location.

Family as a source

Family was one of the first places the young people in this study went to for tobacco because most of their family members smoke. Consequently, it was easy for them to obtain tobacco, particularly when they were unable to buy it themselves, and it was generally free. The most common people to provide social sources of cigarettes to young people were mothers, fathers, older brothers, sisters, aunties, uncles and cousins. Within most of the groups, at least one participant reported that parents, particularly mothers, buy cigarettes for them:

“Mum buys me a packet every week.” (G4)

Although some young people have to pay for their cigarettes:

“…they say I'm not allowed unless I pay for it, so they can go get it from a shop but then I've got to give them the money.” (B1)

Others are more direct when they ask their parents for tobacco:

“Dad, I got some money, do you want to take us down to the dairy and grab some smokes for me?” (B2)

Some parents will buy cigarettes for their children every week; other young people will be given cigarettes each day, while some parents share their own with their children. One participant said her mother buys her cigarettes because she blames her father for getting her addicted and feels responsible for her tobacco addiction. Some participants have had their parents buy their cigarettes since they started smoking (as young as 12 years of age), and participants in two other groups described their parents agreeing after a period of time:

“At first my Dad didn't like it, he didn't agree with it, but he had to get used to it 'cause … he had to agree with it 'cause he couldn't do anything about it.” (G5)

Despite her mother quitting, one participant said her mother still buys cigarettes for her:

“My Mum smoked pretty much her whole life but she's just given up like a year ago and, yeah, she buys them for me.” (G2)

Two groups described taking cigarettes from their parents’ cigarette packs. Participants reported that generally their parents would then replenish their supply by purchasing another packet. The other groups described taking them without their parents knowing, but would only do so if there were at least seven cigarettes left in the pack. Two groups described having to do jobs at home, like the dishes, in return for cigarettes; another made their parents a drink:

“I make my parents a coffee for a ciggy…” (B2)

When asked about why brothers and sisters buy cigarettes for them, one participant stated:

“‘Cause she knows that I will smoke anyhow so she just buys them for me.” (G3)

There were mixed reports of whether they would ask their grandparents to buy tobacco for them. One participant said they would not ask their grandparents, another would ask, and two other participants said they got money from their grandparents to pay for their cigarettes. Sometimes family members give young people money to purchase their own cigarettes. Three groups described asking their parents’ friends, or their friends’ parents to buy cigarettes for them:

“My friends’ mums, all of my friends’ mums know I smoke and they always give me smokes and they just buy it for me.” (B2)

Friends as a source

The young people in these focus groups also obtain their cigarettes either from older friends who will purchase cigarettes for them, or people in their peer group who look old enough, and are able, to purchase tobacco. They say it is easy as they see their friends on a frequent basis, and are not given a lecture from them about smoking. Sometimes they have to pay for tobacco from their friends and other times they do not. They may have reciprocal agreements for sharing; whoever has cigarettes shares them with their group of friends:

“Usually people that you give your smokes to, like they'll be like ‘Oh, can I borrow a smoke and I'll pay you back whenever I've got some’, so it goes both ways.”(G1)

Another participant expressed how you end up giving most of your cigarettes away:

“But then they follow you around for the rest of the day and before you know it they've already smoked half of them for you.” (G2)

The sharing of cigarettes within a peer group was particularly common in the groups of girls as these quotes show:

“Go halves with two people… And if it's the last smoke all of us share it.” (G3)

and

“Like if one person has a packet of smokes, we'll all smoke them and then someone will go get some smokes and we'll share them pretty much.” (G1)

Commercial social market

A commercial social market for cigarettes also exists. This is where young people sell cigarettes to other young people, who are unable to purchase their own cigarettes, to make a profit. One participant of a girls group describes it thus:

“I sell mine to um, people that can't get it at the shops, like fifteen, and sixteen, they always come up to me, oh can I buy a smoke?” (G2)

Others described how they would not sell to younger kids, and how it is not necessarily the smokers who are selling the cigarettes:

“When we are at our school we know people who don't smoke but they've got smokes to sell.” (B2)

These transactions happen at schools – in class, canteen and sports fields, and they also happen in town – at the netball courts, outside dairies, in the library and the city centre, and at parties:

“Yeah, she does it at parties as well, she likes to walk around and get to like, the young ones, that she knows are rich.” (G1)

This idea of selling to other young people who have money was also commented on by a group of boys who sell them at one of the private boys’ schools because they will pay a higher price. The price also depends on the market, as one boys group describes:

“You wait and see if anyone else sells smokes, if they don't you start kind of high, like $5 a ciggy, they go nah, you go down…” (B1)

There are a number of ways that the young people go about obtaining the cigarettes that they sell. One method is to purchase a pouch of rolling tobacco and make it up into 100 cigarettes and sell each cigarette for $1; making up to $50 a day. This can be quite a profitable long-term business, as one participant reports:

“Yeah, they profit themselves $8 and then use $12 to buy another packet, then it keeps going and going.” (B3)

Some people steal the cigarettes and sell them for a lower price, say 50 cents. Some students would be given lunch money, and they use this to support their commercial operation:

“They would only give us lunch money, we'd go and buy cigarettes, and then sell those cigarettes.” (B4)

Others sell cigarettes given to them by their parents:

“They get smokes off their parents and they go to school and sell it to their mates for a dollar.” (G4)

They are also selling through text messages:

“This girl [name] she's always texting me asking if I want to buy 40 g of something.” (G1)

Proxy sales

Most of the groups had been involved in asking other people to buy cigarettes for them. They use this method because they are too young to buy tobacco themselves, when they have money, and:

“Because you're desperate and you need them.” (B3)

This usually occurs outside shops, where they stop people who are entering the shop and ask them to purchase cigarettes for them:

“Oh excuse me, can you buy me a pack of cigarettes?” (B3)

If they say yes, they give them the money; sometimes they repay them by giving them a cigarette. The people they ask are always strangers, and they tend to target those who they think are smokers themselves, people of Māori ethnicity, and people who look like they will agree. One group discussed asking people who are drunk, and another group targeted foreigners in their town; but for others:

“When you're desperate you'll ask anybody.” (G3)

Other sources

Butts: All of the groups discussed smoking the butts of other people's cigarettes, this is termed ‘butt scabbing’, ‘butt rolls’ or ‘butt picking’. This was generally a last resort if they were desperate and usually something they did when they were younger:

“Maybe if I've like absolutely no smokes around, I can't get a smoke anywhere …” (B1)

They get the butts from ashtrays at home, from outside pubs, and off the street. Sometimes they would break the smoke open and roll a new cigarette, others would smoke the butt as it was:

“I used to like go through the ashtray and like grab all the ciggies and take it apart and break them up and roll it up.” (G5)

One group also described ‘ground hutchies’ where they would find a cigarette still burning on the ground, pick it up and smoke it.

Stealing: Young people also steal cigarettes from women's handbags, outside shops and at parties, and steal cigarettes from people they know, such as their parents and cousins. Nearly all the groups described stealing cigarettes from shops when the shop assistant is out the back, and when the cigarettes are positioned near the counter, as one girl describes:

“I've never done it, but you just jump over the counter, 'cause nobody's at the counter where they are, you just jump over the counter, take them and then run away.” (G1)

Asking strangers: A few groups described asking strangers on the street, outside shops, the bus stop, at malls and parties for a cigarette:

“Got a spare smoke?” (G4)

They tended to choose people who were older, smoking themselves, foreigners and those who had been drinking alcohol:

“Wait outside the shop and wait for a nice looking old fella to walk past.” (B4).

This option is used when they cannot purchase their own cigarettes or when their friends have run out:

“Yeah I've done that a few times, like seen a random with a smoke, can I have a smoke?” (G2)

Others: Finally, participants reported other sources including: finding them on the ground after community events such New Year's celebrations; obtaining them from teachers at school or tutors at training institutions; purchasing home-grown tobacco; and being given tobacco by caregivers, or security guards.

“Yeah, some teachers at [name of school] give you smokes.” (B2)

Conclusion

Previous quantitative research has found that a significant number of young people source their tobacco from many non-commercial sources as well as commercial sources.42 This NZ research used qualitative methods to explore these non-commercial sources in more depth, and found that many young people use multiple social sources to obtain their tobacco.

Family was one of the main sources of tobacco for the young people in this study, and parents were the leading source, often purchasing tobacco for their children to smoke. DiFranza and Coleman also found that parents were the main source of tobacco for young people, particularly at the onset of smoking.43 These young people then share their tobacco with their group of friends, so that parents may well be supplying their child's group of friends. This finding emphasises that smoking may best be considered a network phenomenon, and that family is an important part of that network. Among the participants in this study, it is worth considering an analysis of why tobacco smoking is so entrenched in these families, rather than simply focusing on individual children and the influence of parents on their behaviour. Smoking is the ‘norm’ in these families, even if parents have made a decision to quit smoking. For whatever reason, they still in some cases supply tobacco for their children to smoke. This seems at odds with the parents’ behaviour, but may not be so in the context of smoking being a normal behaviour within the family and social environment.

A commercial social market for tobacco exists within groups of young people, where the sellers are profiting from selling to other young people. The original source of this tobacco appears to be commercial; as restrictions on minors access to tobacco increases, their ability to purchase the tobacco to on-sell becomes more difficult. However, this will be happening in parallel with young people themselves being less able to purchase commercially, and increasing their need to buy from friends. This research also points to evidence that tobacco is a commodity for both smokers and non-smokers, and a means of making a profit, consistent with international research.13 It is unknown from this research, but perhaps this also extends to other products such as alcohol and cannabis. One implication may be that, as supply tightens, older adolescents may use this as an economic opportunity to sell tobacco to younger people.

The more difficult it becomes for young people to source their tobacco, the more desperate measures they use to get it; other research has also found that young people resort to acts of desperation.43 These include asking strangers to purchase tobacco for them, picking butts up from the ground and smoking them, and asking random people for cigarettes. In a sense, these other more indirect and non-commercial ways of getting tobacco present a problem for tobacco control. How should we address prevention with so many different sources of access?

This NZ research highlights the extent of reliance on social sources of tobacco for young people. This is very concerning given that previous research has found that social sources are usually the source of a young person's first cigarette, may encourage smoking initiation,3 and may influence moving from experimentation to established smoking.14 There is limited evidence in NZ of tobacco control measures to combat the social supply of tobacco to young people, and this is something we need to focus our attention on if NZ is going to achieve its goal of Smokefree by 2025.

Ours was a qualitative study, using a non-representative sample of young, high-risk smokers throughout NZ, so the findings may not necessarily be generalisable to all young smokers in NZ or beyond, or apply equally to non- Māori or non-Pacific young people. However, a strength of this research is that harder-to-reach groups of smokers were involved, including young people, Māori and Pacific peoples. While surveys provide snapshots of the numbers of young people sourcing tobacco through social means, the focus groups were valuable for providing a better understanding through a range of experiences of how young people are obtaining their tobacco through social networks, and who or what their most important sources are.

Implications

New Zealand is increasing restrictions on commercial sales of tobacco, such as the introduction of infringement notices and increased fines for retailers selling tobacco to minors. These may be important for reducing access to commercial sources of tobacco but, as this study shows, many young people use multiple sources of tobacco, including many types of social sources.

It is likely, as these restrictions increase, that young people will increasingly source their tobacco from social sources in the future. Interventions other than purchase restrictions are important for reducing minors’ access to tobacco. The following points should be considered:

  • • As part of the Māori Affairs Select Committee report to the Government, the Select Committee made recommendations that a campaign, perhaps through the media, is needed to: “reinforce the unacceptability, and illegality, of supplying tobacco to children be implemented”.44 A similar, successful NZ campaign aimed at on-supply of alcohol to young people may be a good model for this.45
  • • Strengthening the smokefree message will be important for addressing social supply of tobacco to young people; a major shift in attitude towards smoking will need to happen. However, media campaigns alone will not shift attitudes to smoking; this also needs to be a community lead initiative.44
  • • Smokefree environments mean young people are less likely to be exposed to smoking; they are then less likely to view smoking as a normal adult behaviour, and potentially less likely to take up smoking themselves. Extending smokefree environments to include inside vehicles, all parks, playgrounds, and beaches, as well as community, sporting and cultural events, particularly those that young people attend, will encourage young people to remain smokefree.
  • • Increasing support for families and whanua to quit smoking. The smoking prevalence rate in NZ has been decreasing since the 1990s; however, the proportion of Māori and Pacific smokers has not been dropping at the same rate.46 It is important that the adults in these families are encouraged and supported to quit smoking to provide young people with smokefree homes, smokefree role models and less access to tobacco at home.
  • • Further research around social supply is needed to understand why adults are supplying tobacco to these young people. This might involve interviewing parents of young smokers to ascertain their reasons for supplying tobacco, and identifying intervention points for future campaigns.

This research illustrates that smoking is not an individual behaviour – it happens in the context of family and social networks. If these family and social networks continue to support smoking and supply tobacco to young people, then young people will continue to smoke, despite increased regulations on commercial sales to minors.

Acknowledgements

The authors acknowledge the time and effort volunteered by the young people taking part in this research, and thank the youth and employment leaders who co-ordinated the groups in each location.

Funding

The Cancer Society Social & Behavioural Research Unit was supported by the Cancer Society of NZ and the University of Otago. This research was also funded by the Dunedin School of Medicine, University of Otago Dean's Bequest Fund.

Ancillary