Evid Based Nurs 11:27 doi:10.1136/ebn.11.1.27
  • Qualitative

Smoking cessation was difficult for adolescents because of daily life stressors and the need for major lifestyle changes

C S Fryer

Correspondence to: Dr C S Fryer, University of Pittsburgh, Pittsburgh, PA, USA; cfryer{at}


What are the beliefs and experiences of adolescents related to quitting smoking?


Grounded theory.


3 high schools in New York City and 6 community-based organisations.


54 adolescents 16–18 years of age (63% men) who had smoked >100 cigarettes in their lifetime and had attempted to quit smoking at least once.


46 adolescents participated in individual interviews (45–60 min), and 31 participated in focus group sessions (60–75 min). Interviews and focus groups addressed different aspects of quitting smoking, including what quitting meant, history of smoking and quit attempts, self-identification as smokers or ex-smokers, reasons to quit, strategies for resisting urges to smoke, influences affecting quitting, and quit methods. Interviews were audiotaped, transcribed verbatim, coded using an inductive approach, and analysed for themes using grounded theory. Focus groups comprised 4–7 participants per group and were audiotaped (6 groups) and videotaped (3 groups).


Beliefs about success in quitting. Most adolescents believed that quitting smoking meant abstaining from smoking forever. This was a major obstacle to quitting because it was difficult to imagine achieving this goal. Initial attempts at quitting. Adolescents who attempted to quit for the first time were apprehensive and found it more difficult than anticipated. Obstacles to initial quit attempts were pressures and stresses of daily life, such as temptations to smoke, urges or cravings, and giving up friends and activities to avoid temptations of smoking. Adolescents felt that it was impossible to overcome these obstacles. The first few days of quit attempts were particularly difficult. Coping with life stress without cigarettes. Quit attempts were difficult because adolescents relied on smoking to help reduce stressors of daily life, such as family tension, strained relationships with friends, doing well in school, and part-time jobs. A few experienced specific events that were especially difficult to cope with (eg, trauma after witnessing violence), and this led them to start smoking again. Temptations and urges to smoke as stress. Adolescents often felt temptations (ie, external stimuli) and intense cravings (ie, internal feelings) to smoke and had different strategies for dealing with them (ie, avoidance v coping). Temptations included seeing others smoke, being in places where people smoked, smelling smoke, and seeing cigarettes on television, at home, or in stores. Coping with cravings was the most difficult aspect of quitting because they were frequent and seemed to last a long time; and adolescents felt unable to focus on anything, got frustrated, and lost control of their lives. Some considered smoking to be addictive and attributed cravings to nicotine withdrawal; others did not feel addicted until the quit attempt. New stressors related to the quitting process included family or friends who challenged the adolescent’s ability to quit or offered them cigarettes. Some women were concerned about weight gain. Adolescents who quit felt they had to make sacrifices and major lifestyle changes, such as spending less time with friends who smoked or avoiding places they used to frequent. Those who did not have non-smoking friends felt socially isolated after quitting.


Smoking cessation was difficult for adolescents because of various stressors of daily life and the major lifestyle changes that were required.


Falkin GP, Fryer CS, Mahadeo M. Smoking cessation and stress among teenagers. Qual Health Res 2007;17:812–23.


  • Source of funding: American Legacy Foundation.


In the study by Falkin et al, the most important insight for nurses and other public health professionals is that approaches based on abstinence or “all or nothing” have not helped to encourage adolescents to quit smoking. These approaches make quitting an extremely difficult, if not impossible, long-term goal. Indeed, when dealing with younger adolescents, nurses should consider using harm-minimisation approaches, which build upon naturally occurring patterns of tobacco reduction and the individual’s attempts to control or limit smoking.1 Given the need to redefine “success” at quitting, it is also important that tobacco education campaigns promote images of ex-smokers that are relevant to youth2 and recognise that the high social costs of quitting are a major barrier to sustaining cessation.3 It was striking that of the youth who had attempted to quit, none indicated that they had accessed formal cessation support or programmes. Perhaps this speaks to the failure of existing health promotion efforts in offering interventions appropriate to the social context of adolescence.

The only caveat is that the study by Falkin et al did not include an analysis of the distinctly gendered nature of smoking, coping, and quitting in adolescence.4 Although the authors briefly discussed concerns of young women about post-cessation weight gain and 12 of 19 longer narrative excerpts were from young women, Falkin et al did not offer insights on how cessation-related stress may differ between young women and men.


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