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Starting to smoke: a qualitative study of the experiences of Australian indigenous youth

Johnston, Vanessa, Westphal, Darren W., Earnshaw, Cyan and Thomas, David P. (2012). Starting to smoke: a qualitative study of the experiences of Australian indigenous youth. BMC Public Health,12(963):1-14.

Document type: Journal Article
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IRMA ID 11035xPUB8
NHMRC Grant No. 545241
Title Starting to smoke: a qualitative study of the experiences of Australian indigenous youth
Author Johnston, Vanessa
Westphal, Darren W.
Earnshaw, Cyan
Thomas, David P.
Journal Name BMC Public Health
Publication Date 2012
Volume Number 12
Issue Number 963
ISSN 1471-2458   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84868551519
Start Page 1
End Page 14
Total Pages 14
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Adult smoking has its roots in adolescence. If individuals do not initiate smoking during this period it is unlikely they ever will. In high income countries, smoking rates among Indigenous youth are disproportionately high. However, despite a wealth of literature in other populations, there is less evidence on the determinants of smoking initiation among Indigenous youth. The aim of this study was to explore the determinants of smoking among Australian Indigenous young people with a particular emphasis on the social and cultural processes that underlie tobacco use patterns among this group.

This project was undertaken in northern Australia. We undertook group interviews with 65 participants and individual in-depth interviews with 11 youth aged 13–20 years led by trained youth ‘peer researchers.’ We also used visual methods (photo-elicitation) with individual interviewees to investigate the social context in which young people do or do not smoke. Included in the sample were a smaller number of non-Indigenous youth to explore any significant differences between ethnic groups in determinants of early smoking experiences. The theory of triadic influence, an ecological model of health behaviour, was used as an organising theory for analysis.


Family and peer influences play a central role in smoking uptake among Indigenous youth. Social influences to smoke are similar between Indigenous and non-Indigenous youth but are more pervasive (especially in the family domain) among Indigenous youth. While Indigenous youth report high levels of exposure to smoking role models and smoking socialisation practices among their family and social networks, this study provides some indication of a progressive denormalisation of smoking among some Indigenous youth.


Future initiatives aimed at preventing smoking uptake in this population need to focus on changing social normative beliefs around smoking, both at a population level and within young peoples’ immediate social environment. Such interventions could be effectively delivered in both the school and family environments. Specifically, health practitioners in contact with Indigenous families should be promoting smoke free homes and other anti-smoking socialisation behaviours.
Keywords Aboriginal
DOI   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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