Over the past few years, together with colleagues at the Trimbos Institute, I have learned more and more about young adults who smoke in various ways. For example, I did this by sending surveys to the target group and talking to them by organising focus groups. Sometimes this produces findings that align with previous observations, and sometimes it gives us relatively new insights.
No urgency to quit smoking, no help, no reach
It emerged that just over half of young smokers want to quit, either now or (far) in the future. Some do not feel that quitting is necessary yet; that can wait until after their studies or when they start a family. They also do not feel they need help quitting because they think they can manage it themselves. The other half do not want to quit or do not know yet. Campaigns about quitting smoking seem to do little to motivate this target group to quit. Or the campaign does not reach the target group at all. Young adults therefore feel no urgency to quit, are not eager for help and campaigns have only a limited impact. As a result, a considerable proportion continue to smoke.
Young adults know that smoking is bad for them, but they do not feel it
Why do young adults feel no urgency to quit? They cannot properly foresee the long-term consequences of their behaviour. Their brains are still fully developing. Another obvious reason is that they do not yet notice any physical consequences of smoking. Young people feel fit and healthy. They do not notice that they are gradually becoming more likely to suffer a heart attack or stroke. They know that smoking is bad for them, but they do not feel it. And if you do not feel the need, it is difficult to quit.
Smoking as a moment of respite
But young adults also get something from smoking itself. Our conversations with young smokers show that the vast majority of this group smoke when they are stressed. Even though we know that nicotine causes a faster heartbeat and a restless feeling. As illogical as this may sound to us scientists, this group associates smoking with relaxation. It is a moment of respite, an excuse to withdraw. A brief escape from a crowded pub, a chance to go outside during a busy shift, or a break while studying for an exam.
Most young people use smoking to cope with stress. It has become a coping style. When we ask further questions, it turns out that they do not actually become calm from smoking itself (because we know that smoking actually causes a restless feeling and that with a cigarette you only smoke away the withdrawal symptoms). The act of smoking a cigarette is equivalent to taking a break. One important reason young adult smokers gave for continuing to smoke was that they did not want to lose that moment of respite.
An important social aspect also plays a role. ‘I’m going to have a cigarette’ is much less vulnerable than saying that you cannot cope anymore. Saying out loud that you can no longer handle the pressure of something—the pub, work or exam week—for a moment is frightening. Will they think I’m weak? Will I fail to keep up in this achievement-oriented society? Young adults seem to find it difficult to talk about this. Even though talking and seeking support can help enormously.
Young people do not want to be lectured
The group that does want to quit makes little use of effective smoking cessation support, such as professional guidance. Most quit ‘cold turkey’: suddenly, without a plan, preparation or help. This way of quitting has the lowest chance of success. During the conversations, the young adults laughingly confirmed that this was also their own experience. But why do they hardly use support while quitting smoking? Most do not feel that they need professional guidance. After all, that would also mean that they must be very addicted, and they do not feel that way. Or they find guidance too much hassle. And if they want to quit in the future and do need guidance, ‘they’ll see about it then.’
But whether they consider it necessary or not, young adults also do not seem particularly open to guidance. And that is not surprising when you consider that this age group most strongly mirrors and identifies with their peers. Interference from outside and patronising attitudes are not appreciated. They would also prefer to quit smoking on their own or together with one another.
Facilitating quitting smoking instead of lecturing
And that is the crux of the matter. Young people say they want to quit on their own or together, but at the same time find it difficult to open up to a peer. Yet quitting smoking is usually a vulnerable process involving good intentions, difficult moments, behavioural changes, failed attempts and successes. Especially for young adults who smoke to cope with stress. When you quit, you will have to deal with stress in a different way. And if you want to do that together with a peer, you have to talk about that stress and therefore dare to make yourself vulnerable.
Fortunately, there is also good news. More and more young adults are willing to talk about stress and performance pressure. From the conversations, we gather that they are tired of the ‘perfect picture’. They want to have real conversations with each other again, instead of pretending that we have the perfect life on Instagram. In addition, they are quite willing to quit smoking if their friends join in too. ‘Facilitate instead of lecture’ seems to be the motto. ‘Don’t force us to do something we don’t want to do, but help us do it our way.’
Quit-smoking help in your pocket
The door seems to be ajar for a smoking cessation app. Smoking cessation apps have important advantages for this target group. You can use an app whenever you want, and you always have it with you. This meets young people’s need to remain in control of the quitting process.
When developing the new smoking cessation app Quiddy, we wanted to incorporate young adults’ desire to be able to quit together. That is why Quiddy has a built-in chat in which users can talk to peers. They are matched with one another: both are approximately the same age and have the same goal or the same pitfall. Do they both find it difficult not to smoke when stressed? From now on, they can support each other in that. This can also be done anonymously. Anonymity can make it easier to talk about certain things. Quiddy will be available to download from the App Store and Play Store from 1 January 2022. Just in time for all those good resolutions.
With the development of this app, we are listening to the target group. With an app that gives them autonomy over their quitting process, perhaps we can finally bring that 23% down a little further.