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175

The
British
Psychological
British Journal of Health Psychology (2009), 14, 175–186
q 2009 The British Psychological Society
Society

www.bpsjournals.co.uk

Smoking to stay thin or giving up to save face?

Young men and women talk about appearance
concerns and smoking

Sarah Grogan1*, Gary Fry2, Brendan Gough2 and Mark Conner2

1
Department of Psychology, Staffordshire University, Staffordshire, UK
2
University of Leeds, Leeds, UK

Objective. This study was designed to investigate how young men and women
smokers and non-smokers talk about the impact of smoking on appearance, with the
aim of using these accounts to inform anti-smoking campaigns targeted at young people.
Design. Volunteer smokers and non-smokers took part in 24 focus groups.
Method. Eighty-seven men and women aged 17–24 were asked to talk about impacts
of smoking on appearance.
Results. A thematic analysis of transcripts suggested that weight gain after quitting
was only a significant concern for the younger (17-year-old) women. Non-smokers of
both genders expressed concern about yellowing of skin and teeth if they started
smoking, and women non-smokers were concerned about skin ageing. Smokers
believed that smoking made them look ‘cool’, mature, and sophisticated and would quit
only if skin ageing and other negative effects on appearance became visible.
Conclusions. Appearance concerns are relevant to the decision whether to start and
quit smoking, and are linked to gender and age. Results are discussed in relation to
implications for the development of age- and gender-relevant anti-smoking interventions.

Recent surveys of smoking prevalence have shown that young adults have the highest
rates of smoking in the US (Centre for Disease Control and Prevention, 2000, 2003) and
in Britain (ASH, 2005; Department of Heath, 2004). As a result, development of anti-
smoking programmes aimed at young people has been identified as a health promotion
priority in the US (Sussman, Sun, & Dent, 2006) and in the UK (ASH, 2005). Youth
smoking has been linked to shortness of breath, number of days taken off school and
college, and increased risk of lung cancer in adulthood (ASH, 2005; Centre for Disease
Control and Prevention, 2004), and is associated with other health-damaging behaviours
such as binge drinking ( Johnson, Boles, Vaughan, & Kleber, 2000).

* Correspondence should be addressed to Professor Sarah Grogan, Department of Psychology, Staffordshire University,
Stoke on Trent, Staffordshire ST4 2DE, UK (e-mail: s.c.grogan@staffs.ac.uk).

DOI:10.1348/135910708X327617
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176 Sarah Grogan et al.

One of the many factors that may influence smoking initiation and maintenance in
young people is desire to look attractive. Body image is of particular relevance to young
people, and motivates a variety of health-related behaviours including dieting (Cooley
& Toray, 2001) and exercise (Martin & Lichtenberger, 2002). Young men (Grogan
& Richards, 2002) and women (Stice & Shaw, 2003) in this age group in Western
cultures tend to place a high value on maintaining a socially acceptable body shape and
fear of weight gain may be a disincentive for smoking cessation, particularly for women
(Potter, Pederson, Chan, Aubut, & Koval, 2004). Young people may also believe that
smoking initiation will help to reduce their weight by acting as an appetite suppressant
(Stice & Shaw, 2003). Although fear of not being thin may promote smoking, other
appearance-related concerns may have the opposite effect. Smoking is linked to skin
ageing and other negative effects such as yellowing of the teeth (Department of Health,
2007), which might be expected to act as disincentives for smoking.
Young women are more likely to be regular smokers than young men according to
statistics from the UK (Department of Health, 2004) and US (Steptoe & Wardle, 2004), and
US studies have indicated that young women find it more difficult to quit smoking than
young men (Ellickson, Tucker, & Klein, 2001). In 2004, the gap in smoking prevalence in
UK between girls and boys in the 15 year old age group reached an all time high with 26%
girls and 16% of boys smoking (ASH, 2005). There are several potential reasons why girls
may initiate and maintain smoking at higher levels than boys. For instance, there is some
evidence that social pressure is more influential in girls decision to smoke than in boys
(Ellickson et al., 2001; Grogan, Conner, Fry, Gough, & Higgins, 2008). Another potential
source of gender differences relates to appearance concerns. Previous work has tended to
focus on pressure to be thin, which is generally greater on women than on men (Grogan,
2008), and various authors have suggested that young women may be more likely than
young men to use smoking to try to manage weight (Lowry, Guluska, & Fulton, 2002; Stice
& Shaw, 2003). Boles and Johnson (2001) reported that female smokers were more likely
than male smokers to believe that smoking controlled weight, and Potter et al. (2004) in a
recent review of available literature noted that dieting was more clearly associated with
smoking in female than in male adolescents.
Most research on smoking and appearance in young women has focused on weight
concern. However, other effects of smoking on appearance, such as ageing of the skin,
would be expected to act as a particular disincentive for young women. Having
youthful-looking skin is generally prized in Western cultures, particularly for women.
Youth and beauty are often seen as synonymous for women, reflected in increasing
numbers of women referring for facial cosmetic surgery to try to create the appearance
of youth (Cepernec & Payne, 2000; Grogan, 2008). The recent Department of Health
‘give up to save face’ anti-smoking campaign in the UK targeted young women who
smoke, encouraging them to quit because smoking can damage their teeth, age their
skin, and increase the likelihood of wrinkles around the eyes and mouth (Department of
Health, 2007). This campaign was built on the assumption that fears about skin ageing
and tooth damage are significant disincentives for young women in this age group.
There was also an assumption in this campaign that young men were not concerned
about appearance (a parallel campaign aimed at young men stressed potential impacts
on sexual performance rather than appearance). In fact, there is a significant literature
on the increase in appearance concerns in young men in the 2000s (Grogan & Richards,
2002; Stanford & McCabe, 2005) suggesting that young men may be more concerned
with appearance now than in previous years, although there is still social stigma against
men admitting to appearance concerns (Hargreaves & Tiggemann, 2006). While sexual
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Appearance concerns and smoking 177

performance may be an important area to target in interventions aimed at men, it may

also be useful to target appearance concerns.
In this study we aimed to explore young men and women’s accounts of the impact of
smoking on appearance. A secondary aim was to make suggestions for targeted
appearance-related anti-smoking campaigns aimed at young people. We wanted to
explore how women and men smokers would talk about smoking in relation to their
appearance (including weight control), and how they would make sense of engaging in
a behaviour that had negative impacts on their appearance and their health. We also
wanted to know about how non-smokers talked about appearance and smoking, and
any appearance-related concerns that might act as disincentives for smoking.

Method
Participants
Ethical approval for this study was obtained through Leeds University Psychology Ethics
Committee. The sample in this study included 87 males and females, aged between
16 and 24 years, smokers and non-smokers, from schools in the Leeds area, and from the
University of Leeds. Although we did not make any attempt to measure social class or
ethnicity in any controlled way, we did try to ensure that we included school pupils
from different social classes in our focus groups, accessing two schools from broadly
middle-class and two from working-class areas in Leeds. University students came from a
variety of disciplines, including mathematics, politics, and psychology. The school
pupils were 16–17 years old at the time of the focus groups. The University students
ranged from 18 to 24 years old. Participants were asked to self-identify as current
smokers or non-smokers. Of the school pupils there were 17 female smokers, 8 female
non-smokers, 16 male smokers, and 6 male non-smokers. Of the University students,
there were 15 female smokers, 8 female non-smokers, 12 male smokers, and 5 male non-
smokers. Smokers and non-smokers were allocated to groups so all combinations of
smoking status were covered (smokers only, non-smokers only, and mixed groups).
Some groups were female-only, some male-only, and some mixed, to maximize variation
in group membership and to encourage a range of accounts.

Materials
A list of topics was prepared prior to the focus groups based on pilot work and previous
literature. Topic headings included: Routes to smoking; Motivations for smoking;
Smoking and health; Social pressure to smoke and not to smoke; Appearance issues; and
Stopping smoking. However, the interview schedule was sufficiently flexible to allow
participants to generate their own understandings. This was part of a larger study of
smoking in young people, and only the accounts of effects of smoking on appearance
will be considered here.

Procedure
The school pupils were recruited by contacting relevant members of staff who then put
us in contact with adolescents who were willing to take part in our focus groups, and the
University students by e-mail and flyers on campus. All participants were paid £10 for
participation. Informed consent was obtained from each participant prior to the focus
groups. Focus groups took place in quiet rooms in the target schools and in the
Psychology department of the University of Leeds, facilitated by a male researcher
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178 Sarah Grogan et al.

(second author). The focus groups lasted around an hour each and were transcribed
verbatim. Participants were then asked to talk around a range of topics relating to smoking
(see above) and were encouraged to discuss these topics among themselves, with
minimal input from the interviewer. Focus groups were chosen as an appropriate method
for enabling young people to talk about smoking. Although they were more challenging
to set up practically than individual interviews, they enabled interaction between
participants to facilitate group discussion in a more naturalistic setting than would have
been possible through individual interviews (Wilkinson, 2008). In addition, focus group
discussions enable us to identify shared understandings among our sample, as well as
highlighting points of debate and disagreement between participants.
Participants were debriefed at the end of the focus groups and were given contact
details for the facilitator should they wish any more information about the study.

Analysis
All interview data were transcribed, including the facilitator’s speech. In the transcripts
below,¼ at the end of one person’s speech and the beginning of another’s is used to
indicate the absence of a gap between participants’ speech. Emphasis is indicated by
italics to show the words emphasized. Round brackets are used to indicate pauses and (.)
to indicate a pause of less than 1 second. Pseudonyms are used to protect the identity of
the participants.
Transcripts were submitted to a thematic analysis adopting a broadly critical realist
perspective (Madill, Jordon, & Shirley, 2000; Willig, 2001). That is, we made the
assumption that participants’ talk reflected their experiences while recognizing
the inevitable role of the researcher/s in interpreting this talk. The active involvement
of the researcher in the construction of knowledge is regarded here as an opportunity to
be exploited rather than a source of bias (see Finlay & Gough, 2003). In performing our
analysis we were broadly informed by the procedures of grounded theory (Strauss &
Corbin, 1990). The analysis summarized the accounts produced by the participants
through the development of abstract categories to integrate and explain the data
(Chamberlain, 1999). This involved several phases of analysis in which we attempted to
develop an understanding of how young women and men talked about the impact of
smoking on appearance through developing and testing hypotheses at each stage.
The first stage of analysis, informed by guidelines produced by Strauss and Corbin
(1990), involved careful reading and re-reading of all transcripts by the second author,
and line-by-line open coding to identify initial themes apparent in the data, resulting in
six clusters of themes. Categories (thematic clusters) emerging at this stage were ‘effects
of smoking on appearance are only long-term’, ‘concern about short-term effect of
smoking on appearance’, ‘smoking is not used for weight control’, ‘smoking is used for
weight control’, ‘smoking looks good in young people’, and ‘negative effects on
appearance can be concealed with cosmetics’. These were then submitted to axial
coding by the first author, where relational sampling and constant comparison
(comparing text segments from different informants and categories systematically for
similarities and differences between them) were used to confirm and elaborate
categories, and to investigate the relationships between categories. Six focus groups
with high school students and six with University students were analysed in this second
phase, and accounts provided by young and older groups, men and women, and from
smokers and non-smokers were compared to develop categories, and to produce a
provisional core category of smoking and ageing. The third phase involved selective
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Appearance concerns and smoking 179

coding, with systematic sampling from accounts provided by each group of participants
in the remaining 12 focus groups to confirm and verify the categories, to examine
negative instances, and to ensure that theoretical saturation had been achieved so far as
possible. This analysis led to a series of interlinked categories which are itemized below,
and the re-labelling of the core category as youth and beauty. Categories and themes
were validated by the remaining three authors through face-to-face and on-line
discussion, prior to determining the final model (Figure 1).

Results
Youth and beauty
The link between smoking and the desire to look young and beautiful was at the core of
the accounts presented by respondents in our focus groups (see Figure 1). Looking
young (wrinkle-free, thin, attractive, and clean and fresh) was the ideal presented by all
respondents (but particularly by women). However, actually being young (which was
linked to being inexperienced and immature) was not perceived positively. The act of
smoking was associated (by smokers) with maturity, having money, and with
media/consumer images of what it means to be sophisticated, including being thin.
Smoking was also associated with negative effects of ageing such as wrinkling of the skin
(by smokers and non-smokers) and yellowing of teeth and fingers (by non-smokers).
There was an interesting tension in accounts between wanting to look mature and not

Figure 1. Smoking and appearance: core category, subcategories, and themes. Note. Inward-pointing
arrows indicate perceived positive impact of smoking on appearance; outward indicate negative impact.
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180 Sarah Grogan et al.

wanting the outward physical signs of maturity such as wrinkles and heavier bodies.
There were three subcategories within the core youth and beauty category that
were independent of each other but interlinked through the youth and beauty core
theme; smoking makes you look older, which emerged in accounts from all respondents;
smoking causes yellowing of teeth and skin, which was only found in non-smokers;
and smoking keeps women thin, which was a clearly gendered category focused around
the link between femininity and slenderness.

Smoking makes you look older

Accounts relating to ageing were used by both smokers and non-smokers to justify their
choices to smoke and not to smoke. However, smokers and non-smokers presented
very different accounts. Smokers represented smoking as contributing to a ‘cool’,
sophisticated look to which they all aspired. Non-smokers stressed the down-side of
smoking on appearance, such as skin ageing. In the case of smokers, there was an
interesting conflict between presenting smoking positively (fulfilling the aim of making
them look more sophisticated and mature while in the act of smoking) and fear of skin
ageing which they linked with smoking in older people.

Smoking makes you look mature and ‘cool’

Only smokers presented this kind of account, which represented smoking as an activity
that enabled young people to look sophisticated, mature, and ‘cool’. Being seen to
smoke was linked with looking older, meaning more mature and sophisticated and
therefore positive. For instance, one of the young women smokers in the school sample
reflecting back on why she started smoking:
Facilitator: You thought you were good? What do you mean by that?
Danielle (school smoker): Like you were only young and that and you thought you were right
good with a cig in your hands. You looked older.
Although in this example Danielle projects the desire to be seen as cool on to herself at a
younger age, there were numerous examples where being seen to smoke was
represented by smokers in all focus groups as a ‘cool’ activity for young people in
general. On the other hand, smoking in older people was linked to addiction and
weakness of will, and was considered unattractive as it was linked to skin ageing:
Sharon (University smoker): It’s only sort of attractive like, acceptable, I’d say, on younger people.
I think when you see older people ¼
John (University smoker) ¼ Yeah. ¼
Sharon (University smoker) ¼ You’re like, oh, they’ve got lines around their mouths ¼
Being mature, engaging in an adult pursuit linked with positive media images of ‘cool’
men and women who smoked, was presented as an ideal by young men and women
smokers. However, this ideal was not represented in the accounts of any of the
non-smokers who focused instead on some of the negative appearance-related impacts
of smoking.

Smoking ages your skin and gives you wrinkles

Female non-smokers described fears of developing wrinkles as they became older as a
significant disincentive for smoking. For instance, in one focus group:
Rachel (University non-smoker): There’s a lot of things in magazines about how smoking
affects the way you look when you’re older, and most people are scared of looking old anyway
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Appearance concerns and smoking 181

and add the effects of smoking to that. I’ve read that many articles about the effect that (.) the
other things in smoking has on your skin and wrinkles and like the lips around your lips and
things, that would be a factor of me not smoking as well.
Smokers (both men and women) had not experienced wrinkling or skin ageing, so did
not believe that wrinkles were a realistic threat at this stage in their lives. For instance, in
another University group:
Cheryl (University smoker): But I don’t think I’ve ever considered skin to be something that’s
affected. I know it is when I think about it, but I don’t ever consider that.
For University smokers, wrinkling of the skin was generally considered not to be a
serious concern for them or for others less than 30 years of age, but was predicted to be
a problem, particularly for women, as they aged. For instance:
Susan (University smoker): As you get older, if you continue smoking for that long period of time,
then it kind of hits you when you’re about thirty, thinking, like, you can tell that your face is
changing because of smoking. Because of smoking, not because you’re ageing.
And in another group:
Jane (University smoker):¼ Yeah, don’t want to get wrinkles.
Sarah (University smoker): Yeah, again that might become a bigger issue as you get older.
University student women and men smokers reported that if they started to see visible
changes in their skin they would be likely to quit smoking:
Facilitator: Well, you know, if, well, as people get older, you know, things we were talking about
earlier like yellow teeth, er, (.) ageing skin, do you think that would ¼
Lisa (University smoker):¼ It depends if I started to see like real, like, (.) horrible cat’s bum
mouth or something like that on me, (.) I’d be more likely to stop.
This was echoed by the male smokers in the University group. Both men and women
smokers argued that they would only stop smoking if they could actually see changes in
their appearance:
Gareth (University smoker): I’d probably feel the same way about the appearance aspect but
I think I can’t really speak in that conjectural way because I am so cynical about things like that.
I just think ‘well how do you know I’m going to look like that you know you could be just
messing me around’.
Jane (University smoker): I think the possibility is enough to scare and that’s really bad because if
I was told ‘you will get cancer if you do not give up smoking’ or ‘you will be severely affected
in your health if you continue to smoke’ for definite then I would stop, but it’s probably more
likely to shock me if I had a significant change in appearance and that it was guaranteed.
Gareth: That’s the thing, the guarantee aspect.
Jane: Yes if it was guaranteed.

Smoking causes yellowing of teeth and skin

Only non-smokers were concerned about yellowing of teeth and fingers, which were
seen as significant disincentives to start smoking:
Laura (University non-smoker):¼ Oh yeah, you get yellow teeth and you get horrible fingers, and
that’s horrible.
Yellowing of skin and teeth was represented by men and women non-smokers in both
school and University groups as ‘disgusting’, not sexually appealing, unclean, and a
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182 Sarah Grogan et al.

significant disincentive for smoking. Yellowing was linked to cleanliness rather than
ageing, and was not linked with ageing in any account:
Michael (University non-smoker): I was just talking to one of my friends the other day
actually about one of our mates who smokes a lot and he looks disgusting now – his hands are
proper like – they’ve got big yellow blobs on them now and you can see his teeth are starting
to go yellow and I was just saying about how sort of disgusting it looks really. It just looks
unclean pretty much really.

Smoking keeps women thin

This category was clearly gendered. None of the male smokers reported concern that
they would gain weight if they stopped smoking. However, both men and women
argued that women used smoking to control their weight and to keep them looking thin
and attractive. Thinness was linked with both youth and attractiveness. Using cigarettes
to control weight was discussed by women smokers and non-smokers. However, only
the younger women smokers from the school sample admitted to using smoking to
control their own weight, and being reticent about stopping smoking in case they
gained weight.

Other women (but not me) use smoking as a weight control strategy
There was agreement in all subgroups of participants that most women wanted to be
thin, and desire to be thin was linked with femininity and youth. Women were
expected to have more concern about their weight than men. University women who
smoked stressed that they themselves were not concerned about being thin, and were
not using smoking as a weight control technique, but that they knew other women
who were. This may have enabled women to discuss the link between thinness and
smoking without expressing personal views or experiences which would be
potentially threatening to reveal in a group context. It may also have helped them
to resist being positioned as being duped into accepting cultural pressures to be thin.
Using smoking to control weight was presented as an immature weight-control
strategy linked with younger women, and with themselves at a younger and less
mature point in their lives:
Kelly (University smoker):¼ Yeah, especially when you’re younger, I think around like sixteen,
they really think it helps you lose weight, and that’s why they start, it could be like a key reason
why people start, girls I mean.
Women in both University and school focus groups believed that the reason that
people put on weight when they gave up smoking was because cigarettes were
replaced with food:
Charlotte (University non-smoker): Yeah, if they’re hungry, they’ll have a cigarette instead of
eating because it, like, sedates – is it sedates? – I don’t know, your appetite, it makes you feel
that you’re not as hungry and stuff. I’ve met two or three people who do that, and then they’re
like, some people who’ve given up cigarettes are like, oh, I’ve put on so much weight because
they’ve got nothing to do, and it’s like, I won’t have a cigarette, I’ll go and eat or something.
This was seen by both male and female University students as a specifically female thing
to do, and the thought of men smoking to satiate their appetites was seen as so unlikely
as to be humorous:
Alison (University smoker): I can’t imagine it being a male thing. I’m going to have a fag instead
of a meal!
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Appearance concerns and smoking 183

Male non-smokers in the University group also argued that women (particularly younger
women) were likely to use smoking as a replacement for food. For instance in one of the
male, non-smoking University groups:
Sean (University non-smoker): I think again this will affect women more I think. Especially
teenage girls because of I think with the change and all that erm that that’s probably why they
started smoking – to lose weight.

Quitting makes you fat

Concern about putting on weight when stopping smoking was only identified as a
concern among the younger women smokers. It was seen as a significant concern for
younger women who smoked and for themselves at a younger age by the University
student women:
Paula (University non-smoker): But I think there is this kind of like myth or whatever about
people putting on weight if they stop smoking. And probably I think like in younger girls who
probably have funny attitudes towards eating anyway – they will have cigarettes.
And younger girls who smoked reported that they were concerned about quitting
smoking in case they ate more and put on weight. This kind of account was not
presented by any of the older women, or by the men.
Rosie (school smoker): That’s one reason I won’t give up cos I’m terrified of that. If I quit smoking
I’ll get fat.

Discussion
The primary aim of this study was to explore young men and women’s accounts of the
impact of smoking on appearance. Neither male nor female smokers reported negative
effects of smoking on any aspect of their current appearance, and generally reported
that smoking made young adult smokers look ‘cool’, mature, and sophisticated
supporting suggestions from Plumridge, Fitzgerald, and Abel (2002). There was some
ambivalence in accounts where smokers presented smoking both positively (fulfilling
the aim of making them, as young smokers, look more sophisticated, and mature while
in the act of smoking) and negatively (where skin ageing was linked with smoking in
older people). Non-smokers tended to display concerns about how smoking would
affect their appearance, and these were a significant disincentive for smoking
initiation. Concerns about skin ageing were most notable in female non-smokers and
male non-smokers were concerned about yellowing of skin and teeth which was
linked to looking unclean and being sexually unattractive. This kind of account could
explain their decision not to smoke through reference to cleanliness rather than
beauty, maintaining a male-appropriate account and resisting potential criticisms of
being overly concerned with beauty which may be perceived as a feminine concern
(Hargreaves & Tiggemann, 2006). Although the link between low sexual attractiveness
and smelling of smoke has been incorporated into recent British anti-smoking
advertizing (Department of Health, 2007) looking unclean has not, and may be an
important disincentive for young non-smoking men.
We also wanted to investigate how smokers and non-smokers discussed smoking
in relation to weight control. Both men and women reported that women used
smoking as a weight control technique, and younger women smokers had used smoking
to reduce their appetite and as a distraction from eating, supporting previous work
(Potter et al., 2004). Fear of gaining weight if they stopped smoking acted as a
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184 Sarah Grogan et al.

disincentive for quitting smoking for the school-age young women who took part in our
focus groups. Weight concern was clearly gendered, in line with current cultural
pressures on young women to be slender (Grogan, 2008). These pressures are different
from those on men where the pressures are to become more muscular rather than
thinner (Hargreaves & Tiggemann, 2006; Stanford & McCabe, 2005). Our focus groups
suggested that anti-smoking interventions need to target these concerns in women,
supporting other authors (Dobmeyer, Peterson, Runyan, Hunter, & Blackman, 2005;
Jeffrey, Henrikus, Lando, Murray, & Liu, 2000).
Another aim of this study was to make suggestions for targeted anti-smoking
campaigns aimed at young people that were gender-appropriate. Our focus groups
suggested that appearance concerns are relevant to young men as well as to women, but
that smoking-prevention and smoking-cessation programmes need to focus on different
aspects of appearance to be optimally appropriate for men and women smokers and
non-smokers. The recent British ‘give up to save face’ campaign (Department of Health,
2007) was based on the assumption that fears about long-term effects on the skin are
significant disincentives for young women. Unfortunately, the young women smokers in
our study did not see long-term skin ageing as a significant concern, so dismissed
warnings about skin-ageing as irrelevant at this point in their smoking careers. Although
both women and men smokers were very concerned not to have wrinkled skin, they
had not experienced any visible changes to their skin, so did not believe that smoking
was having a negative impact on their own appearance. However, both women and
men said that they would give up smoking if they could actually see that smoking was
ageing their skin. Stressing the fact that skin damage caused by smoking may not be
visible to the naked eye but is nonetheless progressing below the surface of the skin
might be an effective way to counter smokers’ beliefs that smoking is not having an
impact on their skin. Since both men and women smokers were concerned about skin
ageing, appearance-related campaigns need to be directed towards both men and
women smokers.
For younger women smokers, fears that they may gain weight if they quit smoking
were also clear in accounts and need to be tackled head-on in health promotion
campaigns. The temporary nature of post-quitting weight gain and the fact that most
women only gain a few pounds when they quit (Peterson & Helton, 2000) may serve to
allay the fears of young women who do not want to gain weight.
For non-smokers, fear of getting wrinkles (young women) and skin yellowing (both
genders) if they initiated smoking in the future were incentives not to start smoking.
Having clean-looking teeth and skin (and potential impact of smoking on these) seemed
particularly important to non-smoking men, so could also be stressed in materials aimed
at non-smoking men. For non-smokers, a focus on long-term appearance effects (such as
in the ‘give up to save face’ campaign) would be expected to be effective, although the
use of male as well as female models would increase the relevance of such campaigns to
young men as well as to women.
Our exploratory study benefited from having a good-sized sample of young men and
women. Similar accounts were presented by men and women in smoker, non-smoker,
and mixed groups; and by men, women, and mixed-gender groups. Analyses were
conducted and cross-checked between male and female authors who were smokers,
past smokers, and non-smokers. It may be that having a male facilitator who identified as
a smoker impacted on what respondents felt able to disclose in the sessions, and it
would be interesting to compare responses with focus groups with a female and non-
smoking facilitators.
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Appearance concerns and smoking 185

Results of this study suggested that appearance concerns are relevant to smoking as
well as to other health-related behaviours such as eating (Stice & Shaw, 2003) and
exercise (Ricciardelli, McCabe, & Ridge, 2006; Slater & Tiggemann, 2006). Appearance
concerns relating to smoking were not specific to women, and not specific to weight,
supporting suggestions that men are becoming more appearance-aware in the 2000s
(Hargreaves & Tiggemann, 2006) and that smoking relates to appearance in general
rather than being confined to overweight concern (Dobmeyer et al., 2005). Results
suggest that health educators should try to convince smokers in this high risk age group
that smoking is having an immediate and significant effect on their skin as well as on
their health, even if the effects of smoking are not yet visible to the naked eye. This will
involve consideration of how best to present evidence of early skin damage resulting
from smoking in a way that will convince young smokers that appearance changes are
indeed self-relevant. Our findings also suggest that initiatives such as the ‘give up to save
face’ campaign should target men as well as women.

Acknowledgements
This study was partly funded by an Economic and Social Research Council (ESRC) grant ‘Gender
differences in smoking: A 6-year longitudinal study’ (reference number RES-000-22-0077).

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Received 28 September 2007; revised version received 30 April 2008