IB Psychology SLTopic 2 — Health ProblemsPaper 1 & 2Sociocultural approach~10 min read
Why Smoking Rates Differ Between Cultures
Everyone knows smoking is dangerous. The warning is printed on the packet in large letters. And yet over a billion people still do it. That gap between knowing and doing is the real puzzle of this page, and psychology has a precise name for it.
📚 What you need to know
The same Hofstede framework applies: individualism vs collectivism, from 60,000+ IBM employees in 50+ countries.
Individualistic cultures may see smoking as a personal choice, even against health advice.
In collectivist cultures, smoking can reflect group norms — shared activities that strengthen social bonds.
Example: waterpipes (shisha) are a significant cultural practice in parts of the Middle East.
Cognitive dissonance is holding two contradictory ideas at once, and it helps explain why prevalence stays high.
Pokhrel et al. (2018) is your study, and its result runs opposite to the obesity findings.
For smoking, prevalence is measured as the proportion who smoked between two dates.
Cognitive dissonance and smoking
Despite widespread knowledge of the serious health risks, many people continue to smoke. That creates cognitive dissonance: holding two contradictory ideas at the same time, such as “smoking is harmful” and “I am still going to smoke”.
Dissonance is uncomfortable, so the mind resolves it. The important insight is that there are three ways out, and only one of them involves stopping.
This is why health campaigns based purely on information often fail. Adding more facts increases the dissonance, and the cheapest way to remove discomfort is usually to dismiss the facts rather than change the habit.
This contradiction highlights how complex health behaviours are, and it explains why smoking prevalence stays high in some populations even where everyone knows the risks. Knowledge is not the missing ingredient. It never was.
Culture and the norm
Individualistic cultures
Individuals may see behaviours such as smoking as a personal choice, even where this goes against health advice. That can contribute to higher smoking prevalence, as people prioritise personal preference or independence over health guidelines.
Collectivist cultures
Smoking may reflect group norms — for example shared activities like smoking together, which can strengthen social bonds but also reinforce unhealthy habits. Smoking may be shaped by group expectations, with individuals less likely to go against family or cultural norms that encourage tobacco use. In parts of the Middle East, the use of waterpipes (shisha) is a significant cultural practice.
🔬 Pokhrel et al. (2018)
The study that refuses to give the expected answer
AIM
To investigate how individualism and collectivism influence adolescent risky health behaviours, including smoking, and the role of social self-control in regulating them.
PARTICIPANTS
716 high school students (mean age 16; 48.5% male, 51.5% female) from the Bashkortostan Republic in Russia, traditionally a collectivist culture. The researchers also explored whether globalisation had encouraged more individualistic values among young Russians.
PROCEDURE
Participants completed anonymous surveys measuring risky health behaviours including smoking, individualism and collectivism values, negative life events, and level of social self-control.
RESULTS
Participants who scored highest on individualism reported the lowest rates of risky behaviours, including smoking.
CONCLUSION
Individualism versus collectivism is a reliable predictor of smoking prevalence among Russian adolescents, and cultural values and globalisation may shape health behaviours in complex ways.
Read that result twice. The obesity page said individualism is linked to worse health outcomes. This page says individualism is linked to lower smoking. Both are in your syllabus. Both are supported by research. They cannot both be describing a fixed effect of individualism — so the dimension does not have a built-in direction.
How to explain the contradiction
This is the most valuable thing on the page, so take a moment with it. The resolution is that a cultural dimension does not push behaviour one way. It determines how strongly the local norm is enforced.
🧩 The rule that makes both results make sense
In a collectivist setting the group norm has real force. If the local norm involves smoking together, that force pushes people toward it.
In an individualistic setting the person decides. That can mean ignoring health advice, or it can mean resisting a peer group that smokes.
So the outcome depends on what the norm is, not on the dimension by itself. In Bashkortostan, resisting the local norm meant not smoking.
Write that in an exam and you have moved from describing two studies to explaining why they differ. That is top-band thinking.
Evaluating this explanation
Strengths
Hofstede’s large-scale global survey gives extensive quantitative data, increasing reliability and generalisability.
The framework is regularly reviewed and updated, reducing temporal validity problems.
Pokhrel used anonymous surveys, which reduces social desirability bias on a sensitive topic.
Measuring social self-control alongside values gives a possible mechanism, not just a correlation.
Limitations
The findings may be reductionist, oversimplifying complex cultural behaviour into rigid categories.
Sample bias in Hofstede: IBM employees over-represented the USA and developed countries.
Pokhrel’s sample was one region of Russia, so generalising to all collectivist cultures is unsafe.
Self-report on smoking may still be inaccurate, even anonymously.
Linking to the concepts
Responsibility: smoking research is socially sensitive, and results could be used to stereotype or discriminate against specific social or cultural groups. Findings should be reported carefully, with researcher reflexivity as a priority.
Change: prevalence may change for the better because of globalisation. Western media output — films, music videos, social influencers — rarely depicts smoking as desirable or fashionable now, which could reduce prevalence across a younger global audience.
EXAM ANSWER
Discuss the influence of culture on one health problem. [22 marks]
Open with the puzzle, not the definition
Health knowledge is near universal, yet prevalence varies hugely by culture. Cognitive dissonance explains why information alone does not change behaviour.
Bring in the dimension
Hofstede’s individualism–collectivism: norms carry more enforcing power in collectivist settings.
Evidence, including the awkward part
Pokhrel et al.: 716 Russian adolescents; highest individualism scores predicted the lowest risky behaviour.
Resolve it rather than ignore it
The dimension sets how strongly a norm is enforced. The direction depends on what the norm is.
Conclude: culture shapes the pressure, not the destinationexplaining a contradictory finding beats quoting three agreeing ones
💡 Exam tips
Define cognitive dissonance with an example. It is precise, memorable and directly creditworthy.
Use the three resolution routes to explain why information campaigns underperform.
Do not hide the Pokhrel result because it is inconvenient. Explaining it is the highest-value move here.
Shisha is a specific, named cultural example. Specificity always beats “in some cultures”.
Anonymous surveys are a genuine methodological strength on sensitive topics. Say why.
This page and the obesity page share a structure, so revise them together as a matched pair.
⚠ Common mix-ups
Claiming individualism always raises health risk. Pokhrel found the opposite for smoking.
Confusing cognitive dissonance with denial. Denial is one possible resolution, not the whole concept.
Assuming Russia is individualistic. Bashkortostan is described as traditionally collectivist in this study.
Calling Pokhrel an experiment. It is a correlational survey study.
Treating “risky behaviours” as only smoking. The measure covered several behaviours.
Forgetting globalisation. It is the change concept for this page and it is easy marks.
Up next: Social Learning as an Explanation of Obesity — we have looked at whole cultures. Now we shrink the group down to the people you actually eat lunch with, and the effect turns out to be surprisingly strong.
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