IB Psychology HLTopic 1 — Health ProblemsPaper 1 & 2Sociocultural approach~9 min read
Why Smoking Rates Differ Between Cultures
Everybody knows smoking is dangerous. The warning is printed on the packet. And yet more than a billion people still smoke. That gap between knowing and doing is the most interesting thing on this page, and psychology has a specific name for it.
📘 What you need to know
Hofstede’s cultural dimensions again, and again the one that matters is individualism vs collectivism.
In individualist cultures smoking may be seen as a personal choice, so preference and independence can outweigh health guidance.
In collectivist cultures smoking can reflect group norms — a shared activity that strengthens social bonds while reinforcing an unhealthy habit.
Cultural practices matter: in parts of the Middle East, waterpipe (shisha) use is a significant social tradition.
Cognitive dissonance is holding two contradictory ideas at once, such as “smoking is harmful” and “I am still going to smoke”.
People usually resolve dissonance by changing the belief rather than the behaviour, which helps explain why prevalence stays high.
Pokhrel et al. (2018) found the opposite of the simple prediction, and that is why the study is worth knowing.
Cognitive dissonance
Dissonance is uncomfortable. Holding a belief that clashes with your own behaviour creates tension, and the brain wants that tension gone. There are only two exits: change what you do, or change what you believe. Quitting is hard. Adjusting a belief is free.
This explains something prevalence data cannot: why telling people the facts, over and over, produces such a small change in behaviour.
Culture and the meaning of smoking
Individualist framing. If health behaviour is my business alone, guidance from a government or a doctor is easy to treat as an opinion to weigh rather than an instruction to follow. That can push prevalence up.
Collectivist framing. Smoking together is a shared activity that strengthens bonds. Refusing can feel like refusing the group, so individuals are less likely to go against family or cultural norms that encourage tobacco use.
Specific practices. Waterpipe use in parts of the Middle East is a social and cultural tradition, not just a nicotine habit, which makes it harder to target with standard cessation messaging.
Whenever you write about collectivism and health, resist the assumption that the group always protects. On obesity the group can normalise unhealthy habits, and on smoking it can make refusing socially costly. Collectivism is not automatically the healthy option.
Research support: Pokhrel et al. (2018)
Aim: to investigate how individualism and collectivism influence risky adolescent health behaviours including smoking, and the role of social self-control in regulating them.
Participants: 716 high school students, mean age 16, roughly half male and half female, from the Bashkortostan Republic in Russia — traditionally a collectivist culture. The researchers also looked at whether globalisation had encouraged more individualist values among young Russians.
Procedure: anonymous surveys measuring risky health behaviours, 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 was a reliable predictor of smoking prevalence among these adolescents, but cultural values and globalisation shape health behaviour in complex ways.
This is the result students always get wrong. The simple prediction says individualism should mean more risky behaviour. Pokhrel found the reverse. One plausible reading is that in a collectivist setting, a young person who resists group pressure needs a strong individual sense of self — so individualism here works as protection, not as licence. Using a study that contradicts the neat theory is a genuinely high-level move in an essay.
Evaluation
Strengths
Hofstede’s data set is large and regularly reviewed, giving the framework reliability and reducing temporal validity problems.
Anonymous surveys reduce social desirability bias when asking teenagers about smoking, which is a sensible design choice for the topic.
Pokhrel measured values directly rather than assuming every Russian adolescent is collectivist because of their nationality. That is more careful than most cross-cultural work.
Limitations
The findings may be reductionist. Complex cultural behaviour is squeezed into rigid categories.
Hofstede’s sample was not representative — IBM employees, mostly from the USA and developed countries.
One region, one age group. 716 students in one Russian republic cannot represent collectivist cultures generally.
Self-report of a stigmatised behaviour remains a problem even when anonymous.
Correlational. Values and behaviour were measured at the same time, so neither can be shown to cause the other.
EXAM QUESTION
Discuss the role of one cultural dimension in one health problem. [22]
Step 1: define the dimension and state the predictionIndividualism should mean personal choice overriding health advice; collectivism should mean group norms driving behaviour.Step 2: add cognitive dissonance as the mechanismKnowing the risk does not change behaviour, because the belief is easier to adjust than the habit.Step 3: present Pokhrel honestly, including the surpriseHighest individualism went with lowest risky behaviour. Offer an interpretation rather than hiding it.Step 4: evaluateReductionist categories, Hofstede’s sample, one region, correlational design, globalisation shifting the values themselves.Top-band move: explain why the theory and the evidence disagree
Link to concepts
Responsibility
Research linking culture to smoking is socially sensitive and can be used to stereotype or discriminate against particular groups. Findings need to be published with their limitations attached and with the researcher’s own position made explicit.
Change
Globalisation cuts both ways. Western media once made smoking look glamorous; now films, music videos and social influencers rarely present it as desirable, which may push prevalence down among young people worldwide. The same force that spreads processed food can also spread changing attitudes.
💡 Exam tip
Cognitive dissonance is the strongest concept on this page. Define it, then apply it to a smoker in one sentence.
Report Pokhrel’s result accurately even though it contradicts the theory. Examiners notice when students bend evidence to fit.
Give the shisha example. Concrete cultural practices score better than general statements.
Do not reuse the obesity mechanism here. Smoking is social bonding; food is shared meals. They differ.
Anonymous surveys are a design strength worth naming when the behaviour is stigmatised.
Link back to the prevalence page for figures. Numbers plus mechanism beats mechanism alone.
⚠ Common mix-up
Reporting Pokhrel backwards because it fits the theory better. Highest individualism, lowest risky behaviour.
Treating cognitive dissonance as simply “being a hypocrite”. It is a measurable state of tension that drives belief change.
Saying collectivist cultures always smoke more. The evidence is mixed and depends on the practice involved.
Using the same explanation for obesity and smoking without adapting it. The mechanisms differ.
Forgetting that values were measured, not assumed, in Pokhrel. That is a methodological strength.
Confusing a predictor with a cause. The data are correlational.
Up next: Social Learning as an Explanation of Obesity — from national culture down to your actual friendship group, and a study that traced obesity spreading through a social network over thirty years.
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