Understanding Health Behaviours

Try and try again: Qualitative insights into adolescent

smoking experimentation and notions of addiction

Justine Leavy, Lisa Wood, Fiona Phillips and Michael Rosenberg

Introduction
The detrimental effects of smoking and nicotine addiction
that become visible during adulthood are well published.1-3
Although addiction is not often explicitly addressed within the
rubric of youth tobacco control programs,4 there is increasing
recognition of the validity of addiction experiences in young
smokers, even those who smoke irregularly.5-7 US estimates
suggest 6.4 million children aged less than 18 years who are
living today will die prematurely as adults because they began
to smoke cigarettes during adolescence.8
The power of addiction is often recognised by adults who
began smoking in adolescence. Recent studies9-12 indicate
that addiction is not a term that resonates with adolescent
smokers, and their understanding of smoking addiction is low.
A Northern Ireland study found that among 10 to 11-year-old
children the notion of tobacco addiction was seen to belong
to the adult world; while adult smokers were perceived as
dependent on nicotine, young smokers were more likely to
perceive smoking in terms of social relations.3,13 Moreover,
evidence suggests that young people believe they can smoke
without fear of becoming addicted or experiencing negative
health outcomes,9,14 often believing they can easily give up
at any time.15-17
Despite most adult smokers commencing smoking during
their adolescence, little is known of the processes and
causes underpinning the notion of what it takes to become
addicted.1,2,4,18 For smokers, the process from experimenting
to addiction has been described as an insidious progression
from believing themselves to being in control to finding they
cannot stop smoking.19
Traditionally, most health promotion efforts to reduce smoking
in young people have concentrated on primary prevention or
harm minimisation and the concept of addiction has rarely
been addressed.19 Addressing this void requires understanding
how adolescents conceive and respond to the notion of
tobacco addiction.

Abstract

Issue addressed: Addiction is a relatively unexplored issue in youth tobacco control. Increasingly, there is
recognition of addiction experiences in regular and irregular teenage smokers. Research was undertaken
on behalf of the Smarter than Smoking (STS) project to probe young peoples reasons for smoking uptake,
their attitudes towards the social acceptability of smoking, predictors of continued smoking after trial and
understandings and perceptions of addiction.
Methods: Twenty focus groups were conducted to collect qualitative data from young people (n=92) aged 13
to 15 years from metropolitan and regional areas of Western Australia (WA), from a variety of socioeconomic
backgrounds, including young Aboriginal and Torres Strait Islander people.
Results: Of the young people spoken to, 20% smoked regularly, 40% had tried smoking and 40% had never
tried. Acceptability and normalcy of trialling smoking was a recurring theme, with little perceived risk of
trial leading to regular smoking or becoming addicted. Even non-smokers accepted just having a try in the
context of curiosity, life experiences and informed choice.
Conclusions: Preventing continuation after trial of smoking among young people needs to increase in
importance, given the prevailing norms around trying it and individual choice.
Key words: youth smoking, addiction trialists, prevention.
Health Promotion Journal of Australia 2010; 21:208-14

So What

By examining key determinants of continued smoking after trial, and the notion of addiction, amenable areas
for primary intervention can be identified.

208 Health Promotion Journal of Australia 2010: 21(3)

Understanding Health Behaviours Qualitative insights into adolescent smoking experimentation

The Smarter Than Smoking (STS) project was established in Stage 1

1995, with the overall aim of reducing the proportion of 10 The mainstream target group was recruited from a list of
to 15-year-olds in Western Australia who take up smoking.10 government and private schools from a range of socio-
The project is managed by the Heart Foundation and a variety economic areas. Letters were sent to the principal of the school
of strategies are used to target young people.10 In addition in the first instance requesting involvement in the research and
to evaluation of campaign media and activities, formative outlining the purpose of the research, followed by a telephone
research is undertaken periodically to gauge young peoples call which confirmed involvement. Upon confirmation of
attitudes, beliefs and perceptions in relation to smoking. involvement in the research, questionnaires were sent to
The decision to take up smoking is generally made between the schools to be completed by students, reflecting smoking
the ages 12 and 17. Based on data collected from 21,805 behaviours and attitudes to smoking. Questionnaire responses
male and female students aged 12 to 17 years surveyed in 376 were used to select students most suited to discussion topics
secondary schools, an estimated 140,400 Australian secondary and, based on smoking status, selected students were then
school children were involved with tobacco smoking in invited to partake in focus group discussions. Letters were
2005.20 This study explores the attitudes and normative values sent to the parents of students involved and passive parental
regarding smoking experimentation and concepts of addiction consent was used, whereby parents were required to contact
that shape the trajectory of smoking behaviour after initial trial the school if they did not wish for their child to be involved. In
among adolescents. Underlying research questions include total, six focus groups were conducted with the Mainstream
investigation of why young people smoke, attitudes towards target group. The composition of these groups is summarised
smoking and peer relationships, experiences of smoking (trial in Table 1 in relation to characteristics considered in the
and continuation), and understandings of addiction. comparative analysis (i.e. gender, smoking status, metro or
regional, and school year).
Methods
Stage 2
The qualitative research described in this paper was undertaken
in Western Australia (WA) in November to December 2004. The second stage of the research comprised 14 focus groups
Focus groups were used as they enabled a greater number with young people from priority populations (see Table1 for
and variety of views to be canvassed efficiently relative to group composition). A combination of school-based focus
individual in-depth interview techniques.21 Focus groups can groups and smaller out of school group discussions were
also yield greater value than the sum of individual interviews used in this component of the research. Out of school groups
because of the interaction that occurs between group were included to reach young people in a more social setting
participants, and are particularly suited to research in which and to ensure that views were obtained from young people
the meanings, beliefs, representations and experiences of lay who may be disconnected from the school system, and were
people are crucial.22 selected for inclusion based on the method used for schools,
however contacts were used opposed to principals. The out
A total of 92 young people aged 13 to 15 years participated
of school groups were less structured and the groups were
(45boys, 47 girls). The research involved a two-staged
conducted with a mix of genders, and the age range increased
approach. Stage one entailed research with the Mainstream
to include people aged 12 to 15 years. Recruiting the ATSI
target group, described as young 13 to 15-year-old females
young people was done through gatekeeper contacts within
and males who reside permanently within metropolitan
the STS project and this proved a successful recruitment
WA. Stage two was directed at a Priority population
group from low socioeconomic backgrounds, regional
Table 1: Sample composition of the focus groups.
groups and Aboriginal and Torres Strait Islanders (ATSI)
Group Current Tried but Never tried
living in metropolitan and regional (but not remote) WA. A smokers not current
combination of school-based focus groups and small out of Mainstream groups
school group discussions wereused. Year 8, 9, 10 3 (m) 1 (f) 8 (m) 13 (f) 12 (m) 5 (f)
Subtotal 4 21 17
All aspects of the recruitment and research were conducted
Regional and lower socio-economic
in ethical accordance with the Australian Market Research
Year 9, 10 3 (m) 5 (f) 2 (m) 6 (f) 1 (m)
& Social Research Societys Code of Professional Behaviour Out of school 2 (m) 1 (m) 3 (f) 1(m)
and Market and Social Research Privacy Principles, including Subtotal 10 (5m, 5f) 12 (3m, 9f) 2 (m)
the obtaining of parental consent, voluntary participation, ATSI
informed use of recording device and confidentiality of data Year 8, 9, 10 1 (m) 3 (f) 6 (m), 3 (f) 12 (m) 12 (f)
Subtotal 4 9 24
storage and reporting.
Total 18 (9m, 9f) 42 (16m, 22f) 43 (25m, 17f)
m=males, f=females

Health Promotion Journal of Australia 2010: 21(3) 209

Leavy et al. Article
strategy for the priority group. Arrangements were made
during recruitment for an ATSI adult to be present during
the focus groups.
Groups were structured based on smoking status and
involved written activities, however the primary focus was
on group discussions. A discussion guide was used as a loose
framework (topics included why people smoke, experience
with smoking [peers or own experiences], meaning of
addiction, and perceived ease of quitting) although this varied
to accommodate the dynamics of different groups and to
allow issues raised by participants to be explored. All groups
gave permission for the discussions to be tape-recorded,
with discussions lasting from 40 to 60 minutes. These were
transcribed with quotes de-identified in the transcripts and
reporting of findings. Thematic analysis was used to allow
themes to emerge from the data and not be imposed by the
researchers. Comparative analysis was also used to explore
similarities and contrasts in relation to smoking status.
Results
The data were analysed for themes discussed in all groups
and encompassed: attitudes to trial; factors determining
continuation; experiences with smoking by smokers/trialists
and settings; contexts in which young people smoke;
and understanding addiction. The findings presented are
illustrated by verbatim quotes identified by gender, smoking
status (smoker, non-smoker, tried), area (metro, regional) and
school year.
The research investigated the smoking-related attitudes of
young people who currently smoke, designated as smoker,
those who have recently tried defined in this paper as
trialists and those who have never smoked. Smokers and
trialists were grouped for purposes of comparative analysis
Smokers/Trialists
Other friends do*
Relieves stress/relaxes* Think it is cool
Problems in life* Peer pressure*
To be rebellious Addicted/get
To be social hooked
Goes with other behaviours To be thinner
(e.g. drinking) Stress
To be like siblings
Bored*
Just do*
* More often cited as a reason among ATSI or lower SES
210 Health Promotion Journal of Australia 2010: 21(3)
with young people who have never smoked. The research
also investigated differences in attitudes among STS priority
population groups.
Why young people smoke
Reasons for smoking articulated by smokers/trialists and non-
smokers mirror many of those identified in past STS research.
While the reasons identified by lower SES and ATSI young
people were similar to those of the mainstream target group,
they were notably more likely to cite stress and troubles in
life, boredom and more overt inducement to try smoking
from friends (Figure 1).
The responses of many non-smokers suggested that this was
not something they necessarily wonder or ponder; it had not
occurred to them to attribute a reason to adolescent smoking.
However, those that did posit a reason most often mentioned
curiosity or the influence of older friends who smoke.
Curiosity was one of the dominant reasons for trying smoking,
and was seen as a normal part of the teenage trajectory, even
among non-smokers. From the target groups perspective,
trialling smoking does not mean that the young people are
either going to like it or want to become a regular smoker.
Across focus groups, there were no perceived risks of trying
(although risks of smoking are well known and accepted).
Although trialists/smokers may have first tried smoking with
others and been offered a cigarette, their comments suggested
that experimentation was mainly about joining in, giving it
a go rather than overt peer pressure. Saying no (or nuh!) was
usually well accepted:
When you are in a group of people and they smoke, then
you tend to do it, just to try it male, tried, metro, year 9.
It was a life experience to have a puff, youve done that
why would you do it again female, tried, metro, year 10.
Figure 1: Why do people smoke?
Smokers/Trialists.
Non-smokers
To get in with a
particular group
Understanding Health Behaviours Qualitative insights into adolescent smoking experimentation
By contrast, ATSI and lower SES were much more likely to
describe overt peer pressure to try or continue to smoke:
People hassle you to try it. If someone offers you a smoke
you can say no, but they might offer again male, tried, ATSI,
regional, out of school.
If you say no they try another day, just keep on doing it
male, tried, metro, year 9, lower SES.
Perceptions of smoking and smokers
Smoking still did not appear to define or affect friendships
in any way, for either smokers or non-smokers. Friendship
groups seem to be more fluid and less defined by common
behaviours than in previous research:
Friends are friends male, tried, metro, year 9.
Probably dont think anything smoking doesnt affect
how you regard others or what you judge them by male,
non-smoker, regional, year 10.
People dont tend to stay in the same group, they drift
aboutMost guys at this school are probably friends and
same for most girls male, non-smoker, metro, year 10.
Across the focus groups, it was evident that young people
value the right of peers to make individual choices about
a whole range of things, ranging from who they socialise
with outside of school, hair colour, what sport they play
and smoking. In some respects, trying smoking, or indeed
smoking, is not something that defines peer groups per se, it is
just something that some people do, and many people do not.
The imagery of smoking as cool often arises in literature
relating to adolescent smoking and to the portrayals of
smoking in advertising and popular media.23 The focus groups
did not ask about coolness overtly, but where it was mentioned
or alluded to by participants further discussion followed. More
Table 3: Perceptions of what determines continuation of smoking after trialing.
Tried smoking and continued
Enjoyment i.e. smoking becomes enjoyable (although not the first time).
Addiction e.g. early experience of needing it.
Its like, oh, that tasted like crap but I still want more.
[male, smoker, metro, year 9]
More friends who smoke i.e. possibly a negative first experience, but tried
again in company of friends who smoke.
More overt experiences of peer pressure
Some smokers respect it if you say no, but not all of them,
Some kids wont give up and keep going and going until you try it
[male, tried, regional, year 9].
Social life encourages smoking
I tend to smoke more at parties [female, smoker, metro, year 10].
Family member smokes, hence access and less negative attitudes to smell,
etc., and for some, if parents smoke, there is perceived leniency.
My mum smokes so she wouldnt care [male, smoker, metro, year 9].
Rebellious e.g. less keen to be told what to do and/or keener to rebel.
Problems in life e.g. life difficulties or stress.
often, the discussions evoked a sense that the perception of
smoking being cool is somewhat outdated:
It used to be cool but it isnt anymore female, non-smoker,
regional, year 9.
People are over it. Way more acceptable to be a non-smoker
than a smoker female, tried, metro, year 10.
Its like a rebel without a cause, like it was cool, but now its
sadly outdated female, tried, metro, year 10.
However, some non-smokers in particular still coupled the
term cool with smoking, although this was linked also to
conforming to group norms:
More to be cool people tend to follow other people in
their group male, non-smoker, metro, year 8.
When you are in a group of people and they smoke, then you
tend to do it, just to try it male, non-smoker, metro, year 9.
Some neutral perceptions about cool were also circulated
among the focus groups.
Smoking is not really cool, but not necessarily uncool
female, non-smoker metro, year 9.
Some people might think it is okay not to smoke and some
might think it is cool to smoke male, non-smoker, metro,
year 9.
Overall, in this research, adolescents were happy to declare they
do not smoke and to express negative views about smoking,
even in the presence of popular peers who smoked.
What determines continuation after trial?
Although the proportion of current smokers in the discussion
groups was not large, a number of those who currently
smoked were articulate and reflective about their smoking
experiences. Some of the factors that appeared to influence
Tried smoking and did not continue
More negative predisposition to smoking e.g. hate smell on people, seems a
waste of money.
Dad smokes and his car stinks [male, non-smoker, metro, year 8].
Negative first experience e.g. cough, tasted disgusting.
Cant see the big deal [female, tried, metro, year 10].
Pointlessness i.e. what is the point of continuing
Thought about trying again but I thought whats the point? I know its not cool,
know its not going to do me any good [female, tried, metro, year 10]
Fewer friends who smoke
Less experience of overt peer pressure to have one.
Social life discourages smoking (especially sport)
You wouldnt start smoking if you played football [male, non-smoker, metro, year 9].
No or fewer family who smoke or adverse views formed because of family
member smoking.
Fear of parent discovery/disapproval.
Health Promotion Journal of Australia 2010: 21(3) 211
Leavy et al. Article
whether their experimentation was one off versus continued
are captured in Table 3. This table also reflects observations
relating to those participants who were non-smokers but who
had smoked intermittently or regularly at some point, and
subsequently discontinued.
Understanding addiction
Addiction was included in the discussions with all groups,
framed around the themes of awareness and understandings
of addiction, knowledge of causes and processes of addiction
and influence of addiction on smoking-related attitudes
andbehaviours.
Addiction was spontaneously identified as a consequence
or reason for smoking in all discussion groups. Despite the
fact that young smokers in this research rarely used the term
addiction it is a notion clearly associated with smoking, and
is universally understood by all segments of the target group.
Introducing the topic of addiction elicited comments such
as cant stop, crave for it, your body depends on it and you
want it every day; constant, cant go without one and cant with peer and social relations, often leads to experimentation
stop. There was also acknowledgement that addiction does
not just apply to smoking chocolate, drugs and caffeine were
also mentioned. However, tobacco was recognised as highly
addictive and there was some awareness that it is harder to
give up than other drugs.
I helped my mum when she quit seeing her go through
that has made me not want to smoke female, non-smoker,
metro, year 9.
Know heaps of people who started smoking and then a
month or so later want to quit, but cant male, non-smoker,
metro, year 10.
In most groups, examples were cited of peers who cannot
stop, even if they want too. Addiction was not attributed
solely to the properties of tobacco, but is also seen to depend
on theindividual.
When I was having one every day after school, then I would
think like, I could really go for one right now female, tried,
regional, year 9.
If people use it as stress relief, then if one little bad thing
happens, they think I will just have one male, non-smoker,
metro, year 10.
However, there are adolescents who only smoke socially or
occasionally and this appears to confound understandings
of addictiveness somewhat:
There are lots of people our age who just smoke sometimes,
like socially, so that cant be addicted female, metro,
non-smoker, year 9.
Harder for young people to get addicted as dont get to
smoke as much, only if someone offers you one male,
tried, metro, out-of-school
212 Health Promotion Journal of Australia 2010: 21(3)
There was also a sense among some participants that addiction
was less likely to occur when you are young:
Might be a serious addiction when youre older, but not at
this age female, tried, metro, year 10.
I dont find them addictive at all I could stop anytime I
want female, regional, smoker, year 9.
It is easier to quit at our age still growing, still forming
habits, more willpower male, tried, metro, year 9
Discussion
This research yields a number of findings pertinent
to understanding adolescents attitudes, beliefs and
experiences towards smoking experimentation and addiction.
Conventionally, preventing young people from smoking has
focused on deterring the trial of a first cigarette.6,24,25 The
findings of this study, however, suggest that experimentation
per se is no big deal in the eyes of adolescents, with teenage
years marked by curiosity and experimentation about many
life experiences, including smoking. Curiosity, in tandem
withcigarettes.
Previous research has shown that social environments and
norms play a role in the trialling of cigarettes.6,26 Friendships
and group membership is increasingly significant during
adolescence, and some studies suggest that young people
may trial smoking to improve their status among friends, fit in
with peer norms or maintain social relations.1,10,23 In this study,
however, smoking did not really appear to define or affect
friendships, for either smokers or non-smokers, i.e. it was
regarded as something that some teenagers do, but did not
determine friendship affiliations or acceptance among peers
per se. Nonetheless, in some of the priority population groups,
norms around trying it out (whether this applied to smoking
or other life experiences) did appear more pronounced, and
participants from ATSI and lower socioeconomic backgrounds
were more likely to mention that peers encouraged them to
try smoking, sometimes from a very young age. Encouraging
the normalisation of not smoking among ATSI groups more
widely in the community may indirectly reduce the peer
pressure among ATSI youth to trial smoking.
There is still a coolness conundrum surrounding youth
smoking, which has been alluded to in the literature3,24
and emerged unprompted in this research. In this research
smoking itself appeared to have diminishing credibility as
being cool, although it is still sometimes mentioned by
young people as something that peers who think they are
cool may do. This was more often the observation of non-
smokers. There did not appear to be any uncool connotations
associated with being a non-smoker, and in fact the inverse
is becoming true, with those who smoke often regarded as
Understanding Health Behaviours Qualitative insights into adolescent smoking experimentation
unsuccessfully trying hard to be cool. This resonates with
recent literature suggesting that young people nowadays are
more likely to exert pressures on smokers by asking them not
to smoke or outwardly displaying their disgust.4
In the literature the concept of addiction among young people
is more often associated with adult smoking and is not viewed
as a danger for young adolescents trialing smoking.1,3,19,27
Moreover, tobacco addiction is often considered in tandem
with smoking cessation, which is also regarded by young
people as an adult issue.19 The findings of this study suggest
that adolescents generally do not recognise or comprehend
the addictiveness of smoking for people their age, and tend
not to see addiction as a likely outcome of just trying it
orexperimenting.
Our research adds to the small evidence base that indicates that
when young people comment on the consequences of smoking,
youth addiction is rarely mentioned. They also observed that
they would not use the word addicted in their conversations,
and at most, would say something like I want to stop smoking or
I need a smoke. They did, however, share a generally accurate
understanding of what addiction looks like in the context of
adult smoking or, indeed, addiction to other things.
In this research, notions of what it takes to become addicted
were very much based on opinion or observation, rather
than known facts. Their understandings of addiction
were not related to frequency or quantity of smoking; for
example, some mentioned relatively light smokers whom
they considered addicted. Moreover, the social smoker
emerged frequently, described as adolescents who typically
smoked irregularly and when opportunity permits and exhibit
no indications of addiction or inability to give up.
Light smokers, social smokers or casual smokers are described
in some literature as an intermittent or immediate stage
between experimentation and addiction, or sometimes as
indicative of frequent quitting and restarting.4 Intermittent
patterns and lower consumption are typical of young adult
smokers and females.4 Our findings are consistent with the
literature suggesting that young people who smoke socially
or occasionally often do not regard themselves as smokers,
typically feel more in control of their smoking and consider
themselves less vulnerable to addiction. When faced with
social pressures not to smoke, they are more likely to choose
not to smoke.4
The variability in beliefs regarding what it takes to become
addicted can be, in part, explained by the fact that young
people see addiction as only partly a function of the drug
itself (i.e. nicotine), recognising that a host of personal
and experiential factors come into play. In this sense, their
understanding of addiction was in fact quite sophisticated
and resonated with the drugs, set and setting contextual
model of addiction.28 However, others suggest that while
children can describe smoking as addictive, the actual nature
of this addiction and why it occurs is not well understood.
Furthermore, the literature suggests that the apparent lack of
awareness about addiction is one of the reasons young people
are so susceptible.19 There are also gaps in knowledge and
understanding of young peoples perceptions of the success
of peers in quitting.10
Other research has suggested that there are important
differences between adolescents who have smoked or
intend to smoke, and those who have never tried it and
have no intention to do so, with regards to their perceptions
of the addictive nature of smoking.15,29 In this study, those
smoking more regularly appeared less convinced about the
addictiveness of tobacco, and were perhaps less receptive to
messages about addiction, most commonly refuting that it had
or will happen to them, or admitting that they were already
addicted, but tacitly accepting this.
We also found that young people strongly valued the
legitimacy of trying lifes experiences and individual choice.
This resonates with the literature indicating that young people
often believe they can smoke without any of the negative
health consequences or addiction being pertinent to them.30
Factors that place a high value on individual choice may be
more amenable to intervention than the short and long-term
health consequences of addiction for those adolescents who
have smoked or intend on smoking.
Given that children and adolescents notions and expectations
of addiction can influence their predisposition and likelihood
to smoke,15,17,31 the findings of this research support the need
for realistic youth smoking prevention initiatives to give greater
consideration to young peoples understandings of addiction
and the consequences of experimentation and just having a
try. An area that may be potentially used to further explore
the notion and salience of addiction among young people,
is the paralleling of other addictive social behaviours, for
example, the tenacious pursuit of popular activities by young
people, such as excessive Internet use and exercise.32
Focus groups provide a dynamic and rich entre to exploring
social interactions and observing how group dynamics work.33
This was a strength of this study, providing both an individual
focused method and a window to observe social interaction.33
There are several limitations of this research. First, peers in
the mainstream focus group may influence comments and the
smoker participants were more reticent to make comments
regarding the notion of addiction despite probing by the
facilitators. Participants were selected conveniently, and it is
possible their views were not reflective of the wider youth
population. Finally, the number of smokers in all three groups
was small.
Health Promotion Journal of Australia 2010: 21(3) 213
Leavy et al. Article
Conclusion
This research builds on recent previous research exploring the
notion of addiction and provides several important insights.
Addiction is a salient issue, however, it potentially has only
limited applicability as young people who are trialists do
not believe that experimental smoking and/or intermittent
smoking will lead to addiction later in their own lives.
Progressing young peoples understanding of tobacco
addiction need not occur solely within the rubric of tobacco
control interventions. As indentified in this research, young
people are aware of the notion of addiction as something you
cant stop, your body depends on it and you want it every
day, and recognise this in relation to various behaviours.
Development of future strategies for health programs should
further explore and capture the short-term concepts of
addictive behaviours that are salient with young people, to
reinforce the notion and relevancy of addiction to young
people and that it is not an adult phenomenon.
Acknowledgements
The Western Australian Health Promotion Foundation
(Healthway) has funded the Smarter than Smoking Project
since 1995, and without its ongoing support for the project this
research would not have been possible. The original research
was undertaken by the second author in collaboration
with TNS Social Research. The contribution of Ms Penny
Ivery in the preparation of the final manuscript is greatly
acknowledged. All authors have contributed to and approved
the final manuscript.
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Authors
Justine Leavy and Lisa Wood, School of Population Health,
The University of Western Australia
Fiona Phillips, Smarter than Smoking Project, Heart
Foundation, WA
Michael Rosenberg, School of Sport Science, Exercise and
Health, The University of Western Australia
Correspondence
Justine Leavy, 10 Stirling Highway, M707 Crawley, Perth,
WA, 6009. Fax: (08) 6488 1199;
e-mail: jleavy@meddent.uwa.edu.au
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