Reasons for Smoking ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

It฀is฀a฀distraction฀from฀poor฀performance฀at฀school. •฀ It฀takes฀the฀smoker’s฀mind฀off฀hisher฀psychological฀problems. •฀ It฀masks฀poor฀self-confidence฀and฀provides฀a฀boost฀to฀a฀vulnerable฀sense฀of฀self-worth. •฀ By฀contrast,฀students฀who฀attain฀a฀higher฀educational฀level฀more฀rapidly฀adopt฀a฀health- conscious฀attitude฀towards฀cigarette฀smoking.฀People฀who฀are฀“smoke-free”฀up฀to฀the฀ age฀of฀20฀have฀an฀overwhelming฀chance฀of฀remaining฀non-smokers฀for฀life฀ [23] .฀Those฀ who฀ smoke฀ in฀ their฀ youth฀ are฀ only฀ rarely฀ able฀ to฀ quit฀ smoking฀ during฀ the฀ next฀ 2–3฀ decades฀ of฀ life.฀ Smoking฀ initiation฀ in฀ childhood฀ is฀ determined฀ by฀ external฀ factors฀ instrumentalised฀and฀is฀based฀upon฀the฀child’s฀or฀adolescent’s฀insuperable฀problems฀ with฀self-worth฀ [24–27] . Behavioural฀ stabilisation฀ increases฀ with฀ distance฀ from฀ age฀ at฀ initiation;฀ people฀ who฀ take฀ up฀ smoking฀ after฀ the฀ age฀ of฀ 20฀ years฀ are฀ relatively฀ rare฀ [28,฀ 29] ,฀ and฀ conversely฀ schoolchildren฀who฀embark฀on฀a฀smoking฀career฀at฀the฀age฀of฀13–15฀years฀are฀at฀risk฀of฀ continuing฀to฀smoke฀for฀decades฀ [23,฀30–34] .฀The฀lower฀the฀age฀at฀cigarette฀smoking฀ini- tiation,฀the฀greater฀the฀probability฀that฀the฀individual฀will฀become฀a฀dependent฀smoker฀ before฀the฀age฀of฀20฀years฀ [28,฀29] .฀Early฀smoking฀initiation฀is฀the฀best฀single฀predictor฀of฀ smoking฀continuity฀ [32,฀33] .฀This฀illustrates฀the฀wisdom฀of฀implementing฀primary฀tobacco- use฀prevention฀programmes฀as฀early฀as฀possible฀ [35–37] . The฀perception฀of฀smoking฀by฀smokers฀and฀non-smokers฀is฀revealing.฀In฀one฀youth฀ survey฀conducted฀in฀1993฀in฀12–16-year-old฀students฀of฀both฀sexes,฀ten฀pairs฀of฀oppo- site฀attributes฀were฀each฀scored฀on฀a฀scale฀from฀1฀to฀5฀ [38] .฀The฀results,฀calculated฀sepa- rately฀for฀female฀and฀male฀adolescents,฀revealed฀only฀quantitative฀differences.฀Some฀ 47฀of฀the฀adolescents฀had฀never฀smoked,฀while฀those฀who฀had฀tried฀smoking฀accounted฀ for฀some฀38.฀For฀many฀of฀the฀attribute฀pairs,฀non-smokers฀were฀more฀critical฀than฀ smokers฀in฀their฀perceived฀image฀of฀smokers฀“Someone฀who฀regularly฀smokes฀ciga- rettes฀is฀…”:฀signiicant฀differences฀were฀reported฀for฀the฀pairs฀“attractiverepulsive”,฀ “inout”,฀ “relaxedstressed”฀ and฀ “interestingboring”฀ [38] .฀ Compared฀ with฀ smoking฀ girls,฀฀smoking฀boys฀rated฀regular฀smokers฀as฀more฀interesting,฀more฀relaxed฀and฀per- forming฀better฀ [38] .

12.3 Primary Prevention Programmes

The฀ several฀ programmes฀ developed฀ for฀ primary฀ tobacco-use฀ prevention฀ in฀ schools฀ are฀ designed฀to฀ensure฀that฀children: Never฀start฀to฀smoke฀in฀the฀first฀place. •฀ At฀least฀defer฀the฀time฀of฀smoking฀initiation฀by฀2–3฀years฀or฀longer฀and฀thus฀in฀future฀do฀ •฀ not฀become฀heavily฀dependent฀smokers฀like฀those฀who฀start฀at฀the฀age฀of฀10–12฀years. Are฀fully฀informed฀about฀the฀health฀consequences฀and฀social฀repercussions฀of฀smoking฀ •฀ and฀also฀feel฀psychologically฀strengthened฀to฀resist฀temptations฀arising฀in฀the฀group฀or฀ in฀other฀settings. Opportunities฀to฀inluence฀young฀people฀in฀this฀way฀invariably฀fail฀when฀scare฀tactics฀are฀ used.฀Showing฀pictures฀of฀a฀bronchial฀carcinoma฀tends฀to฀make฀children฀and฀adolescents฀ think฀that: This฀will฀not฀affect฀everyone฀in฀later฀life. •฀ Two,฀three฀or฀even฀four฀decades฀may฀pass฀before฀this฀happens. •฀ Their฀parentsgrandparents฀have฀smoked฀for฀decades฀without฀any฀harm. •฀ Life฀is฀not฀much฀fun฀anyway฀and฀they฀do฀not฀want฀to฀live฀to฀a฀ripe฀old฀age฀etc. •฀ Further฀discussions฀on฀this฀basis฀tend฀to฀remain฀unproductive฀and฀do฀not฀lead฀to฀the฀desired฀ goal฀of฀smoking฀prevention.

12.3.1 Prevention Programmes for Schools

Most฀studies฀concentrate฀on฀the฀behaviour฀of฀children฀in฀school฀years฀5–8฀because฀it฀is฀ during฀this฀period฀that฀children฀show฀an฀increasing฀desire฀to฀gain฀experience฀with฀tobacco,฀ alcohol฀and฀illicit฀drugs฀–฀a฀inding฀that฀has฀also฀emerged฀from฀studies฀in฀other฀countries฀ [12,฀13,฀18,฀19] .฀As฀a฀result,฀prevention฀programmes฀are฀very฀much฀needed฀during฀the฀early฀ years฀at฀school฀see฀also฀ [20] . Adolescent฀smokers฀in฀school฀year฀6฀tend฀to฀be฀characterised฀as฀the฀self-deined฀type฀ [39,฀40] ฀who฀can฀be฀described฀as฀“matured฀early,฀independent฀of฀authority,฀orientated฀ towards฀peer฀group,฀risk฀takers”฀ [41] .฀There฀probably฀needs฀to฀be฀fresh฀discussion฀as฀to฀ whether฀adolescent฀smokers฀are฀tempted฀or฀even฀compelled฀at฀all฀to฀smoke฀as฀a฀result฀of฀ group฀pressure.฀More฀probably,฀adolescents฀actively฀seek฀out฀groups฀whose฀values฀and฀ norms฀they฀share.฀They฀enter฀into฀a฀commitment฀to฀the฀group฀that฀is฀evident฀in฀terms฀of฀ externals฀e.g.฀style฀of฀dress,฀shared฀activities฀etc..฀If฀smoking฀is฀one฀of฀the฀shared฀norms฀ of฀the฀group฀in฀this฀sense,฀it฀is฀likely฀that฀group฀members฀or฀adolescents,฀who฀ind฀gener- ally฀ informal฀ group฀ membership฀ attractive฀ or฀ wish฀ to฀ become฀ members,฀ will฀ also฀ smoke. The฀view฀that฀children฀and฀adolescents฀are฀led฀astray฀into฀smoking฀by฀their฀peers฀or฀are฀ driven฀or฀compelled฀to฀do฀so฀by฀group฀pressure฀fails฀to฀recognise฀that฀afiliation฀to฀a฀group฀ is฀an฀active฀process฀of฀seeking฀out฀and฀bonding฀that฀is฀initiated฀by฀the฀attractiveness฀of฀the฀ group฀based฀on฀shared฀norms฀frequently,฀also฀based฀on฀externals฀such฀as฀cigarette฀smok- ing฀ [42] .฀The฀inluence฀of฀siblings,฀and฀especially฀of฀best฀friends฀male฀or฀female฀as฀well฀ as฀of฀the฀whole฀group,฀is฀relatively฀high฀and฀outweighs฀that฀of฀parents. Adolescents฀should฀be฀supported฀in฀the฀general฀development฀of฀a฀healthy฀sense฀of฀ self-worth฀ [40] ,฀but฀it฀is฀debatable฀to฀what฀extent฀these฀measures฀contribute฀to฀smoking฀ prevention.฀When฀imparting฀the฀requisite฀skills,฀it฀might฀be฀more฀useful฀as฀part฀of฀the฀ programme฀to฀address฀pupils฀or฀class฀groups฀in฀a฀targeted฀manner฀and฀to฀communicate฀ speciic฀medical-psychological฀information฀designed฀to฀promote฀a฀healthy฀lifestyle,฀with฀ particular฀reference฀to฀smoking฀ [42] . According฀to฀ideas฀developed฀in฀the฀USA,฀effective฀tobacco-use฀prevention฀programmes฀ in฀schools฀depend฀on฀the฀establishment฀of฀seven฀recommendations฀ [43] :