educationallevelareimpressive.Thesameteamhasnowpublisheditsindingsonsmok- ingbehaviouramong14–17-year-oldUSadolescentsfortheperiod1979–1989
[9] .
AccordingtotheinalreportfromtheBundeszentralefürgesundheitlicheAufklärung BZgA;FederalCentralOficeforHealthEducationpublishedin1998,7of12–13-year-
oldchildreninGermanyandasmanyas28of14–15-year-oldsweresmokers.Among 16–17-year-oldstudents,theigurereaches47
[10] .Despitethistrendamongadolescents,
thepercentageproportionofnever-smokersamong12–25-year-oldsmorethandoubledfrom 20in1973to42in1997appliesonlytotheformerWestGermanLänder
[10] .The
percentageproportionofnever-smokersamong12–17-year-oldshasrisenfrom31to56.In total,20ofadolescentsdescribethemselvesasex-smokers
[11] .
AccordingtoaBZgAsurveyamongadolescents,thereasonsfornotsmokingwere relatedprimarilytotheadverseeffectsofsmokingonhealth79,followedbyresponses
suchas“Tastesbad”55,“Tooexpensive”47,“Smellsbad”37,“Makesyou lessit”36,“Doesn’tlookgood”9and“Notallowed”5
[10] .
ComparedwiththeMODRUSIStudyof1998,theMODRUSIIStudy [12]
conducted inSaxony-Anhaltin3,087students,851adultsparentsand153teachersrevealedafur-
therreinforcementinmanyrespectsofadolescents’tendencytobe“adventurous”and “orientedtowardsthebigwideworld”.Thestudyalsofoundadeteriorationofattitudes
towards sport and healthy lifestyle, while reporting that relationships with parents had becomeanareaofincreasedtension.Comparedwith2yearspreviously,greatercriticism
waslevelledatthesocialenvironmentwithinschools.Themeaninitiationageforsmoking wasreportedtobe12.52years,followedby13.03yearsforalcoholand14.1yearsfor
ecstasy.Incommonwithnumerousotherstudies,oneparticularlycriticalnotesoundedby
0.12
0.09
0.06
Initiation Rate
0.03
0.00 1940
1945 1950
1955 1960
1965 1970
1975 1980
4 8
12 16
Sales of Women’s Brands No College
College Billions of Dollars
Calender Year Fig. 12.2
Annualinitiationrateamong10–17-year-oldsmokinggirlsasafunctionofeducational levelcollegeeducation:yesorno.Alsoshown,inancialexpenditureon“women’s”cigarettes
VirginiaSlims,SilvaThinsandEve [7]
MODRUSIIwasthattobaccosmokingcigarettesisviewedasthecommonestentry- leveldrug,potentiallyleadingontoothersrangingfromalcoholtoheroinseeTable
12.1
[12] .Inthoseterms,itisessentialthatpreventivemeasuresbeimplementedtoestablisha
smoke-freeenvironmentinschools.
12.2 Reasons for Smoking
Onestudyinschoolchildren [13–15]
indicatesthatsmokinginitiationinmostEuropean countriesoccursattheageof11yearsandthatbythisagesome20ofboyshavegained
theirirstexperiences [14]
.Girlsstartsmokingslightlylaterbutthenmakeupgroundon boysveryquickly
[16] ,sothatbytheageof15yearsbothsexeshavethesamelevelsof
experience,withmoregirlsthanboyssmokinginsomecountriesincludingGermany [17]
.Ithasbeenreportedthatstudentsattempttogaintheirirstexperienceofsmoking duringtheirst4yearsinschool
[13,18–20] ,althoughsubstantialethnicandhencesocial
differenceshavebeenfound [21]
. Initiationintotobaccoconsumptionisinitiallyanattempttofaceuptotheproblemsjust
asmuchasthechallengesofdailyliving,toderivepleasureandtoprovideacopingmecha- nismforconlictwithparentsandforexperiencesoffailureatschoolbeingkeptbackayear,
lackofpeerrecognition.Tobaccoisseenashelpingtoeliminatesymptomsofstress.Even thoughtheinhaledcigarettesmokemaynottastepleasantfortheirst1or2years,budding
smokersforcethemselvesto“enjoy”itbecausetheyneedto“prove”somethingtofriendsor adults.Duringthisinitiationphase,tobaccoconsumptionhasinstrumentalcharacterinpsy-
chological and sociological terms [22]
. At this stage, but also over the ensuing months, tobaccoconsumptionmaybeimportanttotheadolescentforarangeofreasons
[11] :
Itchallengesparentalandsocialnormsandvalues.
•
Itisadeliberateactagainstthenotionofparentalcontrol.
•
Itdemonstrativelyanticipatesparentalbehaviour.
•
Itrelectsthesearchforconsciousness-expandingexperiences.
•
Itgivesrapidrelaxationandpleasure.
•
Itopensupaccesstoacircleoffriends.
•
Itmarksthesmokeroutasbelongingtoasubculture.
•
Table 12.1
ConsumertypesfromtheMODRUSIIStudyintheyear2000 [12]
Consumersof Cigarettes
Alcohol Cannabis
Ecstasy Cocaineheroin
Cigarettes 100
32 31
7 4
Alcohol 55
100 34
6 4
Cannabis 71
44 100
13 8
Ecstasy 84
41 70
100 42
Cocaineheroin 80
46 77
74 100
Alldataareshownaspercentagesroundedup.Example:Forevery100studentswhosmoke, 32drinkalcoholetc.
Itisadistractionfrompoorperformanceatschool.
•
Ittakesthesmoker’smindoffhisherpsychologicalproblems.
•
Itmaskspoorself-confidenceandprovidesaboosttoavulnerablesenseofself-worth.
•
Bycontrast,studentswhoattainahighereducationallevelmorerapidlyadoptahealth- consciousattitudetowardscigarettesmoking.Peoplewhoare“smoke-free”uptothe
ageof20haveanoverwhelmingchanceofremainingnon-smokersforlife [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 instrumentalisedandisbaseduponthechild’soradolescent’sinsuperableproblems
withself-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 schoolchildrenwhoembarkonasmokingcareerattheageof13–15yearsareatriskof
continuingtosmokefordecades [23,30–34]
.Thelowertheageatcigarettesmokingini- tiation,thegreatertheprobabilitythattheindividualwillbecomeadependentsmoker
beforetheageof20years [28,29]
.Earlysmokinginitiationisthebestsinglepredictorof smokingcontinuity
[32,33] .Thisillustratesthewisdomofimplementingprimarytobacco-
usepreventionprogrammesasearlyaspossible [35–37]
. Theperceptionofsmokingbysmokersandnon-smokersisrevealing.Inoneyouth
surveyconductedin1993in12–16-year-oldstudentsofbothsexes,tenpairsofoppo- siteattributeswereeachscoredonascalefrom1to5
[38] .Theresults,calculatedsepa-
ratelyforfemaleandmaleadolescents,revealedonlyquantitativedifferences.Some 47oftheadolescentshadneversmoked,whilethosewhohadtriedsmokingaccounted
forsome38.Formanyoftheattributepairs,non-smokersweremorecriticalthan smokersintheirperceivedimageofsmokers“Someonewhoregularlysmokesciga-
rettesis…”:signiicantdifferenceswerereportedforthepairs“attractiverepulsive”, “inout”, “relaxedstressed” and “interestingboring”
[38] . Compared with smoking
girls,smokingboysratedregularsmokersasmoreinteresting,morerelaxedandper- formingbetter
[38] .
12.3 Primary Prevention Programmes
The several programmes developed for primary tobacco-use prevention in schools are designedtoensurethatchildren:
Neverstarttosmokeinthefirstplace.
•
Atleastdeferthetimeofsmokinginitiationby2–3yearsorlongerandthusinfuturedo
•
notbecomeheavilydependentsmokerslikethosewhostartattheageof10–12years. Arefullyinformedaboutthehealthconsequencesandsocialrepercussionsofsmoking
•
andalsofeelpsychologicallystrengthenedtoresisttemptationsarisinginthegroupor inothersettings.