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

educational฀level฀are฀impressive.฀The฀same฀team฀has฀now฀published฀its฀indings฀on฀smok- ing฀behaviour฀among฀14–17-year-old฀US฀adolescents฀for฀the฀period฀1979–1989฀ [9] . According฀to฀the฀inal฀report฀from฀the฀Bundeszentrale฀für฀gesundheitliche฀Aufklärung฀ BZgA;฀Federal฀Central฀Ofice฀for฀Health฀Education฀published฀in฀1998,฀7฀of฀12–13-year- old฀children฀in฀Germany฀and฀as฀many฀as฀28฀of฀14–15-year-olds฀were฀smokers.฀Among฀ 16–17-year-old฀students,฀the฀igure฀reaches฀47฀ [10] .฀Despite฀this฀trend฀among฀adolescents,฀ the฀percentage฀proportion฀of฀never-smokers฀among฀12–25-year-olds฀more฀than฀doubled฀from฀ 20฀in฀1973฀to฀42฀in฀1997฀applies฀only฀to฀the฀former฀West฀German฀Länder฀ [10] .฀The฀ percentage฀proportion฀of฀never-smokers฀among฀12–17-year-olds฀has฀risen฀from฀31฀to฀56.฀In฀ total,฀20฀of฀adolescents฀describe฀themselves฀as฀ex-smokers฀ [11] . According฀to฀a฀BZgA฀survey฀among฀adolescents,฀the฀reasons฀for฀not฀smoking฀were฀ related฀primarily฀to฀the฀adverse฀effects฀of฀smoking฀on฀health฀79,฀followed฀by฀responses฀ such฀as฀“Tastes฀bad”฀55,฀“Too฀expensive”฀47,฀“Smells฀bad”฀37,฀“Makes฀you฀ less฀it”฀36,฀“Doesn’t฀look฀good”฀9฀and฀“Not฀allowed”฀5฀ [10] . Compared฀with฀the฀MODRUS฀I฀Study฀of฀1998,฀the฀MODRUS฀II฀Study฀ [12] ฀conducted฀ in฀Saxony-Anhalt฀in฀3,087฀students,฀851฀adults฀parents฀and฀153฀teachers฀revealed฀a฀fur- ther฀reinforcement฀in฀many฀respects฀of฀adolescents’฀tendency฀to฀be฀“adventurous”฀and฀ “oriented฀towards฀the฀big฀wide฀world”.฀The฀study฀also฀found฀a฀deterioration฀of฀attitudes฀ towards฀ sport฀ and฀ healthy฀ lifestyle,฀ while฀ reporting฀ that฀ relationships฀ with฀ parents฀ had฀ become฀an฀area฀of฀increased฀tension.฀Compared฀with฀2฀years฀previously,฀greater฀criticism฀ was฀levelled฀at฀the฀social฀environment฀within฀schools.฀The฀mean฀initiation฀age฀for฀smoking฀ was฀reported฀to฀be฀12.52฀years,฀followed฀by฀13.03฀years฀for฀alcohol฀and฀14.1฀years฀for฀ ecstasy.฀In฀common฀with฀numerous฀other฀studies,฀one฀particularly฀critical฀note฀sounded฀by฀ 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 ฀฀฀Annual฀initiation฀rate฀among฀10–17-year-old฀smoking฀girls฀as฀a฀function฀of฀educational฀ level฀college฀education:฀yes฀or฀no.฀Also฀shown,฀inancial฀expenditure฀on฀“women’s”฀cigarettes฀ Virginia฀Slims,฀Silva฀Thins฀and฀Eve฀ [7] MODRUS฀II฀was฀that฀tobacco฀smoking฀cigarettes฀is฀viewed฀as฀the฀commonest฀entry- level฀drug,฀potentially฀leading฀on฀to฀others฀ranging฀from฀alcohol฀to฀heroin฀see฀Table฀ 12.1 ฀ [12] .฀In฀those฀terms,฀it฀is฀essential฀that฀preventive฀measures฀be฀implemented฀to฀establish฀a฀ smoke-free฀environment฀in฀schools.

12.2 Reasons for Smoking

One฀study฀in฀schoolchildren฀ [13–15] ฀indicates฀that฀smoking฀initiation฀in฀most฀European฀ countries฀occurs฀at฀the฀age฀of฀11฀years฀and฀that฀by฀this฀age฀some฀20฀of฀boys฀have฀gained฀ their฀irst฀experiences฀ [14] .฀Girls฀start฀smoking฀slightly฀later฀but฀then฀make฀up฀ground฀on฀ boys฀very฀quickly฀ [16] ,฀so฀that฀by฀the฀age฀of฀15฀years฀both฀sexes฀have฀the฀same฀levels฀of฀ experience,฀with฀more฀girls฀than฀boys฀smoking฀in฀some฀countries฀including฀Germany฀ [17] .฀It฀has฀been฀reported฀that฀students฀attempt฀to฀gain฀their฀irst฀experience฀of฀smoking฀ during฀the฀irst฀4฀years฀in฀school฀ [13,฀18–20] ,฀although฀substantial฀ethnic฀and฀hence฀social฀ differences฀have฀been฀found฀ [21] . Initiation฀into฀tobacco฀consumption฀is฀initially฀an฀attempt฀to฀face฀up฀to฀the฀problems฀just฀ as฀much฀as฀the฀challenges฀of฀daily฀living,฀to฀derive฀pleasure฀and฀to฀provide฀a฀coping฀mecha- nism฀for฀conlict฀with฀parents฀and฀for฀experiences฀of฀failure฀at฀school฀being฀kept฀back฀a฀year,฀ lack฀of฀peer฀recognition.฀Tobacco฀is฀seen฀as฀helping฀to฀eliminate฀symptoms฀of฀stress.฀Even฀ though฀the฀inhaled฀cigarette฀smoke฀may฀not฀taste฀pleasant฀for฀the฀irst฀1฀or฀2฀years,฀budding฀ smokers฀force฀themselves฀to฀“enjoy”฀it฀because฀they฀need฀to฀“prove”฀something฀to฀friends฀or฀ adults.฀During฀this฀initiation฀phase,฀tobacco฀consumption฀has฀instrumental฀character฀in฀psy- chological฀ and฀ sociological฀ terms฀ [22] .฀ At฀ this฀ stage,฀ but฀ also฀ over฀ the฀ ensuing฀ months,฀ tobacco฀consumption฀may฀be฀important฀to฀the฀adolescent฀for฀a฀range฀of฀reasons฀ [11] : It฀challenges฀parental฀and฀social฀norms฀and฀values. •฀ It฀is฀a฀deliberate฀act฀against฀the฀notion฀of฀parental฀control. •฀ It฀demonstratively฀anticipates฀parental฀behaviour. •฀ It฀relects฀the฀search฀for฀consciousness-expanding฀experiences. •฀ It฀gives฀rapid฀relaxation฀and฀pleasure. •฀ It฀opens฀up฀access฀to฀a฀circle฀of฀friends. •฀ It฀marks฀the฀smoker฀out฀as฀belonging฀to฀a฀subculture. •฀ Table 12.1 ฀฀฀Consumer฀types฀from฀the฀MODRUS฀II฀Study฀in฀the฀year฀2000฀ [12] Consumers฀of 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 All฀data฀are฀shown฀as฀percentages฀rounded฀up.฀Example:฀For฀every฀100฀students฀who฀smoke,฀ 32฀drink฀alcohol฀etc. 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.