Teens motives to start and quit smoking, are different from adults, and their vulnerability to dependence makes the prevention and refusal skills priorities
Tobacco dependence is a serious public health problem worldwide, and the majority of smokers – up to 91% – start smoking during adolescence (Rugka et al 2001). Smoking prevalence varies and depends on the location and socio-economic groups.
The study Dandy (DiFranza et al, 2002), which was attended by 679 students interviewed at the age of 12-13 years, showed that 49% reported the use of certain types of tobacco, and that the average age of first tobacco use was 11.7 years, the average age for tobacco use on a regular basis (at least once a month) was 12.8 years.
Experience has shown that adolescents are more vulnerable to nicotine addiction than adults, and those who smoke are likely to evolve to daily smoking, they smoke for more years and smoke more as adults (DiFranza et al 2002.) Girls tend to develop symptoms of drug addiction in a short period of time, Dandy in the study, more girls than boys reported symptoms of dependence.
Smoking can cause lung damage adolescents (Bush, 2008), so that they can never reach the normal adult lung volumes and function. The belief that the forced expiratory volume per second (FEV1) is at 100% of predicted peak in the age of 25 is not so, FEV 1 may be reduced at the age of 25 years, and this may be due to several factors, such as low birth weight and smoking as teens (Calverley, 2000).
Starting to smoke in adolescence
Simply put, adolescence is a process of development from child to adult. It includes the physical events associated with puberty, as well as psychological development including adult personality.
Peer and social influence
Adolescence is a period when a person becomes more dependent on their peers. This is especially important when considering the reasons why teens start smoking. According to several surveys and studies, the main factor that increases the likelihood of teenagers taking up smoking is the influence of peers and role models, and in their immediate social environment, and in the media (see Box 1).
Droomers et al (2005) studied the behavior of adolescent self-esteem and potential predictors of tobacco smoking. They found children were more than three times more likely to smoke if their friends smoked. Those who “preferred” tobacco-smoking friends were more than six times more likely to smoke. Children’s attitudes to health and perceptions about smoking are also important.
Similarly, snow, and Bruce (2003) examined the smoking status of self-esteem among adolescent girls. The study in particular those related to the role of peer reputations, self-esteem up and how the decision affects adolescents’ decisions about smoking. They found that some adolescents use smoking as a way to achieve status among their peers.
Lucas and Lloyd (1999) interviewed children aged 11-16 years, and organized focus groups of girls surveyed (because more girls are smoking in their sample). All participants were informed about the health risks of smoking. When smokers described the back smoking, they often talked about peer pressure, and described the predatory instigators, who were known to a new smoker, but may not be among his closest friends. Also important were the instigators of the claim “that smoking one cigarette would not hurt that the new smokers do not get involved and that smoking was a pleasure when you’re used to it. Smokers have seen their colleagues, both gay and non-conformist and cigarettes, as a passport interesting and popular way of life.
Investigation of Epstein et al (1999), gave similar results. They found that social factors with friends and family members predicted smoking and anti-smoking attitudes and refusal skills lowered the odds of smoking. They concluded that it would be useful to raise awareness of adolescent social pressures and teach relevant psychosocial skills.
Rugka et al (2001) also identified as important colleagues and added that the participants felt that smoking caused teenagers trying to be seen as “cool” and “hard”, and to gain membership in the group. While teenagers smoking is seen as focused on social relationships, the participants saw an adult smoking in different ways. They are seen as dependent on adults for adults and believed not enough control and use smoking to help them cope with life. The authors concluded that these ideas leave young people vulnerable to nicotine addiction.
Teen peer pressure is reflected in the National Institute for Health and Clinical Excellence (2010) manual, which advises schools to develop a smoking policy, which is especially important, in consultation with young people, and indicates that it should include prevention activities, which can be led by young people.
To mitigate the effects of peer pressure, NICE advocates of intervention should be aimed at the development of decision-making skills through active learning, including strategies to counteract the pressures to smoke from the media, family and colleagues.
Movies and Media
Adolescents’ exposure to smoking is not limited to their immediate social group. For example, Sargent et al (2001) suggested that the greater impact of smoking in movies is associated with trying smoking among adolescents. They surveyed 4919 children aged 9-15 years, and assessed the appearance of smoking in 601 films. They found that smoking prevalence is constantly trying to increase with more exposure to smoking depicted in movies. Of the participants who saw 0-50 cases, 4.9% had tried smoking, rising to 31.3% of those who saw more than 150 cases. In this example, there was a strong, direct and independent association between seeing tobacco use in films and trying cigarettes.
NICE (2008) recognizes that the media can put pressure on children to start smoking. Its recommendations are aimed directly at the media, and include point-of-sales measures to prevent the absorption of smoking by children and young people.
In the future management of NICE (2010) recommends that schools should develop a strategy to resist the pressure of the media to smoke.
Cultural and socio-economic situation
Although the role of peers and adolescent role models is of paramount importance, it is important to remember the role of other factors such as culture and socio-economic status.
Droomers et al (2005) found that adolescents whose fathers were classified in the lowest group of professional status was twice as likely to smoke as those whose fathers occupied the highest status. High risk of daily smoking significantly predicted lower levels of intelligence and a high prevalence of smoking among fathers and friends.
Development of relationship
In a study of Dandy, DiFranza et al (2002), asked if the minimum duration, frequency and amount of tobacco used to adolescent symptoms of dependence. To determine if the boy was displaying signs of addiction, addicted to nicotine is a list (HONC) was used (Box 2). Focus group testing has found that young people understand the HONC items in the same way as adults.
DiFranza et al (2002) applied the theory of the autonomy of tobacco dependence to determine if the symptoms described on the HONC do indicate drug use among adolescents. The autonomy theory is that the appearance of one symptom of dependence indicates a loss of autonomy over tobacco use.
Example of 679 adolescents aged 12-13 were interviewed to determine if they experienced any of the HONC symptoms. About half (332) used tobacco and 40% of them reported symptoms. It was found that the number of HONC symptoms correlates highly with the maximum amount smoked and the maximum frequency of smoking in adolescence.
The development of a single symptom strongly predicted continued use, supporting the theory that the loss of autonomy over tobacco use begins with the first symptom of dependence.
This study concluded that the symptoms of tobacco dependence develop after the appearance of a periodic smoking, although individuals differ in this respect. Teens may begin to report symptoms when smoking in just one day a month, as well as reporting symptoms strongly predicted continued use. It is clear that adolescents should be provided with the opportunity to avoid the first cigarette.
Smoking cessation approaches
Studies that examine the reasons teens start smoking suggest that smoking interventions should be different from those aimed at adults.
Lucas and Lloyd (1999) found smokers were seen by their peers as cheerful and nonconformist, and cigarettes, as a passport exciting and popular way of life. In promoting the end, it may be difficult to create an alternative that has the same appeal as the social representation of the identity of a smoker.
Similarly, snow, and Bruce (2003) found that some adolescents use smoking as a way to achieve a certain status among their peers, and asked that the behavior of young people smoking may be replaced to achieve the desired reputation.
Droomers et al (2005) found smoking cessation programs should be more complex than those aimed at adults, and offered to provide a positive non-smoking, role models, in accordance with the culture and norms of high status groups. They also found that teens have the skills and the resistance of protective behavior from social pressures and influences. These proposals imply that interventions should be individualized.
Several activities have been shown to increase among young smokers to quit. Branstetter et al (2009) examined the psychosocial characteristics and smoking history of the 5892 teen smokers who participated in the American Lung Association of Not On Tobacco (NOT) the termination of the program. It turned out, those who are not worse than smoking or even increased after the program were those who were heavy smokers at the beginning, more addicts and more likely to have parents, siblings and peers who smoked. This confirms the message that prevention is important, and that teenagers should be equipped with the ability to avoid smoking the first cigarette.
Smoking cessation programs are tested with a wide and adolescents can be challenging. (2003) literature review described in Mermelstein eight theoretical frameworks, in 66 studies. Six approaches are shown in Box 3. Many people associated with smoking will be familiar with the stages of change or Tran theoretical model (TTM), which consists of six stages (Table 4).
In a recent review, Cochrane (Grimshaw and Stanton, 2010) tests of quitting during adolescence have also recognized the difficulty of quitting many approaches that integrate the various components of the theoretical framework. They noted that the most frequently used one form or another motivational improvement, combined with psychological support, such as cognitive-behavioral therapy (CBT) and some of them taking into account the stages of change are in the TTM. The authors draw attention to the definition of termination made some studies, such as “a day or more.” These definitions should be challenged when considering the youth of episodic levels of smoking, which may include, for example, smoking only on weekends. This is to some extent explains why some observers believe the test to be positive results, and others have a different interpretation of their requirements.
The authors concluded yet there is insufficient evidence to recommend widespread adoption of any model. Tests of nicotine replacement products or burping did not give statistically significant effects.
The review found that the interference with the positive results were complex and are designed to answer the many questions that characterize young people smoking. A set of activities often contain components that require one-to-one (or one to several) input.
In addition, these Mermelstein is important to understand that significant changes occur during adolescence, and this has implications for whether we can ever one-size universal intervention for all teens.
Adolescence is a process that is strongly influenced by their peers. Approaches designed for adults less successful for young people, and further research is urgently needed.
NICE (2006) recommends that nurses advise everyone who smokes to stop, and take them to an intensive support service. Smoking those who are not ready to stop should be recorded and reviewed with the individual once a year. It remains one of the most cost-effective and potentially useful fact that health workers can do.