Childhood Smoking and Prevention
By Bob Sherman
The United Nations Foundation indicates that tobacco is the single most lethal agent known to humanity. The World Bank declares that smoking by children under age 18 is a worldwide problem.
Internationally, young people are starting to smoke at earlier ages. Somewhere between 82,000 and 99,000 children in developed nations begin smoking each day. The Secretary-General of the UN indicated that 250 million children alive in 1999 will have shortened lifespans because of tobacco related diseases.
While peer influence is a strong motivator to smoke with older children, young children are significantly influenced by family smoking. The Bogalusa Heart Study survey found that 45.9% of smoking 1st through 6th grade children indicated they first tried a cigarette because family members smoked. Only 19.5% of child smokers indicated they first tried cigarettes because their friends smoke. Overall, 71.4% of smoking children indicated curiosity as another reason they tried their first cigarette.
The earlier the exposure to smoking cigarettes, the more likely eventual addiction becomes. Some believe children are especially susceptible because cotinine increases sharply in adolescents, beyond what is expected from cigarette use. This may account for an increase in nicotine-related cravings in child smokers.
The quit rate for adolescents who are trying to quit is only 7%. In fact, 40% of those trying to quit return to smoking within a week. And for those few who do succeed in quitting, 28% resume smoking within a year. Many adolescents have already tried several times to quit.
Tobacco companies appear to be targeting children by several means. Various candy-flavored cigarettes have been introduced that appeal to young people. And, smokers can collect points for cigarette purchases that can be redeemed for clothing and other items highly valued by adolescents.
Children studied in western Oregon grade schools have shown a significant relationship between their intention to use cigarettes and alcohol latter in life and their actual use of these substances within a couple of years. Almost all of them could identify alcohol and cigarettes, indicating either direct exposure to these substances or exposure through the media. By grade 7, more than 18% of these children had tried cigarettes and more than 50% of the children had tried alcohol. In addition, 9% of the boys and 3.2% of the girls indicated that they had tried marijuana. In another study in Israel, 30% of first graders indicated a desire to smoke in the future.
In fact, 80% of all new smokers start smoking before the age of 18, with an average start age of 14. Of the more than 3 million children smoking in the United States, half already consider themselves dependent on cigarettes.
Cigarettes are not the only substance abuse concern. Cigarettes are often considered a "gateway" drug, leading to other drugs such as marijuana. In a survey in rural Texas, 23% of fifth graders were smoking, 17% were using alcohol, and 10% indicated they used marijuana. Another sample of 6th graders indicated that 45% used tobacco, 65% used alcohol, 11% used marijuana and 6% used inhalants.
The worldwide annual death toll from smoking is approximately 4 million. Approximately 440,000 people die of smoking related diseases each year in the United States. But, in the United States, about 3,000 children begin smoking each day--that's over a million new child smokers a year.
Children who smoke experience more sickness and minor ailments than children who do not smoke. In one study, the school absence rate of students (age 12 to 13) who regularly smoked (at least 6 cigarettes a week) was more than double the absence rate of children who never smoked.
In addition, children whose parents smoked were also more likely to be absent from school than children whose parents did not smoke. This was especially true if the mother smoked.
Childhood smoking is a tragic problem for the United States and the world. Smoking leads to major illness and premature death. The earlier we address this issue the sooner the health problems can be reduced.
Help Youth Quit Smoking
Two models of intervention for health professionals have been developed to help young smokers to quit smoking. The first model, promoted by the US Department of Health and Human Services is the "Five A" model. This model suggests that health professionals:
- Ask -- Systematically all tobacco users at every visit
- Advise -- Strongly urge all tobacco users to quit
- Assess -- Determine willingness to make a quit attempt
- Assist -- Aid the patient in quitting
- Arrange follow up to monitor, encourage, and support
The second model is the American Medical Association's Guidelines for Adolescent Prevention Services (GAPS). The primary steps in this procedure involve:
- Gather initial information
- Assess further
- Problem identification
- Solution promotion and negotiation
The best procedure, however, is to change the attitudes of children in elementary grades to reject smoking in the first place.
References
- Anne Charlton & Valerie Blair, Adbsence from school related to children's and parental smoking ahbits, British Medical Journal, v 298, 14 January 1989, 90-92
- Rebecca F Burris & Kathleen A O'Conell, Reversal Theiry States and Cigarette Availability Predict Lapses During Smoking Cessation Among Adolescents, Research in Nursing & Health, v 26, 262-272.
- N Jairath, K Mitchell & B Filleon, Childhood smoking: the research, clinical and theoretical imperative for nursing action, International Nursing Review, v 50, 203-214.
- Judy A Andrews, Elizabeth Tildesley, Hyman Hops, Susan C Duncan & Herbert H Severson, Elementary School Age Children's Future Intentions and Use of Substances, Journal of Clinical Child Adolescense Psychology, 32(4), 556-567.
- Kurt J Greenlund, Carolyn C Johnson, Larry S Webbger & Gerald S Berenson, Cigarette Smoking Attitudes and First Use among Thrid- through Sixth-Grade Students: The Bogalusa Heart Study, American Journal of Public Health, 87(8), 1345-1348.
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