понедельник, 22 октября 2007 г.

Youth and Cigarette Smoking

Introduction

This Factsheet covers only cigarette smoking among children and young people.

In 1996, Peto et al. estimated that unless current trends changed, some 30-40% of the 2.3 billion children and teenagers in the world would become smokers in early adult life . Unless action is taken now, about 250 million of these future smokers will be killed by smoking.

In countries where smoking is long established, almost all smokers begin before age 18 years. Young people are therefore an important focus for action. Trends in smoking among young people follow those in adults. Men take up smoking first, and boys follow them. Women are next, and girls follow them. In the USA, Canada, Australasia and Northern Europe, the epidemic is established, and smoking is found among all four groups.

In Africa, Asia, South America and certain areas of Southern Europe, the epidemic is at an earlier stage and smoking may be found predominantly among men. Here, social influences and the tobacco industry's promotional strategy must be seriously addressed immediately if the smoking epidemic is to be prevented.
The effects of smoking on young people

Addiction

Many young smokers think they can quit easily, but find that they are already addicted. Young smokers develop withdrawal symptoms when they stop smoking. Smokers as young as 12 years may already made unsuccessful attempts to quit. A survey in the UK found that two-thirds of smokers aged 16-19 years had unsuccessfully attempted to stop, most having tried several times.

Long-term health risks

Long-term health risks are increased when regular smoking begins during childhood or adolescence. For example, the earlier regular smoking starts, the greater the risk of lung cancer. The highest risk of lung cancer and of heart and circulatory diseases to in adulthood is seen in those who started to smoke regularly before age 15.

Immediate health effects

Many health problems develop very quickly in the young smoker: for example, respiratory diseases, heart and circulatory problems, and reduced immunity. Children who smoke are more often absent from school, as the result both of smoking-related ailments and for truancy and suspension. The likelihood of absence increases if their parents also smoke. Young smokers are also less fit than their non-smoking peers, because carbon monoxide from tobacco smoke replaces some of the oxygen in their blood.
Stages in youth smoking
Stages in youth smoking

Young smokers go through a series of stages. Each stage is influenced by different factors: any action developed to prevent youth smoking must address these influences. Note that this is not a one-way process: rather, the stages are fluid and may reverse and restart several times.

Precontemplation - the child is not thinking about smoking, but receives messages about it. At this stage, parental and siblings' smoking, advertising, films, television and role models all exert an influence.

Contemplation - received images or peer influence build up to a point where curiosity takes over and the young person considers trying a cigarette. Friends' behaviour is now added to the precontemplation influences.

Initiation - most young people try smoking, but the majority do not become regular smokers. At this stage, friends are usually the strongest influence.

Experimentation - involving repeated attempts to smoke. Young people may become addicted to nicotine after smoking a very small number of cheap cigarettes, which may be why many experimenters become regular smokers. At this stage, peer-bonding is still the strongest influence.

Regular smoking - may involve a new set of influences. As well as addiction and habituation, personal factors such as beliefs about the benefits of smoking, self-efficacy, self-perception and coping join earlier influences. Societal factors including price and availability, and interpersonal factors such as school policy, provide a background.

Maintenance - continuation of regular smoking involves all these influences, but addiction is a major force.

Quitting - occurs when the relative importance of influences changes. For example, a new non-smoking partner, steep increases in the price of cigarettes, decreases in spending money, and beginning work where smoking is not permitted can all trigger a decision to stop.
Why do young people smoke and what can be done to prevent it?

The onset and maintenance of smoking is clearly complex. Here, we discuss selected findings from research in industrialised countries. As these may not apply elsewhere, each country should carry out research to identify areas in which effective action can be developed.

Suggestion for action

Carry out regular surveys with representative samples of young people as a baseline for planning e.g. every two years. WHO can advise on this.

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