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HOW SMOKING AFFECTS TEENAGERS

Assessment smoking among teenagers is on the rise. Statistics have shown that smoking trends were decreasing between 1976 and 1985 by approximately 10%, but have started to climb since the early 1990's (Lawrence 1999). Over the last decade, there has been more than a seventy- percent increase in youth smoking. The average age of onset of smoking is fourteen years old. Ninety percent of those who smoke began before the age of eighteen. (www.healthierohio.org.).

Not all adolescents are at the same risk level to smoke. Studies have been done that demonstrate who is at more risk to smoke than others are, but adolescents of every race, socioeconomic, and sex are affected. Smoking rates are more than doubled among white adolescents than African American adolescents are. "Children who are more committed to education, religion, and family are, in general, at lower risk for cigarette use" (Lawrence, 1999, p699).

Smoking is not a disease, but it is an addiction that usually begins among high school students. An addiction is a compulsive psychological need for a habit-forming substance such as nicotine. There are eight major risk factors that contribute to adolescent smoking. The first one is the social influences (an environmental factor) in a teen's life. There are two types of social influences, direct and indirect. The direct social influences are all of the effects that peers and family have on a youth smoking. Peers demonstrate to each other the ease of obtaining cigarettes and the message that smoking is a normal and necessary aspect of the peer group. (Lamkin 1998). Parental influences regarding smoking has shown to "be a significant, general factor promoting youth smoking, even greater than peer smoking and socioeconomic status." (Males, 1995, p228).

The indirect social influences include the effects of the media and tobacco advertisers. They create a positive attitude related to smoking in adolescent's minds. "Adolescents are more likely to believe information presented by sources when less certain about their own opinions." (Lamkin, 1998, p129). Tobacco-industry documents show that they have been targeting youth as young as nine years old through their advertisements. The top three brands that are advertised the most to target youth are Marlboro, Camel, and Newport. (www.healthierohio.org.)

The next risk factor, psychological factors (environmental factor), consists of two parts. The first is depression or negative affect in adolescents. Depression is a risk factor because smoking helps an adolescent to deal with their emotions and feeling of stress. (Adolescents and Smoking 5) The second is self-efficacy. An adolescent's level of self-efficacy determines whether coping behaviors will be used successfully in the face of obstacles. Therefore, by ensuring that an adolescent feels confident about himself to abstain from smoking would eliminate this risk factor. (Lamkin 1998).

The race (host) of an adolescent as a predictor of smoking is more prevalent in some races more than others are. In the MMWR (April 1998), it states that Caucasian high school students have a higher rate of use and risk versus Hispanic and Black students. Substantial increases in smoking have occurred over the last decade in all races, but especially among White students. (Lawrence 1999). "In a recent study, 80% of African-American parents said they have a "no smoking" rule in the home as compared to 48% of white parents" (www.healthierohio.org).

The fourth risk factor of youth smoking is the sex (host) of the adolescent. Overall, females have greater risk of onset of smoking than males. This stays true throughout the races studied. There is a particular vulnerability to smoking especially among white female students, who consistently hold the highest rates among all of the groups studied. (Lawrence 1999). For example, 39.9% of White females smoke and 39.6% of White males smoke. (MMWR 1998).

Social bonding (environmental factor) is a predictor of smoking that includes the adolescent's family and peer bonding, school influences, and religiosity. Conrad (1992) found that 71% of the subjects studied, there was a correlation between social bonding and a risk of smoking. (Adolescents and Smoking 6) Interpersonal, personality, and self-image (environmental factor) of adolescents are predictors of smoking. Students who exhibited rebellious, risk taking, shyness, submissive, and aggressive behaviors were all found to be positive predictors to the onset of smoking. (Conrad 1992). Intentions (environmental factor) to smoke predicted the onset of smoking 89% of the time. Intentions to smoke means that the adolescent intended to smoke when they got older. This is a higher risk factor for high school students than any other grade level. (Conrad 1992).

The final risk factor of adolescent smoking is previous exposure (agent). Other exposure to alcohol use and other substance use such as marijuana consistently predicts the onset of smoking in adolescents. (Conrad 1992) With these risk factors, this will explain how the natural history of disease affects adolescents and smoking.

The natural history of smoking involves the prepathogenesis, early, middle, and advanced pathogenesis period. Only the prepathogenesis and the early pathogenesis stages involve the high school adolescent. The prepathogenesis period takes into account the interrelations between the agent, host, and environmental factors. This period is the pre-exposure or susceptibility that the host has. The definition of the host is a person or organism that is capable of being infected by the agent. In this case, it is the high school student. The agent is the primary cause of a health-related condition, or the cigarette. The environment is all of the external conditions and influences that affect life and the host's development. This includes the host's influence that is from peers and parents, their lifestyle and school performance, sociodemographic characteristics (such as poor home environments), and the positive portrayal of cigarette smoking within the media, movies, magazines, etc. The previous factors are all prepathogenesis, before the high school students begins to smoke.

Early pathogenesis is in the preclinical stage. The agent, a cigarette, is introduced to the host at this time. In other words, the adolescent takes his first smoke on a cigarette. During the middle pathogenesis, tissue and physiologic changes occur. For...

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