(Friday, 21st Nov, 2014)
According to the Health Promotion Unit, in 1993 more than one quarter (27%) of those aged 15-24 years smoked regularly, which is almost identical to the 28% smoking rate in the population as a whole.
In 1988 one study found that 57% of Irish adolescent boys under 18 years were smokers, according to the World Health Organisation definition. In another study two-thirds of young people in Dublin had smoked at some point. In Britain, more adolescent girls than boys now smoke and this is probably the case in Ireland as well.
The fall in the total number of smokers is caused by more smokers giving up rather than less young people starting.
It is estimated that in the UK in 1993, the cigarette industry spent £100 million on promotional activities while the government spent £10 million on anti-smoking measures. Revenue from cigarette sales to under 16 year olds, (which are illegal), was estimated to be worth £108 million per year in tax receipts. The discrepancies and disincentives for tackling the problem are obvious. The Irish figures are not thought to be proportionately different, except that taxes are higher and health promotion spending is lower.
Smoking is by far the greatest cause of death in developed countries. It poses a big risk, especially among those who start smoking cigarettes regularly in their teenage years. If they keep smoking steadily, about half will eventually be killed by tobacco (about one quarter in old age plus one quarter in middle age).
Those killed by tobacco in middle age (35-69 years) lose an average of 20-25 years on non-smoker life expectancy and most of those killed by tobacco are not particularly heavy smokers (but most did start in their teenage years).
The earlier you start smoking the less likely you are to give up. Those who do not smoke regularly in their teens are much less likely to do so as an adult. Those teenagers who smoke regularly are also more likely to drink alcohol regularly.
Stopping smoking works. Even in middle age, stopping before you get cancer or some other disease reduces most of the later excess risk of death from tobacco, but the benefits of stopping at an earlier age are even greater.
The motivation for any adolescent behaviour is complex. The reasons they smoke are no less so but may include:
All these factors affect an adolescents decision to begin smoking. They continue to smoke because cigarettes are highly addictive.
A recent study by Dr Alan Moran in Drogheda looked at the issues of peer/parent/sibling pressure on smoking and the reasons teenagers stop smoking. He surveyed pupils from three male secondary schools in the North East and found that if a sibling smoked, the adolescent was 3.5 times more likely to smoke. If a best friend smoked they were 11.5 times more likely to smoke. Of the boys surveyed, 79% reported enjoying smoking, 80% reported having tried to stop smoking and 70% wanted to stop. The reasons why they wanted to stop were:
The reasons they stated for smoking were:
It is interesting to note that only 9% thought they smoked because they were addicted but 34% because they were stressed. Also of interest in this study is that, in spite of legislation banning the sale of cigarettes to under 16s, all the adolescent smokers stated they were able to buy cigarettes when asked where they got them from.
Other than the well-documented longer-term effects of smoking some specific problems are related to young smokers. Infertility in female smokers is two to three times higher than in non-smokers, brain haemorrhage (sub-arachnoid haemorrhage) is six times higher in young smokers than young non-smokers.
Asthma, so often attributed to environmental causes, is greatly worsened by cigarette smoking, either active or passive and smoke is a huge pollutant of home and social environments. Persistent health problems are reported by 25% of adolescent smokers, mostly asthma or allergic symptoms, as compared to 16% of non-smokers; this is particularly noticeable in girls.
Many adolescents are aware of the effects of smoking on their health. In a study of 650 teenagers aged 14-17 years in the UK, 98% knew smoking was harmful and 89% knew that passive smoking was harmful yet one in five were or had been smokers.
Advice to teenagers who smoke about the benefits of giving up smoking is best directed at immediate unpleasant consequences like smelly breath and stained nails rather than a warning about what may happen in 20 or 30 years, information they often knew when they started smoking.
Addiction to smoking is both physical and psychological. Many smokers find it very difficult to stop smoking and do not succeed. They get physically addicted to the nicotine in the cigarette, which causes real withdrawal symptoms if you cut down or quit. Psychological addiction occurs because smoking becomes a habit. It may help to address the root cause of smoking, such as boredom or insecurity. Encourage the teenager to take up sports, for example and to carry out another activity when they feel the need to have a cigarette.
Measures in schools aimed at smoking prevention have not been entirely successful. In one study after a school education programme, knowledge about smoking rose but numbers smoking did not change. It was suggested that more comprehensive measures such as effective legislation to control the sale of cigarettes and a banning of all cigarette advertising that is aimed at young people was needed. These measures have been found to be effective in Australia.
It would also help if the legislation that does exist was enforced. Prosecutions for sale of tobacco to minors are virtually unheard of in Ireland. Perhaps when the newsagent who sells cigarettes to children is viewed in the same way as the drug dealer on the street corner, we might see a change in the prevalence of childhood and teenage smoking.
It has been predicted that adolescent smoking will fall considerably in the next 10 years as it becomes unfashionable to smoke. Teenagers are becomingly increasingly green conscious and this as a potent part of peer pressure will probably be more effective that any anti-smoking messages adults may deliver.
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