While tobacco use among adolescents has reduced dramatically over the past four decades, its prevalence remains worryingly high. Nearly 90% of all smokers tried out cigarettes in adolescence and 99% first started by the age of 26. An estimated 3,800 youths aged 18 years or younger try out their first cigarette, and a further 2,100 young adults become daily smokers. In 2015, one in three high school seniors reported having smoked a cigarette, while 1 in 15 12th graders (or 7%) reported smoking regularly and on a daily basis. This translates to nearly 450,000 12- to 13-year olds and about 4.4 million 14- to 17-year olds having smoked. If these trends keep up, 5.6 million youths aged below 18 today (1 in 13) will die from tobacco-related illnesses/complications (Centers for Disease Control and Prevention, 2015; U.S. Department of Health and Human Services, 2015). Considerable ethnic/racial and regional differences in tobacco use exist, with white teens being more likely to smoke than both Hispanic and Black peers. Smoking rates are normally higher in the Midwestern and Southern regions of the US as well as in nonmetropolitan areas. Since early initiation is likely to create addiction that would in turn render the youth into smokers for the rest of their lives, early intervention is critical both to delay and reduce initiation rates in order to avert the tobacco use crisis in the country, as well as the tobacco-related health difficulties.
An issue of public health concern is whether preventing children and teens from smoking may stop them smoking as adults or simply defer the initiation stage. According to Auld (2005), delaying the age of initiation has the effect of reducing smoking among adults, because older people have more information and are least prone to peer pressure. Effectively, policies that deter early smoking initiation lower eventual smoking rates, besides reducing the onset of health problems asssociated with tobacco use among those that become addicted to smoking.
Partners
Governments - The Department of Health and Human Services and other government agencies play a central role in providing funding and enacting regulations to prevent smoking initiation.
The media – Exposure to marketing information and glamorization of smoking is unhelpful for impressionable children. Other than tailoring the content to suit the public health concerns, the media plays a similarly important role in reaching the target population.
Community Opinion Leaders – In 2011-2012, an estimated 58 million Americans were exposed to secondhand smoke, with children who live in multi-unit housing having 45% higher nicotine levels compared to children who live in single family homes. During the same year, two in every five children aged 3-11 (including 7 out of 10 Black children) were exposed to secondhand smoke on a frequent basis. Secondhand smoke is just as harmful to non-smokers and heightens the risk of early initiation . Effectively, it is important that community opinion leaders are involved to help stump out smoking in public and closed spaces (including private homes).
Parents/Guardians – Smoking initiation is linked to among others, parental/sibling smoking or permissiveness, peer influence, access to cigarettes, and financial resources. Parents serve as role models, have direct (and often trusted) access to the teens, and control the teens’ access to money.
Schools – Schools help in getting the message across to teens in their care as well as controlling the children’s exposure to tobacco products.
NGOs – agencies running tobacco control initiatives offer helpful support and leadership despite their resource constraints. These agencies also have established networks in the community, which can be pivotal in implementing potential programs to reduce smoking initiation and smoking among teens.
Public Education Method/Tool(s)
The health promotion campaign will seek to achieve behavioural changes, improve awareness (education), and empower teens. Behavioural change approaches are geared at changing the target population’s conduct so they adopt healthy lifestyles, including keeping off cigarettes or stopping use. Similarly, parents, siblings, and other groups will be encouraged to create an acceptable environment for the target population to lead healthy lifestyles. To achieve behavioural changes, the target population, peers, institutions, and families need information about the risks that teens and children face when they are exposed to tobacco products and tobacco marketing information. The campaign shall present information about the risks of tobacco smoking and early initiation to both the target population (teens, their parents and siblings) to help build attitudes and values that would allow them to make informed decisions. The campaign will also help in carrying out the decision as well as in the adoption of healthy practices. Given the fact that the target population is mainly in formal schools, they re both accessible, and the content may be incorporated into the learning process through the teachers and other parties. The third aspect of the campaign will seek to achieve societal changes in attitudes, coupled with changes in the social, physical, and economic environment to render it more difficult for teens to access cigarettes. This may be achieved by asking parents to reduce allowances for their children and be more vigilant in monitoring what their children spend their allowances on. Similar, increased lobbying of regulatory authorities (government agencies) to raise cigarette prices through even higher taxation and restriction of advertising would be immensely helpful.
Two methods would be used i.e. leaflets and social media. Leaflets with targeted information will be distributed in middle and secondary schools, giving information about the risks and encouraging youths to lay off tobacco products. Leaflets will also be distributed to teens at events popular with this population group, including sporting events, music concerts and other entertainment activities. Efforts will also me made to enlist the support of opinion leaders among teens, including celebrities, teachers, and community leaders to pass on the message to the teens in their events. Social media will also play a key role in public education. According to Pew Research Center (2015), 82% of people aged between 18-29 use at least one form of social media, and moe than 50% of children have used social media by the age of 10. Similarly, 74% of all popualtion in the US use social media. Social media offers an additional advantage because it is cost effective. Other than establishing a presence (setting up pages/accounts) on Facebook, Instagram, Twitter, and Instagram, information about the risks of tobacco use and other support materials will be shared in this way. These pages will also create and/or share entertaining content tht is popular with teens to bait them to share it. Viral content has the potential to reach even more teens at little or no cost at all.
Assurance
Some of the goals that the proposed health promotion campaign seeks to achieve, particularly behaviour change, take a considerably long time to fulfill. This is particularly true for teens that have already had their first smoke and/or smoke regularly, because of the potential of tobacco to be addictive. Similarly, family members and community members that smoke and expose children/teens to secondhand smoke are unlikely to change their behavior easily. However, consistent and targeted campaigns are bound to change behavior over the long the long term. Therefore, the proposed campaign will firstly be targeted at teens to ensure that they choose not to try smoking, and those who do stop before they get addicted to nicotine. Even if there are no behavior changes in society, at least in the short term, it will be possible to raise a generation of teens that are alive to the dangers of tobacco smoking and avoid it. The successful implementation of this program will see a new generation that will in turn produce the change in behavior that is required in the long term.
Evaluation
The success of the program will be assessed on the strength of two measures i.e. implementation and efficacy/impact. Firstly, the program will be evaluated against the implementation plan to ensure that the planned activities are implemented in time, and on budget. The start and end dates as well as cost records will be carefully kept for evaluation. To determine the effects of the program, surveys of the target population will be conducted before, and after the program to determine the number of teens that had had their first smoke, were smoking regularly and/or had stopped smoking, etc. A comparison of the results prior to, and after the study will serve as an indication of the program’s success.
Reflection
Teen smoking is a considerable public health concern, not only because of the large number of teenagers already smoking or are likely to try smoking, but also because of the health consequences of such behavior. Early initiation not only brings forward the onset of smoking-related health complication. The earlier the initiation, the heavier the burden imposed on the society in the form of healthcare costs and lost productivity. I believe I have learnt a lot about smoking in teens, and what I have found out has shocked me. The extent to which the problem is largely ignored i.e. the failure to specifically target efforts to combat smoking to teens and young adults may be the reason why the smoking prevalence remains high and many teens try out cigarettes at such a tender age. I am uncertain as whether I have found out how to prevent or control the problem, not least because of the habit forming nature of tobacco, and complicated socioeconomic and personal factors that lead to teens taking up smoking. Overcoming these factors is difficult, costly, and time-consuming. However, health promotion campaigns can be effective in creating awareness, educating and nudging teens to lead healthy lifestyles. Similarly, this exercise has helped me gain perspective of the extent of the problem, and the need for governments, NGOs, regulators, and other stakeholders to specifically target this population group.
References
Auld, M. (2005). Causal effect of early initiation on adolescent smoking patterns. Canadian Journal of Economics , 38 (3), 709-734.
Centers for Disease Control and Prevention. (2015). Youth and Tobacco Use. Retrieved Mar 25, 2016, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/
Centers for Disease Control and Prevention. (2014). Secondhand Smoke (SHS) Facts. Retrieved mar 21, 2016, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm
Jackson, C., & Dickinson, D. (2004). Cigarette consumption during childhood and persistence of smoking through adolescence . Arch Pediatr Adolesc Med. , 158, 1050-1056.
Lakunchykovaa, O. P., Andreevaa, T. I., Nordstromb, D. L., Shkiryak-Nizhnykc, Z. A., Antipkinc, Y. G., Hryhorczukd, D. O., et al. (2015). The impact of early life stress on risk of tobacco smoking initiation by adolescents. Addictive Behaviors , 50, 222–228.
Pew Research Center. (2015). Social Networking Fact Sheet. Retrieved March 25, 2016, from http://www.pewinternet.org/fact-sheets/social-networking-fact-sheet/
U.S. Department of Health and Human Services. (2015). Trends in Adolescent Tobacco Use. Office of Adolescent Health. Washington, D.C.: U.S. Department of Health and Human Services.
Wang, M., Ho, S., & Lam, T. (2011). Parental smoking, exposure to secondhand smoke at home, and smoking initiation among young children. Nicotine Tob Res. , 13 (9), 827-32.
