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Smoking and quitting among Irish teenage males   Back Bookmark and Share
Maguire Niall
Nicotine addiction in adulthood is usually preceded by exposure to cigarettes in adolescence. A minimal exposure may be sufficient to produce addiction. Strategies to reduce adult smoking must address those factors, which influence teenage smoking. In this study we aimed to establish the prevalence of smoking in male secondary schools, to measure the association between student’s smoking status and parental, peer and sibling smoking and to describe attempted quitting. An anonymous questionnaire was given to 1070 male secondary school pupils in two schools in County Louth. Twenty-seven percent of respondents smoked every day or on most days. Having a best friend who smoked was associated with personal smoking (O.R. 11.75, C.I. 8.6-16.08) as was sibling smoking (O.R. 3.49, C.I. 2.67-4.57.) Seventy percent of smokers stated that they wanted to stop and 75% that they had tried to stop. Only five smokers (1.2%) had been advised to quit by their general practitioner. We conclude that smoking is as prevalent among teenage boys in Ireland as it has been shown to be elsewhere and that most teenagers are unable rather than unwilling to stop.
Author : Maguire Niall , Howell Fenton, Moran A

Abstract

Nicotine addiction in adulthood is usually preceded by exposure to cigarettes in adolescence. A minimal exposure may be sufficient to produce addiction. Strategies to reduce adult smoking must address those factors, which influence teenage smoking. In this study we aimed to establish the prevalence of smoking in male secondary schools, to measure the association between students smoking status and parental, peer and sibling smoking and to describe attempted quitting. An anonymous questionnaire was given to 1070 male secondary school pupils in two schools in County Louth. Twenty-seven percent of respondents smoked every day or on most days. Having a best friend who smoked was associated with personal smoking (O.R. 11.75, C.I. 8.6-16.08) as was sibling smoking (O.R. 3.49, C.I. 2.67-4.57.) Seventy percent of smokers stated that they wanted to stop and 75% that they had tried to stop. Only five smokers (1.2%) had been advised to quit by their general practitioner. We conclude that smoking is as prevalent among teenage boys in Ireland as it has been shown to be elsewhere and that most teenagers are unable rather than unwilling to stop.

Introduction

Smoking is, globally, the single most important cause of preventable illness and death. The World Health Organisation (WHO) estimates that, world-wide, smoking causes three million adult deaths each year and expects this figure to reach 10 million by the year 2020.1 In Ireland there are estimated to be six and a half thousand smoking related deaths each year.

Most adult smokers acquire their addiction as adolescents. In the United States, 77% of all adults who ever smoked became daily smokers before the age of 20 years.2 In England, smoking prevalence among 15 year olds of both sexes is now equal to that seen among adults and has grown year on year through the 1990s.3 Experimentation with cigarettes is hazardous for long term addiction, with as many as one half of all experimental childhood smokers going on to become regular smokers.4 Thereafter, one half of these young adult smokers will continue to smoke to retirement age.5 One half of them will die as a result of their addiction6 and one half of these deaths will be premature.7

This study was designed to inform a smoking prevention strategy at a large boys school to which one of the authors (AM), a general practitioner, serves as medical officer.

Method

Two large boys secondary schools in the North East were studied in 1994. The school principals consented to the study, which required all pupils present on a single day to receive a questionnaire. Enrolment in these schools totalled 1300 and 1070 students completed the questionnaire (82%.)

The questionnaire comprised 38 items covering smoking status, smoking status of parent, siblings and friends, reasons for smoking, attempts and desire to stop smoking, beliefs about the health effects of smoking and sources of advice on quitting. The instrument was piloted and refined in 172 pupils in representative classes of a third school, of whom 48 were interviewed individually following completion of the questionnaire.

We used the WHO definition of smoking, which categorises smoking status as follows: Regular smokers are those reporting smoking every day or on most days; occasional smokers are those smoking on one day or some days over the last month and all others are classified as non-smokers.1

Statistical analysis was achieved with Epi-Info v 5.01.

Results

The response rate was 82% (1070/1300). The school principals estimated absence at a maximum of 200 on any given day. 

The mean age of respondents was 15.3 years.

Smoking status.

Six hundred and fifty-four pupils (61%) were non-smokers. Two hundred and eight-eight (27%) were regular smokers. Of these 241 (22.5% of all pupils) had smoked every day in the preceding month and 47 (4.4%) had smoked on most days. One hundred and twenty-eight (12%) pupils were occasional smokers.

Twenty-five respondents (6%) smoked 20 or more cigarettes per day, 95 (24%) smoked between 10 and 19 per day, 138 (35%) smoked 5 to 9 per day, 113 (28%) smoked 2 to 5 per day and 28 (7%) smoked one cigarette per day.

Asked to volunteer reasons for their smoking, 12 different reasons were cited by 347 respondents. The five most frequent motives were to relieve stress 140 (40%), to feel cool 47 (14%), to boost confidence 42 (12%), for enjoyment 41 (12%) and because I am addicted to cigarettes 38 (11%).

Current parental smoking was associated with an increased likelihood of smoking in the respondent: O.R. 1.97 (C.I. 1.39-2.78) for pupil smoking where both parents were current smokers. 

Having a sibling who was a current smoker increased the likelihood of the respondent smoking: O.R. 3.49 (C.I. 2.67-4.57) The strongest positive correlation with pupil smoking was noted where the pupils best friend was a current smoker: O.R. 11.75 (C.I. 8.60-16.08). 

Stopping smoking.

Among the 416 smokers, between 383 (92%) and 403 (97%) answered items about stopping smoking.

Two hundred and sixty-four (71%) stated that they would like to quit and 291 (75%) that they had already tried to do so. One hundred and ninety-eight (52%) stated that they would like help to stop.

When asked who had advised them to stop smoking, 196 (47%) mentioned parents, 100 (24%) friends, 54 (13%) teachers and five (1.2%) their general practitioner. 

Eighty-two percent said they believed smoking could cause them harm in the future. Among 285 smokers who had previously attempted to quit 222 (78%) cited health concern as the motive.

Discussion

Smoking prevalence in this study (39%) is lower than that found by ORourke8 (57%) in a similar Irish population in 1980 and by Morgan9 (66%) in 1994 among 12-18 year olds in Dublin. However, our definition of smoking did not include young people who had ever smoked as was the case in these other studies. Twenty-seven percent of our sample smoked daily or on most days, the WHO definition of regular smoking, and this is the group who are most at risk of lifelong nicotine addiction and related disease.

Our examination of the social contacts of respondents confirm findings in other studies that having parents, siblings and friends who smoke increase the chances of a teenager becoming a smoker.10,11 It is interesting that our data reveal associations between teenage smoking and social contacts of similar strength to those reported from the United Kingdom. British data suggest a three fold increased risk of smoking where both parents of a teenager are current smokers, which compares with an Odds Ratio for this risk of 1.97 in this study. In our study an Odds Ratio of 3.49 for teenage smoking if a sibling is a current smoker is comparable to a four fold risk reported from Britain.10

It has been shown that even infrequent experimentation with smoking in adolescence raises the risk of adult smoking, up to 16 fold in one study.12 The difficulty experienced by teenage smokers in quitting was demonstrated in our study, where 291 of 416 (70%) had failed in an attempt to quit. In the Teenage Smoking Attitudes Study of 1997 in England, 71% of young smokers reported having tried to give up.11 In that study as well as in a study of smoking cessation among older American teenagers, there was the same dose relationship as seen in the adult population between increased consumption of cigarettes and perceived difficulty in quitting.11,13

The general practitioner should be well placed to work at smoking prevention by virtue of his opportunistic contact with teenagers. That only five respondents recalled being advised to stop by their general practitioner is at odds with this potential input. There appears to be a reluctance on the part of family doctors to address smoking in patients who do not present with smoking related illness, for fear of compromising a longer term therapeutic relationship.14 In addition, consultations with teenage males in Irish general practice are infrequent, reported to be about two per annum.15 Our evidence that young smokers are not unaware of the risk of continued smoking and cite this as the main reason for wanting to quit suggests that lectures about health hazard are not what is required at these brief and rare encounters. A focus on the reason for continued smoking may be more fruitful. In this regard, we have corroborated Byrnes finding in Australia that a cardinal reason for continued smoking is for the relief of stress.16 Our study also confirms the strong relationship between the individuals addiction and that of family and friends.10,11,17 The general practitioner who enables an individual within a family to stop smoking may reasonably expect the effort to achieve a wider beneficial effect. 

In summary, we have found that smoking is still prevalent among teenage boys and that most are unable rather than unwilling to quit.

Acknowledgements

We would like to thank the pupils and principals of the schools studied for their co-operation and interest. Our gratitude also to our families and practices for facilitating our research interest. Finally, we are grateful to the Irish College of General Practitioners and the Department of Public Health Medicine of the North Eastern Health Board for their support.

Correspondence

Niall Maguire,
2 Bedford Place,
Navan,
Co. Meath.
Tel: +353-46-21369
Fax: +353-46-28889
Email:[email protected].

References

  1. World Health Report. Geneva: World Health Organisation, 1995.
  2. Reasons for tobacco use and symptoms of nicotine withdrawal among adolescent and young adult tobacco usersUnited States, 1993. MMWR Morb Mortal Wkly Rep. 1994 Oct 21;43(41):745-50.
  3. Statistics on smoking: England , 1976 to 1996. Department of Health Bulletin 1998/25. London: Department of Health, 1998
  4. McNeill AD. The development of dependence on smoking in children. Br J Addict 1991; 86: 589-92.
  5. Nicotine addiction in Britain. A report of the Tobacc0 Advisory Group of the Royal College of Physicians. London: Royal College of Physicians, 2000. xiv.
  6. Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years observations on male British doctors BMJ 1994; 309: 901-911. 
  7. Nicotine addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians, 2000. 18.
  8. ORourke AH, OByrne DJ, Condren L. et al. Smoking- A survey of post primary schools. Irish Medical Journal 1983;76: 285-9.
  9. Morgan M, Doorley P, Hynes M. et al. An evaluation of a smoking prevention programme with children from a disadvantaged community. Irish Medical Journal 1994; 87:56-7.
  10. Nicotine addiction in Britain. A report of the Tobaccp Advisory Group of the Royal College of Physicians. London: Royal College of Physicians, 2000. 11-12
  11. Barton J. Young teenagers and smoking in 1997. A report of the key findings from the Teenage Smoking Attitudes Survey carried out in England in 1997. London: Office for National Statistics, 1998.
  12. Moss AJ, Allen KF, Giovino GA. Et al. Recent trends in adolescent smoking, smoking update correlates, and expectations about the future. Advance data from vital and health statistics No. 221. Hyattsville Md: National Centre for Health Statistics 1995. DHSS publication no. (PHS) 93-1250.
  13. Sargent JD, Mott LA, Stevens M. Predictors of smoking cessation in adolescents. Arch Pediatr Adolesc Med 1998; 152: 388-93
  14. Coleman T, Murphy E, Cheater F. Factors influencing discussion of smoking between general practitioners and patients who smoke: a qualitative study. British Journal of General Practice, 2000; 50: 207-210.
  15. Comber H. The first national study of workload in general practice. General description of results and preliminary analysis. Dublin: Irish College of General Practitioners, 1992. 
  16. Byrne DG, Byrne AE, Reinhart MI. Personality, stress and the decision to commence cigarette smoking in adolescence. Journal of Psychosomatic Research 1995; 39(1): 53-62.
  17. Wang MQ, Fitzhugh EC, Westerfield RC. Et al. Family and peer influences on smoking behaviour among American adolescents: an age trend. Journal of Adolescent Health 1995;16(3):200-3.
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