Cigarettes and tobacco use

Cigarettes

Why do people smoke? All of know that smoking is a dangerous, even potentially lethal habit - and one moreover that now carries an increasing weight of social stigma. And yet still people do it. There must therefore be compelling reasons why people should endanger their health to such a degree and the most obvious of these reasons is the one that smokers themselves offer up the most often: Smoking is simply pleasurable. This paper examines why people smoke cigarettes and especially how young people (who have been aware of the dangers of smoking their entire lives) begin their love affair with nicotine.

When it comes to the issue of smoking and young people, it seems that despite numerous advertising campaigns to quell the use of tobacco in those under the age of eighteen, the reality is that these tactics have been highly ineffective. While the use of tobacco amongst North Americans is, overall, on the decline, the number of teens using tobacco continues to increase steadily each year. Given this reality, we may assume that as these smoking teens enter young adulthood, their attitudes toward smoking will be more lenient than that of older adults, although this is probably only true if those older adults did not themselves smoke when they were teenagers.

Such research is important because smoking is known to cause a wide range of health problems for the person smoking as well as a somewhat reduced health risk for those who are exposed on a second-hand smoke. Moreover, there is a general overall cost to society.

Literature Review

The first study considered for this investigation was an empirical study in which researchers considered tobacco smoking beliefs and risk awareness of university students in 23 countries. Steptoe etal (2002) designed a study to determine:

the prevalence of current tobacco smoking, associations with beliefs about the health benefits of not smoking and the awareness of risks for lung cancer and heart disease in university students sampled from 23 countries (p. 1561).

Additionally the investigation utilized the World Health Organization's (WTO) model of tobacco epidemic to understand variances in tobacco usage among different countries.

Employing an anonymous questionnaire survey, 19,292 university students (8,482 men and 19,816 women) aged 17-30 studying non-health related disciplines were surveyed from 23 different countries. The researchers used the following instruments: the measure of smoking (which asked the participant to rate their tobacco use based on the number of times the individual has used tobacco); the importance of not smoking as it pertains to health (a Likert-type questionnaire that ranked the participants responses from 1 [low] to 10 [very great] in regard to importance; and risk awareness (questions posed in a yes/no format). Belief ratings for adults and their attitudes concerning smoking were extrapolated for 11 countries to determine if correlations between adult and young adult smoking patterns existed.

The findings of the study indicate that the prevalence of smoking in university students from developed countries such as Europe and the United States was much higher than rates in developing countries such as Thailand and South Africa. Overall health beliefs were strongly associated with prevalence; meaning that the less risk the individual believed smoking posed to overall health, the higher the incidence rate of smoking. In addition, the researchers found that, on the whole, university students were largely uneducated about the health risks associated with tobacco use.

Statistical methods utilized for the interpretation of the data included STATA 6 and SPSS 10.0.5. The researchers found that when correlating data, there were some correlations between smoking patterns and age. To correct the statistics for this problem, STATA 6 results were age- adjusted based on the data produced. Furthermore, Steptoe, et al., found that education levels also had an impact on beliefs and risk awareness. However, this variable could not be corrected in the final presentation of the data.

Using the age-adjusted data, researchers found significantly different attitudes toward smoking between men and women. Overall, more female smokers demonstrated an interest in reducing smoking behavior (70%), while more men had taken up the practice in developing countries.

In a more tightly focused study, Onal, Tumerdum and Ozel (2002) examined smoking addiction patterns among university students in Istanbul. The researchers believe that this study is especially pertinent because of the high rate of smoking in Turkey: While four million individuals die from smoking related causes worldwide each year, in Turkey this number is 100,000, which is more than the combined total of Turkish deaths from traffic and industrial accidents.

For the purposes of this study a randomized sampling method was employed. A questionnaire on smoking addition was administered to groups of 10-30 participants utilizing by means of responding under observation. "Smoking addiction was defined as, smoking more than 100 cigarettes life-long or smoking one or more cigarettes a day" (p. 398). A total of 236 participant responses were utilized out of 250 potential respondents. Logistic regression analysis of the data was utilized to calculate p values: any p value greater than 0.05 was considered significant.

The results of the study indicate that of the total population surveyed, 36% (41.3% males and 26.7% females) were addicted to cigarette smoking. The median age for smokers was 24.0 +2.9 years. Utilizing the Mann-Whitney U-test, the researchers found that males smoked significantly higher numbers of cigarettes per day than females. Upon final analysis of the data the researchers do note that there are a number of intrinsic variables that cannot be accounted for when considering the prevalence of smoking among university students:

Studies relevant to smoking addiction in the young population showed that social status, income and educational levels, as well as age and gender play an important role in smoking attitudes (p. 400).

The article concludes by considering the research findings within the context of alcohol addiction. According to the authors, similar research findings in other studies have shown that smoking additions closely correlate to alcohol addictions; suggesting that there is some inherent component in addition, whether it is to tobacco or alcohol. Finally, the authors are able to demonstrate that students in the study that derived most of their income from their parents were more likely to smoke simply because they could afford to do so. Individuals that were responsible for their own incomes had lower tobacco usage rates. This suggests that income plays a significant role in the development of smoking behaviors.

In a well-focused article, Biasco and Hartnett (2002) attempted to assess American college students' attitudes toward smoking Biasco and Hartnett (2002) surveyed 81 students (one-tenth of the student population) of a northwest Florida university. According to the authors the respondents for the survey were chosen randomly after being stratified for gender and race: 40% of the population was male, 60% female, 78% white, 10% African-American, 5% Asian, 4% Hispanic and 3% "other." The measurement instrument was a 19 question, 3-point Likert-like survey which asked subjects to rate their responses based on agree, uncertain or disagree options.

The results of the study indicate that although most college students viewed smoking as a bad habit and dangerous to one's health a majority felt that individuals should retain the right to smoke (94%). Further, most students agreed that others should not be harmed by an individual's choice to smoke:

the majority of college students believe others should not be injured by their smoking; for example, by smoking in an enclosed area. In addition, students said that people should be advised about the harmful effects of smoking and prohibited from smoking near pregnant women or near children. They also believed that second-hand smoke could cause health problems (p. 446).

According to the researchers the results of the study are commensurate with what other investigators have found on the subject. Overall, it seems that while college students acknowledge that there are health risks associated with tobacco use and further that these risks can affect non-smokers, many believe that their choice to smoke is their own right.

Choosing to Die

One of the great ironies for people born in the 20th and now the 21st century is the fact that many of us will die of diseases that are preventable. Of course, one could argue that this was always true: That people in the 15th century did not need to die of leprosy or cholera because death from these diseases is also preventable if only people will use antibiotics and ensure a clean water supply. However, there is a clear difference in a person of the 15th century dying of cholera and a person of the 21st dying of smoking; a doctor practicing in that century did not know about bacteria or the connection between clean water and cholera outbreaks while today both patients and doctors are aware that smoking has a number of terrible health consequences, including the real possibility of death.

It remains, true, of course, that many people continue to die in our own century of diseases that we do not understand well and have no clear remedy to, but the generations alive today may be seen to be on the far side of what can be seen as a great epidemiological transition in the human species. This is the process by which the pattern of mortality and disease is transformed from one of high mortality among infants and children and episodic famine and epidemic affecting all age groups to one of degenerative and human-caused made diseases (such as those attributed to smoking) affecting principally the elderly or at least the adult (Pendell, 1996, p. 38).

Anti-smoking campaigns are often aimed at young people on the grounds that most people start smoking when they are teenagers, and so if teens can be prevented from starting to smoke then they are less likely to take up smoking later on (when they have better sense and a greater appreciation for mortality!). Of especial concern for anti-smoking advocates are teen mothers because their habit can affect not only themselves but their fetuses and children.

The population of teen mothers has been targeted by anti-smoking campaigns for a number of reasons. The first is the fact that while younger smokers are less concerned about the risks of smoking and less likely to believe that they themselves will be subject to these risks than are older smokers (who are indeed likely to believe that smoking causes lung cancer and heart disease), it has been shown by a number of researchers that the less long a person has been smoking in general the easier it is for that person to quit (www.statistics.gov.uk).Simply by virtue of their age, teenage smokers will have been smoking for a shorter period of time than older smokers, although of course this will not be universally true. A 60-year-old might well have taken up smoking the week before and a 16-year-old might have been smoking for three years, but in general teenagers have only been smoking for a few years.

Studies of ex-smokers show that their risk of dying from smoking-related disease decreases with each year of abstinence. Since the Surgeon General's report in 1964, the proportion of males who smoke has decreased from more than 50% to about 28% while the percentage of women who smoke has fallen from about 34% to 23%. By 1994 an estimated 46 million Americans had quit smoking cigarettes; there are now as many ex-smokers as there are active smokers (Jarvis, 1996, p. 19).

While it is possible for the body to repair 20 or 30 years' worth of damage to the lungs and other organs, it is easier by far for it to repair the damage done in two or three years' worth of smoking, and so while it is certainly better not to start smoking at all, it is better (once having started) to stop sooner than later. Smoking is a primary care measure; it effects all aspects of a person's health and so programs designed to intervene in smoking have very widespread benefits.

The second major reason that this particular population has been targeted is that smoking carries substantial risks to a fetus, and second-hand smoke carries substantial risks to infants. By targeting the teenage mother population, therefore, one may reduce at a single blow the risks of smoking to at least two and perhaps more (if the mother has more than one child) people at once. Young mothers, while often under terrible social and psychological stress and therefore likely to cling to smoking, are also in some key ways vulnerable to intervention. While they may not feel able to quit smoking for themselves, they may be able to summon the will power to do so if they are made aware of the effects of smoking on their child/ren.

And because teenage mothers interact with the medical establishment more frequently than do most teenagers and may also interact regularly with a number of social service agencies, they may be encouraged and supported to quit smoking by a range of health and social service professionals who interact with them on a regular basis, providing the kind of support to quit smoking that is essential for any person trying to break free of the strength of tobacco addiction.

Drug Addiction Like Any Other

The reason that people become addicted to drugs are complex, having to do with educational background, social status, gender, race, personal experiences. There is no single cause or reason for drug addiction any more than there is any one cause or reason that some people do not take drugs.

However, when we turn from the psychological and social reasons that people take drugs to the purely biological we see a much greater degree of similarity in the reasons that people take drugs - or at least why they continue to take drugs after an initial period of usage. For while people are very different from each other in psychological and motivational terms, when it comes down to brain chemistry we are in many ways very much the same.

Many - indeed most - of the most commonly taken recreational drugs have a similar effect on the brain (this is the case even though the effects that one experiences may be quite different from one another). The following summarizes the ways in which many drugs are different in their particulars but similar in their ultimate effect:

Tobacco, alcohol, marijuana, cocaine, heroin, barbiturates, inhalants -- every abusable substance. We know a phenomenal amount. What we also know is that each of these drugs has its own receptor system -- its own mechanism of action. But in addition to having idiosyncratic mechanisms of action, each also has common mechanisms of action. That common mechanism of action is to cause the release of dopamine, a substance in the base of the brain, in what is actually a circuit called the mesolimbic reward pathway. That circuit has a neurochemical neurotransmitter, which is dopamine (http://usinfo.state.gov/journals/itgic/0697/ijge/gj-2.htm).

In other words, a number of the drugs that people take result in the end in an increased level of dopamine in the brain. To understand why this is important we must understand what dopamine itself is. Dopamine is a complex chemical of a class known as neurotransmitters.

As the name of this class of chemicals suggests, they are called neurotransmitters because each of the different chemicals in this class transports of transmits messages between different nerves within the brain. Dopamine (as is true of other neurotransmitters) is regularly sent from one nerve and received or captured by the receptor on another nerve cell. All nerve cells are specific to a certain kind of neurotransmitter. The receptors for dopamine are called dopamine receptors.

Dopamine, while it is free-floating and before it is trapped by a receptor produces feelings of well-being and pleasure. The use of certain drugs allows dopamine to remain free floating for longer because it tricks the neurotransmitters into believing that it is dopamine (Sell 1043).

One of the reasons that many drug users become habituated - become addicted, in other words, is that their brains come to depend upon the use of drugs to stimulate the release of dopamine. Another way of saying this is that their brains become essentially chemically too lazy to produce their own dopamine and begin to rely upon the dopamine triggered by drugs like cocaine.

This is true regardless of the psychological reasons why someone takes drugs. At some level, everyone who takes drugs (and this includes a number of legal drugs such as alcohol) is taking them because their brains want that "hit" of dopamine. The problem for drug users comes when their own brains become incapable - at least temporarily - of producing their own dopamine. Dopamine is a natural substance and is essential for a healthy brain; therefore when drug use interferes with the body's ability to produce dopamine there can be serious consequences.

Without proper levels of dopamine in the body, it is impossible to maintain proper motor control, for example. There are other, fundamentally serious problems associated with lowered dopamine levels, including Parkinson's disease, schizophrenia and depression.

People who have altered the natural equilibrium of their dopamine system by drug use have trouble feeling pleasure precisely because their dopamine systems are altered. This causes them to take more drugs so that they can feel pleasure, which further upsets the natural dopamine production mechanism, which entices people to take more drugs, etc. (Broers 336, Stewart 404). The effect is differentiated amongst different types of drugs. It is not clear whether the changes in brain chemistry of long-term drug use are necessarily permanent, but it is clear that the changes can be very long acting.

One of the reasons that it is so important for us to understand the ways in which the brain reacts to different types of drugs is that it may well provide doctors and other professional with the means to treat various drug addictions.

Difficulty Faced by Anti-Smoking Messages

Young people and especially teen mothers are important for anti-smoking programs to target because it seems clear that national attempts to reduce smoking - for all of their purported emphasis on youth smoking - have failed to have a substantial impact on the number of teenagers who begin smoking, and often at very young ages. This has been seen in the wrangling during the past few years over an attempted national settlement with tobacco companies over costs of smoking-related health problems met a similar fate. A bill implementing a $368 billion proposed settlement in 1997 was shepherded easily through the Senate Commerce Committee by John McCain. It would have raised federal cigarette taxes by $1.10 per pack, restricted tobacco advertising, ordered Federal Drug Administration regulation of tobacco, and established fines if the incidence of teenage smoking failed to drop (http://www.cdc.gov/tobacco/sgr/sgr_2000/factsheets/factsheet_historical.htm).