Smoking Behavior Health Article

SMOKING BEHAVIOR

The act of smoking has been the object of extensive research, especially since the 1950s. It remains difficult, however, to know the historical influences that prompted the early use of tobacco. It is known that smoking developed social significance through tribal ceremonies and customs of the indigenous populations of North America. As industrial societies became established, mass production and corporate marketing took advantage of the stimulative and addictive properties of nicotine. The use of tobacco also took on a new social meanings as it was marketed to fulfill psychosocial needs such as a attaining independence or being part of a "cool" trend. The result was widespread and frequent usage, particularly through the smoking of cigarettes. High consumption has since produced devastating health effects. Although early opponents had to rely primarily on moral and emotional persuasion, epidemiological evidence of tobacco's impact on morbidity and mortality now provides the principal impetus to develop policies to prevent smoking.

The abundance of information that now exists on smoking necessitates the use of various frameworks, theories, and models in order to achieve a comprehensive and coherent perspective. A frame work, such as PRECEDE-PROCEED, helps depict the broad context of smoking and encourages the analysis of a comprehensive range of variables; a theoretical approach facilitates explanations as well as predictions; and modeling enhances visual representation or mathematical relations. Most of the major public health models and theories have been applied to smoking, and the literature contains support for many of these theories. This is partly due to the generality of the theoretical concepts.

Figure 1 is a graph of the prevalence of smoking across age groups in Canada. This graph shows that daily smoking largely begins and expands during the teenage years, and then peaks among young adults before decreasing. The behavior follows a sequence of experimentation, initiation, maintenance, and cessation. While the major behavioral change occurs during the teenage years, many of the predisposing factors develop at an earlier age. Beliefs, attitudes, and values begin to develop very early in life, and these influence later behavioral patterns.

DEVELOPMENT OF BEHAVIOR PATTERNS

Human beings have a long period of infant and child development, which allows children to adapt and acquire coping skills that help them survive in

Figure 1

their environments. Due to the increasingly complex nature of society, the early socialization process needs to build capacities for communication, learning, and making decisions for healthful behavior. The initiation of smoking tends to exist among young people who report having a home environment that includes difficulty communicating with parents, lack of parental understanding, low levels of trust, and a generally unhappy home life. This type of family setting creates conditions conducive to a lifestyle that includes smoking. Such predisposing factors are also evident as social networks expand during the teenage years.

The teenage years are a time of transition. They form a bridge between the relatively sheltered environment of childhood and the roles of adulthood. Teenagers begin to confirm their own identities and emulate adult roles. There is a heightened awareness of role models and a tendency to establish boundaries through experimentation and experiencing new risks. School is obviously an important environment for teenagers and students who smoke at this age are more likely to experience difficulties in the academic setting. They experience lower grades, poor student-teacher interactions, minimal academic aspirations for the future, and often complain of unfair school rules. Teenage smokers also tend to have lower self-esteem—they are more likely to report feelings of unhappiness and loneliness, a lack of confidence, and a sense of being unhealthy.

Young people who smoke generally have a reduced capacity to implement practices that promote advancement at home and at school, and in other important settings. This can affect their ability to maintain a healthy sense of identity that includes belonging, worthiness, and hope for the future. Tobacco advertisements prey on these needs by offering an image of suave independence. The insinuation is that smoking will help an individual to achieve desirable qualities. Data are not readily available to quantify the behavioral impact of this practice. It has been shown, however, that young people are readily able to identify images and brands promoted by the tobacco industry.

Other aspects of the social environment have promoted the acceptability of smoking, such as smoking by role models in the movie industry and the widespread visibility of smoking. Studies indicate that smokers tend to overestimate the prevalence of smoking and underestimate the health hazards. All these processes and conditions are set in place during the early years of socialization, and they contribute toward a predisposition that smoking is acceptable and even desirable. Once individuals are predisposed toward the possibility of smoking, enabling factors facilitate the actual behavior.