Tobacco Prevention Interventions in Adolescents
Tobacco use is a major public health problem in our society. Tobacco addiction begins in adolescence and majority of smokers start using tobacco in the age group between 11-13 years. There are a number of tobacco prevention strategies targeted towards the youth such as school-based educational interventions, community-based interventions, advertising restrictions on tobacco use, youth access restrictions and public health education. The purpose of this article is to review smoking prevention educational interventions in adolescents conducted either in the school or community setting. In order to collect the materials for the study, a search of CINAHL, MEDLINE and ERIC databases was conducted for the time period 1985-2006. A total of 15 studies met the inclusion criteria. Eight out of the 15 interventions were targeted towards students in grades 6-7 which makes sense as majority of the adolescents start using tobacco in the age group 11-13 years. Nine out of 15 interventions reviewed did not use any behavioral theory. The six articles that used theory used social learning theory, community organizing theory, transactional and systems theory of environmental change and some constructs from transtheoretical model. There is need to explicitly reify behavioral theories by tobacco prevention interventions. Characteristics of the length of the intervention, personnel conducting the intervention, types of activities included in the interventions, and process evaluation results are discussed in the article. Recommendations for developing future educational interventions for preventing tobacco use in adolescents are discussed.
Tobacco use is responsible for about 430,000 deaths among adults in the United States (United States Department of Health & Human Services [USDHHS], 2001). In terms of tobacco initiation, it is observed that the use begins in adolescence and act as a gateway drug for use of other drugs later in life. Tobacco use in different forms such as cigars, cigarettes, bidis and spit-tobacco give rise to various morbid health conditions such as cancer of larynx, mouth, esophagus and lung. Also chewing tobacco gives rise to conditions like periodontitis, submucous fibrosis and tooth loss .It is generally seen that there are some sociodemographic, environmental and personal factors which put the youth at risk of using tobacco (USDHHS, 2001).
The Youth Risk Behavior Surveillance System (YRBSS) survey done to study priority health risk behaviors among adolescents between October 2004 and January 2006, found that 54.3% of students nation wide had ever tried cigarette smoking (life-time cigarette use), 23.0% of students had smoked cigarettes on ≥ 1 of the 30 days preceding the survey and 9.4% of students had smoked cigarettes on ≥ 20 days of the 30 days preceding the survey (current cigarette use) (Centers for Disease Control and Prevention [CDC], 2006a). It was also documented that nationwide 14.0% of the students had smoked cigars on ≥ 1 of the 30 days preceding the survey. It is seen that smoking addiction begins in adolescence and majority of smokers start using tobacco in the age group between 11-13 and about 10-15% starting after age 19 (CDC, 2006a). The Global Youth Tobacco survey begun in 1999 by the WHO (World Health Organization), the CDC, and the Canadian Public Health Association, which is a school-based survey, includes questions on prevalence of cigarette and other tobacco use in 132 different countries(CDC, 2006b). The salient findings of their study conducted between 1999 and 2005 reveals that any form of tobacco use was highest in the American and European regions (22.2% and 19.8%, respectively) and lowest in the South-East Asian and Western Pacific Region (12.9% and 11.4%, respectively). Furthermore current cigarette smoking was highest in the European and American regions (17.9% and 17.5%, respectively). Boys were significantly more likely to smoke cigarettes in South-east Asian, and Western Pacific Region (CDC, 2006b). Finally, in the Healthy People 2010 Report that documents national objectives in United States, the objective is to reduce past month tobacco use by students in grades 9 through 12 from a 1999 baseline of 40% to 21% by 2010, reduce past month cigarette use from 35% to 16%, past month spit tobacco use from 8% to 1% and past month cigar use from 18% to 8% (USDHHS, 2001).