Dealing with Tobacco Use Among Youth: What Can Extension Family and Youth Professionals Do?

Cooperative Extension provides educational programs for healthy living. At the community level, Extension provides educational programs relative to food safety, nutrition, human development, and farm safety education. One of the goals of Extension's national health agenda, "Decisions for Health," is to expand the ability of communities to strengthen their health and health related infrastructure needs (Report of the National Extension Health Agenda Task Force, 1992 ). Under this goal, Extension programs will identify and develop strategic partnerships and coalitions at local, state, and national levels involving health providers, educators and consumers.

The Extension Committee on Organization and Policy (ECOP) identified nine priorities for the Extension system to address in fiscal year 1994. Health was given the highest priority. ECOP urged that this issue be addressed by the agricultural sciences and education community in collaboration with other agencies through research and education programs. Pennsylvania State Cooperative Extension, in collaboration with The Pennsylvania Department of Health, and Fox Chase Cancer Center developed six community coalitions to address one of the pressing health problems facing youth in our society, that is, tobacco use among our teenage population.

Cigarette smoking continues to appeal to millions of teenagers despite abundance of information available regarding the negative effects of smoking and efforts to encourage smokers to quit and young people not to start. In fact teenagers are beginning to smoke at younger ages, with the age of initiation decreasing, especially among girls.

According to Boyd (1993) the average age of smoking initiation has fallen over the last 25 years. While 20% begin smoking as early as 9th grade, some begin as early as 8 or 9 years of age. The age of smoking initiation is very important for two reasons: a) the younger the adolescent begins smoking, the more likely he or she will be addicted as an adult; b) the more likely he or she will become a heavy smoker and develop a smoking -related disease in later life (American Cancer Society, 1992). Daily an estimated 3,000 children between the ages of 9 and 16 in the U.S. initiate smoking. Of this, nearly 750 (25%) will eventually die from tobacco related diseases (Center for Disease Control, 1992).

Over the past 25 years, cigarette smoking practices of adolescents in the United States have undergone a number of marked changes (National Center for Health Statistics (NCHS), 1989). In 1968, 17% of teenage boys and 10% of teenage girls reported smoking cigarettes regularly or occasionally. Six years later, in 1974, the number of teenage boys smoking remained more or less the same (16.3%). There was about a 60% increase in the proportion of teenage girls who smoked (up from 10% to 15.9%). The latest available data on adolescent smoking indicates that smoking by adolescents is on the rise (NCHS, 1992).

The major purpose of this study was to determine the extent of cigarette use among 7th, 9th and 12th graders in six counties of Pennsylvania. Specific objectives of the study were to: a) determine the cigarette use patterns among 7th, 9th and 12 graders in the six counties; b) determine differences, if any, between smoking status (smokers vs. non-smokers) and selected characteristics--gender, race, after high school plans, attitude toward school, and perceived GPA, that is grades expected at the end of the school year; and c) determine differences, if any, between smoking status (smokers vs. non-smokers) and attitude/perceptions toward use of tobacco products.

In the Spring of 1995, the Pennsylvania Tobacco Survey for Students was conducted to address youth tobacco use issues in six counties (Bucks, Clarion, Columbia, Franklin, Wayne, and Westmoreland). These six counties are a part of the Community Coalitions for Tobacco-Free Youth--a joint effort by the Pennsylvania State Cooperative Extension, the Pennsylvania Department of Health, and Fox Chase Cancer Center.

Descriptive survey research methodology was used to collect data. The target population of the study consisted of 7th, 9th and 12th graders. This group of was selected because of a state wide study that also used 7th, 9th and 12th graders as its target population. This allows for comparison of this study sample with the state sample. In addition, this study sample is unique in the sense that community coalitions to address youth tobacco were established and impact of the coalitions on communities assessed.

A random sample of 13,196 stratified by grade was selected. A survey instrument was developed to collect data. Included in the instrument were questions related to demographic characteristics, smoking status, and perceptions and attitudes toward tobacco use. Teachers were provided with guidelines and instructions to collect data. A total of 8,634 usable responses were received for a response rate of 65%. Data were analyzed using frequencies, means and percentages. In addition, t-tests were used to determine differences.

Objective 1: Cigarette Use Patterns Three questions were asked to determine the extent of cigarette use among the three groups of respondents. Overall, 45% of the responding students had smoked an entire cigarette. 31% of 7th graders, 54% of 9th graders and 65% of 12th graders had smoked an entire cigarette in their lifetime (Table 1). Thirty- five percent of the respondents had smoked at least 100 cigarettes in their life time. Eleven percent of 7th graders, 29% of 9th graders and 39% of 12th graders had smoked at least 100 cigarettes in their lifetime. Twenty-two percent of the respondents currently smoke cigarettes. Thirteen percent of 7th graders, 26% of 9th graders and 33% of 12th graders currently smoke cigarettes.

Objective 2: Demographic Differences

Significant differences existed between select demographic characteristics--race, after high school plans, and smoking status. Significant differences were found between race and smoking status. Among smokers, a higher proportion students tend to be white, followed by Native Americans, Hispanic and Asian (Table 2). Smokers were more likely than non-smokers to join the military or go to work. On the other hand, non-smokers are more likely than smokers to plan to go to college (Table 2). No significant differences were found between gender and smoking status.

T-tests were used to determine differences between smoking status and attitude toward school and perceived GPA (Table 3). Smokers are more likely than non-smokers to perceive their GPA as lower or below average. Similarly, smokers are more likely than non-smokers to dislike school.

Objective 3: Differences in Attitudes/Perceptions

Significant differences existed between smokers and non- smokers relative to seven questions which measured student attitudes and or perceptions (measured on a five-point Likert scale which ranged from 1=strongly disagree to 5=strongly agree) about tobacco use. Results are shown in Table 4. Smokers more likely than non-smokers to agree that: a) it is OK to sell tobacco products to minors; b) don't mind being around people who smoke; c) smoking helps people to relax; and d) they will probably smoke cigarettes when they are adults. On the other hand, non-smokers more likely than smokers agreed that: a) teachers care a lot about kids smoking; b) schools have the right not to allow smoking in school property; and c) other people's smoke is hazardous to health. No significant differences were found between smokers and non-smokers relative to the statement, smoking is a difficult habit to quit (Table 4).

Tobacco use among teenagers in the six-counties appears to be high and mirrors national averages. Overall, 22% currently smoke cigarettes. Twelfth graders are more likely than 9th and 7th graders to be current smokers. Smokers are more likely than non-smokers to dislike school and to perceive their GPA as lower or below average. Older kids, especially whites, are likely to smoke more than younger and other minority kids.

Despite the consequences and health risks associated with smoking, youth are more likely to smoke cigarettes when they become adults. Kids who currently smoke cigarettes are not aware of the extent of problems and health risks associated with tobacco use. These kids have a strong opinion about tobacco use and its effect on others. There is a need to create awareness, understanding and prevention of tobacco use among youth for a better future and healthy living.

The following recommendations were made based on the findings and conclusions of the study.

Although use of hard drugs is on the decline in the United States, the use of gateway drugs such as tobacco and alcohol are still significant problems among school age youth (National Institute on Drug Abuse (NIDA), 1991). The health and development of students who use these drugs are affected as is their performance in the classroom, which in turn impacts education of all students.

Prevention programs are essential for providing the youth of today with greater awareness and understanding of tobacco issues. The health risks and other pertinent issues relative to tobacco use need to be conveyed to youth. Extension professionals should use this opportunity to develop educational programs which create awareness, understanding, and prevention of tobacco use among youth. Educational programs highlighting the harmful effects of tobacco use should be made available ealy on so that kids are aware of the bad effects of tobacco use. Such awareness and understanding will help kids to either not use tobacco or make informed decisions about using tobacco when they become adults.

Schools are often the second agency (the first being family) to see that there is a problem with the child. In many communities, schools have played an active role in addressing issues related to youth. Extension professionals should closely work with schools to identify how they can collaborate to address issues relative to youth tobacco use.

It has been said time and again that tobacco is a "gateway drug." That is, starting tobacco will lead to use other drugs. Literature suggests that those who had smoked cigarettes also had used other drugs (cocaine, marijuana, pot, etc.). Further, drug prevention programs do exist in many schools, especially inner city schools. Potential exists for Extension professionals to collaborate with schools, teachers and other agencies at the local level to design after school programs relative to youth tobacco use. Extension agents should take advantage of this opportunity to work closely with schools and integrate their programs with the on going drug prevention programs in schools. Such integration will help share resources and expertise, and thereby avoid duplicating programs.

Allen, K.F., Moss A.J., Govino, G.A., Shopland, D.R., and Pierce, J. P. Teenage tobacco use: Data estimates from the Teenage Attitudes and Practices Survey, United States, 1989. Advance data from vital and health statistics; no 224. Hyattsville, Maryland; National Center for Health Statistics. 1992.

Boyd, R., (November 1993). Epidemiological basis for tobacco control. Paper presented at the workshop on Tobacco Control sponsored by the Community Coalitions for Tobacco-free youth, State College, PA.

Centers for Disease Control. Accessability of cigarettes to youth ages 12-17 years, United States, 1989. MMWR: Vol. 4, No. 27: 485-8. 1992

Decisions for Health-An Extension System Agenda (1992). Report of the National Extension Health Agenda Task Force. ES- USDA and the University of Wisconsin Extension under special project number 91-EXCA-2-0148. University of Wisconsin.

Massey, J.T., Moore, T.F., Parsons, V.L. Tadros W. design and estimation for the National Health Interview survey, 1985-94. National Center for Health Statisics. Vital Health Stat 2(110). 1989.

Moss, A.J., Allen, K.F., Govino, G.A., Mills, S.L. (1992) Recent trends in adolescent smoking, smoking-uptake correlates and expectations about the future. Advance data from vital and health statistics; no 221. Hyattsville, MD: National Center for Health Statistics.

National Institute on Drug Abuse (NIDA) (1991). National household survey on drug abuse: Main findings, 1990. Rockville, MD: U.S. Department of Health and Human Services, Alcohol, Drug Abuse, and Mental Health Administration.