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The Habit of Smoking. Prevalence.
Causes and Influences of the
Environment Home-School
in High School Students

Manzur, Rafael; Kriskautzky, Zully

Institute of Cardiology, Santiago del Estero, Argentina

SUMMARY
Introduction: The habit of smoking in teenagers presents questions about its beginnings, causes and influences of home and school.
Objectives: To establish the prevalence, causes for the beginning of smoking and influences of home and school in high school students.
Material And Methods: Anonymous survey was used; 29 questions and multiple answers with previous information in 8 high schools in Santiago del Estero. Some data were analyzed: distribution of frequencies and/or percentages, central tendencies and dispersion.
Results: a) 3.227 cases; age: 15,10±1,98 (13-18 years old) b) boys 33,6 %; smokers 7 %: c) girls: 51,5 %; smokers 27,87 %; d) daily quantity: less than 10 cigarettes 71,2 %; e) they began to smoke: less than one year: 40,7 %; 2 years 31,4 %; f) blond tobacco 85,3 % g) causes: advertising 2,5 %; just to try 40,9 %; as imitation: 8 %; influence of classmates 44,3 % h) place of smoking; with friends 50,1 %; at college 20,8 %; home 29,1 %; i) continuity of habit; custom 30,9 %; need 18,6 %; because they like 50,4 %; j) smoking fathers 46,3 % k) smoking mothers 32,5 % l) smoking teachers 61,2 %; m) smoking students´concept of habit: vice 53,4.
Discussion: The beginning of the habit of smoking in teenagers is a reality in cities of the country similar to those living in Buenos Aires, according to a study (project Gyts OMS) with a sample of 2.223 students, beginning al 9 years old, predominating girls. Similar causes: influence of classmates.
Conclusions: a) presence of smoking in school age, predominating girls b) beginning because of influence of classmates c) they go on smoking because they like it d) preference of blonde tobacco e) influence of smoking parents and teachers f) the habit is widespread in high socio-economic levels.

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INTRODUCTION
   The habit of smoking is considered a true drug addiction and is widespread all over the world; 47% of males and 12 % females smoke (1), causing cardiovascular illness and death by cancer of the lungs and pharynx (2).

   Countries with low level of socio economic development occupy the first places in the rank of the greatest number of smokers with more than 15 years of habit. Our country occupies place 46º, with a prevalence of 35% in people older than 15 years old (3).

   The habit is accepted socially in communities of adults of both sexes and it has lately extended to teenagers, influenced by causes tant tend to improve their social status and other causes. Adults and young people begin smoking during their university life, but in the past few years young people began to smoke earlier, during their high school period.

   That's why we ask ourselves: Where and at what age does the habit begin nowadays? Are high schools fertile ground for the beginning of the habit? Which are the causes for the beginning of smoking? Which is the influence of school and home? These questions are the starting point for the studies in order to find the answers.

OBJECTIVES
   To determine the prevalence over: a) The habit of smoking in students, b) Causes for the beginning, c) Influence of school and home on high school students of the capital city of Santiago del Estero.

MATERIAL AND METHODS
   The design of the studies, is plannified to present a scientific problem of quantification (descriptive), prospective, observational and transversal (4). The population studied: High School students attending schools in the city of Santiago del Estero. The study was made in three steps:

   1st. Step: discussion and information about the habit of smoking and its consequences, through several months using Programmed Conferences given by medical doctors, using didactical material and giving information about the components of cigarettes , organic consequences, physical and psychological consequences, etc.

   2nd. Step: Fulfillment of the anonymous survey , coordinated by a teacher, looking for spontaneous and true answers, without guidance.

   3rd. Step: charge of data and analysis. The studied variables are seen in the 29 questions in the survey, with the option of suggested answers, such as a) college, course and time of attending school b) age, sex, and districts where they live c) parents activities d) students knowledge about the habit of smoking e) information about parents and teachers´ habits f) level of information about smoking g) substances present in cigarettes h) organs that are affected and illnesses produced by the habit of smoking.

   Statistic analysis: Data was placed in a base of related data Foxpro2,5 (5) and then analyzed using statistic program (Statgraphics V.5.0 (6). We analyzed these data for : a) categorical variables : distribution of frequencies and/or percentages and b) variables in superior scale: parameters that resume measures of central tendency and dispersion (7). The manuscript was made with word processor.

RESULTS
   The sample of 3.227 students (a) average age: 15,10 +- 1,98 years old ( 13-18), females 1.084 students ( 33,6% ), belonging to State schools 2.046 students (74,5%) and Private schools 881 students ( 25,5%).

   Distribution according to courses they attend: 1st. Year: 805 students ( 24,59%) 2nd. Year 706 students (21,88%) 3rd. Year: 604 students ( 18,72 %) 4th. Year: 597 students (18,5%)5th. Year: 429 students (13,29%); 6 th year: 40 students (1,21%) and 7 th year : 46 students ( 1,43%). Attending morning school: 2.575 students (79,8%) attending afternoon school: 652 students (20,2%).

   Answers about total sample: ( n= 3.227): Level of information: A) What is smoking? a) habit: 411 students (12,7%) b) pleasure: 206 students (6,4%) c) Vice: 1.629 students (50,5%) d) Illness: 672 students (20,8%) e)Intoxication: 309 (9,6%). B) Problems for the health of smoking people?_a) severe al high degree: 1.499 students (46,5%) b) severe: 902 students (27,9%) c) severe: 587 students (18,2%) d) not very severe: 79 students (2,5%) e) not sever at all: 36 students (1,1%).

   Answers about total sample: (n= 3.227): Level of information: A) Substances present in cigarettes ? a) nicotine 2.078 students (64,3%) b) tobacco 668 students ( 20,7%) c) pitch:167 students (5,2%) d) filter 29 students (0,9%) e) carbon monoxide77 students (2,5%) f) drugs 15 students (0,4%). B) Organs most affected by cigarettes: a) lungs: 2.591 students (80,2%) b) heart: 275 students ( 8,5%) c) brain: 26 students (0,81%) d) lever: 7 students (0,21%) e) kidney: 5 students (0,15%) f) larynx-pharynx: 153 students (4,74%). C) Illnesses caused by cigarettes: a) cancer in general: 1.923 students (59,6%) b) lung cancer: 761 students (23,5%); c) heartbreak: 111 students (3,5%); d) neumonia: 74 students (2,3%) e) asthmatic bronchitis: 65 students ( 2%).

   Students answers about smoking habit: Affirmative: 226 students (7%): females 109 (48,2%) belonging to state colleges 181 students (80,7%): private schools 45 students (19,3%). Courses: 1sr, year: 14 students (6,1%); 2nd. Students 22 students (9,7%); 3rd. Year: 54 students (23,8%); 4th. Year : 63 students (27,8%); 5 th year: 45 students (20,3%); 6 th year: 14 students (6,1%) and 7th year: 13 students (5,7%).(Table 1).

   Students answers about the habit in relation to: A) daily amount: a) less than 10 cigarettes per day: 161 students (71,2%); between 11 and 20 cigarettes: 65 students ( 28,8%). B) when the habit began: a) less than one year before: 92 students (40,7%) b) 1 to 2 years: 71 students (31,4%) c) 2 to 3 years: 35 students (15,4%) and d) more than 3 years: 28 students (12,4%) C) Type of tobacco: a) blonde: 193 students (85,3%) and b) black: 33 students (14,7%). (Table 2).

   Students answers about the habit in relation to: A) place where they smoke: a) when they are with friends: 113 students (50%) b) at home: 66 students (29,2%) c) at school: 47 students (20,8%) B) How they get cigarettes: a) invitation 44 students (19,5%), b) gift: 42 students (18,6%), c) they buy them: 102 students (45,2%), C) causes: a) advertising: 6 students (2,5%) b) just it try: 92 students (40,9%), c) imitation: 18 students (8%) d) status: 10 students (4,3%) e) influence of school partners: 100 students (44,3%), D) Permanence of the habit: a) custom: 70 students (30,9%) b) need: 42 students (18,6%) c) they like it: 114 students (50,4%) (Table 3).

   Students´ answers about paretns´habits: A) Smoking parents (father-mother) 2.511 (77,8%). Fathers: 1.462 (45,3%) mothers: 1049 (32,5%), B) Smoking students with: a) smoking father: 121 students (53,5%) b) non smoking father: 105 students (46,5%), C) Smoking students with: a) smoking mother: 99 students (43,8%) b) non smoking mother: 127 students (56,2%). (Table 4).

   Students answers about: A) Smoking teachers: a) class hours: 554 students (17,4%) b) in breaks: 689 students (21,4%) c) teachers room: 1.974 students (61,2%), B) Smoking students and teachers answers: a) during class hours: 40 students (17,7%) b) during the breaks: 51 students ( 22,6%) c) teachers room: 135 students (59,8%). (Table 5).

DISCUSSION
   The studied population represents approximately 70% of high school students of the capital city of Santiago del Estero. It constitutes a representative sample. The global prevalence of the main capitals of the world in relation to our study has is lower than in other studies. Germany (7,7%) (8) and Mexico (9,1%) and very low compared with the rest of the mentioned capitals, with an average of 35,5%, with similar ages.

   Different works in the entire world show the prevalence of the habit of smoking among students. The study made in Oklahoma (10) established the prevalence of 21% in young adults, the prevalence of feminine sex, with an during high school time up to 38%, percentage that reduces after graduation (28%).

   The study establishes as conclusion that preventive actions through campaigns make the habit decrease between 8 and 9 th grades. Those actions produce more important positive impacts as measures to prevent the habit in adults.

   The prevalence of the habit in German colleges varies according to the considered level. GYMNASIUM presents prevalence of 2,7%, different from HAUPTSCHULE with 14,3 % or KEALSCHULER with 5,6 % , or GESAMTSCHULE with 8,2%.

   The study with the method of the anonymous survey made in Barcelona (11) over students of the 8th. Grade (ages 13 to 14), reveals that adolescence is an important period to develop preventive actions to try to avoid smoking in adults. The results show: teenagers present prevalence of 10,9 % without sex differences. The conclusion is the increase of the habit in school population.

   A national survey in France (12) considering teenagers and adults show the decrease of smoking in both sexes teenagers (16%) along 14 years of control. Boys from the 10th. grade of the Canadian School (13) showed prevalence of the habit of 28 %. In senior and junior high schools in the rural area of Oregon, United States (14), there exists a prevalence of 39 % of the habit of chewing tobacco, 7 % corresponding to women, which is considerably high for this form of addiction.

   Non students teenagers from Chile (15) are: usual smokers 36-40 % (older than 10 years old) and 48 % (older than 15 years old). The results are different in Chinese cities, with almost no smoking women ( 2%)(16), different from men who began smoking between 20-24 years old (52%) as a consequence of customs and beliefs of oriental women.

   An anonymous survey (17) in 3.623 teenagers of 8 schools of Northern England, reveal prevalence of 21 %, more women than men, the same prevalence as in bulimic girls in Japan. (18) The global average prevalence of smoking habit in student teenagers and non student teenagers in the world is about 25%. (Table 6).

CONCLUSIONS
   a) The low prevalence, in relation to other countries and the world average, with predominance of feminine sex, state colleges, in students of 14-15 years old, that regularly are in 3rd-4th grades.

   b) There exists influence of home and colleges as initial places for the habit.

   c) Teenagers smoke less than 10 cigarettes per day, with election of blonde tobacco; more frequent with friends and classmates.

   d) The influence of the students own classmates is a great influence for the beginning of the habit of smoking; then they go on smoking because they like it.

   e) High school students of Santiago del Estero have an adequate level of information about addictions, and they know what happens to the body, with the exception of heart illnesses.

REFERENCES

1. Organización Mundial de la Salud, reporte con motivo del Día del Aire Puro mayo1996.

2. Manzur R.E.: Tabaquismo revisión y actualización. Rev Fed Arg Cardiol 1990; 19 (1)

3. 9º Modulo de Medicina Familiar, org. Consejo Medico de Sgo. del Estero, junio 1995, pag 3-7.

4. Castiglia V.: Principios de Investigación Biomedica. Ed. Producción Gráfica: R. Primavera, Bs. As.-1995: 338.

5. Siegel C.: Mastering Fospro2. Ed Sybex Inc. USA, 1991.

6. Statgraphics: Statical Graphics System. Statical Graphics Corporations Inc. USA, 1988, 321-332.

7. Castiglia V.: Principios de Investigación Biomedica. Ed.Producción Gráfica: R. Primavera, Bs. As.-1995: 128-133.

8. Scholz M., Kaltnbach M.: Cigarrette, alcohol and drug use in 12 to 13 year old adolecents-an anonymous suvery of 2979 students. Gesundheitswesen 1995 jun: 57 (6): 339-44.

9. Lanido Laborin R., Moreno C., Vargas R. Et. Col.: Los niños que trabajan en las calle de Tijuana. Perfil epidemiológico y prevalencia de experimentación con tabaco. Salud Publica Mex 1995 Mar-Apr; 37 (2): 149-54.

10. Hann N., Asgha A., : Smoking: high hazards in high school. J Okla State Med Asso 1995 Jun; 88 (6): 247-51.

11. Villalbi J.R., Nebot M., Ballestin M.: Los adolescentes ante las sustancias adictivas: tabaco, alcohol y drogas no institucionalizadas. Med Clin Barc 1995 May 27; 104 (20): 784-8.

12. Sasco A.J., Grizean D., : Is tabacco use finally decreasing in France ? Cáncer DetectPrev 1995; 10 (2): 210-18.

13. Small S.P., The smoking behaviour of grade 10 student. Can J Cardiovasc Nurs. 1994; 5 (2): 3-10.

14. Salehi S.O., Elder N.C.: Prevelance of cigarette and smokeless tobacco use among students in rural Oregon. Fam Med. 1995 Feb; 27 (2); 122-5.

15. Gutierrez M., Rioseco F., Rojas U. Et Col.: Prevalencia del Tabaquismo en la pobalcion general de Valparaiso y Viña del Mar. Rev Med Chil . 1995 Feb; 123 (2): 250-6.

16. Gong Y.L., Kaplan J.P., Feng W., Et Col.: Cigarrette smoking in China, prevalence, characteristics and actitudes in Minhang District. Jama 1995 oct 18; 274 (15): 1232-4.

17. Gilvarry E., Mc Carthy S., Mc Ardle P.: Substance use among schoolchildren in the north of England. Drug Alchol Depend 1995 Mar; 37 (3): 255-9.

18. Zuzuki K., Takeada A., Malsushita S.: Coprevalence of Bulimia with alcohol abuse and smoking among Japanese male and femele high school students. Adition 1995 Jul; 90 (7): 971-5.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
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Dr. Raúl Bretal
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