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Smoking: Factors of Risk of Cardiovascular
Illness in Young High School Students

Manzur, Rafael; Kriskautzky, Zuly

Instituto de Cardiología. Santiago del Estero. Argentina

Introduction: Smoking is one of the factors of risk of cardiovascular illness in both sexes; we want to know where and when the habit begins in relation to age, causes and influence of parents and teachers, and the role played by advertising.
Objectives: To establish the level of influence of smoking as a factor of risk of cardiovascular illness in high school students.
Material And Methods: 6Sample of 3.227 students; plannified anonimous survey; 29 questions with multiple answers and some free answers ; previous information about the theme to all the students during a year with the active participation of one teacher per schhol; 8 teachers took part in the survey. Probability of relative risk and percentage risk were used to establish the percentage of the influence of factors of risk (FACTOR) about higher possibilities of having an event (RISK) of cardiovascular illness.
Results: Affirmative answers 7 %. Smoking parents 77,8 %; smoking teachers in class hours 45 %. We analyzed relative risk factors (FRR) and percentage considering risk (RAP). Table 1.

Conclusions: a) smoking parents with higher probabilities of developing risk, followed by smoking teachers b) living in downtown areas represents a risk c) parents´work was not the cause of higher probabilities.


   Among the main factors of risk that cause cardiovascular illness (ECV) we can mention the habit of smoking, that favor the appearance of heartbreaks and vascular accidents, and is the most important cause of death by lung and pharynx cancer (1).

   Smoking is a habit spread all over the world, with an incidence of 47% in men, in front of 12 % in women (2). Periphery countries occupy the first places in the ranking of smokers with more than 15 years of habit in relation to the total poblation. Argentina occupies the 46th. Place, presenting a prevalence of 35 % in people older than 15 years old, in a study made in 1991 (3). The global average prevalence of students and non students teenagers smokers in the main capitals of the world is about 25,5% (4).

   Smoking is socially accepted in our communities, first as a habit of high school period, with a strong influence of school, students, and teachers during class hours that constitute factors of risk of ECV. We have to mention influences that increase the risks such as home, with smokers parents, imitation of adults, (1) where the teenagers are easily influenced in this stage of life, where they imitate tendencies and acts.

   The FRICELA study (5) reveals the important association of smokers parents and young smokers. The association of the two qualitative variables (6) allow to relate the presence or absence of EVENTS (final stop) with the presence or absence of EXPOSITION, in this case present in the habit of smoking, in students, parents and teachers, thus making it possible a way of representing the probability in a "proportion" between the event and all the probabilities that can occur. The application of these scientific procedures used to analyze factors as elements of relative and absolute risk, are used frequently for estimations in individual patients (7).

   The use of these procedures to evaluate factors of risk in teenagers that attend high school would be positive, a good possibility to apply precociously strategies of primary prevention.

   To determine the degree of influence of smoking as a probability as factor of risk for cardiovascular illness because of: a) influence uponstudents b) parents habits at home c) teachers habits at school d) parents´ activities e) socioeconomic situation of students attending high school in the capital city of Santiago del Estero.

   With propsective, observational and transversal design (8). We plannified the study in three stages:

1st. Stage: diffusion and information about smoking habit and its consequences; along several months, through programmed conferences in charge of medial doctors, using didactical material and giving information about components of cigarettes, organic consequences, physical and psychological recovering, etc. 2nd. Stage: fulfillment of anonymous survey, coordinated by teachers, looking for true and spontaneous answers, without foreign influences. 3rd. Stage: data load, analysis and conclusions.

   The studied variables are reflected in the 29 questions of the survey, with the options of suggested answers, such as: college, course and time of attendance b) age, sex, district c) parents activities d) students knowledge about the habit of smoking e) information's about parents and teachers habits f) level of information's about smoking g) substances composing cigarettes h) human organs affected and illnesses caused by smoking.

   The analysis of variables related to relative risk factors (FRR) and percentage atribuible risk (RAP), is related to the influence of the smoking habits of students, parents and teachers. These factors show the percentage of an illness that can be eliminated among those who have factors of risk if the effects are suppressed. One factor of risk is a variable (FACTOR or EXPOSITION), whose presence indicates more probabilities of having an event (RISK-EVENT) (8).

   Statistic analysis: it was made with related data base, FoxPro 2,5 (9) and use of statistic program (Stat graphics V.5.0 (10). Probability of relative risk and percentage attributable risk was used Reduction relative risk (RRR), Reduction absolute risk (RRA) and Odds Ratio, with their intervals of trust to 95% (6).

   Sample of 3.227 students, average age 15,10+-1,98 years old (13-18); sex: masculine 1.084 (33,6%); attending state colleges: 2.406 students (74,5%); attending private schools: 881 students (25,5%). Distribution according to the courses they attend: 1sr. 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%).

   Answer about students smoking habit: affirmative answer: 226 students (7%); masculine sex: 109 students (48,2%); distribution in courses: 1st. Year: 14 students (6,19%); 2nd. Year 22 students (9,73%); 3rd. Year: 54 students (23,89%); 4 th. Year: 63 students (27,87%); 5th. Year: 45 students (20,35%); 6 th. Year: 14 students (6,19%) and 7 th. Year: 13 students (5,75%).

   Factors of Present Watering: The factor of Relative Risk (FRR) of smoking students for smoking parents' influence was 1,36 (standard value: 1) with Percentage Attributable Risk (RAP) of 26,4%. (Chart Nº 1).

   The probabilities of incidence of events among students with and without I inhabit, with relationship to the influence exercised by parents (father-mother) and professors (in Hours of class-room professors) summary in Graphic Nº 1.

   The relative Risk (RR) and the Reduction of relative risk (RRR) of contracting smoking students' ECV for parents' influences (father-mother) and professors (in schedules of class) they were increased (Chart Nº 2), (Graphic Nº 2) remaining without influence in the increment of the risk, the professors (during permanency in room professors with I inhabit), as well as the expressed thing the increment of the Odds Ratio, with interval of trust of 95% (Chart Nº 3).

   The information to discriminate against the increment of the Risk by means of the Reduction of the absolute risk (RRA), offering more complete knowledge that the RRR; their results are reflected in the Graphic Nº 3.

   The sample is representative; it includes approximately 70% of high schools students of the capital city of Santiago del Estero, from state schools (75%), majority of girls (66,4%); most students are attending 1st. to 3rd. Year.

  The results of prevalence of smoking students was 7 % for the city of Santiago del Estero, with low density of population and almost no contamination, different from the average numbers of studying and non studying teenagers (25,5%) in similar conditions in the main city capitals of the world. (4), considering that the influence of this risk factor plays an important role in the future adult community and should apply measures of prevention.

   The habit present in relatives has its influence in young students, as it is revealed in the FRICELA study (5), with a frequency of association of risk in teenagers, specially that related with mothers habit and girls habit; that shows statistically p<0,0005, followed by the influence of smoking fathers- boys with p<0,03.

   Our results express a Percentage Atribuible Risk increased in a 36,3% corresponding to the factor of the habit of smoking mother - smoking student, at home. It is also remarkable the influence that teachers have as risk factors upon their students. The association smoking teachers in class hours- smoking students presents a RAP of 35,06%, thus we have to consider this point as an alarm for educational managers.

   a) We have to remark that smoking parents, followed by smoking teachers during classes, mean more probabilities of association of risk factors.

   b) The environment home-school is the main cause together with variables as element of risk in high school teenagers.

   c) The smoking habit in adults is a drug addiction socially accepted; this is the firth stimulus children and teenagers receive for beginning with the smoking habit.


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

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4. Manzur R.E. :Habito de fumar, prevalencia en alumnos de colegios secundarios de la ciudad de Santiago del Estero. Informe preliminar.

5. Tabaquismo en los adolescentes, Consejo de epidemiología y Prevención cardiovascular de la Sociedad Argentina de Cardiología, Informe preliminar, XXIII CONGRESO ARGENTINO DE CARDIOLOGÍA 1996.

6. Doval H. Tajer C.: Evidencias en cardiología: De los ensayos clínicos a las conductas terapéuticas, Impresocolor SA, Bs. As, 2000

7. Riegelman R.K., Hirsch R.P.: Como estudiar un estudio y probar una prueba: Lectura critica de la literatura medica. Editorial OPS. Publicación Nº 531- Washington, 1992: 39-43.

8. Castiglia V.: Principios de Investigación Biomédica. Editorial Producción Grafica: Ricardo Primavera, Bs. As.-1995: 128-133.

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

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


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