A Revisit: What is the Best Predictor of Smoking Initiation?

It has been well-established that daily smokers most frequently began smoking prior to age 18, and smoking habits in peers are among the greatest predictors in whether or not adolescents will begin to smoke (Mahabee-Gittensa, Xiao, Gordon & Khoury, 2013).  The adolescent years are dominated by emotions centred around social acceptance and the need to fit in with peers (Mahabee-Gittensa et. al, 2013).  With peer influences being so prominently known as the main predictor for smoking initiation, the important role played by parents in protecting against smoking initiation is downplayed.

That is not the sole reason why parents consistently play second fiddle to peers in population-based efforts to prevent smoking initiation.  There is a common belief that rules set by parents are ineffective with respect to regulating behaviours in teens, because adolescence is a period during which individuals are in the pursuit of increasing autonomy (Mahabee-Gittensa et. al, 2013).  Additionally, it would be plausible for some to argue that parents are minimally influential in determining the peer groups their son or daughter tends to associate with.

A recent study found that while having peers who smoked proved to put one at the greatest risk for smoking imitation, the effect was found to be significant only until mid-adolescence, or around age 15 (Mahabee-Gittensa et. al, 2013).  During those same years, parental monitoring, punishment for smoking, and perceived connectedness to parents also proved to contribute significantly to the risk of smoking initiation (Mahabee-Gittensa et. al, 2013).  Contrary to findings surrounding the temporal effects of peer influences that begin in early adolescence and diminish past mid-adolescence, parental education and monitoring were found to protect against smoking initiation before adolescence and well past the age of 15 (Mahabee-Gittensa et. al, 2013).  This implies a lasting effect of parents on the risk of smoking initiation, while peer influences only appear to showcase their true potential during the critical period from early- to mid-adolescence.

Despite the common belief that adolescents increasingly seek autonomy from their parents, it has been found that parents contribute greatly to a teen’s choice of friends (Mahabee-Gittensa et. al, 2013).  This illustrates that the most powerful predictor of smoking initiation (peer influences) is itself greatly influenced by parents, suggesting that indirectly, parents may actually be the most influential with regards to the risk of smoking initiation.  This phenomenon has been demonstrated through the increased tendency for children of parents with low education, socioeconomic status, and discipline to associate with troubled peer groups who are also much more likely to smoke (Mahabee-Gittensa et. al, 2013).  Also, one may reasonably argue that under certain circumstances, social risk factors could potentially exacerbate or even confound the influences of parenting.

The findings in this study have important implications for public health approaches taken in the prevention of smoking initiation, the most critical of which is that the role of parents should be taken as seriously as the peer groups of teens.  The authors of the article suggest that a successful intervention aimed at preventing smoking initiation should target both parents and peer groups (Mahabee-Gittensa et. al, 2013).  While I agree with the authors, I would also include social risk factors as a third consideration in smoking-prevention interventions, in addition to parents and peer groups.

References

Mahabee-Gittensa, M., Xiao, Y.,  Gordon, J., Khoury, J. (2013). The Dynamic Role of Parental Influences in Preventing Adolescent Smoking Initiation. Addictive Behaviours, 38(4), 1905-1911

Not Just An Addiction - Another Meaning To The Use of Tobacco

With the hard work of many individuals, smoking rates have decreased in Canada. The smoking rate decreased by about 15% from 1980 to 2004 (Wong, 2006)! Although this is good news for Canada as a whole, it appears that the prevalence of First Nations smoking although also decreased, is still quite high with an astounding 59% of Aboriginals on reserve who smoke (Health Canada, 2011).

           

There are many factors that influence the smoking rate of the First Nations in Canada although some factors in this list are not strictly limited to Aboriginals: nicotine addiction, ease of access for aboriginal youths (whether they get it from friends, family, or willing retailers), poverty, poor education, having access to tax-free tobacco on reserves, as well as the cultural meaning of the use of tobacco (Wong, 2006). For this blog entry, I will be focusing on the last point: the cultural meaning of using tobacco among the First Nations in Canada.

For many Aboriginals, smoking is not just a way to relieve stress or to be accepted into a social group. Smoking has a deeper meaning to many where it becomes part of rituals and traditional ceremonies (Wong, 2006). For First Nations, tobacco is vital in ceremonies where it creates a link between the person performing the ceremony and all living things as well as the Creator. This powerful link can be established by smoking a sacred pipe (Godlaski, 2012). 

These spiritual practices have existed for more than 2300 years (Godlaski, 2012) and carry a significant cultural meaning to the First Nations people of Canada. Through stories, it is known that the pipe was a vital part in sacred acts, as described in the passage below:

“What is perhaps most important is that the sacred pipe is a metonymy; it represents itself, the use of tobacco, and the worshipful act. The pipe is a kind of altar or sacrificial vessel, in which the offering of tobacco is burned, sending its smoke to all directions of the cosmos and ultimately to the Great Holy” (Paper, 1987, 1988).

Therefore, without the use of the pipe in rituals, there would be no meaning or power associated with the act (Godlaski, 2012).

Interestingly, the tobacco used in such ceremonies actually has more nicotine in it when compared to other tobacco ranging from 3.9- 8.6%. The more common types of tobacco only contain 0.05- 4% nicotine (Godlaski, 2012). This puts individuals at risk of developing an addiction to tobacco and may cause them not only use it ritually but also recreationally.

                                Pipe Bowl                                      Mississippi Style Bowl 

The whole entire ritual from the way the tobacco is put into the pipe to smoking and eventually the end of the ceremony holds significant meaning and requires meticulous preparation. The use of tobacco in such rituals is therefore key to the Aboriginals.

            If you’re interested in reading more about the use of tobacco in Aboriginals, try looking at this pdf: http://www.cps.ca/en/documents/position/tobacco-aboriginal-people

References:

Godlaski, T.M. (2012). Holy Smoke: Tobacco Use Among Native American Tribes in North America. Informa Healthcare, 1-8. doi: 10.3109/10826084.2012.739490

Health Canada. (2011). First Nations & Inuit Health. Retrieved from http://www.hc-sc.gc.ca/fniah-spnia/substan/tobac-tabac/index-eng.php

Wong, S. (2010, June). Use and misuse of tobacco among Aboriginal peoples. Paediatric    Child Health, 11(10), 681-5. Retrieved from http://www.cps.ca/en/documents/position/tobacco-aboriginal-people

The Youth Smoking Paradox

According to the World Health Organization, rates of tobacco-use are decreasing in developed countries and increasing in many developing countries (Kostova, 2013).  Resultantly, it has been projected that on the global scale, developing countries will be burdened with approximately 80% of all cases of tobacco-related deaths (Kostova, 2013).  At the present, a majority of the globe (174 countries) has adopted the World Health Organization’s Framework Convention for Tobacco Control, whose central focus is to control tobacco-use through increasing taxes on cigarettes, leading to increased consumer prices of cigarettes (Kostova, 2013).     

The argument that prices on cigarettes should be increased to prevent the initiation of smoking has received an incredible quantity of exposure in the media, and appears to receive an overwhelming amount of support from the public.  Less widespread however, is the criticism of the idea of raising prices on cigarettes, and opinions questioning whether or not such economic policies truly exert a powerful impact on reducing rates of smoking.

In developed countries including Britain, the United States, and Spain, studies looking at the effect of increasing prices on cigarettes with respect to smoking initiation and cessation in youth have been inconclusive, but the bulk of the cited research indicates that price increases on cigarettes are more likely to reduce rates of initiation as opposed to rates of cessation (Kostova, 2013).  This finding serves as a reminder of just how difficult it is to quit smoking following initiation, and that saving money by not purchasing cigarettes is often not the primary reason smokers choose to quit smoking.

Contrary to the predictable findings in developed countries, the findings for developing countries proved to be surprising and unpredictable.  When results from developed countries were compared with those retrieved from developing countries, it was found (overall) that youth in developing countries appeared to be less responsive to price increases in cigarettes (Kostova, 2013).  It is likely that one would have expected the opposite, because these individuals (on average) have significantly lower incomes than their counterparts in developed countries.  The direct implication of this finding is that increasing prices of cigarettes in developed countries may actually produce a more powerful downward force on smoking initiation and cessation.

In conclusion, the paradox exists in the sense that increasing prices on cigarettes appears to be the least effective in preventing smoking initiation and promoting cessation in those who have the greatest difficulty affording them.  A plausible argument in light of these findings is that raising prices on cigarettes may not actually be the most effective method of reducing rates of tobacco-use.  Perhaps a move towards educating individuals (particularly in developing countries), empowering them to make healthier life choices, may prove to be a greater contributor to tobacco control than economic policies.

References

Kostova, D. (2013). A (nearly) global look at the dynamics of youth smoking initiation and cessation: the role of cigarette prices. Applied Economics. 45(28), 3943-3951. doi: 10.1080/00036846.2012.736947

How To Deal With A Parent Who Smokes

When people talk about the effects of second or third hand smoke, they only really discuss the physical harm. However, along with the damage that can be made to someone’s body, there is emotional damage that can be made as well. My parents have been smoking for most of their adult lives. The confusion that a child of a smoker like myself faces is, in my opinion, almost equally as damaging as the effects it has on my physical health. Why is it that they don’t care about my health? Why won’t they quit if they know that their habits are affecting me negatively? As someone in this position, I find it hard to understand my parents’ lack of compassion. I have tried all 19 years of my life to make them quit as I find it a not-so-great habit. There are many ways one can go about getting their parents to quit, many of which I have tried. Here is a list of ways that I myself have tried, the things that have gone wrong with them, and how to deal with it when it doesn’t go in your favour. 

Guilt

This is a manipulation tactic that is one of the most common ways to try and get anyone close to you to quit smoking. I have said many different things to try and guilt them out of it over the years, by expecting that the way that I feel would overpower their addiction. However, what I needed to realize and what many others need to realize is that smoking is an addiction and like any addiction, it overpowers everything else in their mind. It is a device that is able to control them in every way. You need to remember that this does not mean that they care any less about you. If you try guilting them and it works for you, great, but if you try and you fail, don’t think any less of how much they love or care about you. The two don’t have anything to do with each other.

Their Personal Health

This may be considered a form of guilt, but I consider it to be in a different category in terms of the effect it has on you. Everyone knows smoking kills. Research shows that smoking leads to cancer, can provide complications with breathing and with a person’s lungs, and decreases the life expectancy .Many insurance companies even adjust your policy on life insurance when they become aware of your smoking habits. One thing to remember when using this is that your parents and loved ones aren’t stupid. A lot of the facts that you may be spewing to them are things that they are probably aware of too. However, it is important to outline their health to them - especially if they are getting older. Although it may not be completely successful, they may come to a revelation.

Bribery

This may sound dumb but when I was young, I was a little bit naïve. I essentially tried to condition my parents without even knowing what the concept of conditioning was. I told my parents one day that if they cut back on the amount of cigarettes they smoked each week, I would do extra chores/give a bit back in my allowance. However, what I did not realize at the time (once again very young and naïve) is that whatever my parents wrote on a tally table was not necessarily how much they smoked. When I thought that my parents had almost completely quit smoking, they were actually smoking just as much, if not more than they had before because of the stress they felt from hiding it from me. When I eventually found out, I was incredibly disappointed and once again felt insecure about how much my parents cared about me. It is important to make sure that your parents aren’t forced to lie to you because let’s face it, who likes being lied to? If your parents are legitimately honest with you in a situation like this, then maybe this tactic will work for you but just make sure you don’t get disappointed if it doesn’t. Your parents are just trying to make you happy. 

Throwing Books/Nicotine Patches/Nicotine Gum At Them

The book above is one that my mother, who normally reads about 3 books a week minimum, has been pretending to read for the last year and a half. My brother had heard that it worked for a few people that he knew who smoked and he wanted to try it out. Clearly, it didn’t work. The thing about quitting smoking is that if someone doesn’t have the motivation, they will not quit. If you just throw books or gum at them and say here this is the way that you will quit, you cannot guarantee that they will want to. Most likely they will not want to. In my opinion this isn’t really a good way to make them quit, and can only really work if a person has expressed the desire to stop smoking.

Encouragement/Support

A lot of people want to stop smoking and know the risks but they just can’t do it alone. There is a difference between yelling things at them to stop and being supportive. I have of course done both of these things as I can throw quite the temper tantrum when I want to. Yelling obviously did not make it better; actually, it just kind of made my throat hurt. But over time, and I am still working on this, I have made my parents realize how important it is that they quit and also made them realize that I am here every step of the way.

Before I end this blog, I kind of need to clarify some things just in case one of my parents happens to read this. I love my parents and I think that they did an incredible job raising me. This is their flaw. So if you are reading this and you are someone who smokes and has a child, know that this is not his or her only opinion of you. I am still fighting my battle to make my parents quit and you may still be fighting yours as well. This is all a little hard to understand. It has taken me years to grasp the concept and some days, I still don’t even get it. One thing you always have to remember is that none of this is a reflection of how much this person or these people love you. You just have to keep “fighting the great fight”.

References:

http://www.pophealthmetrics.com/content/4/1/14

http://www.amazon.ca/Allen-Carrs-Easy-Stop-Smoking/dp/0973468408

http://www.14legs.net/2011/05/smoking-farting.html

http://www.lifeinsurancecanada.com/life-insurance-for-smokers

Smoking Bans: Why They Aren’t Personal Attacks on Smokers

Smoking bans have become increasingly strict and extensive in recent years. It has even been proposed that the freedom to smoke in public will be eradicated in the not–too-distant future.  This has led to concern amongst smokers that these bans are personal attacks against them, with the intentions of strengthening the divide between smokers and non-smokers.  On the other hand, there has been significantly less emphasis directed towards the positive motives of the introduction of smoking bans, many of which are worth revisiting, including addressing the risks of second-hand and third-hand smoke. 

So just how harmful is involuntary smoke exposure, also known as secondhand-smoke? The Center for Disease Control and Prevention asked the Institute of Medicine to investigate the relationships between second-hand smoke and cardiovascular disease as well as the relationship between smoking bans and heart attacks. To call the results eye-opening would be an understatement:

·      Study results consistently indicate that exposure to secondhand smoke increases the risk of coronary heart disease by 25% - 30% (Institute of Medicine, 2009)

·      All of the publications show a decrease in the rate of heart attacks after a smoking ban was implemented, ranging from 6% to 47% depending on the study (Institute of Medicine, 2009) 

Third-hand smoke is the residue from second-hand smoke absorbed by interior surfaces such as floors, walls, furniture, and clothing.  Residents that combine with reactants in the air can produce dangerous products. Hugo Destaillats, a chemist at Berkeley Laboratory demonstrated that residual nicotine can react nitrous acid to form tobacco-specific nitrosamines or TSNAs, which are among the most potent cancer causing agents present in unburned tobacco and tobacco smoke. 

Gas appliances, which are widely prevalent in homes, are the main source of nitrous acid.  Also, smoking outdoors or opening windows when smoking in the car does not address the dangers of third-hand smoke, as the smoke residues sticks strongly to clothing and countless surfaces found in homes and cars (engines in cars emit nitrous acid, and some enters the cabin).  There are even indications that third-hand smoke poses the greatest risk to infants and toddlers.

Put aside the anti-smoking ideology for a moment, and imagine that no one is against the act of smoking.  What about non-smokers being exposed to second-hand smoke resulting in significantly increased risks of cardiovascular disease? What about the infants and toddlers being exposed to third-hand smoke and TSNAs? They are some of the reasons why smoking bans should be depicted as harm-reduction measures rather than personal attacks on smokers.

References:

Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence (2009).  Washington: National Academy of Sciences, Institute of Medicine. Retrieved from  http://www.iom.edu/~/media/Files/Report%20Files/2009/Secondhand-Smoke-Exposure-and-Cardiovascular-Effects-Making-Sense-of-the-Evidence/Secondhand%20Smoke%20%20Report%20Brief%203.pdf

http://www.msnbc.msn.com/id/35318118/ns/health-addictions/t/third-hand-smoke-danger-babies-toddlers/

What Is It Like To Be A Smoker?

One of the main reasons why people start smoking is because they were curious as to what it feels like. So, for those of us who wondered about this as non-smokers, I will walk you through smoking from the perspective of a smoker so you can feel what they feel. How about through a diary?
______________________________________________________________________________
 
Ok, so, I smoke. My non-smoking parents have asked me why, and I have only been able to tell them that it feels pretty good. Of course, the whole jest of this smoking business goes a little deeper than that, but I never have the patience to explain. They just keep nagging me about how it affects my heath, etc. Seriously, I know that. My smoking buddies know that too; it’s printed on the pack and drilled to us as kids.

I’m 19, a student at Waterloo where my 2nd year academic term has definitely gotten to me. You know that stress from all your assignments, midterms, and job seeking on job-mine as a co-op student? Oh, and of course your friends, those BFs, GFs, and those noisy as hell roommates too? Yeah, the typical university stress dose: academics combined with hormones. It’s a two-pronged attack against me. I keep myself together by smoking.
 
Taking a cigarette for me is like a moment of pleasure. I’ve used cigarettes to procrastinate many MANY times. Simply by saying “Hey, I need to take a smoke” pretty much guarantees me a little break, during which, I have met many interesting people. When one person is smoking, I can casually approach them and start a conversation. This happens to me too; others who are looking for a smoke break would approach me as well. It is funny that this is the place where I remember those funny stories that this one guy Greg have told me. This was also where I’ve really got to know him, my first boyfriend. He’s a sweet person that I’ve gotten to know through the many cigarette breaks that I take between classes. We both know the health problems with smoking, and frankly, it's not a big deal.
 
You see, I value each pack and each cigarette with a pretty strong sentimental value. They bring me to other students, almost like a beacon. Wham! Social life comes easy to me in university. Having friends around is a great stress reliever… not to mention being able to finish homework faster as a productive group too! Can you imagine what an almost empty pack would feel like?! Deprived!
 
Speaking of homework, I’ve found that cigarettes help me concentrate… but not really when I go through my packs too fast. So, when I take my typical doses, cigarettes help me concentrate by acting like a smokescreen (literally!) that blocks outside distractions. Sometimes I would smoke one just so I could ignore Greg (haha sorry if you are reading this!). 
 
Greg is a very calm person, and I actually have some difficulty understanding how he feels at certain times. However, I can always tell his mood from how he smokes. Like that one time he was trying to be a bold “badass” for me in public by holding his cigarette with a forefinger and thumb with the end lighting up the palm of his hand. He was confident and I horridly embarrassed. I wouldn’t have been embarrassed if he was a little more buff.
 
I’ve got many more random smoking stories, but I have to admit that I’ve tried to quit before. Even Greg, and every other smoking friends of mine that I’ve asked said the same thing. If not, they’ve at least tried to reduce on it. Not all of us are successful, because not all of us want to really lose the benefits in smoking; it’s fun and brings us together. But then again, this fun is harmful to me and to those unfortunate folks who happened to have to walked by. It brings us together, but together almost a segregated group. When we smoke, only the smokers hangout with us. But there’s a deal-breaker.
 
Financial burden. I’d prefer to do this without that massive cash sink. I want to graduate without debt, and being addicted to cigarettes isn’t really helping. I will try to quit again another day, and I’ve found help here at Waterloo. Maybe I can find another way to deal with the stresses?

Pot Smoking Isn't Harmful... Right?

Pot Smoking Isn't Harmful... Right?

Smoking marijuana, also referred to as smoking pot or weed, is quite common among the youth population. In Canada,  the rates for the prevalence of pot smoking for youth aged 15-24 were three times higher than their over-25 counterparts: 21.6 % vs. 6.7% in 2011. Many individuals being to start smoking because they believe that everyone else also is. Popular culture heavily promotes it and most importantly, there is a really low perception of harm. Common responses from pot smokers include: 

"Marijuana doesn't have any nicotine in it. I won't get addicted." 

"Weed comes from a plant. It's all natural which means that it won't affect my health."

"Smoking weed is safer than drinking alcohol or smoking tobacco. " 

So What is Marijuana?

Marijuana is a mixture of the dried and shredded leaves, stems, seeds, and flowers of the cannabis sativa plant that is green, brown, or gray. It contains the chemical delta-9-tetrahydrocannabino (THC), which is the main mind-altering ingredient that causes it to be strong. Altogether, marijuana contains about 400 chemicals that can affect health. 

How Do You Use It?

The most common method of ingesting marijuana is to smoke loose marijuana rolled into a cigarette, that is commonly referred to as a "joint". It can be smoked through a water pipe called a bong or as a "blunt", which is a cigar that has been hollowed out and filled with marijuana. It can also be mixed into food (e.g, weed brownies) or can be brewed as tea. 

Why Do People Smoke It?

Once it is inhaled, the THC triggers brain cells to release the chemical dopamine, which creates good feelings for a short time and a person feels "high". Some people smoke to relieve stress, anxiety, fear, pain, or anger and it is also used medically to alleviate symptoms for some diseases.  

Is It Safe?

The largest misconception of smoking marijuana is that it is harmless to health. Under the influence of it, marijuana affects memory, judgement and perception. It can cause you to do things you might not do when you're thinking straight, such as engaging in risky sexual behaviour. THC interferes with learning and can lead to problems studying, learning new things, and recalling recent effects. Research is still being conducted to determine if these effects persist. A new study has just emerged that demonstrates that teenage pot smoking is tied to IQ loss. Before the age of 18, the brain is still being organized and is vulnerable to damage from drugs. In this study, it was found that persistent marijuana use by age 18 affected everyday cognitive functioning and problems in memory and attention. 

 Marijuana use also increases heart rate. Within a few minutes after inhalation, the heart beats more rapidly, the bronchial passages become enlarged and the blood vessels in the eyes expand, making them appear red. Additionally, marijuana used in combination with other drugs can result in greater adverse health effects. 

Although it may seem harmless, smoking pot has adverse side effects, just as smoking tobacco or drinking alcohol do. These risk factors should be take into consideration when youth are starting to think about smoking pot. 

References:

http://www.cbc.ca/news/canada/british-columbia/story/2012/08/27/marijuana-teen-brain.html

http://teens.drugabuse.gov/facts/facts_mj1.php