Smoking Among Middle & High School Students: Critical Perspective

1. Smoking Among Middle & High School Students: Critical Perspective By EvgeniaNoidou Nahed Ali

2. Nice to Meet You!

3. Deal or no Deal?

4. Overview • Introduction • History & Tobacco Legislations • Current Tobacco Use Among Middle& High School Students, USA, 2011 • National programs combat smoking among youth (pro& cons) • Tobacco control advocate • Myth & Smoking • Health Hazards • Quiet Smoking • Smoking & Healthy People 2020 • Conclusion • Learning moments

5. Introduction • Tobacco use continues to be the leading preventable cause of death & disease in USA • Nearly 443,000 deaths occurring annually because of cigarette smoking & exposure to 2nd hand smoking • Tobacco use costs the U.S. $193 billion annually in direct medical expenses and lost productivity (CDC, August, 2012)

6. Introduction 2 • Nearly 90% of adult smokers begin by age 18 years • Each day in US, nearly 3,800 young people under 18 years of age smoke their first cigarette. • An estimated 1,000 youth in that age group become daily cigarette smokers (CDC, August, 2012)

7. The global economic burden of tobacco • Smoking is a tremendous economic burden on society. The World Health Organization (WHO) estimates that the annual global cost of tobacco is 500 billion dollars. • The economic burden is particularly high in the developing world - in 2030, 4 to 5 correlated with tobacco deaths worldwide will be identified in these areas. • The poor are disproportionately affected, because the money they spend on tobacco cannot be spent on necessities, including food, shelter, education, and healthcare.

8. The global economic burden of tobacco2 The economic burden of tobacco exceeding the direct costs of illness and death associated with tobacco and consequent losses in productivity. The substantial economic impact of smoke can be found in: • Direct costs: health care for diseases associated with tobacco- both active smokers and secondhand smoke • Absenteeism and reduced productivity of employees in the workplace • Other costs involved, such as: • Losses from fire due to smoking • Costs associated with cleaning dirt smoke and discarded waste (eg cigarette butts) • Extensive damage to the environment: large-scale deforestation needed to further tobacco, pollution from pesticides and fertilizers is growing, and cigarette butts.

9. Activity • In box 1, please draw someone who is smoking a cigarette for the first time. • In box 2, draw a person who has been smoking for a long time. • In box 3, draw someone who is trying to quit smoking. • Individual assignment

10. Activity2 • Below the pictures write: • The person’s gender • The age • Why (s)he smokes • In a group of 4 collect the feedback of all participants. • The perception of each group will be explained to the class.

11. As a Health Educator, Consider? • http://www.youtube.com/watch?feature=endscreen&v=6IM9poZpAmY • http://www.youtube.com/watch?v=9usMlM7Kvvg

12. Tobacco use during adolescence & health risk behaviors: Tobacco use during adolescence is associated with the following health risk behaviors: • High-risk sexual behavior • Use of alcohol • Use of other drugs (CDC, 2012)

13. Factors Associated with Youth Tobacco Use • Low socioeconomic status • Use and approval of tobacco use by peers or siblings • Exposure to smoking in movies • Lack of skills to resist influences to tobacco use • Smoking by parents or guardians and/or lack of parental support or involvement (CDC, 2012)

14. Factors Associated with Youth Tobacco Use2 • Accessibility, availability, and price of tobacco products • A perception that tobacco use is the norm • Low levels of academic achievement • Low self-image or self-esteem • Exposure to tobacco advertising • Aggressive behavior (e.g., fighting, carrying weapons) (CDC, 2012)

15. Why do boys smoke? • To become “cool”. • Because they are influenced by their friends. • Because they don’t’ want their friends to make fun of them/ to be left out of the group. • To be a member of the crowd. • To make new friends

16. Why do girls smoke? • Girls want to grow up quickly. They think that if they smoke they look older. • To become “cool”. To be “in”. • To lose weight. They think that smoking helps them become thinner. • To deal with their problems. They consider smoking to be an anti-stress factor

17. History • Indians • First people • Smoke cigar or pipe • Discovered the relaxing properties of tobacco • Europeans • 15th Century arrived to America • Cigarette passed on to Europe • Spread gradually throughout the world

18. 1967: Stations broadcasting cigarette commercials must donate air time to antismoking messages. • 1994: Department of Defense (DOD) bans smoking in DOD workplaces. Laws In America

19. Laws in America2 • In 1995, California was the first state to enact a statewide smoking ban for in enclosed public places. • 1996: The first nation's comprehensive program to prevent children and adolescents from smoking cigarettes or using smokeless tobacco and beginning a lifetime of nicotine addiction. • 2010: the law prohibits the tobacco industry from distributing or introducing into the U.S. market any tobacco products for which the labeling or advertising contains the descriptors "light," "low," "mild," or any similar descriptor, irrespective of the date of manufacture.

20. Laws in Egypt • In 2007 Egypt passed a smoke free law for public places, public transport, educational and health facilities • The law is not comprehensive and does not apply to restaurants or bars • In 2010, the government announced that it would launch an anti-smoking campaign that would include raising taxes and going totally smoke free in phases, city by city, over a four year period.

21. Laws in Greece • 2010, Greece was the country with the highest rate of tobacco consumption (more than 40%) in the European Union • From 1 September 2010 law prohibits smoking and consumption of tobacco products • Enforcement of the law is reportedly weak, with most owners of coffee shops, pubs, and restaurants continuing to allow smoking.

22. Economic Impacts in Greece • The total expenditure on health in Greece is estimated at 23.6 billion euros. The diseases associated with tobacco accounting for about 14.4% of the total amount, about 3.4 billion euros. • Smoking is the biggest risk factor for the health of the population, both in terms of mortality and morbidity. • An estimated 20,000 people/year die from diseases associated with smoking. • Smoking is the leading cause of excess morbidity in the country, accounting for 12.9% of all lost years of life due to illness or death (DALYs). • The cumulative effect of risk factors, holding the 5th to 10th position and the root causes of morbidity in the Greek population.

23. Economic Impacts in Greece Greece, which is suffering from government austerity measures, should immediately adopt tobacco control measures, focusing on improving the efficiency of the system. • The average household spent the year 2010 for 998 Euro or smoke an average of 83.2 per month. This is money that could be spent on products that would BENEFIT the economy. • The 27.7 billion cigarettes were smoked by the Greeks in 2010 amounting to 4.8 billion euros spent on tobacco products. This staggering amount of money could create employment opportunities for tens of thousands of people. • Taking care of diseases due to tobacco amount to 14.4% of total health expenditure in Greece, about.4 billion.

24. Current Tobacco Use Among Middle and High School Students —USA, 2011 (Types of Smoking) Cigars Pipe Cigarettes Kretek (clove cigarette) Bidis

25. Common Tobacco Smoking in Egypt

26. Common Tobacco Smoking in Greece

27. Current Tobacco Use Among Middle and High School Students —USA, 2011 (Prevalence)

28. Current tobacco use, combustible tobacco use, and cigarette use among adolescents in middle school. National Youth Tobacco Survey, USA, 2000–2011

29. Current Tobacco Use Among Middle and High School Students —USA, 2011 (Types of Smoking)

30. Current tobacco use, combustible tobacco use, and cigarette use among adolescents in high school. National Youth Tobacco Survey, USA, 2000–2011

31. National & Local Programs that reduce youth tobacco use- Debate Gp (1): Pro: Satisfied Gp (2):Cons: Unsatisfied • Pro & Con= 8/ each min • Rebuttal= 2/each min • Total time= 16 min Rules of debate: • The timekeeper will strictly enforce the time • All members of each side must participate in the debate. • You may use your laptop & bring some brief notes • Maintain good eye contact with the audience. • Use proper language and respect the opinion of the opposing team

32. National & Local Programs that reduce youth tobacco use- Debate 2 Pro: • Counteradvertising mass-media campaigns (i.e., TV and radio commercials, posters, and other media messages targeted toward youth to counter pro-tobacco marketing) • Comprehensive school-based tobacco-use prevention policies and programs (e.g., tobacco-free campuses) • Community interventions that reduce tobacco advertising, promotions, and commercial availability of tobacco products • Higher costs for tobacco products through increased excise taxes

33. National & Local Programs that reduce youth tobacco use- Debate 3 Cons • During 1998 to 2010 states have received a total of $243.8 billion in tobacco settlement and cigarette excise tax revenues; however, only $8.1 billion (2.8%) was dedicated to state tobacco control programs* • Many states are facing drastic budgetary cuts, resulting in near elimination of their tobacco control programs* • Many state governments have eliminated or restricted the scope of tobacco control programs, often under pressure from the tobacco industry which recognizes such programs’ power (AJP, 2012) *(CDC. State tobacco settlement& tax revenue & tobacco control funding, 2012)

34. National & Local Programs that reduce youth tobacco use- Debate 4 Cons • Evidence indicates that low levels of tobacco control funding lead to low levels of media campaigns focusing on tobacco use prevention among youths , which might be one reason why current declines are occurring much more slowly than those observed during the period 1997–2003, which saw a 40% decline . (CDC, 2012)

35. You are now a tobacco control advocate!!! • Tobacco control advocates in some states have tried to create stronger tobacco control program structures to insulate these programs from political attacks • What will you do? • Group work

36. Example of Advocacy The American Lung Association efforts: • FDA Authority over Tobacco Products. Legislation recently enacted into law gave the FDA regulatory authority over tobacco products. • Federal Cigarette Tax. Increasing cigarette taxes is one of the most effective ways to reduce tobacco use, especially among youth. • Cessation Coverage. Many smokers want to quit, but need help to do so. The federal government can help by providing coverage through Medicare and Medicaid. • Framework Convention on Tobacco Control Treaty. Tobacco use is a global problem which requires a global solution.

37. Myths about smoking http://www.youtube.com/watch?v=s2u-Rs3KmgQ

38. Health Hazards • Discuss with your group the health hazards of tobacco smoking on this system • Cardiovascular System • Respiratory System • Smoking & Cancer • Reproductive& early childhood risks • Other health effects • Secondhand smoking http://www.youtube.com/watch?v=TqqApcqKcY0 4.26 Minutes: health hazards of tobacco

39. Health Hazards2 Cardiovascular disease: • Smoking causes coronary heart disease, the leading cause of death in the United States. • Cigarette smoking causes reduced circulation by narrowing the blood vessels (arteries)& cause peripheral vascular disease

40. Health Hazards3 Respiratory System: • Smoking causes lung cancer. • Smoking causes lung diseases (e.g., emphysema, bronchitis, chronic airway obstruction) by damaging the airways and alveoli (i.e., small air sacs) of the lungs

41. Health Hazards4 Smoking and Cancer • Lung cancer • Cancer of the larynx (voice box) • Cancer of the oral cavity (mouth) • Cancer of the pharynx (throat) • Acute myeloid leukemia • Bladder cancer • Cancer of the cervix • Cancer of the esophagus • Kidney cancer • Pancreatic cancer • Stomach cancer

42. Please do not install!!!

43. Health Hazards5 Smoking & reproductive &early childhood risks • infertility, • preterm delivery, • stillbirth, • low birth weight, and • sudden infant death syndrome (SIDS).1,8 • http://www.youtube.com/watch?v=hbsLn4cZmZ4

44. Health Hazards6 Smoking is associated with the following adverse health effects: • Postmenopausal women who smoke have lower bone density than women who never smoked. • Women who smoke have an increased risk for hip fracture than women who never smoked.

45. Health Hazards7 Secondhand smoke causes heart disease and lung cancer in adults and a number of health problems in infants and children, including: • Severe asthma attacks • Respiratory infections • Ear infections • Sudden infant death syndrome (SIDS)

46. Quiet Smoking for Teenagers SfT (Smokefree Teen)A Web site that helps teens quit smoking For support in quitting, including free quit coaching, a free quit plan, free educational materials, and referrals to local resources, call 1-800-QUIT-NOW 1-800-784-8669 http://www.cdc.gov/tobacco/quit_smoking/index.htm

47. Quiet Smoking • http://www.youtube.com/watch?v=ZhdBk0wiXiQ&feature=fvsr 3 minutes: stop smoking http://www.youtube.com/watch?v=18JzqxR3TQo 1.3 minutes

48. Smoking & Healthy People 2020 Goal: Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure. Healthy People 2020: Provide a framework for ending the tobacco use epidemic

49. Smoking & Healthy People 2020-2 The Healthy People 2020 Tobacco Use objectives are organized into 3 key areas: • Tobacco Use Prevalence: Implementing policies to reduce tobacco use and initiation among youth& adults. • Health System Changes: Adopting policies and strategies to increase access, affordability, and use of smoking cessation services and treatments. • Social and Environmental Changes: Establishing policies to reduce exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors.

50. Health People 2020: Smoking Prevention Healthy People 2020 provides a framework for action to reduce tobacco use to the point that it is no longer a public health problem for the Nation. Research has identified a number of effective strategies that will contribute to ending the tobacco use epidemic