Lucrare prezentată la primul congres al Asociației Medicilor Stomatologi din Municipiul București, 18-20 februarie 2021
Aim: The assessment of the behavior of a group of students aged between 14 and 19 years old regarding tobacco use, from two cities: Bucharest and Bacău.
Material and Method: Cross-sectional study conducted between November and December 2020 on a group of 100 students, using a questionnaire with 16 items, distributed on-line.
Results: Out of the total group of students, 18% smoke daily and 28% have tried or smoke occasionally. Most of them smoked their first cigarette between the ages of 15 and 18. They seem to smoke more at parties, during the time spent with friends and in stressful situations. The reasons why they claim to have adopted this habit are curiosity (12%) followed by the influence of the entourage (8%). Among them, 9% plan to quit in the future and 5% have tried in the past.
Conclusion: Students are very vulnerable to the habit of smoking, they are very easily influenced by their entourage, but they are also at an age predominated by curiosity and they want to experience as many things as possible. One way to prevent smoking among students could be open discussions about the curiosities they have about tobacco use.
Key words: behavior, students, smoking
Tobacco use is a major health risk factor and a major cause of premature death. Smoking has become a public health problem worldwide, especially for the younger generations who seem to adopt this habit at a very young age. Therefore, the collection of data on adolescents smoking behavior is of particular importance for future anti-smoking programs organized for youth.
More than 8 million people die from tobacco use each year. Most tobacco-related deaths occur in low and middle-income countries (1). Passive smoking also has negative health consequences, leading to 1.2 million deaths annually (1). Almost 50% of children secondhand smoke and 65,000 of them die each year due to smoking-related diseases (1).
Another problem with smoking that we often encounter is occasional smoking. Young people who smoke occasionally do not consider themselves smokers, so although it is difficult for them to give up cigarettes, they do not attend anti-smoking programs. This category is more difficult to address through traditional anti-smoking programs, even though it faces the same risks and the same negative health consequences (2).
Aim of the study
The study aims to assess smoking behavior among a group of high school students aged between 14 and 19, from two cities, Bucharest and Bacău.
Material and method
The studied group included 100 high school students (average age 16.57; SD ± 1.23), from “Gheorghe Lazăr” National College in Bucharest and “Ferdinand I” National College in Bacău.
As a method of data collection, a cross-sectional study was conducted in November-December 2020 in which students were given an anonymous questionnaire with 16 questions that collected data on their behavior related to tobacco use. The distribution of the questionnaire was done online, in electronic format through Google Forms.
Out of the 100 subjects, 52% were female students. Most participants were17 years old (28%), 27% – 18 years old, 21% – 16 years old, 18% – 15 years old, 5% – 14 years old and 1% – 19 years old. Most answers came from the 12th grade students (35%), followed by 10th grade (24%), 9th grade (21%) and 11th grade students (20%).
The results show that out of the total group of students, 46% smoke daily, occasionally or have tried to smoke a cigarette at least once (table I).
Regarding the age at which they smoked their first cigarette, 61.9% of students said that they started between the ages of 15 and 18, 35.7% – between 9 and 14 years and only 2.4% smoked before the age of 9 (table II).
When asked about what type of cigarettes they prefer, 22% of smokers mentioned cigarettes and 6% have chosen electronic cigarettes (table III).
Regarding the frequency of smoking, 22% of them claim to have or have had periods in which they smoked daily for 30 days (table IV). Out of the last 30 days from the date of completing the questionnaire, 15% smoked for more than 21 days, 4% smoked for 14 to 21 days and 4% smoked for less than 14 days (table V).
Regarding the favourite places to smoking, 34.3% of the subjects answered that they smoke more at parties, 9.4% – in the street, 6.3% – more at home and 50% smoke anywhere (table VI).
The number of cigarettes smoked seems to be higher during the time spent with friends for 63.3% of smokers, in stressful moments for 23.3%, at parties for 6.7% and during normal daily activities for 6.7% (table VII).
Among the main reasons why they started smoking, students mentioned curiosity (46.1%), entourage (30.6%), stress, boredom, desire to socialize and the fact that they consider it a pleasant habit (19.4%) and 3.9% said they do not know exactly why they adopted this habit (table VIII).
As for the desire to quit smoking, 33.4% plan to quit in the future, 18.5% want and have tried in the past, but without success, 29.6% of them do not know if they will and 18.5% do not want to give up (table IX). In the last 6 months from the date of completing the questionnaire, 33.4% of them had attempts to quit smoking (table X).
The level of concern about the negative effects that smoking can have on health seems to be low for 26% of adolescents and absent for 24% of them (table XI).
Regarding the impact of images on cigarette packs, it was observed that 7% of students are determined to reduce the number of cigarettes (table XII).
Given the epidemiological context of 2020, we also wanted to find out the impact of the Covid 19 pandemic on smoking. There was a decrease in tobacco use in 7% of students, 1% of them quit smoking and 1% smoked more (table XIII).
This study shows that approximately 46% of the high school students smoke or have tried a tobacco product at least once.
Regarding smoking in the last month, 22% smoked at least one cigarette a day. A similar study conducted in the United States in 2019 showed that more than half of the subjects tried a product containing tobacco at least once and 3 out of 10 students smoked in the last 30 days (3).
The present study shows that 2 out of 10 students plan to quit smoking in the future and about 1 in 10 have tried in the past, but without success. In the last 6 months, 2 out of 5 students have tried to quit smoking. It was found that among high school students there is a preference for cigarettes (22%), followed by electronic cigarettes (6%). These results do not match with those obtained in the US study mentioned above, where 27.5% said they prefer electronic cigarettes, followed by cigars (7.6%) and cigarettes (5.8%) (3).
It was found that the main reason why most students started smoking is curiosity followed by the influence of the entourage. The 2019 study obtained similar results, on the first place is curiosity followed by the influence of family members and smoking friends (3). Another study conducted in 2011 on a group of 1174 students showed different results, the reasons why students started smoking seem to be the entourage and the example set by smoking family members, followed by curiosity (4).
Regarding the times when they smoke the most, the students said that the frequency of cigarette consumption increases the most during going out with friends, followed by the stressful moments. These results also validate those obtained in the questions related to the reasons why they started smoking, where they mentioned entourage and stress.
Regarding the age at which they smoked their first cigarette, most answered that between 15 and 18 years. Comparing these results with those obtained in the Nigerian study, it can be noted that students in that study group started smoking earlier (10-14 years) (4).
In the context of the Covid-19 pandemic period, it was found that 7% of students smoked less, the main reasons mentioned being less frequent meetings with friends who encouraged them to smoke, lack of parties, but also the fact that they live with their parents around who they cannot smoke. Another 1% say they have given up smoking, mentioning the fear of being more vulnerable to the viral infection. A survey published in 2020 in the United States examined the changes in tobacco use during the Covid-19 pandemic in a study group of 3.415 young people between the ages of 13 and 24. The study group was divided into 2 categories, one of which includes young people under the age of 21 and one that includes young people aged 21 or older. Their results show that 36.5% of young people in the 13-20 age group gave up electronic cigarettes, 30.8% reduced the number of cigarettes and 16.6% increased the amount of nicotine in cigarettes. Although both studies reported a decrease in the number of cigarettes consumed or even complete smoking cessation, the percentage presented in the study conducted in the US is significantly higher. Among the reasons for these changes were the increase in the difficulty of buying cigarettes, not wanting their parents to find out they smoke, but also the fear of being more vulnerable to the infection with the Covid-19 virus (5).
- This study shows that the main reasons why adolescents adopt the habit of smoking are curiosity and entourage. It has been observed that the frequency of tobacco use increases during meetings with friends and at parties. This highlights the easily influential nature of adolescence, but also their lack of experience and desire to discover and practice as many activities as possible.
- Adolescents think a little or not at all about the negative effects of smoking can have on their health. Most believe that young people are not affected by the side effects of smoking and that they only appear late in life.
- These results draw attention to the need for education and smoking prevention programs among young people, many of whom are constantly exposed to secondhand smoke both in schools and in their own homes.
- WHO, Tobacco | [Internet]. [27th of April 2021]. https://www.who.int/health-topics/tobacco#tab=tab_1
- Oksuz E, Mutlu ET, Malhan S. Characteristics of daily and occasional smoking among youths. Public Health 2007; 121(5):349–356
- Wang TW, Gentzke AS, Creamer MR, Cullen KA, Holder-Hayes E, Sawdey MD, Anic GM, Portnoy DB, Hu S, Homa DM, Jamal A, Neff LJ. Tobacco product use and associated factors among middle and high school Students – United States. MMWR Surveill Summ 2019; 68(12):1–22
- Adeyeye OO. Cigarette smoking habits among senior secondary students in Lagos, South West Nigeria. Int J Biol Med Res 2011; 2:1047-1050
- Gaiha SM, Lempert LK, Halpern-Felsher B. Underage youth and young adult e-cigarette use and access before and during the Coronavirus disease 2019 Pandemic. JAMA Netw Open. 2020; 3(12):e2027572.