José Manuel Rodríguez-Ramírez,1 Tania Lizeth Salas-González,1 Brenda Jimena Ruiz-Zúñiga,1 Fátima Marbella Flores-Ortíz,1 Paulina Esmeralda Durán-Sánchez,1 Juan Pablo Gómez-Cardona1
1Centro de Ciencias de la Salud, Departamento de Enfermería, Universidad Autónoma de Aguascalientes. Aguascalientes, México
Correspondence: José Manuel Rodríguez Ramírez
Date received: April 27th, 2015
Date judged: June 24th, 2015
Date accepted: August 19th, 2015
Introduction: Tobacco consumption is considered as a public health problem, is the second leading cause of death worldwide. A growing trend is seen in the first use of tobacco at an increasingly consumption at earlier ages.
Objective: To describe the beliefs of students of sixth grade of primary education on the effects of tobacco.
Methodology: Descriptive study in a random sample of 155 sixth grade students of all elementary schools in the municipality of San Jose de Gracia, Aguascalientes. Data were collected through a self-administered questionnaire to explore the “Beliefs about the effects of snuff.”
Results: The total number of students 40 % reported living at home with smokers, more than half of the students in 60.6 % expressed positive aspects about that “smoking is not related with losing sleep”. In 36.1 % and 31 % respectively believe that “if it helps people to be distracted from the problems”; and “it makes people feel good.” It is significant that 12.9 % of students expressed that consumption of snuff is not addictive and 9 % believe that it does not cause cancer.
Conclusions: Students share personal characteristics, family, economic, social and labor, such as coexistence with active smokers at home and at work and have the belief that the consumption of tobacco helps people to get distracted from the problems and that it feels good.
Keywords: Tobacco use; Smoking; Child health
The World Health Organization (WHO) considers tobacco use one of the world’s greatest health problems, especially since the onset of smoking occurs at increasingly young ages.1 As such, smoking represents the second cause of death in the world, since about 1,300 million people are consumers, of which nearly one billion are men and 250 million are women.2
Based on the Encuesta Nacional de Adicciones (ENA 2011),3 tobacco use causes the premature death of almost 6 million people; if this trend continues, in 2030 tobacco use will produce the death of 8 million people a year, 80% of which will occur in low- and middle-income countries. According to the ENA, in the population aged 12-65 years during 2002-2011, the average consumption of cigarettes per day was 6.8 in men and 5.6 in women; the prevalence of active smokers was 31.4% (12.1 million) in men and 12.6% (5,200,000) in women; in the adolescent group the most tobacco use is between ages 13 and 15 years old, unlike with adult men whose overall prevalence of use has decreased from 42.3% to 34.6%, and the overall prevalence of daily consumption, which fell from 23.7% to 15.5% over the same period. As for the distribution of tobacco use, it is greater in Mexico City and in the north, center, and west of the country, with a similar pattern in the population aged 12 to 65 years and in the 12 to 17 age group. In active smokers, addiction was identified in 7.1% of adolescents and 11.8% of adults.
The average age of onset of tobacco use is 13.7 years in adolescents and 17.4 years in adults, at an early age the main consequence of tobacco use is dependence or addiction and predisposition to tobacco-related health problems. According to ENA 2008, 60% of adult smokers of both sexes and 68.6% of teens began tobacco use only out of curiosity; 29.8% of men, 26.9% of women, and 24.1% adolescents reported living with smokers (family, friends or colleagues).4
The World Health Organization argues strongly that every child has the right to grow up without tobacco around them. That has highlighted the need for comprehensive health strategies, where in addition to the provision of services, attention is also given to the social, economic, and political causes underlying the various health problems. With this approach, care for tobacco use and the health and biopsychosocial problems associated with it and secondhand smoke inhalation, help explain the interaction of factors such as smoking initiation and whether it is maintained or interrupted depending on the way people live, eat, reproduce, work, interact, educate themselves, and develop their capacities to cope with their limitations. In this sense, it is necessary to promote not only health but life, empowering citizens and civil society for healthy lifestyles, life skills, and protective environments that allow children and adolescents to reject their peers’ offers to start smoking; and young and older adults to respect smoke-free spaces (Adelaide Statement on Health in All Policies 2010).5,6
Prevention aims to identify, prevent, reduce, regulate, or eliminate tobacco use as a health risk, as well as its physical, mental, economic, social, and family consequences through preventive, universal, selective, proven, and indicated actions, covering the entire population and especially the most vulnerable groups. In this context, actions in the family and school environment should consider the tobacco industry’s marketing strategies aimed at children and adolescents; there are the programs Safe Schools and Healthy Schools, which through training primary and secondary school teachers on aspects of addiction prevention, help prevent tobacco consumption.6
Several complex reasons interact to explain why children start using cigarettes, including the influence of relatives and other close associates who smoke and act as powerful role models. One can tell a minor not to smoke, but the words lose meaning when adults are not a good example in that regard. The risks of exposing a child to environmental tobacco smoke are increased frequency of respiratory diseases and adverse effects on children’s dental health, as well as increasing the number of cavities, connections with visual disorders, pulmonary dysfunction, brain tumors, mental imbalances, lymphomas, and possible addiction to smoking in adolescence.
A study of beliefs, attitudes, and practices of school children regarding tobacco use found that communication between school peers on tobacco use occurred in 16%, who had a young friend who smoked; the highest proportion of children who had experienced consumption previously reported not having a partner who smoked; however, they lived with an addicted family member. To the question: "Do you think that smoking is...?”, 54.3% thought it was bad and 38% that it damaged health, besides being dangerous to the life of the smoker and people around them. Only one child (0.1%) said it was a good thing. As to whether smoking caused diseases, third graders said yes with 46.6%, 1.2% said no, and 2.3% said they did not know; to refer to people who smoke, they used phrases like "doing something wrong", "they are ugly people", "unpleasant", "smelly", "they annoy others and give a bad example." Moreover, they linked tobacco use with the onset of disease and even with death, arguing: "they hurt themselves and others", "they don’t care if they get sick and die" and "they won’t live long" among other answers. However, 2.3% declined to respond and only one thought it was good.7
An approach to defining beliefs was made by González-Consuegra in their study Creencias (Beliefs) in adult smokers in a cardiovascular health program.8
Beliefs are understood as the way we perceive the world around us, and those that connect with values mainly constitute motivation, being the ones that govern the brain and make action possible. The primary source where beliefs come from is the environment surrounding people from birth and all the environments where a human lives and develops. It is concretized as the acceptance of a popular knowledge as true.
It also constitutes a mental attitude of the individual that serves as the basis for voluntary action and possible emotional connotation; as suggested by Helman. (Cited by R. Biffi)
In this study the following categories were established:a) Motivating factors for tobacco use, which included: emotional and social aspects, initiation factors in tobacco use, contributing factors to tobacco use, and physiological aspects-basic needs; b) discouraging factors for tobacco use, concerning transcendental aspects, manifestations of illness, reasons to stop using tobacco, and maximum time of quitting.
Emotional reasons related to tobacco use are: counteracting anxiety, reducing sadness or depression, despair, rage, or anger; achieving tranquility, sense of satisfaction, and the pleasant flavor of using tobacco, as well as a coping strategy for grief and loss. The social aspects included in the role for the teenager, are feeling grown-up for smoking, smoking as an act of imitation and search for acceptance and group membership, aspects of great value especially in the initiation stage of tobacco use, but later perpetuated, as these feelings have been mentioned by adults and seniors, reflecting that human beings have constant behaviors of approval-seeking, imitation, and the need to belong to a group.
In some cases society is credited with the requirement to use tobacco, even showing the need not to be excluded from "their group" that they believe they belong to, want to belong to, or belong to.
Some of the beliefs relate to the desire to experience new things, due to the stage that they are in; friends are a vital key to maintaining those beliefs and thus beginning smoking habits earlier. One can also observe behaviors and increasing confidence in tobacco consuming students, which can lead to the consumption of other drugs.9
One of the most important aspects of the problem is that people start tobacco use earlier, therefore it is possible that the beliefs, attitudes, and practice observable in adolescents are present in sixth-grade students.
In order to identify the beliefs of this population group, the goal was set of describing the beliefs of sixth grade students on the effects of tobacco use in the municipality of San Jose de Gracia, Aguascalientes, Mexico.
A descriptive study was conducted in a random sample of 155 primary school students in the municipality of San Jose de Gracia, Aguascalientes. It included sixth graders from all primary schools in the municipality, with informed consent provided by the school principal and the students’ agreement to participate in the study. Questionnaires filled in incompletely or incorrectly were not included.
Definition of variables
The instrument "Pros and cons of beliefs about tobacco" was used, which was structured with 17 items, measuring benefits 1 to 8 and cons 9 to 17 with a Cronbach's alpha of 0.79; the "pros" with 0.88 and "cons" with 0.85 of validity. It was necessary to make adjustments to the instrument in order to improve understanding of it.
After the pilot with 111 students in sixth grade, a reliability and validity value of 8.73 was obtained for the instrument by Kuder-Richardson, equivalent to 87% reliability. Therefore, in its final version, the instrument was structured with two dimensions and 16 items, the first for the "pros" of items 1 to 7, and the second for the "contras" from 8 to 16.
SPSS version 21 was used for data capture and analysis.
53.5% of students were female, 71% were 11 years old and 29% were 12. It should be noted that 29.7% of students were economically productive, of which 12.3% worked in varied economic activities such as babysitter and assistant in convenience stores, 5.8% in construction, 3.9% in field activities, 3.2% as a salesperson, and 2.6 % as a tour guide.
The coexistence of students with active smokers occurs at work in 9.7% and at home in 40% of cases.
As for the items in the "pros" section, in response to the phrase "it makes people feel more mature and self-confident", 76.8% of students believed that it was not so; 71% said "it does not make people feel calmer", 60.6% said that "does not wake you up" while 39.4% said yes it does; with respect to the item "it helps you study," 83.2% of students said no; for the item "it helps distract people from their problems," 63.9% said no, however 16.8% of students believed that "it helps you feel good after eating" and 31% believed that "smoking makes people feel good. "
In the second dimension of the instrument "Beliefs about the effects of tobacco use," which measures the "contras" (barriers), in the first item "it makes people become addicted", 12.9% of students responded that that is not true, and 87.1% admitted that it does cause addiction. As to whether "it causes cancer", 91% said so. As for the phrase "it makes people get out of shape," 85.8% of students said yes; in the category of items related to respiratory illness there was: "it causes coughing", "it causes lung disease", and "it irritates the throat," to which 87.7%, 91.6% and 85.2% of students said yes, respectively; whether "it affects your heart" and "brain activity decreases," 90.3% and 91% of students were in support; also, 84.5% believed that smoking "gives people a bad taste in their mouth".
According to the Encuesta Nacional de Adicciones (ENA 2011)3, the average age of first tobacco use is 13.7 years in adolescents and 17.4 years in adults; trends predict that in the future the age of first tobacco use will be at increasingly early ages. There are references about students’ exposure to secondhand tobacco smoke, 39.4% live with smokers and 59% are around smokers outside the home, very similar to that found in the present study, in which 40% live with smokers in their household, and 9.7% spend time around smokers outside their home.11
The beliefs that encourage tobacco use are various, in particular similarity was found regarding the opinion on whether use "helps you feel better" in 27.9% of students in this study. In the questions about negative effects, 94.8% compared with 88.24% had the belief that tobacco use is harmful.12
The most often reported reason for tobacco use was associated with wanting to "forget their problems" with 28.3%, compared to 36.1% in the primary school students. There are no conscious personal reasons for smoking initiation, and it is accepted as just another experience and almost inevitable in adolescence. The smell and taste of tobacco are unpleasant at smoking initiation, and are not a factor favoring consumption; students considered smoking a relaxing activity that allows them to escape from boredom, and it is associated with very specific times of day. Tobacco can increase confidence in younger teens. Students who have been held back and older students feel safer talking in each group having more experience with use, and they underestimate the consumption younger adolescents. For adolescent males, smoking brings a role of personal authority in relation to equals, a step towards maturity and acceptance of the uniformity of the friend group, while for girls, curiosity, a sense of weight control, and the influence of male friends dominated. Boys understand that girls assume more risks in smoking.13
Students share personal, family, economic, social, and labor characteristics, such as coexistence with active smokers at home and at work, and having the belief that tobacco use helps distract people from their problems and makes them feel good.
Most students say that tobacco use creates adverse health effects. With these and other elements student respondents may discern the effects of tobacco use.