go to this link http://animoto.com/play/MfTEjJ95WDk6GrSp401Hzg
Topic is: Smoking.
What problem is it the topic addressing? Priority health-risk behaviors
Quit Smoke: Second hand Smoke is a major indoor air pollutant and health hazard. When you quit, both you and your family will lead longer and healthier lives.
Introduction to your topic: When you start smoking in the long run will regret it. The participants completed questionnaires in class relating to anxiety, depression and antiestablishment attitudes, ADHD symptoms, smoking, alcohol consumption & illicit drug use. Results: Of the total sample, 5.4% met screening criteria for ADHD. Smoking, alcohol & illicit drug use were significantly related to ADHD symptoms. Logistic multiple regressions showed that after controlling for gender & school grade, ADHD symptoms predicted smoking, alcohol use and illicit drug use independent of anxiety, depression and antiestablishment attitudes
Importance of your topic: DO NOT SMOKE "The typical adult smoker begins to craves the next cigarette in 45 Min's to an hour after smoking. . . . But kids can be addicted and not need to smoke again for days, even weeks." (page 11 Teen Smoking by Rodger Williams) If you don't smoke, don't start, and if you do smoke, quit. Social changes and changes in individual behavior are required to achieve a significant reduction in tobacco use.
How long does it take to get hooked? A September 2000 study showed that one quarter of 11 to 13 year olds who smoke as few as two or three cigarettes a day become addicted in just two weeks. And many of the rest got addicted shortly after that. Once hooked, the average smoker is unable to stop for seventeen years! And every year, they will spend $1200 or more on tobacco products, to maintain their addiction. What could you buy with the money you would save in two years? How about your first car! Over 10 years, you would save $12,000!
Why did you chose this topic: Because I wanted to know about smoking affects and the behaviors.
Reporting Period Covered: January-June 2007. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors 6 categories of priority health-risk behaviors among youth and young adults, including behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including human immunodeficiency virus infection; unhealthy dietary behaviors; and physical inactivity.
Those affected by your topic: The percentage of students who had smoked cigarettes during the 30 days before the survey ranged from 23.1% to 37.6% (median: 31.1%). "Of the estimated 14 billion cigarettes smoked in Ontario each year, one in four is now illegal." (page 48 Teen Smoking by Rodger Williams)
"One reason cigarettes are highly taxed is to keep them beyond the reach of youth" (page 51 Teen Smoking by Rodger Williams)
Resource Ideas:
<a href="http://search.ebscohost.com/login.aspx?direct=true&db=sch&AN=39347594&site=scirc-live">Personal Motivation, Exercise, and Smoking Behaviors Among Young Adults.</a>
Personal Motivation, Exercise, & Smoking Behaviors Among Young Adults Erica Rose Scioli, PhD; Henry Biller, PhD; Joseph Rossi, PhD; Deborah Riebe, PhD This study explored the motivational factors that influence individuals across the stages of change for exercise. The authors compared physically active nonsmokers with physically active smokers in a college student population. Half of regular exercisers identified themselves as smokers. Compared with their nonsmoking peers, young smokers have higher rates of physical & emotional distress. Those participants who exercise & do not smoke are more likely to exhibit intrinsic factors for exercise. Undergraduate psychology students (N = 614) completed an Internet survey on exercise & smoking behavior as well as motivational factors for exercise. Multivariate analyses of variance revealed that intrinsic motivational factors for exercise were significantly higher for the active nonsmokers than for the active smokers. Interventions promoting consistent exercise & smoking abstinence should continue to be directed toward young adults, focusing on fostering intrinsic motivational factors for exercise. Index Terms: exercise, motivation, smoking Despite the well-documented links between regular physical activity & health in both the mental & physical domains, facilitation of exercise adherence is a major practical issue in health promotion. In the present society, many people are either sedentary or too infrequently active to accrue health benefits. The primary goal of the present study was to identify the motivational factors that influence individuals across the stages of change for exercise. The focus was on understanding how these motivational factors play a role in guiding individuals to begin & maintain a sufficient exercise program that meets the unique needs of the individual on the basis of appropriate frequency, intensity, & duration. Previous research suggests that intrinsic motivation plays a particularly salient role in the exercise behavior process & may be implicated in long-term maintenance. Moreover, enjoyment & competence factors appear to be associated with both intrinsic motivation & a regular pattern of exercise. Understanding motivational factors underlying exercise adherence may aid researchers, clinicians, & health educators to more effectively highlight the importance of consistent physical activity for individuals of all ages. Further research is needed to add to our understanding of how motivational factors can be used to develop more effective interventions for exercise promotion. What is known this far is that motives for exercise participation tend to vary by age, sex, & personality. For example, younger adults are more motivated by challenge & fitness, whereas older adults are increasingly concerned with their health. By investigating the motivations for individuals who currently exercise, researchers may be able to learn how to increase adherence to regular physical activity among those people who are currently at a relatively sedentary level. Making exercise & physical activities more intrinsically motivating might be a viable route to enhancing persistence. Intrinsic motivation holds promise as a predictor of exercise maintenance, & it has been receiving more research attention recent years. People with intrinsic motivation have a greater likelihood of maintaining a regular exercise routine & making it a continuing part of their life. Furthermore, intrinsic motivations are more likely to lead to an increased sense of psychological well-being. Intrinsically motivated behavior has been operationally defined as the participation by a person in an activity in the absence of a reward contingency or external control. Essentially, it is the amount of time individuals voluntarily spend at an activity during their free time. Intrinsic motivation is based on needs related to being competent & self-determining. It energizes a wide variety of behaviors & psychological processes for which the primary rewards are the experiences of effectance & autonomy.
Self-Determination Self-determination is a primary factor influencing intrinsic motivation. The intrinsic needs for competence & self-determination motivate an ongoing process of seeking challenges. Intrinsic motivation & self-determination are central concepts in organismic theory. Social contexts that satisfy needs for competence & autonomy facilitate the development of a greater sense of self-determination, which, in turn, helps to facilitate task persistence & psychological well-being. However, lack of perceived control leads to feelings of helplessness, impairing both learning & performance. Self-determination is a crucial component of the relationship between exercise motivation & psychological well-being. Intentional action is better conceptualized as varying along a motivational continuum. Varying degrees of self-determination can fall between the continuum endpoints of non self-determined or motivated to extrinsic (somewhat self-determined) & intrinsic (completely self-determined) motivation. This continuum also suggests particular psychological conditions that may lead to motivational changes & enhanced psychological well-being. External regulation involves behavior that is undertaken solely to avoid immediate negative consequences. It is the most basic form of extrinsic motivation. Introjected regulation involves self-administration of sanctions, pressures, & other self-controlling behaviors. This, a regulation is internalized in essentially its original form. In other words, external regulations have become introjected. Introjected regulation is more stable than external regulation because introjected regulation does not require the presence of external contingencies. The contingencies are internalized at this point within the person; therefore, they are continuously present. Identified regulation is action undertaken because of its intrinsic value, importance or usefulness. It involves less internal conflict, & the individual accepts the regulation as his or her own. Integrated regulation is “a natural outcome of internalization that is not impeded or thwarted by environmental influences.” It results from the integration of identified regulation into one’s unified sense of self. Individuals accept external values as being congruent with their own values. They accept them as their own and behave, think, & feel accordingly. Representing full self-determination, integrated regulation reflects that individuals engage in the behaviors purely for fun & enjoyment. Individuals who are initially externally regulated may eventually feel self-determined, even if they were not initially intrinsically motivated. For example, for those individuals who begin to exercise for weight management purposes, the role of health promotion is to facilitate internalization. Through such a process, individuals progressively transform their view of exercise so that it becomes a personally valued part of their lives. Transforming an external regulation into an inner one requires a shift in perspective. Internalization involves mastering external demands and owning them on a more deeply personal level. This internalization process allows for greater autonomy & more effective functioning. It is a constructive process allowing one to be more competently self-determining, even though the goals may initially be extrinsic. Although extrinsic motives may be important in getting individuals initially involved in fitness programs, they are usually not enough to maintain regular exercise. There is evidence that extrinsic motives to exercise lead to stress, whereas intrinsic motives increase feelings of well-being. Researchers have not found a focus on external attributes, such as appearance & body shape, to be associated with improved mental health. However, regardless of one’s initial motive for exercising, intrinsic motivation is crucial for adherence. Most individuals participate in fitness programs for extrinsic reasons. These concerns include losing weight or becoming more attractive. Such reasons for participation are likely to be related to poor adherence because extrinsically focused individuals may derive less enjoyment from the activity itself. They may feel more pressure & anxiety & a general lack of enjoyment of the exercise routine. Even if individuals are trying hard to adhere to their programs, the stress that they feel may quickly lead to non adherence. A combination of smoking & non exercise adherence increases the risk of morbidity & mortality. Because cancer & chronic disease tend to develop over a period of many years, keeping today’s youth healthy should be a top priority. Exercise is a catalyst for engaging in other healthy behaviors. Encouraging young people to be sufficiently active may serve as a protective factor with respect to maintaining or adopting a nonsmoking status. An investigation of college students found that about 1/2 of the participants were primarily motivated to look better rather than being motivated by health concerns. Moreover, 29% reported that they were not at all satisfied with their current exercise program. There is considerable evidence that participation in all types of physical activity declines as children progress through school. The tendency toward a more sedentary lifestyle is likely because of not developing a sufficient amount of intrinsic motivation for regular physical exercise. Although smoking rates in college students have begun to decrease, it is only a modest decline & is still a cause for concern. Literature indicates that 10% of middle school students, 23% of high school students, & more than 2,000,000 college students currently smoke. In a recent investigation of college students, about half of regular exercisers identified themselves as smokers. Furthermore, in comparison with their nonsmoking peers, young smokers have less physical endurance, more complaints of bodily pain, more emotional problems, & poorer overall health. The Transtheoretical Model (TTM) posits that health behavior change involves progress through 6 stages: precontemplation, contemplation, preparation, action, maintenance, & termination. Individuals at the precontemplation stage have no intention of making a positive change within the next 6 months. In contrast, those at the contemplation stage are intending to make such a change at some point within the next 6 months. During the preparation stage, individuals become committed to making a significant change sometime within the next 6 months. Those in the action stage have already made a significant change for up to 6 months. To be in the maintenance stage, individuals must have maintained the positive change for at least 6 months. Finally, those in the termination stage are fully confident that they will not return to the previously unhealthy behavior. However, given the multidimensional nature of adopting a regular exercise regime & a healthy diet, the concept of a termination stage, for these behaviors, is open to question.
METHODS For the present study, we assessed the following hypotheses: Hypothesis 1: Individuals in action stage will exhibit a combination of external regulation, introjected regulation, & identified regulation for exercise. Hypothesis 2: Compared with those in the earlier stages for exercise individuals in the maintenance stage for exercise will be more likely to exhibit integrated or intrinsically regulated motivation for exercise & will have the lowest level of body image anxiety. Hypothesis 3: Individuals who smoke & exercise will be more likely to do so for extrinsic reasons, compared with physically active nonsmokers.
Measures TTM Stages of Change Measures used to identify & categorize where each participant was functioning with respect to exercise & smoking behavior. Exercise Motivation Scale (EMS) is a 31 item questionnaire designed to assess behavioral tendencies according to self-determination theory. Factor loadings have been found to be statistically significant & moderate in size, ranging from .59 to .88, with an average value of .71. Values of internal consistency vary from .75 to .90, with an average of .80.30
Procedure Participants were 614 undergraduate students; 489 were from psychology classes at the University of Rhode Island and 125 were from business classes at Florida Gulf Coast University. Students received course credit for their participation & were at least 18 years of age (range = 18–48; M = 19.63, SD = 3.69), the majority being 18–19 years of age. Most participants were also female (63%) and freshmen
(65%). With respect to ethnic background, 81.4% identified themselves as white, 6% as Hispanic, 4.1% as black, 2.4% as Asian, & 5.6% as other. This distribution is consistent with the demographics at each university. Participants filled out an online survey relating to their exercise & smoking behaviors. They also filled out questions concerning intrinsic & extrinsic motivational factors for exercise. The anonymous survey, containing several questionnaire components, was administered over the Internet and took less than hour to complete. A link to the survey was established for each relevant course on both universities’ Web-connect systems. Upon completion of the survey, a confirmation page appeared as receipt of an individual’s participation. The universities’ institutional review boards approved all aspects of the study. Examples of survey items include the following: “Do you currently engage in regular exercise (at least 4x per week for 30 or more minutes per session)?” “Do you intend to engage in regular exercise in the next 6 months?” and “Do you intend to engage in regular exercise in the next 30 days?” Examples of smoking-related items include the following: “Are you seriously considering quitting within the next 6 months?” “Are you planning to quit within the next 30 days?” & “In the last year, how many times have you quit for at least 24 hours?” In addition, participants responded to exercise-motivation items on a 6-point Likert-type scale ranging from 1(strongly disagree) to 6(strongly agree). The opening question for these items was “Why are you currently participating in this activity?” The participants then rated the following items: “for the pleasure it gives me to experience positive sensation from the activity, because it is consistent with what I value, because other people believe that it is a good idea for me to exercise, because I feel pressure from others to participate, & for the satisfaction I feel when I get into the flow of the activity.”
RESULTS: Subject Characteristics We conducted preliminary analyses to determine if there were any significant differences between participants at the University of Rhode Island and those at Florida Gulf Coast University. Because we found no significant differences between the two groups of students with respect to any of the health behaviors or motivational factors, further analyses included the combined results from both campuses. It is noteworthy that a little less than 1/3 of the participants simultaneously engaged in the 2 targeted health behaviors—a small minority that can be characterized as nonsmokers, as well as regular exercisers. The percentage of participants at various stages of exercise indicated a cubic trend such that there was an increase from precontemplation to preparation, then a decrease to action, followed by an increase to the highest point at maintenance (6.1%, 9.9%, 31.1%, 14.7%, and 38.2%, respectively). A chisquare analysis indicated that there was a significant association between sex and stage of exercising, χ2(4, N = 586) = 30.1, p < .01. Comparisons of group percentages by sex indicated that more women than men were in the preparation and action stages (36% vs 22% and 17.2% vs 10.1%, respectively), and more men than women were in the maintenance stage. The percentage of participants engaging in smoking to non smoking behavior indicated a quartic trend with a decrease from precontemplation to contemplation, an increase in preparation and action, followed by a decrease in maintenance (16.2%, 14.1%, 15.7%, 38.9%, and 15.2%, respectively). The percentage of women, compared with that of men, was greater in contemplation (16.2% vs 10.3%, respectively), preparation (16.9% vs 13.2%, respectively), and maintenance (16.2% vs 13.2%, respectively), whereas the percentage of FIGURE 1. Participant percentages in Exercise Stage × Gender. PC = precontemplation; C = contemplation; P = preparation; A = action; M = maintenance. 60%, 50%, 40%, 30%, 20%, 10%, 0% PC C P A M Female Male Total TABLE 1. Participant Demographics Among University of Rhode Island and Florida Gulf Coast University Students Native Variable White Hispanic Black Asian American Other Total Female Number 306 21 8 13 2 24 374, Percentage 81.8 5.6 2.1 3.5 0.5 4.3 100.0, Percentage of total 52.2 3.6 1.4 2.2 0.3 4.1 63.8, Male Number 171 14 16 1 1 9 212, Percentage 80.7 6.6 7.5 0.5 0.5 4.2 100.0, Percentage of total 29.2 2.4 2.7 0.2 0.2 1.6 36.1, Total percentage 81.4 6.0 4.1 2.4 0.5 5.6 100.009 men, compared with that of women, was greater in action. Gender and smoking were not significantly related for both schools combined χ2(4, N = 198) = 4.33, p > .01 and separately (for University of Rhode Island, χ2(4, N = 117) = 2.22, p > .01; for Florida Gulf Coast University, χ2(4, N = 38) = 4.60, p > .01. To test Hypothesis 1, we conducted a multivariate analysis of variance (MANOVA) to determine if the external regulation, introjected regulation, an identified regulation motivational factors for exercise were significantly greater in the action stage, compared with the other stages of change. According to Wilks’s criterion (λ = .914), the overall MANOVA was found to be significant, F(12, 1095.6) = 3.16, p < .01. Follow-up analyses of variance (ANOVAs) revealed identified regulation to be the only variable significantly different across the stages for exercise, F(4, 416) = 6.27, p < .01, η2 = .057, m2 = 44.26. With respect to motivational factors, Tukey follow-up tests indicated that those participants in the precontemplation stage were significantly different from those in the preparation, action, and maintenance stages. Comparisons of group means revealed that those students in the preparation through maintenance stages had higher mean values. The hypothesis was partially supported such that 1 of the hypothesized motivational variables, identified regulation, was highest in the more active stages of change. Participant percentages in Smoking Stage × Gender. PC = precontemplation; C = contemplation; P = preparation; A = action; M = maintenance. 50%, 40%, 30%, 20%, 10%, 0% PC C P A M Female Male Total 45%, 35%, 25%, 15%, 5% TABLE 2. Motivational Variables × Exercise Stage: Hypothesis 1 Results MANOVA result Follow-up ANOVA result Motivational variable F p dfs F m2 p dfs External regulation 1.46 19.13 > .01 4, 416 Introjected regulation 3.15a < .01 12, 1095.6 1.94 31.21 > .01 4, 416 Identified regulation 6.27 44.27a < .01 4, 416 Note. MANOVA = multivariate analysis of variance; ANOVA = analysis of variance. All ps < .01. ameets required level of significance. Significant Identified Regulation Tukey Results × Exercise Stage Identified regulation Stage of exercise n M SD Precontemplation 12 16.50 3.45 Contemplation 18 19.06 2.88 Preparation 98 20.04* 2.62 Action 80 20.13* 2.81 Maintenance 213 20.24* 2.55 *significantly different from precontemplation, p < .05. To test Hypothesis 2, we conducted an ANOVA for integrated regulation and the sum of the intrinsic motivational factors (intrinsic motivation to accomplish things, intrinsic motivation to learn, and intrinsic motivation to experience sensations). The ANOVA revealed that both variables were significantly different from the stage categories, Precontemplation through action (PC–A) and maintenance (M), F(1, 433) = 19.49, p < .01, m2 = 5.63, and F(1, 415) = 15.51, p < .01, m2 = 29.47. Focused mean comparisons indicated that these motivational factors were highest in the maintenance stage. In testing Hypothesis 3, the MANOVA, using Wilks’s criterion (λ = .939) and follow-up ANOVAs indicated that integrated regulation and intrinsic motivation to accomplish things differed significantly for the active nonsmokers and active smokers, F(1, 272) = 13.95, m2 = 3.6, and F(1, 272) = 11.77, p < .01, m2 = 142.5, respectively. The other motivational variables did not differ significantly between these subgroups. Taking the means and standard deviations for the significant motivational variables into consideration, active nonsmokers, compared with active smokers, had a higher mean value for integrated regulation and for intrinsic motivation to accomplish things.
COMMENT Examined separately, the percentages of those who exercised regularly & did not smoke suggested that the participants in this study were living a moderately healthy lifestyle. However, when these 2 variables were assessed together, only 29% of the participants were engaging in TABLE 4. Motivational Variables × Exercise Maintenance Stage: Hypothesis 2 Results ANOVA result Motivational variable F m2 p dfs Integrated regulation 19.49 5.63a < .01 1, 433 Sum of intrinsic motivational variables 15.51 29.47a < .01 1, 415 Note. ANOVA = analysis of variance. Amotivational variable is significantly different from PC–A (precontemplation—action) exercise stages. Significant Results × Exercise Maintenance Stages, & Sample Sizes, Means, & Standard Deviations Motivational variable & stage n M SD Integrated regulation PC–A 215 2.39 0.58 Maintenance 220 2.61* 0.50 Total 435 2.50 0.55 Sum of intrinsic motivational variables PC–A 201 7.01 1.43 Maintenance 216 7.54* 1.33 Total 417 7.28 1.40 Note. PC–A = precontemplation–action. *p < .05. MANOVA Results for all Motivational Variables × Exercise Stage MANOVA result Motivational variable F p Amotivation 0.28 > .01 External regulation 2.39 > .01 Introjected regulation 0.63 > .01 Identified regulation 0.33 > .01 Integrated regulation 13.94a < .01 Intrinsic motivation to learn 6.14 > .01 Intrinsic motivation to accomplish things 11.77a < .01 Intrinsic motivation to experience sensations 1.35 > .01 Note. All dfs = 1, 127. MANOVA = multivariate analysis of variance. ameets criteria for statistical significance. these behaviors simultaneously. The vast majority of participants may be at some risk for later health problems. Findings related to Hypotheses 1, 2 indicated that the more intrinsically related motivational factors (identified & integrated regulation) were present to a greater degree in the more active stages of exercise. Consistent with prior research, higher levels of self-determination seem to lead to continued maintenance of regular exercise. Those people who are less self-determined may be at risk for remaining or returning back to a relatively sedentary lifestyle. Interventions to increase intrinsic motivation should be a significant part of programs designed to help individuals incorporate regular exercise into their daily lives. With regard to Hypothesis 3, physically active nonsmokers displayed significantly higher levels of intrinsic motivation than did physically active smokers. Additionally, active smokers expressed higher levels of extrinsic motivation than did active nonsmokers. Other research suggests that one of the reasons that many individuals smoke is a perception that it will help to control their body weight. Because extrinsic motivational factors tend to be related to concerns about physical appearance, those exercisers who continue to smoke may be doing so because of chronic body image dissatisfaction. Self-determination theory (SDT) fits well TTM, focusing on a level of change relating to internal perceptions & motivational factors. In conjunction with TTM-based interventions, integrating SDT-based measures could aid in assessing, tracking, & capturing an individual’s internal change processes. With more precise measurement of the internal change process, interventions could target both environmental influences as well as the individual’sunderlying motivations. Such an approach is likely to improve the quality of interventions, leading to more lasting behavioral changes. Interventions promoting consistent exercise & smoking abstinence should continue to be directed toward young adults. In addition, trying to better understand the paradox of the physically active smoker should involve a careful analysis of ways that these individuals manage their psychological distress. The present study has several limitations. The data may only be reflective of the behavior of a young adult college population. The findings were also cross-sectional, limiting the possibility of inferring causal relationships among variables. The data were collected using a self-report Internet survey. In self-report surveys, individuals tend to portray themselves in a relatively positive light. For example, a study found that participants tend to overreport their physical activity. However, another study found that participants felt they were more likely to be honest when participating in an Internet study because of the increased comfort of anonymity. Furthermore, they liked the flexibility provided by the Internet (eg, taking it at a time convenient for them). Hopefully, the present study will encourage others to use the Internet as a research tool.
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<a href="http://search.ebscohost.com/login.aspx?direct=true&db=sch&AN=35573557&site=scirc-live">Youth Risk Behavior Surveillance -- Pacific Island United States Territories, 2007.</a>
November 21, 2008
Youth Risk Behavior Surveillance — Pacific Island United States Territories, Abstract Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity & mortality among youth & adults in Pacific Island territories, often are established during adolescence & extend into adulthood. Reporting Period Covered: January–June 2007. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors 6 categories of priority health-risk behaviors among youth & young adults, including behaviors that contribute to unintentional injuries & violence; tobacco use; alcohol & other drug use; sexual behaviors that contribute to unintended pregnancy & sexually transmitted diseases, including human immunodeficiency virus infection; unhealthy dietary behaviors; & physical inactivity. In addition, the YRBSS monitors the prevalence of obesity & asthma. YRBSS includes a national school-based survey conducted by CDC & state, territorial, tribal, & local school-based surveys conducted by state, territorial, tribal, & local education & health agencies. This report summarizes results from surveys of students in grades 9–12 conducted in five territories (American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Republic of the Marshall Islands, & Republic of Palau) during January–June 2007.
Results: Across the 5 Pacific Island territories, the leading causes of mortality among all ages include unintentional injuries, including motor-vehicle crashes; cancer; cardiovascular diseases; stroke; & diabetes. Results from the Youth Risk Behavior Survey (YRBS) indicated that high school students in the Pacific Island territories engaged in behaviors that increased their risk for mortality or morbidity from these causes. Across the five territories during 2007, the percentage of high school students who had rarely or never worn a seat belt when riding in a car driven by someone else ranged: 11.8% to 83.2% (median: 30.9%). During the 30 days before the survey, the percentage who had ridden in a car or other vehicle driven by someone who had been drinking alcohol ranged: 34.8% to 49.8% (median: 42.8%), the percentage who had driven a car or other vehicle when they had been drinking alcohol ranged: 7.8% to 16.1% (median: 11.9%), & the percentage who had carried a weapon ranged: 16.9% to 32.0% (median: 19.6%). The percentage of students who had smoked cigarettes during the 30 days before the survey ranged: 23.1% to 37.6% (median: 31.1%), the percentage who had not eaten fruits & vegetables five or more times per day during the 7 days before the survey ranged: 72.8% to 83.6% (median: 79.5%), & the percentage who had not met recommended levels of physical activity ranged: 64.0% to 77.2% (median: 68.9%).
Interpretation: The prevalence of many health-risk behaviors varies across the 5 Pacific Island territories, & many high school students engage in behaviors that place them at risk for the leading causes of mortality & morbidity.
Introduction Across the 5 Pacific Island territories, the leading causes of mortality among all ages include unintentional injuries, including motor-vehicle crashes; cancer; cardiovascular diseases; stroke; & diabetes. Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity & mortality, often are established during childhood & adolescence & then extend into adulthood. These behaviors are monitored by
YRBSS. The
YRBSS monitors 6 categories of priority health-risk behaviors among youth & young adults, including behaviors that contribute to unintentional injuries & violence; tobacco use; alcohol & other drug use; sexual behaviors that contribute to unintended pregnancy &
STDs, including human immunodeficiency virus (
HIV) infection; unhealthy dietary behaviors; & physical inactivity. The
YRBSS also monitors obesity & asthma & includes national, state, territorial, tribal, & local school-based surveys of students in grades 9–12. This report summarizes results from the 2007
YRBS conducted in 5 Pacific Island Territories
(American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Republic of the Marshall Islands, & Republic of Palau) during January 2007–June 2007. Methods Detailed information about
YRBSs has been described elsewhere. Additional information also is available at
http:// www.cdc.gov/yrbs.
Sampling Each territory school-based survey employed a two-stage cluster sample design to produce a representative sample of public school students in grades 9–12. In the first sampling stage, all schools with any students in grades 9–12 were selected. In the second sampling stage, in American Samoa, Commonwealth of the Northern Mariana Islands, Republic of the Marshall Islands, & Republic of Palau, all students were eligible to participate; in Guam, intact classes from either a required subject (e.g., English or social studies) or a required period (e.g., homeroom or second period) were selected randomly, & all students in selected classes were eligible to participate. Pacific Island territories that had a representative sample of students, appropriate documentation, & an overall response rate of 60% or higher were weighted. A weight was applied to each record to adjust for student nonresponse & the distribution of students by grade & sex. Therefore, weighted estimates are representative of all students in grades 9–12 attending public schools in each territory. In 2007, all 5 Pacific Island territories had weighted data. Student sample sizes ranged from 732 to 3,625 (Table 1). School response rates were all 100%; student response rates ranged from 78% to 90%; & overall response rates, calculated by multiplying the school response rate by the student response rate, ranged from 78% to 90%. Data Collection Procedures & Questionnaire Procedures were designed to protect students’ privacy by allowing for anonymous & voluntary participation. Before survey administration, local parental permission procedures were followed. Students completed the self-administered questionnaire during one class period & recorded their responses directly on a computer-scannable booklet or answer sheet. The core questionnaire contained 87 questions. Territories could add or delete questions from the core questionnaire. Skip patterns were not included in any questionnaire to protect student privacy by ensuring all completed the questionnaire in approximately the same amount of time. Information about the reliability of the core questions has been published previously Data Processing & Coding Data from each territory data set were cleaned & edited for inconsistencies. Missing data were not imputed statistically. The number of completed questionnaires that failed quality control checks & were excluded from analysis ranged from 1 to 12 (median: four). Race/ethnicity was defined differently for each Pacific Island territory &, therefore, it is not included in this report. Students were classified as obese or overweight based on their body mass index (kg/m2) (BMI), which was calculated from self-reported height & weight. The BMI values were compared with sex- & age-specific reference data from the 2000 CDC Growth Charts. Obese was defined as a BMI of >95th percentile for age & sex. Overweight was defined as a BMI of >85th percentile & <95th percentile for age & sex. Previous YRBS reports used the terms “overweight” to describe those youth with a BMI >95th percentile for age & sex & “at risk for overweight” for those with a BMI Data only available for American Samoa, Commonwealth of the Northern Mariana Islands, & Guam. A questionnaire that fails quality control has less than 20 remaining responses after editing or has the same answer to 15 or more questions in a row. MMWR November 21, 2008 >85th percentile & <95th percentile. However, this report uses the terms “obese” & “overweight” in accordance with the 2007 recommendations from the Expert Committee on the Assessment, Prevention, & Treatment of Child Adolescent Overweight & Obesity convened by the American Medical Association (AMA) & cofunded by AMA in collaboration with the Health Resources & Services Administration & CDC. These classifications are not intended to diagnose individual students as obese or overweight, but rather to provide estimates of obesity & overweight for the population of students surveyed. The reliability & validity of self-reported height & weight among high school students has been described previously. Analytic Methods Statistical analyses were conducted on weighted data using SAS® & SUDAAN software to account for the complex sampling designs. Prevalence estimates were computed for all variables & all data sets. Confidence intervals were computed for Guam because that site used a sample rather than a census of students.
Results
Dating Violence Across surveys, the overall percentage of students who had been hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend (i.e., dating violence) ranged: 13.3% to 30.8% (median: 14.1%). Prevalence among female students ranged: 12.5% to 25.9% (median: 14.8%), & prevalence among male students ranged: 10.0% to 35.5% (median: 14.9%).
Felt Sad or Hopeless Across surveys, the overall percentage of students who had felt so sad or hopeless almost every day for two or more weeks in a row that they stopped doing some usual activities during the 12 months before the survey ranged: 37.1% to 47.3% (median: 41.9%). Prevalence among female students ranged: 43.8% to 52.6% (median: 46.3%), & prevalence among male students ranged: 29.4% to 48.2% (median: 34.4%).
Tobacco Use Lifetime Cigarette Use Across surveys, the overall percentage of students who had ever tried cigarette smoking (even one or two puffs) (i.e., lifetime cigarette use) ranged: 56.8% to 78.1% (median: 69.7%). Prevalence among female students ranged: 53.1% to 78.7% (median: 67.6%), & prevalence among male students ranged: 57.1% to 77.6% (median: 71.6%). Lifetime Daily Cigarette Use Across surveys, the overall percentage of students who had ever smoked at least one cigarette every day for 30 days (i.e., lifetime daily cigarette use) ranged: 13.6% to 17.6% (median: 16.6%). Prevalence among female students ranged: 12.6% to 16.2% (median: 13.1%), & prevalence among male students ranged: 14.2% to 22.3% (median: 17.8%).
Current Cigarette Use Across surveys, the overall percentage of students who had smoked cigarettes on at least one day during the 30 days before the survey (i.e., current cigarette use) ranged: 23.1% to 37.6% (median: 31.1%). Prevalence among female students ranged: 20.4% to 31.1% (median: 25.4%), & prevalence among male students ranged: 22.9% to 44.4% (median: 31.2%). Current Frequent Cigarette Use Across surveys, the overall percentage of students who had smoked cigarettes on 20 or more days during the 30 days before the survey (i.e., current frequent cigarette use) ranged: 8.2% to 13.1% (median: 11.0%). Prevalence among female students ranged: 2.6% to 10.7% (median: 6.7%), & prevalence among male students ranged: 7.2% to 21.3% (median: 13.9%).
Smoked More than 10 Cigarettes per Day Across surveys, among students who currently smoked cigarettes, the overall percentage of students who had smoked more than 10 cigarettes per day on the days they smoked during the 30 days before the survey ranged: 4.7% to 11.8% (median: 6.9%). Prevalence among female students ranged: 5.3% to 8.2% (median: 6.3%), & prevalence among male students ranged: 6.5% to 18.1% (median: 7.8%). Tried to Quit Smoking Cigarettes Across surveys, among students who currently smoked cigarettes, the overall percentage of students who had tried to quit smoking cigarettes during the 12 months before the survey ranged: 74.0% to 89.3% (median: 81.9%). Prevalence among female students ranged: 75.7% to 91.7% (median: 83.9%), & prevalence among male students ranged: 70.8% to 87.6% (median: 82.3%).
Bought Cigarettes in a Store or Gas Station Across surveys, among students who currently smoked cigarettes & were aged <18 years, the overall percentage of students who usually got their own cigarettes by buying them in a store (i.e., convenience store, supermarket, or discount store) or gas station during the 30 days before the survey ranged: 14.9% to 30.8% (median: 17.3%). Prevalence among female students ranged: 12.1% to 21.6% (median: 17.3%), & prevalence among male students ranged: 12.8% to 40.6% (median: 21.3%).
Current Tobacco Use Across surveys, the overall percentage of students who had reported current cigarette use, current smokeless tobacco use, or current cigar use (i.e., current tobacco use) ranged: 25.4% to 50.9% (median: 38.8%). Prevalence among female students ranged: 23.4% to 47.4% (median: 28.1%), & prevalence among male students ranged: 24.6% to 54.1% (median: 50.5%).
Age of Initiation of Risk Behaviors Smoked a Whole Cigarette Before Age 13 Years Across surveys, the overall percentage of students who had smoked a whole cigarette for the first time before age 13 years ranged: 6.9% to 28.6% (median: 22.7%). Prevalence among female students ranged: 6.2% to 27.4% (median: 19.4%), & prevalence among male students ranged: 7.5% to 29.8%(median: 25.2%).
Tobacco, Alcohol, & Other Drug Use on School Property Smoked Cigarettes on School Property Across surveys, the overall percentage of students who had smoked cigarettes on school property on at least one day during the 30 days before the survey ranged: 6.7% to 16.3% (median: 10.2%). Prevalence among female students ranged: 7.3% to 10.7% (median: 9.0%), & prevalence among male students ranged: 6.1% to 23.1% (median: 11.5%.
Asthma Lifetime Asthma Across surveys, the overall percentage of students who had ever been told by a doctor or nurse that they had asthma (i.e., lifetime asthma) ranged: 15.6% to 18.5% (median: 16.2%). Prevalence among female students ranged: 14.4% to 16.1% (median: 15.0%), & prevalence among male students ranged: 16.3% to 20.7% (median: 17.9%) (Table 46). Current Asthma Across surveys, the overall percentage of students who had lifetime asthma and still had asthma (i.e., current asthma) ranged: 5.7% to 6.5% (median: 5.8%). Prevalence among female students ranged: 5.4% to 6.6% (median: 6.4%), & prevalence among male students ranged: 5.2% to 6.5% (median: 5.9%).
Conclusion YRBS data collected by the Pacific Island territories will be used for decision making & evidence-based program planning. Education agencies in the territories use the YRBS data to establish health education & health promotion goals, to support curricular modifications, to support legislation that promotes health, & to seek funding for new initiatives. Data only available for American Samoa, Commonwealth of the Northern Mariana Islands, & Guam.
SMOKING BEHAVIOR: The act of smoking has been the object of extensive research, especially since the 1950s. It remains difficult, however, to know the historical influences that prompted the early use of tobacco. It is known that smoking developed social significance through tribal ceremonies and customs of the indigenous populations of North America. As industrial societies became established, mass production and corporate marketing took advantage of the stimulative and addictive properties of nicotine. The use of tobacco also took on a new social meanings as it was marketed to fulfill psychosocial needs such as a attaining independence or being part of a "cool" trend. The result was widespread and frequent usage, particularly through the smoking of cigarettes. High consumption has since produced devastating health effects. Although early opponents had to rely primarily on moral and emotional persuasion, epidemiological evidence of tobacco's impact on morbidity and mortality now provides the principal impetus to develop policies to prevent smoking. The abundance of information that now exists on smoking necessitates the use of various frameworks, theories, and models in order to achieve a comprehensive and coherent perspective. A frame work, such as PRECEDE-PROCEED, helps depict the broad context of smoking and encourages the analysis of a comprehensive range of variables; a theoretical approach facilitates explanations as well as predictions; and modeling enhances visual representation or mathematical relations. Most of the major public health models and theories have been applied to smoking, and the literature contains support for many of these theories. This is partly due to the generality of the theoretical concepts. Figure 1 is a graph of the prevalence of smoking across age groups in Canada. This graph shows that daily smoking largely begins and expands during the teenage years, and then peaks among young adults before decreasing. The behavior follows a sequence of experimentation, initiation, maintenance, and cessation. While the major behavioral change occurs during the teenage years, many of the predisposing factors develop at an earlier age. Beliefs, attitudes, and values begin to develop very early in life, and these influence later behavioral patterns.
DEVELOPMENT OF BEHAVIOR PATTERNS: Human beings have a long period of infant and child development, which allows children to adapt and acquire coping skills that help them survive in their environments. Due to the increasingly complex nature of society, the early socialization process needs to build capacities for communication, learning, and making decisions for healthful behavior. The initiation of smoking tends to exist among young people who report having a home environment that includes difficulty communicating with parents, lack of parental understanding, low levels of trust, and a generally unhappy home life. This type of family setting creates conditions conducive to a lifestyle that includes smoking. Such predisposing factors are also evident as social networks expand during the teenage years. The teenage years are a time of transition. They form a bridge between the relatively sheltered environment of childhood and the roles of adulthood. Teenagers begin to confirm their own identities and emulate adult roles. There is a heightened awareness of role models and a tendency to establish boundaries through experimentation and experiencing new risks. School is obviously an important environment for teenagers and students who smoke at this age are more likely to experience difficulties in the academic setting. They experience lower grades, poor student-teacher interactions, minimal academic aspirations for the future, and often complain of unfair school rules. Teenage smokers also tend to have lower self-esteem—they are more likely to report feelings of unhappiness and loneliness, a lack of confidence, and a sense of being unhealthy. Young people who smoke generally have a reduced capacity to implement practices that promote advancement at home and at school, and in other important settings. This can affect their ability to maintain a healthy sense of identity that includes belonging, worthiness, and hope for the future. Tobacco advertisements prey on these needs by offering an image of suave independence. The insinuation is that smoking will help an individual to achieve desirable qualities. Data are not readily available to quantify the behavioral impact of this practice. It has been shown, however, that young people are readily able to identify images and brands promoted by the tobacco industry. Other aspects of the social environment have promoted the acceptability of smoking, such as smoking by role models in the movie industry and the widespread visibility of smoking. Studies indicate that smokers tend to overestimate the prevalence of smoking and underestimate the health hazards. All these processes and conditions are set in place during the early years of socialization, and they contribute toward a predisposition that smoking is acceptable and even desirable. Once individuals are predisposed toward the possibility of smoking, enabling factors facilitate the actual behavior.
ENABLING FACTORS: Two obvious requirements are necessary for someone to smoke: being able to acquire cigarettes and having a setting that is conductive to lighting up. Increased access to a supply of cigarettes is closely related to the expansion of a person's boundaries and social networks. Peer groups create an important source and setting for the uptake and maintenance of smoking. During their midteens, smokers tend to have a larger number of friends and spend a great deal of time with them outside of school activities. Friends and relatives often supply cigarettes to begin smoking, but commercial outlets quickly become the main source. Studies have found that young people do not have difficulty obtaining tobacco, even with recent legislation to prevent the sale of tobacco to minors. When prices are increased, largely through taxation, additional sources become important. These include roll-your-own tobacco, illegal smuggling, tax-free sales on Indian reservations, and mail order. The inverse relationship between price and consumption may be because smoking is more prevalent among persons with a lower socioeconomic status who have a limited amount of money to spend on tobacco products. However, once smoking has begun there is a tendency toward continuance and an integration of smoking into one's lifestyle. The predisposing and enabling factors develop into patterns that reinforce the behavior, as do the addictive properties of nicotine.
REINFORCING BEHAVIOR PATTERNS: Reinforcing patterns begin with having friends who are smokers. Spending time with such friends provides ample opportunities to reinforce smoking behavior. Patterns develop to have a cigarette during breaks at work, with food and beverages, and during social events such as parties. Strong correlations exist between smoking and the consumption of caffeine, alcohol, and marijuana. These patterns move smokers away from healthy and productive lifestyles. There are thus a host of illness symptoms and premature deaths attributable directly to smoking as well as indirectly to the broader pattern of unhealthful behavior. In 1999, The World Health Organization reported that "the joint probability of trying smoking, becoming addicted, and dying prematurely is higher than for any other addiction." Although smokers downplay the consequences of smoking, they do recognize that a risk exists, though they find it difficult to quit. Many teenagers believe they will only smoke for a short duration. Others state they can "quit anytime." Unfortunately, a significant number are in for a long struggle, and perhaps a lifetime addiction to tobacco. Most of the decline in the proportion of smokers does not occur until past the age of forty. This is partially related to successful quitters and premature deaths of smokers. More than two out of three adult smokers report a desire to quit smoking. The most common reason for successful quitting is a concern about future health. The influence of these health concerns is enhanced by a continual decline in the proportion of adult smokers subsequent to the publication of the 1964 Surgeon General's report outlining the consequences of smoking. However, during the 1990s there was a slightly upward trend in the proportion of high school students who are smoking. For young people, the subjective meaning of smoking extends beyond the concern about future health consequences. The principal predisposing and enabling factors for smoking occur during the socialization process. Personal insecurities, problems at home, and difficulties in academic environment are all preyed upon by a tobacco industry driven by profits, and smoking cigarettes and intake of nicotine become entrenched into behavioral patterns that create a high-risk trajectory and bleak outlook for the health of individuals and the population. The underlying causes of smoking are complex and deeply rooted, and the necessary research on smoking continues to expand. Public health advocates recognize the need for comprehensive tobacco control strategies, but also admonish individuals that: If you don't smoke, don't start, and if you do smoke, quit. Social changes and changes in individual behavior are required to achieve a significant reduction in tobacco use.
BIBLIOGRAPHY: 1 Green, L. W., and Kreuter, M. W. (1999). Health Promotion Planning: An Educational and Ecological Approach. Mountain View, CA: Mayfield. 2 Health Canada. Tobacco Use Monitoring Survey, Wave 1 Fact Sheets. Available at http://www.hc-sc-.gc.ca/hpb/lcdc/bc/ctums/pdf/ctums99.pdf. 3 Lalonde, M. (1974). A New Perspective on the Health of Canadians: A Working Document. Ottawa: Canadian Department of National Health and Welfare. 4 National Association of County and City Health Officials (2000). Programming and Funding Guidelines for Comprehensive Local Tobacco Control Programs. Available at http://www.naccho.org/downloadfile2.cfm/General185.pdf. 5 Pollay, R. W. (2000). "Targeting Youth and Concerned Smokers: Evidence from Canadian Tobacco Industry Documents." Tobacco Control 9:136–147. 6 World Health Organization (1999). "Combating the Tobacco Epidemic." In The World Health Report 1999—Making a Difference. Available at http://www.who.int/whr/1999/.
Understanding Parental Influence on Your Teens Behavior
Despite what teens may say, their parents do play a critical role in determining what influences them. In many ways, parental behavior and the nature of the parent/teen relationship influences a teens decision to smoke, take drugs, become sexually active, and use contraception. Parental behavior can also affect teenager's choices to join a gang or participate in criminal activity. As a parent, you play a vital role in helping your child avoid risky behaviors. Actively listening to what your teen has to say will pave the way for conversations about topics that concern you, but setting harsh, unbending rules may only drive your teen toward negative choices. If parents have a dominating parenting style and aren't knowledgeable about their teens activities and interests, it is more likely that their teen will engage in risky behaviors. On the other hand, teens who report feeling 'connected' to their parents are the least likely to engage in risky behaviors.
Parents who are involved, responsive, and who hold their children to a reasonably high standard of behavior tend to have teens that are less likely to smoke than those whose parents do
not. Research has shown that teens who have parents that smoke are at an increased risk of smoking, and teens who believe their parents would strongly object to their smoking are less likely to become smokers. To help prevent your teen from smoking, be a good role model, clearly communicate your disapproval of smoking, and consistently set firm rules and guidelines. Make sure your teen is well informed on the health risks of smoking. A 2000 study on health-compromising behavior among teens showed that 86% of teens who have dinner with their families 5 or more nights in a typical week had never tried cigarettes, compared with 65% of those teens who have dinner with their families 2 nights a week or less. Again, this shows the best way that you can prevent your teen from smoking is to be a positive role model and be active in your teens life.
Tobacco Is Extremely Addicting
