Int J Adolesc Med Health 2016; 28(1): 1–2

Editorial Ariel Tenenbaum* and Joav Merrick

Smoking: do you really know the risk? DOI 10.1515/ijamh-2015-0025

Introduction Cigarette smoking prevalence among adults over 18 years of age has decreased to 42.4% since 1965 (1), but currently, it is still at a level that public health agencies are not happy with (1). The Center for Disease Control and Prevention (CDC) has looked at the National Health Interview Survey (NHIS) data for 2004–2010 to describe cigarette smoking prevalence among working adults by industry and occupation (1). Researchers found a 19.6% prevalence of age-adjusted cigarette smoking prevalence among working adults, with the highest rates among those with less than a high school education (28.4%), with no health insurance (28.6%), living below the federal poverty level (27.7%), and those belonging to the 18–24 year age group (23.8%) (1). During the years 2000–2004, cigarette smoking and exposure to tobacco smoke in the US resulted in about 443,000 premature deaths, $97 billion in productivity losses, and $96 billion in health-care costs annually (1). Smoking is the most common addiction among adolescents and young adults (2, 3). In almost 90% of adults, it is reported that the first use of tobacco occurred during one’s adolescence. Although the use of tobacco has declined over the last decades, it remains one of the major health and social challenges today. In fact, its use is still very common: among high school students, almost one third of females and one half of males report using more than one tobacco product in the last 30 days. In the US alone, almost 400,000 young people become regular smokers every year (2, 3).

Risks of smoking Smoking has well-known health hazards. It is associated with lung cancer, oral cancer, stroke, heart disease, emphysema, and other short- and long-term breathing problems. These troubling facts are very well known to

the public – both adults and adolescents. There is also a concerning association between the use of tobacco and other dangerous behaviors, e.g., use of other substances like alcohol and marijuana, and high-risk sexual behavior. Cognitive and mental problems, including anxiety, depression and attention deficit/hyperactivity disorder, are also associated with smoking (4). It is of great concern and frustration that all the abovementioned facts do not prevent millions from starting to smoke every year around the world. In fact, smoking is practiced by many people in every nation in the planet and appears to take place in every society, regardless of race, color, or social status. Some adolescents would pick up smoking because of false notions of presumably positive effects of smoking, e.g., lower appetite resulting in weight loss and stressreducing effect. The ugly truth is that smoking is associated with undesirable cosmetic and social effects, including yellow teeth, bad smell, bad breath, and lower sporting achievements. There are social and environmental factors and trends that may increase smoking prevalence in adolescence. The history of tobacco use shows that males have always been more likely to smoke compared with femaless (2, 3). Advertisements encouraging people to smoke are still very common around the world (e.g., shown in newspapers, commercial breaks on TV, and street posters) and are generally successful in increasing sales and use. The appearance of people smoking in movies and television shows also increase smoking rates, and family members and friends who smoke appear to have a similar effect. It is sad and even bizarre to witness family members, the young and the adults, smoking together even when obvious medical problems have already compromised the parents’ and the grandparents’ health and physical abilities (5). Smoking is more common among adolescents of low socioeconomic and educational status (1), while regular physical activity may be a preventive factor. Smoking is addictive. Nicotine, a major ingredient in the tobacco, is highly addictive. Stopping this hazardous habit is, therefore, often difficult to do. Many products that contain nicotine and other substances have been developed over the years and may help one quit this habit. However, avoiding cigarettes is still much more effective.

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2      Tenenbaum and Merrick: Smoking: do you really know the risk?

Intervention to stop smoking Intervention programs that aim to prevent adolescents from smoking or to quit smoking are introduced frequently, with considerable success (6). For example, banning tobacco product advertisements, preventing actors from smoking in films, reducing availability of these products in the market, raising their prices and taxes, and implementing special educational programs in schools are some ways to intervene. Legal measures, such as preventing the sale of tobacco products to minors, are also used to reduce cigarette smoking. Smoking is common among adolescents, and its detrimental effects on the health and mental state of the smokers are well known. Smoking poses a major social, medical, and economical challenge in every country in the world. Therefore, adequate resources are required to fight against this hazardous behavior, which in turn, can prevent major diseases and disabilities.

References 1. Syamlal G, Malarcher AM. Current cigarette smoking prevalence among working adults, United States, 2004–2010. MMWR 2011;60:1305–9.

2. US Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department Health Human ­Services, Centers Disease Control Prevention, Office Smoking Health, 2012. 3. Centers for Disease Control and Prevention. Current tobacco use among middle and high school students. United States, 2011. MMWR 2012;61:581–5. 4. Zoloto A, Nagoshi CT, Presson C, Chassin L. Attention deficit/ hyperactivity disorder symptoms and depression symptoms as mediators in the intergenerational transmission of smoking. Drug Alcohol Depend 2012;126:147–55. 5. Gilman SE, Rende R, Boergers J, Abrams DB, Buka SL, et al. Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control. Pediatrics 2009;123:e274–81. 6. Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs, 2007. Atlanta, GA: US Department Health Human Services, Centers Disease Control Prevention, National Center Chronic Disease Prevention Health Promotion, Office Smoking Health, 2007.

*Corresponding author: Ariel Tenenbaum, MD, Down Syndrome Center, Division of Pediatrics, Hadassah Hebrew University Medical Center, Mt Scopus Campus, POB 24035, IL-91240 Jerusalem, Israel, E-mail: [email protected] Joav Merrick: Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, Jerusalem, Israel

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Smoking: do you really know the risk?

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