The rate of smoking is increasing in the United States among adolescents and the cause of leading preventable death in the United State (Husten, 2009). Smoking cause many health problems such as cancer of the lung, esophagus, larynx, bladder and oral cavity (Stephenson &Allen, 2007). The goal of the Healthy People 2020 Objectives focus is to “reduce tobacco use by adolescent, establish laws on smoke-free indoor air that prohibit smoking in public places, worksites and increased adolescent’s disapproval of smoking”( Healthy People, 2020). This will be discussing the factors that predispose adolescent to smoking, the national, state and local prevalence of smoking. The paper will also be discussing the principals of health promotion and disease prevention in primary, secondary and tertiary prevention. This paper will have examples of national, state and local initiatives leading to achieving the Healthy People 2020 objectives. This paper will discuss the roles of the professional registered nurse in providing care for adolescents who smoke.
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Many health problems results in smoking and the earlier individuals start smoking the higher risk they have in developing these health problems in later life. To understand the etiology of smoking, one must understand the factors predisposing the adolescent to behave in this manner. These factors are peer pressure, parents who smoke the mass media and movies all influence smoking behavior in adolescent. Other factors that may also contribute this behavior include having a low self-esteem, and having a problem controlling weight (Tingen, Andrews & Stevenson, 2009). Adolescents who are starting smoking at the start of early age would most likely to become heavy smoker when they get older (Lewis, 2008). With the proper preventive measures and educating adolescents about the importance of not smoking can aid in reducing smoking rate among adolescents in the United States. Counseling, community programs and state laws prohibited smoking, promote a tobacco free environment.
There are five stages of smoking initiatives occurring in adolescents. Precontemplation is the first stage, this is when the adolescent has not even thought about smoking. The second stage is contemplation, in this stage, the adolescent start to learn about smoking and is thinking about smoking. The next stage, preparation is when the adolescent is experiment smoking with other people smokers. The action stage last for about a month and is when the adolescent starting smoking on every day basis. The last stage is maintenance, which last more than more six month. In this stage, the adolescent is already smoking regularly and smoking make smoking as a habit.
Nicotine is the chemical in tobacco that cause nicotine dependence, which cause smoking addiction. A study has shown that adolescents who smoke less frequently than adults would both exhibit the same nicotine dependence withdraw symptoms. Study also has shown that the nicotine play a big role in smoking cessation in adolescents. Adolescents who are willing to quit smoking are less likely to succeed as a result of nicotine dependence. Adolescents who smoke at early age would also have less successful smoking cessation ( Heikkinen, Pitkaniemi, Koskenvuo & Merman, 2009) “Research suggests that nicotine is as addictive as heroin, cocaine or alcohol” ( CDC, 2010). “Smokers’ who are experiencing nicotine withdrawal symptoms often have anxiety, increased appetite and difficulty concentrating” ( CDC, 2010).
Adolescents who smoke are not aware with associated health problems caused by smoking. Some adolescents believed that they would not be addicted to smoking and that they would be able to quit whenever they want. They do not think about how the nicotine in cigarette, which causes addiction, could affect them and make it harder for them to quit. Many adolescents reporting smoke as a way to solve their personal problems. They feel better when they smoking during emotional times, when they are feeling depress and as stress reliever (Fritz, Wider, Hardin & Horrocks).
It is important to understand what factors predispose adolescents into trying smoking cigarettes. Intrapersonal and interpersonal are some environmental factors that influence smoking behaviors in adolescents. An example of intrapersonal behavior is a smoking behavior that is influence by “self-esteem, knowledge and intentions” (Tingen at el., 2009). These behaviors are influence by the interactions in the environment, which leads to smoking initiations.
Interpersonal behavior is the behavior influence by act of family members and friends. Children portray the behavior of the adults as being normal and act in the same manner. If a member in the family smoke, the adolescent would observe that behavior and start smoking themselves. “Children’s exposures to socialization factors in the home that promote risk-taking behaviors are associated with early experimentation with tobacco” (Tigen at el., 2009). The behavior in the household has a huge effects on how children behavior outside of the home. Watching the other people in the household smoking would influence the adolescent to experiment smoking. Children also observed the behavior of their friends and model that behavior. Friends also pressure each other to behaving like them. Peer pressure may play strong role in smoking behavior, but “Benchmark studies have shown that parent and home influences are stronger than peer influences in the earliest phases of smoking” ( Tigen et al,. 2009).
National, State and Local Data
Every day, about 4,400 youths in the United States smoke their first cigarette. One- third of youths will die prematurely of smoking associated diseases, if this trend continues (krainuwat, 2005). The goal of New York State is to reduce the youths smoking prevalence to 10% by 2010. Smoking prevalence has been reducing dramatically in adolescents. The NY prevalence for smoking in 2000 was 27.1% compared to the smoking prevalence in 2005, which was 23%. The national smoking prevalence in 2000 was 28.4, slightly higher than the NY. In 2005, the national smoking prevalence was 16.2% compared to 2000 (New York State Tobacco Control Program, 2008-2010). In 2009, the smoking prevalence for national increased to 19.5% and 14.8% for NYS (Center for Disease Control and Prevention, 2010). After researching for many hours, could not find the local statistic data on smoking for adolescents.
More than 3 million youths are current smoker in the United States. Male smokers have higher smoking rates than female smokers. “Smoking accounts for 30% of all cancers deaths and 87% of lung cancer deaths” ( Krainuwat, 2005).
For the past month, the national average for youths that smoke was 10.1%, 8.2% and range 6.5% to 15.9% across the states. The average exercise tax for national was $ 1.34 per pack and $2.7, but $ 0.07 to $3.46 per pack was the range for states in 2009 (CDC, 2010).
According to Center for Disease Control and Prevention, the median funding for smoking in the state was 17.2% and 34.8% in 2007 was more than recommended CDC amount. As a result, the recommended state spending amount ranged from 1.1% to 8.5% for cigarettes. In 2006 through 2007, the United States percentage for homes with no rules in was 77.6% and 75.3% in New York.
A health promotion activity is an important part of preventing smoking in adolescents because many health problems are raised from smoking. Health promotion would focus on educating adolescents about smoking cessation. The earlier the adolescent quit smoking, the better the chance they have in reducing the health problems they would encounter in later life. The professional nurse has an important role in preventing smoking in primary, secondary and tertiary prevention strategies.
It is important to understand some of the reasons that predispose the adolescents into trying smoke. Intrapersonal and interpersonal are environmental factors that influence smoking behaviors in adolescents. An example of intrapersonal behavior is a smoking behavior that is influence by “self-esteem, knowledge and intentions” (Tingen at el,. 2009). These behaviors are influence by the interactions in the environment, which would lead to smoking.
Primary, Secondary and Tertiary Prevention
Primary, secondary and tertiary health promotion is an important part of preventive measures when it comes to educating adolescents about smoking prevention. Primary prevention focuses on the efforts to educate and prevent adolescents from smoking. By making smoke- free laws in every state, the selling of tobacco to minors and tobacco product production could be stopped schools have large number of youth populations and are an important place to educate youths about primary smoking prevention (Tigen at el., 2009). Guess speaker coming to schools to speak to students about the health risks associated with smoking and emphases the importance of not smoking is a preventive initiatives.
Other primary preventive initiatives include programs at schools that discourage the initiation of smoking and support group to help students with personal problems. Encourage parents to have talked with their children about not smoking and health problems. Nonsmoking parents living in an area, where smoking is not allowed; will increase the changes of their children not smoking (Tigen at el., 2009).
Secondary prevention focuses on screen anyone who may be at risks for certain disease or disorder, but in this case, it will focus on screening adolescents who may be at risk for smoking initiation. Some of the risk factors that may lead the adolescent to smoking initiation are adolescents who have at least one person in the household who smokes, peer pressure, Parent involvement is important is important. Parents having talk to their children about not smoking, especially if they hang with friends’ who are smokers. Encourage peers at school who may be thinking about smoking to get help (Tigen at el., 2009).
Adolescent who live with parents who smoke should be encourage quitting. Adolescents that live with parents who smoke should be encourage to quitting smoking. Adolescents who parents smoke have weaker parenting role in preventing their children from smoking than nonsmoker parents (Tigen at el., 2009). School nurses have an important role in secondary smoking prevention.
Tertiary prevention focuses on treating adolescent who already starting smoking and educating them about programs that can help them quit smoking. School and community counseling programs are other helpful preventive strategies to help adolescents in dealing with tobacco withdraw symptoms and providing social support system to help with smoking cessation. Nicotine patches can be useful in helping adolescents stop cigarette cravings. Chewing gum also has been effective with strategies in stopping cravings. A study has shown other effective smoking strategies, included ” exercising, deep breathing, sucking on a straw, drinking water, meditating, brushing teeth and listening to music”( Fritz at el., 2008).
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The New York State Smoker’s Quitline has also been effective in smoking cessation (New York State Tobacco Control Program, 2008-2010). Smoking programs have been effective in promoting smoking cessation in adolescent. A study has shown educating adolescent on the effects cigarette have on the health and providing them with information has been effective in quitting smoking (Fritz at el., 2008).
Health Behavior Change Models
For adolescents to become motivating in participating in smoking cessation program, they must understand their perception of smoking and the reason to stop. They must also understand how serious they putting their health at risk. Barriers play an important role in behavior change models in promoting smoking cessation in adolescents. Many adolescents start smoking for many reasons, which makes quitting difficult for them. Other problems that could affect smoking prevention in adolescent is that they don’t think about the health problems that are associated with smoking. Nicotine addiction poses difficulty when trying to quit, which is a barrier to smoking. Being addicting to the nicotine in cigarette can prevent the adolescent from trying to quick smoking. The strong nicotine addiction causes withdraw symptoms and craving, which makes it hard to quit (Lewis, 2008). Some adolescents had reporting using alcohol as barriers to stop smoking. (Fritz at el., 2009).
Other barriers include being in denial of the health risks associated with smoking and thinking that it would never happen to them and can quit anytime when they want. “The difficulty with preventing adolescents from using tobacco is that often they do not considered the long-term effects of tobacco use” (Lewis, 2008).
National, State and Local Health Promotion Initiatives
As mention earlier, smoking cause many health problems later on in life. It is important to start health promotion initiatives as soon as possible to decrease these health risks by promoting smoking cessation. An example of national and New York State initiative aimed in preventing smoking in adolescent include community action to increase the price of tobacco. Raising the price of cigarette can help in many ways, including individuals stop buy cigarettes because they cannot afford it. The New York State Smokers’ Quitline was developed to help people who are willing to quit smoking. Anyone that wants to quit smoking can call the number and can be directing to place where they can be help. State and communities have come together to increase the use of the New York State Smoker’s Quitline (1-800-QUIT NOW). Other initiatives includes encourage Smoking prevalence would also be reduced if people living in homes where smoking is now allowed, which would decrease the smoking prevalence among adolescents (New York State tobacco control program, 2008-2010).
Most movies they make today have many smoking scene in them and adolescent are likely to portray this as a normal behavior and might want to try smoking. One other initiative is to making PG movies that does not have smoking scene in them. Other strategies includes increasing the number of tobacco free areas, including parks, recreation areas, building entryways and health care, business and education campuses”( New York State Tobacco Control Program, 2008-2010). Other initiative includes using the mass media to promote smoking cessation by focusing on the smoking health risks. Health care organizations are urging health care professionals to screen any patients that is using tobacco and offering them help in quitting. This would be effective in ways that if the nurse is caring for adolescents and they smoke, the nurse can teach them about quitting and providing interventions that would lead to smoking cessation (New York State Tobacco Control Program, 2008-2010).
Westchester County have come up with efforts in preventing smoking initiatives in youths and adults and those who are at a higher risk for smoking relating diseases. The Westchester County’s mission “is to create a cultural norm to be embraced by every community which clearly and strongly discourages all use of tobacco by all populations” (Westchester County, 2010). To make this into effect in preventive smoking cessation, Westchester County provided smoking cessation programs that would be available to all the residents in Westchester County including schools, youth centers and minorities’ organization communities (Westchester, 2010).
The Professional Nurse’s Role
The role of the professional nurse in providing care for the adolescent in smoking cessation includes educating the adolescents about the importance of smoking cessation to reducing smoking relating health problems. It is also important that the professional. This would help the adolescent have trust in the nurse for advising and assistance for quitting (Lewis, 2008).
The professional nurse should recognize all attempts as a positive during smoking cessation period. The professional nurse needs to set realistic achievable goals for the individual because this is important part of the quitting process. This gives the client the opportunity to evaluate their own goals and motivates them to work harder in achieving the next goals. Praising the adolescent and giving a positive feedback can motivate them to work harder towards achieving the next goal (Quinlivan, 2008). The professional nurse also need to referral the client to attend programs offered by the hospital or the clinic for helping patients quit smoking, such as a support group or counseling program. During discharge, the nurse should include teachings about smoking cessation and provide information to take home when the client is ready to quit if not now (Lewis, 2008).
In conclusion, many health problems are the result of smoking in the United States. Adolescents starting smoking initiations at early age have greater chances acquiring these health problems. Nationals, states and local had come up many smoking initiations to prevent smoking in adolescents and to decrease the health risks. The professional nurse has an important role in smoking prevention. The professional nurse can educate the adolescent about smoking health problems and providing help to quit. Counseling programs and support groups also has been effective in preventing smoking.
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