According to Mackay and Eriksen (2002), since early 20th century, when cigarette was first manufactured, there has been a steady increase in the number of cigarette consumers throughout the whole world. Although there are ups and downs in the graph of cigarette consumption level in certain countries, the number of people who smoke around the world continues to rise and more cigarettes are being consumed every day. As the human race populations keep on expanding and become larger, so will the number of smokers in the world. It is expected that at least 2 billion people will live in this planet smoking cigarette by year 2030. The number of people who smokes will continue to increase, even as the prevalence rates drop. Female smokers are growing in numbers, particularly in developing countries, which will fill the gap of decrease in the prevalence rates among male smokers
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Goddard (2008), in another study found out that from 1974 until 1982, the popularity of smoking in Great Britain had fallen significantly, from 45% to 35%. This decrease however, began to slow down, where for every two years only approximately one percentage of the rate fell down until 1994 to 27%. The general decrease in smoking popularity mentioned above was caused by decline of both light smokers and heavy smokers. Here, light smokers are identified as people who smoke less than 20 cigarettes per day whereas heavy smokers are people who smoke more than 20 cigarettes per day. There has been a decrease on the number of adult smokers who consume average 20 or more cigarettes per day from 1974 to 2006 with the percentage of 26% and 8% respectively. Over the same period, the female smokers also showed a decline in number from 13% to 5%.
Meanwhile, in Mexico, a decrease in smoking trends occurred at the offset of 20th century especially on exposure of smoking, daily smoking consumption as well as smoking frequency among the society, especially among men. In addition, smoking popularity and smoking frequency has shown a significant decline particularly among adult smokers in both genders compared to the younger smokers. Nonetheless, men are facing a worse smoking situation compared to women in both mentioned areas. However, during year 2002, it was found out that daily female smokers smoked more cigarettes than men (Franco-Marina, 2007).
Surprisingly, in worldwide, nearly one billion men, consists about 35% in developed countries and another 50% in developing countries, are smokers. The rate of male smoking across the world had reached its peak but is slowly declining. Nevertheless, there declining rate is very slow compared to the current effects it has on human. Although more and more researches had been conducted to reveal the negative impacts of smoking, currently the decrease has been slow. In overall, the ones who give up the smoking habit come from those who are educated and so smoking becomes more popular among poorer and less educated man. (Mackay and Eriksen, 2002).
Concern over health issues related to tobacco usage is not a new issue. According to Shafey (2003), not only that health concern is increasing, presently the dominance of smoking also began shifting to low-income and middle-income countries especially in many Asian countries (as cited in Parkinson et al., 2009). This is true especially when tobacco usage among human has become a global outbreak. Cigarettes are manufactured with the amount of five and a half trillion for every one year. This is enough to feed everyone on earth about approximately 1,000 cigarettes for each one of them. The largest tobacco consumers identified are Asia, Australia and the Far East with consumption of 2,715 billion cigarettes, before the Americas with 745 billion cigarettes, Eastern Europe and Former Soviet Economies with 631 billion cigarretes and Western Europe with 606 billion cigarettes (Mackay and Eriksen, 2002).
Situation in Malaysia however, is slightly different. According to National Health Morbidity Survey (1986 and 1996), the prevalence of smoking among Malaysian adults has increased from 39% to 49% (as cited in Shahidan et al., 2002). National Health and Morbidity Survey (1996) also states the occurrence of tobacco consumption is roughly 24.8% and among all men, 49.2% of them are smokers, whereas for women only 3.5% of them are smoke (as cited in Parkinson et al., 2009). Meanwhile according to statistic in PROSTAR (2007), in 2000 there are 3.6 million smokers in Malaysia and by 2025, it is speculated that the total will increase to 4.6 million (as cited in Kim et al., 2009). Even though currently no clear evidence exists, some survey had identified that smoking among teenagers is increasing nowadays. (Parkinson et al., 2009). However, according to Thambypillai (1985); Shamsuddin & Haris (2000); Naing et al. (2004) and Ahmad et al. (1997), there are no significant changes of trends for teenage smoking. Several surveys done in different regions found out that smoking habit among male teenagers was between 17% to 36% meanwhile for female it was between 1% to 5% (as cited in Lim et al., 2006).
2.1 Reasons for Smoking
According to Baker et al. (2002), smokers give almost the same justifications or rationales for smoking. Apparently, majority of them regard smoking activity as a form of relaxation and a way to cope with stress. It is also an addictive habit which presents smokers with good feelings and lessens the bad feelings through the effects of nicotine. In a way smokers consider cigarette as a helpful tool to them although they are aware of its negative effects. This is consistent with the research done by KaÅŸikçi et al. (2008) in which they stated that smoking is one way for smokers to have pleasure while at the same time relaxing themselves or easing their stress. Moreover, British American Tobacco Malaysia (2010) reported that an important aspect experienced by smokers comes from the “pharmacological effect of nicotine – a mild stimulant effect not unlike that of caffeine, and a mild relaxing effect”. Baker et al. (2002) also stated that serious cigarette smokers are addicted to tobacco, which lead them to smoke heavily whereas light smokers smoke more for social purpose.
On the other hand, according to Jarvis (2004), during early adolescent is a period where people like to experiment with smoking due to psychosocial reason. For people who just started smoking, a cigarette is a symbolic way of saying that they are no longer their mother’s child and a way of showing that they are mature. Children who have tendency to smoke usually come from environment that promotes smoking culture. Such environment includes situation where family members and peers are smokers or where smoking is considered common in school and in society. They also have tendency to smoke due to their own internal or external conditions such having low self esteem, overweight, psychologically impaired, or having poor achievement at school.
Moreover, it is believed that there is a distinguishable pattern among smokers from different gender group. Parkinson et al. (2009), conform to this idea in which the findings of his study revealed that males tend to believe that smoking makes people look more attractive compared to women and see smoking as a mark of being modern. Furthermore, both genders also similarly tend to believe that by smoking they can control their body weight. This finding however contradicts with Western studies by Cavallo (2006), where the data showed that male teenagers do not worry about their weight as much as female teenagers and so are less likely smoke in order to control weight than females (as cited in Parkinson et al., 2009).
2.2 Review of Related Studies
The smoking rate for university students is rising gradually in Turkey as well as the world (KaÅŸikçi et al., 2008). A research by Cooper et al. (2004) said that there is an increase for the rate of smoking in Turkey in which 64% of the increase is among the men and 23% of it is women. Abolfutuoh et al. (1998) states 40% of the students in Education Council are heavy smokers and only 23% of the Medicine Council students smoke. Meanwhile, Kader and Alsadi (2008) found that most of the students are light smokers (50.6%). They also said that students in the medical school tend to smoke less than their friends in other faculties. Surprisingly, a study by Kypri and Baxter (2004) said that the smoking pattern is higher among Maori women than men, in which the women tend to smoke daily.
Sharker (2005) in his study about knowledge, attitude and practice on smoking among students and staff in Universiti Putra Malaysia states that 13.7% from respondents who smoke comes from students while 9.9% was comes from the staff. He also found that Indians and Malays were among the highest percentage due to ethnic groups which comprises of 12.7% and 11.6% respectively; meanwhile Hindus and Muslim were among the highest percentage due to religious group which equal to 13% and 11.9% respectively.
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According to Azlan (2006) in his study on smoking among secondary school students in Kuantan, the smoking percentage was 43%; with 63.5% comes from males and 17.5% comes female. This study is quite similar to the study done by Rapeah et al. (2008) whereby almost half of the respondents in her study on factors influencing smoking behaviours among male adolescents in Kuantan were smokers (45.8%) and Malays were contribute up to 53.1%.
A cross-sectional study of 16-year old secondary school students in Kota Tinggi district reported that 29.7% from the respondents were found to be smoking and the highest percentage of male smokers comes from FELDA (Federal Land Development Authority) areas which comprises of more than 50% (Lim et al., 2006). Meanwhile, the study done by Shahidan et al. (2002) on smoking habits among secondary school students in Kedah reported that the average age for smoking and non-smoking groups were 16 years old the research has reveal that the age of onset smoking among respondents began as early as 13 years old.
According to KaÅŸikçi et al. (2008), 40.2% of the final grade students at the AtatÅ©rk University smoked. 56.5% from that said that they smoke to release tense while 24.6% smoke for pleasure. Abolfutuoh et al. (1998) states that curiosity was the main reason for initiation of smoking among students in medical students at the University College of Medicine and students of the College of Education. There are findings found in a research by Kader and Alsadi (2008) that say the students smoke because it helps them to concentrate as well as calm them down. They also said that students smoke because they also want to cope with stress and social anxieties. Kypri and Baxter (2004) also stated that students smoke because it helps them to relax.
According to Shahidan et al. (2002), “matured, attractive and classy” are among the reasons students start smoking with percentage of 70.0%, 62.2% and 54.0% respectively. Meanwhile, Sharker (2005) found that the main reason for the onset of smoking among students and staff in Universiti Putra Malaysia was “just for fun” and it was comprises of 54.2%. In addition, Azlan (2006) revealed that the main reason for students to smoke is because of the influences of friends.
Rapeah et al. (2008) states that “wanted to try” received the highest frequency among reasons for smoking with percentage of 68.9% and “peer influence” follows behind with percentage of 56.1%. Nonetheless, nearly 70% of the respondents disagrees that trendy is the reason for initiating smoking. There are also findings found in a research by Khairani et al. (2007) that say curiosity and peer pressure are the most common reasons for starting smoking with percentage of 69.3% and 51% respectively. On the other hand, the most frequent reason for continuing smoking reported was stress with percentage of 70% followed by addiction with percentage of 49%.
KaÅŸikçi et al. (2008) stated that one of the factors that encourage the students to smoke is the parents of the students. Most of the students who smoke have fathers and brothers who smoke as well. Friends are also one of the factors that lead to smoking habit among the students. These findings are quite similar with the study by Shahidan et al. (2002) which conducted in Kedah. Their research stated that family members and peers who smoke have great influence to students to start smoking. There is twice higher risk for students who come from smoking family to smoke than those who are not. In addition, there are nearly six times higher risks of smoking for student who have peers who are smokers than those who do not have peers who smoke. Same goes to the study by Khairani et al. (2007), which found out significant connection between smoking among family members and teenager smoking.
Sharker (2005) reported that the popularity of smoking was linked with race, family, age, religious, economic status as well as peers’ smoking habits. These findings are consistent with the study done by Azlan (2006) on the prevalence of smoking among secondary school students and its associated factors in the district of Kuantan. Meanwhile, according to Lim et al. (2006), smoking is associated with factors such as having low academic achievement as well as having a lot of close friends and siblings who smoke.
Another finding also discovers that respondents who smoke are linked with factors which are attitude towards smoking, type of class stream and having smoking friends (Rapeah et al., 2008). In addition, among the main factors for students to start smoking are showing off, curiosity and pressure from peers (Abolfutuoh et al., 1998).
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