Cigarette smoking is the chief preventable cause of premature disease and death in the United States. Each year more than 400,000 Americans die from smoking-related illnesses; a total of two mil lion die in all developing countries combined.1 The World Health Organization estimates that given the current patterns, smoking will eventually kill about 500 million people alive today.2
Smoking kills more Americans annually than AIDS, automobile accidents, suicide, murder, fire, alcohol, and illegal drugs combined.3 The early adolescent years (11 through 15) are the crucial life stage for preventing tobacco use, and it is uncommon for tobacco use to begin after high school.4
Tobacco use among American teens
The rate of tobacco use among American teens is high and rising. From 1991 to 1994, smoking among eighth graders increased from 14 percent to 18 percent, among tenth graders from 20 percent to 25 percent, and among high school seniors from 27 percent to 31 percent.5 It is estimated that between one-third and one-half of adolescents who try only a few cigarettes become regular smokers, a process that takes an average of two to three years.6
A key factor in the increased use of tobacco among youth is the rapid growth in the use of smokeless tobacco (chewing tobacco, snuff) by young Americans. In the 1970s, most smokeless tobacco users were men over 50. This changed in the 1980s as the tobacco industry targeted a younger generation of American men.
At present, young males are the most common users of smokeless tobacco, with about 11 percent of male high school seniors being users.7 Rather than decreasing the use of cigarettes, in the end, smokeless tobacco frequently serves to introduce teens to regular cigarette smoking.
Besides this, tobacco is associated with the increased likelihood of young smokers using other addictive substances. Thus tobacco acts for some as a gateway drug. It is generally the first substance used by teens, with later sub stances being alcohol and illicit drugs.
The Surgeon General of the United States has found that 12- to 17-year-olds who said they smoked in the past 30 days were three times more likely to have used alcohol, eight times more likely to have smoked marijuana, and 22 times more likely to have used cocaine within the past 30 days than those teens who had not smoked.8
Patterns of nicotine dependence
Nicotine dependence forms a pattern of compulsive use of nicotine-containing products, such as cigarettes, chewing tobacco, snuff, pipes, and/or cigars. The use of these various forms of tobacco results in nicotine tolerance and thus withdrawal symptoms when the tobacco use is discontinued.
As a person attempts to quit smoking or reduce the amount of nicotine used, several signs of withdrawal can begin within 24 hours, including depressed mood, insomnia, irritability, frustration, anger, problems with concentration, anxiety, restlessness, and weight gain.
Cigarette smoking has the most intense habit-creating pattern among tobacco products and is the most difficult to quit. There is usually a craving to use cigarettes. Many individuals who become nicotine dependent continue to smoke despite knowledge that they may have a medical condition, such as bronchitis, adversely affected by their smoking.
The tobacco industry spends billions of dollars on advertising and product promotion, much of which appeals directly to young people. Research show that teens exposed to these promotions are more likely to be smokers.9
Besides this, in the United States, annual illegal sales of tobacco products to minors total 950 million packs of cigarettes and 26 million containers of smokeless tobacco.10 About one-half of minors who attempt to purchase tobacco products report never being asked for proof of age.11
The faith factor
Results of 26 separate studies con ducted in the U.S., Great Britain, Switzerland, Nigeria, Australia, Norway, Israel, Canada, France, Scotland, and Ireland showed that greater religious involvement has been strongly associated with lower risk of use of tobacco and other addictives.12 The National Study on Youth and Religion recently found that teens who never attended church were almost three times more likely to smoke regularly than regular church worshipers (30.1 percent versus 11.9 percent).13 Many research studies on teen and young-adult drug use, including nicotine, show a consistently inverse relationship between frequent attendance at religious services and reporting religion as important in their lives. A study of 33,397 high-school students in 112 different communities in the U.S. measured 16 problem behaviors in seven areas: tobacco use, alcohol use, illicit drug use, sexual activity, depression and suicide, antisocial behaviors, and school problems. Analysis revealed that the number of youth involved in activities connected to religious institutions was strongly related to lower rates of all these negative behaviors.14 In Great Britain, a study involving 4,753 adolescents found that religious belief and practice had a strong association with a young person's attitudes toward the impropriety of substance abuse, including the use of marijuana, alcohol, glue, heroin, butane gas, and tobacco.15
If involvement in faith communities has a positive effect on teens' attitudes and behavior toward smoking cigarettes, then encouraging young people to be involved in religious life may be beneficial to those seeking to avoid tobacco. Teens who connect to a religious youth group may find it a helpful place to find peer support that can help them quit smoking. Tobacco-use prevention pro grams for teens would be a valuable ministry of the congregation, especially since the National Study on Youth and Religion indicates that about one in ten teenagers who regularly attend church smoke.16 Faith-based intervention programs need to address teens' abilities to recognize social and advertising pressures to use tobacco, as well as to develop skills to resist these pressures.17 Increased self-reliance and self-esteem with decreased social alienation appear to be important factors in resisting the pressure to smoke.18 Faith-based tobacco-cessation programs focused on minority groups, which have high levels of religious participation and suffer a disproportionately higher burden of tobacco-attributable illnesses and deaths, may be of particular value.19
1 R. Peto, A. D. Lopez, J Boreham, M. Thun, and C Heath, Mortality From Smoking m Developed Countries, 1950-2000 (New York: Oxford University Press, 1994).
2 World Health Organization. 1999 The World Health Report 1999. Making a Difference. Geneva, Switzerland World Health
Organization.
3 Centers for Disease Control and Prevention 1994. "Cigarette Smoking Among Adults United States 1993." Morbidity and Mortality Weekly Report, 43, 925-930
4 L. D. Johnston, P M. O'Malley, and J. G Bachman. 1995. National Survey Results on Drug Use from the Monitoring the Future Study, 1975-1994 (NTH Publication No. 95-4026) "Washington, D.C.: U.S. Government Printing Office.
5 Ibid
6 J. E. Henmngfield, C. Cohen, and], D Slade 1991 "Is Nicotine More Addictive Than Cocaine?" British Journal of Addiction, 86, 565-569.
7 Johnston et al, 1995
8 M. J. Elders, C. I- Perry, M. P. Enksen, and G A. Giovmo (1994) "The Report of the Surgeon Geneial: Preventing Tobacco Use Among Young People " American Journal of Public Health, 84(4), 543-547.
9 D. G Altman, D W Levine, R. Coeytano, J. Slade, and R. Jaffe. 1996. "Tobacco Promotion and Susceptibility to Tobacco Use Among Adolescents Aged 12 through 17 Years in a Nationally Representative Sample " American Journal of Public Health, 86(11), 1590-1593.
10 S. J Heishman, L. T. Kozlowski, and J. E. Henmngfield. 1997 "Nicotine Addiction. Implications for Public Health Policy." Journal of Social Issues, 53(1), 13-33.
11 Centers for Disease Control and Prevention. 1996. "Tobacco Use and Usual Source of Cigarettes Among High School Students-United States, 1995 " Morbidity and Mortality Weekly Report, 45, 413-418.
12 H G Koemg, M E. McCulloch, and D. B. Earson, Handbook on Religion and Health (Oxford- Oxford University Press, 2001).
13 C. Smith and R. Fans (2002) National Study on Youth and Religion, Religion and American Adolescent Delinquency, Risk Behaviors and Constructive Social Activities Vol 1. University of North Carolina, Chape! Hill, North Carolina
14 D. A Blyth and N Leffert. 1995. "Communities as Contexts for Adolescent Development: An Empirical Analysis " journal of Adolescence Research, 10(1), 64-87
15 L. J, Francis and K Mullen 1993. "Religiosity and Attitudes loward Drug Use Among 13-15-Year-Oids in England." Addiction, 88, 665-672.
16 Smith and Fans.
17 W H Bruvold 1993. "A Meta-Analysis of Adolescent Smoking Prevention Programs," American Journal of Public Health, 83(6), 872-880.
18 Bruvold, 1993
19 J. G. Spanglei, R. A Bell, S. KmcK, R. Michielutte, M. B Dignan, and J. H. Summerson. 1998 "Church-Related Correlates of Tobacco Use Among Lumbee Indians in North Carolina." Ethnicity and Disease, 8(1), 73-80.
