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Smoking tobacco is part of many societies and cultures. It is also a major cause of many diseases, including cancers.

There are many factors that play significant roles in influencing people to smoke, but the most common ones appear to be peer pressure, family history of smoking and the tobacco industry's advertising and media campaigns portraying smoking as a glamorous and socially accepted behavior. Family Smoking Family smoking and role models are significant factors in influencing young children to smoke. An article in the Journal of Consumer Affairs by Karen H. Smith and Mary Ann Stutts, reported that the most important factors associated with smoking are family smoking behavior, peer pressure and prior beliefs about smoking. Young people tend to imitate their parents behavior. In addition to the notion that smoking is an acceptable behavior, children often see smoking as grown-up behavior, which further encourages them to smoke. Children from families where smoking is prevalent tend to develop the habit and are less likely to quit later in life.
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shipping!www.smeshstyle.com Peer Pressure Peer pressure is a significant factor for many people who start to smoke. Economic status, educational level and family history are significant factors that determine the level of peer pressure and the consequences of such pressures. A 1993 study by Cornelia Pechmann, published in Marketing Science Institute, concluded that prior beliefs refer to the images and ideas about smoking that children develop before any formal antismoking education. Often these beliefs are subconsciously held and are resistant to education. Advertising and Media As with any other type of advertising, advertising by tobacco companies hopes to influence people to smoke. A study published in Journal of Consumer Research by researcher Cornelia Pechmann, concluded that adolescents are influenced and affected by the type of tobacco advertising and media they are exposed too. Although the ways in which tobacco companies can reach the public have been curtailed by legislation, the effects can still be seen by marketing campaigns using cartoon characters, giveaways and free samples

Read more: http://www.livestrong.com/article/77788-factors-influence-peoplesmoke/#ixzz2Bk7b14U8

Smoking: psychological and social influences


Reviewed by Dr Sheila Bonas, lecturer in health psychology, Coventry
75

As more of us become aware of the dangers of smoking, the percentage of smokers in the UK has fallen from around 50 per cent of the population in the 1950s to 25 per cent in 2003. Even with this fall in the number of smokers, it's estimated that cigarettes were responsible for more than 1.2 million deaths in 2000 in the European region of the World Health Organisation. In the UK, smoking is responsible for around one in five deaths. The illnesses caused by smoking extend beyond the well-reported links with cancer, heart disease and respiratory illnesses. Smoking can cause impotence, ulcers and fertility problems and it's doesn't just harm smokers.

Passive smoking causes lung cancer and is linked to cot death, glue ear and asthma in children. However, the decline in smoking in the population has levelled off and the percentage of people smoking in the last 10 years seems to have remained at around 25 per cent. The good news is that about 70 per cent of smokers say they want to quit. Yet success rates for quit attempts are between 10 and 20 per cent. This article looks at some of the psychological and social barriers that smokers face.

The problem starts in childhood


Most smokers first start experimenting with cigarettes in their teens: in the UK only 1 per cent of 11 year olds smoke regularly. By the age of 15, this number has risen to 22 per cent, with girls more likely to smoke than boys. There are many reasons why children start to smoke: Children whose parents smoke are twice as likely to start compared to those with nonsmoking parents. A Scottish study of teenage girls found that smoking was part of an image cultivated by the girls who were seen as leaders of their groups. Smoking went along with wearing short skirts, jewellery and make-up. In contrast, a study by the World Health Organisation found that the 11 to 15 year olds who were most likely to be smokers were lonely, had difficulty talking to parents, had problems at school and had started drinking alcohol.

How we learn to smoke


Health psychology looks at the complex array of biological, social and psychological factors that influence our health and illness-related behaviour. Smoking is a biological addiction, with nicotine as addictive as cocaine and heroin. However, there is more to being hooked on cigarettes than the physical addiction to nicotine. When people want to quit, they also have a psychological habit to break. Social learning theory describes how we learn by example from others. We are strongly influenced by our parents, and other people we look up to, such as peers, actors and pop stars. This can lead us to emulate their behaviour and try smoking. There is an almost immediate effect on our brains with those first cigarettes, so we keep smoking to get this reward. Later we learn to associate smoking with other activities such as drinking coffee, going to the pub, etc. We can become conditioned so just the thought of the activity triggers the need for a cigarette, just like Pavlov's dogs learned to drool at the sound of a bell. These psychological associations remain when smokers try to quit. Finally, you learn to keep smoking, because if you try to quit you are punished by withdrawal symptoms - irritability, snappiness, lack of concentration. Having a cigarette gets rid of these symptoms, negatively reinforcing the desire to carry on smoking.

Such conditioning keeps you hooked on smoking because the reward when you smoke is instant, whereas it takes years before you become aware of the damage in terms of your health. Similarly, when you try to quit, the 'punishment' of withdrawal symptoms comes quickly, whereas the benefits of better health take longer to realise.

Attitudes to smoking and risk taking


Health promotion campaigns often use warnings and shocking images to try and motivate people to quit smoking. While these adverts are powerful for non-smokers, they may have little effect on people who are more willing to engage in risky behaviour.

Coping with stress


Giving up cigarettes can be very stressful. People who are trying to quit have to put up with cravings, change their habits, and resist the temptation to have or buy cigarettes. If smoking is used as a strategy for coping with other sources of stress, such as work stress, smokers suffer a double blow: their prop for dealing with stress is taken away and their stress levels rise as a result of trying to quit.

Social influences
Peer pressure can be hard for anyone to resist, no matter what your age. Smoking can play an important role in friendships, while offering a cigarette or asking for a light can be ice-breakers to start a conversation. It can create a bond between smokers, for example the huddled groups who smoke outside offices. If your friends smoke, deciding to quit can be awkward because they may see it as an implicit criticism of their habit.

Cultural influences
Over the years television shows and films have effectively built up associations between smoking and glamour, sex and risk-taking. From classic movies with Humphrey Bogart to Uma Thurman in Pulp Fiction, cultural images involving cigarettes are strong, and generally positive about smoking. In addition, we are still subject to advertising that deliberately promotes smoking and makes positive associations with brands. The tobacco industry denies targeting young people, but the result of sponsoring exciting, risky, macho sports, is that it attracts the attention of young boys. A study found that boys who were fans of motor racing, which is heavily sponsored by the tobacco industry, were more likely to smoke than those who weren't. What these images don't convey are the negatives of smoking, from the yellow stains on your fingers and the stench of your breath, or the long-term serious consequences from smoking.

What are your issues?


There are many psychological and social pressures on smokers, and on those who are trying to quit. But this doesn't mean it's impossible to quit, or that you'll find it difficult.

Some people quit first time, some take more attempts, but if you don't try, you can't become one of the 11 million ex-smokers in the UK. Understanding your habit is the first step in overcoming these obstacles - the next is to come up with strategies to tackle them. References
1. Prevalence of cigarette smoking by sex and age: 1974 to 2003: General Household Survey 2003, Office for National Statistics, 2004. 2. Peto, R et al. Mortality from smoking in developed countries 1950-2000 (2nd edition) . 3. Smoking-related behaviour and attitudes, ONS Omnibus Survey, Department of Health, 2003 4. Denscombe M, Smoking cessation among young people. Health Education Journal, 60 (3) 221-231, 2001. 5. Leventhal H, & Cleary P, The smoking problem: a review of the research and theory in behavioral risk reduction. Psychological Bulletin, 88: 370-405, 1980. Based on a text by Dr Sheila Bonas, lecturer in health psychology, Coventry University

Read more: http://www.netdoctor.co.uk/smoking/psychologicalinfluences_000509.htm#ixzz2Bk 8GjBiB Follow us: @NetDoctor on Twitter | NetDoctorUK on Facebook http://www.netdoctor.co.uk/smoking/psychologicalinfluences_000509.htm

Why people smoke


The most important factors associated with high rates of smoking appear to be linked to socio-economic factors such as:

unemployment, low education, low income, home ownership status, age, and living in an area of socio-economic disadvantage (Winstanley 2008). Other factors include:

Mental Health (stolen generation) Incarceration Other drugs and alcohol

Aboriginal and Torres Strait Islander people are the most disadvantaged group within Australia and based on this alone are more likely to be smokers (Winstanley 2008). However there are other factors influencing smoking behaviour since even those of higher socio-economic status smoke at a high rate compared to non-Indigenous Australians (ABS 2007).

Impact of colonisation
The process of colonisation of Aboriginal and Torres Strait Islanders and the resulting family separation and loss of land and culture has lead to large differences in socio-economic status between Indigenous and nonIndigenous Australians. These factors together with the impact of racial discrimination increases susceptibility to the stresses that cause high levels of tobacco use.

Factors that influence people to smoke


emotions: feeling stressed, bored, lonely, upset, angry, frustrated or unhappy pleasure: to add to the enjoyment of something, to take time out or as a reward social pressure: to feel part of the crowd if youre not part of the smoking group you are missing out on the best information, nonparticipation may lead to feelings of alienation; habit: linking smoking with other activities eg having a cup of coffee, talking on the phone, drinking alcohol addiction: to satisfy the craving for nicotine Additional factors influencing Aboriginal and Torres Strait Islander smoking are: 'smoking is everywhere': because nearly half of Aboriginal and Torres Strait Islanders over the age of 15 smoke cigarettes daily, smoking is seen as an everyday, acceptable or 'normalised' behaviour within communities. Children raised in this environment will often see smoking as just another part of becoming an adult and so the cycle continues. smoking is a lesser evil: smoking is viewed by many as an acceptable alternative to other drugs such as alcohol, cannabis and intravenous drugs to alleviate stress and negative feelings: Smoking is perceived by many to have a calming effect and may also be seen as an enjoyable activity over which people can retain control no matter how difficult other parts of their lives may be. This is particularly relevant within Indigenous communities where control over many aspects of their life may be difficult. An individual's risk of engaging in smoking may also be conditioned by the social and community environment, not just socio-economic characteristics of the individual. Smoking occurs more in disadvantaged areas, and giving up smoking appears to be more difficult for people living in such areas. The effects of

area-level deprivation may be related to factors in the physical and social environment such as:

Access to and quality of health education Access to quitting resources living in an environment that is less valued, and provides fewer healthy choices availability of tobacco products local promotional activity by the tobacco industry

Why do some people not smoke?


There is not a lot of research in the past that has looked at why some people do not start smoking. Currently 34% of Aboriginal and Torres Strait Islanders have never smoked and it would be useful to understand more in planning future programs. Some of the possible reasons that prevent the uptake of smoking in young people include:

they have seen the harmful effects of smoking on other family members they do not enjoy it they do not want to be dependent on cigarettes smoking affects their fitness and health they are too young they could get into trouble We also know that children of non-smokers are less likely to become smokers themselves and that strong non-smoking role models improve a young persons determination not to take up smoking.

Further reading:
CEITC Just the facts information sheet Tobacco in Australia: Facts and Issues, Chapter 8 - Tobacco use among Aboriginal peoples and Torres Strait Islanders http://www.ceitc.org.au/why-people-smoke

Foreign Studies

Smoking rates

Aboriginal and Torres Strait Islander peoples are nearly three times as likely as the non-Indi population to be daily smokers. Generally Indigenous people:

take up smoking at an earlier age; smoke for longer; and make fewer quitting attempts than the broader Australian population.

Some Aboriginal and Torres Strait Islander smoking rate facts:

Table 1

Table 2

Source: The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, October 2010 (ABS 010)

How Many?

Australia has some of the lowest rates of smoking in the world Generally, smoking rates for Australia have declined over recent years from 34% in 1980 (Winstanley and White 2008) to16.6% in 2007 being daily smokers (AIHW 2007). Indigenous people are more than twice as likely to smoke than other Australians In 2008 nearly half (45%) of Indigenous Australians over the age of 15 smoked cigarettes daily (ABS 2010). Recently there has been a slight drop in smoking rates for Indigenous people After many years of no change in smoking rates we are beginning to see a slight drop in the number of Indigenous people who smoke. Between 2002 and 2008 smoking rates for Indigenous people aged 15 years and over have dropped from 49% to 45% (ABS 2010). Indigenous Australians make fewer quitting attempts and are less successful at quitting than other Australian Smokers (Ivers 2001; AIHW 2004) In 2008, nearly two in three (62%) Aboriginal and Torres Strait Islander current daily smokers had attempted to quit or reduce their smoking in the previous 12 months (ABS 2010). This is less than for other Australians of

which 81% had attempted to quit in the preceding 12 months (Ellerman, Ford et al. 2008). Most Indigenous households are smoking households. In 2004-2005, 62% of households with Indigenous residents had a least one regular smoker (ABS 2007). Smoking and Age

Indigenous smoking rates are at least twice that of non-Indigenous rates for both men and women across all age groups Smoking rates are higher in the younger age groups and lower in the over 55 age group for both Indigenous and non-Indigenous populations (ABS 2010). More Aboriginal and Torres Strait Islander people take up smoking younger than other Australians The rate of uptake of smoking is earlier (Ellerman, Ford et al. 2008) and much higher among Indigenous children, with the decision to smoke usually taken between the ages of 12-16. One in ten Indigenous current or ex smokers began smoking before 13 years of age (ABS 2007). Smoking rates for Indigenous 15-24 year olds in 2008 were 38.7% for males and 39.7% for females and for non-Indigenous 15-24 year olds were 15.7% for males and 13.9% for females. See Table 1 & 2 Aboriginal and Torres Strait Islander women's smoking rates are highest during their child bearing years For both men and women, the highest levels of smokers are for those aged 25-44 years (ABS 2010). This is particularly significant for women since this is the age when women are having their children. See Table 1 & 2. Smoking and Location

Generally smoking rates are higher for Indigenous people living in remote areas than those living in major cities (53% compared to 42%) (ABS 2010). Smoking rates can vary considerably from community to community. Studies have found that in some regions the prevalence of tobacco use for men is as low as 39% in Alice Springs and as high as 80% in Bourke and for women as low as 17% in Tennant Creek and as high as 69% in the Ballarat region (Winstanley 2008).

Smoking and Gender

Smoking rates are similar for both Aboriginal and Torres Strait Islander men and women In 2008 46% of Indigenous men and 43% of Indigenous women smoked daily (ABS 2010). Smoking and Pregnancy

Studies that have reported on smoking rates among pregnant Aboriginal and Torres Strait Islander women show rates at least as high as those among the Aboriginal and Torres Strait Islander community generally. This is much higher than for non-Indigenous women (15%) (ABS 2010; Winstanley 2008). Smoking during pregnancy increases the risk of preterm birth and low birth weight. Smoking rates by state Generally Indigenous smoking rates are much the same from state to state

History
Aboriginal and Torres Strait Islander peoples suffer disproportionately to the broader Australian population from tobacco related health conditions. The high prevalence and normalisation of tobacco use is at least partially attributable to the process of colonisation, and the subsequent low socioeconomic status of Indigenous Australians.

Aboriginal people chewed the dry leaves of pituri (Duboisia hopwoodii) and native tobacco such as Nicotania gossei prior to contact with non-Aboriginal people (Low 1987). Some Aboriginal people continue to use pituri and native tobaccos. Macassan fishermen and trepangers (sea cucumber gatherers) introduced tobacco into northern Australia approximately 400 years ago (MacKnight 1976). People in Northern Australia continue to use Macassan style pipes and tobacco still plays a role in traditional ceremonies. Modern tobacco was introduced to Aboriginal and Torres Strait Islander people after colonisation and was used as a means of bargaining and trade. In the decades that followed and as Indigenous people were displaced onto church, government or private missions, tobacco was an important part of rations provided in exchange for work and to reward co-operation (Rowse 1998). Smoking has become normalised in many Aboriginal and Torres Strait Islander communities. While smoking is not a cultural practice as such, it has become a part of most Indigenous peoples daily experience given that nearly half of adults currently smoke. Additionally Aboriginal and Torres Strait Islanders have a strong tradition of sharing resources and the sharing of cigarettes reinforces smoking (Johnston and Thomas 2008). A comparison of other Indigenous people worldwide, particularly those who have been colonised (for

example New Zealand Maori, Native Canadians, and Native Americans), indicates that the prevalence of tobacco use is higher among these population groups than for non-Indigenous people in these countries (CEITC 2010).

Source: National Aboriginal and Torres Strait Islander Health Survey, 2004-2005 (ABS 2006a)

However regional surveys have found that the smoking rates can vary considerably. For example:

Wilcannia, New South Wales - in the late 1980s, 71% of Indigenous males and 76% of Indigenous females reported smoking (Stephenson and Lenz 1990). Bourke, New South Wales - in the early 1970s, 87% of Indigenous males and 71% of Indigenous females reported smoking (Kamien 1978). Northern Territory - in 1987-1988, 56% of Indigenous people (71% of males and 43% of females) smoked and, of the 44% who did not smoke, 12% had smoked in the past (Watson, Fleming et al. 1988). Adelaide , South Australia - in 1989, 78% of Indigenous males and 64% of Indigenous females reported smoking (Lake 1989).

Country Victoria - in 1992, 67% of Indigenous males and 63% of Indigenous females reported smoking (Guest, O'Dea et al. 1992). Southern Western Australia - in 1992, 60% of Indigenous people aged between 15 and 29 years smoked, and nearly half of the older Indigenous people also smoked (Knowles and Woods 1993)

Further information
Download 'Just the Facts' a fact sheet about tobacco use among Indigenous Australians Tobacco kills. Youve probably heard that before, so lets put it in perspective: for every person who dies in a road crash, more than 10 die due to tobacco. 1 Most people who smoke began as teenagers. It makes sense its hard to take the risks of smoking seriously when the consequences seem so far away. Plus, plenty of young smokers believe they can quit at any time they want, before those unwanted health consequences kick in. But guess what? More than 90 percent of Australians who smoke began smoking as teenagers. 2 Most of them probably thought they could quit at anytime

too. Why do young people smoke? Good question. Theres no simple answer. As well as individual reasons for smoking like plain old curiosity and rebellion there are also wider social and environmental influences: We all have different attitudes toward smoking, or other personality traits like curiosity or rebelliousness that might influence whether we start smoking as a young person. Social Factors Social and family situations can have a big impact on whether someone decides to take up smoking. Two of the most common influences are parents and family, and peer pressure and social environment. Parents and Family Basically, it boils down to this if youre hanging around with people that smoke, youre more likely to start smoking too. Young people who have family members or close friends who smoke are

significantly more likely to smoke than those who dont. 3 Peer Pressure and the Social Environment Its no secret that smokers can feel like they belong to a club. For many young people, that sense of belonging can seem a lot more important than any long-term health effects. There are plenty of societal reasons that make young people more likely to take up smoking, particularly when life gets difficult and stressful. 4 These can include: lack of parental support and direction family conflict not doing very well at school financial hardships unemployment or unstable employment. Wider Environmental Influences There are also broader reasons for smoking that relate to the media and legislation which influence

whether young people smoke. UNIVERSITY OF THE PHILIPPINES Bachelor of Arts in Communication Research Joyce M. Aguillon Precious B. Romano SmokeCheck: A Study on the Effects of NCR Male High School Students Exposure to and Recall of Anti-Smoking Advertisements to Their Perceptions of and Attitudes toward Smoking Thesis Adviser: Professor Randy Jay C. Solis College of Mass Communication University of the Philippines Diliman Date of Submission April 2012 Permission is given for the following people to have access to this thesis: Available to the general public Yes Available only after consultation with author/thesis adviser No Available only to those bound by confidentiality agreement No Students signature: Students signature:

Signature of thesis adviser:UNIVERSITY PERMISSION I hereby grant the University of the Philippines non-exclusive worldwide, royalty-free license to reproduce, publish and publicly distribute copies of this thesis or dissertation in whatever form subject to the provisions of applicable laws, the provisions of the UP IPR policy and any contractual obligations, as well as more specific permission marking on the Title Page. Specifically I grant the following rights to the University: a) to upload a copy of the work in these database of the college/school/institute/department and in any other databases available on the public internet; b) to publish the work in the college/school/institute/department journal, both in print and electronic or digital format and online; and c) to give open access to above-mentioned work, thus allowing fair use of the work in accordance with the provisions of the Intellectual Property Code of the Philippines (Republic Act

No. 8293), especially for teaching, scholarly and research purposes. _________________________ _______________________ Joyce Aguillon Precious B. Romano April 2012SMOKECHECK: A STUDY ON THE EFFECTS OF NCR MALE HIGH SCHOOL STUDENTS EXPOSURE TO AND RECALL OF ANTI-SMOKING ADVERTISEMENTS TO THEIR PERCEPTIONS OF AND ATTITUDES TOWARD SMOKING JOYCE AGUILLON PRECIOUS BARREDO ROMANO Submitted to the COLLEGE OF MASS COMMUNICATION University of the Philippines Diliman In partial fulfilment of the requirements for the degree of BACHELOR OF ARTS IN COMMUNICATION RESEARCH April, 2012SMOKECHECK: A STUDY ON THE EFFECTS OF NCR MALE HIGH SCHOOL STUDENTS EXPOSURE TO AND RECALL OF ANTI-SMOKING ADVERTISEMENTS TO THEIR PERCEPTIONS OF AND ATTITUDES TOWARD SMOKING

by JOYCE MENDOZA AGUILLON PRECIOUS BARREDO ROMANO has been accepted for the degree of BACHELOR OF ARTS IN COMMUNICATION RESEARCH by Professor Randy Jay C. Solis and approved for the University of the Philippines College of Mass Communication by Professor Roland B. Tolentino Dean, College of Mass CommunicationBIOGRAPHICAL DATA PERSONAL DATA Name Joyce M. Aguillon Permanent Address Blk.17, Lot 7, Moonstone St., Citation Homes, Meycauayan City, Bulacan Cellphone Number 09059305552 E-mail Address joyce_aguillon8@yahoo.com EDUCATION Tertiary Level BA Communication Research, University of the Philippines-Diliman, Quezon City,

Metro Manila Secondary Level Valedictorian, St. Dominic Academy, Caloocan City, Metro Manila Primary Level Salutatorian, St. Dominic Academy, Caloocan City, Metro Manila WORK EXPERIENCE Intern HealthJustice Philippines Summer AY 2010-2011 ACHIEVEMENT College Scholar 2 nd 1 Semester AY 2008-2009 st University Scholar Semester AY 2010-2011 2 nd Semester AY 2009-2010ACKNOWLEDGMENTS This thesis would not have been possible without the help of these following

people whose love, support and guidance have helped us in our venture to finish this paper. I owe my deepest gratitude first of all to God whose unconditional love has helped me during my stay in the university. I offer all my endeavours to His Glory. I would like to show my gratitude to Prof. Randy Jay Solis, our thesis adviser. His support and guidance have helped us to finish this paper. I like to thank him for his understanding, leniency and making himself available whenever we need consultations regarding our thesis. In addition, I am grateful to Dr. Elena Pernia, our thesis proposal adviser. Her advice regarding our topic has helped us to think of means to improve our thesis. Its an honor for me to thank Atty. Rizalino T. Jose, OIC of DepEd National Capital Region for the issuance of permit in order for us to conduct survey in selected NCR schools. I would also like to thank the ten schools for their participation. I am very grateful to my family: my mother, Ate Cynarra and Joseph for their love and support. Lastly, I want to show my gratitude to my thesis partner and best

friend, Precious B. Romano. This thesis is the fruit of our hardship, sleepless nights and worried times. I want to thank you for being an understanding and caring thesis partner. I am glad to finish this thesis with you. Thank you!BIOGRAPHICAL DATA PERSONAL DATA Name Precious B. Romano 466 Libis 2 Sittio Libis Muzon San Jose

Permanent Address Del Monte,

Bulacan Telephone Number E-mail Address EDUCATION Tertiary Level BA Communication Research University of the Philippines-Diliman Quezon City, Metro Manila Secondary Level High School, First Honorable Mention, Polo National (+63-926) 288-9196 preciousheart711@yahoo.com

Valenzuela City Primary Level Elementary School, Valenzuela City ORGANIZATIONS Fellowship President, Polo United Methodist Youth Salutatorian, Perpetua R. San Diego

Christian Nurture&Formation Head, South Bulacan District United Methodist Youth Fellowship WORK EXPERIENCE Research Intern, HealthJustice Philippines, AprilMay 2011 Script Writer, Manila Episcopal Wide Christmas Institute, September-December 2010 Private Tutor, Hwang Residence, 2009-2012 ACHIEVEMENTS College scholar: 2 nd University Scholar: 2 semester, AY 2009-2010 nd Semester AY 2011-2012ACKNOWLEDGMENTS The time has finally come for me to express my deepest gratitude and appreciation to the people who made it possible for me and my thesis partner Joyce Aguillon to finish this thesis. First, I wish to thank our Thesis Adviser, Prof. Randy Solis, for his expertise, dedication, and most of all patience in giving us guidance and constructive criticisms in our thesis. Every word that he said indeed encouraged and inspired me to work harder. I would like to thank too our Thesis Proposal Adviser,

Dr.Elena Pernia, for motivating us to pursue our thesis topic. I wish to give my deepest appreciation to Ms. Stephanie Manacop for being the proof-reader of our thesis. Of course, I thank my mom , Mrs. Malou De Jesus, and my siblings Jonmar, Sabel, &Kinah for loving and supporting me unconditionally not only throughout my thesis but throughout my life. Next, I wish to thank my church mates at Polo UMC, Pastor Jun Vinoya, and tita Beth Vinoya for always praying for me. I wish to thank my friends, co-execoms at SBD UMYF and Intimacy Worship Team for always cheering me up whenever I'm stressed with this thesis. In addition, I wish to thank the principals and guidance counselors of the schools who assisted me in conducting survey to the male high school students. I would like also to express my sincere gratitude to all the students who participated in our study. Finally, I wish to thank my best buddy Joyce for being my best thesis partner. Thank you for staying strong, kind, and patient through all the ups and downs of our thesis adventure. Above all, I thank the Lord God Almighty for being my Saving Grace,

my Daddy, my Comforter, and my Deliverer in doing this thesis. DEDICATION To our families Aguillon and De Jesus-Romano For supporting us to do our best And achieve our dreams To God be the GloryABSTRACT Aguillon, J. &Romano, P(2012). SMOKECHECK: A study on the effects of NCR male high school students exposure to and recall of anti-smoking advertisements to their perceptions of and attitudes towards smoking, Unpublished Thesis, University of the Philippines College of Mass Communication. The study aims to determine the effects of the extent of exposure to antismoking advertisements and the recall of National Capital Region (NCR) male high school students to their perceptions of and attitudes toward smoking. Male students were chosen because The Health Belief Model (HBM), Mere Exposure Theory, and Availability Heuristics Principle were used for the theoretical framework of the study. A survey was

conducted randomly among 400 NCR male high school students. The researchers also conducted two Focus Group Discussions divided to smokers and nonsmokers. the 2007 Global Youth Tobacco Survey estimates that there are 17% or 4 million Filipino youths with ages 13-15 years who are smoking. Of these early starters, 2.8 million are boys and 1.2 million are girls, thus majority are male in the high school level. Results found out that three in ten NCR male high school students had tried smoking at ages 12 to 14 years. There was a high general perceived susceptibility and severity of having smoking-related diseases among the NCR male high school students. The general attitude of the students toward smoking was either positive or negative (neutral). The study also found out that there was a weak correlation between the NCR male high school students exposure to and recall of anti-smoking advertisements and their perceptions of and attitudes towards smoking. xi TABLE OF CONTENTS Page University Permission i

Title Page iii Approval Sheet Biographical Data &Acknowledgments v Dedication ix Abstract x Table of Contents xi List of Tables xiii List of Figures xiv I. INTRODUCTION A .Background of the Study 1 B. Statement of the Problem and Objectives 3 C. Significance of the Study 5 II. REVIEW OF THE RELATED iv

LITERATURE A. Dangers of Smoking 7 B. Exposure and Recall to Anti-Smoking Advertisements 10 C. Other Sources of Information About

Smoking 15 D. Perception and Attitude toward Smoking 17 E. Smoking Among the Youths 20 F. Synthesis 24xii III. STUDY FRAMEWORK A. Theoretical Framework 28 B. Conceptual Framework 33 C. Operational Framework 35 D. Operational Definition of Terms 39 E. Hypothesis 40 IV. METHODOLOGY A. Research Design and Methods 42 B. Variables and Measures/Concepts and Indicators 42 C. Research Instruments 43 D. Units of Analysis and Sampling 44

E. Data Gathering/Generation and Construction 46 F. Data Analysis 47 G. Scope and Limitations 48 V. RESULTS AND DISCUSSIONS A. Results 50 B. Discussions 92 VI. SUMMARY AND CONCLUSION A. Summary 99 B. Conclusion 103 VII. IMPLICATIONS AND RECOMMENDATIONS A. Implications 105 B. Recommendations 106 BIBLIOGRAPHY 112 APPENDIX 121xiii LIST OF TABLES Number Title Page 1 Age 51 2 Monthly Income of the Respondents Families 52

3 Age they started to Smoke 53 4 Cigarette Brand consumed during the last 30 days 54 5 Other Sources of Information and Cues to Action about Anti- Smoking 55 6 Extent of Exposure to these Other Sources of Information 56 7 Anti-smoking Advertisements 58 8 Extent of Exposure to Anti-Smoking Advertisements 59 9 Quantity of Recalled Anti-smoking Advertisements Messages 61 10 Quantity of Recalled Anti-smoking Advertisements Characteristics 61 11 Knowledge on RA 9211 64

12 Knowledge on the First Hand, Second Hand,& Third Hand Smokes; and their Severity &Threats 65 13 Perceived Susceptibility of Having Smokingrelated Diseases 66 14 Perceived Severity of the Smoking-related Diseases 67 15 Extent of Exposure to Smoking Advertisements and Promotions 68 16 Likelihood of Not Smoking 70 17 Likelihood of Smoking 71 18 Attitudes toward Smoking 71 19 Perceived Benefits of Not Smoking 72 20 Perceived Barriers to Not Smoking 73 21 Correlation of the students' extent of exposure to anti-smoking advertisements and their perception of and attitudes towards smoking(r=correlation)

75 22 Correlation of the students extent of exposure to other sources of information about antismoking and their perception of and attitudes towards smoking(r=correlation) 76xiv 23 Correlation of the students quantity of recall of anti-smoking ads messages to anti-smoking advertisements and their perception of and attitudes towards smoking(r=correlation) 77 LIST OF FIGURES Number Title Page 1 Theoretical Model of the Health Belief Model 31 2 Integrated Theoretical Model 32 3 Integrated Conceptual Model 34 4 Integrated Operational Model 38 5 Distribution of recalled messages of antismoking advertisements given by the respondents 631 CHAPTER I. INTRODUCTION

A. Background of the Study Many Filipinos die due to smoking-related diseases. On a daily basis, 240 Filipinos die because of these smoking-related diseases such as heart failure, stroke, chronic obstructive pulmonary disease, peripheral vascular disease and many cancers. This accounts for 87,600 deaths due to smoking-related diseases in the country every year (WHO, 2009b). Direct and indirect exposures to cigarette smoking cause these diseases. Direct exposure or first- hand is the actual smoking, while indirect exposure may be second hand or inhaling the smoke when a person smokes near and third-hand smoke or exposure to chemicals that remain after the cigarette is put out (Apelberg, 2007). In connection with these dangers of smoking, there are increasing numbers of Filipino smokers and an alarming number of youth smokers. Republic Act of 9211(as cited in Department of Education [DepEd],2011), or the Tobacco Regulation Act of 2003, specifies the smoking prohibition in public places: Section 5. Smoking in Public Places - Smoking shall be absolutely

prohibited in the following public places: a. Centers of youth activity such as playschools, preparatory schools, elementary schools, high schools, colleges and universities, youth hostels, and recreational facilities for persons under eighteen (18) years old (p.1).2 Thus, this law of the country protects specifically the youth from being exposed to smoking. The Global Youth Tobacco Survey (2007) estimates that there are 17% or 4 million Filipino youths with ages 13-15 years who are smoking. Of these early starters, 2.8 million are boys and 1.2 million are girls. With these alarming statistics, a number of anti-smoking campaigns are being implemented around the country. The Department of Education (DepEd) through their program Oplan Balik-Eskwela integrates anti-smoking campaign in schools for the protection of the students against the hazards of smoking. The main goal of the campaign is to ensure the implementation of the anti-smoking policies in schools (DepEd , 2011). Aside from the efforts of DepEd, the Metro Manila Development Authority (MMDA) has

also launched its anti-smoking campaign in the National Capital Region (NCR). The MMDA enforcers have started to reprimand those who are smoking in public places (Aning, 2011). MMDAs vision of having a smoke-free Manila is the main reason why this study is made in NCR. When it comes to advertisements, according to Bovee (1992), "Advertising is the non-personal communication of information usually paid for and usually persuasive in nature about products, services or ideas by identified sponsors through the various media." (p.7).The three major functions of advertisements are to disseminate information, to provide incentives to viewers for them to engage in action, and to provide constant reminders and reinforcements to generate the desired behavior the advertiser wants from them (Puranik, 2011). There are forms of advertising which are mainly connected 3 through the use of media; they are print (newspapers, magazines, and brochures), broadcast (TV, movies), oral (radio), and online (Gentry, 2010). Most of the anti-smoking advertisements are in the form of advocacy advertising.

Advocacy advertising aims to influence publics attitudes toward a particular issue (Shivani, 2009). Anti-smoking advertisements are tools to disseminate information about the dangers of smoking. They also aim to increase nonsmoking intentions (Pechmann, Goldberg, & Reibling, 2003). In contrast, most smoking advertisements which sell cigarette products to people are in the form of product advertising. Product advertisings main purpose is to promote certain products (Shivani, 2009). Anti-smoking advertisements as well as other Information, Education and Communication (IEC) health programs against smoking can greatly diminish the prevalence of smoking in the country especially among the youth sector. Efforts to strengthen these health promotions by further studies related to antismoking advertisements are a must hence this study aims to contribute to those anti-smoking efforts. B. Statement of the Research Problem and Objectives Because of the prevalence of smoking in the youth sector nowadays, it is important to know their exposure to the current anti-smoking advertisements that help

minimize the number of youth who are smoking. Hence the research problem and objectives will be:4 1. Research Problem: 1.) How do the extent of exposure to and recall of anti-smoking advertisements of NCR male high school students affect their perceptions of and attitudes toward smoking? 2. General Objectives: 1.) To determine the extent of exposure to and recall of anti-smoking advertisements of NCR male high school students 2.) To determine how the anti-smoking advertisements affect the NCR male high school students perceptions of and attitudes toward smoking 3. Specific objectives: 1. To determine the socio-demographic profile of NCR male high school students 2. To determine the NCR male high school students sources of information and cues to action about anti-smoking 3. To identify the different forms of anti-smoking advertisements that they were exposed to

4. To determine their extent of exposure to and recall of anti-smoking advertisements 5. To determine their knowledge, perceptions and attitudes toward smoking: a. law (RA 9211 which absolutely prohibits smoking in schools) b. dangers (perceived susceptibility, severity and threats of first-hand, second-hand and third-hand smoke)5 c. ads and promotions d. cessation (perceived benefits, perceived barriers and likelihood of not smoking) 6. To determine if their perceptions and attitudes toward smoking vary according to their: a. extent of exposure to anti-smoking advertisements b. extent of exposure to other sources of information about smoking 7. To determine if there is a significant relationship between the messages they recall from anti-smoking advertisements and their perceptions and attitudes about smoking C. Significance of the Study The main rationale of this study is to contribute to the efforts of Information Education and Communication health campaigns on smoking by providing data on the extent of exposure to anti-smoking advertisements and recall of the NCR male high

school students. In the Philippines, there are 17% or 4 million Filipino youth with ages 13-15 years who are already smoking. Of these early starters, 2.8 million are boys and 1.2 million are girls (Global Youth Tobacco Survey [GYTS], 2007). This is a serious issue that must be given attention. Survey results show that boys are most likely to start smoking during their high school days. Thus, this study focuses on the male high-school students. NCR is chosen in order to contribute to the MMDAs vision of a smoke-free Manila.6 Moreover, the anti-smoking advertisements provide messages that are very vital in persuading students to not smoke. Hence, the researchers want to know the messages in the anti-smoking advertisements that the students recall. The students extent of exposure to anti-smoking advertisements and recall are factors that can affect the students behavior on smoking. In order to have a more comprehensive view of the extent of exposure and recall of the NCR male high school students to anti-smoking campaigns, the study uses the

Health Belief Model (HBM) that looks on the students perceptions of and attitudes toward smoking. The HBM provides a framework that relates the specific objectives of this study to each other; it provides a possible explanation on the students smoking behavior. This study is a significant endeavor in promoting public health and proper law implementation of RA 9211 among the youth today. Hence, the knowledge of the students about the dangers of smoking and the smoking law is determined in this study. It is known that cigarettes can be purchased in tingi-tingi or by piece. Cigarette vendors openly sell cigarettes in streets and sidewalks. This kind of strategy makes it easy for an adolescent to buy a stick violating a section in RA 9211 that prohibits selling of cigarettes within the 100 meter perimeter of the school. The study through the awareness of the students on where to buy cigarettes provides incidental data if this law is followed. Hence this study is helpful to those government agencies like the DepEd and MMDA; and Non-Government Organizations (NGOs) who are promoting anti-smoking

among the Filipino youths today.7 CHAPTER II. REVIEW OF RELATED LITERATURE It is becoming increasingly difficult to ignore the number of youth smokers today. Because of the diseases smoking can cause, it becomes a threat to public health. Hence, the public must prioritize decreasing smoking prevalence. The youths inherent characteristic of curiosity makes them prone to try smoking. Proper education and guidance are needed to protect the youth from the hazards smoking imposes. In order to delve deeper on the study, a review of related literature is extensively done by the researchers. A. Dangers of Smoking Tobacco product is defined as any manufactured product made of leaf tobacco that is used for smoking, sucking, chewing, or snuffing (WHO FCTC, 2005). There are three types of tobacco preparation. The first one is the roll of tobacco which is smoked. Cigarette is the best example of this. The second type is pipe like water pipes. The third is the oral preparation which is chewed, held in mouth or placed in nose. Examples are

snuff, snus, betel and quid (WHO, 2006). Tobacco contains nicotine and many carcinogens. Hence, it is an addictive plant (WHO, 2006). Scientific evidences show that the consumption and exposure to tobacco smoke cause these three: (1) Death, (2) Disease, and (3) Disability. Aside from this, it has been found out that there is a time interval between the exposure to smoking and the start of tobacco-related diseases (WHO FCTC, 2005). Smoking indeed causes pre-mature deaths. Around half of the continuing cigarette smokers, which are approximately 650 million people, who are still alive will sooner or 8 later die from tobacco-related disease if they still smoke. Right now, the higher burden of tobacco-related diseases and deaths is fast shifting to developing countries (WHO, 2006). Cigarettes are considered to be among the most deadly and addictive products made by men. If the users will smoke cigarettes according to the intention of the cigarettes manufacturers, cigarette smoking can kill half of its users (WHO, 2006). On the other hand, its not only the tobacco consumers who are susceptible to its

negative effects. The second-hand tobacco smoke which is also known as passive smoking has exposed millions of people including half of the worlds children to the negative effects of tobacco consumption. Evidences link second-hand smoking to the increased risk of cardiovascular diseases, lung cancer and other cancer, asthma and other respiratory diseases, ear infection and sudden infant death syndrome in children. The above mentioned diseases are but a few of second-hand smokings harmful effects (WHO, 2006). The tobacco epidemic is rising rapidly hence the regulation of tobacco products is critical. All tobacco products can cause disease and death aside from the fact that they are harmful and addictive (WHO, 2006). Tobacco consumption has harmful effects to smokers and non-smokers. It is harmful to children causing them to have respiratory problems and other health problems (USDHHS, 2000). Annually, secondhand smoke causes an estimated 3000 lung cancer deaths and 62,000 coronary heart disease deaths in California (NCI, 1999).

All tobacco products are dangerous and addictive. Government effort should be made to discourage the use of tobacco in any forms as well as to raise awareness about its 9 harmful and deadly effects (WHO, 2006). However, in order to maintain profit, tobacco companies continue to develop new products. These companies cover the tobacco products harmful effects by portraying tobacco products as attractive and less harmful (WHO, 2006). Tobacco-related diseases have been widely reviewed. According to WHO (2006): It is now also known that tobacco use contributes to cataracts, pneumonia, acute myeloid leukemia, abdominal aortic aneurysm, stomach cancer,

pancreatic cancer, cervical cancer, kidney cancer, periodontitis and other diseases. These diseases join the familiar list of tobacco-related diseases, including cancer of the lung, vesicle, esophagus, larynx, mouth and throat; chronic pulmonary disease, emphysema and bronchitis; stroke, heart attacks and other cardiovascular diseases. In fact, we know today that tobacco causes 90% of all lung cancers. Tobacco seriously damages the reproductive system too, contributing to

miscarriage, premature delivery, low birth weight, sudden infant death and pediatric diseases, such as attention hyperactivity deficit disorders. Babies born to women who smoke are, on average, 200 grams lighter than babies born to comparable mothers who do not smoke. (p.13) Nowadays, the prevalence of smoking is commonly very high among adolescents in many countries. It is said that people start smoking with median age of less than 15 years old (GYTS, 2007). The risk of death from smoking-related diseases increases when people started smoking at younger ages. Young people who start smoking early will be likely to die at 10 lower age, and they will often find it difficult to quit smoking. It is said that half of them will die from their tobacco consumption (GYTS, 2007). B. Exposure and Recall to Anti-Smoking Advertisements According to the study of Terry-Mcelrath (2005), all anti-smoking advertisements were not alike in their characteristics, their thematic content, the level to which they engage youth, or how youth were likely to respond. Advocates attempting to develop increasingly successful anti-smoking campaigns should consider the characteristics of

proposed ads. The use of personal testimonials or visceral negative executions or both that include themes of health effects may increase the likelihood that fewer youth would smoke in the future. Message content format and approach must be considered to have a successful anti-smoking campaign. Personal and real life testimonials could be helpful to get the attention of the intended audience. These would serve as evidences of the hazards imposed by smoking and would serve as warning to the public of the smoking dangers. Siegel (2000) found a significant effect of exposure to televisions antismoking advertising on progression to establish smoking during a 4-year period that was specific to younger adolescents but found no significant effect of exposure to radio or outdoor advertisements. He also found that youths exposed to antismoking television advertisements were more likely to have an accurate as opposed to an inflated perception of youth smoking prevalence. The effect was significant only to younger adolescents. The study indicated that TV was the most widely used medium for anti-smoking campaigns. Thus youths were most likely to be informed thru watching. 11

In order to address the challenges brought by the increasing tobacco epidemic, the WHO Framework Convention was made. This aims to reduce the burden of disease and death caused by tobacco (WHO, 2006). Anti-smoking advertisements are encouraged in this framework convention through Article 20 which is about the achievement of product regulation goals by means of research, surveillance and exchange of information (WHO FCTC, 2005). One of the types of anti-smoking advertisements is the pictorial warning labels. These pictorial warning labels are said to be an important opportunity to communicate the risk of tobacco consumption. The pictorial warning labels are vital since the tobacco companies are using the tobacco packages as a way of promotion. Growing evidence shows that larger, bold and pictorial warning labels have an impact on the awareness of tobacco consumption risks. Many countries introduce stronger labels; evaluation shows that effective warning labels increase knowledge about the smoking risks as well as it can persuade smokers to quit (Hammond, Fong, McNeill, Borland & Cummings, 2006). Its

found out that smokers receive more information about smoking risks from the tobacco product package than from any other source except television (Hammond et al, 2006 &Hammond, 2008). Picture warning labels on tobacco products increase knowledge about tobacco consumption risks, reduce adolescents intentions to smoke, and motivate smokers to quit. These labels counter the tobacco industry advertisements. It was found out that pictorial warning labels had a greater impact than text-only labels (White, Webster & Wakefield, 2008, Hammond, 2008). These pictorial warning labels could be recognized by children and low-literacy audiences. According to a study (Hammond, Fong, Mc Donald, Cameron & Brown, 2003) in Canada, the exposure of smokers to 12 images printed on packs is at least 20 times a day every time they buy and use cigarettes. This exposure was an opportunity to bring ant-smoking messages at critical stage which was the time of smoking. Thus the use of pictorial images increased the impact of the anti-smoking messages. On the other hand, the public awareness about the true dangers of smoking is low

even in countries with widespread anti-smoking campaigns (Ayanian & Cleary, 1999). Yet the exposure to anti-smoking media messages is rising compared to pro-smoking media messages. The tobacco industrys advertising influence is still asserted. Children and adolescents will continue to be persuaded by the pro-smoking messages in the media if there will be no total ban on advertisements (GYTS, 2007). Philippines GYTS (2007) found out that among the Filipino youths, theres a significant increase in the prevalence of current use of cigarettes, from 10.6% in 2003 to 27.3% in 2007(39.3% change). In addition, there was a significant increase also to second-hand smoke at home, public places, and around peers. Regarding the exposure of Filipino youths to anti-smoking advertisements there was a decreased percentage of students who had seen anti-smoking media messages. In the Philippines, youths are likely to buy the most heavily advertised brands. They are three times more affected by advertising than the adults (GYTS, 2007). The youths are exposed to smoking promotion and advertisements where smoking is portrayed as glamorous, social and normative (GYTS, 2007).

In the Philippines, GYTS (2007) found that:13 Almost nine in ten students (87.3%) saw anti-smoking media messages in the past30 days, with girls more likely than boys to have been exposed to. Nine in ten students (87.9%) saw pro-cigarette advertisement on billboards and saw messages in magazines and newspapers during the past 30 days, with the 4th year and 3 rd Wakefield (2002) conducted a study to determine the characteristics of antismoking ads that were more or less likely to be potentially effective in influencing teenage smoking. The study was designed to determine which ad characteristics were associated with higher teen ratings on standard advertising response scales and which advertisement characteristics were associated with higher rates of recall, thinking about the ad and discussion about the ad at follow-up. Ming Ji (2007) study about the effectiveness of anti-smoking media campaigns by recall and rating scores made use of a statistical modeling approach for systematically assessing the effectiveness of antismoking media campaigns based on ad recall rates and rating scores. The study found out

the effectiveness of advertising messages in a laboratory environment before put them in mass media. These studies proved that recall of those anti-smoking advertisements could verify the effectiveness of the ads. Effective recall was linked with the characteristics of the ads. The youth with a stored memory of the characteristics of the ads most likely recall that advertisement. year students significantly higher than the 2nd year students. Over one in ten (12.6%) have an object with a tobacco company logo on it and one in almost one in ten (8.5%) to have offered free cigarettes, with boys significantly more than girls. (p.5)14 In a study done in Canada (Youth Smoking Survey, 1997), it was found out that among Canadian youth, the three most frequently recalled pack warning labels were Smoking during pregnancy can harm your baby, Smoking is the major cause of lung cancer, and Cigarettes can kill you. On the other hand, the least-recalled anti-smoking messages were Smoking causes strokes and Smoking can harm your children. Recall of these anti-smoking messages increased with age and smoking experience.

According to a study (Youth Smoking Survey, 1997), there was a positive relationship between the recall of the anti-smoking messages and the recall of the tobacco-related diseases like lung cancer, heart problems, strokes and cancer. People who saw the anti-smoking messages in the warning labels are more probably to recall the tobacco-related diseases. The findings of Youth Smoking Survey (1997) showed that Canadian youths were well informed about the health dangers of smoking. Health risks with immediate impact like harm to children and harm during pregnancy could be reinforced. The awareness of health problems and warning labels were based on the studys unprompted recall questions. Over one third of Canadian youth were able to recall without prompting three or more smoking-related diseases. These youths gained knowledge about the long-term effects of smoking when they were still teenagers (Youth Smoking Survey, 1997). In contrast, according to GYTS (2007), the Filipino youths couldnt recall antismoking messages on television or movies however they could recall movies that portray smoking. They could also recall actors and actresses who smoked in their roles. Most

smokers could not recall the specific smoking health dangers. (Hammond et al, 2007).15 C. Other Sources of Information about Smoking Parental expectations that their child will avoid smoking have been shown to affect levels of adolescent tobacco use. Among those polled in the Whos Who survey (1997) out of the 68% of students who never tried smoking, most (86 %) were told by parents never to smoke. In comparison of those who had smoked, almost one-third said their parents never discussed smoking with them. Indeed, parents play a significant role in influencing their children. Parental guidance is needed to regulate behavior of the youth and to protect them from the hazards of the environment. Ethnicity also affects the peoples attitudes toward smoking. Strong ethnic ties like those in Asians are more likely to favor anti-smoking messages from their family compared to non-Asians (Nicotine Tobacco Research, 1999). This is because the Asian cultures value more their family needs. It is said that the positive messages from a wife, mother, or sister powerfully influence the smoking behavior of the male family members

(Health Education Research, 1999). A study (Grace, Maa, Steven, Shiveb, YinTan, Jamil et al, 2005) found out that fathers and brothers had greater social influence on male youth smoking behavior. On the other hand, the school also affects the youth smoking prevalence (GYTS, 2007). In Canada, three quarters (76%) of their youths reported that their schools had taught them about the health effects of smoking. In Quebec, 64% of their youths reported that they were receiving smoking school-based education (Youth Smoking Survey, 1997).16 In the Philippines, according to GYTS (2007), majority of the youth received teachings about the dangers of smoking in their schools but the survey did not include the details of the curriculum and how it was taught. The survey also found out that majority of the youth smokers wanted to stop smoking. However, there were no concrete programs available in schools to help the current youth smokers to stop. The youths smoking behavior especially the male ones was influenced by their smoking friends. Smoking was said to be primarily a male behavior. This was evident in

Southeast Asian men who were found out to have the highest reporting rates in the U.S (Grace, Maa, Steven, Shiveb, YinTan, Jamil et al,2005). There are laws made in different countries in order to regulate tobacco consumption and its epidemics. In Australia, a law mandated health warning labels in 1995. Through this law, the smokers became more knowledgeable than the non-smokers when it came to smoking-related disease and tobacco components (Borland, 1997). The World Health Organization (WHO) Framework Convention on Tobacco Control requires every party involved in it to implement health warnings on all tobacco product packaging (FCTC, 2003). The Philippines is part of the WHO FCTC. The Republic Act of 9211(RA 9211) or the Tobacco Regulation Act of 2003 has been made but poorly implemented. In 2007, the National Tobacco Prevention Control Program (Administrative Order 2001-004) has been established by the Department of Health (DOH). In 2008, a total ban of tobacco advertising in mass media except point of sale advertisement was implemented (WHO, 2006).17

According to the Philippine GYTS (2007), the enforcement made by the Philippine local government officials of the National Tobacco Laws and the WHO-FCTC was poor. Despite of the strong national government and NGOs efforts in advocating full implementation of the anti-smoking laws, there was still lack of political will, monitoring, and reporting guidelines for the offenders of these antismoking laws. Another source of information about smoking is the anti-smoking campaign. Campaigns are created with planned effects to the target people set before-hand by the originator; hence the evaluation process consists of a match between the planned effects and the achieved effects. The campaign is said to be effective if the planned effects are achieved after the implementation of the campaign (McQuail, 1994). According to a study of Hong Liu (2009) about the effects of anti-smoking media campaign on smoking behavior, those mass media anti-smoking campaigns were promising and costly tool for health promotion. However in his study about California anti-smoking campaigns, he concluded that the said anti-smoking media campaign was a

successful tobacco control in reducing smoking prevalence in the short run as well as in the long run. It provided empirical evidence to support the continuous funding of the antismoking media campaigns. D. Perceptions of and Attitudes toward Smoking Previous studies showed that knowledge of smoking health threats may vary across the smokers ethnicity as well as educational level. Higher educational levels were related to higher knowledge on smoking health risks (Ma, Tan, Freely &Thomas, 2002;18 Ma, Shive, Tan & Toubbeh, 2002). A study (Grace, Maa, Steven, Shiveb, YinTan, Jamil et al, 2005) found out that among Asian Americans the mean age of smoking was 18.3. Factors such as gender, ethnicity, educational level, marital and employment status and smoking were associated with the Asian Americans knowledge and attitudes about smoking and second hand smoke. A study (Brenda, 2008) of nursing students revealed that the smoking behaviors of the nursing students affected their beliefs about smoking. Results showed that the smoking status of students was a perceived barrier in giving cessation intervention. One

of the major findings of the study was the significant differences among the beliefs about smoking of the student smokers and student non-smokers. Smokers and occasional smokers reported higher agreement with the smoking positive aspects that it brought pleasures. When it comes to smoking negative aspects, the non-smokers reported more agreement. This was attributed to the non-smokers motivation not to smoke while the smokers might deny the negative aspects of smoking in choosing to use tobacco products. Smokers with lower levels of knowledge about the health dangers of smoking is associated with their positive attitudes toward smoking (Shankar, Gutierrez, Mohamed, & Alberg, 2000; Wiecha et al., 1998). For comparison among Asian American subgroups, regardless of smoking status, Koreans were aware that smoking was detrimental to health especially to the lungs (Kim et al., 2000). They had more negative perceptions toward smoking compare to Chinese (Averbanch et al., 2002; Yu et al, 2002). It was said that beliefs became part of a persons system and these beliefs influenced the persons choices and behaviors. Occasional smokers do not smoke daily, 19

or if they smoke they smoke just a few. A study (Hammond, 2008) showed that most smokers perceive themselves having lesser risk than other smokers. Smokers also are less aware of the health risks of secondhand smoke to others. Thus it is important that smokers understand the risks as well as the severity of smoking in order to motivate them to quit smoking (Environics Research Group, 1999). Attitudes toward smoking are significantly associated with smoking status (Shankar, Gutierre-Mohamed &Alberg, 2000; Marin, Marin, Perez, Stable ,Otero, Sabogal & Sabogal, 1990; Klesges, Somes, Pascale, Klesges, Murphy & Williams, 1988). Particularly current smokers perceived smoking as having positive attributes while the non-smokers perceived smoking as having negative characteristics (Taylor, Ross, Goldsmith, Zanna &Lock, 1998; Shervington, 1994). Moreover, current smokers perceived susceptibilities of having smoking-related diseases were lesser than the nonsmokers and former smokers even though the perceived seriousness of all the groups was almost the same (Klesges,Somes,Pascale,Klesges,Murphy&Williams,1988; Taylor,Ross,Goldsmith,Zanna&Lock,1998; Shervington,1994).

The results of the study on the perceptions of risks among Asian Americans (Ma, Fang, Tan&Feeley, 2003) revealed that the Asian Americans attitudes toward smoking dangers were associated with smoking status. Non-smokers as well as those who quitted smoking had more negative perceptions regarding smoking compared to smokers. Attitudes toward smoking are associated with socio-demographics, educational levels, and ethnicity. Younger and more educated smokers perceived smoking with 20 higher personal risks of heart disease or cancers (Shankar, Gutierrez, Mohamed & Alberg, 2000; Ma, Fang, Tan & Feeley,2003). Asian Americans knowledge about the health dangers of smoking was found higher among Korean and Chinese American males no matter what their smoking statuses were. They acknowledged the relationship between smoking and chronic diseases like lung cancer and heart disease. At the same time they were aware of the addictive nature of tobacco yet still a number of respondents attached attractive attributes to smoking like it is relaxing, and enhances concentration (Ma, Fang, Tan & Feeley,

2003). When it comes to age, a study (Moeschberger, Anderson, Kuo, Chen, Wewers & Guthrie, 1997) suggested that smoking behavior was associated with it; older Southeast Asian men who were 44 years of age were almost 10 times more likely to quit smoking than younger men below 24 years old. E. Smoking among the Youths Adolescents follow adults course on substance use. According to Lloyd and Lucas (1998) in their London study, mood control, stress coping, pursuit of pleasure and concerns of the body influenced adolescent smoking behavior. The belief that smoking alleviates stress might initiate experimentation with cigarettes by adolescents. This is supported by Lotecka and Lassleben(1981) in their study about stress. They found that negative distress was the most common reason of adolescents for restarting smoking after a period of abstinence. Adolescents gained pleasure from action involved in smoking: 21 handling cigarette packs, matches and lighters, lighting up, inhaling and exhaling and blowing the smoke. Smoking symbolized a sense of being adult or being able to do as

one pleases (Heaven, 1996). Body image is a highly salient aspect of identity as adolescence is a time of dramatic bodily changes. Adolescent girls are more concerned with thinness and weight than adolescent boys. In Lloyd and Lucas study (1998) images of adolescent smokers were generally negative. Only a small number of adolescents described smokers to be physically attractive. Boys described girl smokers as attractive, sophisticated, and pretty. Girls described an adult smoker as someone who looks good and almost healthy. The negative descriptions given by majority of adolescents were: ugly, fat, pimply, greasy hair, yellow teeth and scruffy. Images of the non-smokers, on the other hand, were described to be less colorful and less contradictory. Nonsmokers were depicted to be sensible, studious and obedient, and family-and parentoriented. Nonsmokers were viewed more positively than smokers. Other factors affecting youth smoking are the smoking ads and promotions made by the different tobacco companies. According to Fine (1972), smoking ads and promotions especially the cigarette advertisements had three purposes: first is to convince

non-smokers especially the youths that smoking is enjoyable; second is to convince those who are already smoking that it is safe and smart to smoke; and lastly is to convince the smokers to use the right brand of cigarette. These factors affect the recall of youth. The most common smoking-related health diseases recalled by the youths in Canada were lung cancer and heart disease. While the22 least recalled were stroke, bronchitis and asthma. It was said that the youths recall of these health problems increased with age (Canada Youth Smoking Survey, 1994). Smoking is also associated with risk and rebellion, sociability and use and construction of time. Cigarette smoking is viewed by some adolescents as an arousal jag (Eysenck and Eysenck, 1975). A study (Canada Youth Smoking Survey, 1994) also revealed that the current smokers with ages ranging from 15 to 19 years compared to non-smokers were more aware that heart diseases and cancers were caused by smoking. The number of recalled smoking related health diseases increased with smoking experience. However, for those youths aged 10-14 years their smoking status had no relation to the number of smokingrelated diseases recalled.

In order to profile the youth smoking, these definitions from a study (Lim, Sumarmi, Amal, Hanjeet Wan, Rozita, Norhamimah, 2009) were used. Smoker is defined as someone who smoked for at least one day in the last 30 days. Former smoker stopped smoking for at least 6 months while non-smoker never smoked. Previous studies showed that smokers tend to downplay the negative health effects of smoking (Mcmaster&Lee, 1991; Parerri-Wattel, 2006). This was attributed to the smokers ignorance of the dangers of smoking. The cognitive dissonance of the smokers could also be one factor, in which the smokers may know that smoking is harmful to health yet they downplay it in order to be compatible with their smoking habit. Another study (Taylor et al, 1998) revealed that heavy smokers have positive attitudes towards smoking compared to former smokers and non-smokers.23 Cigarette smoking is considered as one of the problem behaviors. Other activities include drinking alcohol, taking drugs, early sexual intercourse, as well as various forms of delinquency (Lloyd and Lucas, 1998). According to Gliksman and his colleagues, adult patterns of cigarette smoking become well established by age 15. This

fact is very alarming as cigarette smoking can cause cardiovascular disease and lung cancer (Hill, et al 1990). In India, there was a more rapid increase of youth smokers among the sixth grade boys compared to the eighth-grade boys (WHO, 2006). In the Philippines (GYTS, 2007), over one in ten of non-smokers youth said that they were likely to start smoking next year. This likelihood to smoke is higher among boys than girls. Focusing on the smoking of youths in the Philippines, the study made in the country (GYTS, 2007) showed that: 3 in ten of students aged 12-17 years currently use some form of tobacco, 21.7% currently smoke cigarettes; 9.7% currently use tobacco other than cigarette; 67% were exposed to Environmental Tobacco Smoke in places other than home. Almost seven in ten (68.8%) also think that exposure to smoke is harmful to them. Majority of the students (56.7%) have admitted one or more parents smoke in their presence, 9 in 10 students think smoking should be banned in public places; 7 in 10 students think smoke from others is harmful to them; 9 in

10 smokers want to stop; 9 in 10 students saw anti-smoking media messages in the past 30 days; 9 in 10 students saw pro-cigarette ads in the past 30 days. (p.4)24 This survey was made in order to monitor and assess the smoking prevalence, knowledge, attitudes, and behaviors among school-based youths. Indicators used in the survey were prevalence of tobacco use, access to tobacco products, exposure to environmental tobacco smoke, exposure to media messages and school lessons, and smoking beliefs and attitudes (GYTS, 2007) F. Synthesis Smoking was a serious health topic that had been widely studied because of its effect in health and environment. The World Health Organization or WHO conducted studies on tobacco products, preparation and chemicals it contained (WHO, 2005 and 2006). Cigarettes could kill half of its users making it one of the most deadly and addictive products made by men (WHO, 2006). Smoking-related diseases that eventually led to death were widely reviewed (WHO, 2006). Tobacco epidemic was rising rapidly

and the increasing consumption of tobacco products would result to addiction (WHO, 2006). Adolescent smoking was prevalent nowadays and smokers start to smoke even in younger age (Philippine GYTS, 2007).Facts about smoking called on the government to make possible actions for the regulation of smoking (WHO, 2006). Anti-smoking advertisements success would lie with the executional characteristics and the medium used (Mcelrath, 2005; Siegel, 2000). Antismoking advertisements are encouraged within the WHO Framework Convention on Tobacco Control to reduce the burden of disease and death of smoking (WHO, 2006).25 Anti-smoking advertisements in the form of picture warning labels were efficient means to increase public awareness about the dangers of smoking (Hammond, Fong, McNeill, Borland & Cummings, 2006; Hammond et al, 2006 & Hammond, 2008 ; White, Webster & Wakefield, 2008; Hammong, Fong, McDonald, Cameron & Brown, 2003). However in the Philippines, Filipino adolescents were more exposed with pro-smoking advertisements increasing the prevalence of smoking in the youth sector (GYTS, 2007).

There was a decreased in percentage of Filipino youth who were exposed with antismoking messages (GYTS, 2007). Recall and rating scores were used to measure the effectiveness of antismoking advertisements (Wakefield, 2002; Ji, 2007). This was to determine what characteristics of the ads were most likely to be remembered by the audience who had seen it. Antismoking messages that were imprinted in pack warning labels were the ones that were easily recalled (Canadian Youth Smoking Survey, 1997). The Canadian youth showed significant results in recalling messages in antismoking advertisements (Canadian Youth Smoking Survey, 1997). Unlike in the Philippines, Filipino youth could only recall actors and actresses that portray smoking and not the exact messages anti-smoking advertisements convey (GYTS, 2007). Other sources of information varied on how smoking was taught and how people were influenced by information they gained. Strong family ties could influence ones smoking behavior (Nicotine Tobacco Research, 1999; Health Education Research, 1999; Grace, Maa, Steven, Shiveb, YinTan, Jamil et al, 2005). The school also contributed with the education of youth about smoking (Canadian Youth Smoking Survey, 1999 ; 26

Philippine GYTS, 2007). Friends were more influential for males regarding smoking behavior as this was evident in Southeast Asian men (Grace, Maa, Steven, Shiveb, YinTan, Jamil et al, 2005). Smoking laws were implemented to regulate smoking in different countries (Borland, 1997; WHO FCTC, 2003; WHO, 2006; Philippine GYTS, 2007). But these smoking laws differed with the strictness of enforcement. Anti-smoking campaigns also helped in information dissemination about smoking (Liu, 2009). Smoking in adolescence could be associated with stress, risk and rebellion and body image (Lloyd and Lucas, 1998; Lotecka and Lassleben, 1981; Eysenck and Eysenck, 1975). Smoking also gave a sense of adulthood (Heaven, 1996). Smoking advertisements, on the other hand, could affect smokers by convincing them of the pleasure smoking could give (Fine, 1972). Education about smoking was related with the higher educational level a person had attained (Ma, Tan, Freely &Thomas, 2002; Ma, Shive, Tan & Toubbeh, 2002; Grace, Maa, Steven, Shiveb, YinTan, Jamil et al, 2005). Age also linked with the amount of

knowledge about smoking (Canadian Youth Smoking Survey, 1994). Perceptions about smoking differed between the smokers and nonsmokers (Brenda, 2008 ; Taylor, Ross, Goldsmith, Zanna &Lock, 1998; Shervington, 1994 ; Klesges,Somes,Pascale,Klesges,Murphy&Williams,1988). There were also different beliefs and amount of knowledge regarding smoking behavior between smokers (Hammond, 2008 ; Environics Research Group, 1999). Meanwhile attitude was associated with socio-demographics, educational level and ethinicity (Shankar, Gutierrez, Mohamed & Alberg, 2000;Ma, Fang, Tan & Feeley,2003 ; Moeschberger, Anderson, 27 Kuo, Chen, Wewers & Guthrie, 1997) suggested that smoking behavior was associated with it; older Southeast).28 CHAPTER III. STUDY FRAMEWORK In order to describe the extent of exposure and recall of the NCR male high school students to anti-smoking advertisements as well as to explain the effects of their exposure to these advertisements to their smoking behavior, the Health Belief Model (HBM), Mere Exposure Theory, Availability Heuristics Principle are used. A. Theoretical Framework

The HBM which is one of the most widely used model in health behavior has been said to be good predictors for smokers, ex-smokers, and nonsmokers smoking behavior (Li & Kay, 2009). While the Mere Exposure Theory states the effects of exposure to something on the peoples preferences, the Availability Heuristics probes on the relationship between recall and the judgment that people make. 1. Health Belief Model The Health Belief Model (HBM), developed by social psychologist Irwin M. Rosenstock, is a psychological model that focuses on the individuals beliefs and attitudes in order to explain and predict their health behaviors. It was because of a failed tuberculosis (TB) health screening program in the 1950s that HBM was developed. Since then, HBM has been widely used in health communication (Rosenstock, 1974). The HBM is defined through its four main constructs that serve as factors for behavior change. The first one is perceived susceptibility or the individuals opinion of chances that he/she might acquire a certain condition. The second one is perceived 29 severity; this is the individuals view of the extent of seriousness of a condition as well as

its consequences. The third construct is perceived benefits; this is the individuals' belief that the recommended health action can reduce the seriousness of the consequences of a condition. The fourth one is the Perceived Barriers or the individuals' belief of the costs of doing the recommended health action. The other constructs that are added are: the Cues to Action, these are the strategies to activate the individuals' readiness to do the recommended action and Self-Efficacy, or the confidence of the individual in his/her ability to do the recommended health action (Glanz et al, 2002). On the other hand Perceived Threat is said to be the combination of perceived susceptibility and perceived severity. If the perceived threat of the disease has serious risk to health, behavior change happens (Stretcher&Rosentock, 1997). HBM also states that the modifying factors such as demographic, socio-psychological and structural variables are important in order to change behavior (Corcoran, 2007). 2. Mere Exposure Theory The core assumptions of HBM are that an individual will take a healthrelated action if he/she expects that negative health conditions will be avoided by taking the

recommended health action; feels that a negative health condition can be avoided; believes that he/she can successfully take a health recommended action. (Rosenstock, 1974) The Mere Exposure Theory states that the more exposure we have to a certain stimulus, the more we will tend to like it. It asserts that people develop preference to the 30 things or persons that are familiar to them. Thus familiarity is increased by repeated exposure (Zajonc, 1968). Aside from this, the mere exposure theory also states that the more often people see a certain information, the better you can process it. Prior exposure also increases the fluency in processing judgment during a decision making. This supports that human beings prefer easy processing rather than difficult cognitive processing thats why they stick with familiar things. Hence this explains their positive feelings towards certain things or people like brand and advertisement (Izard, Kagan,&Zajonc,1984) . 3. Availability Heuristics Principle Availability Heuristic Principle is a phenomenon that refers to the tendency to

judge the frequency or likelihood of an event by the ease with which relevant instances come to mind (Baumeister& Bushman, 2008). Figure 1 shows the HBM theoretical model, for the individual perceptions the box of perceived susceptibility and seriousness of the disease is affected by the box of modifying factors like age, sex, ethnicity etc. These modifying factors also affect the perceived benefits and barriers in doing the recommended action. The perceived threat is affected by the cues to action, modifying factors, and perceived susceptibility and Tversky and Kahneman (1973) proposed that people use an availability heuristic to judge frequency and the probability of events. With the availability heuristic, people would judge the probability of events by the ease in which instances could be brought to mind. Using the availability heuristic, people would judge the likelihood of occurrence of an event if they could think of more examples of that event.31 seriousness of the disease. Finally, the perceived threat of the disease affects the likelihood of doing the recommended action.

Figure 1. Theoretical Model of The Health Belief Model Individual Perceptions Modifying Factors Likelihood Action Source: Stretcher,V.&Rosentockj, I.M.(1997).The Health Belief Model.InK.Glanz,F.M.Lewis,&B.KRimer (Eds).Health Behavior and Health Education:Theory,Research and Practice (2 nd ed).San Francisco:Jossey Bass. Figure 2 shows the integrated theoretical model of this study. The relationships between the boxes are similar to figure 1; its just that the availability heuristics and PERCEIVED BENEFITS MINUS PERCEIVED BARRIERS CUES TO ACTION PERCEIVED THREAT OF DISEASE PERCEIVED SUSCEPTIBILITY AND SEVERITY OF DISEASE AGE,SEX,ETHNICITY

PERSONALITY, SOCIO ECONOMICS KNOWLEDGE LIKELIHOOD OF BEHAVIOR32 exposure to the cues to actions are inserted between cues to action and perceived threat in order to magnify the effects of exposure and recall. Figure 2. Integrated Theoretical Model Individual Perceptions Modifying Factors Likelihood Action PERCEIVED SUSCEPTIBILITY/ PERCEIVED SEVERITY OF DISEASE LIKELIHOOD OF BEHAVIOR CUES TO ACTION PERCEIVED THREAT OF DISEASE AGE,SEX, PERSONALITY, SOCIO ECONOMICS, KNOWLEDGE

PERCEIVED BENEFITS MINUS PERCEIVED BARRIERS EXPOSURE AVAILABILITY HEURISTICS33 B. Conceptual Framework The study focuses on Anti-Smoking advertisements and how exposure and recall of these advertisements affect the NCR male high school students knowledge, perceptions, and attitudes toward smoking. Exposure and recall of antismoking advertisements are the main entities that this study will concentrate on. The availability heuristic principle focuses on the ease of recall of student to anti-smoking messages and their sources while the mere exposure theory in this study dwells into the students exposure to anti-smoking messages. Using the HBM Model, the cues to action are the male high school students sources of information about anti-smoking. Their exposure to anti-smoking messages will

affect their ability to recall what these messages are and where they come from. Their ability to recall is defined to be the availability heuristics or the information readily available in the mind. The study focuses on the top-of-the mind memory of the students or which information they can easily recall. Modifying factors such as age, sex, personality, socio-economic and knowledge affect the perception on susceptibility and severity of smoking-related diseases and the perception of benefits against the barriers .The perceived susceptibility and severity of having smoking-related diseases influence the perception on the threat of these smokingrelated diseases. It, therefore, affects the likelihood of action which is not smoking. Figure 3 shows the integrated conceptual model of this study which demonstrates the relationships discussed in this conceptual framework.34 Figure 3. Integrated Conceptual Model Individual Perceptions Modifying Factors Likelihood Action PERCEIVED SUSCEPTIBILITY/ PERCEIVED SEVERITY OF DISEASE

(Perceived susceptibility/severity of having smoking-related disease) LIKELIHOOD OF BEHAVIOR (Likelihood to not smoke) CUES TO ACTION (Sources of information about anti-smoking) PERCEIVED THREAT OF DISEASE (Perceived threat of smokingrelated disease) AGE,SEX, PERSONALITY, SOCIO ECONOMICS KNOWLEDGE PERCEIVED BENEFITS MINUS PERCEIVED BARRIERS

(Perceived benefits minus perceived barriers to not smoke) EXPOSURE (Exposure to Anti-smoking messages) AVAILABILITY HEURISTICS (Availability heuristics or the ease of the person in recalling anti-smoking advertisements and their messages)35 C. Operational Framework The study aims to determine the effects of the extent of exposure to antismoking advertisements and the recall of NCR male high school students to their perceptions of and attitudes toward smoking. The operational framework specifies how to measure the variables in the study. The first objective of the study is to determine the socio-demographic factors of NCR male high school students. In order to do this, the age, sex, city, school, year level, family income as well as the smoking history of the students were asked through a survey. The HBM model states these variables as the modifying factors in a persons

perceptions and attitudes. Other modifying factors that can influence the NCR male high school students perceptions of and attitudes toward smoking are their sources of information and cues to action about anti-smoking. Knowing these variables answers the second objective of the study. These may include the NCR male high school students school, family, peer, church etc. The anti-smoking advertisements which are the focus of this study are also part of the cues to action. Now since the study focuses on the anti-smoking advertisements, the antismoking advertisements which the students were exposed to were determined; this answers the third objective of the study. They were asked if they already saw, heard or read any anti-smoking advertisements in the radios, televisions, magazines/newspapers, internet and posters. In order to operationalize the students recall of antismoking advertisements, they were asked to tell and describe the messages they remembered from36 the anti-smoking advertisements that they saw, read or heard. The variable recall was measured by the quality and quantity of constructs that the students gave. The student has

a high level of recall if they have given many messages with quality, otherwise the recall is low. High recall constitutes to their ease of remembering the antismoking ads and their messages which can be more likely used by the students for developing their perceptions of and attitudes toward smoking as what stated in the Availability Heuristics (Baumeister& Bushman, 2008). On the other hand, the variable exposure was measured by the frequency and recency of their exposure to anti-smoking advertisements. Exposure is high if the frequency is high (ranging from daily exposure to weekly exposure) and the recency of exposure is within 30 days, otherwise the exposure is low. By Mere Exposure Theory, high level of exposure results to a persons likelihood of the thing that he/she is exposed to (Zajonc, 1968) The next variables to be operationalized are the NCR male high school students knowledge, perceptions, and attitudes towards smoking which address the fifth objective of the study. The knowledge is measured as high level or low level of knowledge. The knowledge level is high if the students know smoking laws, dangers, ads and promotions

and cessations; otherwise the knowledge is low. Perceptions are operationalized by the students view of the possibilities that are related to smoking that might happen to him like their perceived susceptibility /severity/ threats of having smokingrelated disease as well as perceived barriers and benefits of not smoking. Their perceptions of the .Hence we can hypothesize that the students high exposure to these anti-smoking ads will result to their likelihood of the ads messages. Determining the extent of exposure to anti-smoking advertisements and the recall of the NCR male high school students is the fourth objective of this study.37 possibilities can be high or low, high if they think it will most likely happen to them or low if it will most likely not happen to them. The attitude towards smoking was measured as positive, negative, or neutral. Positive means favoring smoking while negative is being against it. Lastly, the likelihood of not smoking is the perceptions/beliefs of the student in his ability to stop smoking. Figure 4 shows the integrated theoretical model for this study. The left most box is the NCR male high school students perceptions of how susceptible they are from

getting smoking-related diseases and they perceptions of how severe it will be for them if they will acquire such disease. The modifying factors (top-middle box) of NCR male high school students like age, sex, year etc affect their perceived susceptibility and severity of smoking-related diseases as well as the perceived benefits and barriers of not smoking(top-right most box). These perceptions of susceptibility and severity as well as the modifying factors affect their perceived threat of smoking-related disease (middle box) which is the dangers of first hand, second hand, and third hand smoking. The perceived threat of smoking-related diseases is also affected by antismoking advertisements which are the focus of this study as well as other cues to not smoking (bottom box) like school, family, peer, and church. The two oval shapes in the figure are the recall and exposure of the NCR male high school students to antismoking advertisements which affect their perceived threat of smoking-related diseases. This perceived threat then affects the likelihood (left-most box) of the NCR male high school students to not smoke.38

Figure 4. Integrated Operational Model Individual Perceptions Modifying Factors Likelihood Action

PERCEIVED SUSCEPTIBILITY/ PERCEIVED SEVERITY OF DISEASE (NCR male high school student perceptions/beliefs &attitudes that they can get diseases in smoking) (NCR male high school students perceptions/beliefs&attitudes to the seriousness ,difficulties ,or effects of having smoking related diseases) LIKELIHOOD OF BEHAVIOR NCR Male High School

students likelihood of to not smoke) Perceptions/beliefs in his ability to stop smoking Attitude towards not smoking CUE TO ACTION (ANTI-SMOKING ADVERTISEMENTS, school,family,peer,church etc..) PERCEIVED THREAT OF DISEASE (NCR male high school students perceptions and attitudes on the dangers of first hand, second hand and third hand smoke NCR Male High School students: Age, sex, city, school, year level, smoking history, family income Knowledge on smoking: (laws,dangers, and promotion

and ads) PERCEIVED BENEFITS MINUS PERCEIVED BARRIERS (NCR Male High School students perceptions/beliefs that not smoking results to healthy well being) Minus (NCR Male High School students perceptions/beliefs of the obstacles he will undergo if he stops smoking) EXPOSURE (Level of exposure to Anti-smoking Advertisements) RECALL (quality and quantity of information recalled

about anti-smoking advertisements and their messages)39 D. Operational Definition of Terms 1. Student-term to address the NCR male-high school students for the purpose of this study 2. Anti-smoking advertisements-these are advertisements that promote 'no-smoking' to people 3. Threats/Dangers of smoking-negative consequences of smoking to people 4. Perceived susceptibility of having smoking-related diseases-the belief of a person on the extent of chance that he will acquire smoking-related diseased 5. Smoking-related diseases-diseases caused by smoking such as cancers, heart attack etc 6. Exposure to anti-smoking advertisements-frequency and recency of time that the student is exposed to anti-smoking campaigns 7. Recall of anti-smoking advertisements-quality and quantity of information recalled about anti-smoking advertisements and their messages. 8. First-hand smoke-smoke inhaled by the smoker 9. Second-hand smoke-smoke inhaled by the person near a smoker

10. Third-hand smoke-smoke chemicals that remained after a cigarette/tobacco is extinguished 11. Perceived benefits of not smoking-knowledge on the benefits of not smoking40 12. Smoking ads and promotions-any strategies or activities made/sponsored by the tobacco companies in order to sell/promote smoking 13. Smoking history-a persons life that relates to smoking like age he started smoking or havent smoke at all, times he tries quitting,etc.. E. Hypothesis According to the Mere Exposure Theory (Zajonc, 1968), the more you are exposed to a particular thing, the more you become familiar with it and there will be a tendency that you will like it. The exposure to anti-smoking advertisements can develop familiarity and likelihood which can necessarily affect the perceptions and attitudes of its audience. Perceptions and attitudes are based on ones own experience. Smokers and nonsmokers have significant differences in their beliefs about smoking. The other sources of information consisting mainly of significant others can also influence a persons

perception and attitude. With this a hypothesis is proposed for the studys sixth objective which is determine if their perceptions and attitudes towards smoking vary according to their extent of exposure to anti-smoking advertisements and extent of exposure to other sources of information about smoking. Thus the proposed hypothesis for this objective is: H1: There is a significant relationship between the NCR male high school students perceptions and attitudes toward smoking and their extent of exposure to anti-smoking advertisements and to other sources of information about smoking.41 Advertisements are best recalled according to their characteristics and specific features. Advertisements can get more attention if they have attractive qualities. A person most likely remembers an ad based on the things associated with it. According to Availability Heuristics Principle (Baumeister& Bushman, 2008), people retrieve memories easily if they will choose those data which are readily available to them. The ability to recall an ad can be a basis for the effectiveness of that ad. Perceptions and attitudes are still influenced by the persons belief to a certain thing. It is less to be

influenced by other factors. Based on this assumption the second hypothesis is proposed for the seventh objective of this study which is to determine if there is a significant relationship between the messages they recall from anti-smoking advertisements and their perceptions and attitudes about smoking. Hence the proposed hypothesis is: H2: There is a association between the messages and strategies NCR male high school students recall from the anti-smoking advertisements and their perception and attitude towards smoking. Having laid all the necessary theories and hypotheses for the framework of this study, the next chapter which is the methodology part explains the data gathering and analysis processes that the researchers have done for the purpose of this study.42 CHAPTER IV. METHODOLOGY A. Research Design and Methods The study both employed quantitative and qualitative approaches in obtaining data from the effects of exposure to anti-smoking advertisements and recall of NCR male

high school students to their perception and attitude towards smoking. This was a crosssectional study of male high school students. The study made use of a 5 page survey questionnaire consisting of 55 items. This was done to attain data from students even they had classes during the data gathering period. For the qualitative part, the researchers conducted two focus group discussions divided to smokers and nonsmokers. The FGDs were done in two separate schools and the participants were chosen according to their willingness and availability to participate. FGDs were conducted to get first hand data from actual smokers and the nonsmokers. B. Variables and Measures/ Concepts and Indicators For the first objective of the study, the socio-demographic factors were determined by the variables: age, sex, city, school, year level, smoking history, and family income. The next variables which answered the second and third objectives were the sources of information/cues to actions of the NCR male high school students about smoking. These included the anti-smoking advertisements, school, family, peer, and church which the students were exposed to. Exposure and recall were the variables measured to address the fourth objective of

this study. The variable exposure was measured by means of the frequency and recency of anti-smoking advertisements the students saw and heard. The variable recall was43 measured through the quantity and quality of information the students recalled about the anti-smoking advertisements and their messages. Three variables were measured to answer the fifth objective. These were the knowledge, perceptions, and attitudes of NCR male high school students towards smoking. Knowledge was measured through the students awareness on smoking laws, dangers, ads and promotions, and cessation. Perception was measured by the view of the student on the possibilities of some situations that might happen to him because of smoking; these views of the possibilities could be high or low which in turn could reflect if they had positive, negative or neutral perceptions about smoking. Attitude was measured by the students position about smoking; positive, negative or neutral. Positive attitude implied that the student favored smoking while negative was being against it. The survey was employed to gather descriptive data on the students perception of

smoking. However in order to delve deeper on these gathered data, the FGD was conducted. The indicators for the perception were the students perceived susceptibility, severity, and threats of smoking related disease as well as the perceived benefits and barriers of not smoking. C. Research Instruments Two research instruments were used in this study; the survey instrument and the Focus Group Discussion (FGD) guide. Reinard (1994) defined survey as the process of looking at something in its entirety in quantitative research, a survey is an empirical study that uses questionnaires or interviews to discover descriptive characteristics of phenomena (p. 168). The survey instrument for this study has six parts. The first part 44 was the socio-demographic profile. The second part was about the smoking history of the NCR male high school students. The third part measured the students knowledge about the smoking ads and promotions, laws, and dangers. The fourth part of the survey instrument dealt with the students exposure and recall of anti-smoking advertisements.

The fifth part was about the other sources of information and cues to action about smoking of the NCR male high school students. Finally, the sixth part of the survey questionnaire measured the students perceptions of and attitudes towards smoking. The survey was adapted from the 2007 Philippine GYTS (Global Youth Tobacco Survey), 2007 Australian National Youth Tobacco Campaign Evaluation and WHO tobacco survey. The FGD guide included the students recall of anti-smoking advertisements, perceived susceptibility, severity, and threats of smoking related disease as well as the perceived benefits and barriers of not smoking. D. Units of Analysis and Sampling According to the 2007 Global Youth Tobacco survey, four million Filipino youths aged 13-15 are smoking in the Philippines. Among these youth smokers, 2.8 million are boys and 1.2 million are girls. Survey results showed that boys were the most likely to start smoking at the early age of 13-15 years old; this age range were mostly in the secondary schools. Hence, this study focused on the male high-school students. In order

to give contribution to the MMDAs vision of a smoke-free Manila, NCR male high school students were chosen.45 The researchers decided to acquire 400 respondents based on +/- 5% with 95 % confidence interval. The sample size for the study was statistically determined based on the population of the NCR male high school students. Statistically, the sample size needed is only 384, but in order to give reservations for possible spoiled instruments the researchers settled to have 400 respondents as sample size. In order to come out to this number of accomplished survey questionnaires, five probability sampling stages were employed. These were: Stage 1: Simple random sampling through fishbowl method in selecting five cities to limit sample size Mandaluyong, Manila, Malabon, Paranaque, and Pateros/Taguig Stage 2: Stratified random sampling in selecting one public and one private school per city NCR City Public School Private School Mandaluyong Bonifacio Javier National High School

Good Shepherd Christian School Manila Antonio Maceda Integrated School San Rafael Parochial School Malabon Malabon National High School St. Therese the Child Jesus Academy Paranaque Dr. Arcadio Santos National High School Arandia Academy Pateros/Taguig Ricardo G. Papa Sr. Memorial High School Colegio de Sta. Ana46 Stage 3: Stratified random sampling in terms of year level (40 respondents per school where 10 respondents per year level) Stage 4: Systematic random sampling in choosing the section per year level The first section/room per year level that the researcher passed by was chosen.

Stage 5: Systematic random sampling in choosing the student respondent Inside the room, the nth male student was chosen as the survey respondent where n was computed by dividing the required number of respondents per year level (which is 10) from the total number of male students per room. E. Data Gathering/Generation and Construction Before the actual data gathering, the researchers conducted two pretests in a school not selected for the study. This was for the finalization of the research instrument. The results of the first pre-test showed that the question numbers 46 and 47 which were about the perceived benefits and barriers of not smoking were somehow vague for the students. So the researchers edited those questions and made another set of pre-test to the same school. The second pre-test results showed the validity and reliability of the said questions. In order to have access to the chosen NCR secondary schools, the researchers secured a permit from the office of the Department of Education (DepEd) NCR Regional Director Rizalino Jose T. Rosales. The researchers decided to have division of labor

during the data gathering process in order to finish conducting survey for 400 47 respondents in a span of three weeks of (late February and early March 2012). The first researcher was assigned to the cities of Taguig/Pateros and Paranaque, while the other researcher went to Manila and Mandaluyong. Both researchers went to Malabon. There were schools like the schools in Taguig/Pateros and Paranaque who still asked for their city division permit aside from the regional permit that was issued to the researchers thus the researcher assigned to those cities still went to the divisions office of Taguig/Pateros and Paranaque. In schools, the researchers asked permission from the principals to conduct survey in their school then the principals would assign someone especially the guidance counselors in their schools to accompany the researchers in the whole duration of the survey. For the qualitative method, the researchers did two FGDs: one was the FGD for non-smoker students and the other was the FGD for the smoker students. The researchers chose 10 male high school students for each group who were available and willing to

participate. The FGD for non-smoker students was made in the library of Colegio De Sta. Ana in Taguig while the FGD for smoker student was made in the corridor of Malabon National High School. F. Data Analysis The data obtained from the survey were organized using SPSS program. The researchers used Pearson-r test to determine the correlation of extent of exposure to antismoking advertisement and other sources of information about smoking to the perception and attitude of NCR male high school students towards smoking. The Pearson-r test was used to find a significant relationship between recall and the perception and attitude 48 towards smoking. Because the study is descriptive in nature, the researchers made tables to show frequencies and relationship of variables for analysis and interpretation. The data generated from the FGD were organized through open coding. The codes and the indicators used were based on the framework of the study which resulted to typologies of perceptions of smoking. Similarities and differences between the answers of the smoker group and the non-smoker group were interpreted to obtain data

from their exposure and recall of anti-smoking advertisements and how these affected their perception and attitude toward smoking. G. Scope and Limitations As stated in the general objective, the study focused on the effects of exposure to anti-smoking advertisements and the recall of NCR male high school students perceptions of and attitudes towards smoking. The study only included male respondents as the majority of the smokers were males according to the 2007 Philippine GYTS. The schools were all in urban areas and were categorized as public and private. The study did not include students from rural areas. The survey was the main tool for gathering data. The structure of the questionnaire was designed to cover the variables within the objectives of the study. The focus group discussions included participants from the school where the survey was also conducted. This was for the comfort of finding readily available students. The researchers found it difficult to select rooms without the schools prerogative and the availability of the students. There were instances that the school head was 49

choosing the room where the survey would be conducted. Some schools selected students from each year level and assigned a room (mostly the library) where they could answer the survey. There were chances where the chosen room was not available because they had test, film showing and room activity. The originally planned systematic sampling was not always followed. The study is descriptive and correlational in nature so the researchers aimed to describe the extent of exposure and recall of NCR male high school students and their effects to the perception and attitude towards smoking and to find the relationships between each variable. The researchers only described the relationship of exposure and recall of anti-smoking advertisement to the perception and attitude towards smoking. The study did not focus on the possibility of behavior change of the respondents. Finally since this is a descriptive and correlational research, part of the limitation of this study is that correlation does not equal causation. Thus the results of this study only showed the observed correlation between the NCR male high school students

exposure to and recall of anti-smoking advertisements and their perceptions of and attitudes towards smoking.50 CHAPTER V. RESULTS AND DISCUSSIONS A. Results 1. Survey Results The study employed a self-administered questionnaire based on 2007 Philippine GYTS (Global Youth Tobacco Survey), 2007 Australian National Youth Tobacco Campaign Evaluation and WHO tobacco survey to determine the effects of exposure to antismoking advertisements of NCR male high school students and recall to their perceptions and attitudes toward smoking. This chapter presented tables of the sociodemographic factors, smoking prevalence, knowledge and Health Belief Model (HBM) constructs including perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, cues to action, and self-efficacy. In addition, the chapter also presented the results from statistical analyses and the focus group discussions. a. Socio-demographic Factors 400 respondents comprising of male high school students from National Capital

Region (NCR) completed the survey questionnaire. Table 1 shows the age of the respondents in the study.51 Table 1. Age (N=400) Frequency Valid Percent Valid 10 1 .2 12 15 3.8 13 84 21.0 14 103 25.8 15 95 23.8 16 74 18.5 17 18 4.5 18 6 1.5 19 1 .2 21 1 .2 23 2 .5 Total 400 100.0 As seen in the table above, there were 25.8% of the respondents were 14 year olds. Because they were high school students it was expected that the age range was 1316 years old. Surprisingly there was a 10 year old who answered the survey. There were

one 19 year old, one 20 year old and two 23 year olds. This seems confusing because they were in the age not suitable to the high school level. This implied that there were students who were old enough to be in high school or the students might not want to reveal their true age. In Table 2, the respondents family income was recorded. Of the 400 respondents, 52.5% were not sure how much their families monthly income. This might be of confidentiality or they simply did not know. Of those who answered, 24.4% of the respondents had a family income of 20000 and below. The rest of the respondents had a 52 family income of more than 20000 implying that they belong to middleupper class families. Table 2. Monthly Income of the Respondents Families (N=400) Frequency Valid Percent Valid 9,999 at pababa 45 11.2 10,000-19,999 53 13.2 20,000-29,999 31 7.8 30,000-39,999 13 3.2 40,000-49,999 11 2.8

50,000 at pataas 37 9.2 Hindi ko sigurado 210 52.5 Total 400 100.0 b. Smoking Prevalence To determine the smoking prevalence among these youth, the respondents were asked when they started to smoke. To avoid biases, the questionnaire provided choices which both smokers and nonsmokers could choose from. The result was there were 273 or 68.2% respondents who had not ever tried to smoke in their lives. This means majority of the respondents were nonsmokers. Table 3 shows the age of the respondents when they started to smoke and the number of nonsmokers.53 Table 3. Age They Started to Smoke (N=400) Frequency Valid Percent Valid Hindi pa ako nanigarilyo kailanman 273 68.2 7 taong gulang pababa 6 1.5 8 o 9 taong gulang 7 1.8 10 o 11 taong gulang 15 3.8 12 o 13 taong gulang 45 11.2 14 o 15 taong gulang 34 8.5

16 taong gulang pataas 19 4.8 999 1 .2 Total 400 100.0 The data presented in Table 3 showed that majority of students who admitted to be smokers had started to smoke when they were in late elementary to early high school (probably a freshman). 11.2% of the respondents started to smoke when they were 12-13 years old. 4.8%respondents started to smoke when they were 16 so probably during their junior to senior years in high school. The most striking result was 3.3% respondents who admitted to smoke below 10 years old. This might be a small value but it implied that a small child could learn how to smoke. To further verify this finding, the respondents knowledge of where to buy cigarettes was asked. Survey results revealed that the most cited way that the students got their cigarettes was through buying the cigarettes from stores, markets, groceries and street vendors. In fact 60.5% students said that they knew stores near their schools (within 100 meter- perimeter) who were selling cigarettes. Among the places where

students usually smoked, the public places (ex. Park, shopping center, mall, streets etc.) and their friends house were the top answers.54 As additional information, the respondents cited which cigarette brand they consumed for the last 30 days. The specific timeline decided in order to know if there were respondents who quitted smoking and continued to smoke. Table 4 shows the cigarette brand consumed during the last 30 days. Table 4.Cigarette brand consumed during the last 30 days (N=400) Frequency Valid Percent Valid Hindi ako naninigarilyo nitong nakaraang 30 araw(1 buwan) 337 84.2 Walang particular na pangalan o brand 2 .5 Marlboro 50 12.5 Philip Morris 2 .5 Winston 2 .5 Memphis 1 .2 iba pa 6 1.5

Total 400 100.0 It was apparent from this table that there was an increase in the number of nonsmokers. This implied that there were respondents who did not smoke for a month or probably quitted smoking. Of those who continue to smoke, they cited Marlboro as the top cigarette brand consumed. It was followed by Philip Morris, Winston and Memphis. There were 6 respondents who were not able to cite a specific brand. The researchers chose male high school students to participate in the survey. Majority of the respondents age range were 13-16 years old as expected to students in high school. Because half of them did not know their families monthly income, the 55 researchers assumed from those who answered that a number of them belong to middle to upper class families. On their smoking prevalence, the results showed that more than half of the respondents were nonsmokers. For those who admitted to be smokers, their age was recorded and implied that they had started to smoke upon reaching high school. Their knowledge of where to buy cigarettes were also asked as well as their most consume cigarette brand. The results showed that they could avail cigarettes easily as it

was being sold in the streets and stores and Marlboro was the most consumed cigarette brand by these smokers. c. Sources of Information and Cues to Action about Smoking The respondents answered what were their other sources of information and cues to action about smoking other than anti-smoking advertisements. They cited their schools (80%) as their primary source of information about smoking. It was followed by their families (77%) and their church (65.8%). Table 5 shows the respondents other sources of information and cues to action about smoking. Multiple responses to this question is allowed. Table 5. Other Sources of Information and Cues to Action about AntiSmoking (N=400) Sources of Information and Cues to Action About Smoking Percentage of Students Who Cited These Sources Family 77 Peer Group 49.2 School (teachers,classmates) 80

Church 65.8 Acquaintances 6456 The exposure to these other sources of information about smoking had a slight difference from the respondents answer which was their primary source of information. The table below shows the extent of exposure to these other sources of information. Multiple responses to this question are allowed. Table 6. Extent of Exposure to these Other Sources of Information (N=400) Frequencies Sources 1 Everyday (arawaraw) 2 Few times a Week (minsanisa ng lingo) 3 Few times a month

(minsanisa ngbuwan) 4 Seldom (bibihira) 5 Never (hindikailan man) Family 40% 19.5% 10.2% 19.2% 11% Peer Group 18.5% 16% 9.8% 35.5% 20.2% School 31.8% 22.2% 13% 21.5% 11.5% Church 24.5% 25.2% 10.8% 23% 16.5% Acquaintance 16.8% 16.5% 12.8% 35.8% 18.2% Smoking Program 31% 14.5% 15.8% 25.2% 13.5% Interestingly the respondents cited their families as the source they were most exposed to. 40% answered that they were exposed with their families every day. The school (31.8%) and church (24.5%) followed. But according to Table 5, the respondents

said that school was their primary source of information about smoking. This might be because they could be more exposed with their families but smoking was not always discussed. The school put the topics of smoking under the different academic subjects and the students learned from it.57 The respondents considered their significant others and their own groups to be the other sources of information about smoking and their cues to action. The school was the primary source of information as it was a place of learning. The family then was cited to be the source that students were more exposed to. In this finding, the home and school played a great part in influencing the respondents. d. Anti-smoking advertisements Anti-smoking advertisements were helpful tools for information dissemination about smoking. This might come with different types and forms. Antismoking advertisement could be found in places where smoking was strictly prohibited or by using a medium so that information could be distributed. The respondents identify health care facilities (79.5%) as the place where they

mostly saw anti-smoking advertisements. The TV was the first medium that respondents notice and had watched anti-smoking ads. It was then followed by the school smoking campaigns (72%).The radio was the least medium the respondents answered they had listened an anti-smoking advertisement. Table 7 shows the percentage of students who saw anti-smoking advertisements in the following places and media.58 Table 7. Anti-smoking Advertisements (N=400) Anti-smoking Advertisements Percentage of Students Who Saw Anti-smoking Advertisements in These Forms/Places Newspaper, magazines 56.2 TV 75.8 Radio 45.2 Billboards 46.2 Monorails (MRT/LRT) 55.5 Movie House 47 Health Care Facilities

(clinics, hospitals) 79.5 Malls 61.2 Schools Smoking Campaigns 72 Street sides 50.8 As Table 7 showed, the respondents were able to identify anti-smoking advertisements shown in different places and media. Health care facilities were cited as the place where one could see anti-smoking advertisements. This implied that hospitals and health clinics and centers should inform the people who went there about smoking. Health care facilities should be conducive enough for health and wellness. TV was still a helpful medium for information dissemination about smoking. The finding also implied that radio and billboards must further utilize for information dissemination about smoking. e. Exposure to Anti-Smoking Advertisements After determining what were the places or media that the respondents saw antismoking advertisements, the researchers asked the latter how exposed they were to these 59 places and media. The extent of exposure was determined according to the frequency of

their exposure. Table 8 shows the extent of exposure to anti-smoking advertisements. Table 8. Extent of Exposure to Anti-Smoking Advertisements (N=400) Frequencies Sources 1 Everyday (arawaraw) 2 Few times a Week (minsanisa ng lingo) 3 Few times a month (minsanisan gbuwan) 4 Seldom (bibihira) 5

Never (hindikailan man) Newspaper, magazines 11.2% 23.5% 10.2% 42% 13% TV 24.5% 28.2% 12.2% 28.5% 6.5% Radio 11.2% 20.2% 10.8% 37.2% 20.5% Billboards 9% 13.5% 14% 37.8% 25.8% Monorails (MRT/LRT) 17.2% 14.8% 14.0% 34.5% 19.5% Movie House 16.2% 15.8% 12.5% 30.8% 24.8% Health Care Facilities (clinics, hospitals) 47.5% 17.2% 10.2% 15.2% 9.8% Malls 26% 22.5% 11.8% 25.2% 14.5% Schools Smoking

Campaigns 37.8% 13.5% 10.5% 23.5% 14.8% Street sides 21.6% 14.8% 7.5% 31.6% 24.6% In Table 7, Health care facilities were cited as the top place where the respondents saw anti-smoking ads. The same was also true for their extent of exposure to these antismoking ads. The result seem to be confusing in a way that respondents answered health care facilities as the one they were exposed with anti-smoking advertisements every day. This might mean that they went to hospitals or clinics everyday or every time they went there they noticed anti-smoking advertisements. Schools smoking campaigns were cited 60 as second (37.8%) as it was told in Table 5 that schools were the top source of information about smoking other than anti-smoking advertisements. f. Extent of Recall of Anti-smoking Advertisements The quantity of recall was based on how many anti-smoking messages and descriptions of the anti-smoking advertisements were remembered by the respondents. This was to now if they could recall any characteristic of the advertisement. For the quantity of recall, the researchers counted the number of anti-smoking messages recalled

by the students. The number of the recalled anti-smoking advertisements characteristics or descriptions was also counted. The characteristics of the recalled antismoking advertisements somehow reflected the strategies of these ads. In order to get the quantity of recall, the researchers put five spaces each for the recalled antismoking advertisements messages and characteristics where the students filled up. The researchers just counted the number of recalled anti-smoking advertisements messages and characteristics of the students regardless of the quality of their recall. Almost half of the respondents were able to recall at least 3-5 anti-smoking messages, 75% recalled at least 2 messages, while around 90% recalled at least one anti-smoking message. Table 9 shows the quantity of recalled anti-smoking messages together with the percentage of students who recalled them.61 Table 9. Quantity of Recalled Anti-smoking Advertisements Messages (N=400) Number of Recalled Antismoking Advertisements

Messages At Least 5 messages At Least 4 messages At Least 3 messages At Least 2 messages At Least 1 message Number of Students who recalled the number of antismoking ads messages 205 215 247 309 361 Percentage of the number of students 51.25 53.75 61.75 77.25 90.25

However when it came to the number of characteristics/descriptions of antismoking ads recalled by the students, around 60% students recalled at least 2-5 characteristics/descriptions while 81.5% recalled at least one. Below was the table for the number of characteristics /descriptions of anti-smoking ads with the percentage of students who recalled them. Table 10. Quantity of Recalled Anti-smoking Advertisements Characteristics (N=400) Number of Recalled Antismoking Advertisements Characteristics At Least 5 messages At Least 4 messages At Least 3 messages At Least 2 messages At Least

1 message Number of Students who recalled the number of antismoking ads Characteristics 224 233 241 256 326 Percentage of the number of characteristics 56 58.25 60.25 64 81.562 The quality of recall was the degree of recall that was significant for the study. In order to find out the quality of recall of the students, their responses were categorized into major themes. Looking on these key themes reflected the quality of their recalled messages and characteristics of the anti-smoking ads. From this categorization, the researchers found out what messages and characteristics were most recalled by the students. The respondents most recalled message of anti-smoking advertisements was

Cigarette smoking was dangerous to your health. This was because this message was mostly seen in cigarette packs, TV and posters as a warning that cigarette smoking was hazardous to ones health. The other message recalled was no smoking, preferably the signs and posts that could be seen in places where smoking is strictly prohibited. The other messages recalled are those indicating the diseases caused by smoking, prohibition for adults to smoke, smoke is also harmful to the environment and the laws against smoking. There were also a number of respondents who do not answer at all because they cannot recall any anti-smoking advertisements. The pie chart provided the distribution of recalled messages of anti-smoking advertisements.63 Figure 5. Distribution of Recalled Anti-Smoking Messages As shown in Figure 5 majority of the respondents could only recall one antismoking advertisement (90%) and one message or characteristic of that ad . A small number of respondents could recall more than five messages were the answers were almost identical to each other. The most common warning was Cigarette smoking is dangerous to your health because it was seen in cigarette packs and the sign No

smoking in places where smoking was strictly prohibited. The results showed that the respondents were able to identify anti-smoking advertisements. They cited health care facilities and TV as the top place and medium where they noticed anti-smoking ads. Their extent of exposure was the same with the 64 addition of schools anti-smoking campaigns verifying their answer that schools were the top source of information about smoking. In the extent of recall, almost all of the respondents could recall a one anti-smoking ads characteristic. Their descriptions were synonymous to each other and the most common answer were Cigarette Smoking is dangerous to your health and No Smoking. g. Knowledge on Smoking RA 9211 or the Tobacco Regulation Act of 2003 was created as an answer to the increasing smoking problem in the country. It contained the different requisites and policies about smoking. Table 11 presents the percentage of students who know RA 9211. Table 11. Knowledge on RA 9211(N=400) Category of

Responses Percentage of Students who Have Correct Answer Percentage of Students who Have Wrong Answer Percentage of Students who Dont Know the Answer Other name for Tobacco Regulation Act of 2003 17.3 19.3 63.2 RA 9211s Smoking Prohibitions in Public Places 81 2 16.8 RA 9211s Prohibition of

Selling Cigarettes to minors 79.9 5 15 RA 9211s Prohibition of Selling Cigarettes within the 100meter perimeter of the school 35.8 27 3765 From the table we could see that majority of the respondents did not know RA 9211 (63.2%). But they had knowledge on what a smoking policy must consist. 81% answered that smoking was prohibited in public places, 79.9% answered the prohibition of selling cigarettes to minors and 37% answered that they did not know the exact measurement of the area of prohibition of selling cigarettes near schools. Knowledge on the severity and threats of first hand smoking or actual smoking, second hand smoking or passive smoking and third hand smoking or exposure with the

chemicals or cigarette residue were asked to the respondents. This was to determine their awareness to these types of smoking. Table 12 shows the percentage of respondents with knowledge on first hand, second hand and third hand smoke and their severity and threats. Table 12. Knowledge on the First Hand, Second Hand,& Third Hand Smokes; and their Severity &Threats(N=400) Category of Responses Percentage of Students who Have Correct Answer Percentage of Students who Have Wrong Answer Percentage of Students who Dont Know the Answer Definition of First Hand Smoke 46.5% 29.8% 23.5%

Definition of Second Hand Smoke 32% 43.2% 24.8% Definition of Third Hand Smoke 53.8% 5.8% 40.5% Smoking causes cancer,heartfailure,TB&emphysema 88.2% 2.2% 9.5% Threat that people exposed to Second-Hand Smoke are more susceptible to smoking-related diseases that those exposes to first hand smoke 76.8% 6.5% 16.8% Smoking causes impotence 63.8% 35.0% 1.2% Smoking is detrimental to the environment 87.8% 91% 99.8%66 Data obtained from the table showed that the respondents had a high knowledge on the definition of first hand smoke (46.5%) and third hand smoke (53.8%). Surprisingly only 32% knew second hand smoking but 76 8% answered that people who were exposed to second hand smoke is more susceptible to smoking diseases. This might be because

they were not sure of secondhand smoking but still knew that danger of smoking. h. Perceptions of Smoking Respondents were asked the degree of their vulnerability of having smokingrelated diseases. This was to know how they would rate themselves to be vulnerable with the certain diseases caused by smoking. The respondents have a high perceived susceptibility of having smoking-related diseases (47.5%). They cited lung cancer (59.2%) and halitosis (47%) as the disease that they were very vulnerable. Meanwhile cataracts (16%) and impotence (15.2%) were the diseases the respondents answered that they least likely to have. Table 13 shows the respondents perceived susceptibility of having smoking-related diseases. Table 13. Perceived Susceptibility of Having Smoking-related Diseases (N=400) SmokingRelated Disease 1 Very High 2

High 3 Moderate 4 Low 5 Very Low Mean Smokingrelated Diseases In General 47.5% 31.5% 10.2% 5.8% 4.8% 1.88 Lung Cancer 59.2% 22.8% 6.8% 4% 7.2% 1.7767 Tuberculosis 42% 32% 11.5% 7% 7.5% 2.06 Heart Attack 35.5% 30.5% 19% 7.8% 7.2% 2.21 Stroke 31.2% 29% 18.2% 11.2% 10.2% 2.4 Impotence 23% 21% 20.5% 20.2% 15.2% 2.84 Halitosis 47% 21.5% 12.2% 9.5% 9.8% 2.14 Cataracts 22.5% 19.2% 22.5% 19.8% 16% 2.88 Stomach

Cancer 29.8% 19.8% 22.5% 16.2% 11.8% 2.6 Leukaemia 31% 24.8% 16.5% 14.2% 13.5% 2.54 Emphysema 35.8% 22% 16.5% 12.8% 13% 2.45 As a supporting information, respondents were asked to indicate the degree of severity of smoking related diseases. The findings showed that respondents had a high perceived severity in smoking-related diseases (46.8%). 63% answered lung cancer to be the most extremely severe smoking related disease followed by tuberculosis 46.8%. Similar to their perceived susceptibility, the respondents answered impotence and cataracts to be the not severe smoking-related diseases. Table 14 shows the perceived severity of the respondents of smoking-related diseases. Table 14. Perceived Severity of the Smoking-related Diseases (N=400) SmokingRelated Disease 1 Extremely Severe 2 Very

Severe 3 Severe 4 Less Severe 5 Not Severe Mean Smokingrelated Diseases In General 46.8% 18.5% 20% 4.5% 10.2% 2.13 Lung Cancer 63% 17.2% 9.5% 3.5% 6.8% 1.74 Tuberculosis 46.8% 27% 14.5% 4% 7.8% 1.99 Heart Attack 45.2% 21% 18.2% 7.5% 8% 2.12 Stroke 37.3% 26.1% 18.8% 8.3% 9.5% 2.27 Impotence 32.2% 17% 20.2% 14.8% 15.8% 2.6568 Halitosis 41.8% 18.5% 17.2% 12% 10.5% 2.31

Cataracts 29% 20.5% 21.5% 14.8% 14.2% 2.65 Stomach Cancer 36% 22.2% 19% 12.5% 10.2% 2.39 Leukemia 37.2% 21.2% 17.2% 11.5% 12.8% 2.41 Emphysema 40.2% 20% 17% 10.2% 12.5% 2.35 Smoking advertisements were the counterpart of anti-smoking ads. These had the goal of selling tobacco products to the public. As a form of marketing strategy, smoking ads had promotions to introduce their product. Respondents were asked about their knowledge regarding smoking ads and promotions. Table 15 shows the extent of exposure to anti-smoking advertisements and promotions. Table 15. Extent of Exposure to Smoking Advertisements and Promotions (N=400) Frequencies Smoking Ads& Promotions Not applicable (Dont have posters,newspape

rs,radioetc..or dont attend any events) Often Sometimes Never Posters 14.2% 13.8% 30.2% 41.8% Newspapers,mag azines 14.2% 13.8% 30.2% 41.8% Radio 29.2% 8.2% 24.2% 38.2% Events(Sports, fair,concerts, community affairs) 27.5% 10.5% 23.5% 38.5% When it comes to seeing actors or actresses smoking in movies or TV programs, about 54% of the students said that they saw those sometimes and 38.8% answered that 69 they saw smoking scenes many times. About 8.5% of the students said that they owned T-shirts, pens, bags or anything that had the logo or name of a cigarette brand on them.

The brands mentioned were Marlboro, Philip, Winston, Hope and Fortune. When asked about the frequency in which they saw cigarette brands on TV for the last 30 days, 46% of the students said that they saw cigarette brand sometimes, 30.5% said they didnt see any while 18.8% answered that they often saw cigarette brands on TV. About 30%of the students said they saw many smoking ads on posters while 37.8% saw only few and 20.5% of the students didnt see any. The most frequent cigarette brand that the students saw on posters and TV was Marlboro followed by Philip Morris then Hope. In case of the knowledge, majority of the respondents do not know RA 9211 or the legal name of the 2003Tobacco Regulation Act of The Philippines. Those who were able to get the right answer might be caused by their intelligent guess to the question. In other way, the respondents had a high knowledge on the types of smoking and their dangers. They knew that they were susceptible to have smoking related diseases once they smoked and perceived high severity of these diseases. Of the smoking ads and promotions, the respondents notice more ads that promote smoking. Just like in antismoking advertisements, TV was also a medium where they saw smoking ads. Only few

of them knew any activities sponsored by tobacco companies as well owning materials with cigarette brand logos. i. Attitudes toward Smoking The respondents were asked about the likelihood or the chances that they would not smoke to determine their self-efficacy or their ability to do the recommended action which was not to smoke. For those who desire not to smoke 71% of respondents 70 answered that they never tried smoking while 14.2% had quitted smoking already. 12.5% answered yes they desired not to smoke. Self-efficacy of students who hadnt tried to smoke was high 70.5% and only 10.2 % to those who had tried smoking could stop the habit. 17.8 % of respondents answered that they could stop smoking if they chose to. Table 16 shows the percentage of respondents regarding their likelihood of not smoking. Table 16. Likelihood of Not Smoking (N=400) Category of Responses Never Tried Smoking

Before Quitted Smoking Already Yes No Desire not to smoke (Do you want to stop smoking?) 71% 14.2% 12.5% 2.2% Self-Efficacy of Not Smoking (Can you stop smoking if you choose to? 70.5% 10.2% 17.8% 1.5% As a contrast to their likelihood not to smoke, respondents were also asked if there were chances that they would smoke in the near future. In terms of the respondents likelihood to smoke, majority of them answered that they would not smoke or continue to

smoke for a year (50.8%). It was the same with their likelihood to smoke 5 years from now (49.5%). This results showed that majority of the respondents would not sought to smoking. Table 17 shows the respondents likelihood of smoking.71 Table 17. Likelihood of Smoking (N=400) Category of Responses Strongly Agree Agree No Opinion Disagree Strongly Disagree Likelihood to smoke 12 months from now (You will smoke 12 months from now) 4% 3% 19% 23.2% 50.8% Likelihood to smoke 5 years from now (You will smoke 5

years from now) 2.8% 3.5% 21% 23.2% 49.5% Respondents attitude toward smoking was associated with how they would accept or the likelihood that they would agree to the different instances where smoking would affect their lives one way or the other. Table 18 shows the attitude of the respondents regarding the different situations and instances that smoking affected their lives. Table 18. Attitudes toward Smoking (N=400) Category of Responses Strongly Agree Agree No Opinion Disagree Strongly Disagree Mean Smoking makes people cool& fit in 8.5% 9% 15.8% 25.8% 41% 3.82

Smoking bans should be implemented in restaurants,pubs,bars, and clubs 48.8% 23% 13.5% 7.8% 7% 2.01 Youths should not smoke 66% 19% 7.8% 2.8% 4.5% 1.61 People who started smoking will have hard time quitting it 17.2% 39.2% 25.5% 10.8% 7.2% 2.52 Guys who smoke have more friends 5.8% 10.2% 30% 28.5% 25.5% 3.58 Smoking adds personality to a guy 4.8% 10.5% 30.2% 24.8% 29.8% 3.6472 The table revealed that41% were strongly disagree that smoking made people cool and fit in. 48.8% of the respondents strongly agreed that smoking bans should be implemented in restaurants, pubs, bars and clubs. 85% had answered that youth should not smoke because according to 56.4% of the respondents, people who started to smoke

would have a hard time quitting it. As males, about 30% did not give their opinion if guys who smoke had more friends and smoking would add personality to a guy Respondents were asked what benefits they could gain if they did not smoke. Majority of the respondents answered that having a cleaner environment (91%) was their perceived benefit of not smoking. It was followed by having a healthy body (90.2%), favor from the family (84%) and friends (70.5%). We could see that the environment and the significant others were the major hindrances for the youth not to try smoking. Table 19 shows the perceived benefits of not smoking. Table 19. Perceived Benefits of Not Smoking (N=400) Benefits of Not Smoking Percentage of Students who Perceived the Following as Benefits of Not Smoking Healthy Body 90.2 Saved More Money 63.2 Favor from Family(because the family doesnt like smoking) 84 Favor from Friends (because the friends dont like smoking)

70.5 Cleaner Environment 91 The barriers of not smoking were the possible reasons that the respondents would smoke or not. The respondents answers regarding the barriers to not smoke vary whether 73 they are smokers and non-smokers. 45.5 % answered that peer pressure is the perceived barrier of not smoking. Smokers answered vary cheap cigarette prices is also a barrier of not smoking. Because of the cigarettes availability and affordability, smokers could continue to smoke. Smoking could be a good past time (27.8%) and once you were addicted to it (25%) it would be a barrier not to smoke. Table 20 shows the perceived barriers to not smoking. Table 20. Perceived Barriers to Not Smoking (N=400) Barriers to Not Smoking Percentage of Students who Perceived the Following as Barriers to Not Smoking Peer Pressure 45.5 Very Cheap Cigarette Prices 28.8 Addiction 25 Smoking is a good past time 27

The respondents had a high self-efficacy in terms of their perception and attitude toward smoking. Majority of the respondents were nonsmokers as shown in Table 3 and it was significant to know that they wanted to stay that way. Their likelihood to smoke is low while the likelihood not to smoke is high. They also had a positive attitude toward smoking and how it affected their everyday lives. They also knew the benefits of smoking and cited to have a clean environment as the top benefit of not smoking. In case of barriers, they perceived peers to be a barrier of not smoking and the availability and affordability of cigarettes. This might be because friends and peers could influence them to smoke and cigarettes seen around them could attract them to purchase it.74 j. Correlation Between Exposure and Perception of and Attitude toward Smoking Perceptions and attitudes about smoking would be compared with the extent of exposure to anti-smoking advertisements and to other sources of information about smoking. This was to determine if perception and attitude were influenced or affected by anti-smoking ads and the other sources of information about smoking. In order to answer

this, the bivariate correlation analysis was used. The bivariate correlation described the degree of relationships between two variables. Specifically, the Pearsons-r statistical test was used. In addition, the researchers conducted also a two-tailed significance test with significance level of .05 and .01 in order to be determined that the observed correlation did not occur only by chance. Pearsons correlation figures vary from -1 to +1, the larger the value, the stronger the correlation (Griffith, 2007). j.1. Extent of exposure to anti-smoking advertisements Using the bivariate correlation analysis, the researchers found out that there was a very weak correlation between the students' smoking perceptions (perceived susceptibility, perceived severity, likelihood to smoke in 12months&likelihood to smoke in 5 years) and their extent of exposure to anti-smoking ads. The same weak correlation was observed between the students' smoking attitudes and their extent of exposure to anti-smoking ads. Using the Pearson's R correlation test which states that R varies from -1 to +1,the larger the value the stronger the correlation, results showed that almost all the

correlations have value around .01 to .1, this showed a very weak correlation between the exposures to anti-smoking ads and the students smoking perceptions and attitudes. However there is a significant correlation between the general perceived susceptibility 75 and exposure to TV and movie house at .05 significant levels determined via two-tailed significant test, and monorails and health care facilities at .01 significant levels. The highest correlation value is the correlation between the likelihood of smoking 12 months from now and the exposure to anti-smoking ads in monorails (MRT, LRT) which is r=.623. Table 21 shows the correlation of the respondents extent of exposure to antismoking advertisements and their perception of and attitude towards smoking. Table 21. Correlation of the students' extent of exposure to anti-smoking advertisements and their perception of and attitudes towards smoking(r=correlation) (N=400) Smoking perceptions&Attitudes Exposure to: General Perceived

Susceptibility General Perceived Severity Likelihood of Smoking 12 months from now Likelihood of smoking 5 years from now Smoking Attitude Newspaper, magazines r=.046 r=.002 r=.087 r=.066 r= -.015 TV r=.122* r=.029 r=.021 r=.052 r=.029 Radio r=.093 r= -.006 r=-.015 r= -.009 r=.038

Billboards r=.083 r=.024 r=.058 r=.076 r= .021 Monorails (MRT/LRT) r=.132** r=.081 r=.623 r=.042 r=.018 Movie House r=.121* r=.071 r=-.091 r= -.061 r=.068 Health Care Facilities (clinics, hospitals) r=.136** r=.035 r= -.068 r= -.064 r=.072 Malls r=.043 r=.023 r=-.022 r= -.005 r=.024 Schools Smoking Campaigns r=.037 r= -.032 r=.048 r=.005 r=.076 Streetsides r=.016 r=.016 r=.046 r= .034 r=.056 NOTE: *Correlation is significant at .05 level(2-tailed) **Correlation is significant at .01 level(2-tailed)76 j.2. Extent of exposure to other sources of information about smoking There is a very weak correlation also between the extent of exposure to other sources of information about anti- smoking and their perception of and attitudes towards

smoking. Results showed a significant correlation between the general perceived susceptibility and the family (r=.160), school(r=.166), church (r=.218), and smoking program(r=.156). A significant correlation was also found between general perceived severity and family(r=.108), peer group(r=.132), church(r=.142), school (r=.098) and smoking program(r=.134). However these significant correlations are very weak. Table 22 presented the correlation of the respondents extent of exposure to other sources of information about anti-smoking and their perception of and attitude toward smoking. Table 22. Correlation of the students extent of exposure to other sources of information about anti- smoking and their perception of and attitudes towards smoking(r=correlation) (N=400) Smoking perceptions&Attitudes Exposure to: General Perceived Susceptibility General

Perceived Severity Likelihood of Smoking 12 months from now Likelihood of smoking 5 years from now Smoking Attitude Family r=.160** r=.108* r=-.08 r= -.059 r=.073 Peer Group r=.092 r=.132** r=.019 r= -.004 r= -.013 School r=.166** r=.098* r=.039 r=.015 r=.088 Church r=.218** r=.142** r=-.056 r= -.089 r=.087 Acquaintance r=.087 r=.063 r=-.011 r= -.047 r= .028 Smoking Program r=.156** r=.134** r=.007 r= -.018 r=.096 NOTE: *Correlation is significant at .05 level(2-tailed)

**Correlation is significant at .01 level(2-tailed)77 k. Correlation between Recall and Perception of and Attitude toward Smoking There is a weak correlation between the students quantity of recall of antismoking ads messages to anti-smoking advertisements and their perception of and attitudes towards smoking. A significant weak negative correlation was found out between the quantities of recall of anti-smoking ads messages and general perceived susceptibility (r=-.127) and general perceived severity (r=-.153). However a weak positive correlation was found between the quantity of recall of antismoking ads characteristics/definitions and general perceived susceptibility (r=.138) and general perceived severity (r=.147). Table 23 shows the correlation of the respondents quantity of recall of anti-smoking ads messages and their perception of and attitude toward smoking. Table 23. Correlation of the students quantity of recall of anti-smoking ads messages to anti-smoking advertisements and their perception of and attitudes towards smoking(r=correlation) (N=400) General

Perceived Susceptibilit y General Perceive d Severity Likelihoo d of Smoking 12 months from now Likelihoo d of smoking 5 years from now Smokin g Attitude Quantity of Recall of

Anti-smoking ads Messages r= -127* r=.153** r= .109 r=.072 r= -.061 Quantity of Recall of Anti-smoking ads descriptions/characteristic s r=.138* r=.147* r=.049 r= .053 r= .062 NOTE: *Correlation is significant at .05 level(2-tailed) **Correlation is significant at .01 level(2-tailed)78 The results in Tables 21-23 proved that there was a weak correlation between exposure (both to anti-smoking advertisements and other sources of information about smoking) and recall of anti-smoking ads to the perception and attitude of the respondents toward smoking. This implied that anti-smoking advertisements might have a low influence with the perception and attitude of the respondents toward smoking. It was the same with the other sources of information about smoking which includes the school and

family. The perceived barrier of not smoking which was the availability and affordability of cigarettes could be a hindrance for anti-smoking ads to achieve its goal. 2. Focus Group Discussion Results In March 2012, two separated Focus Group Discussions (FGD) were conducted with 20 NCR male high school students (10 smokers and 10 non-smokers) who were chosen from the schools who participated in the survey. The first FGD was done with 10 male non-smoker high school students from Colegio De Sta. Ana (CDSA), Taguig while the second FGD was conducted with 10 male smoker students from Malabon National High School (MNHS). In order to analyze the FGDs, Debus (1988) suggested some useful parameters in analyzing data which the researchers used in the studys FGD analysis. The researchers categorized the research finding according to key themes. The researchers also identified the different positions that occurred under each theme. Upon identifying the different positions, a summary of these positions as well as an assessment of the extent on which the students held their positions were made. Some verbatim phrases from the students

were also pulled out to represent their positions.79 a. Perception and Attitude toward Smoking a.1 Smokers The respondents were asked about their perception when they hear about smoking. This was to determine what came first in their mind that was related to cigarettes and tobacco. The prevailing answers were; it was a vice, dangerous to ones health and addict. Bisyo (vice)- Student 1 Masama sa kalusugan (dangerous to ones health)- Student 2 Adik (Addict) Students 3 and 4 The other responses pertained to ones outer appearance. The respondents relate smoking to the possible faade of a smoker. The responses were: bad smell (mabaho) did not take a bath (di naliligo). One of the respondents even mocked his fellow classmates by telling the facilitator to smell their mouth which still smelled cigarettes. The next question was about the students' perception on what were the benefits of smoking. Two students answered it by saying that smoking made them braver and gave them self-confidence

Nakakatapang maam (could make us brave)-Student 6 Nakakalakas ng loob (could gave self-confidence)-Student 7 Student 4 also said that one could have a face like student 6 and everyone laughed.80 The facilitator asked them what were their perceived danger or threat of smoking the respondents replied that smoking could cause many diseases and even death. Nakamamatay (deadly)- Student 4 Nagkakaroon ng sakit (one would acquire disease)- Student 9 TB-Student 10 When asked about their vulnerability to acquire those diseases or threat all of them answered yes because they smoked. The students were joking until Student 5 answered that it would depend if one smoked heavily Kapag sumobra pwedeng magkasakit (if you exceed you might got sick) Student 5 After asking their vulnerability the facilitator asked them what would be the rate of severity of the disease. Some answered to be mild while others answered it would be level 10 or extremely severe. Mild lang (Mild only)- Student 5

Level 10 Student 7 The facilitator then asked the students what were their perceived benefits of not smoking. The students were joking and were not orderly. Student 7 had to shout at his classmates to keep in order because they were being recorded. The facilitator then asked the students again and among their responses were no illness, cool and not bad breath. Walang sakit (no illness)- Student 981 Presko (cool) Student 8 Hindi bad breath (not bad breath) Student 5 They were always joking Student 6 especially when Student 4 pointed a handsome guy and compare it with the face of student 6. When asked if they had experienced smoking, they jokingly answered they hadnt tried it. The facilitator then asked the students what the possible reasons why people find it hard to quit smoking. They answered that cigarette was addictive, they got sick when they did not smoke, they liked the taste, salivating which for one of them was severe, and their day was not complete without cigarette and they feel restless. Kasi meron anu..nakakaadik (because it had something addictive) Student 9

Nagkakasakit nagkakaroon ng sakit (they got sick.. they acquire illness)- Student 8 Di nabubuo ang araw kapag hindi nakakapagyosi (the day was not complete without cigarette) Student 7 When asked about the possibility if they would stop smoking, Student 4 kept on insisting Student 6 could answer that. Student 6 shyly answered that if one liked someone. Student 4 reveal it as Agang(the name of the girl Student 6 liked). Student 10 answered that if one would court someone and Student 8 one could stop if they had found leisure. Kapag manliligaw (if courting someone)- Student 10 Kapag may napaglilibangan na (if one could find another leisure) Student 882 The other respondents spoke at the same time. Student 5 replied if they would be disciplined while Student 6s other answer was if there was no filter. The facilitator asked them when they started smoking. The respondents were joking and laughing about the question. Some answer when they were in kinder while some even before their father but among these the other respondents answer just recently

or at the age of 11 to 13. When asked who influenced them to smoke they were jokingly pointing to Student 6 who was wondering why they were pointing him. The facilitator interpreted it as a peer influence that everybody agreed. Aside from their peers, they were also influenced by their teacher and father. The respondents were asked how they perceived these people, their answers reflected to adulthood or maturity. Feeling nila malaki na sila (they feel they were grown up)- Student 1 Feeling nila manong na sila (they feel they were adult men) Student 2 The facilitator asked the student what they could say to those youth who smoke. The respondents were not able to give a concrete answer. They asked the facilitator to ask other third year student to answer the question. a.2 Non-smokers The facilitator asked the respondents what would be the first thing that came up when they hear smoking, the students associated it with cigarette smoking, some of them answered tobacco, burning of lungs, deadly, addictive ,darkening of lips, toxic, could pollute the air and environment and can cause halitosis. They even joked for immunity. Sunog baga (lungs were burned) Student 483

Nakakamatay (deadly) Student 5 Addictive Student 6 Nakakasira ng hangin sa kalikasan (could pollute the air in the environment) Student 9 When asked about their perceived benefits of smoking, most of them answered none. They insisted that there was no benefit of smoking until Student 9 answered smoking was relaxing that surprised the others. Student 8 replied smoking could cast away problems and Student 5 answered smoking gave comfort to the feeling. Student 6 jokingly answered smoking was a cure for asthma and when the facilitator asked to verify it he just laughed. When asked about the dangers of smoking, everybody was able to give answers. They cited diseases of the lungs as the most commonly known danger associated with smoking. Nakakamatay (deadly) Student 1 Lung cancer Student 2 Magkakaroon ng TB (could acquire TB) Student 4 The respondents were asked what would be the probability that they would

acquire those diseases. They answered that it would be because of second hand smoke. They were not sure if there was third hand smoke. The facilitator then asked them how severe it would be if they acquired those diseases. All of them answered it would be 84 severe and difficult. They would have a hard time to work and it was a burden for their pockets. Malala (severe) Student 9 Mahirap magtrabaho (difficult to work) and mahirap tigilan (difficult to stop) Student 3 Masakit sa bulsa (difficult to the pocket) Student 8 everyone was laughing The facilitator then asked what the benefits of not smoking were. The respondents answered that one would acquire healthy body, less fatigue, breathe easily and good breath. Mabuting kalusugan (good health) Student 2 Hindi madaling mapagod (less fatigue) Student 10 Nakakahinga nang maayos (could breathe easily) Student 9 The respondents were asked what would prevent them not to smoke. The answers

were mostly the people they interacted daily and those around them Kaklase (classmate) Student 6 Barkada (peers) Student 4 Tao sa tabi-tabi (people in every corner) Student 7 Pwede parents (could be parents) Student 285 The respondents affirmed that peers could influence them but not always. Aside from the persons they interacted mostly every day, TV could also influence them because of their curiosity. The facilitator asked the students if they could smoke in the near future, the students reply that they would not some or 0 percent. One student answered that he might smoke when he got older. When asked how they perceived the youth who smoke, they answered that they might had a problem in the family or broken family and in the heart or broken hearted. b. Exposure and Recall of Anti-smoking Advertisements b.1 Smokers The facilitator asked the respondents about their exposure and recall of antismoking advertisements. The students answer that they had not seen any anti-smoking

advertisements. When the facilitator clarified what kind of advertisements were these, the students replied that they had seen advertisements inside jeepneys. They remembered the No smoking signs that could be found in jeepneys. The students affirmed that there were no anti-smoking advertisements in their school. The other answers were: in public areas, inside the comfort room, in tricycle, in the market in hospitals, in malls and at home. The students were asked to described each anti-smoking advertisements that they commonly seen that made them remember it. The students answered the picture of a cigarette with an X (hand gesture of X) the message Cigarette Smoking is dangerous to your health that they saw in cigarette packs and to the traffic enforcers.86 Sigarilyo na nakaganoon (cigarette like that) Student 2 with a hand gesture of X Government Smoking is dangerous to your health Student 6 Sa may ano sa may traffic enforceryun may bilog bilog na bawal manigarilyo (in the traffic enforcer with circles indicating no smoking) Student 9 The students were then asked if these anti-smoking advertisements affected them

one way or the other. Sadly they answered No. For them it was nonsense and it had no effect because cigarettes were still being sold. They replied that antismoking advertisements were few and all of them agreed. About the smoking ads and promotions the respondents were able to answer more. They cited Marlboro, Fortune and Philip to be the most common brands. They noticed a message Yosi Astig (Cigarette is great) to some of those smoking ads. They were laughing because they notice that their classmates were really addicted to smoking for knowing those advertisements. They also answered that they noticed smoking ads in TV especially TV programs. Some of these also contain the message Cigarette smoking is dangerous to your health. When asked about their knowledge on activities sponsored by cigarette companies, they answered none. The facilitator asked the students if the smoking ads had any effect on them. Just like the anti-smoking ads, they had no effect on them. To compare the two ads the facilitator asked them who among the ads they were most exposed to the students answer it would be the smoking advertisements.87

As an ending question, the respondents were asked what they would suggest so they could be affected by those anti-smoking ads. The respondents answered it would be better not to sell cigarettes anymore in order not to attract the public. Wag na magbenta maam (do not sell maam) Student 4 b.2 Non-Smokers The facilitator asked the respondents to raise their hands if they would answer to avoid noise. They were asked what the anti-smoking advertisements they were familiar with. They answered the message Cigarette Smoking is dangerous to your health, smoking ban and the No smoking sign. Government warning smoking is dangerous to your health Student 3 Smoking Ban Student 7 No Smoking sign Student 5 One respondent answered that he had seen an advertisement in TV that showed an image of a face that almost exploded it looked that a piccolo exploded to the face of a man Meron po yun may ma nakakatakot na mukha dun sa ano.yun parang sumabog yung mukha (there was a scary face as if the face had exploded)- Student 10

The respondents answered that they had seen posters that display pictures of smoking victims and different kinds of cancer caused by smoking. The students saw these posters in Barangay hall, gym and hospital. Student 10 answered that antismoking 88 advertisements are aired in TV specifically in Channel 13. Although it was not an antismoking channel, there were advertisements about quitting tosmoke or preventing to smoke. The respondents were asked if they were affected by these advertisements and they answered YES. They admitted that the anti-smoking ads were insufficient and they could only be found in selected areas. When asked what they could suggest to improve the anti-smoking advertisements, they answered there should be pictures of smokers to vote for Frankie for president (while laughing), unity and cooperation. Lagyan ng picture ng mga naninigarilyo (put pictures of smokers) Student 10 Dapat ikalat sa buong parte ng Pilipinasmerong batas na isinisulong (to be distributed in different parts of the Philippines.. to have laws that push it) Student 2 Dapat magkaisa.. unity lang (should unite..unity only) Student 1

Cooperation Student 8 When asked what should be the design of the anti-smoking advertisements, two students jokingly pointed one student in the group while laughing; a student answer there should be a warning message not to be like a smoking victim. Yun naninigarilyo kung ayaw mong matulad sa akin may picture ng sakit (the one who smoke if you did not want to be like me with picture of disease) Student 589 The respondents admitted that they know more smoking advertisements. They were able to describe them too. They were familiar with Marlboro and Winston; they saw these ads in the form of calendars, notebook and in some TV programs. The respondents were also asked to describe the smoking ads. They answered it was colorful with promotions, horses and women. They usually saw these in posters. They admitted that they saw more smoking ads than anti-smoking advertisements. They had not participated any event or activity sponsored by cigarette companies. As the last question the facilitator asked the students if they were influenced or if

the smoking ads had any effect on them. They answered that there was still no effect they would still not some because they did not want to get hurt. Hindihindi pa rin (nonot at all) all Ayokong mapaso ako (I did not want to get hurt) Student 9 c. Synthesis The two groups were able to give significant information about the smokers and nonsmokers perception, knowledge and attitude about smoking as well as their exposure and recall to anti-smoking ads and smoking ads. Because the two groups were different in characteristics they had different belief and perception especially about smoking prevalence. In some points they had similarities especially regarding their knowledge in 90 smoking. The two groups were able to give different suggestions about youth smoking regulation or smoking regulation as a whole in the country. Their answers were based on their own experiences and their conviction as the better good for all. In terms of their perception about smoking, both groups were able to associate smoking as negative. They describe the smokers as someone with an awful appearance

and smoking was addictive and dangerous to ones health. In case of their vulnerability smokers and nonsmokers believed that they were vulnerable to the dangers and threats of smoking The smokers believed that if they smoked heavily they would be seriously sick while nonsmokers believed that they could get sick due to secondhand smoke The same was true for the rate of severity. Both groups answered that the dangers and threats of smoking was severe. A striking result of this discussion was their perceived benefit of smoking. Smokers cited easily what were the benefits of smoking that they gained. They associated it with adulthood and maturity For the nonsmokers they insisted that there were no benefits of smoking The answers they gave were from their observation of smokers or what they thought to be the possible reason why smokers smoke. For the benefits of not smoking the two groups were able to similar answers which were good health, clean environment and avoidance of diseases. The smoker group was not able to give their perception to other youth who smoke but the nonsmoker associated it with rebelliousness or these youth might have problems

at home or in heart. It was probable that smokers did not want to justify their fellow 91 smokers and the nonsmokers perceived smoking was a comfort zone. Cigarette smoking was viewed by some adolescents as an arousal a (Eysenck and Eysenck, 1975). In their exposure and recall both groups admit that anti-smoking ads were insufficient and few The smoker group admitted that anti-smoking ads were seen in selected areas In their recall of anti-smoking ads the nonsmokers were able to give more detailed description of anti-smoking advertisements Both groups were familiar wit the warning Cigarette Smoking is dangerous to your health and No Smoking sign. Both groups were also familiar with smoking ads and promotions. Compared to anti-smoking ads, smoker and nonsmoker group admitted that they were more familiar to smoking ads. They could recall the characteristics of these ads with detailed description. Cigarette ads and promotions were used to convince the public of the good traits and benefits of smoking (Fine 1972). These were a marketing strategy of tobacco companies for their products.

In case of effect, the smokers perceived anti-smoking ads to be useless and nonsense because cigarettes were still sold in the market The nonsmokers on the other hand answered that they were influenced by the anti-smoking ads but due to insufficiency it was their own control to hold firm that they would not smoke In smoking ads and promotions, both groups admitted that they were not affected by these ads the smokers smoke with their own conviction while nonsmokers resisted to be influenced by these ads. Both groups have their own suggestion to improved anti-smoking messages. Smokers suggested that cigarette should no longer be sold in order not to attract smokers 92 and the public. Nonsmokers believed that anti-smoking messages should be distributed in the different parts of the country and a strict law should be pushed and implemented about smoking regulation. These findings showed that smokers and nonsmokers ad similarities and differences regarding smoking because of their own experiences Smokers had more positive attitude toward smoking than the nonsmokers In case of their exposure it was

verified that anti-smoking messages were not enough and strict law should be implemented about smoking regulation. Besides the dissemination, nonsmokers gave more value and appreciated anti-smoking ads than the smokers. B. Discussion Numerous studies had been made about smoking. According to WHO (2006), there are many reviews of tobacco related studies. With these numerous topics about smoking, the researchers decided to examine deeply the issues about youth smoking in reference to how the youth were influenced by advertisements. To be more specific, antismoking advertisements would be the primary focus. The study aims to know how the extent of exposure to and recall of these anti-smoking ads affect the perceptions and attitudes of the youth about smoking. Starting with the methods used, a survey was randomly conducted to 10 schools in Metro Manila. A total of 400 male high school students from the National Capital Region were selected as respondents for the survey. To dig more information, two Focus 93 Group Discussions were made in two schools from the ten schools that were originally

chosen as samples. With this methodology, we could verify the data we obtained. The respondents were mostly 14 years old and their age range was 13 16 as expected for high school students. Because of the little data that these students gave about their families monthly income, the researchers concluded that majority of them belonged to middle to upper class families. In case of smoking prevalence, more than half of the respondents admitted that they did not smoke. To those who smoke, the researchers asked the age when they started to smoke. As seen in Table 3, the ages that most of the respondents had smoked were 12 and 13 years. The researchers wanted to verify if there were smokers who had quitted smoking so they asked about the students consumption of cigarette brand. There was a probability that some of the smokers had quit smoking already. In terms of their other sources of information about smoking and cues to action, the school was cited as their top source of information followed by their families and churches. As compared with their exposure, the family became the source they were most

exposed to, the schools anti-smoking campaigns and church. This finding indicated that school was where the students acquired more information about antismoking. The family might be the one they were most exposed to but smoking was not always discussed inside their home. The study indicated that family, school and the church were the respondents sources of information about smoking. This asserts the GYTS (2007) data that in the Philippines, majority of the youths received teachings about the dangers of smoking in their schools.94 The respondents exposure of anti-smoking advertisement proved that they were able to identify ads that informed about smoking. The study pointed out Health Care facilities to be the place where the respondents noticed anti-smoking advertisements most. This means that hospitals and health clinics were supposed to be conducive for health and wellness. The same with their exposure, health care facilities were ranked as the top. This seemed to be confusing if it could mean that respondents went there every day. Regarding the results from the FGD, smokers pointed that they had not seen antismoking advertisements. They admitted that their school did not have anti-smoking

campaigns. They only knew the No Smoking Signs that could be found in jeepneys. Antismoking advertisements could only be found in public places where smoking was strictly prohibited. In case of the nonsmokers, they were more attentive to antismoking ads. They even knew a TV Channel that aired anti-smoking advertisements. According to Philippine GYTS (2007), regarding the exposure of Filipino youths to antismoking advertisements there was a decreased percentage of students who had seen anti-smoking media messages. The finding of this study verifies the data of Philippine GYTS. By means of recall, surprisingly 90% of the students were able to recall a characteristic of the anti-smoking advertisement. The most common message was Cigarette Smoking was dangerous to your health and No Smoking signs. From the FGD, the participants saw these messages mostly in cigarette packs and in TV. Prior studies had noted the importance of pictures or cigarette warning labels in cigarette packs. (Hammond, Fong, McNeill, Borland & Cummings, 2006). Picture warning labels on tobacco products increase knowledge about tobacco consumption risks, reduce adolescents intentions to smoke, and motivate smokers to quit. These labels counter the 95

tobacco industry advertisements. The present study shows that pictorial warning labels were implanted with the minds of those who had seen them. Pictorial warning labels could easily be recognized even by children. (White,Webster & Wakefield, 2008, Hammond, 2008). For the knowledge about smoking, the researchers found that the respondents were aware of the places where cigarettes were sold. Almost 61 % also admit that cigarettes were sold near their schools. The study found that the students did not know what RA 9211 was or the legal name of the 2003 Regulation Act of the Philippines. As seen in Table 11, 63% did not know RA 9211. The present findings seem to be consistent with other research which found that the enforcement made by the Philippine local government officials of the National Tobacco Laws and the WHO-FCTC was poor (GYTS, 2007) But in spite of this the respondents were aware of what a smoking law should consist. In the case of their knowledge on dangers of the types of smoking, the study found that the respondents had a high awareness of these types. The same with the

FGD, when the nonsmokers answered they might get sick due to secondhand smoking or when inhaling the smoke from a nearby smoker. Their perception about vulnerability of having smoking related diseases was consistent on both the survey results and FGD. They knew that they were vulnerable to the dangers of smoking. They associated smoking to lung diseases that were deadly. At the rate of severity, the respondents perceived it to be high. The smoker group from the FGD believed that there was a high severity of smoking related diseases but it would only affect those who smoked heavily. These findings further support the study of Hammond 96 (et al., 2003) that showed most smokers perceive themselves having lesser risk than other smokers. Exposure to smoking ads had produced an interesting result. The participants in FGD were more exposed with smoking ads and promotions. They could give detailed characteristics of those ads. Marlboro was the top or most common cigarette brand. The survey results showed that respondents had seen smoking scenes in TV programs and

some were aware of the activities sponsored by the tobacco companies. This study confirms that the youths were exposed to smoking promotion and advertisements where smoking was portrayed as glamorous, social and normative (GYTS, 2007). The nonsmokers hold firm in their control to not smoke. In FGD, the nonsmoker group gave a zero probability that they would smoke in the near future. The study found out that majority of the respondents had a high self-efficacy that they would not smoke or they would quit smoking. In case of their perceived benefits of not smoking, both survey and FGD gave similar results: healthy body, clean environment and good appearance. Having a clean environment was cited to be the top priority (91%). For the benefits of smoking, the smokers were able to give answers that associated with maturity and manhood. The nonsmokers were not able to immediately gave an answer so they replied according to what they thought was the reason. This means that smokers and nonsmokers had their own perception of smoking. There are several possible explanations for this result. Particularly, current smokers perceived smoking as having positive attributes

while the non-smokers perceived smoking as having negative characteristics (Taylor, Ross, Goldsmith, Zanna &Lock, 1998; Shervington, 1994). Moreover, current smokers perceived susceptibilities of having smoking-related diseases were lesser than the non-97 smokers and former smokers even though the perceived seriousness of all the groups was almost the same (Klesges, Somes, Pascale, Klesges, Murphy&Williams, 1988;Taylor, Ross, Goldsmith, Zanna&Lock,1998; Shervington,1994). The attitude also varies especially with the smokers and nonsmokers. Because majority of the respondents were nonsmokers, they perceived smoking should be regulated and smoking law should be implemented. In the FGD, the smokers had more positive attitude toward smoking and they believed that their vulnerability of smoking dangers would be lessen if they would be more careful. It was important that smokers understand the risks as well as the severity of smoking in order to motivate them to quit smoking (Environics Research Group, 1999). For their perceived barriers to not smoke, family, peers, and the environment were

those who could influence them to smoke. The availability and affordability of cigarette sticks could attract the public to purchase cigarettes. Because of this when asked by the facilitator, the smokers suggested that cigarettes should not be sold to reduce the number of smokers. The nonsmokers suggested on the other hand to improved anti-smoking advertisements and distributed it in the whole country. They also added that a strict smoking law should be implemented. The study found a weak correlation between exposure (both to antismoking advertisements and other sources of information about smoking) to the perceptions and attitudes of the respondents toward smoking. It was the same with the extent of recall and the perception and attitude toward smoking. These findings were rather disappointing. It was in agreement with the Philippine GYTS 98 (2007) study that Filipino youth were not exposed to anti-smoking messages. Anti-smoking advertisements had little to no effect to the public especially the youth. The smoker group commented that anti-smoking ads were useless and nonsense because of the prevalence of cigarette selling. This finding has

important implications for developing improved anti-smoking ads and campaigns. This finding provides some support for the premise that RA 9211 should be strictly implemented. Another reason for this weak correlation that was computed using the Pearson-r test was the proposition of the Mere Exposure Theory. The theory states that the attitude change caused by the frequent exposure to stimulus is a positive one however too much repetition of exposure to that stimulus can reduce the effects to the preference of a person toward that stimulus (Izard, Kagan,& Zajonc,1984). For this study, the stimulus is the anti-smoking advertisements. The students too much repetitive exposure to antismoking ads may weaken the effect of the ads to the students attitudes toward and perceptions of smoking. This was supported by the results of the FGDs that most of the antismoking ads that the students saw had little effects on their perceptions of smoking. The students also said that they saw more smoking ads than antismoking ads. They suggested that the anti-smoking ads should be more graphical, colorful, and many in order for these ads to have a great effect on them.99 CHAPTER VI. SUMMARY AND CONCLUSION A. Summary

Smoking is one of the leading causes of death in the Philippines. According to the Report on Global Tobacco Epidemic (WHO,2009b), 240 Filipinos die every day because of smoking-related diseases such as cancer and heart disease. Over the past decades, there has been a dramatic increase in the prevalence of smoking among the Filipino, especially the youth. It is becoming increasingly difficult to ignore the number of male Filipino youths with ages 1315 years who are smoking. According to the Global Youth Tobacco Survey (2007) among the 4 million Filipino youth smokers, 2.8 million are boys and 1.2 million are girls. This shows that majority of the early starters are male in the high school level. In order to contribute to the efforts of Information Education and Communication health campaigns, the present study was designed to determine the effects of the extent of exposure to anti-smoking advertisements and the recall of National Capital Region (NCR) male high school students to their perceptions and attitudes toward smoking. Three theories were used for the framework of this study namely the Health

Belief Model (HBM), Mere Exposure Theory, Availability Heuristics Principle. Applying these theories on the study, the HBM provided the psychological model in describing the students perceptions of and attitudes towards smoking. The Mere Exposure Theory gave explanation on the effects of exposure to anti-smoking ads on the students smoking perceptions and attitudes while the Availability Heuristics probed on the relationship 100 between recall of anti-smoking ads and the judgment that students made regarding smoking. This study utilized qualitative and quantitative data gathering methods in order to satisfy the objectives of the study. A survey was randomly conducted among 400 NCR male high school students with the aim of determining the relationship between the NCR male high school students exposure to anti-smoking advertisements and recall; and their perceptions and attitudes toward smoking The study has found that almost three in ten NCR male high school students had tried smoking and most of them started smoking at ages ranging from 12 to 14 years. The study found that for the students knowledge on where

to buy cigarettes, almost 60% NCR male high school students knew stores near their schools (within 100 meter-perimeter) which were selling cigarettes. Marlboro is the most recalled cigarette brand that has advertisements. Majority of the students did not know the RA 9211 yet they had high knowledge on some smoking policies. . Data were obtained from students through the use of self-administered questionnaires. Two Focus Group Discussions divided to smokers and nonsmokers were conducted to give supporting data for the survey responses. The Pearson-r test was used to determine the correlation of the variables in the study. There is generally a high susceptibility and severity of having smokingrelated diseases as perceived by NCR male high school students. Thus the students perceived that they had a high-chance of acquiring very severe smoking-101 related diseases. The findings assert the Availability Heuristics Principle which states the tendency to judge the frequency or likelihood of an event by the ease with which relevant instances comes to mind (Baumeister& Bushman, 2008). It

seems possible that these results are due to the NCR male high school students high level of recall of anti-smoking advertisements which contain messages about the severity of having smoking-related diseases. On the other hand, the general attitude of the students toward smoking was either positive or negative (neutral). Surprisingly, though they have high self-efficacy of not smoking, almost 50% of the respondents have the likelihood to smoke for the next year and next five years. Having a clean environment followed by having a healthy body and favor from family were the most cited perceived benefits of not smoking by the students. While the peer pressure and the cheap price of cigarettes were highly perceived as barriers of not smoking. Among the other sources of anti-smoking messages, the school is cited to be as the top source of information about anti-smoking followed by the family then the church. The study has shown that when it comes to exposure to anti-smoking advertisements, majority of the students saw/heard these ads in health care

facilities (clinics, hospitals, etc), TV and schools anti-smoking campaigns while only one-fourth of the NCR male high school students saw anti-smoking ads on 102 billboard. However, according to FGD results, the NCR male high school students were more exposed to cigarettes ads than anti-smoking advertisements. This study has found that generally the NCR male high school students recall of messages in and characteristics of anti-smoking advertisements was high. A vast majority of 80% of the students recalled at least one anti-smoking ads messages and characteristics while almost 50% of them recalled at least five. The top three messages of anti-smoking ads that the students recalled were Government Warning: Cigarette smoking is dangerous to your health, Dont smoke/No smoking/Stop smoking/Be 100% smoke-free, and Smoking is prohibited in public places (malls,schools,city,roads,etc). The major finding of this study was that there was a weak correlation between the NCR male high school students exposure to and recall of antismoking advertisements and their perceptions of and attitudes towards smoking. This relationship was found using the Pearson-r test where the correlations of the

variables were computed. The reason behind this is not clear but it may have something to do with what the Mere Exposure Theory has proposed that the attitude change caused by the frequent exposure to stimulus is a positive one however too much repetition of exposure to that stimulus can reduce the effects to the preference of a person toward that stimulus (Izard, Kagan,&Zajonc,1984). In the case of this study, the stimulus is the anti-smoking advertisements. It was found out that the students have high exposure to anti-smoking ads; this exposure could be too much repetitive that it weakens the effect of the ads to the students attitudes toward and perceptions of smoking. Aside from this, the participants of 103 the FGDs said that most of the anti-smoking ads that they saw had little effect on their perceptions of smoking. They also said that they saw more smoking ads than anti-smoking ads. They suggested that the anti-smoking ads should be more graphical, colorful, and many in order for these ads to have a great effect on them. B. Conclusion

The purpose of this study was to determine the effects of the extent of exposure to anti-smoking advertisements and the recall of National Capital Region (NCR) male high school students to their perceptions of and attitudes toward smoking. The NCR male high school students have high exposure to and recall of anti-smoking advertisements. The study has shown that when it comes to exposure to anti-smoking advertisements, majority of the students saw/heard these ads in health care facilities (clinics, hospitals, etc), TV and schools antismoking campaigns. The following conclusions can be drawn from this study, majority (71%) of the NCR male high school students are non-smokers however their general attitude toward smoking is neutral. Even though they have a high general perceived susceptibility and severity of having smoking-related diseases, almost half of the NCR male high school students have the likelihood to smoke in the next year and next five years. According to them, aside from the antismoking ads, their schools are their top source of information about anti-smoking followed

by their families then their churches.104 However, there was a weak correlation between the NCR male high school students exposure to and recall of anti-smoking advertisements and their perceptions of and attitudes toward smoking. Using the Pearson-r test, the computed values of correlations were so small(r ranging from 0.1 to 0.2) in order for the variables to have strong correlations with each other. From these results, the first hypothesis that there is a significant relationship between the NCR male high school students perceptions and attitudes toward smoking and their extent of exposure to anti-smoking ads and to other sources of anti-smoking messages is accepted. The second hypothesis which states that there is a significant relationship between the messages the students recalled from the anti-smoking advertisements and their perceptions and attitudes toward smoking is also accepted.105 CHAPTER VII. IMPLICATIONS AND RECOMMENDATIONS A. Implications The findings of this study have important implications for developing Information

Education and Communication health campaigns on smoking. Perhaps the most significant finding in this study is that there is a weak correlation between the NCR male high school students exposure to and recall of anti-smoking advertisements and their perceptions of and attitudes toward smoking. An implication of this is the possibility that the anti-smoking advertisements have only little effects on the students perceptions of and attitudes toward smoking. This indicates a need for evaluating the effectiveness of the current anti-smoking advertisements for the NCR male high school students. The study has shown that majority (71%) of the NCR male high school students are non-smokers yet their general attitude toward smoking is neutral. Surprisingly, almost half of the NCR male high school students have the likelihood to smoke in the next year and next five years even if they have a high general perceived susceptibility and severity of having smoking-related diseases. These findings enhance our understanding of the NCR male high school populations perceptions of and attitudes toward smoking hence these have important implications for the design of anti-smoking advertisements inside

and out of NCR high schools. Anti-smoking advertisements may be tailored to the smoking perceptions and attitudes of the NCR male high school students as the target. In addition, an implication of the finding that almost half of the NCR male high school students have the likelihood to smoke in the next year and next five years should be taken into account in the MMDA efforts in achieving the vision of a smoke-free 106 Manila. This is because of the possibility that one year to five years from now this number of students can add to the number of smokers in Metro Manila. According to the Health Belief Model, the persons likelihood to do a specific action can be a predictor of the persons behavior (Rosenstock, 1974) Finally, this study is a significant endeavor in promoting public health and proper law implementation of RA 9211 among the youths today. This law prohibits selling of cigarettes to minors as well as selling of cigarettes within the 100 meter perimeter of a school. The study found out that 61% of the NCR male high school students knew stores near their schools which were selling cigarettes. This provides incidental data that the law

is not followed. This finding has important implications for improving the implementation of the RA 9211 in the country. . Hence efforts to put a stop to the increasing prevalence of smoking in youths should be made. Prevention measures are still always better than cure. B. Recommendations 1. Theoretical Issues The study uses the Health Belief Model (HBM) which is useful in predicting behaviors. The perceptions of the respondents are measured according to their perceived susceptibility, severity and threat of the disease as well as the perceived benefits and barriers that are affected by the modifying factors (age,sex,personality,knowledge). Another concept, self-efficacy is added to HBM, this is the persons view of his/her ability to do the recommended action. The study focuses on the perceptions and attitudes 107 of NCR male high school students toward smoking. The researchers want to know if there is any likelihood of behavior change based on the effects of exposure and recall of anti-smoking advertisement to their perceptions and attitudes toward smoking. The

researchers suggest for future studies to use a theory that can cover attitude, knowledge, awareness and practice of the respondents that lead to behavior change. HBM does not clarify behavior or attitude change as likelihood of action. Another theory used is the Mere Exposure Theory. To be able to measure exposure to anti-smoking advertisements, the researchers have decided to focus on the advertisements which the respondents are more exposed to and more familiar with. The theory states that the more you are exposed to something the more you become familiar with it. The theory says that at first people tends to like something that they always see yet overexposure to that something can also lead to people to dislike that thing. Hence the time element is very important in this theory. Thus the researchers recommend if this theory will be used again in a similar study, emphasize on the time the students exposure to anti-smoking ads and try to find out how long will it take for the students exposure to the anti-smoking ads before they will change their attitude toward the ads. The last theory is the Availability Heuristics. The researchers have used this theory to obtain data from the top-of-the-mind recalling ability of the respondents. The

data were gathered by asking the first thing that comes to the minds of the respondents about anti-smoking advertisements messages and characteristics. With these, only those information readily available to the respondents minds were used in the study. The type of recall used in this study was unprompted recall where the researchers didnt give any clue about anti-smoking advertisements hence the students just gave answers based on 108 how they understood anti-smoking ads .Future studies on this topic may involve the use of prompted recall based on the existing anti-smoking ads. 2. Methodological Issues The study includes only NCR male high school students because of the data from Philippine Global Tobacco Report that majority of the smokers is male. The researchers suggest including female respondents for future studies. High school students were chosen to be studied because they were at the stage where the youths were experiencing maturity and changes not only physically but psychologically. Their ages also are in the stage where most youths start smoking. The researchers also think high school students

are old enough to answer a 5 page questionnaire at ease. For future studies, the researchers suggest, if possible, to conduct research about smoking that engages elementary students. It is important to know the childrens perceptions and attitudes toward smoking and their exposure and recall of anti-smoking advertisements. The children with ages 13 and below must also be equipped with information about smoking. Possible actions to protect the childrens health must be done as early as possible. The researchers foresee the difficulty in conducting a related study to children because of the sensitivity of the issue of smoking just like sex and drugs. Yet if the study will be well done and planned for the appropriateness of the children as the subjects that research can greatly contribute to the anti-smoking efforts in decreasing smoking prevalence in the country.109 The study found out that there was a weak correlation between the NCR male high school students exposure to and recall of anti-smoking advertisements and their perceptions of and attitudes towards smoking. Hence the researchers recommend for a

qualitative study that will seek to answer the reasons behind this findings because the FGD findings in this study are so limited. The researchers recommend a comparison of study to urban and rural areas. The study is conducted in Metro Manila. It is also better to include students from public and private schools in provinces. Since some of the systematic sampling stages in this study were not followed due to some limitations imposed by the schools authority, the researchers suggest a stricter random sampling in order to obtain higher level of representativeness in the data. For the survey instrument, in the part where the recall to anti-smoking advertisements was asked, the researchers suggest to make the recall questions more specific in terms of the media used in the anti-smoking advertisements and their characteristics. Example: Describe the anti-smoking ads messages and characteristics that you saw on: a. TV (include what channel) b. radio c. magazines (etc). This was for the better identification of the anti-smoking ads where the students were exposed too. The researchers also recommend having a list of at least all anti-smoking ads that

are circulating around NCR then have a similar study based on that list. From there, the researchers suggest to find out which of the anti-smoking ads in the list are effective in being a cue for the NCR male high school students to not smoke.110 3. Practical Issues The study found out that there was a weak correlation between the NCR male high school students exposure to and recall of anti-smoking advertisements and their perceptions of and attitudes towards smoking. The survey results showed that the students exposure to anti-smoking advertisements was high but their general attitude toward smoking was either positive or negative (neutral). This weak correlation may imply the ineffectiveness of the anti-smoking advertisements in which the students were exposed. The study also found out that less 50% of the NCR male high schools students was knowledgeable of the smoking laws and dangers. Thus the researchers suggest that the Department of Education have an evaluation on the effectiveness of the anti-smoking advertisements inside the NCR secondary schools in disseminating antismoking information like the smoking laws and dangers. The same recommendation goes for the

MMDA who is currently promoting 100% smoke-free Manila and to those Information/Education Health campaigns around the metro. Massive and effective antismoking advertisements especially made for the NCR high school students must be done in Metro Manila. According to the FGD results, students saw more cigarette promotions and advertisements compared to anti-smoking advertisements. This suggests the need to have more anti-smoking advertisements. In chapter I, it is said that this study is a significant endeavor in promoting public health and proper law implementation of RA 9211 among the youths today. According to RA 9211, selling of cigarettes to minors as well as selling of cigarettes within the 100 111 meter perimeter of a school is prohibited. The study through the awareness of the students on where to buy cigarettes found out that 60.5% of the NCR male high school students knew stores near their schools which were selling cigarettes. This provides incidental data that the law is not followed. There is, therefore, a definite need for stricter implementation of this law in places around NCR high schools. Finally, this study aims to help government agencies like the DepEd and MMDA;

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To whom it may concern: Greetings! We are Communication Research (Comm Res) students from University of the Philippines Diliman and are currently enrolled in Comm Res 200 (Thesis). In line with this, we are doing a research entitled, SmokeCheck: Effects of NCR male high school students exposure to and recall of anti-smoking advertisements to their perceptions of and attitudes towards smoking. Our study primarily focuses on the possible effects of anti-smoking advertisements to the perceptions and attitudes of male high school students on smoking. Ten of National Capital Region (NCR) schools were selected randomly to participate in our study. The list of chosen schools is attached with this letter. We want to request permission from your good office to conduct a survey to 40 male students from first to fourth year levels. We would very much appreciate their thoughts and insights regarding the topic. Confidentiality of data will be ensured. If you have concerns regarding our study, please do not hesitate to contact us through the mobile number provided below.

Your kind consideration is highly appreciated. Thank you! Sincerely, __________________________ Joyce Aguillon 09059305552 __________________________ Precious B. Romano 09262889196 Noted by: _________________________ Prof. Randy Jay Solis Thesis Adviser122 List of Chosen NCR Schools for the Study NCR City Public School Private School Mandaluyong Bonifacio Javier National High School Good Shepherd Christian School Manila Antonio Maceda Integrated School San Rafael Parochial

School Malabon Malabon National High School St. Therese the Child Jesus Academy Paranaque Dr. Arcadio Santos National High School Arandia Academy Pateros/Taguig Ricardo G. Papa Sr. Memorial High School Colegio de Sta. Ana123 APPENDIX B. SURVEY QUESTIONNAIRE Questionnaire No: ________ Communication Research 200 University of the Philippines Diliman INTRODUCTION Magandang araw! Kami ay mga mag-aaral sa kursong Communication Research ng UP Diliman at kasalukuyang gumagawa ng aming thesis tungkol sa Exposure at Recall ng mga estudyanteng lalake sa sekondarya sa mga patalastas(advertisements) laban sa paninigarilyo. Lubos kaming nagpapasalamat sa inyong oras at sa mga

impormasyong inyong maibabahagi sa amin. Makakaasa kayong ang lahat ng impormasyon ay mananatiling confidential at gagamitin lamang para sa aming pag-aaral. Maari lamang na sagutan nang buong katapatan ang mga tanong. PART 1.SMOKING PREVALENCE-Ang sumusunod na mga katanungan ay tungkol sa inyong paggamit ng sigarilyo/tabako. BILUGAN ANG LETRA NG IYONG SAGOT. 1. Nasubukan mo na ba ang magsigarilyo, kahit isa o dalawang hithit lang? a. Oo b. Hindi 2. Ilang taon ka noong una kang sumubok manigarilyo? a. Hindi pa ako nanigarilyo kailanman b. 7 taong gulang pababa c. 8 o 9 taong gulang d. 10 o 11 taong gulang e. 12 o 13 taong gulang f. 14 o 15 taong gulang g. 16 taong gulang pataas 3. Nitong nakaraang 30 araw (1 buwan), ilang araw kang nanigarilyo? a. 0 days (wala) b. 1 hanggang 2 araw c. 3 hanggang 5 araw d. 6 hanggang 9 araw

e. 10 hanggang 19 araw f. 20 hanggang 29 araw g. 30 araw (araw-araw) 4. Nitong nakaraang 30 araw (1 buwan), ilang sigarilyo ang kadalasang nasisigarilyo mo? a. Hindi ako nanigarilyo nitong nakaraang 30 araw (1 buwan) b. Mababa sa 1 sigarilyo kada araw c. 1 sigarilyo sa isang araw d. 2 hanggang 5 sigarilyo kada araw e. 6 hanggang 10 sigarilyo kada araw f. 11 hanggang 20 sigarilyo kada araw g. higit sa 20 sigarilyo kada araw 5. Nitong nakaraang 30 araw (1 buwan), paano ka karaniwang kumukuha ng sigarilyo mo? (PUMILI LAMANG NG ISANG SAGOT) a. Hindi ako nanigarilyo nitong nakaraang 30 araw ( 1 buwan) b. Binili ko sa tindahan/palengke/grocery/naglalako sa kalye c. Binili ko sa tindahan na malapit sa paaralan d. Nagpabili ako ng sigarilyo sa iba e. Humingi ako sa iba f. Ninakaw ko g. Binigyan ako ng sigarilyo ng taong mas nakatatanda

h. Nakuha ko sa iba pang paraan 6. Nitong nakaraang 30 araw (1 buwan), anong brand o pangalan ng sigarilyo ang palagi mong sinisigarilyo? (PUMILI LAMANG NG ISANG SAGOT) a. Hindi ako nanigarilyo nitong nakaraang 30 araw (1 buwan)124 b. Walang particular na pangalan o brand c. Marlboro d. Philip Morris e. Winston f. Hope g. Memphis h. Others (Iba pa.Pakisulat:)______________ 7. Sa nakalipas na 30 araw (1 buwan), gumamit ka ba ng ibang produktong tabako maliban sa sigarilyo a. Oo b. Hindi 8. Saan ka madalas naninigarilyo?(PUMILI LAMANG NG ISANG SAGOT) a. Hindi pa ako nanigarilyo kailanman b.Sa bahay c. Sa paaralan d. Sa trabaho e. Sa bahay ng kaibigan

f. Sa mga pagtitipon g. Sa mga pampublikong lugar (park, sa shopping center o mall, kanto) h. Other (Iba pa)Pakisulat ______________________ 9. May alam ka bang nagtitinda ng sigarilyo malapit sa inyong paaralan (sa loob ng 100 meter-perimeter)? a. Meron b. Wala PART 2. SMOKING KNOWLEDGE Ang sumusunod na mga katanungan ay ukol sa iyong kaalaman sa:(1) mga batas tungkol sa paninigarilyo, (2) panganib na dulot ng paninigarilyo at (3) Mga Smoking Ads&Promotions. 10. Alin sa mga sumusunod na batas ang Tobacco Regulation Act of 2003 in the Philippines? a. RA 8111 b. RA 9211 c. RA 3063 d. RA 5312 e. Hindi ko alam 11. Ayon sa Tobacco Regulation Act of 2003 in the Philippines, bawal ang paninigarilyo sa mga pampublikong lugar tulad ng paaralan,simbahan etc. a. Tama b. Mali

c. Hindi ko alam 12. Ipinagbabawal sa batas ang pagtitinda ng sigarilyo sa mga kabataang may edad na 18 pababa a. Tama b. Mali c. Hindi ko alam 13. Ayon sa Tobacco Regulations Act in the Philippines,,maaring magtinda ng sigarilyo sa lugar sa loob ng 100 meter perimeter ng paaralan. a. Tama b. Mali c. Hindi ko alam 14. Ang First Hand Smoke ay ang usok na nalalanghap mula sa naninigarilyong malapit sa iyo a. Tama b. Mali c. Hindi ko alam 15. Ang Second Hand Smoke ay ang usok na nakukuhang direkta ng taong naninigarilyo. a. Tama b. Mali c. Hindi ko alam

16. Ang Third Hand Smoke ay ang mga naiwang kemikal mula sa upos ng sigarilyo a. Tama b. Mali c. Hindi ko alam 17. Ang paninigarilyo ay nagdudulot ng mga malulubhang sakit tulad ng cancer, sakit sa puso, tuberculosis at emphysema. a. Tama b. Mali c. Hindi ko alam 18. Ang mga taong nakakalanghap ng usok mula sa naninigarilyong malapit sa kanya ay higit pa ang panganib na magkaroon ng malulubhang sakit dulot ng paninigarilyo,kaysa sa mismong taong naninigarilyo. a. Tama b. Mali c. Hindi ko alam125 19. Ang paninigarilyo ay nagdudulot ng pagkabaog. a. Tama b. Mali 20. Ang usok mula sa paninigarilyo ay nakakasira ng ating kalikasan a. Tama

b. Mali c. Hindi ko alam 21. Kapag nanonood ka ng telebisyon, video o sine, gaano kadalas ka nakakakita ng artistang naninigarilyo? a. Hindi ako nanonood ng telebisyon, sine o video b. Madalas c. Minsan d. Sa aking panonood, wala pa akong nakikitang naninigarilyo 22. Mayroon ka bang gamit katulad ng t-shirt, panulat, bag, atbp. na may nakasulat/nakaukit/nakatahi na logo ng sigarilyo? a. Meron b. Wala Kung meron,anong brand ng sigarilyo ito _____________ 23. Nitong nakaraang 30 araw (1 buwan), gaano ka kadalas nakakita ng brand ng sigarilyo sa tuwing nanonood ka ng mga programa o palabas sa telebisyon. a. Hindi ako nanonood ng telebisyon b. Madalas c. Minsan d. Wala akong nakita Kung meron,anong brand ng sigarilyo ito _____________

24. Nitong nakaraang 30 araw (1 buwan), ilang anunsiyo para sa sigarilyo ang nakita mo sa mga posters? a. Walang posters sa amin b. marami c. kaunti d. Wala akong nakita Kung meron,anong brand ng sigarilyo ito _____________ 25. Nitong nakaraang 30 araw (1 buwan), ilang patalastas para sa sigarilyo ang nakita mo sa diyaryo o magasin? a. Wala kaming diyaryo or magasin b. Madalas c. Minsan d. Wala akong nakita Kung meron,anong brand ng sigarilyo ito _____________ 26. Nitong nakaraang 30 araw (1 buwan), ilang patalastas para sa sigarilyo ang narinig mo sa radyo? a. Hindi ako nakikinig ng radyo b. Madalas c. Minsan d. Wala akong nakita Kung meron,anong brand ng sigarilyo ito _____________ 27. Sa pagdalo mo ng mga torneong pampalakasan, perya, konsyerto o gawaing pangkomunidad, gaano kadalas

kang nakakakita ng mga patalastas para sa sigarilyo? a. Hindi ako dumadalo sa mga torneong pampalakasan, perya, konsyerto o gawaing pangkomunidad) b. Madalas c. Minsan d. Wala Kung meron,anong brand ng sigarilyo ito ________ PART 3. SMOKING ATTITUDE-Sa bahaging ito,nais naming malaman ang iyong saloobin sa ilang bagay-bagay na may kinalaman sa paninigarilyo 28. Gusto mo na bang tumigil sa paninigarilyo? a. Hindi pa ako nanigarilyo kailanman b. Hindi na ako naninigarilyo ngayon c. Oo d. Hindi 29. Sa iyong palagay, kaya mo bang humintong manigarilyo kung gugustuhin mo? a. Hindi pa ako nanigarilyo kailanman b. Hindi na ako naninigarilyo ngayon c. Oo d. Hindi 30. Ang paninigarilyo ay tumutulong sa tao upang magmuhang cool at fit in126

a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon d. Hindi sang-ayon e. Lubos na di sang-ayon 31. Ang Smoking ban ay dapat ipatupad sa mga restaurants,pubs,bars at clubs. a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon d. Hindi sang-ayon e. Lubos na di sang-ayon 32. Ang mga kabataang tulad mo ay hindi dapat manigarilyo. a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon d. Hindi Sang-ayon e. Lubos na di sang-ayon 33.Makakapagsigarilyo ka sa susunod na 12 buwan? a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon

d. Hindi Sang-ayon e. Lubos na di sang-ayon 34. Maninigarilyo ka 5 taon simula ngayon. a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon d. Hindi Sang-ayon e. Lubos na di sang-ayon 35. Kapag sinimulan na ng isang tao ang manigarilyo, sa tingin mo bay mahihirapan na siyang tumigil? a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon d. Hindi Sang-ayon e. Lubos na di sang-ayon 36. Ang mga lalaking naninigarilyo ay nagkakaroon ng mas maraming nagiging kaibigan a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon d. Hindi Sang-ayon e. Lubos na di sang-ayon

37. Ang paninigarilyo ay nakadaragdag ng persnalidad sa isang lalake. a. Lubos na sang-ayon b. Sang-ayon c. Walang opinyon d. Hindi Sang-ayon e. Lubos na di sang-ayon127 PART 4 ANTI-SMOKING ADVERTISEMENTS-Sa bahaging ito,nais naming malaman ang iyong exposure at recall sa mga anti smoking advertisements A. Exposure to Anti-Smoking Advertisements 38. Sa nakaraang 30 araw, may napansin ka bang mga patalastas/impormasyon tungkol sa panganib na dulot ng paninigarilyo at naghihikayat na ikaw ay hindi manigarilyo sa mga sumusunod?(Lagyan ng tsek ang iyong angkop na sagot sa bawat letra) Oo Hindi a.dyaryo,magazines b. TV c. radyo d. billboards e. monorails (MRT/LRT) f. sinehan g. health care facilities(clinics,ospital) h. malls

i. Smoking Campaigns sa paaralan j. Bangketa/Gilid ng mga kalye k.Iba pa Specify:__________ 39. Gaano kadalas kang makakita/makabasa/makarinig ng anti-smoking advertisements sa mga sumusunod ?(Lagyan ng tsek ang iyong angkop na sagot sa bawat letra) Araw-araw Minsan isang linggo Minsan isang buwan Bibihira Hindi Kailanman a.dyaryo,magazines b. TV c. radyo d. billboards e. monorails (MRT/LRT) f. sinehan g. health care facilities(clinics,ospital) h. malls

i. Smoking Campaigns sa paaralan j. Bangketa/Gilid ng mga kalye k.Iba pa Specify:__________ B. Recall of Anti-smoking Advertisements 40. Ano ang mga mensaheng natatandaan mo na ipinahahatid ng mga nakita/nabasa/narinig mong anti-smoking advertisements?( Ilagay ang lahat ng natatandaang mensahe) 1. 2. 3. 4. 5.128 41. Ano ang itsura ng mga anti-smoking ads na nakita mo?Ilarawan ang iyong mga nakita/nabasa/narinig na anti-smoking advertisements. (Ilagay ang lahat ng natatandaan) PART 5. OTHER SOURCES OR CUES TO ACTION TO NOT SMOKE-Sa bahaging ito,nais naming malaman ang iyong exposure sa iba mo pang pinagkukunan ng impormasyon sa anti-smoking maliban sa mga anti-smoking advertisements.

42. Sa nakaraang 30 araw, may nakuha ka bang mga impormasyon(e.g napag-uusapan,o itinuturo) tungkol sa panganib na dulot ng paninigarilyo at naghihikayat na ikaw ay hindi manigarilyo sa mga sumusunod?(Lagyan ng tsek ang iyong angkop na sagot sa bawat letra) Oo Wala a.pamilya b. barkada c. paaralan (mga guro,kamag-aral) d. simbahan e. kakilala f.Iba pa Specify:__________ 43. Gaano kadalas kang makakuha ng impormasyon tungkol sa panganib na dulot ng paninigarilyo at naghihikayat na ikaw ay hindi manigarilyo sa mga sumusunod? (Lagyan ng tsek ang iyong angkop na sagot sa bawat letra) Arawaraw Minsan isang linggo Minsan isang buwan Bibihira Hindi

Kailanman a.pamilya b. barkada c. paaralan (mga guro,kamag-aral) d. simbahan e. kakilala f. Smoking program f.Iba pa Specify:__________ 1. 2. 3. 4. 5.129 PART 6. SMOKING PERCEPTION Sa bahaging ito nais naming malaman ang iyong palagay tungkol sa ilang bagay-bagay na may kinalaman sa paninigarilyo.. A.Perceived Susceptibility 44. Ano ang sa tingin mong posibilid na ikaw ay magkasakit ng malubha dahil sa usok ng sigarilyo na iyong nalalanghap? a. Napakataas b. Mataas

c. Katamtaman d. Mababa e. Napakababa 45. Ano ang sa tingin mong posibilidad na ikaw ay magkaroon ng mga sumusunod na sakit na dulot ng paninigarilyo?(Lagyan ng tsek ang iyong angkop na sagot sa bawat letra) Uri ng Sakit Napakataas Mataas Katamtaman Mababa Napakababa a. Lung Cancer b. Tuberculosis c. Heart Attack d. Stroke e.Impotence(pagkabaog) f. Halitosis(Bad breath) g. Cataracts (katarata) h. Stomach cancer i. Leukemia j. Emphysema Iba pa: _________________ B. Perceived Benefits 46. PARA SA MGA NANINIGARILYO: Ang mga sumusunod ba ang mga nakikita mong dahilan kung bakit ka titigil sa

paninigarilyo? PARA SA MGA HINDI NANINIGARILYO: Ang mga sumusunod ba ang mga nakikita mong dahilan kung bakit hindi ka magsisimulang manigarilyo? (Lagyan ng tsek ang iyong angkop na sagot sa bawat letra) OO HINDI a. Upang mapabuti ang aking kalusugan b. Upang makatipid c. Dahil ayaw ng pamilya ko ang aking paninigarilyo d. Dahil ayaw ng mga kaibigan ko ang aking paninigarilyo e. Para mapangalagaan ang kalikasan Isulat ang iba pang mga dahilan: C. Perceived Barriers 47. PARA SA MGA NANINIGARILYO: Ang mga sumusunod ba ang mga nakikita mong dahilan kung bakit hindi mo magawang tumigil sa paninigarilyo ? PARA SA MGA HINDI NANINIGARILYO: Ang mga sumusunod ba ang mga nakikita mong hadlang para mapanatili mo ang sarili mo na hindi naninigarilyo? (Lagyan ng tsek ang iyong angkop na sagot sa bawat letra) OO HINDI a. Dahil sa udyok ng aking mga kaibigan

b. Dahil napakamurang bumili ng sigarilyo c. Dahil napakamurang bumili ng sigarilyo d. Dahil na-adik na ako sa paninigarilyo e. Dahil pampalipas oras ko ang paninigarilyo. Isulat ang iba pang mga dahilan:130 D. Perceived Seriousness 48. Kung sakaling ikaw ay magkakaroon ng sakit na dulot ng paninigarilyo, gaano kalala sa tingin mo ang magiging epekto nito sa iyo? a. Labis na malubha b. Napakalubha c. Malubha d. Bahagyang malubha e. Hindi malubha 49. Gaano kalala sa tingin mo ang magigng epekto sa iyo ng mga sakit na dulot ng paninigarilyo, kung sakaling ikaw ay magkaroon ng mga sakit na ito(Lagyan ng tsek ang iyong sagot). Uri ng Sakit Labis na malubha Napakalubha Malubha Bahagyang Malubha Hindi malubha a. Lung Cancer b. Tuberculosis

c. Heart Attack d. Stroke e.Impotence(pagkabaog) f. Halitosis(Bad breath) g. Cataracts (katarata) h. Stomach cancer i. Leukemia j. Emphysema Iba pa: _________________ PART 7. SOCIO-DEMOGRAPHIC PROFILE 50. Pangalan(optional): ______________________________51.Edad: ____ 52. Paaralan: _____________________________________________ Uri ng paaralan: public school private school

53. Lungsod ng Paaralan: _______________________ 54. Antas sa Sekondaryang Paaralan (Year Level):

st

year high school nd

year high school rd

year high school th 55. Buwanang Kita ng Pamilya (Lagyan ng tsek): year high school

P19, 999 P29, 999 P39,999 P49, 999

KATAPUSAN. Salamat sa partisipasyon131 APPENDIX C. FOCUS GROUP DISCUSSION GUIDE B. Focus Group Discussion Guide I. Smoking Perceptions 1. What come to your mind whenever you hear the word smoking? 2. What do you think are the good sides of smoking?

3. What do you think are the dangers/threats of smoking? 4. Do you think you are vulnerable to these dangers? Why? 5. If you will be susceptible to these dangers, how serious do you think the effects will be for yourself? 6. What are the benefits of not smoking to you? 7. What do you think are the barriers for you to not smoke? 8. What is the likelihood that you will not smoke now? 9. If yes, when did you start to smoke? Who influence you to smoke? 10. If no, what makes you to avoid smoking? 11. What is your view about youth smoking? II. Recall of Anti-Smoking Advertisements 1.What are the anti-smoking advertisements that you know or familiar with? 2.Where do you see it? 3.Can you describe the anti-smoking advertisements that you know? 4.What are the specific characteristics of the advertisements that help you remember it? 5.Did it affect your perception on smoking? 6.If sa tingin mo kaunti lang ang mga anti-smoking ads?Ano ang mai-sa suggest mo na itsura ng mga anti-smoking ads?

III. Recall of Smoking Ads and promotions 1. What are the smoking Ads and promotions that you know or familiar with? 2. Where do you see it? 3. Can you describe the smoking Ads and promotions that you know? 4. What are the specific characteristics of the smoking Ads and promotions that help you remember it? 5. Do you participate in activities sponsored by tobacco companies? How? 6. Did it affect your perception on smoking?132 APPENDIX D. FOCUS GROUP DISCUSSION TRANSCRIPTS FOCUS GROUP DISCUSSION FOR SMOKERS AT MALABON NATIONAL HIGH SCHOOL Transcriptions legend: F-FACILITATOR S1-STUDENT 1 S2-STUDENT 2 S3-STUDENT 3 S4-STUDENT 4 S5-STUDENT 5 S6-STUDENT 6 S7-STUDENT 7

S8-STUDENT 8 S9-STUDENT 9 S10-STUDENT 10 F: Walang tama o maling sagot, so ano yung unang pumapasok sa isip nyo kapag naririnig nyo yung salitang paninigarilyo? S1: bisyo S2: masama sa kalusugan S3: Adik S4: Adik! S5: Tambay F: tambay, ano pa? S4: mabaho S6: Di naliligo maam.. S4: Amuyin nyo mga bunganga nyan the,amoy yosi! F: So ayan,ang susunod kong tanong,anu yung magagandang benepisyo ng paninigarilyo?Anu yung magagandang makukuha sa paninigarilyo? S6: nakakatapang maam S7: Nakakalakas ng loob S4: Nagiging ganito ang mukha (joking,showing the face of S6) (tumatawa ang iba)

F: Meron pa ba? S6: Wala na.. F: Susunod,anu yung mga naiisip nyo na mga dangers ng paninigarilyo? S4: namamatay.. S8: Magkakaroon ng sugat sa baga S9: Magkakaroon ng sakit S10: TB F: Magkakaroon ng sakit.. (sabay sabay na magsasalita..) F: Sa tingin nyo ba di ba karamihan naman naninigarilyo.. S4: wala wala S1: madami..133 F: Sige,sa tingin nyo ba pwede kayong magkaroon ng mga sakit na binanggit nyo kanina? S6: Opo maam,pwede rin.. F: Dahil sa paninigarilyo S2: opo! F: Bakit? Bakit sa tingin nyo pwede kayong magkaroon ng sakit na yun? S3: Dahil po sa ..back to the moon (joking, nagtawanan) S5: Kapag sumobra pwedeng magkasakit

F: Kung sakaling magkaroon kayo ng sakit na ganito,ganu kalala sa tingin nyo? S5: Mild lang S7: Level 10 F: pinakamataas na level na ba yun? S7: opo F: Meron pa ba? S4: Pag malala te,ganito na..(showing again the face of S6) (nagtawanan) F: Ano ba ang benepisyo ninyo ng hindi paninigarilyo? S3: Magkakaroon ng ano..tao sa katawan (joking) S7: Umayos kayo,nirerecord eh F:Ay de,anu yung benepisyo ng hindi paninigarilyo? S10: Ayun makakarinig S9: Walang sakit S8: presko S5: Hindi bad breath S4: Magiging ganun yung mukha (pointing someone who is handsome) pero pag nagyoyosi magiging ganito (pointing S6) (magtatawanan) F: Ahm teka diba naranasan nyo ng manigarilyo,anu yung dahilan kung bakit..

S10: mam di pa naming nararanasan yun (joking) F: Anu yung dahilan kung bakit nahihirapan ang tao na itigil ang paninigarilyo? S9:Kasi merong anu..nakakaadik S8: Nagkakasakit..nagkakaroon ng sakit S1: nasarapan F: Nagkakaroon ng sakit pag tinitigil.. S2: Naglalaway! F: Naglalaway kapag tumitigil?anu pa? S3: Grabe yan dude! (tawanan) F: Anu yung sa tingin nyong dahilan kung bakit nahihirapan S4: Nakakaadik S7: Di nabubuo ang araw kapag hindi nakakapag-yosi S8: bangag!134 F: Anu pa..ayan..sumunod,anu yung sa tingin mong posibilidad para tumigil ka sa paninigarilyo? S4: maam ito ang makakasagot jan (pointing S6) F: Bakit?bakit? Anu yung sa tingin mong posibilidad para tumigil ka sa paninigarilyo? S4: Alam ko alam mo yun eh (talking to S6) F: Meron ba?

S6:Kapag may nagugustuhang babae maam.. S4: SI Agang..si Agang maam S6: Kapag nagkakagusto sa babae maam.. F: Kapag nagkakagusto sa babae S10: Kapag manliligaw S8: Kapag may napaglilibangan na.. F: Meron pa ba kayong naiisip na dahilan?Kapag..para tumigil sa paninigarilyo.. (sabay-sabay nagsasalita) S5: Kapag nadidisiplina S6: Kapag walang filter maam haha F:Sunod,ilang taon ba kayong nagsimulang manigarilyo? S1: Ngayon lang S2:onse S1: Ngayon lang S4: ito po kinder! F: third year.. kinder? Ah thirteen..Ilang taon kayo nagsimulang manigarilyo? S1: Ngayon lang maam F: Ngayon lang S9: Wag kayong maniwala,adik yan eh nauna pa sa papa nya yan eh (nagtawanan)

F: Sino ang naka-impluwensya sa inyong manigarilyo? LAHAT: heto! (pointing to S6,tawanan) S6: Ako? Ako? (tawanan) F: So barkada ang nakaimpluwensya sa inyo S8: opo maam F: Bukod sa barkada, meron pa bang ibang naka-impluwensya sa inyo? S5: teacher F: teacher?? S5: tatay F: Tatay?ah anu pa..ahm sunod,anu yung pananaw nyo sa paninigarilyo ng mga kabataan ngayon? S1: Mayayabang F: Bakit mayayabang? S2: Kase feeling nila.. S1: Feeling nila malaki na sila S2: Feeling nila manong na sila S4: Pag nagyoyosi te ganun na ang mukha oh (pointing at S6)135 S5: Practice makes perfect haha F: So anu pa ang tingin nyo sa paninigarilyo ng mga kabataan ngayon?Meron pa ba kayong naiisip na..

S4: Maam yung isang third year naman daw ang sasagot.. S6: oo nga kayo naman.. F: Yung susunod kong tanong ahm..meron ba kayong anti-smoking advertisements na nakita na? S3: maam English di ko maintindihan S4: Meron S8: wala pa S7: wala pa F:Mga patalastas na naghihikayat para wag kang manigarilyo S10: Sa jeep,sa jeep F: Ano yung nakasulat sa jeep? S10: No smoking! F: No smoking.. S9: Sa jeep lang te meron pero dito wala te.. F: so sa school wala.. S5: Sa public area F: so sa public area S3: Sa banyo (nagtawanan) F: So san nyo karaniwang nakikita yun? S6: Maam sa jeep F: Sa jeep talaga

S1: Sa tricycle.. S5: Sa palengke S4: Sa ospital S10: Sa mall S7: sa bahay F: pwede nyo bang i-describe yung nakita nyong anti-smoking?Anu yung mga nakita nyo? S1: Yung smoking bawal.. F: Ano yung mga characteristics ng anti-smoking advertisements na nakita nyo..ng mga patalastas na nakita nyo na dahilan para matandaan nyo siya? S2: Sigarilyo na nakaganon (hand-gesture ng x) F: SIgarilyo nan aka-ekis,anu pa?Meron pa ba kayong nakikitang patalastas? Yun lang ang nakikita nyo? S6: Government Smoking is dangerous to your health.. F: Saan nyo pala nakikita yung ganun? (medyo maingay) S7: Sa ano,sa kaha ng sigarilyo maam S4: ito oh isang kaha ng sigarilyo kada araw (pointing at S6) (umayon lahat) F: so sa kaha ng sigarilyo,meron pa? saan nyo pa nakikita?136

S9: Sa may ano,sa may traffic enforcer..yung may bilog bilog na bawal manigarilyo F: Susunod kong tanong,naapektuhan ba ng mga nakita nyo ang pananaw nyo sa paninigarilyo? Lahat: Hinde F: Hinde? S5: Nonsense F: Walang epekto yun sa paninigarilyo nyo? S9: wala F: Bakit walang epekto yun? S4: Kase nagbebenta sila eh F: Kase nagbebenta sila so nakikita nyo rin S3: Anu po yun teh? F: Sa tingin nyo ba konti lang ba yung mga anti-smoking advertisments,yung mga patalastas kaunti lang? S7: Konti lang te S10: kakapiranggot lang te S2: tama S9: iilan lang F: Susunod kong tanong,konti na lang patapos na ako,anu yung mga smoking

ads,mga patalastas na naghihikayat na manigarilyo na nakita nyo S1: Marlboro S8: Fortune S5: Philip S10:yosi astig! F:Yosi astig..yun yung nakasulat? S10: hahaha S4: Meron ba nun? S5: Adik na adik oh F: Ano pa yung mga nakita nyo?Mga patalastas na naghihikayat para manigarilyo S9: Wala naman eh S5: yung mga palabas sa TV F:palabas sa TV S6: yung dangerous to your health S7: cigarette smoking F: yung mga naghihikayat na manigarilyo,meron na ba kayong mga sinalihan na mga activities kung saan ang sponsor eh mga sponsor ng sigarilyo? S3: wala pa S2: wala Lahat: wala

F: Naapektuhan ban g mga patalastas na iyon yung pananaw nyo sa paninigarilyo?137 S4: wala S6: hinde F: Sa kabuuan,ano ang mas marami kayong nakita..yung mga smoking advertisements o yung mga patalastas na anti-smoking? S5: yung mga smoking advertisements F: Yung mga smoking advertisements? Lahat: oo F: Last question ko na lang, huli na to..ahm panghuli kong tanong,ano ba ang mai-sa suggest nyo para maapektuhan kayo ng mga anti-smoking ads na patalastas? S4: Wag nang magbenta maam S7: Wag na silang magbenta ng sigarilyo S10: Bakit bumibili ka?bakit bumibili ka? S4: Naaakit..siyempre S6: Nakakaakit noh? F: So sa tingin nyo eh wag na lang magbenta ng sigarilyo? Lahat: opo.. __________________________________Katapusan_________________ ____________138

FOCUS GROUP DISCUSSION FOR NON-SMOKERS AT COLEGIO DE STA. ANA-TAGUIG Transcriptions legend: F-FACILITATOR S1-STUDENT 1 S2-STUDENT 2 S3-STUDENT 3 S4-STUDENT 4 S5-STUDENT 5 S6-STUDENT 6 S7-STUDENT 7 S8-STUDENT 8 S9-STUDENT 9 S10-STUDENT 10 F: Ano yung pumapasok sa isip nyo kapag naririnig nyo yung salitang smoking? S1: paninigarilyo po S2: tinagalog mo lang eh F: anu pumapasok sa isip nyo kapag narinig nyo yung salitang smoking? S3: tobacco S4: sunog baga

F: meron pa ba? S5: nakakamatay F: nakakamatay.. S6: addictive F: addictive.. S7: umiitim yung labi F: umiitim yung labi,meron pa ba kayong naiisip? S8: Maraming lason F: maraming lason. S9: Nakakasira ng hangin sa kalikasan S10: Nakaka-cause ng halitosis S3: Nakaka-immune (tawanan) F: Nakaka-immune..meron pa bang ibang sagot?Susunod kong tanong,anu yung tingin nyong magagandangbenefits na nakukuha sa paninigarilyo S3: wala po S1: wala po S6: wala ba? S2:wala (halos lahat sinasabing wala..) S9: relaxing lang po relaxing.. S3: alam na alam ah

S8: nakakawala po ng problema ILAN: alam na alam ah S7: Bakit alam nyo yan ah? F: Anu pa?meron pa ba kayong naiisip na magandang nakukuha?139 S5: Nakakagaan ng loob F: Nakakagaan ng loob,meron pa ba? S6: gamot sa hika F: gamot sa hika?talaga bakit mo nasabing gamot sa hika? S6: joke lang F: sige sunod naman,ani sa tingin mo yung mga dangers na dulot ng paninigarilyo? S1: nakakamatay S2: lung cancer S5: nakakasunog ng baga S4: magkakaroon ka ng TB F: Magkakaroon ka ng TB S7: asthma F: asthma..meron pa ba?ayan ang susunod kong tanong sa tingin nyo ba may tendency ba na magkaroon kayo ng mga sinabi nyong sakit? LAHAT: opo.. F: bakit?

S10: secondhand smoke S8: secondhand smoke F: second hand smoke S3: si popeye (tawanan) S1: May thirdhand po ba? F: oo may thirdhand smoking, so yun yung dahilan nyo?ahh kapag kung sakali ba na magkaroon kayo ng sakit na to,ganu kaseryoso sa tingin ninyo ang maidudulot na epekto nito sa inyo? S9: malala F: malala S2: mahirap S3: mahirap magtrabaho F: mahirap magtrabaho S3: mahirap tigilan S8: Masakit sa bulsa F: Masakit sa bulsa (tawanan) S4: Masakit sa wallet F: Sige masakit sa wallet,meron pa ba?Sige susunod kong tanong ahh anu yung mga magagandang naidudulot ng hindi paninigarilyo sa inyo S6: malusog

F: Malusog,anu pa S2: mabuting kalusugan S10:Hindi madaling mapagod F: Hindi madaling mapagod,anung sabi mo? S9: Nakakahinga ng maayos S7: Mukhang matino yung tingin ng tao sa iyo140 F:hmm S5: good breath F: hmm S1: malusog na baga F: Malusog na baga,meron pa ba kayong sagot? Sumunod..Ano sa tingin nyo yung mga nakakahadlang sa inyo para di kayo manigarilyo?parang nakakaakit sa inyo para manigarilyo,meron bang ganun? S6: kaklase S1: nakakaakit? S4: barkada S1: barkada S7: tao sa tabi tabi S4: kapitbahay S1: nakakaakit

S5: mga tambay F:tambay, adik meron pa ba? S8: Mga malalakas ang loob F: malalakas ang loob na? S1: ito malalakas ang loob ng mga ito eh (pointing his classmates) S2: pwede parents.. F: So barkada talaga yung nakakapaghikayat para manigarilyo? ILAN: hindi naman S6: pwede rin S4: pwede rin S8: sa TV F: Sa TV,ano ba sa TV yung mga nakikita nyo? S8: nakakaimpluwensya F: Nakakaimpluwensya yung mga nasa TV S1: nakaka-curious F: Meron pa ba kayong sagot? S1: wala na po. F: Yung susunod kong tanong eh,ano sa tingin nyo yung probability na kayo ay manigarilyo? S4: zero percent F: Zero percent yung probability na manigarilyo kayo..

Lahat: zero percent S1: pag tanda.. F: So naiisip nyo na pagtanda nyo eh maninigarilyo kayo? S1: pwede F: ahh susunod kong tanong ano ang pananaw nyo sa paninigarilyo ng mga kabataan ngayon? S4: Broken family S8: May malaking problema S3: Broken-hearted141 F: Anu yung mga anti-smoking advertisements na pamilyar ka o nakita mo na..isaisa lang yung sasagot ah,taas muna ang kamay S3: Government warning smoking is dangerous to your health F: Meron pa ba? S9: No smoking area (tawanan) S7: Smoking ban F: Smoking ban, anu pa? S4: Maam,sa jeep S5: No smoking sign F: Bukod sa No smoking sign meron pa ba kayong iba pang nakikitang anti-smoking? S2: wala na

F: yung nagpapakita na parang may sakit ganun parang something like that S10: Meron po yung may mga nakakatakot na mukha dun sa ano..yung parang sumabog yung mukha F: owww..san mo siya nakita? S10: Dun sa TV F: sa TV S10: yung poster siya na parang sumabog yung piccolo sa mukha pero nakasulat bawal manigarilyo (tawanan) S2: yung poster na maraming sakit kabilang nang maraming kanser F: May nakita na ba kayong ganun din? Yung poster na maraming sakit? IBA: opo.. S10: Makita lang yung mukha ng kaklase ko eh napapatigil na ako S1: Sa barangay hall F:posters..san nyo nakita yung mga posters? S1: sa barangay hall S5: sa gym S6: sa ospital F: So iyun lang ang nakikita nyo, sa TV meron din ba kayong nakikita? S9: wala..

S10: channel 13 F: channel 13? Anu yung sa channel 13 S10: yung pumipigil po satin na manigarilyo S1: smoking channel? (tawanan) F: Meron pa ba kayong naiisip na anti-smoking advertisements na pamilyar kayo? LAHAT: wala nap o F: Wala na,susunod ko naming tanong ay ahm naapektuhan ban g mga nakita mong antismoking advertisements yung mga pananaw nyo about smoking? LAHAT: opo,opo.. F: Sa kabuuan,marami bang anti-smoking advertisements na nakakalat? LAHAT: kaunti lang po..kulang po kulang S7:..kulang F: So kaunti lang,bakit kaunti lang,so bibihira kayong makakita nito?142 LAHAT: opo S4: parang pili lang po kasi yung lugar na nilalagyan nila ng ganun F: So sa tingin ninyo ano ang mai-sasuggest nyo sa ganito..kung magkakaroon ng mga anti-smoking advertisements pa..Ano ang maisa suggest nyo? S10: Lagyan ng picture ng mga naninigarilyo S2: Dapat ikalat sa buong parte ng Pilipinas ,merong batas na isinusulong..

S4: Iboto nyo si Frankie Lahat: wuhoo S8: For president! S1: Dapat magkaisa,unity lang S8: cooperation S1: Ayun te,yun yung gusto kong sabihin F: Meron pa ba kayong ibang sagot? S1&S10: wala na po F: May naisip ba kayo na design dapat ng anti-smoking advertisements? S1&S4: meron po..opo S4: picture nya (joking)..sigurado walang maninigarilyo (tawanan) S5: yung naninigarilyo kung ayaw mong matulad sakin may picture ng sakit.. F: owww sige..next naman,konti na lang to..patapos na S1: habaan mo pa te S3: Habaan nyo pa LAHAT: habaan nyo pa F: Meron ba kayong nakitang smoking advertisements,yung nagpropromote naman ng paninigarilyo? LAHAT: yes yes,marami

S7: yan ang marami S3: Marlboro maam F: Sa TV? S2: Yung sa Winston yung nakasakay sa kabayo S8: ikaw yun (tawanan) F: Meron pa ba ngayon sa TV? LAHAT: Wala na po S9: sa palabas S4:wala na po, sa mga kalendaryo na lang F: Sa palabas at kalendaryo? S4: sa kalendaryo yung mga nakikita ko sa kalendaryo S9: yung sa So Lucky S2: yung sa notebook F: Sa notebook, anu pa?saan pa? S1: sa food chain po F: Tapos ahm,anu yung mga characteristics ng smoking ads na nakita nyo?143 S5: colorful F: colorful,anu pa?(tawanan) S6: Meron silang anu,may promo sila S2: either merong kabayo o babae F: So karamihan,posters ba itong nakikita nyo

S9: kadalasan po LAHAT: kadalasan.. F: So kumpara sa anti-smoking ads,anung mas maraming nakikita nyo.. anti-smoking ads o smoking ads? LAHAT: smoking.. F: Ahm nakapagparticipate na ba kayo sa mga concert kung saan ang sposors eh mga tobacco companies? S1: hindi pa po.. LAHAT: Hindi pa po F:So ang tanong ko,panghuling katanungan LAHAT: awwww S1: konti pa ate F: Yung huli kong katanungan ay naapektuhan ban g mga smoking advertisements na nakita nyo yung pananaw nyo sa paninigarilyo? LAHAT: Hindi..hindi pa rin F: SO talagang hindi maganda sa inyo ang paninigarilyo? S4:depende na lang S9: Ayokong mapaso ako __________________________KATAPUSAN______________________ ___________

http://iskwiki.upd.edu.ph/images/c/c7/Aguillon,Joyce_Mendoza%26Romano,Precious_Barredo%3 BApril_2012%3BA_Study_on_the_Effects_Anti-Smoking_Ads.pdf

Smoking FAST FACTS


Philippine Daily Inquirer
4:53 am | Sunday, October 14th, 2012 1 683 19

A man holds a cigarette as he smokes in his house in Manila in this file photo. The Japan Tobacco International Philippines Inc. said a rise in tobacco tax would not curb the incidence of smoking but would only increase consumption of cheap, smuggled cigarettes. AFP/NOEL CELIS

17.3M Estimated number of Filipinos aged 15 and older who smoke, according to the 2009 Philippine Global Adult Tobacco Survey (GATS) 70 Estimated number of carcinogens, or cancer-causing ingredients, contained in a cigarette stick 13.8M Estimated number of Filipinos aged 15 and older who smoke every day (GATS, 2009) P326.4 Average amount of money spent monthly on cigarettes (GATS, 2009) 10.6 Average number of cigarettes smoked per day by daily cigarette smokers in the Philippines (GATS, 2009) 36.9%

Percentage of Filipino adult workers who said they were exposed to tobacco smoke in enclosed areas in their work places 0.25 Estimated proportion of all types of cancer which can be attributed to smoking, according to the World Health Organization 55.3% Percentage of Filipino adult workers who said they were exposed to tobacco smoke in public transportation P177B Estimated annual cost of the four leading smoking-related diseases cancer, heart attack, stroke and chronic obstructive pulmonary disease. 2 of 5 Estimated proportion of Filipino students who live in homes where other people smoke 71% Percentage of lung cancer deaths in the world that can be attributed to tobacco 2M Estimated reduction in number of smokers in the Philippines by 2016 if tobacco taxes were increased by 10 percent, according to the Department of Health Sources: Isabatas Na! Sin Tax is Anti-Cancer Tax: A Primer for Pro-Health Citizens, Global Adult Tobacco Survey Philippines (2009) Compiled by Inquirer Research
http://business.inquirer.net/87196/smoking-fast-facts

Filipinos Among Worlds Top Smokers Survey


By JENNY F. MANONGDO June 26, 2012, 5:29pm

MANILA, Philippines Despite the existence of laws that limit smoking, male Filipino smokers are among the top smokers in the world occupying the ninth spot following India and China among others, data from the American Cancer Society and World Lung Foundation revealed on Tuesday. The 2008 data was revealed by the Department of Health (DoH) as it sought to emphasize the urgency of the passage of the sin tax bill. Other top male smokers in the world tobacco atlas ahead of the Philippines are Indonesia, the Russian Federation, USA, Japan, Bangladesh, and Pakistan. Male Chinese smokers took the top spot with 311,203,202, followed by India with 229,392,725; Indonesia, 53,392,709; the Russian Federation, 32,827,525; USA, 32,474,518; Bangladesh, 21,453,3412; Pakistan; 17,723, 216; and the Philippines on ninth spot with 17,634,512. Meanwhile, female Filipino smokers are also a worsening lot as they climbed from the 26th spot in 2006 to 16th place in 2008.

Topping the list are American female smokers at 23,671,860; China, 13,532,810; India, 11,908,517; the Russian Federation, 10,189,820 and the Philippines, 3,848,908. The Philippines global adult tobacco survey in 2009 revealed that adult current smokers 15 years and above reached 17.3 million with 14.6 million males and 2.8 million females. Meanwhile, one in five youth aged 13 to 15 years old currently smoke cigarettes. The DOH said 23.9 million Filipinos are exposed to tobacco smoke daily with 66.7 percent of workers exposed to second hand smoke in worksites and 75.7 percent of workers are exposed to second hand smoke where there is no anti-smoking policy. Moreover, almost 28 million Filipinos who used public transportation during the past 30 days were also exposed. But what is more alarming is that 10 Filipinos die daily because of tobacco-related diseases. In yesterdays forum, Luz B. Tagunicar, Supervising Health Program Officer of the National Center for Health Promotion cited the World Health Organization (WHO) that said non-communicable diseases or lifestyle diseases are the leading causes of deaths worldwide. These illnesses include cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Although government revenue from tobacco taxes is about P23 Billion annually, economic losses due to productivity and heath care costs of the top four tobacco related diseases: Cancer, Chronic Obstructive Pulmonary Disease, and stroke are conservatively estimated at P149 Billion annually, the 2008 Tobacco and Poverty study of the WHO said. The study further said that one-third of the Philippine population is at risk of dying from debilitating diseases and tobacco use. The average Filipino household earning about P5,100 monthly spends approximately 2.6 percent of the household income on tobacco, which is more than they spend on education and heatlh which is 1.6 percent and health at 1.3 percent respectively, the study added. The WHO recommends that tobacco excise tax must be at least 70 percent of the tobacco retail prices. Non-government organization Health Justice recommends the removal of price classification freeze and a unitary system of taxation applied across all tobacco products. It also recommends a high tax rate of at least P30 per box and a taxation rate that is pegged to inflation. http://www.mb.com.ph/articles/363574/filipinos-among-world-s-top-smokers-survey#.UJ0z3h2Bn3Y http://health.howstuffworks.com/wellness/smoking-cessation/10-reasons-people-start-smoking1.htm

Peer Pressure
While there are certainly other influences that can lead a smoker into the habit, peer pressure is one of the biggest. A large part of the reason peer pressure comes under scrutiny is that one of the groups most likely to begin smoking -young teenagers -- is also one of the most susceptible to peer pressure.

The awkward years between pure, dependent-on-parents childhood and independent young adulthood are marked for many by frustration and insecurity as status, family roles and physical changes happen in ahormone-addled flood. Quite often, this is the time of life when young people rely most heavily on friends of the same age for social support and affirmation. Enter cigarettes. If a child in a social circle starts experimenting with tobacco, it's all too easy for him or her to lead peers into smoking as well -- the smoker doesn't want to be alone, and the not-yet-smokers don't want to be seen as afraid to try something risky or boundary-pushing. Social Rewards
This reason for smoking is tied to peer pressure, although it's a little more complex and has the potential to affect more than just peer-pressure-sensitive tweens and teens. In short, social rewards are the "gifts" people feel they receive when participating in a group activity. Most often, this means some form of acceptance: Smokers at an office building who take cigarette breaks at similar times may bond while they smoke. Likewise, the relationship struck when one smoker asks another, "Got a light?" gives the participants a feeling of acceptance and camaraderie [source: Teen Drug Abuse]. Although many adults mature beyond the need to constantly please their peers, we carry into adulthood the teen's desire to be part of a group. And as smoking becomes more and more restricted, smokers find common ground in complaints over dirty looks and occasional ridicule from the nonsmoking public and the increasing limits on when and where they can smoke. This only makes the sense of camaraderie -- that social reward -- that much stronger for smokers. For nonsmokers who lack that social bond in their lives, that connection can be enough to drive them through the beginning phases of a tobacco addiction, when the chemical and psychological chains of addiction have yet to lock the smoker into the habit [source:

Risk-taking Behavior
Adults in countries where smoking is frowned upon are familiar with the nosmoking signs, designated smoking areas and general restrictions on their ability to smoke when and where they wish. But these rules -- legal, physical and social -- can offer tempting lines to cross for young people who tend toward risk-taking behavior. There's a thrill that comes from breaking rules. Combine that with the natural tendency of many teenagers to push the limits of rules imposed by school,

parents and their communities, and it's no wonder that many young people will instinctively push against any limit. For some young people, smoking provides fertile ground for getting that limitpushing thrill. Since it's illegal in many countries for minors to purchase tobacco, the process of obtaining, learning to use and eventuallysmoking tobacco is full of broken rules from the first step. Teens get thrill after thrill from breaking so many rules, enough so that the rush can overcome the sickening effects of those first few cigarettes.

7: Parental Influence
The relationship between parents smoking and their children smoking is blunt: Children of active smokers are more likely to start smoking than children of nonsmokers, or children of parents who quit smoking. According to some studies, a parent's choice to smoke can more than double the odds that the child will smoke [source: Faucher]. Even nonsmoking parents can act in ways that inadvertently make it easier for their children to start smoking. Studies have found that parents who place few restrictions on movies, allowing their children to watch films that depict heavy smoking and drinking, may be setting their children up to be smokers. Likewise, parents who react to smoking as a socially acceptable behavior -- even if they don't smoke -- can leave the door open for their children to experiment with tobacco [source: Hood Center for Children and Families]. What studies of parental influence on smoking suggest is that simply not smoking or quitting may not be enough. Parents committed to raising smoke-free children have to communicate that smoking is dangerous, unhealthy and unacceptable. Even as the children grow into teenagers, those parental messages will resonate, potentially protecting the young adults from becoming addicts as they grow older.

Misinformation
Tobacco advertising has come under close scrutiny -- and very strict regulation -in the United States in recent decades. But a mix of popular cultural beliefs, lingering effects of advertising and simple misinformation still abound about tobacco and smoking. In some developed countries, in fact, misinformation about

smoking runs very deep and works directly against public health efforts to curb tobacco use. A study of Japanese literature on smoking revealed findings that may seem shocking to some Westerners: Tobacco, in some cases, is promoted as a source for increased health and vitality. Likewise, tobacco's supposed boost to virility is a long-running myth, supported in the U.S. by long-gone ads featuring masculine characters such as the Marlboro Man [source: Kanamori]. Likewise, there are myths that abound among smokers: that so-called "light" cigarettes are less harmful than others, or that certain brands of cigarette aren't as dangerous as other brands. This attitude may keep them smoking longer, as they switch to "safer" cigarettes, rather than quitting, to try to avoid the health consequences of their addictions

Genetic Predisposition
A large section of the field of modern medical research focuses on genetics, and for good reason: From allergies to blood disorders and certain types of cancer, subtle mutations in a person's genes can mean the difference between sickness and health. Medical genetic research is beginning to suggest, too, that addictions -- including addiction tonicotine, the effective ingredient in tobacco products -may have a genetic component [source: Benowitz]. Studies of addiction genetics don't necessarily seek a "smoking gun" gene that controls addictions; rather, the research explores how a combination of a genetic susceptibility, societal factors and other health factors, such as alcohol use, can make one person more likely to take up smoking than another. If a tendency toward addiction is seen along family lines or within certain ethnic groups, public health officials can use that information to target their efforts toward populations that have the highest risk for tobacco addiction [sources: Raffin, The Partnership at Drugfree.org].

4: Advertising
Research has suggested that, worldwide, tobacco advertising plays a role in the number of people who start or stop smoking. This is not news for public health officials, who, in many nations, began fighting smoking-related illness by

restricting tobacco advertising. A 1975 ban on tobacco advertising in Norway, for example, helped reduce long-term smoking prevalence in that nation by 9 percent [source: Willemsen]. Tobacco advertising in the U.S. came under heavy scrutiny in the late 1990s, when internal tobacco-industry memos suggested that companies may have been targeting potential new smokers -- young adults -- through the use of colorful, catchy ads with stylish cartoon characters, such as Joe Camel. After a series of major court rulings found that the companies bore responsibility for the effects of their products, a portion of the funding that once went into creating these ads was redirected to fund public health and smoking-cessation programs, including ad campaigns encouraging teens not to smoke. While the effectiveness of these campaigns is still being debated and studied, one thing is clear: Advertising is a powerful tool, one that plays a large role in whether people decide to start smoking or not.

3: Self-medication
Smokers who are addicted to tobacco report a range of positive sensations that come from smoking a cigarette. These range from reduced tension or appetite to a heightened sense of well-being. Researchers trace these sensations back to the flood of chemicals released into the nervous system by nicotine. Just like any prescription or illicit drug, it changes the body's chemistry and functioning when it enters the system. For some, smoking is essentially a way to self-medicate for illnesses that cause tension and pain. Patients suffering from some forms of mental illness, such as depression or anxiety disorders, may take up smoking because it can help mitigate some of their symptoms [source: Lillard]. But as is the case with many powerful drugs, using nicotine to manage medical conditions comes with a host of negative side effects. Beyond addiction, the risks of lung disease, cancer, heart disease and early death mean nicotine, while potentially effective in treating some disease symptoms, is truly a double-edged sword when used to self-medicate.

2: Media Influences
Like advertising, media can exert a significant influence on viewers' decisionmaking. One only has to look at how hairstyles or clothing fashions can be launched by a single movie or TV episode to see the extent of this power in many parts of the world. Smoking in the media can have the same influence as fashion or the appearance of a trendy gadget in an actor's hand. Studies have suggested that when young viewers see a main character smoking, they're more likely to see smoking as something socially acceptable, stylish and desirable. Adding to this problem is what some researchers see as the media over-representing smoking: By some estimates, a disproportionately large number of film characters smoke [source: Watson]. Pressure from antismoking groups has reduced the prevalence of smoking onscreen in recent years, and this effort, as part of a holistic campaign to remove smoking as a socially acceptable habit in the public eye, could be a key factor in reducing the number of people who take up smoking in the future.

1: Stress Relief
For people not suffering from severe mental illness, cigarettes may still become a form of self-medication. For decades, soldiers have taken up smoking on the battlefield to deal with wartime stress, for example. Many people experiencing much lower levels of stress -- in a high-pressure job, for example -- may start to smoke as a way to manage the tension and nerves associated with the situation. Unfortunately, these people may find that they can't easily give up tobacco once the stress passes. The tobacco becomes a psychological -- as well as chemical - crutch, as any potentially stressful situation sends them instinctively reaching for a cigarette. The tool they had used to alleviate stress suddenly becomes a stressor in itself, as they shift from fighting through a difficult situation with the help of nicotine to fighting the nicotine itself [source:Cleveland Clinic]. To read more articles about smoking, check out the links on the next page.

http://www.manilatimes.net/index.php/news/top-stories/29104-philippines-topsmoking-country-in-southeast-asia http://www.smokefree.doh.gov.ph/section_show.php?name=News&id=31

The Effects of Smoking on the body (A MUST READ)


Many teenagers and adults think that there are no effects of smoking on their bodies until they reach middle age.1 Smoking-caused lung cancer, other cancers, heart disease, and stroke typically do not occur until years after a person's first cigarette. However, there are many serious harms from smoking that occur much sooner. In fact, smoking has numerous immediate health effects on the brain and on the respiratory, cardiovascular, gastrointestinal, immune and metabolic systems. While these immediate effects do not all produce noticeable symptoms, most begin to damage the body with the first cigarette sometimes irreversibly and rapidly produce serious medical conditions and health consequences. Rapid Addiction from Early Smoking Many teenagers and younger children inaccurately believe that experimenting with smoking or even casual use will not lead to any serious dependency. In fact, the latest research shows that serious symptoms of addiction -- such as having strong urges to smoke, feeling anxious or irritable, or having unsuccessfully tried to not smoke -- can appear among youths within weeks or only days after occasional smoking first begins.2 The average smoker tries their first cigarette at age 123 and may be a regular smoker by age 14.4 Every day, more 3,500 kids try their first cigarette and about 1,000 other kids under 18 years of age become new regular, daily smokers.5 Almost 90% of youths that smoke regularly report seriously strong cravings, and more than 70% of adolescent smokers have already tried and failed to quit smoking. Immediate and Rapid Effects on the Brain Part of the addictive power of nicotine comes from its direct effect on the brain. In addition to the well-understood chemical dependency, cigarette smokers also show evidence of a higher rate of behavioral problems and suffer the following immediate effects: Increases Stress. Contrary to popular belief, smoking does not relieve stress. Studies have shown that on average, smokers have higher levels of stress than non-smokers.7 The feelings of relaxation that smokers experience while they are smoking are actually a return to the normal unstressed state that non-smokers experience all of the time.8

Alters brain chemistry. When compared to non-smokers, smokers brain cellsspecifically brain cell receptors- have been shown to have fewer dopamine receptors. Brain cell receptors are molecules that sit on the outside of the cell interacting with the molecules that fit into the receptor, much like a lock and key. Receptors (locks) are important because they guard and mediate the functions of the cell. For instance when the right molecule (key) comes along it unlocks the receptor, setting off a chain of events to perform a specific cell function. Specific receptors mediate different cell activities. Smokers have fewer dopamine receptors, a specific cell receptor found in the brain that is believed to play a role in addiction. 9 Dopamine is normally released naturally while engaging in certain behaviors like eating, drinking and copulation.10,11 The release of dopamine is believed to give one a sense of reward. One of the leading hypothesis regarding the mechanism of addiction theorizes that nicotine exposure initially increases dopamine transmission, but subsequently decreases dopamine receptor function and number. The initial increase in dopamine activity from nicotine results initially in pleasant feelings for the smoker, but the subsequent decrease in dopamine leaves the smoker craving more cigarettes.12,13 New animal studies have shown that brain chemistry and receptors may be altered early in the smoking process. 14 Habitual smoking may continue to change brain chemistry, including decreasing dopamine receptors and thus yielding a more intense craving and risk of addiction. These brain chemistry changes may be permanent. In addition, because the role played by receptors in other cognitive functions, such as memory and intelligence, is unknown, how cigarette smoking effects SMOKINGS IMMEDIATE EFFECTS ON THE BODY 1400 I Street, NW - Suite 1200 Washington, DC 20005 Phone (202) 296-5469 Fax (202) 296-5427 www.tobaccofreekids.org Tobaccos Immediate Effects on the Body / 2 ly mucus. k. other brain functions by altering brain chemistry is unknown. 15 Immediate and Rapid Effects on the Respiratory System The respiratory system includes the passages from the nose and sinuses down into the smallest airways of the lungs. Because all of these spaces are in direct communication with one another, they can all be affected by tobacco smoke simultaneously. Bronchospasm. This term refers to airway irritability or the abnormal tightening of the airways of the lungs. Bronchospasm makes airways smaller and leads to wheezing similar to that experienced by someone with asthma during an asthma attack.16 While smokers may not have asthma, they are susceptible to this type

of reaction to tobacco smoke.17 An asthmatic that starts smoking can severely worsen his/her condition.18 Bronchospasm makes breathing more difficult, as the body tries to get more air into irritated lungs. Increases phlegm production. The lungs produce mucus to trap chemical and toxic substances. Small finger like hairs, called cilia, coat the lung's airways and move rhythmically to clear this mucus from the lungs. Combined with coughing, this is usually an effective method of clearing the lungs of harmful substances. Tobacco smoke paralyzes these hairs, allowing mucus to collect in the lungs of the smoker.19 Cigarette smoke also promotes goblet cell growth resulting in an increase in mucus.20,21 More mucus is made with each breath of irritating tobacco and the smoker cannot easiclear the increased Persistent cough. Coughing is the bodys natural response to clear irritants from the lungs. Without the help of cilia (above), a smoker is faced with the difficult task of clearing increased amounts of phlegm with cough alone. A persistent cough, while irritating, is the smokers only defense against the harmful products of tobacco smoke. A smoker will likely have a persistent, annoying cough from the time they start smoking. A smoker who is not coughing is probably not doing an effective job of clearing his/her lungs of the harmful irritants found in tobacco smoke.22 Decreases physical performance. When the body is stressed or very active (for example, running, swimming, playing competitive sports), it requires that more oxygen be delivered to active muscles. The combination of bronchospasm and increased phlegm production result in airway obstruction and decreased lung function, leading to poor physical performance. In addition, smoking has been shown to stunt lung development in adolescent girls, limiting adult breathing capacity. 23,24 Smoking not only limits ones current state of fitness, but can also restricts future physical potential. Immediate and Rapid Effects on the Cardiovascular System The cardiovascular system includes the heart and all of the blood vessels that carry blood to and from the organs. Blood vessels include arteries, veins, and capillaries, which are all connected and work in unison with the lungs to deliver oxygen to the brain, heart, and other vital organs. Adverse lipid profile. Lipids, a form of fat, are a source of energy for the body. Most people use this fat in its good form, called high-density lipoproteins, or HDLs. Some forms of fat, such as low-density lipoproteins (LDLs, triglycerides and cholesterol) can be harmful to the body. These harmful forms have their greatest effects on blood vessels. If produced in excess or accumulated over time, they can stick to blood vessel walls and cause narrowing. Such narrowing

can impair blood flow to the heart, brain and other organs, causing them to fail. Most bodies have a balance of good and bad fats. However, that is not the case for smokers. Nicotine increases the amount of bad fats (LDL, triglycerides, cholesterol) circulating in the blood vessels and decreases the amount of good fat (HDL) available.25 These silent effects begin immediately and greatly increase the risk for heart disease and stroke.26 In fact, smoking 1-5 cigarettes per day presents a significant risk for a heart attac27 Atherosclerosis. Atherosclerosis is a process in which fat and cholesterol form "plaques" and stick to the walls of an artery. These plaques reduce the bloods flow through the artery. While this process starts at a very young age (Some children younger than 1 year of age already show some of the changes that lead to plaque formation.28) there are several factors that can accelerate atherosclerosis. Nicotine and other toxic substances from tobacco smoke are absorbed through the Tobaccos Immediate Effects on the Body / 3 lungs into the blood stream and are circulated throughout the body. These substances damage the blood vessel walls, which allow plaques to form at a faster rate than they would in a non-smoker.29 In this way, smoking increases the risk of heart disease by hastening atherosclerosis. In addition, a recent study in Japan showed a measurable decrease in the elasticity of the coronary arteries of non-smokers after just 30 minutes of exposure to second hand smoke.30 Thrombosis. Thrombosis is a process that results in the formation of a clot inside a blood vessel. Normally, clots form inside blood vessels to stop bleeding, when vessels have been injured. However, components of tobacco smoke result in dangerously increased rates of clot formation. Smokers have elevated levels of thrombin, an enzyme that causes the blood to clot, after fasting, as well as a spike immediately after smoking.31 This process may result in blockage of blood vessels, stopping blood flow to vital organs. In addition, thrombosis especially occurs around sites of plaque formation (above). Because of this abnormal tendency to clot, smokers with less severe heart disease, have more heart attacks than nonsmokers.32 In addition, sudden death is four times more likely to occur in young male cigarette smokers than in nonsmokers.33 Constricts blood vessels. It has been shown that smoking, even light smoking, causes the bodys blood vessels to constrict (vasoconstriction). Smoking does this by decreasing the nitric oxide (NO2), which dilates blood vessels, and increasing the endothelin-1 (ET-1), which causes constriction of blood vessels. The net effect is constriction of blood vessels right after smoking and transient reduction in blood supply. Vasoconstriction may have immediate complications for certain persons, particularly individuals whose blood vessels are already

narrowed by plaques (atherosclerosis), or partial blood clots, or individuals who are in a hyper-coagulable state (i.e. have sickle cell disease). These individuals will be at increased risk of stroke or heart attack. 34,35,36,37 Increases heart rate. Heart rate is a measure of how fast your heart is pumping blood around your body. Young adult smokers have a resting heart rate of two to three beats per minute faster than the resting heart rate of young adult nonsmokers.38 Nicotine consumption increases a resting heart rate, as soon as 30 minutes after puffing; and the higher the nicotine consumption (through deep inhalation or increased number of cigarettes) the higher the heart rate.39,40 Smokers' hearts have to work harder than nonsmokers hearts. A heart that is working harder is a heart that can tire-out faster and may result in an early heart attack or stroke. Increases blood pressure. Blood pressure is a measure of tension upon the walls of arteries by blood. It is reported as a fraction, systolic over diastolic pressure. Systolic blood pressure is the highest arterial pressure reached during contraction of the heart. Diastolic blood pressure is the lowest pressure, found during the hearts relaxation phase. Nicotine consumption increases blood pressure.41 Older male smokers have been found to have higher systolic blood pressure than nonsmoking men do. 42 Higher blood pressure requires that the heart pump harder in order to overcome the opposing pressure in the arteries. This increased work, much like that related to increased heart rate, can wear out a heart faster. The higher pressure can also cause organ damage where blood is filtered, such as in the kidneys.43 Immediate and Rapid Effects on the Gastrointestinal System The gastrointestinal system is responsible for digesting food, absorbing nutrients, and dispensing of waste products. It includes the mouth, esophagus, stomach, small and large intestines, and the anus. These continuous parts are all easily affected by tobacco smoke. Gastroesophageal Reflux Disease. This disease includes symptoms of heartburn and acid regurgitation from the stomach. Normally the body prevents these occurrences by secreting a base to counteract digestive acids and by keeping the pathway between the esophagus (the tube between the mouth and stomach) and stomach tightly closed; except when the stomach is accepting food from above. The base smokers' bodies secrete is less neutralizing than nonsmokers and thus allows digestive acids a longer period of time to irritate the esophagus.44 Smokers also have an intermittent loosening of the muscle separating the esophagus and stomach, increasing the chance of stomach acid rising up to damage the esophagus.45 These immediate changes in base secretion and esophagus/stomach communication cause painful heartburn and

result in an increased risk of long-term inflammation and dysfunction of the esophagus and stomach.46 Smoking also increases reflux Tobaccos Immediate Effects on the Body / 4 rs is high. of stomach contents into the esophagus and pharynx.47 Occurring regularly over time, this reflux may cause ulcerations of the lower esophagus, called Barretts esophagus, to develop.48 Barretts esophagus may develop into esophageal cancer, which has a poor prognosis in most patients.49 Peptic Ulcer Disease. Peptic ulcers are self-digested holes extending into the muscular layers of the esophagus, stomach, and a portion of the small intestine.50 These ulcers form when excess acid is produced or when the protective inner layer of these structures is injured.51 Mucus is produced in the stomach to provide a protective barrier between stomach acid and cells of the stomach. Unlike in the lungs where mucus production is stimulated by cigarette smoke, mucous production in the stomach is inhibited.52 Peptic ulcers usually result from a failure of wound-healing due to outside factors, including tobacco smoke.53,54 Cigarette smoking increases acid exposure of the esophagus and stomach, while limiting neutralizing base production (above).55 Smoking also decreases blood flow to the inner layer of the esophagus, stomach and small intestine.56 In these ways, cigarette smoking immediately hinders gastrointestinal wound healing, which has been shown to result in peptic ulcer formation, when not treated.57 Peptic ulcers are terribly painful and treatment involves the long-term use of medications. Complications of peptic ulcers often require hospitalization and may be fatal secondary to excessive blood loss. Periodontal Diseases. These occur when groups of bacteria are able to form colonies that cause infections and diseases of the mouth. Smoking quickly changes the blood supply, immune response, and healing mechanisms of the mouth, resulting in the rapid initiation and progression of infections.58,59,60 In this way, smoking makes the mouth more vulnerable to infections and allows the infections to become more severe. The bacterial plaques of smoking also cause gum inflammation and tooth decay.61 In addition, smoking increases tooth and bone loss and hastens deep gum pocket formation.62 Halitosis. This is a fancy word for bad breath. Everybody knows that smoking makes individuals and everything around them smell bad. Bad breath, smelly hair and clothes, and yellow teeth are among the most immediate and unattractive effects of smoking.63 Immediate and Rapid Effects on the Immune System The immune system is the bodys major defense against the outside world. It is a complicated system that involves several different types of cells that attack and

destroy foreign substances. It begins in the parts of the body, which are in direct contact with the environment, such as the skin, ears, nose, mouth, stomach, and lungs. When these barriers become compromised, there are serious health consequences. Tobacco smoke weakens the immune system in a number of ways.64 Otitis Media. This is inflammation of the middle ear. The middle ear is the space immediately behind the eardrum. It turns received vibrations into sound. The middle ear is very vulnerable to infection. Children exposed to environmental tobacco smoke (ETS) have more ear infections than those not exposed.65 Tobacco smoke disrupts the normal clearing mechanism of the ear canal, facilitating infectious organism entry into the body. The resulting middle ear infection can be very painful, as pressure and fluid build up in the ear. Continued exposure to tobacco smoke may result in persistent middle ear infections and eventually, hearing loss.66 Sinusitis. Sinusitis is sinus inflammation. Sinuses are spaces in the skull that are in direct communication with the nose and mouth. They are important for warming and moisturizing inhaled air. The lining of the sinuses consists of the same finger-like hairs found in the lungs. These hairs clear mucus and foreign substances and are therefore critical in preventing mucus buildup and subsequent infection.67 Cigarette smoke slows or stops the movement of these hairs, resulting in inflammation and infection.68 Sinusitis can cause headaches, facial pain, tenderness, and swelling. It can also cause fever, cough, runny nose, sore throat, bad breath, and a decreased sense of smell.69 Sinusitis is more serious and requires a longer course of medical treatment than the common cold. Long-term smoke exposure can result in more frequent episodes and chronic cases ofsinusitis; and the rate of sinusitis among smoke70 Rhinitis. This is an inflammation of the inner lining of the nasal passages and results in symptoms of sneezing, congestion, runny nose, and itchy eyes, ears, and nose.71 Similar to symptoms of the Tobaccos Immediate Effects on the Body / 5 common cold, rhinitis may begin immediately in the regular smoker. Smoking causes rhinitis by damaging the same clearing mechanism involved in sinusitis (above).72 Rhinitis can cause sleep disturbances, activity limitations, irritability, moodiness, and decreased school performance.73 Smoking causes immediate and long-lasting rhinitis. Pneumonia. Pneumonia is an inflammation of the lining of the lungs. This inflammation causes fluid to accumulate deep in the lung, making it an ideal region for bacterial growth. Pneumonia results in a persistent cough and difficulty

breathing. A serious case of pneumonia often requires hospitalization. Smoking increases the bodys susceptibility to the most common bacterial causes of pneumonia and is therefore a risk factor for pneumonia, regardless of age.74 Pneumonia, if left untreated, can lead to pus pocket formation, lung collapse, blood infection, and severe chest pain.75 Immediate and Rapid Effects on the Metabolic System Your metabolic system includes a complicated group of processes that break down foods and medicines into their components. Proteins, called enzymes, are responsible for this breakdown. The metabolic system involves many organs, especially those of the gastrointestinal tract. Scurvy and Other Micronutrient Disorders. Micronutrients are dietary components necessary to maintain good health. These include vitamins, minerals, enzymes (above) and other elements that are critical to normal function. They must be consumed and absorbed in sufficient quantities to meet the bodys needs. The daily requirement of these micronutrients changes naturally with age and can also be affected by environmental factors, including tobacco smoke.76 Smoking interferes with the absorption of a number of micronutrients, especially vitamins C, E, and folic acid77 that can result in deficiencies of these vitamins. A deficiency in Vitamin C can lead to scurvy which is a disease characterized by weakness, depression, inflamed gums, poor wound healing, and uncontrolled bleeding.78 Vitamin E deficiency may cause blood breakdown, eye disease, and irreversible nerve problems of the hands, feet, and spinal cord.79 Folic acid deficiency may result in long-lasting anemia, diarrhea, and tongue swelling.80 Oxidative Damage. Oxidants are active particles that are byproducts of normal chemical processes that are constantly underway inside the body. Their formation is called oxidation. These particles are usually found and destroyed by antioxidants, including vitamins A, C, and E. The balance of oxidation and antioxidation is critical to health. When oxidation overwhelms anti-oxidation, harmful consequences occur. Oxidants directly damage cells and change genetic material, likely contributing to the development of cancer, heart disease, and cataracts.81 Oxidants also speed up blood vessel damage due to atherosclerosis (above)82 which is a known risk factor for heart disease.83 Because smoking increases the number of circulating oxidants,84 it also increases the consumption of existing antioxidants. This increase in antioxidant consumption reduces the levels of antioxidants such as alpha-tocopherol, the active form of vitamin E.85,86,87 Smoking immediately causes oxidant stress in blood while the antioxidant potential is reduced because of this stress.88 This dangerous imbalance cannot be neutralized and results in immediate cell, gene, and blood vessel damage.89 In addition, a National Cancer Institute study found that betacarotene supplements, which contain precursors of vitamin A, modestly increase the incidence of lung cancer and overall mortality in cigarette smokers.90,91

Immediate and Rapid Effects on Drug Interactions Drug breakdown, or metabolism, is important to drug effectiveness and safety. Medicines are naturally broken down into their components by enzymes. Factors that effect drug metabolism effect drug function. Factors that speed up drug metabolism decrease drug exposure time and reduce the circulating concentrations of the drug, which compromises the effectiveness of the prescription.92 Conversely, factors that slow down drug metabolism increase the circulating time and concentration of the drug, allowing the drug to be present at harmful levels. Tobacco smoke interferes with many medications by both of these mechanisms.93 For example, the components of tobacco smoke hasten the breakdown of some blood-thinners, antidepressants, and anti-seizure medications; and tobacco smoke also decreases the effectiveness of certain sedatives, painkillers, heart, ulcer, and asthma medicines. 94 Tobaccos Immediate Effects on the Body / 6 Especially Vulnerable Populations Asthmatics. Mainstream or Environmental Tobacco Smoke (ETS) exacerbates asthma symptoms in known asthmatics. In addition, some studies have shown a link between ETS in childhood and a higher prevalence of asthma in adulthood.95 Infants and Children. Infants and children exposed to Environmental Tobacco Smoke (ETS) are at increased risk for death and disease. Mothers who smoke during pregnancy are known to have low birth-weight babies. In breastfeeding women who smoke, there is a decrease in maternal milk production and less weight gain in the exposed infant. 96 In addition, infants whose mothers smoke have an increased risk of Sudden Infant Death syndrome (SIDS), and their overall perinatal mortality rate is 25-56% higher than those infants of mothers who choose not to smoke. 97 Children exposed to ETS are at increased risk of many infections, most commonly middle ear and respiratory infections, and thus require more doctor visits and hospital stays. Sickle Cell Patients. Patients with sickle cell anemia who smoke are known to have increased incidence of Acute Chest Syndrome.98 Acute Chest syndrome is a condition that presents with severe chest pain, and is a life-threatening emergency. Conclusion While some of these effects are wholly or partially reversible upon quitting smoking, research has shown that many are not. Quitting smoking provides enormous health benefits, but some smoking-caused damage simply cannot be reversed.99 Moreover, many of the effects outlined here can cause considerable

harm to kids and others soon after they begin smoking and well before they become long-term smokers.
Campaign For Tobacco-Free Kids, September 17, 2009

This report was originally developed by Dr. Jen Doe and Dr. Chris DeSanto from Georgetown Hospital's community pediatrics program while serving as interns at the Campaign for Tobacco-Free Kids, with subsequent work done by Dr. David Granger and Dr. Stacey Cohn during separate internships at the Campaign, and by future doctors Brent Tamamoto and Stacey Smith, while at the Campaign through American Medical Student Association internships. Related Campaign Fact Sheets (available at http://www.tobaccofreekids.org) The Path to Smoking Addiction Starts at Very Young Ages Smoking & Kids Tobacco Harm to Kids Tobacco Use Among Youth Health Harms from Tobacco Use Smoking and Decreased Physical Performance 1 American Academy of Pediatrics October 1998 Child Health Month Report: The Risks of Tobacco Use: A Message to Parents and Teens; Milam JE, Perceived invulnerability and cigarette smoking among adolescents, Addictive Behaviors, 25(1): 71-80, Jan-Feb, 2000. 2 Russell MA, The nicotine addiction trap: A 40 year sentence for four cigarettes, British Journal of Addiction, 85(2): 293-300, February, 1990. 3 DiFranza JR, et al., "Tobacco Acquisition and Cigarette Brand Selection Among Youth," Tobacco Control, 3: 334-38, 1994. 4 Hogan MJ, Adolescent Medicine: Diagnosis & Treatment of Teen Drug Use, The Medical Clinics of North America, 84(4): 927-66, Jul 2000. 5 Substance Abuse & Mental Health Services Administration, (SAMHSA), HHS, Results from the 2008 National Survey on Drug Use and Health, NSDUH: Detailed Tables, http://www.oas.samhsa.gov/NSDUH/2K8NSDUH/tabs/Sect4peTabs10to11.pdf 6 DiFranza, et al, Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development & Assessment of Nicotine Dependence in Youths) Study, Archives of Pediatrics & Adolescent Medicine, 156(4): 397403, April 2002. 7 Caumo W, et al, Risk factors for preoperative anxiety in adults, Acta Anaestheiologica Scandinavica, 45(3): 298-307, March 2001. 8 Parrott AC, Does Cigarette Smoking Cause Stress?, American Psychologist, 54(10): 817-20, October 1999.

9 Dagher A, Bleicher C, Aston JA, Gunn RN, Clarke PB, Cumming P, Reduced dopamine D1 receptor binding in the ventral striatum of cigarette smokers, Synapse, 42(1): 48-53, October 2001. 10 Di Chiara G, Acquas E, Carboni E. Drug Motivation and abuse: A neurobiological perspective, Ann NY Acad Sci 1992 654:207-219. 11 Pfaus JG, et al., Sexual behavior enhances central dopamine transmission in the male rat, Brain research 1990 430:345-348 12 Gamberino WC & Gold MS. Neurobiology of Tobacco Smoking & Other Addictive Disorders, The Psychiatric Clinics of North Americ,a June 1999 22(2):301-312. Tobaccos Immediate Effects on the Body / 7 13 Shadel WG, et al., Current models of nicotine dependence: what is known and what is needed to advance understanding of tobacco etiology among youth, Drug & Alcohol Dependence 59 Suppl 1(2000) S9-S21. 14 Trauth JA. An animal model of adolescent nicotine exposure: effects on gene expression and macromolecular constituents in rat brain regions, Brain Res, June 2000 867(1-2): 29-39. 15 Trauth JA, et al., Persistent and delayed behavioral changes after nicotine treatment in adolescent rats, Brain Res 880(1-2), Oct. 2000. 16 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company. 17 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company; Brodish PH, The Irreversible Health Effects of Cigarette Smoking, The American Council on Science & Health, June 1998, http://www.acsh.org/publications/pubID.377/pub_detail.asp. 18 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company; Brodish PH, The Irreversible Health Effects of Cigarette Smoking, The American Council on Science & Health, June 1998, http://www.acsh.org/publications/pubID.377/pub_detail.asp; Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 46398, September 1999; U.S. Department of Health & Human Services (HHS), Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994. 19 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company; U.S. Department of Health & Human Services (HHS), Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994. 20 Takeyama K, et al, Activation of epidermal growth factor receptors is responsible for mucin synthesis induced by cigarette smoke. American Journal of Physiology: Lung Cellular & Molecular Physiology, 280(1): L165-72, January, 2001. 21 Maestrelli P, et al, Remodeling in response to infection and injury. Airway inflammation and hypersecretion of mucus in smoking subjects with chronic obstructive pulmonary disease, American of Respiratory & Critical Care Medicine, 15; 164(10 Pt 2): S76-80, Nov. 2001.

22 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company; Brodish PH, The Irreversible Health Effects of Cigarette Smoking, The American Council on Science & Health, June 1998, http://www.acsh.org/publications/pubID.377/pub_detail.asp; U.S. Department of Health & Human Services (HHS), Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994. 23 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company; Brodish PH, The Irreversible Health Effects of Cigarette Smoking, The American Council on Science & Health, June 1998, http://www.acsh.org/publications/pubID.377/pub_detail.asp; Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 46398, September 1999; U.S. Department of Health & Human Services (HHS), Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994; Gold DR, Effects of cigarette smoking on lung function in adolescent boys and girls, New England Journal of Medicine, 335(13): 931-7, September 26, 1996. 24 Louie D., The effects of cigarette smoking on cardiopulmonary function and exercise tolerance in teenagers, Canadian Respiratory : Journal of the Canadian Thoracic Society, 8(4): 289-91, July-August, 2001. 25 Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 463-98, September 1999. 26 U.S. Department of Health & Human Services (HHS), Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994. 27 Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 463-98, September 1999. 28 Cotran; Robbins Pathologic Basis of Disease, 6th Edition, 499-503, 1999. 29 Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 463-98, September 1999. 30 Otsuka R, et al., Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults, Journal of the American Medical Association, 286(4): 436-41, July 25, 2001. 31 Hioki H, et al, Acute effects of cigarette smoking on platelet-dependent thrombin generation, European Heart Journal, 22(1):56-61, Jan. 2001. 32 Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 463-98, September 1999. 33 Brodish PH, The Irreversible Health Effects of Cigarette Smoking, The American Council on Science & Health, June 1998, http://www.acsh.org/publications/pubID.377/pub_detail.asp ; Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 46398, September 1999.

34 Barua RS, et al, Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: an in vivo and in vitro correlation, Journal of the American College of Cardiology, 39(11): 1758-63, June 5, 2002. 35 Barua RS, et al, Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: an in vivo and in vitro correlation, Journal of the American College of Cardiology, 39(11): 1758-63, June 5, 2002. 36 Tsuchiya M, et al, Smoking a single cigarette rapidly reduces combined concentrations of nitrate and nitrite and concentrations of antioxidants in plasma. Circulation, 105(10): 1155-7, March 12, 2002. 37 Barua RS, et al, Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: an in vivo and in vitro correlation, Journal of the American College of Cardiology, 39(11): 1758-63, June 5, 2002. 38 U.S. Department of Health & Human Services (HHS), Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994. 39 Rose JE, et al, Acute effects of nicotine and mecamylamine on tobacco withdrawal symptoms, cigarette reward and ad lib smoking. Pharmacology, Biochemistry & Behavior, 68(2): 187-97, February, 2001. Tobaccos Immediate Effects on the Body / 8 40 Pickworth WB, et al, Sensory and physiologic effects of menthol and nonmenthol cigarettes with differing nicotine delivery. Pharmacology, Biochemistry & Behavior, 71(1-2): 55-61, January-February, 2002. 41 Rose JE, et al, Acute effects of nicotine and mecamylamine on tobacco withdrawal symptoms, cigarette reward and ad lib smoking. Pharmacology, Biochemistry & Behavior, 68(2): 187-97, February, 2001; Pickworth WB, et al, Sensory and physiologic effects of menthol and non-menthol cigarettes with differing nicotine delivery. Pharmacology, Biochemistry & Behavior, 71(1-2): 5561, January-February, 2002. 42 Primatesta P, et al, Association between smoking and blood pressure, Hypertension, 37:187-193, 2001. 43 Righetti M & Sessa A, Cigarette smoking and kidney involvement. Journal of Nephrology, 14(1): 3-6, January-February 2001. 44 Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000; Kadakia SC, et al., Original contributions: Effect of Cigarette smoking on Gastroesophageal Reflux Measured by 24 h Ambulatory Esophageal pH Monitoring, American Journal of Gastroenterology, 90(10): 1785-1791, October 1995; Kahrilas PJ, Mechanisms of acid reflux associated with cigarette smoking, Gut, 31(1): 4-10, January 1990. 45 Brodish PH, The Irreversible Health Effects of Cigarette Smoking, The American Council on Science & Health, June 1998http://www.acsh.org/publications/pubID.377/pub_detail.asp; Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000; Kadakia SC, et al., Original contributions: Effect of Cigarette smoking on Gastroesophageal Reflux Measured by 24 h Ambulatory Esophageal pH Monitoring, American Journal of Gastroenterology, 90(10): 1785-1791, October

1995; Karilas, 1990; Wo JM & Waring JP, Medical Therapy of Gastroesophageal Reflux and Management of Esophageal Strictures, Surgical Clinics of North America, 77(5): 1041-62, October 1997. 46 Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000; Katz PO, Gastroesophageal Reflux Disease, Journal of the American Geriatrics Society, 46(12): 1558-65, Dec. 1998. 47 Smit CF, et al, Effect of cigarette smoking on gastropharyngeal and gastroesophageal reflux. The Annals of Otology, Rhinology & Laryngology, 110(2):190-3, February 2001. 48 Falk GW, Barretts esophagus, Gastroenterology, 122(6): 1569-91, May 2002. 49 Swisher SG, et al, Gastroesophageal junction adenocarcinoma, Current Treatment Options in Oncology, 1(5): 387-98, December 2000. 50 Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 51 Coroll: Primary Care medicine, 3rd Edition, 1995. 52 Ma L, et al, The role of polyamines in gastric mucus synthesis inhibited by cigarette smoke or its extract. Gut, 47(2): 170-7, August 2000. 53 Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 463-98, September 1999; Cotran; Robbins Pathologic Basis of Disease, 6th Edition, 499-503, 1999; Coroll: Primary Care medicine, 3rd Edition, 1995. 54 Shin VY, et al, Cigarette smoke extracts delay wound healing in the stomach: involvement of polyamine synthesis. Experimental Biology & Medicine (Maywood, NJ), 227(2): 114-24, February 2002. 55 Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000; Kadakia SC, et al., Original contributions: Effect of Cigarette smoking on Gastroesophageal Reflux Measured by 24 h Ambulatory Esophageal pH Monitoring, American Journal of Gastroenterology, 90(10): 1785-1791, October 1995; Kahrilas, 1990. 56 Sabiston: Textbook of Surgery, 15th Edition, 1997. 57 Mitchell B, et al., Tobacco Use and Cessation: The Adverse Health Effects of Tobacco and Tobacco-Related Products, Primary Care: Clinics in Office Practice, 26(3): 463-98, September 1999; Cotran; Robbins Pathologic Basis of Disease, 6th Edition, 499-503, 1999; Coroll: Primary Care medicine, 3rd Edition, 1995; Sabiston, 1997. 58 Palmer RM, Potential mechanisms of susceptibility to periodontitis in tobacco smokers, Journal of Periodontal Research, 34(7): 363-9, October 1999; Genco RJ Current view of risk factors for periodontal diseases, Journal of Periodontology, 67(10 suppl): 1041-9, October 1996. 59 Obeid P, Bercy P, Effects of smoking on periodontal health: a review. Advances in Therapy; 17(5): 230-7, September-0ctober 2000.

60 Fredriksson M, Bergstrom K, Asman B, IL-8 and TNF-alpha from peripheral neutrophils and acute-phase proteins in periodontitis. Journal of Clinical Periodontology, 29 (2): 123-8, February 2002. 61 Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000. 62 Johnson GK, Slach NA, Impact of tobacco use on periodontal status, Journal of Dental Education, 65(4):313-21, April 2001. 63 Katz PO, Gastroesophageal Reflux Disease, Journal of the American Geriatrics Society, 46(12): 1558-65, Dec. 1998; Belfiglio G, Breath Mint. Two words are the centerpiece of HealthPartners successful anti-tobacco campaign, the winner of AAHPs Community Leadership Award, Healthplan, 38(4): 4652,54, July-August 1997; Lamkin L & Houston TP, Adolescent Medicine: Nicotine Dependency & Adolescents: Preventing & Treating, Primary Care, 25(1): 123-35, March 1998; U.S. Preventive Services Task Force, Guidelines from Guide to Clinical Preventive Services, Second Edition,1996.. 64 Moszczynski P, et al, Immunological findings in cigarette smokers. Toxicology Letters, 118(3): 121-7, January 3, 2001. 65 Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000; DiFranza JR & Lew RA, Morbidity and Mortality in Children Associated with the Use of Tobacco Products by Other People, Pediatrics, 97(4): 560-8, April 1996; Daly KA, et al, Knowledge and Attitudes about Otitis Media Risk: Implications for Prevention, Pediatrics, 100(6): 931-6, December 1997; Stenstrom C, Otitis-prone Children and Controls: A study of possible predisposing factors. 2. Physical findings, frequency of illness, allergy, daycare, and parental smoking, Acta Oto-laryngologica, 177(5): 696-703, September 1997. 66 Agius AM, Smoking and middle ear ciliary beat frequency in otitis media with effusion, Acta Oto-layrngologica, 115(1): 44-49, January 1995. 67 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company.

Tobaccos Immediate Effects on the Body / 9 68 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company; Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000; Pedersen M, Ciliary activity and pollution, Lung, 168 (supplement): 368-76, 1990; Proctor DF, Nasal mucus transport and our ambient air, Laryngoscope, 93: 58-62, January, 1983. 69 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company. 70 Lieu JE, Feinstein AR, Confirmations and surprises in the association of tobacco use with sinusitis, Archives of OtolaryngologyHead & Neck Surgery, 126(8):940-6, August 2000. 71 Lasley MV & Shapiro GG, Pediatric Allergy and Immunology: Rhinitis and Sinusitis in Children, Immunology & Allergy Clinics of North America, 19(2): May 1999. 72 Fitzpatrick TM & Blair EA, Smoking and pulmonary and Cardiovascular Disease: Upper Airway Complications of Smoking, Clinics in Chest Medicine, 21(1): 147-157, March, 2000. 73 Lasley MV & Shapiro GG, Pediatric Allergy and Immunology: Rhinitis and Sinusitis in Children, Immunology & Allergy Clinics of North America, 19(2): May 1999. 74 Coroll: Primary Care medicine, 3rd Edition, 1995; Paul ME & Shearer WT, Pediatric Allergy and Immunology: The Child Who Has Recurrent Infection, Immunology & Allergy Clinics of North America, 19(2): May 1999. 75 Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 76 Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 77 Goldman: Cecil Textbook of medicine, 21st Edition, 2000; Munro LH, Plasma RRRalpha-tocopherol concentrations are lower in smokers than in non-smokers after ingestion of a similar oral load of this antioxidant vitamin, Clinical Science [London], 92(1): 87-93, January 1997. 78 Goldman: Cecil Textbook of medicine, 21st Edition, 2000; Feldman: Sleisenger & Fordtrans Gastrointestinal & Liver Disease, Sixth Edition, 1998. 79 Goldman: Cecil Textbook of medicine, 21st Edition, 2000; Feldman: Sleisenger & Fordtrans Gastrointestinal & Liver Disease, Sixth Edition, 1998. 80 Goldman: Cecil Textbook of medicine, 21st Edition, 2000; Feldman: Sleisenger & Fordtrans Gastrointestinal & Liver Disease, Sixth Edition, 1998. 81 Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 82 Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 83 Gidding SS, Pediatric Cardiology; Preventive Pediatric Cardiology- Tobacco, Cholesterol, Obesity, and Physical Activity, Pediatric Clinics of North America, 46(2): 253-262, April 1999. 84 Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 85 Traber MG, et al., Smoking and Pulmonary and Cardiovascular Disease- TobaccoRelated Diseases: Is there a Role for Antioxidant Micronutrient Supplementation? Clinics in Chest Medicine, 21(1): 173-87, March 2000. 86 Liu CS, et al, Autoantibody against oxidized low-density lipoproteins may be enhanced by cigarette smoking. Chemico-Biological Interactions, 127(2): 125-37, July 3, 2000.

87 Tsuchiya M, et al, Smoking a single cigarette rapidly reduces combined concentrations of nitrate and nitrite and concentrations of antioxidants in plasma. Circulation, 105(10): 1155-7, March 12, 2002. 88 Durak I, et al, Acute effects of smoking cigarettes with different tar content on plasma oxidant/antioxidant status,Inhalation Toxicology 12(7): 641-7, July 2000. 89 Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 90 Albanes D, et al, Alpha-tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention studye, Journal of the National Cancer Institute, 88(21):1560-70, November 6, 1996. 91 Albanes D, Beta-carotene and lung cancer: a case study. The American Journal of Clinical Nutrition, 69(6): 1345S-1350S, June 1999. 92 Desai HD, Seabolt J, Jann MW, Smoking in patients receiving psychotropic medications, CNS Drugs 15(6): 469-94, 2001. 93 Eke BC, Iscan M, Effects of cigarette smoke with different tar contents on hepatic and pulmonary xenobiotic metabolizing enzymes in rats. Human & Experimental Toxicology, 21(1): 17-23, January 2002. 94 Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright 2000 W.B. Saunders Company; Goldman: Cecil Textbook of medicine, 21st Edition, 2000. 95 Larsson ML, et al. Environmental Tobacco Smoke Exposure During Childhood is Associated With Increased Prevalence of Asthma in Adults. Chest. 120(3): September 2001. 96 Committee on Drugs, 2000-2001, The transfer of drugs and other chemicals into human milk, Pediatrics 108(3): 776-789, September 2001. 97 Committee on Artherosclerosis & Hypertension in Children. Active and Passive Tobacco Exposure: Aserios Pediatric Health Problem. Circulation Vol 90 (5): 25812590, November 1994. 98 Young RC, et al, Smoking is a factor in Causing Acute Chest Syndrome in Sickle Cell Anemia Journal of the National Medical Association, 84(3): 267-271, March 1992. 99 Brodish, P., The Irreversible Health Effects of Cigarette Smoking, June 1998, http://www.acsh.org/publications/pubID.377/pub_detail.asp.

Philippines top smoking country in Southeast Asia



Published on 17 August 2012 Hits: 4,203 Written by Jovee Marie N. Dela Cruz, Reporter 0 80 24 1517

THE Philippines is now number one in smoking in Southeast Asia, the Department of Health said on Thursday. In a statement citing World Health Organization (WHO) studies, Health Secretary Enrique Ona said that the country tops its regional neighbors in terms of smoking. He added that the number of teenage smokers is rising. Boys between 13 and 15 years old comprise 28.3 percent of tobacco users in the country today, while girls in the same age group make up 17.5 percent, according to Ona. The Health secretary said that the total annual cost of the top four smoking-related diseaseslung cancer, chronic obstructive pulmonary disease, coronary artery disease, and cardiovascular diseasereached P177 billion in 2011. In the Philippines, the top four killers of our people are diseases related to smoking: ischemic heart disease, strokes, emphysema and cancer of the lungs, trachea and the gastrointestinal tract, Ona said. He added that tobacco use is a risk factor for six out of eight preventable deaths in the world. Ona also said that the countrys annual spending for the treatment of smoking-related diseases was higher compared to the P26 billion collected by the government from tobacco companies. He added that excessive alcohol drinkingdefined as the daily intake of more than 40 grams in men and more than 20 grams in womenis a risk factor for liver, cardiovascular, neurological, and psychiatric illnesses.

The Health department had said that at least 17.3 million people smoke in the country, while 87,000 die of tobacco-related diseases annually.

f we love life keep it smoke free and clean


Date Published: February 05, 2013

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Written by Fr. Shay Cullen

Does a 150 meter high smoke stack belching black fumes from a coal-burning power plant do more harm to children than burning ten million cigarettes? We may never know the answer to that but each has the same results - suffering lung damaged children gasping for breath hour after hour, with tears streaming down their cheeks. It is happening right here on beautiful Subic Bay. It will be much worse as the Subic Bay Management Authority (SBMA) board members are trying to get more money from RP Energy before they approve the 600 MW coal plant.

The huge Smoke and steam stacks will be an aeronautical hazard to planes coming in to land and taking off at the Subic Bay airport.

Experienced 747 Jumbo Jet lifelong pilot David Beechcroft-Kay says international pilots like him would not fly into Subic if the smoke stacks are built. In his life he never flew into an airport with giant smoke stacks nearby. The government authorities in Manila approved the planned twin towers but allegedly it was based on faulty information provided by the power company. The stack will scare passengers too and electric magnetic impulses from the huge turbines will affect navigational instruments,.experts say. The airport will be dangerous and unsafe. The thing is the US navy will not want to risk flying into that airport under the VFA. The airport will not get FAA international clearance for commercial flights. So the airport will be useless. Its goodbye happy tourists and hello to coal-caused dirty diseases. Fumes smoke, gases and air pollution of all kinds kill and hurt people especially children. Thousands of children world wide are struck down with asthma. This is

the direct result of secondary cigarette smoke. How many more victims will there be from huge smoke belching coal plants? Coal is dirtiest fossil fuel of all. Asthma in children is the most distressing and frightening result of irresponsible parents, relatives or neighbors smoking cigarettes in the presence of young children. Tobacco and coal fired power plants company executives ought be made to visit the childrens hospitals and see the results of their dirty work. They ought to know and see that suffering to know what hell on earth they are creating for the children. Perhaps they will change to renewable energy production like geothermal, wind power and solar power.

Recently a 2 -year-old child called Ralph was so damaged by the secondary smoke from his fathers cigarettes that he almost choked and suffered lung failure as a result. He had an asthma attack and was unable to breath and was turning blue in the face from the extreme effort. He was rushed to the hospital still gagging where he was put on a nebulizer with medication that helped him breath.

The ban on smoking in enclosed public palaces in the UK in 2007 has brought about a big reduction in the number of children admitted to hospitals across the UK. The good news is, it worked. There has been a 12.3 percent fall in the hospital admission rates. If such a thing could cruelly inflict over 26,969 children with severe attacks how much more damage does a smoke belching stack of a coal power plant do? It will cause hundreds of sever asthma attacks and afflict thousands of children who will be puking their lungs out day after day. Thats just one of the damaging effects of burning black sooty coal to produce electricity. Coal is the dirtiest and most dangerous source of electric generation after nuclear. I repeat what I wrote previously, coal plants saturate the air we breath with toxic chemicals that accumulate in our bodies 24 hours-a-day doing the damage that cannot be stopped. People living within the 50- kilometer danger zone of a coal plant are doomed to a shorter life and possibly a very painful death.The reason they build the smoke stacks so high is to carry away the deadly fumes from their own plant operators and neighbors, otherwise people close to the plant would be dropping dead like flies sprayed with pesticide.

The worst chemical of all coming from burning coal for electric generation is mercury, a toxic killer if ever there was one. What is almost almost as bad are the

radioactive cancer causing uranium that is found in the air near coal plants. Small amounts that accumulate in our bodies over time can kill us dead just as an arrow through the heart, only a lot more painfully. Sulphur, nitrogen compounds, silicon, aluminum, are being pumped into the air around us carried by the wind and sucked into our lungs with every breath. If we love life and our world we need to keep it smoke free and clean.
reposted from manilatimes.net, February 03 2013

http://www.smokefree.doh.gov.ph/section_show.php?name=News&id=311