A Qualitative Study of Smoking

Behaviors Among Teenager

in Philippines
(Science, Technology, Engineering & Mathematics) 11- FLEMING

Lontok,John Felix P.

Paiste, Jayson

Javier, Joshua

Meera, Russel Jake

Romero, Kelvin

2019
 CHAPTER I

The Problem and Its Background

Introduction

The Problem

Smoking is a hard habit to break because tobacco contains nicotine, which is

highly addictive. Like heroin or other addictive drugs, the body and mind quickly become

so used to the nicotine in cigarettes that a person needs to have it just to feel normal.

People start smoking for a variety of different reasons. Some think it looks cool. Others

start because their family members or friends smoke. Statistics show that about 9 out of

10 tobacco users start before they're 18 years old. Most adults who started smoking in

their teens never expected to become addicted. That's why people say it's just so much

easier to not start smoking at all.

Tobacco consumption is the second major cause of death and the fourth most common

risk factor for diseases, worldwide. Epidemiologic studies have traced the use of alcohol,

tobacco, and illicit substances among medical students and physicians.

Its Background

Smoking remains an increasing high-risk behaviour among the youth, despite its

harmful effects on health. This study sought to find out the determinants of cigarette

smoking among youth of a rural Nigerian community and suggested intervention

measures which have potential for the control of smoking among in-school population.

Smoking tobacco has become a usual thing in our culture nowadays. A person

with a cigarette is a usual thing: we can see them on the street, actors smoke in films,

there are also book characters who smoke, we have relatives or friends who smoke.

Starting as mainly as a part of a religious ritual a long time ago, it has become a routine

thing for us.

A Pulse Asia survey conducted form January 26 to 31, 2019 found that 9 out of 10

Filipinos agreed to measures such as raising the minimum age for the purchase of

cigarettes from 14 to 19 years old.

Smoking has been identified as the single most important cause of

preventablemorbidity and premature death. Although many of the adverse health effects

oftobacco occur later in life, smoking has health implications for young people and

isassociated with other high-riskbehavior

among young people including abuse ofother drugs, fighting and high-risk sexual

behavior. Smoking is commonly seennowadays to college students. Many studies have

reported that tobacco smoking isrising in young adult between the ages of 18-24 years as

they are legal targets oftobacco industry marketing and increased the prevalence of

smoking among collegestudents (Aslan, et al, 2014).

Like most people, you already know that smoking is bad for your health. But do

you really understand just how dangerous smoking really is? Tobacco contains nicotine, a

highly addictive drug that makes it difficult for smokers to kick the habit. Tobacco

products also contain many poisonous and harmful substances that cause disease and

premature death. Did you know that out of a group of 1000 smokers (age 30), that a full

quarter of them (250!) will die of smoking-related illnesses prior to completing middle

age, an additional quarter will die prematurely from smoking-related illnesses shortly

after retirement age, and another large group will develop disabling chronic illnesses as a

result of their smoking? Most people don't know the odds of getting sick as a result of

smoking are really that bad, but when you calculate the numbers, that is how they come

out. For many people, truly understanding the very real dangers associated with smoking

becomes the motivating factor that helps them to quit.

Although it can be a very difficult habit to break, smoking is ultimately a choice;

it is your responsibility to choose whether or not you will continue to smoke. This article

provides a brief synopsis of the risks associated with smoking; an overview of nicotine

addiction, including why it is so difficult to give up smoking; and an outline of the

advantages and disadvantages of quiting. Once you have decided to quit, you will benefit
from the information in this article about the physiological, psychological, and behavioral

aspects of nicotine addiction; the different methods available to help you quit; and the

steps you can take to make the process easier. Learning about and understanding the

many facets of the smoking habit can put you on the right track to successful smoking

cessation.

Review of Literature and Studies

The review of related literature for this study focuses more on the smoking banson other

countries and its effects on the perceptions and smoking behavior of people.The review includes both

local and international studies. The researchers believe thatthe following studies are very much related to

the problem; thus providing other possibleadditional effects of the smoking ban to the smoking behavior

to the target respondents:Teenager in Philippines.

Synthesis

The FDA has a legislative mandate to require new warnings on cigarette packs

that communicate the health risks of smoking. In this supplement to an existing research

grant, researchers will synthesize the published literature on the impact of warnings on

smoking-related outcomes and then will conduct an experiment in which they label

smokers’ own cigarette packs with text or graphic warnings to examine real-world impact

on smoking behavior. Specific aims are: (1) to assess the impact of cigarette pack

warnings by conducting a systematic review and meta-analysis of the existing literature;

and (2) to test the impact of cigarette pack warnings on smoking behavior. To accomplish

Aim 1, researchers will search research databases and examine references in review and
primary articles, code relevant articles for important study characteristics, and conduct a

separate analysis for each key outcome (i.e., cognitive and emotional reactions, risk

perception, intention to quit, and the moderating effects of income, race/ethnicity, age,

smoking status, sampling method, and study design). To accomplish Aim 2, researchers

will randomly assign 2,250 smokers aged 18-65 to one of seven experimental conditions

in which smokers’ cigarette packs are labeled with a warning (i.e., three text-only

warnings, three graphic warnings, and the current Surgeon General’s warning as a control

condition). Researchers will then assess the relationship between warning type (i.e., text

or graphic) and cessation behaviors (i.e., quitting, attempting to quit, smoking fewer

cigarettes); evaluate the impact of graphic warnings on emotional and cognitive reactions,

perceived risk of smoking-related harm, discouragement from smoking, and quit

intentions; and examine whether the impact of warnings varies by income level. This

research may inform future regulatory activities related to cigarette pack warning labels.

Conceptual Framework

In this paper, we present a conceptual framework for understanding factors that

contribute to the use of MTPs. Our framework includes Person, Product, and

Context/Situation factors (and their interactions) that influence tobacco-product use. The

framework is meant to be useful in understanding the mechanisms that lead to MTP use

in the first place and for understanding how/when MTPs are used and/or discontinued by

an individual. The framework is also meant to be useful in understanding how changes in

the use of any one tobacco product influence the use of other tobacco products.

Illustrative examples of variables that influence MTP use under each category are

described—but they are not exhaustive. In addition, the impact of MTP use on toxicant

exposure and health outcomes are not considered here. Moreover, given the state of the

existing literature and for the sake of simplicity and illustration, we focus the majority of

our examples on dual tobacco-product use. Additionally, the focus of our conceptual

framework and discussion largely applies to the use and/or adoption of MTP among

current tobacco users; less attention is given to MTP use during the initiation and early

experimentation with tobacco products. After describing the framework, we provide a

map for how different regulatory actions target specific factors, in an effort to better

understand where such actions can have influence and how such actions on one STP

influence the use of other tobacco products. Our conceptual framework draws on and

synthesizes elements from a number of health behavior theories (eg, Theory of Triadic

Influence the Health Belief Model, and Reasoned Actionand Planned Behavior

Theorybut also draws from marketingand behavioral economicliteratures.

Research Paradigm

The most difficult form of collaboration requires developing a new language and

the questioning of the very core assumptions of the existing disciplines. These

assumptions are often so implicit in our thinking that we take them for granted. It also

requires a fundamental change in attitude among scientists. Scientists must be secure,

confident, and competent in their own discipline. Scientists must be open to each other's

disciplines and resist the stereotyping of disciplines that become insurmountable barriers

to mutual respect and collaboration (Kahn &Prager, 1994). There is no such thing as

biology being 'hard' science and psychological and social science being 'soft.' Basic

research is not only molecular biology, neuroscience, or animal research; it is also

epidemiology, the study of cognitive schemata, and of the psychological mechanisms

underlying motivation. Basic research includes the sociocultural analysis of the macro-

economic forces that influence neighborhood pockets of disproportionate smoking

prevalence, and exploration of the fundamental mechanisms that facilitate or impede the

rapid diffusion of new preventive interventions at the school, community, or state level.

There is only 'good' or 'bad' science--not hard or soft science. Development of common

methods, measures, and language are essential to foster transdisciplinary research and the

creation of new paradigms. Methods and measures must be considered that are

appropriate to each level or unit of analysis, such as at national, state, community,

organization, small group, family, individual, behavioral, cognitive-emotional,

psychopbysiological, neurochemical, molecular, and cellular levels (Anderson, 1995).

New work will be needed in basic methods and measurement development to produce

individual profiles of risk and protective factors as well as aggregate data concerning

ban'iers and facilitators. Both idiographic (within an individual over time) as well as

nomothetic (across individuals) perspectives are needed. At the aggregate level,

establishing tracking and surveillance systems around the nation could produce timely

'report cards' to inform such a general systems approach. As illustrated by the work of

Chaloupka and colleagues (this special issue, p. xxx), individual patterns of tobacco use

are strongly influenced by the proximal and distal aggregate units such as household,

block, neighborhood, and community. This approach is facilitated by the informatics

revolution and also by the latest statistical applications that can be used to model

multivariate hierarchical systems across time, such as structural equation models and

general estimating equations. The complex interaction between macro-socioeconomic

forces, pockets of prevalence at community and neighborhood levels, and the more

proximal units of social network, peer, family, and individual must be examined. The

aggregate levels must be linked to interactions with individuals and with intra-individual

factors, from cognitions to brain function to genes and cells. Biomedical to population

paradigms: from benches to bedsides to trenches The assumption in the biomedical

paradigm is of reductionisfic and molecular root causes. This paradigm isextended in

what biomedicine refers to as translational research from 'bench' and animal laboratory to

'bedside' in the form of the randomized controlled clinical trial. However, this paradigm

begins to break down when examining population trends where much variance remains

unexplained by the biomedical and individualdifference methodologies and measures

derived from the molecular disciplines (McKinlay, 1999). For example, 'pockets of

prevalence' in community smoking initiation rates are tied to the neighborhood as an

aggregate rather than an individual metric of measurement. This is an inherent

characteristic of the neighborhood (a defined population) rather than one of the individual

(Rose, 1992). A second and equally important type of translational research from clinical

trials to large-scale dissemination or diffusion interventions delivered to the 'real world

trenches' of whole populations or communities-- is often overlooked within the

biomedical research Culture. In this 'bench and bedside to trench' type of translational

research, the focus is on population change, and the measures of outcome shift from

individual (e.g., number of cigarettes smoked in 30 days) to aggregate (e.g., proportion of

high schools in a community with policies banning smoking and with evidence-based,

state-of-the-science, cessation-treatment programs); qualitative measures take on

increasing importance along with quantitative measures; the unit of intervention and

analysis changes from individual to aggregate and contextual factors (community

capacity, poverty, and social support), and intraclass correlations must be taken into

account. Intervention foci also shift. The outcome metric of efficacy in a randomized

controlled clinical trial is replaced by measures of effectiveness and cost, using concepts

such as efficiency of diffusion or impact (i.e., reach or penetration into a defined

population, multiplied by efficacy per incremental cost; see Abrams, Orleans, Niaura,

Goldstein, Prochaska, &Velicer, 1996). At the aggregate level, interventions must focus

on policy and enforcement of policy (e.g., limiting youth access to vending machines in

neighborhood 'morn-and-pop' stores). Observed patterns of tobacco use at aggregate

levels reveal anomalies that force a questioning of the fit of the biomedical paradigm. For

example, the gene pool of the population did not change so dramatically in the brief 100

years of the 20th century, when male tobacco use rose from almost zero in 1900 to an

epidemic in 1930-1960 (or in the 20 years it took for girls' and women's smoking

prevalence to rise to that of men in the 1960-1980 era). Examining alternative paradigms,

with their assumptions of a more holistic or populationbased nature, can help explain this

observed pattern. Such population-based paradigms can provide an alternative view--of

macro-socioeconomic factors as the ultimate root causes, as characteristics of a

population rather than of individuals (McKinlay, 1999; Rose, 1992). The 'causes of the

causes' are more likely to reside in economic forces and societal patterns of exposure and

availability than in single-gene or other 'magic bullet' variables in individuals. Because

differing paradigms have differing assumptions and languages, it is not surprising that
researchers can become polarized into two camps: those who believe that dramatic

reductions in tobacco use prevalence can only come from molecular research, versus

those who focus at the molar level--the macro-socioeconomic 'causes of the causes.' The

latter views appear to be at odds with those of researchers embracing a reductionistic

philosophy, searching for breakthrough research from a better understanding of genetics,

cellular mediators, and neuroscience, and developing methods that can improve screening

for profiles of risk and better tailoring of treatments.

The apparent conflict between biomedical and public health is exacerbated by

lack of common language, measures, and methods. Both camps clearly have much to

offer in informing each other and ultimately contributing to our Human Tobacco

Mapping Project. This expanded tobacco map embraces the molar level of societal

sources of smoking behavior and includes the multivariate and multi-factorial interactions

at all levels of structural organization, including the genetic level. Once again, a parallel

pattern emerges at the molar and molecular levels of systems organization. The pathways

and sources of change are multi-factorial, multilevel, and multi-determined at the molar

level--just as they are polygenic, multi-determined, and multi-factorial (and likely involve

a complex cascade of extracellular environmental switches) at the genetic or molecular

level.

Once biomedical and population scientists realize they are in the same boat,

common ground emerges. For example, the new tools of structural equation models are

proving useful when applied to population and genetic epidemiology and molecular
genetics. Common language can resolve the different conclusions one could draw when

employing different paradigms and their related levels of analysis, methodologies, and

measures. Such methods are appropriate to the particular unit or level of analysis. The

enormous opportunities at the boundary of the biomedical and the public health

paradigms can shed light on mechanisms and root causes at both molecular and molar

levels (Abrams et al., 1996; Abrams, Emmons, Niaura, Goldstein, & Sherman, 1991).

Researchers need to be open to developing new common languages, measures, and

methods, and to questioning fundamental assumptions implicit within their own

disciplines, be they biomedical or population/public health.

Research Objectives/ Statement of the Problem

The current study aimed to investigate the prevalence of cigarette smoking and

the related factors among the teenager in Philippines.

The aim of this research is to identify the impact of smoking behaviors among

teenager in the Philippines.

The objectives of this research can be defined as follows:

 To increase awareness and the intention to quit among smokers.

 To prevent the use of tobacco among young people and adults.

 To reduce access to tobacco products to minors.

 To reduce the influence of the tobacco industry on young people and adults

Hypothesis
 A new hypothesis is presented to explain some aspects of human smoking

behaviour. While acknowledging the importance of the nicotine self-titration

phenomenon, changes in puffing intensity during the smoking of a single cigarette are

related not to the control of nicotine uptake but to the modification of cigarette smoke

composition prior to inhalation. It is suggested that nicotine, in addition to its central

effects, has the local action of reducing the acute airway response to irritant

components of cigarette smoke. The new hypothesis explains some of the 'anomalous'

results of smoking behaviour research, and has implications both for cigarette design

and for the recommendations made to smokers by statutory health agencies.

Significance of the Study

The main rationale of this study is to contribute to the efforts

of InformationEducation and Communication of health campaigns on smoking cessation

programs by providing data on the extent of exposure to smoking cessation

programs andrecall of smokers ages 15-5.

In the Philippines, there are 17% or 4 million Filipino youth with ages 13-15 years whoalready

smoking. Of these early starters at 2.8 million are boys and 1.2 million are girls (Global Youth Tobacco

Survey, 2007). . About 17.3 million Filipinos aged 15 years old and above are tobacco user with atleast

13.8 million smoking daily, the Philippine Global Youth Tobacco Survey (GATS) showed in 2011. This

is serious issue that must be given attention. Survey results that show that most are likely start smoking
during their high school day . Thus, this study starts with 15 years old smokers. NCR chosen in order to

contributes MMDA’s vision of a smoke-free Manila.

Moreover, the smoking cessation programs provide messages that are very vital in

persuading smokers not smoke. Hence, the researchers want to know the messages in the

smoking cessations programs that make smokers recall. The smokers extent of exposure

to smoking cessation programs and recall are the factors that can affect the respondents

behavior of smoking.

In order to have more comprehensive view of extent of exposure and recall of the

respondents to smoking cessations program, the study use to Health Belief Model that

looks on the respondents perception, knowledge and practices toward smoking. The

HBM provides a framework that relates the specific objectives of this study to each

other; its provides a possible explanation of the respondents smoking behavior.

This study is a significant endeavor in promoting public health and proper law

implementation of RA9211. Hence, the knowledge of the respondents about

thedangers of smoking and the smoking law is determined in this study. It is

knownthat cigarettes can be purchased in tingi-tingi or by piece. Cigarette vendors

openlysells cigarettes in streets and sidewalks. This kind of strategy makes it easy

foranadolescent or a teenager to buy a stick violating a section in RA9211 that

prohibitss e l l i n g o f c i g a r e t t e s w i t h i n t h e 1 0 0 m e t e r p e r i m e t e r o f t h e s c

h o o l . T h e s t u d ythrough the awareness of the adolescent and teenagers on where to

buy cigarettesprovides incidental data if this law is followed.

 Hence this study is helpful to those government agencies like the

DepEd , DOH and MMDA; and Non-Government Organizations, (NGO’s)

who are promotinganti-smoking among the Filipinos today.

Scope and Delimitation of the Study

This study will be conducted in the school year 2019-2020. In addition, this study

focused on the impact of the Less Smoking Policy to the country of Philippines.

Theresearchers limit only their study about the implementation. The respondents

ofthis study are the residents in country of the Philippines.

Questionnairesand informal interviews will be used to gather information about

the saidtopic.

Limitations of the Study

It is recognized that no single machine smoking regime can represent the different

behaviors of individual human smokers. It has been argued that the current ISO standard

regime provides machine yields that are somewhat low for certain cigarette designs

compared to human intake. Various cigarette machine smoking regimes have been

proposed as options for regulatory use to provide data that reflect "average" or

"maximum" yields as related to human intake. Some public health representatives have

proposed that the intense regime mandated for testing in Philippines with 100% of the

ventilation holes in the cigarette filter blocked, should be used for product
characterization and that it is not necessary that it should reflect general human smoking

behavior.

We believe that this is a flawed approach because our studies and those of other

workers demonstrate that the conditions generated in the cigarette when using this intense

machine smoking regime are extreme in comparison to the conditions found for regimes

based more realistically on human smoking. In this paper, we provide data to show that

smokers modify their smoking intensity over the course of smoking in response to

changes in draw resistance, smoke concentrations and smoke temperatures. We compare

changes in and interactions between these parameters during puffing when smoking

cigarettes of different designs.

Cigarettes were smoked using various machine smoking regimes previously

proposed for smoke testing as well as a regime based on human smoking data from an

'in-house' study. Puffing parameters were derived from this study to represent the

'average smoker' under laboratory conditions and equivalent to the 90th percentile when

the studied smokers smoked under natural conditions. Biomarker data from human

uptake studies have shown that ventilation is an effective cigarette design tool to reduce

total smoke constituent uptake in humans so demonstrating that any blocking of filter

ventilation is far from 100%. Likewise, this current work also shows how smokers

modify their smoking behavior in ways not well reflected by the 100% ventilation

blocking regime. It seems logical that any machine smoking regime chosen for future

product regulation should reflect these findings for it to have valid public health

relevance. In addition, it seems misguided to discourage product design features, such as

ventilation, which clearly can provide products with reduced human smoke exposure, just

to maintain the dogma, counter to the scientific evidence, that there must be a regulatory

regime with 100% ventilation blocking.

Definition of Terms

Nowadays, the harmful effect of smoking is no secret to anyone, unfortunately it

is still causes the loss of lives for many adults and young peoples. The Ministry of Health

(MOH) seeks to control it and help smokers to quit to save their lives and protect them

against smoking-caused diseases and to secure healthy, comfortable and disease free life

for all members of community. The term "smoking" is not restricted to cigarette smoking

only, but includes e-cigarette, shisha and others.

Statistics:

Smoking in the Philippines kills 71 men and 21 women every week, or around

five thousand persons every year because of tobaccocaused diseases.

Key Facts:

 Smoking deprives you of living a disease-free life.

 Smoking slows down lung growth in children and teens.

  Smoking increases a person’s risk of getting tuberculosis and dying from it.

 It increases the risk of developing type2 diabetes

 It influences effectiveness of blood pressure medications.

 It speeds up appearance of wrinkles and skin aging.

 Some think smoking calm them down, while studies have shown that it increases
stress and anxiety.

 Tar in cigarette stains fingers and teeth.

 Nicotine in cigarette causes addiction as same as heroin and cocaine.

Passive Smoking:

 The likelihood of developing lung cancer and heart diseases increase among
inhalers of cigarette smoke and not only smokers.

 Deaths from heart diseases caused by passive smoking increased.

 Infants exposed to passive smoke are more likely to develop some diseases such
as bronchitis, pneumonia and ear infection.

Electronic Cigarette:

 The vapor from electronic cigarettes (e-cigarette) contains other substances that
can cause cancer; there is no way to compare it with fresh air.

 Most types of e-cigarettes contain nicotine, which is harmful to your health and
causes addiction.
Shisha:

Many people think that shisha is less harmful than smoking cigarettes but in fact,

it contains nicotine and has the same damages of smoking cigarettes.

Indirect Smoking:

This term refers to the inhalation of smoke hanging in the air from an

extinguished cigarette even with no strong odor. Studies have showed that it is air

polluting and harmful to health as same as the passive smoking, even opening windows,

in home or vehicle, is not enough to expel the smoke hanging around.

Complications:

 Nicotine causes addiction and constriction of blood vessels and arteries.

 Tar causes lung cancer and constriction of respiratory tract.

 Carbon monoxide reduces the red blood cells ability to transport oxygen, resulting
in less supply of oxygen to heart and other organs of the body and therefore

causing the followings:

1. Atherosclerosis and high blood pressure

2. Emphysema and bronchitis.

3. . Heart attack.

4. Atrophy of the optic nerve.

 5. Stroke

6. Teeth falling.

7. Cardiac infarction.

Nicotine:

Nicotine is a substance that can lead to addiction, when you inhale cigarette

smoke passes through your blood to reach the brain in less than 10 seconds.

Treatment:

The Ministry of Health (MOH), represented by the Smoking Control Program has

sought to develop therapeutic services to assist to help the smokers who like to quit the

habit through the following:

 Opening anti-smoking clinics in different regions and provinces of the Kingdom.

 Issuing

 Holding many theoretical and practical courses for workers in the field.

 Providing anti-smoking drugs to citizens without charges.

Preventions:

 Monitor tobacco use and prevention policies

 Contribute to helping others quit smoking.

 Enforce bans on tobacco advertising, promotion and sponsorship

 Raise taxes on tobacco, shish and others.

 Protect community for direct and indirect smoking.

 Warning those around you will save their lives.

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