The Relationship between Socio-Economic and Environmental Factors and Smoking among Teens and Adults in New Hampshire
Abstract
The paper seeks to review the relationship between socio-economic and environmental factors with smoking among teens and adults in New Hampshire. The paper is developed from a qualitative research process that involved an extensive review of the literature regarding smoking and factors that influence the decision to begin smoking or continue smoking despite numerous information regarding the health consequences of health smoking. The study established that social-economic and environmental factors do indeed influence smoking behavior because they determine the acceptable behavior and norms within society.
Introduction
Tobacco smoking is a major challenge in many societies. In fact, Tobacco smoking is not a leading cause of both premature and preventable deaths in the world but a serious concern with regard to individuals, environmental health, and wellbeing. In addition to the health problems that result from cigarette smoking, governments and individuals spent numerous resources to deal with both the direct and indirect effects of cigarette smoking despite losing many productive hours. Numerous attempts have been initiated to help curb or reduce the rates of cigarette smoking including numerous studies, documentation, and advertisements showing and making the consequences to health both immediate and long-term of cigarette smoking well known.
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Despite these efforts at educating, preventing, and curbing cigarette smoking, millions of people continue smoking, while many others also begin smoking raising the question regarding the influences and motivations that would drive someone to continue smoking or begin smoking despite knowing the risks to their health.
With foregoing in mind, the purpose of this paper is to add to the existing body of literature regarding the factors ( biological, psychological, social-economic, and environmental) that influence tobacco consumption with a specific focus of exploring whether, social-economic and environmental factors have an influence on the consumption and dependence of Tobacco among adults and adolescents in New Hampshire, USA. Further, the study provides actionable recommendations based on the identified evidence that can help reduce, control, and prevent tobacco use and dependence among adolescents and adults in New Hampshire.
Methodology
The study was conducted using a qualitative research method that involves an exploration and extensive review of existing literature from studies and articles focused on examining associations between smoking with socio-economic and environmental variables. All studies selected for the purpose of the literature review had to be directly related to smoking and had been published not earlier than the year 2010.
Literature Review
Background
Tobacco smoking is a major public health issue and challenge to many countries globally. This is despite the fact that cigarette or tobacco smoking is responsible for the highest cases of preventable diseases and deaths in the world (Johnson. et.al. 2018). Moreover, smoking poses huge burdens to both individuals’ countries and the environment. In the United States alone and according to the Centers for Disease Control and Prevention (CDC), more than 18.1% of the United States population are regular smokers, with 2,100 of these people, both adolescents and adults being daily smokers (Jamal et al., 2015). Moreover, Marshal. et.al, (2016) posits that smoking causes 480,000 deaths annually representing 1 in every 5 deaths recorded in the country.
In the state of New Hampshire, which forms the basis for this study, Tobacco use and dependence rank high according to the state's health improvement plan 2013-2020. This is because smoking and associated health problems are not only the major killer in the state but also because the state incurs numerous economic losses resulting from tobacco use and its associated effects. For instance, Tobacco smoking causes more than 1,764 deaths in the state each year (Johnson. et.al. 2018).
Moreover, the state runs into billions of economic expenses and consequences due to smoking. Despite the staggering consequences of smoking and attempts at preventing and controlling the use of tobacco, the state is among the highest ranking in terms of tobacco use with 19.5% regular smokers and over 1,700 adolescents becoming new smokers every year. The state, therefore, has a plan to not only reduce cigarette smoking among adults and adolescents but also prevent the number of new initiations by 2020.
The case of New Hampshire is therefore crucial to this study as it provides a basis for examining the factors, especially social-economic and environmental factors, and their relationship with cigarette smoking given that many people are still smoking and getting initiated into cigarette smoking despite numerous efforts to prevent or reduce smoking and huge costs associated with smoking. This is even more important to understand the influences among adolescent smokers given that over 80% of adult smokers began smoking during their adolescent or young adult ages (Mennis, Stahler & Mason, 2016). To achieve this, there is a need to understand the factors that influence smoking in order to establish preventive or advocacy measures.
Socio-Economic Status and Environmental Factors
Cigarette smoking or tobacco use in teens and even adults is determined by risk factors which may be biological social-economic or environmental, which either present themselves as protective or risks in terms of initiation or continued use of cigarettes US Department of Health and Human Services. (2012). While the protective factors reduce the likelihood that an individual will be initiated or continue smoking, the risk factors raise the probability or likelihood of being initiated or starting to smoke and continuing previous smoking behavior.
The personal or biological factors that influence an individual's likelihood or probability to either become a smoker or not include personal attributes such as impulsivity and rationality among others all associated with the construct of a person and individually unique (Trinidad, et. al. 2017). On the other hand, the social-economic and environmental factors arise from the society or environment that an individual lives in.
Human beings are inherently connected to other human beings; live in an interconnected society characterized by differences in age, ethnicities, race, religion, and class all of which determine their attitudes, beliefs, roles, and consequently behavior (Soneji, Sargent, Tanski & Primack, 2015). Within society, individuals are influenced by the practices that are considered appropriate or inappropriate depending on the society that they find themselves in. Social-economic and environmental factors can be defined as the attributes due to the society that determines the behavior of individuals within a particular society or environment. These factors are defined individually and separately as follows.
Social-economic factors: Social-economic factors explain an individual societal construct as well as their economic situation or position in a given society. They include age, gender, beliefs, culture, religion, ethnicity, class, race, employment, poverty, education, and parenting among others (Evans, Horn & Gray, (2015).
Environmental Factors: Environmental factors are factors due to the society or within a society that promotes or prevents the occurrence of certain behavior and in this case the use of tobacco or cigarette smoking. These factors include regulations, policies, and laws regarding tobacco use, ease of access to cigarettes, and interpersonal variables such as peer pressure.
Social-economic and environmental factors determine societal norms and behavior. Concerning cigarette smoking, these factors determine, when, where, who, and whether cigarette smoking is acceptable or not. For instance, according to Surgeon General’s report in 2012, there has been a reduction in smoking rates in the United States. For instance, in 1964, 50% of the adult male population in America were smokers; both women and children were smoking in large numbers because smoking was highly accepted in all parts of the country.
Moreover, there was increased advisements for cigarettes in the media and the fact that cigarette smoking was tied or associated to higher social class, sexual appeal, and glamour compared to the current period where only 18.7 percent of Americans regularly smoke due to increased awareness, improved living standards, tobacco controls, and education. US Department of Health and Human Services. (2012).
Further, cigarette advisements alone, which is an environmental factor is a key factor in initiations to cigarette smoking or the continued use of cigarettes. This because advertisements not only influence the perception or attitudes of individuals toward cigarette smoking but also increases their urge and influence their intention to smoke (Trinidad, et. al. 2017).
Another social factor that influences initiation into cigarette smoking is religion. This is because some religions such as Hinduism and Christianity while acknowledging the ills of cigarette smoking do not specifically forbid or restrict people from smoking, unlike the Muslim religion. In a case like this, people believing or belonging to Islam as their religion are faced with protective societal factors with regard to initiation to cigarette smoking (Ulrich John, 2019).
Moreover, there is a growing and increasing body of evidence indicating that social and organizational characteristics, especially in neighborhoods that are considered disadvantaged pose a higher likelihood of smoking above the national average when compared with other neighborhoods that fare better both social-economically and politically. For instance, disadvantaged societies have higher poverty levels or low standards of living due to low unemployment and poor pay (Hodder, Freund, Bowman, Wolfenden, Gillham, Dray & Wiggers, 2016). This can translate into broken families and increased emotional distress forcing people within such a society to turn into cigarette smoking as a way of finding some solace or a coping mechanism.
In addition, the literature review showed consistency in the relationship between the likelihood of smoking and lower social-economic status. For example, disadvantaged communities, with lower social-economic status and reduced societal capital experienced higher levels of smoking (Soneji, Sargent, Tanski & Primack, 2015). In determining this, the study particularly focuses on the income of the people within the society as well as the amounts available to adolescents for daily expenditures while in school. However, while examining the role of social capital in relation to increased smoking risk, Evans, Horn & Gray, (2015) found that communities or societies with high social capital or in other words increased parental involvement were less involved in smoking both among the teens and among the adults.
Discussion
A majority of the studies and articles reviewed associated initiation into cigarette smoking and continued smoking to societal and environmental factors. These factors include family structure, ethnicity, unemployment, poverty, religion emotional distress among others. This is because these factors largely determine what society expects or in other words, what the society considered positive and acceptable behavior and by whom (Trinidad, et. al. 2017). For instance, societies that consider smoking acceptable are likely to have more smokers considered to societies where smoking is frowned upon and considered unhealthy or disturbing. These factors, therefore, pose threats or opportunities to individuals with regard to indulgence in tobacco use, and can either, be risks or protective depending on the nature of the social-economic and environmental situations because individuals live in a web of connectivity with other people and their environment.
From the data collected through the literature review, it was established that social economic, and environmental factors influence whether or not an individual will get initiated into cigarette smoking or will continue smoking (Marshall, Lotfipour & Chakravarthy, 2016). The factors found to be responsible for increased initiation and continued cigarette smoking include low social-economic status, increased societal acceptance, and ease of access to cigarettes, peer pressure or the search for approval, inadequate parenting and parental support, low academic levels, and low personal esteem and image (Evans, Horn & Gray, 2015).
Based on this it is imperative that the risk and preventive factors smoking are identified and understood not just merely by their presence but also by their design before any initiative is established aimed at addressing the problem of cigarette smoking in New Hampshire. This is because a preventive factor, for instance, may exist due to a low-level risk factor and not the complete absence of a risk factor (Marshall, Lotfipour & Chakravarthy, 2016).
Theoretical Considerations
According to the literature review, many studies regarding tobacco use among both teens and adults have a theoretical basis or ground upon which they are developed. The theories identified are the social learning theory, the rational approach, and the developmental approach.
Social learning theory: The theory posits that individuals learn, observe, and imitate the behavior of other people in society. For example and as seen earlier, it is more likely for an individual to begin smoking if their society has favorable attitudes towards cigarette smoking or is they see their role models within the society smoke.
Rational Approach: According to the rational approach, individuals are able to make the decision on whether to smoke or not based on their personal attributes and knowledge regarding the benefits and disadvantages of smoking (Trinidad, et. al. 2017). However since the society and environment influence what is considered acceptable societal behavior, an individual may be exposed highly to the risk of cigarette smoking hence becoming a smoker.
Developmental Approach: The approach shows that people are able to learn new ways or behaviors and even change their behaviors as they age. For example, in adolescents, people may easily be influenced by smoking since they are in a period of continuous trial and progression into adulthood.
However as seen from the research, the majority of people who start smoking in their adolescent ages continue smoking in adulthood compared to those that start smoking in the later years of adulthood (Hodder, Freund, Bowman, Wolfenden, Gillham, Dray & Wiggers, 2016). This approach, however, is unable to explain why with regard to social economic, and environmental factors some of the smokers from adult age continue smoking during their ages as adults. Even though these approaches while theoretical have the backing of real-life experiences as seen from the literature review and are sound in explaining the decision to start or continue smoking, none can be comprehensively be used to explain the problem individually and independently.
Conclusion
As seen from the discussion, social-economic and environmental factors influence the use of tobacco either, during initiation to tobacco use or continued consumption of tobacco. Some of the social-economic and environmental factors associated with cigarette smoking include unemployment, poverty, advertisements, inadequate family involvement, religion, and class among others.
In addition, these social factors pose risks and opportunities to either smoke or protection against smoking. With this understanding, it is crucial or imperative that people responsible for either helping societies to curb, prevent or control smoking to understand both the role of the biological and individual factors that promote smoking as well as the social-economic and environmental factors that promote or encourage people into cigarette smoking.
References
- Jamal, A., Homa, D. M., O’Connor, E., Babb, S. D., Caraballo, R. S., Singh, T. & King, B. A. (2015). Current cigarette smoking among adults—the United States, 2005–2014. Morbidity and mortality weekly report, 64(44), 1233-1240. Retrieved from: https://www.dhhs.nh.gov/dphs/tobacco/ [dhhs.nh.gov]
- Marshall, J. R., Lotfipour, S., & Chakravarthy, B. (2016).Growing Trend of Alternative Tobacco Use among the Nation’s Youth: A New Generation of Addicts. Western Journal of Emergency Medicine, 17(2), 139.
- Ulrich John, C. M.-J. (2019). Strength of the Relationship between Tobacco Smoking, Nicotine Dependence and the Severity of Alcohol Dependence Syndrome Criteria in a Population-Based Sample. Retrieved 09 10, 2019, from Alcohol and Alcoholism, Volume 38, Issue 6, November 2003, Pages 606–612: https://doi.org/10.1093/alcalc/agg122 [doi.org]
- US Department of Health and Human Services. (2012). Preventing tobacco use among youth and young adults. A report of the Surgeon General, 2012.
- Johnson, A. L., Collins, L. K., Villanti, A. C., Pearson, J. L., & Niaura, R. S. (2018). Patterns of nicotine and tobacco product use in youth and young adults in the United States, 2011–2015. Nicotine and Tobacco Research, 20(suppl_1), S48-S54.
- Trinidad, D. R., Pierce, J. P., Sargent, J. D., White, M. M., Strong, D. R., Portnoy, D. B. & Shi, Y. (2017). Susceptibility to tobacco product use among youth in wave 1 of the Population Assessment of tobacco and health (PATH) study. Preventive medicine, 101, 8-14.
- Mennis, J., Stahler, G. J., & Mason, M. J. (2016). Risky substance use environments and addiction: a new frontier for environmental justice research. International journal of environmental research and public health, 13(6), 607.
- Evans, W. D., Horn, K. A., & Gray, T. (2015). A systematic review to inform dual tobacco use prevention. Pediatric Clinics, 62(5), 1159-1172.
- Soneji, S., Sargent, J. D., Tanski, S. E., & Primack, B. A. (2015). Associations between initial water pipe tobacco smoking and snus use and subsequent cigarette smoking: results from a longitudinal study of US adolescents and young adults. JAMA pediatrics, 169(2), 129-136.
- Hodder, R. K., Freund, M., Bowman, J., Wolfenden, L., Gillham, K., Dray, J., & Wiggers, J. (2016). Association between adolescent tobacco, alcohol, and illicit drug use and individual and environmental resilience protective factors. BMJ Open, 6(11), e012688.
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