By C. Ibe Adaugo, RDH, BSDH, MS
Tobacco use is increasing with tobacco companies finding new and fancier ways to market tobacco products. Tobacco control has been a public health concern since the discovery that tobacco products cause a variety of health problems. Tobacco smoking is one of the leading social habits around the world. Tobacco death and related diseases are the leading cause of preventable death in developed and developing countries. The World Health Organization recognized this trend by issuing a directive to all nations to control the use of tobacco.1
In the United States, tobacco control as a public health intervention has spanned decades. A major step was taken in 1964 by placing the surgeon general’s health warning on cigarette packages. The health problems linked to tobacco led families of impacted victims to file lawsuits against the tobacco industry in the 1980s and 1990s.
Despite the controversy and payouts, the tobacco industry still thrives, as companies have found new and attractive ways to market their products. According to Sosenky, tobacco use is the leading cause of respiratory infections, lung and oral cancer, asthma, and other breathing problems in the United States.2 According to the American Dental Association and the American Dental Hygienists Association, 42,000 Americans will be diagnosed with oral and throat cancer related to tobacco use and or exposure.3
To address this issue and reduce the illness caused by tobacco use, the United States Department of Health and Human Services has banned smoking in public and federal buildings to protect the population from second-hand smoke. Some states such as Maryland and Virginia also made similar laws to control tobacco use. Some added sales taxes to tobacco products to help reduce purchases.
Despite the efforts made to control tobacco use, it still appeals to the younger generations. Tobacco companies have modified their sales and advertisement strategies to attract young buyers. Colorful advertisements, uses of celebrities, and eye-catching phrases are some of the methods used in tobacco advertisement. Studies show that 25% of high school students and about 8% of middle school students have been exposed to some kind of tobacco product.2
Tobacco industries have greatly modified their products to make them look different from regular cigarettes. Added flavors, repackaging, and added gadgets were used to create products that look different but contain similar materials and have the same effect as cigarettes. Some of the modified products are e-cigarettes, hooker pipes, bidis, and cigars. The manufacturers often create the impression that these products are safer than smoking cigarettes. However, research by the Centers for Disease Control and Prevention found that these products pose the same danger as cigarette smoking because they contain nicotine tar, eugenol, and other additives that are proven to cause health problems, addiction, and other mental problems with regular and prolonged use.4
Intervention program for teenagers
High school and middle school students are targets for tobacco intervention programs. Studies show that most adults who smoke start in middle school, around age 13. In my clinic practice as a dental hygienist, I have interviewed adult smokers and their responses correspond to those study results. The adolescent years are characterized by vulnerability and risk-taking.5 Students at this age are easily influenced by peers or family members who smoke. The middle school students are transitioning to independence, which places them at risk for exposure to harmful habits.
Parents also give students money to purchase school lunches and snacks for after school programs. Tobacco use during adolescent years has been linked to students’ assets, and the habit may extend to adulthood.6 It is possible that the students may divert these funds to purchase tobacco and other recreational products, which is why tobacco and drug use is on the rise in these age groups.
Parents’ work schedules are another factor that may enhance students’ tobacco use. Most parents in the suburbs work the 8 a.m. to 5 p.m. schedule, leaving middle and high school students unsupervised before and after school. This time frame may be used to try new habits. Students’ interaction at the bus stop while waiting for the school bus pickup can foster the influence of peer pressure to try new and harmful habits.
The first part of the intervention is the collaboration with the school board to explain the problem and the intervention plan and why the population is a target. The role of the school board is to authorize the school administration to allow the students to participate in the intervention program. The dental profession should utilize the help of the guidance counselor and teachers at each school to distribute questionnaires to parents and also gain parents’ permission for their students to participate.
The next step is presentation and discussion with the students to explain the purpose of the program. Students are given questionnaires that will indicate if they have been exposed to tobacco use and what type and by whom and at what age. All students’ responses should be kept confidential, with no identifying information on the papers. Participants will be identified by numbers only. The dental professional will prepare visual presentations about the health and social impacts of using tobacco in any form. The forms that will be discussed should include hookers, pipes, kerets, bidi, and e-cigarettes. A staff from the environmental health department will be invited to discuss the environmental dangers of cigarette smoking.
The evaluation part of the program is to ask students to write essays comparing their thoughts about tobacco use before and after the program. Students can choose to make their impressions with posters or essays. To ensure that the message is passed on to the non-participants, the posters and pictures can be placed in the school hallways, the cafeteria, bathrooms, or other places where students are likely to gather or smoke. To create more awareness, students who were participants can be trained to teach other students.
Collaboration with professionals
Collaboration and leadership principles can be applied in the intervention program by working with other professionals to ensure that youths stay off tobacco. The results the intervention plan can be shared with policy makers so that they can avoid zoning convenience stores, gas stations, or any store that sells tobacco products near a school.
There are recommendations that law enforcement should monitor stores to ensure that identifications are checked as required by most state and federal laws prior to the sale of tobacco products.2 Adults who purchase tobacco products for minors should be discouraged from doing so. Some states also have increased taxes on tobacco products to deter people from making purchases. To keep young people engaged, it is recommended that the government should invest in recreation centers for youths and provide funding for youth recreation and tobacco and drug use prevention programs.7
The dental profession should also collaborate with insurance companies to include smoking counseling and cessation as a covered benefit for teens. Primary care doctors and pediatricians should incorporate tobacco counseling and cessation as part of routine care for teens. The school board leaders can approve posters on school sign boards that designate a school as a tobacco- and smoking-free zone, similar to the signs that already exist in most schools as drug-free zones.
I believe that that it is within the professional duty of the dental professionals to champion the cause of reducing tobacco use among middle school and high school students with the hope that it will reduce the incidence of tobacco use in adults.
C. Ibe “Ada” Adaugo, RDH, BSDH, MS, is a dental hygienist currently practicing in a public health clinic setting. She is also an adjunct Instructor at Fortis College and currently enrolled in a doctoral program with a focus on public health leadership and advocacy at Capella University.
Seeing the effect
The intervention program for the students should also include field trips to the cancer and respiratory disease units of the local hospitals. This will enhance participation and offer the students a hands-on experience with victims of tobacco use. The students will be given the opportunity to interact with patients whose diagnoses are directly linked to tobacco use. Parents can also participate in the field trips to enable them to enforce abstinence at home.
1. Tobacco Free Initiative: Implementing tobacco control. World Health Organization website. http://www.who.int/tobacco/control/en/.
2. Sosensky MM, Doyle EA. Polytobacco use among adolescents. Pediatr Nurs. 2016 May-June;42(3):150-4.
3. Oral and oropharyngeal cancer. American Dental Association website. http://www.ada.org/en/member-center/oral-health-topics/oral-cancer. Updated January 10, 2017.
4. Youth and tobacco use. Centers for Disease Control and Prevention website. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm. Updated April 14, 2016.
5. Pound P, Campbell R. Locating and applying sociological theories of risk-taking to develop public health interventions for adolescents. Health Sociol Rev. 2015;24(1):64-80.
6. Cheney MK, Oman RF, Vesely SK, Aspy CB, Tolma EL. The prospective association of youth assets with tobacco use in young adulthood. J Health Educ. 2015;46(6):329-37.
7. Leeman J, Myers A, Ribisi K, Ammerman A. Disseminating policy and environmental change interventions: Insights from obesity prevention and tobacco control. Int J Behav Med. 2015 Jun;22(3):301-11.