Cigarette smoking among male teenagers. Revised

Revised Edition 2013

A systematic review of a contemporary healthcare issue in Malaysia: Cigarette smoking among male teenagers. Revised By Regidor III Poblete Dioso, BSN, RN Lecturer, Lincoln University College and Lianah bin Samporna, MLT, Healthcare professional, Lincoln University College. Email – Regidor III at [email protected] and Lianah at [email protected] Faculty of Nursing 2013 (1)

Abstract This systematic review of contemporary healthcare issues focuses on active cigarette smoking among male teenagers in Malaysia. This literature review also discusses the wider health impact on cigarette use among male teenagers in Malaysia, by identifying its severity, size and determinants. It will compare and contrast the world view on tobacco smoking from global (43 trillion) to Malaysia (4.7 trillion). The issue here is its impact on the 2.1 trillion male teenagers in Malaysia who smokes actively. Finally, it will conclude with an analysis of the contemporary issues of cigarette smoking that affects healthcare and healthcare environment and the reasons why healthcare professionals need to identify these issues.

Special contributions:

Introduction Cigarette smoking is the action or habit of inhaling and exhaling

Mohd Zailani Affendi bin Ait, Mohamad Shahrezza bin Jamil, Jerryvislly John, Muhamad Azfar Ikhwan bin Muhammad Azian, Rajamanikam Paramasivam, Abdul Hadi bin Abdul Salim, Azman Husun, Muhammad Musyawer bin Zambary, Mohamad Naim bin Abd Hamid and Syed Muhamad Fisol bin Syed Jamal.

Nursing Students, Faculty of Nursing, Lincoln University College, Malaysia. 1|Page

thesmoke of cigarettes (Isohanni et al, 2006). This contemporary issue sites the impact of cigarette smoking focusing on adolescents ages of 14-19 years old in Malaysia (Isohanni et al, 2006; Lee et al, 2005; Naing et al, 2004; World Health Organisation, 2012/2007/2006; Ferrante et al, 2010; Lim et al, 2010). Contemporary issues are to be identified by healthcare professionals to formulate the best strategy for health promotion and illness prevention in all health sectors. This is because cigarette-smoking disturbs a person’s well being and their state of health (Mohide, 1988; Kiechl et al, 2002).

Smoking can

attribute a lot of physical illnesses and diseases hence, it distracts the mental, psychological and social capacity of an individual to adapt (Kiechl et al, 2002; Lim et al, 2010; Isohanni et al, 2006; Lee et al, 2005; Naing et al, 2004; WHO, 2012; Ferrante et al, 2010). Faculty of Nursing 2013:1

Revised Edition 2013 There are 2 types of smoking. The first type of smoking is called the active smoking (Kiechl et al, 2002). The second type of smoking is called second hand smoking or passive smoking defined as the exposure to environmental cigarette smoke (Kiechl et al, 2002; Lim et al, 2010). The active cigarette smoking or first-hand cigarette smoking is defined as, the act of inhaling the smoke of cigarettes from one’s self (Kiechl et al, 2002; Lim et al, 2010; Isohanni et al, 2006; Lee et al, 2005; Naing et al, 2004; WHO, 2012; Ferrante et al, 2010). Graph 1. Global illustration from 6 regions who smoke cigarettes for their whole teenage life from a total population of 43 trillion.

Worldwide Prevalence of cigarette smoking Active cigarette smoking among teenage adolescents globally America is illustrated on graph 1.

This global

Europe

illustration shows a total of 43 trillion male teenagers Western Pacific Africa who smoke for their whole teenage life who are found Southeast asia

on the regions of America (11%), Europe (24%), East East mediteranean

America

Europe Western Pacific Africa Southeast asia East mediteranean

Mediterranean (6%), Western Pacific (48%), Africa (3%) and Southeast Asia (8%) (WHO, 2012). From year 2000 to 2010, the global severity of cigarette smoking by male teenagers increased over 100 times with an average of 865 pieces of cigarettes or 43 packs per day (WHO, 2012) worldwide.

Malaysian prevalence, size and severity of cigarette smoking In Malaysia, a survey from a global organisation called Global Adult Tobacco Survey (GATS) (2012) gave the size of 4.7 trillion of the Malaysian populations who currently smoke cigarettes having 43.9% who are male teenagers. From 2010-2012, about

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Faculty of Nursing 2013:1

Revised Edition 2013 2.1 trillion adolescent male active cigarette smokers in Malaysia smoke on a daily basis as surveyed by GATS (2012) which is the focus of this literature analysis. These 2.1 trillion male teenagers in Malaysia who smokes can be local citizens, transient visitors or international immigrants (GATS, 2012; WHO-MOH, 2012; WHO, 2012).

Another study was done by Lim et al (2010) for 1,180 teenage student in comparison and in contrast with the GATS (2012) survey, with a response rate of 94.7% (1117). Of the 1,117 respondents, 705 (63.1%) are former smokers and 397 (35.5%) are current smokers. Among the current smokers, 36 (9.1%) were daily smokers, 48 (12.1%) smoked once every two days, 131 (33.0%) smoked once or twice a week and the rest smoked once a week (Lim et al, 2010).

The GATS (2012) survey in comparison from the studies done by Lim et al (2010) was found to be 37.5% higher as prevalence in male adolescents’ cigarette smoking. It is also higher compared with what was reported by the Ministry of Health (MOH) (2006) spanning from the city of Kota Bharu in the state of Kelantan to the city of Petaling Jaya in the state of Selangor (Afiah et al, 2006).

The severity is also complicated by gender, race, ethnicity and culture, particularly influenced male teenage cigarette smokers who continue the chain of influence among their peers. Thus, increases the size of male teenage cigarette smokers in Malaysia (Wakefield et al, 2000; Naing et al, 2004 Poland et al, 2006).

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Revised Edition 2013 The increasing size and severity is further identified by the determinants of cigarette smoking.

Determinants of cigarette smoking Influence is a determinant of health towards cigarette smoking especially for the teenage male gender (Child and Wi, 2010; Ferrante et al 2010; Watsen et al, 2010).

Teenage boys who actively smoke cigarettes influence their peers (Ferrante et al, 2010; Lim et al, 2010). Influence using peer pressure are perceived to be one of the determinants of an increase in size and severity of cigarette smoking among teenagers (Lim et al, 2010; Afiah, 2006) especially if they are of the same gender.

Perceptions coming from the teenagers’ same gender is influential (Child et al, 2010; Lee et al, 2005; Jeanfreau et al, 2010). The perception of a relief from stress after so much studying and thinking makes teenage boys influence other boys who belongs in their same gender to believe (Isohanni et al, 2006). Teenagers are at their most stressful life, whenever they are studying and given deadlines for submissions of assignments and projects (Child et al, 2010; Lee et al, 2005).

The size of active

cigarette smoking increases as the teenagers of the same gender smoke together.

Aside from gender, the race, ethnicity and culture are also influential (Isohanni et al, 2006; Gonseth et al, 2012; Poland et al, 2006). The successful lifestyles coming from the same race, ethnicity and culture eventually become influential to young boys. The severity of this influence includes smoking cigarettes as a part of thier lifestyle.

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Lastly, cigarettes used for entertainment influences male teenagers to increase the size and severity of active cigarette smoking (Isohanni et al, 2006). According to Poland et al (2006), the influence of teenagers’ active smoking entertains the social appetite and social life. Teenage boys smoke cigarettes as a form of entertainment (Afiah et al, 2006). It is also entertaining when young boys in Malaysia tend to show off their ability to buy cigarettes to make their social status higher as influenced by adults (Lim et al, 2010; Naing et al, 2004).

These determinants of active cigarette smoking stimulate the Malaysian healthcare initiatives to formulate strategies to curtail the impact of smoking among teenagers in Malaysia (MOH, 2007/2006). Strategies in health promotion and campaign against cigarette smoking should be strong enough to control or decrease the size, severity and prevalence of male teenage active cigarette smoking. These health determinants was evaluated and examined using a system called health screening.

Health screening evaluation Health screening is done in public and private schools in Malaysia by GATS (2012) and MOH (2007). High school young boys are interviewed with survey forms to know their perceptions regarding smoking cigarettes (WHO-MOH, 2012).

Health screening also involved organisation to visit hospitals and to analyse statistics on average teenage adolescents confinement taken yearly with collaborations from the MOH (Gabing, 2010). A schedule of yearly statistical presentation among other healthcare institutions and hospitals gather together in a certain place to present

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Revised Edition 2013 findings or analyse statistical data collected from hospital confinement, mortality and discharged patients with presenting illnesses and diseases as caused by cigarette smoking (MOH, 2007).

Another form of health screening is being done annually on a continuous research conducted by Disease Control Division (MOH, 2007).

The survey result found that active cigarette smokers among teenage boys are divided into current smokers, daily smokers, occasional heavy smokers and former daily (not more than 5 years ago) smokers (Lim et al, 2010; GATS, 2012; MOH, 2007). This impacts healthcare since teenagers health are at risk if they become habitual smokers (Lim et al, 2010; WHO, 2008; Lee et al, 2005).

There is a need to ensure that the Malaysian government invests strategies to control or decrease the number of teenagers who smoke (WHO-MOH, 2012).

Strategies and healthcare initiatives WHO-MOH (2012) used a framework to control cigarette smoking with an aim to lower its use.

One of its programmes is to promote pictorial health warnings on

cigarette packs with a general message that says Smoking Causes Harm to Health (MOH, 2008).

These photos were further enhanced when other researchers

suggested showing pictures of cancerous organs i.e. throat, neck, lung, mouth and brain cancers (Azam and Maizura, 2004).

Another illustration of these pictures

suggested by Azam and Maizura (2004) used heart failures with ischemic tissues,

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Revised Edition 2013 emphysemas, veins with plaques and miscarriage as adopted from anatomy and physiology books (Tortora and Derrickson, 2010).

In addition, the MOH (2007/2008) launched a campaign called Say No implemented since 2004.

This campaign was first initiated by the Southeast Asian Tobacco

Control Alliance and sooner was adopted by MOH in 2008. The MOH used teenagers to rally and march across main roads and all over national highways of Malaysia carrying a banner with printed words saying Tak nak (Say No) (MOH, 2008). This kind of campaign may stimulate the minds of influenced teenagers that it is not good to smoke (MacFarlane et al, 2010) and that egos can be boosted in other ways that are non-health hazard related (MOH, 2008).

Another campaign from the MOH (2008/2006) adopted from the policies of the World Bank (Lewit et al, 1981) recommended that governments worldwide introduce a dedicated tax on tobacco products. This may be effective for teenagers so that they cannot afford to buy cigarettes in their youth (Wakefield et al, 2000). However, some of the school age students who cannot afford a pack of cigarettes will buy a single stick (Lim et al, 2010).

The control of smoking is not strong enough using taxes on cigarettes, that is why they made another policy to make the strategy against cigarette smoking stronger.

The MOH (2006/2007) banned certain areas in Malaysia from smoking and used signboards with written warnings for smokers such as smoke free area. The MOH also placed an amount when a smoker is caught by securities who are smoking

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Revised Edition 2013 within the “no smoking” zone. Over 80% of private institutions in Malaysia supported this campaign using a total cigarette smoking ban on indoors with air-conditioners such as restaurants, hospitals and educational institutions (MOH, 2006/2007). This is also practiced worldwide as indoor-private institutions place a smoking area that is located in a small place so that lesser people will smoke (Wakefield et al, 2000).

Analysis Forty-three trillion male teenagers actively smoke all across 6 regions in the world and 2.1 trillion comes from Malaysia (WHO, 2012; GATS, 2012) who some of them thinks that they are in the safe category of active cigarette smokers. Categorising active cigarette smokers is a bad strategy to reduce smoking addiction because it gives an excuse for them to influence others to smoke cigarette (Lim et al, 2010; Watsen et al, 2010).

This influence can lead to the severity of chain smoking.

Becoming a chain smoker is one of the threats to healthcare institutions and antismoking campaigns that endeavors to curtail this health hazard especially among teenage boys in Malaysia (Isohanni et al, 2010; Ferrante et al, 2010).

Chain

smokers among male teenagers in Malaysia can acquire diseases and illnesses that are morbid and very difficult to cure when they grow older (Kiechl et al, 2002; Tortora and Derrickson, 2010).

Cigarette smoking is the primary cause of preventable morbidity and premature death both local and global (Kiechl et al, 2002; Isohanni et al, 2006; Lee et al, 2005; Naing et al, 2004; WHO, 2012; Ferrante et al, 2010; Lim et al, 2010). Tortora and Derrickson (2010) added that smoking causes a range of illnesses from all kinds of cancers, to emphysema, ischemia of heart tissues and miscarriage. This is the wider

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Revised Edition 2013 health threat that impacts teenage boys who smokes cigarettes at all categories (Lim et al, 2010) especially if their smokes affects their family members or peers who are confirmed to be pregnant or ill – extending to the severity of second-hand smoking.

In order for healthcare initiatives to overcome problems of smoking, a good strategy is important especially on campaigning preventive measures against the threats of active cigarette smoking among male teenagers in Malaysia.

In addition, an

awareness campaign should emphasise on preventing second hand smoking that also leads to a physiologic imbalance (Tortora and Derrickson, 2010; Gonseth et al, 2012; Kiechl et al, 2002). Just like active smoking, such physiologic imbalance of second hand smoking may significantly correlate with the thickness of arterial blood vessel walls among men and women of all ages whether they are first hand or second hand smokers (Kiechl et al, 2002; Mohide et al, 1988). This effect is harder to cure than to prevent (WHO, 2006/2007).

United Nations Development Programmes (UNDP) (2011) recommended to healthcare professional a multi-disciplinary approach to encourarge individuals to join campaigns against cigarette smoking (WHO, 2012) in order to achieve the Malaysian Millennium Development Goal Plan on health sector.

Identifying contemporary healthcare issues may help achieve the Malaysian Millennium Development Goal Plan on health sector. Identifying contemporary healthcare issues may help acquire a critical understanding of, demonstrate a commitment to, and apply professional values in complex healthcare situations. Healthcare professionals must act in taking preventative or necessary health

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Revised Edition 2013 promotion measures and procedures to improve a person's wellbeing (Olla, 2006). This is because wellbeing describes a person’s happiness, confidence, physical condition and general outlook on life and taking care of oneself (Mohide, 1988).

Conclusion Active cigarette smoking in a Malaysia is a contemporary healthcare issue that needs to be identified. About 2.1 trillion male teenagers in Malaysia actively smoke (GATS, 2012). A healthcare professional must identify this issue and play an important role that consider the diversity of human experiences of health and illnesses from a wide variety of inter-disciplinary and multidisciplinary perspectives in order to enhance their professional performance (Olla, 2006; Mohide, 1988).

A

healthcare professional must also acquire a deeper knowledge of what is the best strategy to maintain health and wellbeing, in order to decrease the prevalence and severity of illness (Olla, 2006).

The target of the Malaysian Millennium Development goal in health sector is to identify the factors and the determinants of smoking to curtial its threats that impacts on teenage boys in Malaysia (UNDP, 2011). A good evaluative measure should be statistically compared and contrasted with other global researches to assess the credibility and validity of the identified size and severity of cigarette smokers.

It is also concluded that healthcare professionals must campaign on illness prevention and health promotion (UNDP, 2011).

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Revised Edition 2013 References

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