Smokers in terms of Cigarette Smoking - Literature review Example

Smokers in terms of Cigarette Smoking 1. Introduction: Smoking has become a growing problem across the world. Children of all ages have been seen to become addictive smokers. The aim of the study is to gain a clear detailed understanding of the relationship between self esteem and smoking among the adolescents in UK. The ultimate aim is to increase the awareness and to bring out the research findings to be able to attain the relationship of how the self esteem of a person can affect the smoking habits (Crocker, 2004). This will allow us to provide for a few recommendations to the readers to help reduce the chances of becoming smoking addicts. There have been several researches that have been conducted in the past. Based on the previous researches and along with some important and essential statistics, the literature review for this chapter has been formed. The chapter will include an introduction to smoking and smokers, following which this chapter will entail the smoking statistics that have been found in the UK smokers. A detailed research of the affects of esteem, i.e., both high self esteem and low self esteem will be discussed here. 2. Smokers and Smoking: Over the past few years the level of smoking has seen dip when compared to the past years. It has been noted that almost 21% of the total population of United Kingdom have been recorded to be smokers. These statistics of smokers is relatively much lower than the amounts that have been recorded in the past. In the earlier years as far as 1974, the government has been able to record as many as 45% of the total population to be smokers in the United Kingdom (NHS, 2009). This report as the name suggests, is a proposal for a dissertation which aims at understanding and gaining complete information about the relationship between smokers and the self esteem. The main targets here are the adolescents of the country. The World Health Organisation has done numerous researches about the smoking and smoking statistics. This research is based on smoking in adolescence in the UK. Before moving into the topic directly, it is essential to gain a perspective of the smoking statistics that has been provided by the WHO (Ready to Quit, 2008). These are as follows: a) The highest level of smoking is among people with 9 - 11 years of education and totals to as much as 37.5% and is much lower or lowest among people with 16 or more years of education as little as 14% (Ygoy, 2008). b) The level of smokers living below poverty levels is much higher and totals to as much as 32.5% than people living at or above the poverty level at 23.8%. c) As many as 25 million men and 19.3 million women have been former smokers. This accounts to approximately 44.3 million adults (Ygoy, 2008). d) Nearly 15 billion cigarettes are sold everyday, which accounts for almost 10 million every minute. Smoking is the cause of death for almost one in ten adults globally. e) Every 8 seconds someone dies of tobacco use and this translates to approximately 5 million deaths annually (Ygoy, 2008). Figure: Percentage of Smokers across the Globe (TIMES, 2009) Smoking is seen to become a part of the lifestyle of people very easily and there are several reasons for this, these will be discussed further in the research. 2.1 Smokers Although the definition of a ‘Smoker’ has been provided as an individual who is habitual to consuming tobacco in the form of cigarettes there are several other forms of smokers as well. It is essential to understand, smoking can be as harmful as it is to the actual smoker as well as to the people around the person who smokes (Dhillon, 2009). 2.1.1 Smokers in terms of Cigarette Smoking: Smokers in terms of the cigarette smoking can be classified as follows: a) Chain Smokers – This refers to people who are completely addicted to smoking and who smoke non – stop. Here the term non – stop is a literal meaning. Chain smokers, tend to have a habit of lighting the next cigarette before the first one is even completed. These people tend to have as many as three packs or more of cigarettes per day (Dhillon, 2009). b) Heavy Smokers: Heavy Smokers are very similar to the chain smokers however, they do have a will power that allows them to be able to leave gaps between each cigarette consumed. These smokers tend to smoke as much as two to three packs per day (Dhillon, 2009). c) Moderate Smokers: These smokers are relatively much lesser than the other two groups and tend to have a habit of smoking, which however is yet at moderate levels. The smokers tend to smoke as much as one to two packs per day and these people tend to be more aware of the number of cigarettes that they smoke (Dhillon, 2009). d) Light Smokers: This stage of light smoking tends to be a more at a level where the smokers are new to smoking. These people tend to be individuals who start smoking for the sack of it, to be individuals who start as a stress relief or who move a step up when compared to their original approach, i.e. being casual smokers (Dhillon, 2009). e) Casual Smoker – Smokers that smoke only to socialize with friends fall into this category. This is the very first step of the smokers. This forms an entrance into the world of smoking. Most people consider this to be fun and a form of entertainment, however there are numerous smokers who continue with the urge of smoking and this takes them up the ladder to finally realise that they fall into category of chain smokers (Dhillon, 2009). It is essential to note that the line between becoming a smoker and being a social smoker is very fine and is one of the easiest break and jump over. However apart from this classification there a few other classifications that have also been developed. 2.1.2 Smokers in Terms of Addictions / Habits Smokers in terms of the cigarette smoking can be classified as follows: a) Chemical Addiction: Cigarettes contain a very addictive drug called Nicotine. People tend to be addicted to cigarettes due to the addiction to the drug. People who show addiction to this drug generally need a cigarette as soon as they wake up, and cannot stay for long hours without a smoke, and face issues with concentration and in some cases motivation as well, without cigarettes (Dhillon, 2009). b) Habit: For numerous people, it has been noted that cigarette smoking is a part of their regular activities of their daily lives. Like the other activities, smoking has become a behaviour that may be very difficult to change. Some of the common links for smokers are: smoking and drinking tea or coffee; smoking and alcoholic beverages; smoking and taking a break from work; smoking after a meal; smoking whilst relaxing watching TV or talking to friends etc (Dhillon, 2009). c) Psychological Dependency: A number of people tend to turn towards smoking in times of different moods and feelings. A few of the most common moods and feelings include, coping with stressful situations, when feeling tense (helping to relax), other uncomfortable feelings such as: anger, nervousness, self-pity, loneliness, sadness or feeling unloved (Dhillon, 2009). Apart from these kinds of smokers there are other non smokers as well, who never smoke, however due to being in the company of the smokers are equally affected and have health issues as much as the actual smokers. These people are referred to as passive smokers. The next section will deal with the statistics of smokers and the trends that have been noted in the smokers. 3. Statistics of Smokers: The various statistics of smokers in the country over the years has relatively reduced. This can be noted in the image below which provides for the percentage of the smokers over the age of 16. This shows a trend of the smokers over the years of 1974 – 2005. Researches from the Cancer Research (UK), highlight that the main age group of people smoking in the UK falls within 20 – 24 years. There is a high 32% of this age groups who fall into the category of smokers (Cancer Research UK, 2009). Figure: Prevalence of cigarette smoking by age (Cancer Research UK, 2009) If noticed in the previous graph, it is seen that almost around 22% of the people fall into the adolescents groups. This is a growing problem in the UK and the number of adolescence smoking currently is becoming very common. Adolescence is a very sensitive age for all. This age determines the person’s personality, person’s habits and also the behaviours (Cancer Research UK, 2009). This study is very important as it help look at the issues that cause people to take up unhealthy habits and harmful habits. The various studies in the past have shown that the reasons for people to take on unhealthy habits are many which include, living in a smoking environment with parents, peers or sibling, being part of one parent family, bad academic records, low self – confidence or self – esteem and even being exposed to tobacco advertising. It has been noted that children tend to become addicted to nicotine and to tobacco just like as adults and they tend to take solace in these unhealthy items (Cancer Research UK, 2009). Similar to adults who have low levels of self – esteem and motivation tend to take comfort in abusing themselves by use of drugs, alcohol and tobacco, children tend to shown similar symptoms behavioural aspects (Cancer Research UK, 2009). 4. Adolescence and Smoking As discussed earlier, adolescence smoking is growing to a great extent. Hence, it is essential to understand how the children move into such habits and the underlying reasons for this behaviour at the right time to be able to mould the children and help them overcome and find solutions for the issues before these become an addiction. This section will deal with the issue that is being faced, i.e. Childhood smoking and about childhood smokers. The section will also entail the self esteem issues and issues of self regulation that is faced by the children in the current times. Also a link will be made between the issues of self esteem and smoking among adolescence. 4.1 Childhood Smokers The studies and researches from the cancer institute has also shown the smoking pattern within the childhood (Cancer Research UK, 2009). It has been noted that less than 1% of the children between the ages of 11 and 12 have been recorded to smoke, however by the age of 15, in every 5, i.e. 20% of the children tend to become regular smokers in England. Although the age of smoking and buying tobacco has been set to 16 years, yet the children have been noted to have become regular smokers. It has also been noted that almost 9% of the children between the ages of 11 -15 have been noted to smoke the minimum of one cigarette each week. It is also essential to note that almost 10% of these are girls while only 7% are boys (Cancer Research UK, 2009). Over the years, Great Britain has seen a consistently higher rate of young girls as smokers since 1986. By the year 2006, (as seen below), it was noted that almost 24% of the 15 year old girls were regular smokers when compared to the 16% of boys. It has also been recorded that an average child smokes as much as 42 cigarettes per week in the country (Cancer Research UK, 2009). Figure: Percentage of Children Smoking Regularly in England (Cancer Research UK, 2009) 4.2 Self Esteem: Self – Esteem refers to taking pride in oneself and being proud of the person one is. Self – esteem plays a central role of everyone’s life. Knowing or unknowingly, the self esteem of a person can lead to the success or failure of the person. Understanding this and recognising this is one of the most essential aspects in life (Braden, 2001). Over the years, psychologists have noted that the level of self esteem plays a major role in the beliefs, emotions, and also behaviours of the individuals. Self esteem is synonyms with other terms like, self – worth, self – regard, self – respect, self – love, self – integrity, self – confidence and self – efficacy. According to Branden’s (1969) description of self-esteem, it includes the following: 1. Self-esteem as a basic human need, i.e., "...it makes an essential contribution to the life process", "...is indispensable to normal and healthy self-development, and has a value for survival". 2. Self-esteem as an automatic and inevitable consequence of the sum of individuals' choices in using their consciousness 3. Something experienced as a part of, or background to, all of the individuals thoughts, feelings and actions (Braden, 1969). Other researches have also shown that the level of self esteem is generally much lesser in girls than in boys. The lack of self esteem from young ages leave the children with no choice but to move into something which is more harmful and is very satisfying to hide away the feeling of low self esteem. This is how children tend to move into smoking at ages of adolescence. There have been a number of arguments and disagreements whether the level of self esteem has any affect on the health behaviour of the individuals. “Although the correlation between smoking and self-esteem is not clear, school-based health education programs, aimed at raising adolescent self-esteem, have evolved to prevent smoking among adolescents. Previous studies that attempt to show an association between smoking and self-esteem among adolescents have compared mean self-esteem scores between groups of smokers and non-smokers. Using the mean score as a summary statistic of self-esteem for the whole population does not adequately reflect the distribution of scores in that population. Moreover, this summary score is hard to interpret and may simply represent a skewed population in which a large proportion of adolescents score either high or low. The present study, however, compares the smoking status of students at the extreme high and low ends of the self-esteem scale, assuming that if no differences can be detected between them, an association is not likely” (Abernathy, et. al, 1995). Researchers have found that the effects of self esteem can be on a wide range of things in the daily lives, which include the mental health, physical well being, eating disorders, depression, and unhealthy addictions like alcohol, tobacco and smoking. This will be touched upon in detail within the actual research that will be conducted. 4.2.1 High Self Esteem Over the years psychologists have conducted numerous researches to check for human behaviour and to find out if people tend to behave with high self esteem and whether this is healthy self esteem. In a latest research that has been conducted by a psychology professor in University of Georgia, there have been several different results that have been got, the results showed that those with "secure" high self-esteem are less likely to be verbally defensive than those who have "fragile" high self-esteem (Braden, 2001). "There are many kinds of high self-esteem, and in this study we found that for those in which it is fragile and shallow it's no better than having low self-esteem," said Michael Kernis of University of Georgia.  "People with fragile high self-esteem compensate for their self-doubts by engaging in exaggerated tendencies to defend, protect and enhance their feelings of self-worth" (Rees, 2002). There has been a slow and very different approach that psychologists ate now using to approach self – esteem. In the earlier times it was felt that a high self esteem is a better self esteem, however in the resent times, it has been noted that a high self esteem can lead to some other forms of behaviour like aggressive behaviour, indulging in bad habits like excessive drinking and smoking (Rees, 2002). Also, individuals with high self-esteem sometimes become very unlikable when others or events threaten their egos. High self esteem has generally been valued as a good quality and is referred to as a mode to happy and productive life, however in the recent years, researchers have changed their opinions to this and they are breaking it down into finer gradations and starting to understand when high self-esteem turns from good to bad. It is also now thought that there are various forms of high self esteem and only some of which consistently relate to the being a positive psychological functioning (Rees, 2002). The researches have also shown that the high self esteem can move towards the wrong side of human behaviour and can bring our aggressive behaviour and the urge of people to move toward more negative habits, opinions, beliefs, statements and also values. In the same research that had been conducted by Georgia University, Kernis highlighted that "Our findings offer strong support for a multi-component model of self-esteem that highlights the distinction between its fragile and secure forms" (Rees, 2002). "Individuals with low self-esteem or fragile high self-esteem were more verbally defensive than individuals with secure high self-esteem. One reason for this is that potential threats are in fact more threatening to people with low or fragile high self-esteem than those with secure high self-esteem, and so they work harder to counteract them" (Rees, 2002). He also went on to explain, "We aren't suggesting there's something wrong with people when they want to feel good about themselves. What we are saying is that when feeling good about themselves becomes a prime directive, for these people excessive defensiveness and self-promotion are likely to follow, the self-esteem is likely to be fragile rather than secure and any psychological benefits will be very limited" (Rees, 2002). Hence from the above research, it has been noted that the effects of high self esteem are not always necessarily good and peaceful and not always a ‘healthy self esteem’. Moving on to the other side of the same coin the next sub section will deal with low self esteem (Rees, 2002). 4.2.2 Low Self Esteem: As has been discussed, high self esteem is bad to have similarly it is very harmful to also have a low self esteem (Harmsen, Bischof, Brooks, Hihagen & Rum, 2006). Low self esteem has been recognised and has mainly been seen in people who have had either or all of the below mentioned in their lives: a) As children the need have not been met up to adequately, and siblings might have been treated in a better way than themselves b) As children being bullied c) As children beings assaulted, physically or sexually abused d) As children frightened to be themselves and the fear of not being liked by people around them e) As children unfavourable comparisons f) As children being over protected or not being as protected as needed. g) As children being forced to take on undesired lessons and live their parents’ choice of life (Upadhyaya, Drobes, Thomas, 2004). As an adult as well self esteem can be lowered in certain circumstances like, loss of a job, long periods of unemployment, not being shown love and respect, being taken for granted, having needs ignored, opinions being discounted, and being verbally/ emotionally/ physically/ sexually abused. These factors do play a very important role in the levels of self esteem and how a person see themselves and the self respect that they might have for themselves (Rees, 2002). Having a low self esteem especially for children and adolescents can be quite a breaker for the individual. Low self esteem may contribute to development of some unrealistic goals and shying away from possible opportunities and this is mainly due to negative self image of the person (Abernathy, Massad & Romano-Dwyer, 1995). Children can move to become more pessimistic about themselves and their future and can be oversensitive to criticism of any kind. Negative feedback can cause the child to go over the edge and cause a lot of issues like pulling away from the public, getting into bad company and developing bad habits like smoking, drinking or even in some cases gambling. In addition, they are also concerned about the social impression and impact they make and have upon others (Upadhyaya, Drobes, Thomas, 2004). 4.3 Self Regulation: According to a research conducted by Crocker et.al, self regulation is another essential aspect of a person’s wellbeing. She explains that “the willingness to exert effort toward one’s most important goals, while taking setbacks and failures as opportunities to learn, identify weaknesses and address them, and develop new strategies toward achieving those goals” (Crocker, Brook, & Niiya, 2006). This is an essential element of the research and this highlights how people who break down due to the pressures and set backs and are faced with crisis, tend to have lower levels of self – esteem. Also this can lead them to take up bad habits and become addicts to harmful habits like drinking, smoking and consumption of drugs (Mruk, 2006). 5. Self – Esteem and Smoking “According to the World Health Organization, self-esteem, self-image and tobacco use are directly linked. Adolescents who smoke tend to have low self-esteem, and low expectations for future achievement. Often they see smoking as a way to cope with the feelings of stress, anxiety and depression that stem from a lack of self-confidence” (Media – Awareness, 2009). Studies and this research have highlighted how the teen’s attitudes towards their peers like their friends, classmates, boyfriends and girlfriends and this has a high influence on their chances of smoking. The habits of any teen is directly influenced by the habits of their five best friends and girls with a best friend who smokes are nine times likelier to become smokers themselves than those with non-smoking best friends. Research by the WHO shows that, “Some teens believe that smoking cigarettes will improve their image, by making them appear more mature or "cool." Role models who smoke are frequently seen as tough, sociable and sexually attractive. For these teens, smoking is an attempt to improve the way they're perceived by friends and peers (Eppel, O’Loughlin, Paradis & Platt, 2006). Studies have shown that if peers do react positively to this strategy, then the new smoker is likely to continue smoking. This attitude is not lost on tobacco advertisers, who portray smoking as a proof of adulthood, maturity, sophistication, popularity and sexual attractiveness. In the case of young girls, smoking is also equated with thinness - feeding on adolescent insecurities about body image. Being slim gives these girls self-confidence, and makes them feel fashionable. Surrounded by a culture that supports such beliefs, some teenage girls may see cigarettes as a way to attain these goals” (Media – Awareness, 2009). Hence it has been noted that smoking is directly influenced by the people around them and with the need to be able to fit into the group and this is the influence of the low self esteem that the adolescents face. Also, the use of cigarettes is a form of cover up to cover the self esteem issues and to be able to mingle with the groups and get accepted among the peers (Eppel, O’Loughlin, Paradis & Platt, 2006). 6. Summary This chapter forms the literature review for this research. A brief understanding of the various theories has been made in this chapter. This chapter has dealt with the main literature on the topic of self esteem. This chapter has also detailed the statistics of smoking in the UK and has brought out the various details of how the self esteem impacts the choice of adolescents and how they use cigarettes to be able to cover for their issues and to fit into groups. This forms a major part of the study and this forms the basis for the entire study. The next chapter will deal with the research methodology that has been adopted for this research. 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