Smoking is linked to a wide array of mental disorders including depression, anxiety disorders, and schizophrenia. Individuals suffering from mental illnesses have high mortality and morbidity rates as a result of smoking-related illnesses for instance cancer, respiratory diseases, and cardiovascular diseases (Kazdin, 1993). One of the reasons for the solid association between current smoking and mental illness is that smoking initiation is influenced by mental illness. Anxiety and depression in teenagers are strong predictors of daily smoking transition and experimentation. However, smoking is also linked to the onset of teenagers’ psychiatric symptoms. This suggests that anxiety and depressive symptoms and smoking begin at the same time.
Justification of the concern, problem, and issue
Every day, approximately four thousand people aged less than eighteen years in the US smoke their 1st cigarette. An estimated one thousand youths in this age group become novel daily cigarette smoker. In essence, nearly four hundred thousand youths adopt the habit of smoking on a daily basis each year. About 80 to 90 percent of adult smokers begin the smoking habit during adolescence. Presently, ten percent of middle school students as well as 23 to 26 percent of students in high school are smokers (Luke, Stamatakis & Brownson, 2000). If there is persistence of the present tobacco use patterns, approximately 6.4 million youth smokers will eventually succumb to premature death as a result of smoking-related diseases and mental illnesses. In Virginia, around 15.5% of students in high school smoke. It is projected that 152,000 children who are less than 18 years of age in Virginia will die prematurely due to smoking (DiClemente & Prochaska, 1982).
People suffering from schizophrenia have odds of smoking 5.3 times. There has been an extensive description of excess mortality among individuals suffering from mental illness as a result of common conditions that have smoking as a risk factor in community-based and service-based samples. These include cancers, respiratory diseases, and cardiovascular diseases. Smokers suffering from mental illnesses consider smoking as the easiest and most readily accessible strategy through which mental illness symptoms can be relieved (Pierce, et al 1991). This is particularly the case with people who are not enrolled with any prescribed treatment form for mental health conditions. Many people meet the mental disorders’ diagnostic criteria but fail to seek treatment for the conditions. The efforts of reducing the prevalence of smoking are a key concern among psychologists (Kazdin, 1993).
An analysis of the evidence
Treating US teenage smokers using medication or counseling has been extremely vital at promoting higher abstinence rates. However, using medication and counseling at the same time has more benefits, as opposed to using either on its own. Usually, medication is not advisable in special conditions or populations where efficacy or safety evidence is insufficient; light smokers smokeless tobacco users, adolescents, and during pregnancy (Kassel, Stroud & Paronis, 2003).
There are a number of psychosocial and behavioral interventions that psychologists can use to promote smoke cessation and address mental illness issues among smoking teenagers in the United States. The most effective interventions usually rely on established human behavior theories.
The TTM (Transtheoretical Model) of Behaviour Change
The TTM model of behaviour change was developed by DiClemente and Prochaska and individuals undergoes through five stages so as to transform an established behavior efficiently. According to TTM, smoking cessation progresses via five stages; the first step is precontemplation and the teenager may be unwilling to quit. Second, the teenager moves into contemplation and plans on the period on which to start quitting. Third, there is active preparation and planning to quit. Fourth, there is action and active quitting, and finally, the abstinence has to be maintained after six months. Research denotes that smoking is a chronic disorder where patients normally find themselves in remission and relapse. Therefore, a psychologist using the TTM strategy should include relapse and termination so as to promote effective cessation. When using TTM, motivation is a key ingredient throughout the progression, and it influences a person’s readiness to change. As a result, a person perceives the seriousness of the problem and has confidence in positive behavior change (Goodman & Capitman, 2000).
The 5 A’s Approach
Psychologists working in the clinical setup can use this approach that entails asking about smoking, advising on quitting, assessing a teenager’s willingness to attempt quitting, assisting in the quitting attempt, and arranging for follow-ups (Gruber & Zinman, 2001). All the five components should be implemented with follow-up actions and assistance that are based on the smoking status, abstinence length, and readiness to change.
Nicotine Replacement Therapy (NRT)
According to Patton et al (1996), nicotine is identified as the addictive ingredient that is contained in cigarettes. When teenagers quit smoking, there is an experience of nicotine withdrawal, and it involves difficulty concentrating weight gain, hunger, sleep disturbance, depression, irritability and craving. On resuming smoking, these symptoms subside and therefore, withdrawal symptoms are an indication that there is a risk of relapsing to smoking (Luke, Stamatakis, & Brownson, 2000). NRT aims at preventing or reducing withdrawal symptoms through ensuring a steady nicotine dose to individuals trying to quit. However, the toxic carbon monoxide and carcinogens are eliminated. This is associated with long-term abstinence, and five forms of nicotine that can be used are nicotine patch, nicotine nasal spray, nicotine lozenge, nicotine inhaler, and nicotine gum. Combining gum and the patch is highly effective in adults (Pierce, et al 1991).
The target population
Teenagers are the target population, and there are approximately 4.5 million smoking adolescents in the US. Teenagers who have smoke are more likely to use other drugs including marijuana, bhang, alcohol, and engage in risky sexual behavior (Luke Stamatakis, & Brownson, 2000). This predisposes them to numerous health challenges. Smoking related illnesses account for many death. Moreover, since smoking is closely linked to the use of other drugs, teenagers end up in crimes such as risky sexual behavior, assault, and theft (Kazdin, 1993).
Stakeholders include cigarette manufacturing companies, the health and public health ministers, government, learning institutions, various counseling and psychology programs, and the media. These and other stakeholders should coordinate and lay down strategies aimed at preoccupying teenagers with productive activities and preventing them from engaging in smoking (Gruber & Zinman, 2001). Efforts from all the concerned bodies promotes more positive outcomes.
Participants include parents and relatives, neighbors, peers, and shopping facilities. Parents are relatives play a great role in determining whether teenagers smoke or not. Parents and relatives who smoke make teenagers assume that smoking is acceptable. Neighbors should report teenagers who are smoking to their teachers and parents so that the habit is terminated early. Teenagers should associate with well-behaved peers, to avoid bad habits. Shopping facilities should not trade in cigarettes so that they are not readily accessible to teenagers (Mrazek & Haggerty, 1994).
Data collection and analysis methods- needs assessment
So as to assess the needs of smoking teenagers efficiently, both qualitative and quantitative data should be gathered. Self- administered questionnaires are essential in gathering qualitative and quantitative date (Eccles & Gootman, 2002). Likert-scale questions can help in gathering quantitative data regarding attitudes and awareness about anti-smoking messages, reasons for smoking, smoking behavior, and demographic information that includes gender, age, and level of education. Focus groups can also be used to assess the needs of smoking teenagers. Finally, conducting targeted interviews is particularly crucial in needs assessment as the interviewer gathers facial expressions and poses questions in different ways so as to collect data on different aspects. Since the interviewer and the participants interact face-to-face, the interviewee can assess the extent of mental illness (Gruber & Zinman, 2001).
The data collected can be analyzed through various ways (Patton et al., 1998). Bivariate analysis identifies the statistically significant linkages between demographic characteristics and method of data collection. Bivariate relationships should also be examined so as to enable an exhaustive description of the sample and avoid the inclusion of collinear variables in smoking-related attitudes’ and behaviors’ multivariate models. Multivariate logistic regression analysis examines the association between smoking-related respondents’ behavior and attitudes of people close to the teenager, and data collection methodology while demographic characteristics are being controlled. Cox proportional hazard analysis assesses the link between time-dependent variables and the interview modality (Kazdin, 1993).
Project goals and their assessment
The goals of this project are to research on the relationship between teen smoking and mental health disorders and illnesses health among American youth (Mrazek & Haggerty, 1994). The project is also aimed at identifying the specific mental that are linked to teen smoking in the United States teen population. The project looks at how teenagers, stakeholders and participants can work together in the fight against tobacco smoking and promoting mental health. The project shows how the stakeholders the participants that could include the family, youth professionals, non-Governmental organizations and the government can work together in dealing with the high tobacco smoking rates among the U.S teenagers (Mrazek & Haggerty, 1994). Despite the fact that tobacco smoking among the youth is on the decline, there is a need to facilitate this decline by using anti-smoking campaigns that change the perception of smoking and other drugs among the youth (Gruber & Zinman, 2001).
The project looks into the perceptions of smokers and non-smokers and how these perceptions facilitate the use of tobacco among the youth. Finally, it focuses on the action plan that can be used to reduce and prevent teen smoking (Gruber & Zinman, 2001). These goals can be achieved if there are adequate funds from governments and non-governmental organizations. These goals can be assessed by means of questionnaires, surveys, interviews and other qualitative studies that can determine whether there is any reduction in the use of tobacco among teenagers and whether the treatment plans put in place for those having mental problems are successful (Mrazek & Haggerty, 1994). The assessment will include analyzing the success of the anti-smoke campaigns and treatment that is used on the affected teenagers. In addition, it will determine how well the project is preventing the use of tobacco to nonsmokers. The use of baseline measures is the best to method determine whether the programs put in place are working or not (Mrazek & Haggerty, 1994).
An action plan
An action plan that can be applied in reducing tobacco smoking among the American youth can be a 5-A method (Kazdin, 1993). This stands for ask, advice, assist, assess, and arrange. This method is appropriate because it takes a psychological aspect of treatment. This method is appropriate mostly to those who are already smokers. Although the teenagers rarely visit physicians, the sports or school physicians can play a good role in assessing tobacco use among the youth keeping in mind that encounters with the school or sports physicians is almost unavoidable for the teens. The teenagers are not willing to volunteer and admit that they are smokers and, therefore, asking them if they smoke can get them talking (Kazdin, 1993). When an adolescent is asked if they smoke in the absence of their parents, this increases their chances of telling the truth. This is because of the feeling that they are safe if their parents do not know this truth. Offering confidentiality motivates the youth to share and also facilitates cooperative treatments up to a point where the teen feels that parents can be involved. After the physician knows that the teenager is a smoker, he can work together with a therapist in helping the teenager to quit (Kazdin, 1993). The therapist then advices the teenager accordingly, and an assessment will be carried out to determine the level of tobacco dependence, by use of qualitative or quantitative methods, and then determine the appropriate treatment plan (DiClemente & Prochaska, 1982). The therapist assists the adolescent towards cessation and arranges for the treatment and follow-ups even after the treatment is over (Kazdin, 1993).
In this 5-A method, the treatment plans mostly used include counseling, nicotine replacement therapy, psychoactive medication, and combined therapy. The cessation of tobacco smoking at an early age reduces the chances of developing mental health disorders as compared to cessation at later ages, for example, in old age and adulthood (Kazdin, 1993). This strategy provides the smokers with alternative ways of dealing with pressure and challenges without having to smoke on a daily basis. Counseling also tackles the mental illnesses that could have come up as a result of smoking, and they could include depression and anxiety. Community intervention programs can be used to prevent the use of tobacco in adolescents who have not started smoking (Eccles & Gootman, 2002).
Education programs in combination with strong anti-smoking policies work effectively at preventing tobacco use among adolescents (Patton et al., 1998). Anti-tobacco counter-advertising is another form of community intervention that can help in reducing tobacco smoking among the youth. Tobacco advertising is said to contribute to adolescent smoking and, therefore, anti-tobacco campaigns through the media can counter this effect (Eccles & Gootman, 2002). Banning smoking at home and in school effectively works at reducing tobacco smoking among the youth. If these bans are implemented strictly, they reduce tobacco smoking by up to 40 percent. These bans give the perception that smoking is bad, and that is why it is unacceptable (Eccles & Gootman, 2002). This perception has a big effect on the behavior of the youth since they will avoid situations that can introduce them to smoking. Through the implementation of these community intervention programs, adolescents are made to know that there are better ways of dealing with problems other than engaging in smoking. As a result, the occurrence of mental health illnesses and disorders reduces because of the reduction of smoking. Through these programs, other factors that contribute to mental illnesses and disorders are addresses especially through counseling and, thus, reduce the number of mental illness occurrences (Eccles & Gootman, 2002).
Possible challenges and how they can be addressed
One of the challenges in the fight against tobacco smoking is inadequate resources. The campaigns and programs that are put in place for the treatment and prevention of smoking have mostly failed due to inadequate funding and resources. The percentage of youth smokers in the United States still remain high, and the funds and resources available do not adequately meet their needs (Pierce, et al 1991). The programs for cessation of smoking require expensive facilities and hiring professionals. If there are no funds to employ the professionals and purchase the equipment necessary for treatment, them the intervention plans could fail. The parents also cannot afford the treatment processes for their children, and as a result, these adolescents continue with smoking. Most of the therapy plans are expensive; therefore, those who are already dependent on tobacco may not get adequate treatment to clear the tobacco from their bodies. The psychological help offered cannot work alone in such extreme situations (Pierce, et al 1991). The government of the U. S needs to review its budget on the amount of money allocated towards the fight against teen smoking. This should be taken as a major concern by the government because the high numbers of youth smokers means more tobacco related health problems, more mental illnesses and eventually more deaths as a result of smoking. The stakeholders and participants should ensure that they collect sufficient funds to promote the project. The stakeholders and participants can also be increased so as to increase funds for the project (Pierce, et al 1991).
Another challenge is the use of advertisements by tobacco companies that are targeted towards the youth. This counters the media campaigns that educate the youth on the real truth about tobacco smoking. To address this challenge, strict policies should be put in place, to restrict how advertisements on tobacco products should be designed. The other challenge is lack of co-ordination between communities, the government and non-governmental organizations in the fight against teen smoking (Pierce, et al 1991).
This project is expected to influence social change in a number of ways. One of them is the belief of self-medication with tobacco smoking. Through this project, people will learn that smoking is not a solution to any problem but is it rather an additional problem (Luke, Stamatakis, & Brownson, 2000). Through educating the teenagers on better ways of coping with problems, they will stop the use of tobacco as a solution to their problems. Through the use of advertisements that teach the consequences, it is possible to reduce second hand smoke. This project will help to counter the tobacco industry’s marketing efforts to deceive people so that they can start smoking. It will also help in motivating teen tobacco users to quit smoking and discourage the assumption that once a person starts smoking, they cannot quit. This program will help in changing the social beliefs that discourage people from quitting smoking and these could include religious reasons for smoking and impossibility to stop smoking (Luke, Stamatakis & Brownson, 2000).
The other social change that the project will bring in the society is the need to seek therapy regularly especially for the young people so that they can be guided on the right path, to take in their lives. There will be reduced peer influence to abuse tobacco among the teenagers. Equipping the youth with knowledge about tobacco smoking helps them to avoid possible negative peer influence from their peers (Luke, Stamatakis & Brownson, 2000). This project will also educate the society that some of the mental illnesses and disorders found among the youth in the American society are as a result of tobacco smoking and, therefore, smoking should be discouraged and treated for those who are smokers. The society gets to know the importance of seeking immediate help in a situation when one becomes a smoker.
From the foregoing discussion, it has been established that smoking among teenagers in the US is linked to mental conditions such as depression, anxiety, and schizophrenia. Statistics indicate that every year, there are many teenagers who start the habit of smoking daily. Participants and stakeholders have a collaborative role in ending the habit among teenagers. The 5’A approach and education programs are cardinal action measures that can be used in addressing the issue. The stakeholders can cooperate and provide the necessary resources. Teenagers should be informed that smoking does not solve any challenge and whenever they are experiencing problems, it is important to seek counseling and therapy.
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