Tobacco Tobacco is one of the most addictive drugs known to humans and is the second leading cause of deathworldwide. Tobacco use is associated with lung, esophageal, and multiple other cancers, cardiovascular disease, and pulmonary diseases such as pneumonia, chronic obstructive pulmonary disease, and bronchitis. Tobacco is available in many forms: cigarettes, hookahs, cigars, kreteks or ‘clove cigarettes,’ pipes, bidis, and smokeless varieties. WHOestimates that of the 300 million young people who currently smoke, half will die of smoking- related causes later in life, the vast majority of these deaths occurring in the developing world (WHO, 2005). Women who smoke during pregnancy are more likely to have infantswho are premature and small for their age. The hundreds of millions of children exposed to secondhand smoke are more likely to die from sudden infant death syndrome and suffer from ear infections, upper respiratory infections, asthma, pneumonia, and malignancies. Children are most likely to be exposed to secondhand smoke in areas in South and East Asia. Although many of the adverse health effects do not become evident until adulthood, tobacco use is in many ways a disease of adolescence. The vast majority of adult smokers started their habit during adolescence. The Global Youth Tobacco Survey of young people at nearly 400 different sites found that 17.3% currently use tobacco, with the highest use among males in the Americas and Europe (Figure 6). Young people who desire peer acceptance or to appear mature or rebellious may try smoking. Harmful health effects may be unknown to a young person, or may seem a lifetime away. In the United States, having a peer group that smokes is the most important predictor of smoking in adolescence. Teenagers whose parents smoke are also more likely to use tobacco. Teenagers who smoke are more likely to become addicted than adults, often becoming addicted within the first few weeks after trying their first cigarette. For these reasons, tobacco companies target young people, especially those living in developing countries using ‘teen- friendly’ campaigns such as ‘‘Joe Camel,’’ flavored tobacco, individually sold cheap tobacco ‘sticks,’ and promotions where teenagers can win tobaccobranded items. Media campaigns generally portray people who smoke as attractive, energetic, and healthy. In developing regions, regulations against marketing and sales to minors are more relaxed, and tobacco is cheaper and readily available. Some economically disadvantaged adolescents may choose to purchase tobacco instead of food as it acts as an appetite suppressant; girls in industrialized countries may also smoke for this reason. Even in industrialized countries, cigarette use is associated with lower socioeconomic status. Although most adolescent smokers want to quit, this act is very challenging for those who are not only addicted but also surrounded by peers, movie stars, and even their own physicians using tobacco. Pharmacotherapy and behavioral therapy have been shown to help adults stop smoking, but are not as well studied in teenagers. Young women are often worried about the potential for weight gain associated with smoking cessation. All youth are at risk to suffer nicotine withdrawal, which causes mood changes, insomnia, and restlessness. Increasing the price of tobacco through taxation has been shown to prevent some young people from smoking, since they tend to be more sensitive to price than adults. Banning tobacco vending machines, enforcing a minimum age to purchase tobacco, and establishing smoke-free areas has also been effective in reducing smoking initiation in young people. Nearly 200 countries have signed the Framework Convention on Tobacco Control (FCTC), a treaty designed to control tobacco use. The FCTC recommends that governments ban tobacco advertising and marketing toward children under 18 years of age. Many mass public health campaigns designed to educate young people on the dangers of tobacco use have been launched across the globe, some of which have been demonstrated to be effective.
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