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Example 2: Youth Smoke Out: Understanding and Preventing Tobacco Use Among Youth

NAMING THE ISSUE/PROBLEM/ GOAL TO BE ADDRESSED 

JUSTIFY THE PRIORITY ISSUE(S)/PROBLEM(S)/GOAL(S) TO BE ADDRESSED:

The use of tobacco and tobacco related products is a growing trend among U.S. adolescents. More than 4 million American adolescents currently smoke, with the prevalence of cigarette smoking increasing from 27.5% in 1991 to 36.4% in 1997 among U.S. high school students. Our community is no different from the rest of the U.S. - a local high school poll found that 38% of respondents reported smoking regularly (3 times a week or more). With 400,000 Americans dying from tobacco-related illnesses a year, we want to prevent our youth from acquiring an addictive and debilitating habit that is costly to their pocketbooks, health, and possibly their life

STATE THE ISSUE/PROBLEM/GOAL TO BE ADDRESSED: 

The problem is that too many teens are smoking cigarettes and using tobacco-related products.

REVIEW THE NAMING AND FRAMING OF THE ISSUE/PROBLEM/ GOAL:

The problem is that too many teens are smoking cigarettes and using tobacco- related products. ( Note: We did not say, "The problem is that teenagers have easy access to tobacco products" or " The problem is that teenagers smoke because of media and peer pressure." The latter two labels identify potential components of an intervention - i.e. enforcement of laws restricting sales to minors or removing tobacco advertisements from venues frequented by youth. But, the label for the problem or issue should refer to the root condition or concern - i.e. too many teens using tobacco-related products.)

ANALYZING THE ISSUE 

Ask questions about the issue/problem/goal to identify key behaviors and actors and their consequences:

Some behaviors (and actors) that contribute to the problem of tobacco use among youth include:

  • Youth-buying/obtaining and smoking cigarette
  • Merchants-selling tobacco products to minors
  • Peers-offering cigarettes; social disapproval for not using cigarettes
  • Parents and guardians-not monitoring what their kids are doing
  • Law enforcement-minimal enforcement of laws against selling to minors

This analysis suggests the need for a comprehensive intervention that goes beyond a "just say no" program for youth.

A variety of people are affected by the problem of youth tobacco use. They include:

  • The youth (who may have adverse but delayed health effects of smoking and/or adverse but more immediate social consequences for refusing to smoke),
  • Merchants (who stand to be fined for selling and/or lose profits for not selling),
  • Peers (who may gain or lose social status depending on their use),
  • Parents (who may avoid conflict by ignoring tobacco use) and
  • Law enforcement officials (who may gain or lose public favor for cracking down on sales to minors).

Tobacco use is the leading cause of death in the United States. Use of tobacco products among minors is widespread. Nationally, 36.4% of U.S. high school students report using cigarettes regularly. Nine of ten regular adult smokers began using tobacco before 18 years of age. If a person can avoid tobacco use before age 21, he or she is much less likely to ever smoke. Stopping tobacco use before it starts is a major public health strategy.

ANALYZE  "ROOT" CAUSES OF THE ISSUE OR PROBLEM TO IDENTIFY THE CONDITIONS/BEHAVIORS AND MIGHT CONTRIBUTE TO IMPROVEMENT. (BUT WHT? ANALYSIS):

The problem is that "Too many kids are smoking cigarettes"

  • "But, why?" Because they think it's perceived as a rite of passage; because they've become addicted to nicotine; because it's something they do with their friends who smoke; because it's easy to get cigarettes
  • "But, why?" (Choosing one possible reason: Because it's easy to get cigarettes.)
  • Because teens can buy them at almost any store in the community.
  • "But, why?" Because many vendors will sell tobacco products to minors, despite laws prohibiting it.
  • "But, why?" Because cigarette sales are very profitable.

Based on analyses of root causes like the above, we can identify some specific conditions/behaviors and related interventions that might contribute to improvement. These include:

  • Too little information about the problem of tobacco use among youth and its consequences (provide information through public service announcements on popular radio stations)
  • Lack of skill in refusing peer pressure to smoke (training in peer refusal skills through schools)
  • Too few positive consequences for not smoking (promote peer support through influential youth networks)
  • Access to tobacco products is too easy (arrange regular "stings" to detect sales to minors, change local ordinances to increase the size of fines)
  • Too few affordable services for quitting smoking (provide smoking cessation services through school-linked services)
  • Law enforcement policies ignore tobacco sales to minors (change law enforcement policies to increase enforcement of laws against sales to minors)

Identify restraining and driving forces (Conduct a Force Field Analysis) Some forces are keeping the situation youth tobacco use the same include: a) little or no media coverage about the problem locally; and b) people affected by the problem-youth and families-lack power to influence compared to tobacco companies.:

Forces that are causing things to change include: a) growing public awareness of the issue; b) a political constituency that cares about tobacco use among youth; and c) lawsuits against tobacco companies for promoting sales to minors.

SEE RELATIONSHIPS AMONG THE ISSUE/PROBLEM/GOAL: 

Our priority issue is tobacco use among youth. We know that for some youth tobacco use is a "gateway" to other forms of substance use. Youth who use tobacco are more likely to use alcohol and other drugs. Some substance use, especially alcohol use, contributes to violence. As important is the consideration of teenagers' future health. Tobacco-related illnesses kill 400,000 Americans every year. Many more people's quality of life is sharply diminished. Seeing the interrelationships among a variety of youth issues suggests the value of a more comprehensive approach that connects with the work of those concerned about youth health and development more broadly.