Adolescent Tobacco Smoking through the Theory of Planned Behaviour

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Adolescent Tobacco Smoking through the Theory of Planned Behaviour

There is no safe level of smoking. Tobacco smoking among adolescent Australians is at an all time high. Nearly 40 000 Queensland secondary school students are classified as current smokers (Epidemiology and Health Information Branch, 1992). Research evidence indicates that if these students continue this poor life choice into their adult life, up to 10 000 of them will die from smoking related illnesses (Epidemiology and Health Information Branch, 1992). The only way to avoid detrimental health effects linked with tobacco smoking is to sidestep cigarettes as a whole. Perceived behavioural control from the theory of planned behaviour aims at the belief that one has, and can exercise, control over performing behaviour, this applies fittingly within the solution to reducing tobacco smoking among the young Australian population.

Fatalities and illnesses regarding tobacco smoking among young Australians, has become an epidemic within Australia. “In 2014/2015, one in seven (14%) Australians aged 15 years and over smoked daily” (Heart Foundation, 2019) Smoking is the largest single preventable cause of death and disease in Australia. “Smoking kills almost 18,800 Australians every year” (Heart Foundation, 2019). It is estimated that seven in ten deaths from drug-related causes (tobacco, alcohol, and drug use) are due to cigarette smoking. Young Australian smokers is equivalent to an estimated 14,503 Australian school children progressed from experimental to established smoking behaviour in 2017 (Heart Foundation, 2019). There are many factors which can lead to smoking onset, for example, weight control. However, the myth of this is that smoking does not lead to weight loss. It can slow down the metabolism and prevent weight gain, however, this can take up to a few years and should be no reason as to why smoking onset occurs. Smoking during adolescence or childhood causes respiratory and asthma-related symptoms including shortness of breath, coughing, phlegm and wheezing. Smoking impedes lung development and causes the early beginning of lung capacity decrease during late youth and early adulthood. Youngsters who smoke have an expanded danger of growing early indications of coronary illness (Cancer Council Victoria, 2016).

The Theory of Planned Behaviour (TBP) can pose successful in assuming a variety of social cues, however, it hasn’t been successful in envisaging the epidemic of smoking. Marieke Hiemstra’s article, titled, ‘Smoking-specific communication and children’s smoking onset: An extension of the theory of planned behaviour’ aimed to test whether parental smoking-specific communication and parental smoking related to smoking cognitions derived from the Theory of Planned Behaviour in association with smoking onset during preadolescence. The TPB is designed to predict and interpret human behaviour in specific situations. With respect to smoking, the TPB posits that smoking cognitions (i.e. attitudes, self-efficacy and social norms) predict the intention to start smoking. In turn, intention to start smoking predicts actual smoking onset. Assumptions regarding potential results of smoking lead to positive or negative frames of mind towards smoking, convictions about the regularising smoking beliefs of significant others lead to social standards and convictions about the presence of variables that may encourage or avoid smoking lead to refusal self-viability of smoking (Hiemstra, Otten, Van Schayck, & Engels, 2012).

Hiemstra’s aim throughout the study was to assess whether “distal smoking-specific maternal communication (i.e. frequency and quality of communication) and parental smoking is important in shaping children’s smoking cognition” (Hiemstra, et., al, 2012). The study predicted that the links present in past adolescent literature would similarly align with preadolescents also. This link to previous adolescent literature relates to the commencement of smoking as a child and smoking-explicit correspondence relates indirectly to smoking commencement through smoking cognitions (Hiemstra, et., al, 2012). In relation to parental smoking, it was predicted that this would create a link to child smoking onset directly and indirectly by smoking reasoning’s (Hiemstra, et., al, 2012). Researchers tested for contrasting effects on incidence and quality of communication between the adolescents and the mothers. Through the TPB and the behaviours connected to adolescent smoking with “smoking – specific parenting practices and corrected for data collection method (phone vs. questionnaire)” (Hiemstra, et., al, 2012). Some parents may overemphasize their parenting skills to conform to the norm of being a ‘good’ parent. Therefore, it is vital to study how children perceive their parents, parenting practices.             

In sum, the current findings suggest that during preadolescence, smoking-specific communication of parents and parents’ own smoking behaviour contribute to the formation of smoking cognitions prior to smoking onset (Hiemstra, et., al, 2012). At this young age, only pro-smoking attitudes was associated with smoking onset. However, several studies have shown that also self-efficacy and social norm are associated with smoking onset later in life. Present findings suggest that cognitions that increase the likelihood of smoking onset in adolescence may already take place years before actual smoking onset. Therefore, prevention programmes, such as Smoke-free Kids aimed at families with children in primary school are important in stimulating communication about smoking.

A Dutch home-grown tobacco smoking prevention program within the Netherlands was assessed through the randomised control trial technique. Data was gathered before randomisation. This study focused on gathering families from institutions such as primary schools, media and health experts. In particular, primary school boards were to distribute letters to all children within the school aged nine to 11 years old and to then pass this letter on to their parents (Hiemstra, et., al, 2012). Participation in this study was monitored by either returning the letter to the school or a registration online via a protected webpage. In order to partake in this study, the families had to match the following criteria: all children must be between the ages of nine to 11, the adult participating needed to be a female guardian of the child or the mother, and clearly the adult and the child participating needed to be of a competent level of interpreting Dutch (Hiemstra, et., al, 2012). One child per family was entitled to partake to minimise bias and keep the study as simple as possible.  “A total of 1478 mothers and children were selected. Families were contacted by phone by trained interviewers (61.2%) or they received written questionnaires by mail (38.8%)” (Hiemstra, et., al, 2012). Radbound University in Nijmegen selected trained Master students to conduct the telephone interviews with the mother and child participants. The female guardians or mothers were interviewed first to confirm the criteria of the family. Following this, the children were interviewed days later. In order to allow privacy and freedom of speech, before the interview was conducted, the interviewers assured the adult and child could answer in any way they wanted and speak freely. By using close-ended questions, the interviewers were able to protect children who would follow the answers their parent would use as children aren’t as aware of this topic. The Questionnaires were sent out to families via postage and were to be given back in two separate envelopes, to ensure children were able to return their questionnaire without any intervention by their mother. It was evident that children who received the questionnaires had a different perspective on the questions being asked compared to the children who partook in the phone interviews.

This theory extrapolates evidence supporting the health behaviour of adolescent tobacco smoking. Through Hiemstra’s article the theory of planned behaviour was explained through smoking-specific communication and children's smoking onset. Therefore, it overall describes the smoking-specific communication of parents and parents’ own smoking behaviour contribute to the formation of smoking cognitions prior to smoking onset. Hiemstra’s article takes a different approach to why tobacco smoking among teens is such an epidemic. It touches on the cognitive aspects of smoking, however intricately explains the science and mental battles youngsters face from this addiction. 

Hiemstra’s study exhibited three strengths. Firstly, focussing on preadolescence instead of most generic studies focussing on just the adolescence phase in which children mostly begin smoking, allowed the researchers to see into the perspective of preadolescents as to reasons why smoking takes place. Secondly, by using a large sample size of 1478 children, “which allowed us to test the conceptual model derived from the TPB” (Hiemstra, et., al, 2012). Thirdly, to gain more insight into smoking -specific communication, using the mother and child data enabled the study to see this. Although few strengths, there are numerous limitations within the study that must be addressed. Firstly, Hiemstra’s study was cross – sectional study. Smoking matures through several phases, the results found within this study directs to the worrisome risk factors at various phases of smoking. A more suitable design would have been the longitudinal study as it focusses more on the development of smoking and connected risk factors in adolescents and “allow testing for potential bidirectional relationships between smoking-specific parenting and cognitions” (Hiemstra, et., al, 2012). Secondly, due to reports from children of their own smoking reasonings and smoking attitudes, which points to the red flag of recall bias or social desirability as it poses a threat to the results of this report. However, previous research on similar studies show that self – report data are quite dependable, and discretion is guaranteed. Thirdly, after assessing adolescent smoking cognitions, it is a possibility that children perceived a more negative attitude as they were conscious of what the report was testing and the existing social norms. It is directed that in order to overcome this, using the implicit measure of attitudes and comparing “implicit with explicit attitudes” (Hiemstra, et., al, 2012). Fourthly, Hiemstra’s study only targeted the perspectives of female figures and failed to recognise the attitudes of father figure behaviours. Due to this, the lack of evidence found on mother – father communication and partnering efforts from both parents is currently missing.  The self – efficacy questions asked within the questionnaires and interviews may pose too intricate for young adolescents to imagine as children are definitely too young of an age to encounter a situation where they will be forced to refuse any smoking endeavours. Therefore, in future research with pre – adolescents, Hiemstra’s researchers recommend “measuring, in addition to self-efficacy skills, also self-regulation as a precursor of self-efficacy to measure the effect of the environment on the behaviour of the child” (Hiemstra, et., al, 2012.) Finally, families were recruited from primary schools, media and health professionals. Specifically, primary school boards were asked to distribute letters to all children aged nine to 11 years old and to request that children give this letter to their parents. This automatically poses unreliable to the study. Entrusting children to deliver a letter to parents is massively untrustworthy. Simply, sending an email to all parents would have been the smarter option as it ensures direct contact with the adults and validity that the letter was received.

Overall, as an intern within Queensland Health, it can be corroborated that through the TBP, tobacco smoking among adolescence must be addressed immediately. The TPB doesn’t particularly connect with young tobacco smoking. There are numerous limitations that follow the TPB construct. Firstly, Hiemstra’s study was cross – sectional study. A more suitable design would have been the longitudinal study as smoking-specific parenting and cognitions. Secondly, recall bias or social desirability poses a threat to the results of this report. Thirdly, it is a possibility that children perceived a more negative attitude as they were conscious of what the report was testing and the existing social norms. Although a variety of limitations, there were few strengths. This study focussed on preadolescence as well as adolescence unlike most studies to encapsulate pre – pubescent attitudes. Secondly, by testing the conceptual model from the TPB allowed for the study to use a large sample size of children. Lastly, using both the parent (mother) and youngster’s perspective, allowing for smoking – specific communication. Therefore, due to all of this information it can be concluded that Hiemstra’s article was informative in providing smoking-specific communication and children’s smoking onset: An extension of the theory of planned behaviour.

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