Influence of Peers and Parents on Smoking Initiation in Adolescents

Introduction

In Lifespan Development (Fifth Edition), Boyd et al. defines sensation-seeking as “…a desire to experience increased levels of arousal, such as those that accompany fast driving or the ‘highs’ that are associated with drugs.”.¹ This is a common behaviour across all adolescents, however, it does not come without its risks. Smoking cigarettes releases nicotine into our bodies, which in turn releases various chemicals in our body that result in what is typically considered a high. Thus, smoking cigarettes is often attractive to adolescents as there is a sensation felt as nicotine enters one’s body. However, as many should know, smoking cigarettes has a plethora of negative health outcomes: an increased risk of developing a cardiovascular disease, a respiratory disease, and various cancers,² are just a few of the many on the seemingly endless list of negative health outcomes of smoking cigarettes. In knowing how detrimental smoking cigarettes can be to our health, why then are they so prevalent in our world today? The side effects of smoking can ultimately lead to death, and, in the United States, smoking accounts for over 480,000 deaths each year.As of 2016 an estimated population of 37.8 million United States adults were currently smokers,³ and of this population it is reported that nearly 90% of current adult cigarette smokers in the United States tried by smoking by age 18,⁴ meaning that 90% of all adult smokers in the United States began smoking while they were in adolescence. Not only does smoking often begin during adolescence, is also very prevalent in adolescent populations around the world. In the United States specifically, each day over 3,200 individuals under 18 smoking their first cigarette, and additional estimated 2,100 adolescents become daily smokers.⁴ Daily cigarette smoking is the result of developing a nicotine dependency, which can be “…characterised by tolerance, cravings, feeling a need to use tobacco, withdrawal symptoms during periods of abstinence, and loss of control over the amount or duration of use.”.⁵

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This paper focuses on adolescent smoking initiation, but specifically on the development of nicotine dependency. Nicotine is the main addictive chemical found in cigarettes, and because of this it is typically what leads to excessive smoking, which leads to the negative health outcomes of smoking cigarettes. Along with nicotine dependency, the main social determinants associated with adolescent smoking initiation will also be looked at. The smoking habits of both parents and peers can have either a direct, or indirect influence on adolescents, and ultimately results in increasing the likelihood that an adolescent will try smoking.⁶ Parental and peer influence, as of now, are believed to have the biggest impact on adolescent smoking initiation.⁶

Adolescent Smoking and Nicotine Dependency

Nicotine stimulates our adrenal glands, which in turn release epinephrine. The sudden release of epinephrine stimulates the abrupt release of glucose, and increases our heart rate and blood pressure, as well as our breathing rate. Nicotine also causes the release of dopamine in the regions of the brain that are responsible for both pleasure and motivation. The sudden release of both epinephrine and dopamine are deemed responsible for the pleasure associated with smoking a cigarette. There is also the potential for nicotine to have a sedative effect, however this depends on the amount of nicotine in one’s body as well as the arousal level of one’s nervous system.⁷ The effects of nicotine on the human body play a massive role in the development of a nicotine dependence. A study by DiFranza et al. involved observing when the initial symptoms of an adolescent with a nicotine dependence were first visible. Using a cohort of 681 seventh grade students, this longitudinal study would result in four years of data collection. The results showed that 25% of the students in the study reported at least one symptom of a nicotine dependence within two weeks of the beginning of a monthly smoking habit. On a more extreme note, several students reported feeling nicotine dependence symptoms within several days off beginning smoking.⁵

One major factor in developing a nicotine dependence is one’s tolerance for nicotine. Tolerance, as defined by the Merriam-Webster dictionary is the ability of the body to “…endure or become less responsive to a substance…”.⁹ It has been indicated by several studies that one’s tolerance of nicotine can begin with the initial dosage, which makes it clear as to why adolescents who simply try a cigarette, or some other form of tobacco, develop dependencies. Several other studies have also found that daily use is not a prerequisite for developing a nicotine dependence; rather, the simple act of nicotine consumption is enough to develop a dependence.⁵ An increase in tolerance is due to repeated exposure to a substance.⁷ In the case of smoking, as an adolescent moves from one occasional cigarette to daily consumption of multiple cigarettes, their tolerance for nicotine increases as nicotine exposure increases.

Nicotine, a stimulant, can have many side effects to the physiology of developing adolescents. As with tobacco, it increases one’s risk of cardiovascular and respiratory disease, and it can also negatively affect one’s immune response ability and reproductive health. It can also interfere with several mechanisms which lead to cancer, including: cell proliferation, oxidative stress, apoptosis, and DNA mutation. Along with increasing one’s risk of developing cancer, it also increases one’s resistance to chemotherapy.¹⁰ For someone who develops some form of cancer, having a greater resistance to the therapeutic technique being used to kill the cancer could be potentially deadly. A study done in 2008 by Shram et al. tested exposure to nicotine in adolescent and adult male rats to assess whether adolescents were biologically more susceptible to the addictive component of cigarettes. The data obtained from this experiment showed that nicotine was actually less reinforcing in adolescent than in adult rats. Due to this, it was concluded that factors outside the addictive properties of nicotine must be responsible for tobacco adolescents.¹¹ This leads to the question: what else, besides an adolescent way of thinking (sensation-seeking, risk taking, etc.), causes smoking initiation?

Social Determinants of Adolescent Smoking Initiation

While one may assume that there are many factors that could influence smoking initiation in adolescence, there remains little research and the exact determinants are relatively unknown. In the book Nicotine Addiction Among Adolescents, author Eric F. Wagner outlines the fact that significant work has been done in an effort to treat nicotine addiction in adults, but that same level or work has not been done for neither understanding nor treating adolescent nicotine addiction.¹² This is somewhat surprising as the earlier in life that one begins smoking can greatly reduce the likelihood that they will quit.In one study, Simons-Morton et al. describes the fact that social influences can both encourage and discourage the use of substances. It is further stated that there are increased rates of experimentation during the adolescent period of life, specifically with smoking and drinking.¹³ This relates back to the fact that adolescence is a time of sensation-seeking and risk taking. The act of sensation-seeking tends to lead to reckless behaviour, which can include tobacco, as well as other substances.Sensation-seeking is the factor of adolescence that can ultimately lead to a nicotine dependency.

Peer influence is one of the most commonly linked factors to adolescent smoking. Direct influence from peers may occur by an adolescent being encouraged to try smoking or being offered cigarettes, and indirect influence may occur when an adolescent individual chooses to associate with peers who smoke, which makes cigarettes readily available. Associating with individuals that smoke also establishes role models, in turn setting the use of cigarettes as normal; this in turn can result in an adolescent believing that the smoking will increase their acceptance socially.Simons-Morton et al.’s study actually found a positive association between both direct and indirect peer pressure when looking at smoking and drinking. These findings show that adolescents may be encouraged by their peers to try substances or simply have substances readily available, and how much of an influence simply associating with certain people who use substances can influence substance usage.¹³

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Parents that smoke can also provide influence that may cause an adolescent to be morel likely to smoke. Having parents that smoke means that cigarettes are likely readily available, and, whether they are trying to or not, the parents are modelling smoking as a normal behaviour.In the same study looking at peer influence, Simons-Morton et al. also looked at parental influence. It was found that the practice of authoritative parenting, which involves being both demanding and responsive, was the most effective method for reducing the likelihood of adolescent substance usage. This relates to similar in other studies in which it was found that adolescents who had parents that were more involved and had high expectations for appropriate behaviour were less likely to participate in substance use. Although this study only measured the adolescents’ perceptions of how their parents acted (what their parenting style was), it still provides insight as to what type of parenting is most effective for one’s child to avoid substance use.¹³ Another study by Gilman et al. found that parental smoking strongly correlated to a higher risk of adolescent smoking initiation. The number of smoking parents, as well as how much the adolescent was exposed to parental smoking both increased the chance for smoking initiation for the adolescent.¹⁴

Parental influences are beyond factors like socioeconomic status, or household income. Alves et al.’s cross-sectional survey on six cities in Europe found that parental influence, and adolescent susceptibility to smoking, remained the same across social classes. While socioeconomic status in parents may increase the chance that the adolescent in question will be at a similar status when they become adults,¹³ that does not affect the probability of them trying cigarettes and developing a nicotine dependency. Mays et al. completed a study in which the objective was to determine the smoking trajectory for adolescents. From the sample taken, four smoking trajectories were identified in the adolescents: early regular smokers (6%), early experimenters (23%), late experimenters (41%), and non-smokers (30%). Of these four classes, early regular smokers and early experimenters were more likely to arise with smoking parents that had a nicotine dependency. This leads to the conclusion that adolescents may pick up a more intense habit of smoking depending on how strong their parents nicotine dependency is.¹⁵ The common thread is found across most studies regarding parental influence on adolescent smoking initiation is: if an adolescents’ parents smoke, they are more likely to begin smoking.

Conclusion

Nicotine dependency is perhaps the most serious outcome of smoking cigarettes as it involves the user being required to smoke more and more cigarettes as tolerance increases. The number of cigarettes one is smoking heavily influences the level of risk one has of developing one, or multiple side-effects. An adolescent brain is highly susceptible to substance usage do to the sensation-seeking it experiences. Because of this, it is crucial for adolescents to try to be aware of the countless negative health outcomes that are receivable if one smokes cigarettes

It is clear that the most effective way to prevent an adolescent from trying cigarettes and risking developing a nicotine dependency, as a parent, is simply to demonstrate the same behaviour you expect from your child. It is also important for adolescents to be aware of the lifestyle choices of their peers, and to associate with those who provide positive social support. The adolescent brain is easily influenced, and, as uncovered through my study for this paper, there are seemingly endless sources of social influence. While an adolescent’s parents and peers have the biggest impact on smoking initiation, there remain many factors, outside of social influence, that may also play a major role.

References

1. Boyd DR, Bee HL. Lifespan Development (Fifth Edition). Boston: Pearson; 2015.
2. Smoking & Tobacco Use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm. Published May 15, 2017. Accessed November 18, 2018.
3. Smoking & Tobacco Use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Published September 24, 2018. Accessed November 21, 2018.
4. Smoking & Tobacco Use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm. Published June 25, 2018. Accessed November 18, 2018.
5. Difranza JR. Initial symptoms of nicotine dependence in adolescents. Tobacco Control. 2000;9(3):313-319. doi:10.1136/tc.9.3.313.
6. Simons-Morton B, Haynie DL, Crump AD, Eitel P, Saylor KE. Peer and Parent Influences on Smoking and Drinking among Early Adolescents. Health Education & Behavior. 2001;28(1):95-107. doi:10.1177/109019810102800109
7. Nicotine | Psychology Today Canada. Psychology Today. https://www.psychologytoday.com/ca/conditions/nicotine. Accessed November 21, 2018.
8. Dictionary by Merriam-Webster: America’s most-trusted online dictionary. Merriam-Webster. https://www.merriam-webster.com/. Accessed November 21, 2018.
9. Chaturvedi P, Mishra A, Datta S, Sinukumar S, Joshi P, Garg A. Harmful effects of nicotine. Indian Journal of Medical and Paediatric Oncology. 2015;36(1):24. doi:10.4103/0971-5851.151771
10. Shram MJ, Funk D, Li Z, Lê AD. Nicotine Self-Administration, Extinction Responding and Reinstatement in Adolescent and Adult Male Rats: Evidence Against a Biological Vulnerability to Nicotine Addiction during Adolescence. Neuropsychopharmacology. 2007;33(4):739-748. doi:10.1038/sj.npp.1301454.
11. Wagner EF. Nicotine Addiction Among Adolescents. Google Books. https://books.google.ca/books?hl=en&lr=&id=H6xDvbTH9b8C&oi=fnd&pg=PP11&dq=nicotine addiction in adolescents&ots=yDvqT5S_eQ&sig=0R46B_EcBKTdwGtK0bk1Bvk-2dU#v=onepage&q=nicotine addiction in adolescents&f=false. Accessed November 18, 2018.
12. Simons-Morton B, Haynie DL, Crump AD, Eitel P, Saylor KE. Peer and Parent Influences on Smoking and Drinking among Early Adolescents. Health Education & Behavior. 2001;28(1):95-107. doi:10.1177/109019810102800109.
13. Gilman SE, Rende R, Boergers J, et al. Parental Smoking and Adolescent Smoking Initiation: An Intergenerational Perspective on Tobacco Control. Pediatrics. 2009;123(2). doi:10.1542/peds.2008-2251.
14. Alves J, Perelman J, Soto-Rojas V, et al. The role of parental smoking on adolescent smoking and its social patterning: a cross-sectional survey in six European cities. Journal of Public Health. August 2016. doi:10.1093/pubmed/fdw040.
15. Mays D, Gilman SE, Rende R, Luta G, Tercyak KP, Niaura RS. Parental Smoking Exposure and Adolescent Smoking Trajectories. Pediatrics. 2014;133(6):983-991. doi:10.1542/peds.2013-3003.