essay about smoke free community

Smoke-Free Society

The prevalence of smoking has sparked debates and raised concerns about its impact on individuals and society. Despite being legal in many countries, overwhelming evidence showcases the severe health risks associated with this habit and the economic burdens it poses. This prompts a crucial question: should smoking be made illegal? In this essay, we delve into the various facets of the issue – analyzing detrimental health consequences, healthcare systems’ strain on economies along with potential benefits that come from prohibition- to establish why banning smoking is an essential step towards promoting public wellness while reducing societal costs for all people’s welfare through creating smoke-free environments thereby fostering improved living standards overall.

Smoking presents significant health risks to smokers and those exposed to secondhand smoke. An abundance of scientific research firmly establishes the connection between smoking and numerous severe medical conditions, such as lung cancer, heart disease, stroke, and respiratory illnesses (Centers for Disease Control and Prevention). Every year globally, over eight million deaths result from tobacco-related ailments, according to World Health Organization(WHO) data. Banning smoking will help prevent people from being subjected to avoidable dangers that harm their long-term well-being while relieving pressure on healthcare systems. Moreover, nonsmokers- especially children- are at increased risk when inhaling dangerous chemicals in secondhand smoke. Exposure results in more than seven thousand toxic compounds containing sixty-nine known carcinogens, threatening lives across all sections of society(Centers for Disease Control and Prevention, “Health Effects”). By making it illegal, the government can ensure a safer future by avoiding exposure by providing better air quality, leading us towards maintaining healthy living surroundings for everyone.

Aside from the adverse effects on public health, smoking has a significant economic impact on society. Expenses related to treating illnesses caused by smoking, lost productivity, and premature deaths weigh heavily on healthcare systems and economies (The Lancet). An analysis conducted by the Centers for Disease Control and Prevention revealed that in America alone, cigarette consumption resulted in $170 billion worth of healthcare expenses per year(Centers for Disease Control and Prevention). On top of this expense are reduced work efficiency and increased sick days due to smoke-related conditions, which add more economic burden. By banning smoking altogether, we can ease financial pressures placed upon our medical institutions; lower production losses while freeing up resources for alternative channels such as education or improving social welfare services.

Banning smoking would have numerous advantages beyond improving public health and decreasing economic burdens. To begin with, it would act as a strong deterrent for young individuals who are frequently influenced by their peers and the targeted advertising of tobacco companies. We can prevent addiction initiation by removing access to legal sales or consumption of tobacco products. Additionally, outlawing smoking would decrease social acceptance and normalization; this shift in societal attitudes towards smoking cultivates an environment that values optimum health and well-being instead(The Lancet). As time passes, without cigarettes being so prevalent, subsequent generations will be less likely to view them favorably or consider them socially acceptable behavior overall.

Moreover, illegalizing cigarette/tobacco use could make implementing more effective controls regarding its usage easier/more streamlined. Stricter regulations could be enforced with age restrictions intact alongside further awareness campaigns geared at discouraging folks from taking up unhealthy habits like these (Centers for Disease Control and Prevention, “Health Effects”). All measures taken together along with the absence of legally available market/supply chain outlets exclusively dealing solely toward any form/genre/type of hazardous-smoking material/products/consumables may do a lot also towards realizing very significant reductions both generally related directly/e.g., regarding chronic diseases common among smokers themselves. Still, other associated risks/effects felt eco-socially broadly constraining e,g air pollution effects around the planet & waste-management problems.

Although some contend that smoking is a decision made on an individual level and should offer the liberty to make their own health-related choices, realizing its harmful side effects is imperative. Smoking may affect individuals other than smokers as secondhand smoke detrimentally affects one’s wellness; not only this but society bears an economic setback due to the habit as well(“Taxation: Most Effective but Still the Least-Used Tobacco Control Measure”). Implementing legislation restricting cigarette consumption is essential in preserving public health, safeguarding citizen well-being, and mitigating economic loss experienced by society overall. Some argue that banning smoking could increase unlawful behaviors and underground transactions(Mitchell and https://www.facebook.com/pahowho). Despite this legitimate issue, it is crucial to acknowledge the inclusion of strict enforcement protocols and educational initiatives to promote abstinence from smoking if cigarettes were made illegal. The dangers associated with a clandestine economy should not surpass the advantages of better public health and decreased financial pressures.

To sum up, smoking should be banned owing to its adverse effects on public health, the economic burden on society, and the potential benefits of prohibition. The ban will shield people from unhealthy hazards linked with smoking and secondhand smoke; it will relieve pressure on healthcare systems while redirecting resources to more productive areas. In addition, outlaws could act powerfully against social acceptance while at the same time facilitating effective tobacco control policies implementation – therefore serving also as an impediment for smokers considering this action. Notwithstanding counterarguments that may emerge during debates regarding such prohibitions, taking decisive measures to create change is fundamental when pursuing individual and community welfare. A concerted effort must be put into place to achieve better prospects concerning our future – one marked by healthier societies accompanied by significant growth opportunities beyond restricted boundaries traced forth alongside general smoker demographics within any nation’s populace structure today.

Centers for Disease Control and Prevention. “CDC – Fact Sheet – Health Effects of Cigarette Smoking – Smoking & Tobacco Use.”  Smoking and Tobacco Use , U.S. Department of Health & Human Services, 29 Oct. 2021, www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm.

—. “Health Effects.”  Centers for Disease Control and Prevention , 28 Apr. 2020, www.cdc.gov/tobacco/basic_information/health_effects/index.htm.

Mitchell, Cristina, and https://www.facebook.com/pahowho. “PAHO/WHO | Effective Tobacco Control Measures.”  Pan American Health Organization / World Health Organization , www3.paho.org/hq/index.php?option=com_content&view=article&id=1350:medidas-efectivas-control-tabaco&Itemid=0&lang=en#gsc.tab=0.

“Taxation: Most Effective but Still the Least-Used Tobacco Control Measure.”  Blogs.worldbank.org , 19 July 2017, blogs.worldbank.org/health/taxation-most-effective-still-least-used-tobacco-control-measure#:~:text=1%20Monitoring%20tobacco%20use%20and%20prevention%20policies%3B%202. Accessed 21 June 2023.

The Lancet. “The Global Burden of Tobacco.”  Www.thelancet.com , 27 May 2021, www.thelancet.com/infographics-do/tobacco.

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Health Issues

Why are smoke-free environments a big deal.

​​​Millions of people—adults and children—are exposed to secondhand smoke​ . Sometimes, the smoke that poses a health threat comes from an adjacent housing unit such as another apartment or condominium unit. Smoke travels through walls, ventilation systems, and hallways, which expose non-smokers to the same health threats faced by smokers.

Many towns, states, casinos, medical centers, campuses, and residential buildings are moving towards keeping all of their structures smoke free, in an effort to reduce the amount of people exposed to tobacco smoke. This is especially helpful for children, who have still-developing lungs and are easily harmed by smoke exposure.

Fast Facts:

Blood levels of cotinine, the typical marker of tobacco smoke exposure, are higher for children in non-smoking apartments than other non-smoking types of homes. This is most likely due to smoke from neighboring apartment units.

Children exposed to tobacco smoke are at risk for asthma and other respiratory illnesses, earaches , and sudden infant death syndrome (SIDS) .

Some populations are more likely to become sick from smoke exposure such as children, the elderly, people with disabilities, or pregnant women. Some of these groups are also more likely to live in public housing buildings and can be easily exposed to smoke.

The estimated cost of decontamination of a two-bedroom housing unit can be as much as $15,000.

How far can tobacco smoke travel? Tobacco smoke can be measured in high quantities more than 20 feet from an outdoor source.

Despite marketing claims, no ventilation system can protect from the death and disease caused by exposure to secondhand smoke.

Some organizations are taking smoke-free laws even further: tobacco-free laws are gaining traction. These policies include products like electronic nicotine delivery systems ( e-cigarettes ) and smokeless tobacco like dip or chew.

Where We Stand:

The American Academy of Pediatrics (AAP) policy statement, Tobacco Use: A Pediatric Disease , supports clean-air and smoke-free environment ordinances and legislation in communities and states—particularly for environments in which children live, learn, work, and play, such as schools, multi-unit housing, public parks, child care settings, public beaches, sidewalks, restaurants, and sporting arenas. These environments should be smoke free even when children are not present.

To aid in accomplishing smoke-free environments, parents and caregivers can:

Make your voice heard. Work with your local and state legislators to support smoke-free environments.

Keep a smoke-free home and car. If quitting isn't possible, the only way to fully protect others from secondhand smoke is to maintain smoke-free homes and vehicles .

Educate your landlords and homeowners associations about the importance of maintaining smoke-free multi-unit housing environments.

Additional Information & Resources on Smoke-free Environments:

Smoke-free Housing Toolkits:  Owners  and  Residents (U.S. Department of Housing and Urban Development)

Going Smoke Free (Americans for Non-Smokers Rights)

Tobacco-Smoke Exposure in Children Who Live in Multiunit Housing  (Study published in Pediatrics )

Regulation of Smoking in Public Housing  (Study published in The New England Journal of Medicine )

Toolkit for Implementing Smoke-Free Laws (Campaign for Tobacco-Free Kids)

Healthy Housing (ChangeLab Solutions)

Smoke-Free Housing Tips and Resources (Group to Alleviate Smoking Pollution)

Smoke-free Parks (ChangeLab Solutions)

Smoke-free Workplaces (Centers for Disease Control and Prevention)

Tobacco-free Beaches

Tobacco-free College Campus Initiative

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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012.

Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

1 introduction, summary, and conclusions.

• Introduction

Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation’s public and economic health in the future ( Perry et al. 1994 ; Kessler 1995 ). The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of American spending on health care ( Anderson 2010 ), is well-documented and undeniable. Although progress has been made since the first Surgeon General’s report on smoking and health in 1964 ( U.S. Department of Health, Education, and Welfare [USDHEW] 1964 ), nearly one in four high school seniors is a current smoker. Most young smokers become adult smokers. One-half of adult smokers die prematurely from tobacco-related diseases ( Fagerström 2002 ; Doll et al. 2004 ). Despite thousands of programs to reduce youth smoking and hundreds of thousands of media stories on the dangers of tobacco use, generation after generation continues to use these deadly products, and family after family continues to suffer the devastating consequences. Yet a robust science base exists on social, biological, and environmental factors that influence young people to use tobacco, the physiology of progression from experimentation to addiction, other health effects of tobacco use, the epidemiology of youth and young adult tobacco use, and evidence-based interventions that have proven effective at reducing both initiation and prevalence of tobacco use among young people. Those are precisely the issues examined in this report, which aims to support the application of this robust science base.

Nearly all tobacco use begins in childhood and adolescence ( U.S. Department of Health and Human Services [USDHHS] 1994 ). In all, 88% of adult smokers who smoke daily report that they started smoking by the age of 18 years (see Chapter 3 , “The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”). This is a time in life of great vulnerability to social influences ( Steinberg 2004 ), such as those offered through the marketing of tobacco products and the modeling of smoking by attractive role models, as in movies ( Dalton et al. 2009 ), which have especially strong effects on the young. This is also a time in life of heightened sensitivity to normative influences: as tobacco use is less tolerated in public areas and there are fewer social or regular users of tobacco, use decreases among youth ( Alesci et al. 2003 ). And so, as we adults quit, we help protect our children.

Cigarettes are the only legal consumer products in the world that cause one-half of their long-term users to die prematurely ( Fagerström 2002 ; Doll et al. 2004 ). As this epidemic continues to take its toll in the United States, it is also increasing in low- and middle-income countries that are least able to afford the resulting health and economic consequences ( Peto and Lopez 2001 ; Reddy et al. 2006 ). It is past time to end this epidemic. To do so, primary prevention is required, for which our focus must be on youth and young adults. As noted in this report, we now have a set of proven tools and policies that can drastically lower youth initiation and use of tobacco products. Fully committing to using these tools and executing these policies consistently and aggressively is the most straight forward and effective to making future generations tobacco-free.

The 1994 Surgeon General’s Report

This Surgeon General’s report on tobacco is the second to focus solely on young people since these reports began in 1964. Its main purpose is to update the science of smoking among youth since the first comprehensive Surgeon General’s report on tobacco use by youth, Preventing Tobacco Use Among Young People , was published in 1994 ( USDHHS 1994 ). That report concluded that if young people can remain free of tobacco until 18 years of age, most will never start to smoke. The report documented the addiction process for young people and how the symptoms of addiction in youth are similar to those in adults. Tobacco was also presented as a gateway drug among young people, because its use generally precedes and increases the risk of using illicit drugs. Cigarette advertising and promotional activities were seen as a potent way to increase the risk of cigarette smoking among young people, while community-wide efforts were shown to have been successful in reducing tobacco use among youth. All of these conclusions remain important, relevant, and accurate, as documented in the current report, but there has been considerable research since 1994 that greatly expands our knowledge about tobacco use among youth, its prevention, and the dynamics of cessation among young people. Thus, there is a compelling need for the current report.

Tobacco Control Developments

Since 1994, multiple legal and scientific developments have altered the tobacco control environment and thus have affected smoking among youth. The states and the U.S. Department of Justice brought lawsuits against cigarette companies, with the result that many internal documents of the tobacco industry have been made public and have been analyzed and introduced into the science of tobacco control. Also, the 1998 Master Settlement Agreement with the tobacco companies resulted in the elimination of billboard and transit advertising as well as print advertising that directly targeted underage youth and limitations on the use of brand sponsorships ( National Association of Attorneys General [NAAG] 1998 ). This settlement also created the American Legacy Foundation, which implemented a nationwide antismoking campaign targeting youth. In 2009, the U.S. Congress passed a law that gave the U.S. Food and Drug Administration authority to regulate tobacco products in order to promote the public’s health ( Family Smoking Prevention and Tobacco Control Act 2009 ). Certain tobacco companies are now subject to regulations limiting their ability to market to young people. In addition, they have had to reimburse state governments (through agreements made with some states and the Master Settlement Agreement) for some health care costs. Due in part to these changes, there was a decrease in tobacco use among adults and among youth following the Master Settlement Agreement, which is documented in this current report.

Recent Surgeon General Reports Addressing Youth Issues

Other reports of the Surgeon General since 1994 have also included major conclusions that relate to tobacco use among youth ( Office of the Surgeon General 2010 ). In 1998, the report focused on tobacco use among U.S. racial/ethnic minority groups ( USDHHS 1998 ) and noted that cigarette smoking among Black and Hispanic youth increased in the 1990s following declines among all racial/ethnic groups in the 1980s; this was particularly notable among Black youth, and culturally appropriate interventions were suggested. In 2000, the report focused on reducing tobacco use ( USDHHS 2000b ). A major conclusion of that report was that school-based interventions, when implemented with community- and media-based activities, could reduce or postpone the onset of smoking among adolescents by 20–40%. That report also noted that effective regulation of tobacco advertising and promotional activities directed at young people would very likely reduce the prevalence and onset of smoking. In 2001, the Surgeon General’s report focused on women and smoking ( USDHHS 2001 ). Besides reinforcing much of what was discussed in earlier reports, this report documented that girls were more affected than boys by the desire to smoke for the purpose of weight control. Given the ongoing obesity epidemic ( Bonnie et al. 2007 ), the current report includes a more extensive review of research in this area.

The 2004 Surgeon General’s report on the health consequences of smoking ( USDHHS 2004 ) concluded that there is sufficient evidence to infer that a causal relationship exists between active smoking and (a) impaired lung growth during childhood and adolescence; (b) early onset of decline in lung function during late adolescence and early adulthood; (c) respiratory signs and symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea; and (d) asthma-related symptoms (e.g., wheezing) in childhood and adolescence. The 2004 Surgeon General’s report further provided evidence that cigarette smoking in young people is associated with the development of atherosclerosis.

The 2010 Surgeon General’s report on the biology of tobacco focused on the understanding of biological and behavioral mechanisms that might underlie the pathogenicity of tobacco smoke ( USDHHS 2010 ). Although there are no specific conclusions in that report regarding adolescent addiction, it does describe evidence indicating that adolescents can become dependent at even low levels of consumption. Two studies ( Adriani et al. 2003 ; Schochet et al. 2005 ) referenced in that report suggest that because the adolescent brain is still developing, it may be more susceptible and receptive to nicotine than the adult brain.

Scientific Reviews

Since 1994, several scientific reviews related to one or more aspects of tobacco use among youth have been undertaken that also serve as a foundation for the current report. The Institute of Medicine (IOM) ( Lynch and Bonnie 1994 ) released Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, a report that provided policy recommendations based on research to that date. In 1998, IOM provided a white paper, Taking Action to Reduce Tobacco Use, on strategies to reduce the increasing prevalence (at that time) of smoking among young people and adults. More recently, IOM ( Bonnie et al. 2007 ) released a comprehensive report entitled Ending the Tobacco Problem: A Blueprint for the Nation . Although that report covered multiple potential approaches to tobacco control, not just those focused on youth, it characterized the overarching goal of reducing smoking as involving three distinct steps: “reducing the rate of initiation of smoking among youth (IOM [ Lynch and Bonnie] 1994 ), reducing involuntary tobacco smoke exposure ( National Research Council 1986 ), and helping people quit smoking” (p. 3). Thus, reducing onset was seen as one of the primary goals of tobacco control.

As part of USDHHS continuing efforts to assess the health of the nation, prevent disease, and promote health, the department released, in 2000, Healthy People 2010 and, in 2010, Healthy People 2020 ( USDHHS 2000a , 2011 ). Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. Each iteration of Healthy People serves as the nation’s disease prevention and health promotion roadmap for the decade. Both Healthy People 2010 and Healthy People 2020 highlight “Tobacco Use” as one of the nation’s “Leading Health Indicators,” feature “Tobacco Use” as one of its topic areas, and identify specific measurable tobacco-related objectives and targets for the nation to strive for. Healthy People 2010 and Healthy People 2020 provide tobacco objectives based on the most current science and detailed population-based data to drive action, assess tobacco use among young people, and identify racial and ethnic disparities. Additionally, many of the Healthy People 2010 and 2020 tobacco objectives address reductions of tobacco use among youth and target decreases in tobacco advertising in venues most often influencing young people. A complete list of the healthy people 2020 objectives can be found on their Web site ( USDHHS 2011 ).

In addition, the National Cancer Institute (NCI) of the National Institutes of Health has published monographs pertinent to the topic of tobacco use among youth. In 2001, NCI published Monograph 14, Changing Adolescent Smoking Prevalence , which reviewed data on smoking among youth in the 1990s, highlighted important statewide intervention programs, presented data on the influence of marketing by the tobacco industry and the pricing of cigarettes, and examined differences in smoking by racial/ethnic subgroup ( NCI 2001 ). In 2008, NCI published Monograph 19, The Role of the Media in Promoting and Reducing Tobacco Use ( NCI 2008 ). Although young people were not the sole focus of this Monograph, the causal relationship between tobacco advertising and promotion and increased tobacco use, the impact on youth of depictions of smoking in movies, and the success of media campaigns in reducing youth tobacco use were highlighted as major conclusions of the report.

The Community Preventive Services Task Force (2011) provides evidence-based recommendations about community preventive services, programs, and policies on a range of topics including tobacco use prevention and cessation ( Task Force on Community Preventive Services 2001 , 2005 ). Evidence reviews addressing interventions to reduce tobacco use initiation and restricting minors’ access to tobacco products were cited and used to inform the reviews in the current report. The Cochrane Collaboration (2010) has also substantially contributed to the review literature on youth and tobacco use by producing relevant systematic assessments of health-related programs and interventions. Relevant to this Surgeon General’s report are Cochrane reviews on interventions using mass media ( Sowden 1998 ), community interventions to prevent smoking ( Sowden and Stead 2003 ), the effects of advertising and promotional activities on smoking among youth ( Lovato et al. 2003 , 2011 ), preventing tobacco sales to minors ( Stead and Lancaster 2005 ), school-based programs ( Thomas and Perara 2006 ), programs for young people to quit using tobacco ( Grimshaw and Stanton 2006 ), and family programs for preventing smoking by youth ( Thomas et al. 2007 ). These reviews have been cited throughout the current report when appropriate.

In summary, substantial new research has added to our knowledge and understanding of tobacco use and control as it relates to youth since the 1994 Surgeon General’s report, including updates and new data in subsequent Surgeon General’s reports, in IOM reports, in NCI Monographs, and in Cochrane Collaboration reviews, in addition to hundreds of peer-reviewed publications, book chapters, policy reports, and systematic reviews. Although this report is a follow-up to the 1994 report, other important reviews have been undertaken in the past 18 years and have served to fill the gap during an especially active and important time in research on tobacco control among youth.

• Focus of the Report

Young People

This report focuses on “young people.” In general, work was reviewed on the health consequences, epidemiology, etiology, reduction, and prevention of tobacco use for those in the young adolescent (11–14 years of age), adolescent (15–17 years of age), and young adult (18–25 years of age) age groups. When possible, an effort was made to be specific about the age group to which a particular analysis, study, or conclusion applies. Because hundreds of articles, books, and reports were reviewed, however, there are, unavoidably, inconsistencies in the terminology used. “Adolescents,” “children,” and “youth” are used mostly interchangeably throughout this report. In general, this group encompasses those 11–17 years of age, although “children” is a more general term that will include those younger than 11 years of age. Generally, those who are 18–25 years old are considered young adults (even though, developmentally, the period between 18–20 years of age is often labeled late adolescence), and those 26 years of age or older are considered adults.

In addition, it is important to note that the report is concerned with active smoking or use of smokeless tobacco on the part of the young person. The report does not consider young people’s exposure to secondhand smoke, also referred to as involuntary or passive smoking, which was discussed in the 2006 report of the Surgeon General ( USDHHS 2006 ). Additionally, the report does not discuss research on children younger than 11 years old; there is very little evidence of tobacco use in the United States by children younger than 11 years of age, and although there may be some predictors of later tobacco use in those younger years, the research on active tobacco use among youth has been focused on those 11 years of age and older.

Tobacco Use

Although cigarette smoking is the most common form of tobacco use in the United States, this report focuses on other forms as well, such as using smokeless tobacco (including chew and snuff) and smoking a product other than a cigarette, such as a pipe, cigar, or bidi (tobacco wrapped in tendu leaves). Because for young people the use of one form of tobacco has been associated with use of other tobacco products, it is particularly important to monitor all forms of tobacco use in this age group. The term “tobacco use” in this report indicates use of any tobacco product. When the word “smoking” is used alone, it refers to cigarette smoking.

• Organization of the Report

This chapter begins by providing a short synopsis of other reports that have addressed smoking among youth and, after listing the major conclusions of this report, will end by presenting conclusions specific to each chapter. Chapter 2 of this report (“The Health Consequences of Tobacco Use Among Young People”) focuses on the diseases caused by early tobacco use, the addiction process, the relation of body weight to smoking, respiratory and pulmonary problems associated with tobacco use, and cardiovascular effects. Chapter 3 (“The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”) provides recent and long-term cross-sectional and longitudinal data on cigarette smoking, use of smokeless tobacco, and the use of other tobacco products by young people, by racial/ethnic group and gender, primarily in the United States, but including some worldwide data as well. Chapter 4 (“Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth”) identifies the primary risk factors associated with tobacco use among youth at four levels, including the larger social and physical environments, smaller social groups, cognitive factors, and genetics and neurobiology. Chapter 5 (“The Tobacco Industry’s Influences on the Use of Tobacco Among Youth”) includes data on marketing expenditures for the tobacco industry over time and by category, the effects of cigarette advertising and promotional activities on young people’s smoking, the effects of price and packaging on use, the use of the Internet and movies to market tobacco products, and an evaluation of efforts by the tobacco industry to prevent tobacco use among young people. Chapter 6 (“Efforts to Prevent and Reduce Tobacco Use Among Young People”) provides evidence on the effectiveness of family-based, clinic-based, and school-based programs, mass media campaigns, regulatory and legislative approaches, increased cigarette prices, and community and statewide efforts in the fight against tobacco use among youth. Chapter 7 (“A Vision for Ending the Tobacco Epidemic”) points to next steps in preventing and reducing tobacco use among young people.

• Preparation of the Report

This report of the Surgeon General was prepared by the Office on Smoking and Health (OSH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), USDHHS. In 2008, 18 external independent scientists reviewed the 1994 report and suggested areas to be added and updated. These scientists also suggested chapter editors and a senior scientific editor, who were contacted by OSH. Each chapter editor named external scientists who could contribute, and 33 content experts prepared draft sections. The draft sections were consolidated into chapters by the chapter editors and then reviewed by the senior scientific editor, with technical editing performed by CDC. The chapters were sent individually to 34 peer reviewers who are experts in the areas covered and who reviewed the chapters for scientific accuracy and comprehensiveness. The entire manuscript was then sent to more than 25 external senior scientists who reviewed the science of the entire document. After each review cycle, the drafts were revised by the chapter and senior scientific editor on the basis of the experts’ comments. Subsequently, the report was reviewed by various agencies within USDHHS. Publication lags prevent up-to-the-minute inclusion of all recently published articles and data, and so some more recent publications may not be cited in this report.

• Evaluation of the Evidence

Since the first Surgeon General’s report in 1964 on smoking and health ( USDHEW 1964 ), major conclusions concerning the conditions and diseases caused by cigarette smoking and the use of smokeless tobacco have been based on explicit criteria for causal inference ( USDHHS 2004 ). Although a number of different criteria have been proposed for causal inference since the 1960s, this report focuses on the five commonly accepted criteria that were used in the original 1964 report and that are discussed in greater detail in the 2004 report on the health consequences of smoking ( USDHHS 2004 ). The five criteria refer to the examination of the association between two variables, such as a risk factor (e.g., smoking) and an outcome (e.g., lung cancer). Causal inference between these variables is based on (1) the consistency of the association across multiple studies; this is the persistent finding of an association in different persons, places, circumstances, and times; (2) the degree of the strength of association, that is, the magnitude and statistical significance of the association in multiple studies; (3) the specificity of the association to clearly demonstrate that tobacco use is robustly associated with the condition, even if tobacco use has multiple effects and multiple causes exist for the condition; (4) the temporal relationship of the association so that tobacco use precedes disease onset; and (5) the coherence of the association, that is, the argument that the association makes scientific sense, given data from other sources and understanding of biological and psychosocial mechanisms ( USDHHS 2004 ). Since the 2004 Surgeon General’s report, The Health Consequences of Smoking , a four-level hierarchy ( Table 1.1 ) has been used to assess the research data on associations discussed in these reports ( USDHHS 2004 ). In general, this assessment was done by the chapter editors and then reviewed as appropriate by peer reviewers, senior scientists, and the scientific editors. For a relationship to be considered sufficient to be characterized as causal, multiple studies over time provided evidence in support of each criteria.

Four-level hierarchy for classifying the strength of causal inferences based on available evidence.

When a causal association is presented in the chapter conclusions in this report, these four levels are used to describe the strength of the evidence of the association, from causal (1) to not causal (4). Within the report, other terms are used to discuss the evidence to date (i.e., mixed, limited, and equivocal evidence), which generally represent an inadequacy of data to inform a conclusion.

However, an assessment of a casual relationship is not utilized in presenting all of the report’s conclusions. The major conclusions are written to be important summary statements that are easily understood by those reading the report. Some conclusions, particularly those found in Chapter 3 (epidemiology), provide observations and data related to tobacco use among young people, and are generally not examinations of causal relationships. For those conclusions that are written using the hierarchy above, a careful and extensive review of the literature has been undertaken for this report, based on the accepted causal criteria ( USDHHS 2004 ). Evidence that was characterized as Level 1 or Level 2 was prioritized for inclusion as chapter conclusions.

In additional to causal inferences, statistical estimation and hypothesis testing of associations are presented. For example, confidence intervals have been added to the tables in the chapter on the epidemiology of youth tobacco use (see Chapter 3 ), and statistical testing has been conducted for that chapter when appropriate. The chapter on efforts to prevent tobacco use discusses the relative improvement in tobacco use rates when implementing one type of program (or policy) versus a control program. Statistical methods, including meta-analytic methods and longitudinal trajectory analyses, are also presented to ensure that the methods of evaluating data are up to date with the current cutting-edge research that has been reviewed. Regardless of the methods used to assess significance, the five causal criteria discussed above were applied in developing the conclusions of each chapter and the report.

• Major Conclusions
• Cigarette smoking by youth and young adults has immediate adverse health consequences, including addiction, and accelerates the development of chronic diseases across the full life course.
• Prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
• Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults.
• After years of steady progress, declines in the use of tobacco by youth and young adults have slowed for cigarette smoking and stalled for smokeless tobacco use.
• Coordinated, multicomponent interventions that combine mass media campaigns, price increases including those that result from tax increases, school-based policies and programs, and statewide or community-wide changes in smoke-free policies and norms are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults.
• Chapter Conclusions

The following are the conclusions presented in the substantive chapters of this report.

Chapter 2. The Health Consequences of Tobacco Use Among Young People

• The evidence is sufficient to conclude that there is a causal relationship between smoking and addiction to nicotine, beginning in adolescence and young adulthood.
• The evidence is suggestive but not sufficient to conclude that smoking contributes to future use of marijuana and other illicit drugs.
• The evidence is suggestive but not sufficient to conclude that smoking by adolescents and young adults is not associated with significant weight loss, contrary to young people’s beliefs.
• The evidence is sufficient to conclude that there is a causal relationship between active smoking and both reduced lung function and impaired lung growth during childhood and adolescence.
• The evidence is sufficient to conclude that there is a causal relationship between active smoking and wheezing severe enough to be diagnosed as asthma in susceptible child and adolescent populations.
• The evidence is sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and early abdominal aortic atherosclerosis in young adults.
• The evidence is suggestive but not sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and coronary artery atherosclerosis in adulthood.

Chapter 3. The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide

• Among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
• Almost one in four high school seniors is a current (in the past 30 days) cigarette smoker, compared with one in three young adults and one in five adults. About 1 in 10 high school senior males is a current smokeless tobacco user, and about 1 in 5 high school senior males is a current cigar smoker.
• Among adolescents and young adults, cigarette smoking declined from the late 1990s, particularly after the Master Settlement Agreement in 1998. This decline has slowed in recent years, however.
• Significant disparities in tobacco use remain among young people nationwide. The prevalence of cigarette smoking is highest among American Indians and Alaska Natives, followed by Whites and Hispanics, and then Asians and Blacks. The prevalence of cigarette smoking is also highest among lower socioeconomic status youth.
• Use of smokeless tobacco and cigars declined in the late 1990s, but the declines appear to have stalled in the last 5 years. The latest data show the use of smokeless tobacco is increasing among White high school males, and cigar smoking may be increasing among Black high school females.
• Concurrent use of multiple tobacco products is prevalent among youth. Among those who use tobacco, nearly one-third of high school females and more than one-half of high school males report using more than one tobacco product in the last 30 days.
• Rates of tobacco use remain low among girls relative to boys in many developing countries, however, the gender gap between adolescent females and males is narrow in many countries around the globe.

Chapter 4. Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth

• Given their developmental stage, adolescents and young adults are uniquely susceptible to social and environmental influences to use tobacco.
• Socioeconomic factors and educational attainment influence the development of youth smoking behavior. The adolescents most likely to begin to use tobacco and progress to regular use are those who have lower academic achievement.
• The evidence is sufficient to conclude that there is a causal relationship between peer group social influences and the initiation and maintenance of smoking behaviors during adolescence.
• Affective processes play an important role in youth smoking behavior, with a strong association between youth smoking and negative affect.
• The evidence is suggestive that tobacco use is a heritable trait, more so for regular use than for onset. The expression of genetic risk for smoking among young people may be moderated by small-group and larger social-environmental factors.

Chapter 5. The Tobacco Industry’s Influences on the Use of Tobacco Among Youth

• In 2008, tobacco companies spent $9.94 billion on the marketing of cigarettes and $547 million on the marketing of smokeless tobacco. Spending on cigarette marketing is 48% higher than in 1998, the year of the Master Settlement Agreement. Expenditures for marketing smokeless tobacco are 277% higher than in 1998.
• Tobacco company expenditures have become increasingly concentrated on marketing efforts that reduce the prices of targeted tobacco products. Such expenditures accounted for approximately 84% of cigarette marketing and more than 77% of the marketing of smokeless tobacco products in 2008.
• The evidence is sufficient to conclude that there is a causal relationship between advertising and promotional efforts of the tobacco companies and the initiation and progression of tobacco use among young people.
• The evidence is suggestive but not sufficient to conclude that tobacco companies have changed the packaging and design of their products in ways that have increased these products’ appeal to adolescents and young adults.
• The tobacco companies’ activities and programs for the prevention of youth smoking have not demonstrated an impact on the initiation or prevalence of smoking among young people.
• The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.

Chapter 6. Efforts to Prevent and Reduce Tobacco Use Among Young People

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• The evidence is sufficient to conclude that increases in cigarette prices reduce the initiation, prevalence, and intensity of smoking among youth and young adults.
• The evidence is sufficient to conclude that school-based programs with evidence of effectiveness, containing specific components, can produce at least short-term effects and reduce the prevalence of tobacco use among school-aged youth.
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• Cite this Page National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012. 1, Introduction, Summary, and Conclusions.
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• Research article
• Open access
• Published: 07 January 2019

A descriptive study of a Smoke-free Teens Programme to promote smoke-free culture in schools and the community in Hong Kong

• Oi Kwan Chung 1 ,
• William Ho Cheung Li   ORCID: orcid.org/0000-0002-2562-769X 1 ,
• Ka Yan Ho 1 ,
• Antonio Cho Shing Kwong 2 ,
• Vienna Wai Yin Lai 2 ,
• Man Ping Wang 1 ,
• Katherine Ka Wai Lam 1 ,
• Tai Hing Lam 3 &
• Sophia Siu Chee Chan 1  

BMC Public Health volume  19 , Article number:  23 ( 2019 ) Cite this article

5079 Accesses

3 Citations

Metrics details

Youth smoking continues to be a significant global public health concern. To ensure healthier lives for youths, healthcare professionals need to increase awareness among the youth of the health risks and addictive nature of smoking, strengthen their ability to resist negative peer influence and curiosity, and help those who smoked to quit. The Smoke-free Teens Programme was launched in 2012 to equip youngsters with up-to-date information about smoking and global trends in tobacco control and to encourage them to play a pioneering role in tobacco control. This paper describes the process and outcomes of this programme for youths in Hong Kong.

The Smoke-free Teens Programme contained three major components: (i) a 2-day-1-night training camp; (ii) creative activities to promote smoke-free messages in schools and the community; and (iii) an award presentation ceremony to recognize the efforts of outstanding Smoke-free Teens in establishing a smoke-free culture. All secondary school students or teenagers aged 14 to 18 years from secondary schools, youth centres and uniform groups were invited to join the programme. The outcome measures were changes in (1) knowledge about smoking hazards; (2) attitudes towards smoking, tobacco control, and smoking cessation; and (3) practices for promoting smoking cessation.

A total of 856 teenagers were recruited during the study period (July 2014 to March 2017). The results showed statistically significant changes in participants’ knowledge about smoking hazards, attitudes towards tobacco control, and practice for promoting smoking cessation.

Conclusions

The Smoke-free Teens Programme demonstrated effectiveness in equipping youngsters with up-to-date information about smoking and global trends in tobacco control and in encouraging them to play a pioneering role in tobacco control. The trained Smoke-free Teens not only promoted the smoke-free messages among their schoolmates, friends, and families, but also gathered community support for a smoke-free Hong Kong. The programme has been instrumental in fostering a new batch of Smoke-free Teens to advocate smoke-free culture and protect public health.

Trial registration

Clinicaltrials.gov ID NCT03291132 (retrospectively registered on September 19, 2017).

Peer Review reports

With an annual death toll of almost 7 million worldwide, cigarette smoking is the biggest preventable cause of premature death and disease [ 1 ]. Two-thirds of all premature deaths of smokers can be directly attributed to smoking, and smoking is especially hazardous for those who start smoking at a young age [ 2 , 3 , 4 , 5 , 6 ]. There is evidence that smoking cessation before the age of 40 can reduce the death rate by more than 90% [ 2 ]. Even though early cessation is critical to reducing the hazard that smoking poses to an individual’s health, young people who, driven by curiosity and peer pressure, begin to experiment with smoking are likely to continue the habit into adulthood [ 7 ]. Most adult smokers started smoking when they were young [ 8 ]. It is therefore essential that healthcare professionals should increase awareness among the young of the health risks and addictive nature of smoking, strength their ability to resist negative peer influence and curiosity, and help those who smoked to quit.

Over the past 30 years, enormous efforts have been made by the Hong Kong government to raise tobacco tax and introduce legislation, law enforcement, and smoke-free campaigns, which have led to remarkable success in tobacco control [ 9 , 10 ]. The prevalence of daily cigarette smoking in Hong Kong decreased from 23.3% in 1982 to 10.5% in 2015 [ 11 , 12 ]. Nevertheless, 641,300 people aged 15 years or above still smoke daily [ 12 ] and this remains an important public health concern in Hong Kong.

The Hong Kong Council on Smoking and Health (COSH) was established under its own ordinance in 1987. This is a statutory body vested with various functions, as set out in the Hong Kong Council on Smoking and Health Ordinance ( http://smokefree.hk/UserFiles/resources/about_us/CAP_389_Eng.pdf ), to protect and improve the health of the community by (1) informing and educating the public about smoking and health matters; (2) conducting and coordinating research into the cause, prevention, and cure of tobacco dependence; and (3) advising government, community health organizations, or any public body on matters related to smoking and health. Under this charter, COSH has been an active player and commentator on all issues related to tobacco control. To educate youngsters about smoking hazards and the latest trends in tobacco control, and to encourage them to play a pioneering role in spreading smoke-free messages, COSH launched the Smoke-free Teens Programme in 2012 (formerly named Smoke-free Youth Ambassador Leadership Training Programme). The objectives of the programme are to (1) equip a group of young leaders with up-to-date information about smoking hazards and global trends in tobacco control and to encourage them to play a pioneering role in tobacco control; (2) penatrate the smoke-free message into schools and the community via the Smoke-free Teens; (3) encourage the Smoke-free Teens to act as role models and develop a smoke-free healthy lifestyle; and (4) equip the young leaders with basic smoking cessation counseling skills. In fact, training teenagers to serve as behavior change agents has been widely suggested in the literature [ 13 ], and has been proven effective to combat alcohol use and substance abuse [ 14 , 15 ]. Yet, this strategy has not been applied to establish a smoke-free culture. To address the gap in existing literature, this paper describes an evaluation of this programme’s effectiveness in promoting the smoke-free culture among youths. However, the evaluation was carried in relation to the first three objectives, but not the fourth. This is because, some participants might not encounter any smoker during the study period; it would be difficult for us to assess their smoking cessation counseling skills.

The study evaluated the Smoke-free Teens Programme from July 2014 to March 2017. The study design and the procedure to obtain informed consent were approved by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (reference UW14–412). Written consent was obtained from the participants’ parents after fully informing them of the study’s purpose and details. They were told that the participation of their child was totally voluntary and without any prejudice.

Design and participants

All students or teenagers aged 14 to 18 years from secondary schools, youth centres and uniform groups were eligible to join the Smoke-free Teens Programme. The uniform groups referred to any organization with their members wearing uniforms to signify the mission of serving different members in the community [ 16 ]. Promotion and recruitment was conducted early in each year and the programme was implemented from July to March of the next year. To recruit eligible participants, invitation letters were sent to around 450 secondary schools every year. For those schools that showed interested to join could contact us via the reply mail. Due to the limited capacity and resources., each school could only nominate around 10 students to join the programme every year. A total of 51 schools agreed to join this programme over the past 3 years. This gave an overall response rate of 11.3%. Figure  1 summarizes the recruitment process. The programme contained three major components. The first component was a 2-day-1-night training camp that aimed to train participants as Smoke-free Teens to promote a smoke-free culture. For the second component, participants were asked to organize creative activities to promote smoke-free messages in their schools and community. The third component included an award presentation ceremony to recognize the efforts of outstanding Smoke-free Teens in establishing a smoke-free culture. To publicize the Smoke-free Teens Programme, COSH produced publicity materials such as posters for display in secondary schools, youth centres, and uniform group meetings. Advertisements were placed in newspapers and magazines, on the radio, television and social media platforms. Programme webpage was set up to promote the programme and allow extended learning for the participants. COSH also organized a series of camp briefing sessions, communication skills training workshops, health talks and seminars. To evaluate the effectiveness of the training programme, a one-group pretest–posttest, within-subjects design was used.

Summary of the recruitment process

Details of the programme

Smoke-free teens training camp.

Approximately four Smoke-free Teens Training Camps were held during each summer holiday. Participants were invited to join the 2-day-1-night training camp between July and August of each year. The camp provided a wide range of adventurous and experiential indoor and outdoor activities, which were implemented by COSH and campsite coaches. In addition, health education talks were delivered by COSH staff and a registered nurse with more than 5 years’ experience in smoking cessation. The talks covered a variety of topics, including the hazardous effects of smoking, tobacco control policies, existing cessation services in Hong Kong, and basic counseling skills, etc. In addition, the participants were taught to deliver brief smoking cessation advice using the AWARD model: A sking about smoking history; W arning about the high risk that one out of every two smokers will be killed prematurely by smoking, which is the mortality risk for smokers in general suggested by World Health Organization; A dvising to quit as soon as possible; R eferring to smoking cessation clinics or hotlines; D oing it again until smokers quit smoking. The AWARD model was developed according to the clinical practice guideline for smoking cessation. It aids quitting by warning smokers of the high mortality risk of smoking and referring those in need of more intensive counseling to smoking cessation services [ 17 ]. This model has been tested in our previous studies on smoking cessation. The findings of these studies indicated that this model is effective in helping smokers in community settings quit smoking [ 17 , 18 , 19 ]. By engaging in the 2-day-1-night camp activities, participants obtained the latest information about tobacco hazards and tobacco control. To help them effectively design and execute their smoke-free advocacy activities, participants were trained in a broad array of skills, including leadership, creative and critical thinking, communication, problem solving, team building, programme planning, smoking cessation counseling techniques, and social media marketing techniques.

Promoting smoke-free messages in schools and the community

After completing the training camp, participants were asked to apply the various skills they had learned to design and implement at least one smoke-free activity in their schools or the community during September–December in small groups to promote smoke-free messages. They also encouraged their friends, families, and neighbors to quit smoking and promote the concept of a smoke-free Hong Kong.

Award presentation ceremony

To commend the outstanding Smoke-free Teens and schools/organizations for their efforts in establishing a smoke-free culture, an award presentation ceremony was held in March of the following year. Smoke-free Teens who had shown outstanding performances were presented with a trophy and book voucher as encouragement. In addition, certificates were presented to Smoke-free Teens who had completed the entire programme.

To evaluate the Smoke-free Teens Programme, teenagers who participated in the programme between July 2014 and March 2017, and whose parents had signed the consent forms, were included in this evaluation study. The outcome measures were changes in (1) knowledge about smoking hazards; (2) attitudes towards smoking, tobacco control, and smoking cessation; and (3) practices for promoting smoking cessation.

Data collection

A structured questionnaire was administered by a research assistant at baseline, immediately after the training camp, and 3 and 6 months later to assess changes in participants’ knowledge and attitudes regarding smoking and tobacco control. At baseline, participants were asked whether they had experienced in promoting smoking cessation in the previous 6 months. At 3- and 6-month follow-ups after attending the training camp, participants were asked to report their practice of promoting smoking cessation for the past 3 months.

Data analyses

We used the Statistical Package for the Social Sciences (SPSS: Version 23; SPSS Inc., Chicago, IL, USA) for Windows to analyze the data. Descriptive statistics were used to analyze participant demographic characteristics. The paired samples t-test and McNemar’s test were used to assess any changes in participants’ knowledge and attitudes regarding smoking and tobacco control before and after the training camp. One-Way Repeated Measures ANOVA was used to assess any changes in participants’ cessation practice before and after the training camp. Descriptive statistics were used to describe the purposes of the smoke-free activities organized by the participants. Missing values were handled by the baseline-observation-carried-forward.

A total of 856 teenagers were recruited during the study period. However, 26.5% (227/856) and 34.5% (295/856) lost to follow-up at 3 and 6 months, respectively. Figure  2 is a CONSORT diagram tracking how the participants flowed in this evaluation study.

The CONSORT diagram showing how participants flowed in the study

Table  1 shows the participant demographic characteristics at baseline. The mean age of the participants was 15.2 (SD = 1.1) years. About 65.0% (556/856) of the participants were female and 33.2% (284/856) were male. About 46.0% (394/856) of the participants were Secondary 4 students and 82.1% (703/856) were never smokers. About 53.5% (458/856) of the participants lived with at least one smoker. Of these participants, 65.9% (302/458) lived with smokers who were their fathers.

Table  2 shows the changes in knowledge about smoking hazards. When compared with baseline, a significant improvement was observed in knowledge about smoking hazards (58.0% versus 75.0%; p  = .016; correctly answered all items) at 6-month follow-up. Table  3 shows the changes in attitudes towards smoking cessation and tobacco control. Compared with baseline, significant improvements were observed in several areas at 6 months, including advising their friends to quit smoking (4.43 ± 0.68 versus 4.49 ± 0.61; p  = .012), asking people not to smoke around them (4.39 ± 0.75 versus 4.50 ± 0.66; p  < .001), reminding others not to smoke in non-smoking areas (4.12 ± 0.85 versus 4.29 ± 0.77; p  < .001), supporting expanding non-smoking areas (4.31 ± 1.05 versus 4.50 ± 0.78; p  < .001), increasing tobacco tax (4.14 ± 0.94 versus 4.39 ± 0.82 ; p  < .001), and a total ban of the sale of tobacco products (4.08 ± 0.99 versus 4.43 ± 0.82; p  < .001). Table  4 shows statistically significant changes in practice towards smoking cessation and tobacco control. Compared with baseline, participants reported that they had provided smoking cessation advice to more smokers (1.6 ± 1.5 versus 2.3 ± 4.3; p  < .001) at 6-month follow-up. All of them also reported making more smoker referrals to existing smoking cessation services (2.2 ± 2.2 versus 3.3 ± 7.7, p  < .001) at 6 months.

Over the course of the 3-year study, Smoke-free Teens organized 552 smoke-free programmes, with each group conducting 3.2 programmes on average. These programmes reached 144,528 people in schools and the community. The highly diverse programmes included among the many activities exhibitions, mosaic art and microfilm production, game booths, debate and poster design competitions, as well as the promotion of a smoke-free culture on busy streets. An outstanding example was the team that won the 2014 championship. It organized a wide range of activities including a slogan competition, game booths, an anti-cancer health talk, and video production. To enforce the smoke-free message to primary school students and the public, they also invited people to make a smoke-free pledge, distributed bookmarks and cards with smoking cessation hotline numbers to smokers, as well as hung a banner with a smoke-free slogan at a minibus terminal. Over 2000 citizens were reached by their activities.

Table  5 shows the aim of the smoke-free activities organized by the participants. Of the organized smoke-free activities, 73.6% (406/552) publicized smoke-free messages, 61.4% (339/552) educated the public about the hazardous effects of smoking and secondhand smoke exposure, 35.3% (195/552) promoted smoking cessation, 1.6% (9/552) introduced our training programme to the public, and 0.7% (4/552) discussed the economic losses caused by smoking.

Youth smoking is a global public health concern that has been regarded as a “pediatric epidemic” [ 20 ]. Building an awareness of tobacco control and smoking cessation among youths is very important in reducing smoking initiation, which in turn can lower the prevalence of cigarette use. This paper reports a study to promote a smoke-free lifestyle and smoking cessation in the community by mobilizing teenagers from secondary schools, youth centres, and uniform groups to serve as smoke-free ambassadors. In addition, we evaluated the effectiveness of the training programme by assessing changes in knowledge, attitudes, and practices of tobacco control and cessation among the ambassadors.

The present study demonstrated that the training programme was effective in enhancing the knowledge of smoking hazards among youths. This is evidenced by the fact that 75.0% of participants were able to correctly answer all items at 6-month follow-up compared with only 58.0% at baseline. Moreover, there were statistically significant improvements in participants’ attitudes towards tobacco control policies, such as expanding non-smoking areas, increasing tobacco tax, and a total ban of the sale of tobacco products. In addition, the results supported the effectiveness of the training programme in changing Smoke-free Teens’ practice of smoking cessation promotion. There were statistically significant increase in the mean number of smokers who received smoking cessation advice and who were referred to smoking cessation services by participants at 6-month follow-up compared with baseline. However, caution must be taken when interpreting these findings. The results might be highly confounded by the number of smokers that the participants had encountered before and during the study. Furthermore, the results could be misleading if the participants only encountered a few smokers at baseline, but more smokers during the period of evaluation. Nevertheless, the results demonstrated that the trained Smoke-free Teens could successfully promote cessation among smokers using the AWARD model. One advantage of the AWARD model is that it can be easily learned and used by teenagers with minimal training. In addition, it takes only a minute or slightly longer to communicate advice based on the AWARD model. This makes it very useful in promoting smoking cessation in community settings and permits a sizeable number of smokers to be reached at low cost.

Following the intensive training, the Smoke-free Teens formed into groups and applied the various skills they had learned to design and implement creative projects to disseminate smoke-free messages in their schools or the community. During the study period, 552 smoke-free activities were held, which reached 144,528 people. These smoke-free activities were effective in raising public awareness about smoking hazards and obtaining support for public health policies. In addition, the activities allowed the promotion of smoke-free messages to a segment of smokers who are difficult to be reached by existing smoking cessation services. When compared with other methods in health promotion, such as educational talks and self-help materials, these activities are a practical and effective way to rapidly disseminate health messages to a large number of people.

We received much positive feedback from the trained Smoke-free Teens. One group of Smoke-free Teens commented that they found the experience of organizing such a large-scale event valuable. They felt that the experience helped them realize the importance of group unity and planning, and that the activities had fully utilized the potential of every teammate. They hoped that everyone might develop a smoke-free healthy lifestyle. Most importantly, by joining this programme, participants were not only equipped with knowledge about tobacco control and smoking hazards, but were also more likely to refrain from trying smoking in the future. One trained Smoke-free Teen of the 2016–2017 champion team stated that “I spent half a year planning and organizing the smoke-free activities and promoting a smoke-free lifestyle. I never regretted joining the programme, as what I learned and experienced was invaluable and could not be acquired at school. It is a very precious memory. Besides, my father reduced his tobacco consumption with my support and encouragement.”

There are several benefits in mobilizing secondary school students to serve as ambassadors of smoking cessation in the community. First, they may encounter smokers in their social circles. Young smokers, particularly those who are reluctant to access smoking cessation services, may be more willing (and may find it easier) to receive brief advice on smoking cessation from the ambassadors owing to the established rapport between them. Second, there are more than 300,000 secondary school students in Hong Kong [ 21 ]. Trained Smoke-free Teens could play an important role in helping to widely disseminate smoke-free messages in the community. In particular, they can motivate their smoking peers to quit by being healthy role models.

Despite only small changes in participants’ knowledge and attitudes regarding smoking and tobacco control after the programme, it is meaningful and relevant to public health practice. In particular, within a 6-month period of evaluation, 856 ambassadors were able to deliver brief cessation advice to 1968 smokers in their social circles. The ambassadors also referred 2824 smokers to smoking cessation services. It was expected that the ambassadors would continue such practice after the evaluation. The running cost of this programme is low in comparison to the healthcare cost resulted from treating tobacco-related diseases of a smoker. Therefore, this innovative, inexpensive and sustainable approach can make an important contribution to establishing a smoke-free culture in schools and the community in Hong Kong, consequently saving more lives.

Limitations

There were some limitations of this study. Frist, this study was limited because only 51 out of 450 schools joined the Smoke-free Teens Programme over the past 3 years. The low response rate might be due the Hong Kong education system is exam-oriented and the schools in Hong Kong are highly academic-oriented. Majority schools in Hong Kong are mainly focused on academic results, but neglect the importance of having extra-curricular activities and building students’ personal characters. Consequently, students are busy with attending different tutorial classes after school but no more extra time for joining activities. Given the significant health impact of the Smoke-free Teens Programme on our new generation, more resources and efforts should be allocated to this area to create a rapport with schools and parents with regard to tobacco control advocacy. The second limitation was that we did not follow up smokers who had received brief smoking cessation advice from Smoke-free Teens, and hence could not evaluate the long-term impact of the training programme in the community, particularly in terms of smoking cessation outcomes. Studies with longer follow-ups are therefore warranted to examine the sustainability of the training effects. Furthermore, a comprehensive evaluation is needed to determine whether the training effects are translated into smoking cessation at an individual level. Additional measures, including (1) how many family members and friends are invited to make a quit attempt, (2) whether local quitlines receive more referrals, and (3) whether friends of ambassadors are more willing to receive cessation advices from the ambassadors in comparison to other sources could be assessed in future evaluation. The third limitation was that participation in this study was on a voluntary basis. It was expected that participants and their families were more negative towards cigarette smoking, consequently might bias the results. Despite the family background might influence the participants’ attitudes towards smoking and their smoking status [ 22 ], we did not observe any significant difference in these two variables with different family backgrounds in subgroup analyses. Future studies with more stringent design are necessary to confirm our findings.

Implications for practice

The findings from this project have important implications for future practice. The project enhanced the community’s capacity to promote smoking cessation because there was a significant improvement in the knowledge, attitudes, and smoking cessation practices of the trained Smoke-free Teens. Moreover, trained Smoke-free Teens can continue to help promote smoking cessation after training. Participants were encouraged to join the Smoke-free Teens Alumni Programme and they continue to promote a smoke-free message by attending sharing sessions, managing game booths and exhibitions in the community, and participating in other tobacco control activities organized by COSH. The World Health Organization [ 23 ] emphasizes the importance of member states implementing multisectoral control measures against the tobacco industry. By joining the Smoke-free Teens Programme, the activities of trained Smoke-free Teens could become one of the main ways of implementing the government’s tobacco control policies in Hong Kong.

Notwithstanding some limitations, the overall results of this study suggest the effectiveness of the training programme in changing knowledge about smoking hazards, attitudes towards smoking, and tobacco control and smoking cessation practices. It is encouraging that the trained Smoke-free Teens not only promoted smoke-free messages among their schoolmates, friends, and families, but also began to gather community support for a smoke-free Hong Kong. The Smoke-free Teens Programme has been instrumental in fostering a new batch of Smoke-free Teens to advocate a smoke-free culture and protect the health of the public.

Abbreviations

Ask, Warn, Advise, Refer and Do-it-again

The Hong Kong Council on Smoking and Health

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Acknowledgements

We thank Diane Williams, PhD, from Edanz Group ( www.edanzediting.com/ac ) for editing a draft of this manuscript.

This study is funded by the Hong Kong Council on Smoking and Health (#260007591). We would like to declare that the funding body did not have any role in the design of the study, data collection, analysis, the interpretation of data, and in writing the manuscript.

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OKC, WHCL, KYH, KKWL, MPW, ACSK, VWYL, THL and SSCC contributed in study concept and design. OKC, WHCL, KYH participated in acquisition of data. OKC, KYH, WHCL, KKWL analyzed and interpreted the data. All authors participated in drafting, reading and approving the manuscript.

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Chung, O.K., Li, W.H.C., Ho, K.Y. et al. A descriptive study of a Smoke-free Teens Programme to promote smoke-free culture in schools and the community in Hong Kong. BMC Public Health 19 , 23 (2019). https://doi.org/10.1186/s12889-018-6318-4

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Smoking in multi-unit housing poses serious health threats to children and adults even if no one smokes in their home. In multi-unit housing like apartment buildings and condominiums, secondhand smoke from one unit can move into other units. Smoking in multi-unit housing can also lead to fires, which can have deadly consequences. The videos below feature stories from residents, firemen, and public health advocates who have worked to make multi-unit housing properties smokefree.

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Smoke-Free Campus

A smoke-free campus Smoking is bad for everyone. When people have a non-smoking area, they really appreciate it. However, some people ruin the place where there are signs that is prohibited; they still smoke in that place. On the other hand, almost every school, college and university is smoke-free. Although there are signs around the schools, some people are still smoking. It looks like they do not see the signs. In my opinion, every school needs a strong cooperation with students so that they can make a healthy campus. The most important in people’s lives is health.

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To protect people’s health, people, themselves need to block all bad situations that can happen for their health. One of the situations that they can protect themselves is “Say no to smoking”. Smoking is bad for people’s lungs. Besides, some people have asthma and they really do not like the smell of cigarettes. Therefore, every place that has lots of people such as schools and hospitals, smoking is definitely prohibited. The more people around the more they breathe the smoke. Schools are the place that students come to study. They do not want to come there and worry of their health.

Smoking can make the school‘s reputation come down without they notice it. Every school needs to convince students and people to follow the rules so that everyone can have a good health and a nice place to study. Secondly, if every school can make a smoke-free campus, they will change the atmosphere of their schools. All of the parents love to see a school without any bad habits that can happen to their children. So they will bring their children to school without worrying. And to make a school becomes nice and perfect, the atmosphere of the school is very important.

People want to have fresh air after long period of studying in class. It is really nice to have a smoke-free campus. The atmosphere in school is one of the reasons that parents and students choose the school. Of course, it is hard for the schools to satisfy both smokers and non-smokers. And I believe in every school, there are some places that allow students to smoke. But still, people need to think for their health and others. Therefore, smoking is one of the issues that campus can try to control to make a peaceful and healthful campus.

Nevertheless, in the United States, people have freedom. They have freedom in everything and they can do whatever they want as much as in the law. Smoking in campus is one of their freedoms. Some people say that smoking will help them decrease the stress and give them more energy. But do they think about how it will affect their health in the future? Smoking is not the only way to help to forget or get over the stress. People can hang out with friends or listen to music or playing sports. There are many ways that can help a smoking person.

Not many people like smoking, some of them just pretend to smoke like their friends or to prove that they can smoke. But what is that for? They need to think for their health first. It is better to quit smoking than to continue dig a hole for their lives. In conclusion, every campus should not allow smoking on campus. I know it is a difficult work but there will be some way that can make it. And not for school but also for students, they need to know and follow the rule. It does not harm them but it will help them in the future. Smoking is really bad for our health.

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• Copy URL https://www.pbs.org/newshour/nation/california-has-some-of-the-worst-air-quality-in-the-country-the-problem-is-rooted-in-the-san-joaquin-valley

California has some of the worst air quality in the country. The problem is rooted in the San Joaquin Valley

FRESNO, Calif. — The ongoing effects of climate change have left much of the western United States to suffer from worsening air quality in recent years, with more than 40 percent of people in the country now living in places that earned failing grades for unhealthy levels of particle pollution or ozone, according to the American Lung Association.

But in places like California’s San Joaquin Valley, home to large productions of oil, agriculture and warehouse distribution, this has been the case for years. The region has been out of compliance with Environmental Protection Agency standards for 25 years, earning the region the unwanted distinction of being among the most polluted regions in the country, and residents and air quality activists say there have been few significant solutions. As California heads into another wildfire season, environmentalists and lawmakers are trying to revive a decades-long push to strengthen air quality regulation to curb pollution and reduce the many consequences of daily life with dirty air, including rising health care costs.

Clean air activists argue that the Valley’s air district hasn’t done enough to meet air standards because polluting industries in the region have been too influential in shaping policies around air quality and has contributed to the slow pace of cleaning up the air in the region.

During his time as an emergency room doctor between 2007 and 2015 in Selma, just outside Fresno, Dr. Joaquin Arambula remembers patients regularly seeking care for breathing problems. Visits increased when pollution levels spiked.

Now a representative for California’s 31st district in the state assembly, he recently introduced a new law that he hopes can help boost regulatory powers on air pollution across the state, and in his home region.

Read More: ‘You can’t just hold your breath.’ Toxic smoke, fueled by wildfires, chokes California

Assembly Bill 2550 would give greater power to the California Air Resources Board, which works with local air districts to prepare plans on combating air quality, to examine why local air quality plans fail and to bring in community groups to help strategize new ways to combat air pollution. The bill could come up for a vote in the state Senate by August.

The bill is symbolically numbered “2550” because it has been 25 years since the region has been in compliance with federal air standards. The goal, Arambula said, is to meet those air standards within 50 years.

“I believe we have to think outside the box and ask for more assistance from other regulators to help us to get into compliance,” Arambula told the NewsHour.

In April, the American Lung Association released its 23rd “State of the Air” report, which showed the number of days of “very unhealthy” or “hazardous” air rose to the highest level in two decades across the United States.

The report measured air quality between 2018 and 2020, which it noted were among the seven hottest years on record globally. Heat is a major contributor to ozone pollution, which happens when emissions react under heat and sunlight. Natural disasters like wildfires have also released hazardous fine particles into the air in California and other western states. The particles in smoke, known as PM 2.5, are tiny enough to enter the bloodstream and cause a number of health challenges. Particle pollution causes breathing problems of varying severity, including asthma attacks and COPD exacerbations, and even lung cancer, according to Laura Kate Bender, national assistant vice president of healthy air for the American Lung Association.

The Lung Association found that counties in California and several western states received failing grades for air quality despite states putting stronger emissions standards in place and cleaner vehicles being on the road. According to the association, the Fresno area ranked the highest in the nation this year for short-term air pollution; it replaced Fairbanks, Alaska. A hundred miles south, Bakersfield ranks the highest for year-round pollution. The report also notes the pollution disparities created by climate change, which are likely to grow through drought and heat events, and which are disproportionately affecting communities where majority Black and brown people live.

“Unless we take action to really address climate change, it’s going to undo a lot of the progress that we’ve made in the country in cleaning up the air,” Bender told the NewsHour.

Pollution: a local problem

Last year, communities around Fresno and Bakersfield were shrouded in ash and smoke from multiple wildfires burning in the state. Large wildfires have become a more common occurrence in recent years, making fighting local pollution more difficult.

Nationally, pollution levels have gone down ever since the Clean Air Act was passed in 1970, and subsequent amendments were passed in the 1990s. These targeted common pollutants like particles and ozone, among others. According to the Environmental Protection Agency, emissions from the most common pollutants dropped by 78 percent between 1970 and 2020 — and the agency estimates around 2 million premature deaths from asthma exacerbations related to air pollution were prevented.

The agency credits cleaner fuels and tougher regulations at the state level to lower emissions for the improved air quality. But while the federal law has had a wide-reaching impact, some places have seen slower change.

The EPA, which has approved only portions of air quality plans for the San Joaquin Valley in the past decades, has classified the valley as in “serious” or “extreme” non-compliance with pollution standards for ozone and fine particulate matter (PM 2.5), which at 2.5 microns or less in width can travel deep into a person’s respiratory tract.

A mail truck drives down a rural road in Kern County as a haze covers the Sierra Nevada mountains in the distance. Photo by Cresencio Rodriguez-Delgado/PBS NewsHour

To meet standards set by the EPA, state and local air regulators must submit detailed attainment plans to reach federal standards and must outline funding to reach those goals.

The EPA has routinely given California air officials extended deadlines to submit new plans due to shortfalls on things like funding or incomplete implementation plans in the Valley. It has even threatened to place sanctions on highway funding unless plans were submitted to show how the state would meet air standards. So far, none of those extreme actions have come through.

Frustrated over a decades-long battle to attain federal air standards, environmental groups last fall sued the EPA to pressure state agencies on taking tougher action against pollution. Similar lawsuits were filed as far back as 2001. Environmental groups have also accused air regulators of not being tough enough on polluting industries.

The San Joaquin Valley Air Pollution Control District, which oversees eight counties, has pumped $4.2 billion in public and private funding into clean air projects, according to a statement provided to the NewsHour by spokeswoman Jamie Holt.

Holt said the district has adopted more than 650 rules on air quality since 1992 and at least 212,000 tons of emissions have been reduced in that time. Holt acknowledged the district can’t control the issue alone, and the air district has tried to meet federal air regulations as best it can. Holt said the Valley continues to see population growth and also pointed to the growing challenges from wildfires, which – given the region’s geography – can trap smoke for long periods of time.

WATCH: How air pollution is disproportionately impacting minority communities in San Diego

“Meeting the latest federal ambient air quality standards will require significant additional emissions reductions from sources under local, state and federal jurisdiction, particularly with respect to mobile sources that now make up the majority of emissions in the San Joaquin Valley,” Holt said.

While the air district can’t control all the pollution coming into the region alone, there is interest in examining how the air district can better respond to the air crisis, similar to the approach taken by Arambula’s legislation.

Cade Cannedy, who graduated from Stanford University in 2021 and earned an award for his research on the Valley’s air quality , told the NewsHour that his research found strong interest in restructuring the way the Valley’s air district conducts its work.

He said California is “overrepresented in air quality problems, and underrepresented in successful outcomes,” which could be a result of local air districts facing the possibility of industry influencing which policies get passed.

Cannedy researched financial disclosures for members of air district boards, which are often made up of locally-elected officials, like supervisors or city council members. Cannedy’s research showed that of the 157 members of air quality boards in the San Joaquin Valley and South Coast, in Southern California, 37 were “demonstrably connected to the industries they were intended to regulate.”

Based on the research, he argues that “centralized, state-level regulation of air quality in California’s San Joaquin Valley is the only way significant progress on air quality will ever occur.”

“If you really want things to improve, you have to take power away from the polluting industries who are collaborating to stop progress on this front,” said Cannedy, who now works as a program manager for Bay Area-based group Climate Resilient Communities.

Holt, the spokeswoman for the air district, said board members who may have a conflicting financial interest on an air regulation are prohibited from participating in decision-making. She said officials on the board are required to submit a Statement of Economic Interest form which would disclose financial interests “to ensure officials are making decisions in the best interest of the public and not enhancing their personal finances.”

Despite its poor marks on air quality overall, Fresno has seen some improvement in recent years. A drop in ozone pollution helped the city move from third place to fourth place nationally this year. Between 2001 and 2003, Fresno averaged 217 high ozone days; a decade later, it averaged 60 high ozone days, according to the American Lung Association’s latest air report. Los Angeles remains the smoggiest region in the country. The significant cut to the number of high ozone days in cities like Fresno is a small reason to celebrate, Bender of the Lung Association said, but there is still much work ahead to curb pollution in the Valley.

“Not every community has seen the same level of cleanup,” Bender said. “There are a lot of cities and particular communities where people have been living by polluting sources for far too long and they’re still waiting for the benefits of the Clean Air Act.”

One estimate by medical researchers from California State University, Fullerton and Sonoma Technology from 2008 still widely accepted by air experts suggests that air pollution costs roughly $1,600 per person per year.

The Lung Association estimates that a full transition to zero-emission transportation and electricity could result in $1.2 trillion in public health benefits in addition to 110,000 lives saved by 2050.

The sun, obscured by smoke from wildfires, as seen in Fresno, California. Photo by Alex Edelman/Bloomberg

‘Canaries in a coal mine’

It’s been nearly 20 years since retired journalist Mark Grossi and a team of writers released “Last Gasp,” a special news report in The Fresno Bee calling the San Joaquin Valley “the most dangerous place in the United States to breathe.”

The series of stories set out to inform the public about the way air quality worked, who and what contributed to it and who was in charge of regulating it. It chronicled stories of asthma, medical visits and the way geography and climate collude to create hazardous breathing conditions. The stories also provided information on what readers could do, including monitoring daily air quality.

All of those stories are relevant today, said Grossi, who remembers when most people didn’t think the Valley’s agriculture industry or dairy production had much to do with the air quality. He said information about air quality was difficult to find and break down.

“Everybody had a kid on the block that had asthma,” he said. “But it wasn’t really connected to anything, other than ‘that’s just the way it is.’”

Today, the direct and second-hand impacts agriculture production has on the air quality in the Valley is well documented, including the mixing of dust and vehicle emissions near communities.

The Lung Association’s latest report also hints at rising particulate matter pollution in the Fresno area. Between 2017 and 2019, days per year in the Fresno area when particles exceeded safe standards in a 24-hour period reached 34. Between 2018 and 2020 – a time that has seen heavy wildfires – the average number of high particle days reached 51. On these days, air officials will send warnings and residents are encouraged to reduce or avoid activities based on their risk levels.

Read More: Devastating heat wave in South Asia ‘sign of things to come’ in face of climate change

The team of researchers from California State University, Fullerton and Sonoma Technology have run models that would determine how much economic benefits there would be if federal air standards were met in the San Joaquin Valley. Poor air quality in the Valley typically leads to limited outdoor activities and the loss of work and school days in addition to a number of health issues; all of that carries a financial cost. Researchers, however, estimate under attainment of federal air standards for particulate matter and ozone, day-to-day impacts would be reduced and the region could save up to $5.73 billion annually that is otherwise lost to health treatment, as well as lost days for school and work from air quality.

Catherine Goroupa-White, executive director of the Central Valley Air Quality Coalition, has spent 16 years advocating for cleaner air in the Valley. She said the clash of problems facing residents related to pollution in the San Joaquin Valley has turned the region into an example of what happens when air regulation doesn’t go far enough.

“We’re like the proverbial canaries in the coal mine in the San Joaquin Valley,” she said. “We are the evidence of what our future is going to look like if these climate extremes persist.”

In 2021, environmental groups secured a victory after they convinced state air officials to phase out agricultural burning in the San Joaquin Valley; it had taken years of advocacy to get there. Agricultural burning involves burning fields that are no longer in production.

The open air fires are typically preceded by uprooting trees, then creating piles of waste which is then set on fire. While the burns typically happen in fields away from communities, wind carries smoke toward homes. The phase-out is set to be complete by 2024.

Goroupa-White said she has often answered questions from residents who wondered whether the pollution they experience in the Valley came from elsewhere, but she said she feels those questions are part of the misinformation that has existed about what contributes to pollution in the Valley.

“I still have people ask me all the time, ‘Oh, well isn’t it coming in from the Bay Area? Isn’t it blowing in from China? Isn’t it because you’re in a bowl? Isn’t it your geography?’” Goroupa White recounted to the NewsHour. “All of the excuses that the air district has as a narrative to explain away their responsibility, those are still persistent.”

Cresencio Rodriguez-Delgado is a reporter for the PBS NewsHour out of Fresno. Follow him on Twitter @cres_guez

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Persuasion Essay: Smokefree-Campus Policy

Introduction

We’ve all been there- stuck behind a smoker walking to class. You breath in the smoke, it gets caught in your hair, and you can still smell it later. But these things are trivial compared to the harmful effects smoking can have on all of those involved. Colleges and Universities across the country are implementing smokefree-campus policies. In these policies, indoor and outdoor smoking will be eliminated across the entire campus. As of January 2, 2013, at least 1,129 college or university campuses in the U.S. have adopted 100% smokefree campus policies. Penn State should impliment a similar policy for the health and safety of nonsmokers as well as smokers themselves, in addition to improving the school and campus.

Why? –Persuasion

• Risk of tobacco use peaks between 18-25 years of age- college years. If can’t smoke on campus, will most likely not pick up a cigarette in the first place
• The number of smokers who initiate smoking after 18 has increased in the past years
• Progression from occasional to daily smoking almost always occurs by age 26. Stop smoking before it becomes a daily habit.
• Convenience- If smokers have to go out of their way, all the way off campus, to smoke, most probably will be less inclined to do it.
• May be that extra push someone needs to finally quit
• According to Gallup, 79% of smokers which they could quit
• 59% of student smokers said they tried to quit in the last year
• Would be doing them more of a favor
• For those surrounding them
• In 2010, there were more than 20 million students enrolled in degree-granting institutions. Plus faculty, staff, and visitors. All are affected.
• Air contamination à health effects
• Secondhand smoke
• More than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer.
• Secondhand smoke exposure causes an estimated 3,400 lung cancer deaths annually among adult nonsmokers in the United States.
• Second hand smoke can lead to birth defects
• 4/5 students don’t smoke, they shouldn’t be exposed to it.
• Why not do it if you can? If you have the ability to improve the quality of living, why not take the opportunity?
•  If we all know how bad smoking and secondhand smoke are for one’s health, why wouldn’t the school do something about it?
• 2/3 of students report that they would prefer to attend a smokefree college
• ¾ (including a majority of smokers) say it is okay for colleges to prohibit smoking on campus to keep secondhand smoke away from students and staff
• Fire hazard
• 48.6% of the US population is protected by a 100% smokefree workplace, restaurant, and bar law. Others are protected by workplace and restaurant- like PA.
• A college is a workplace for the faculty as well as a learning environment
• Many consider “student” and occupation- is it our workplace too?
• Time and money are spent on picking up cigarette butts and cleaning smoking areas
• Many colleges with non-smoking policies have seen enrollment increase, and more community involvement with facilities
• 69% of students said they’d choose a smokefree college over one that allowed smoking
• No more complaints about smoking on campus
• Legal liability for secondhand smoke
• “Since becoming tobacco-free, our enrollment has increased and there has been a strong demand in the community to use our facilities. Our transition to a tobacco-free campus was a positive experience—one that we’ve been proud to share with other colleges across the country.”Robert K.Knight,President,Clark College
• “In addition to representing students, I’m also a parent. Like many other parents, if given the choice, I would like to send my child to a college that provides a tobacco-free campus, and now we have that option.” Victoria Galanopoulos, student, Portland Community College
• “OHSU is committed to helping our employees, students, patients, volunteers and visitors live longer and healthier lives—that’s why all OHSU properties are tobacco-free. By developing a simple, no-exceptions policy and smoking cessation support, we saw a dramatic decline in people smoking on campus.” Joe Robertson, M.D., M.B.A., President Oregon Health & Science University
• “The debate is over. The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard.”  U.S. SurgeonGeneral Richard Carmona,2006

But how would you enforce it?

• Most schools offer three strike systems, or something similar
• Especially in early months after implementation, volunteers can simply walk up to smokers and ask them to put out there cigarettes, and educate them about the resources for quitting that are available to them.
• Sample policies I’ve found are in steps
• 2. A fine (usually $15-$20) OR 2 hours of cleaning up tobacco litter
• 3. Probation which eventually could lead to much harsher consequences (some schools even include expulsion)
• Aware that not going to catch somebody every time they smoke, but the policy and the threat of punishment are still there, and if they continue to smoke, eventually will be caught.
• The majority of the time, people choose to obey rules that are in place.
• Offer resources for quitting. Some schools offer coupons for cheap nicotine replacements like patches or gum.

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Essay on Smoking

500 words essay on  smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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How To Write A Smoking Essay That Will Blow Your Classmates out of the Water

A smoking essay might not be your first choice, but it is a common enough topic, whether it is assigned by a professor or left to your choice. Today we’ll take you through the paces of creating a compelling piece, share fresh ideas for writing teen smoking essays, and tackle the specifics of the essential parts of any paper, including an introduction and a conclusion.

Why Choose a Smoking Essay?

If you are free to select any topic, why would you open this can of worms? There are several compelling arguments in favor, such as:

• A smoking essay can fit any type of writing assignment. You can craft an argumentative essay about smoking, a persuasive piece, or even a narration about someone’s struggle with quitting. It’s a rare case of a one-size-fits-all topic.
• There is an endless number of  environmental essay topics ideas . From the reasons and history of smoking to health and economic impact, as well as psychological and physiological factors that make quitting so challenging.
• A staggering number of reliable sources are available online. You won’t have to dig deep to find medical or economic research, there are thousands of papers published in peer-reviewed journals, ready and waiting for you to use them. 

Essential Considerations for Your Essay on Smoking

Whether you are writing a teenage smoking essay or a study of health-related issues, you need to stay objective and avoid including any judgment into your assignment. Even if you are firmly against smoking, do not let emotions direct your writing. You should also keep your language tolerant and free of offensive remarks or generalizations.

The rule of thumb is to keep your piece academic. It is an essay about smoking cigarettes you have to submit to your professor, not a blog post to share with friends.

How to Generate Endless Smoking Essay Topic Ideas

At first, it might seem that every theme has been covered by countless generations of your predecessors. However, there are ways to add a new spin to the dullest of topics. We’ll share a unique approach to generating new ideas and take the teenage smoking essay as an example. To make it fresh and exciting, you can:

• Add a historic twist to your topic. For instance, research the teenage smoking statistics through the years and theorize the factors that influence the numbers.
• Compare the data across the globe. You can select the best scale for your paper, comparing smoking rates in the neighboring cities, states, or countries.
• Look at the question from an unexpected perspective. For instance, research how the adoption of social media influenced smoking or whether music preferences can be related to this habit.

The latter approach on our list will generate endless ideas for writing teen smoking essays. Select the one that fits your interests or is the easiest to research, depending on the time and effort you are willing to put into essay writing .

How To Write An Essay About Smoking Cigarettes

A smoking essay follows the same rules as an academic paper on any other topic. You start with an introduction, fill the body paragraphs with individual points, and wrap up using a conclusion. The filling of your “essay sandwich” will depend on the topic, but we can tell for sure what your opening and closing paragraphs should be like.

Smoking Essay Introduction

Whether you are working on an argumentative essay about smoking or a persuasive paper, your introduction is nothing but a vessel for a thesis statement. It is the core of your essay, and its absence is the first strike against you. Properly constructed thesis sums up your point of view on the economic research topics and lists the critical points you are about to highlight. If you allude to the opposing views in your thesis statement, the professor is sure to add extra points to your grade.

The first sentence is crucial for your essay, as it sets the tone and makes the first impression. Make it surprising, exciting, powerful with facts, statistics, or vivid images, and it will become a hook to lure the reader in deeper. 

Round up the introduction with a transition to your first body passage and the point it will make. Otherwise, your essay might seem disjointed and patchy. Alternatively, you can use the first couple of sentences of the body paragraph as a transition.

Smoking Essay Conclusion

Any argumentative and persuasive essay on smoking must include a short conclusion. In the final passage, return to your thesis statement and repeat it in other words, highlighting the points you have made throughout the body paragraphs. You can also add final thoughts or even a personal opinion at the end to round up your assignment.

Think of the conclusion as a mirror reflection of your introduction. Start with a transition from the last body paragraph, follow it with a retelling of your thesis statement, and complete the passage with a powerful parting thought that will stay with the reader. After all, everyone remembers the first and last points most vividly, and your opening and closing sentences are likely to have a significant influence on the final grade.

Bonus Tips on How to Write a Persuasive Essay About Smoking

With the most challenging parts of the smoking essay out of the way, here are a couple of parting tips to ensure your paper gets the highest grade possible:

• Do not rely on samples you find online to guide your writing. You can never tell what grade a random essay about smoking cigarettes received. Unless you use winning submissions from essay competitions, you might copy faulty techniques and data into your paper and get a reduced grade.
• Do not forget to include references after the conclusion and cite the sources throughout the paper. Otherwise, you might get accused of academic dishonesty and ruin your academic record. Ask your professor about the appropriate citation style if you are not sure whether you should use APA, MLA, or Chicago.
• Do not submit your smoking essay without editing and proofreading first. The best thing you can do is leave the piece alone for a day or two and come back to it with fresh eyes and mind to check for redundancies, illogical argumentation, and irrelevant examples. Professional editing software, such as Grammarly, will help with most typos and glaring errors. Still, it is up to you to go through the paper a couple of times before submission to ensure it is as close to perfection as it can get.
• Do not be shy about getting help with writing smoking essays if you are out of time. Professional writers can take over any step of the writing process, from generating ideas to the final round of proofreading. Contact our agents or skip straight to the order form if you need our help to complete this assignment.

We hope our advice and ideas for writing teen smoking essays help you get out of the slump and produce a flawless piece of writing worthy of an A. For extra assistance with choosing the topic, outlining, writing, and editing, reach out to our support managers .

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Essays on Smoking

Essay-writers in each smoking essay emphasize the dangers of smoking, and fairly so. After all, smoking is one of the most widespread bad habits in the world – there are about 2 billion smokers worldwide. It is a detrimental habit, as cigarette smoke contains more than 30 toxic components – you can go into them one by one in your essays on smoking. It's no secret how dangerous smoking is, however, around 18 billion cigarettes are sold globally every day. Smoking essays often include a lot of statistics, as facts speak louder than opinions. An estimated $50 billion a year is spent on treating smoking-related diseases in the United States alone. This means that for every pack of cigarettes, about $2 are spent on treating smoking-related diseases. Crazy, right? If you need more info on smoking for your essays, review our smoking essay samples.

Smoking and its Impact on Health Smoking predisposes one to various health problems including cancer of the lung, addiction, and adoption of harmful behaviors. Amongst adult smokers, smoking patterns have shown no significant reduction and a possible rise in smoking in the young individuals and the preteens has been reported (Lando,...

Words: 1022

1. Do you agree with the no smoking law in all public buildings in the state of Illinois? Should other states pass this law? What are the physical effects of second hand smoke on a child's airway? Should smoking in the presence of young children be...

Smoking in Public Places: A Health Hazard Smoking in public places is a health hazard for the smokers as well as the non-smoking public. The main dangers of smoking in public are often health-related as well as accident fires. More fatalities arise from public smoking are connected to the adverse effects...

Words: 1538

The World Health Organization suggests that approximately 5 million people die every year in the world because of tobacco use. Further, the report argues that, “the use of tobacco may cause about one billion deaths in the 21st century if current trends continue” (World Health Organization, " Research for International...

The Health Risks of Public Smoking The ban on smoking in public spaces has been an ongoing topic of discussion in different health platforms all over the world. Every year, several people are reported to die from lung cancer and other smoking-related health conditions. Nonetheless, despite the several reported deaths, tobacco...

Words: 1695

The number of the individuals who smoke has risen over the years. Even though they are aware of how harmful smoking can be, the public still decides to use a cigarette. It is an individual decision, and it is a habit which is extremely addictive. It is not the responsibility...

Words: 1413

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The opening sentence The opening sentence used by the author does not induce vigor of reading the article. Words arrangement in the sentence is not right, it should have read, ‘Herbert A. Gilbert filed the first electronic cigarette for a patent in 1963.’ The writer assumes that the reader knows what...

The Importance of Tobacco Control Policies Over the years, tobacco smoking has become a worldwide concern for health. Thus, the US government alongside other countries has been on the move in passing policies and ordinances which control the use of tobacco. The health implications associated with tobacco smoking have been more...

Smoking is an endemic problem that not only affects smokers, but also goes as far as affecting innocent non-smoking public. At the core of this problem is the issue of smoking in public places. Being a risk to public health a ban on public smoking can be a life saver,...

Introduction Even though almost every smoker realizes the harm caused by smoking, the number of smokers in the world remains enormous. Due to a low price, availability, legality, and the promotion of cigarettes in the media, almost every second there is a new person that starts smoking. The main reason for...

Words: 1220

The cigarette is one of the deadliest drugs known to human beings. In the developed countries, there are attempts to minimize the smoking rates. There are different measures which have been suggested to help reduce the risks posed by consumption of the drug which includes increased taxes, bans on cigarette...

Words: 1017

The Question of Outlawing Cigarettes and Tobacco Products The question of whether cigarettes and other tobacco products should be outlawed is still an argument as many agree as well as disagree from the same. Tobacco is a plant which is grown and contains nicotine which affects one to be dependent on...

Words: 1040

Related topic to Smoking

Orange High School junior earns second place in City Club’s Free Speech Essay Contest

• Updated: Apr. 19, 2024, 4:39 p.m. |
• Published: Apr. 19, 2024, 9:08 a.m.

Orange High School junior Lucy Campbell earned second place in the City Club of Cleveland’s 2024 Hope and Stanley Adelstein Free Speech Essay Contest (Photo Courtesy of Orange City Schools)

• Ed Wittenberg, special to cleveland.com

PEPPER PIKE, Ohio -- Orange High School junior Lucy Campbell earned second place and $750 in the 11th/12th-grade category of the City Club of Cleveland’s 2024 Hope and Stanley Adelstein Free Speech Essay Contest.

Winners were announced April 9.

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