:
'
.
San Fernando Va l l ey State C o l lege
The
ne l ationship Between Smoking Practices and
Knowl edge of Hea lth Haz ard s of Smoking
A the s i s submitted in par t i a l s a t i s faction of the
requi rements for the degree of Ma s ter of Sc ience
in He alth Sc ience
by
Lore tta Birken Tagr e s s
Ju ly, 1969
The the s i s o f Lor etta Birken Ta
San Fernando Val l ey State Col lege
July , 1969
ii
FOR
WILLI
iii
TABLE OF CONTENTS
P age
viii
ACKNO\"i'LE DGEMENTS .
xi
ABS TRACT .
CHAPTER
I.
1
INT RODUCT ION
2
He alth Educ ation .
S cope and Delineation of the Study .
5
.
5
Purpose .
Terms and De finition s
•
6
•
6
He alth .
He alth Educ ation. .
. . .
.
.
Health Ins truction .
He alth Practi ce s .
6
.
.
7
. .
.
7
.
He alth Edu c ator . .
He alth Knowledge .
.
. .
. . .
.
.
.
. . . . .
.
. .
7
.
7
S choo l He alth Progr am .
8
Attitude s
8
Cogn itive Ski l l s .
8
.
9
Re c a l l or Knowledge .
Tran s l ation or Comprehe n s ion .
•
9
App l i cation
9
Analys i s .
9
Synthe s i s
.
9
•
Evaluation .
9
.
iv
Page
CHAPTER
C l a s s i f i c ation of Smokers
I I.
•
.
Purported He alth Haz ards ( o f smoking )
.
REVIEW OF THE LITERATURE
.
•
•
.
.
.
.
.
•
.
9
11
12
•
Purported He alth Haz ards of Smoking
.
o
•
•
14
C i g arette Smoking Behavior and
P atte rns o f T eenagers
o
•
•
•
•
•
•
o
29
The Re l at ion ship o f the Smok ing Practi ces
o f P arents and Other Adults to the
Smoking Practice s of Youth .
30
Re l ation s hip Betwe en Smoking Behavior
of Youth and Smok ing Practice s of
Peers :
B ehavior and Inf luence of
Peer Group .
•
.
•
.
.
•
•
.
•
•
.
.
•
37
Re lation s hip of Knowl edge o f Purported
He alth Hazards of Smoking to Smoking
Behavior of Teen age rs
Education for Smoking .
III .
..,
""""·
•
.
•
.
o
•
RESEARCH PROCEDURES AND DESIGN .
Popu lation
.
Con ference s .
.
45
51
62
62
•
Que st ionnaire
.
•
.
.
63
.
63
T e s t S chedule
65
T e s t Envi ronment .
65
S amp l ing .
66
.
v
P age
CHAPTER
IV.
v.
Que s t ionnaire D e sign. . . . . . . . . . . .
67
Prepar ation of Re spon s e s For Analysis .
68
ANALYS I S OF THE DATA.
•
70
•
An aly s i s of the D ata.
70
Opinion Re spons e s . . .
71
76
SUMMARY AND CONCLUS IONS
Summary . .
76
Conc l u s ions .
77
79
B IBLIOGRAPHY .
APPEND IX
A.
IN STRUCT IO�S TO PUP ILS.
B.
ENVELOPE P ROVIDED FOR ANSvill R SHEET.
93
c.
QUESTIONNAIRE
95
D.
AN SWE R SHEET FOR QUESTIONNAI RE.
E.
FREQUENCY D I STRIBUT ION OF RE SPONSE S
•
�
.
.
•
.
•
.
•
91
102
O F REPORTED SMOKERS , EXPERIMENTERS ,
AND NON- SMOKERS .
F.
•
.
.
•
.
CUMULAT IVE FREQUENCY CURVE IN PER CENT.
vi
104
106
LIST OF TABLE S
: TABLE
I.
II.
III.
Page
Demograph ic Data of Re spondents .
Re sponde n t s ' Reported Smoking Behavior .
v.
.
68
New C l as s i f ication of Reported Smoking
Behavior .
IV .
67
.
.
69
Score s of Knowledge for Three Groups .
Op i n ion Re spon s e s in Per Cent
vii
.
70
72
ACKNOWLEDGMENTS
The wr iter acknowledg e s with s incere apprec iation
the a s s i s tance and contributions of tho s e who have he lped
to make th i s s tudy_po s s ible .
Dr . John T . Fodor , her the s i s chairman , Dr . Wi lfred
Su tton and Dr . Bernard Hane s , who served on her com­
mi ttee , and Dr . John M . We iner , who s e sugge s tions he lped
d e l ineate the s tudy .
The P l e a s ant Valley School D i s trict .
Mr . Char le s
Honn , Super intendent , and Mr . Ra lph Al amillo , D irector
of Educ ation ; Mr . Mi lo Sprack len , Princ ipal of Lo s Alto s
Junior High School and Mr . Richard Burton , Principal o f
Monte Vi s ta Junior High School , and facu l t i e s and students
of both s choo l s , who s e cooperation and partic ipat ion made
the s tudy po s s ible .
The author i s e spec i a l ly grateful to tho s e who
submitted copie s o f the ir own paper s , te s t s , inve s ti ­
gation s , and f i nd i ng s , and the ir o f fe r s of a s s i s tance
and encouragement :
Dr . Eva Salber , Harvard Univer s ity
Schoo l o f Public He al th; Roy H . Davi s , National C l earing­
hou s e for Smoking and He alth ; Dr . Wi ll iam H . C r e swe l l ,
Unive r s i ty of I l l�no i s ; Vern D i amond , Produc er-Director ,
National Smoking Te s t , Co lumb i a Broadc as ting System ;
The American Cancer Soc iety , Lo s Ange le s ; Dr . V . J . Sallek ,
vi ii
Buf fa lo and Erie County Tuberculos i s and Health
As sociation , New York ; O f f i ce of the Super intendent
of Pub l ic I n s truction and Department of Health ,
S tate of I l l inoi s ; Pennsylvania C ommittee on Smoking
and Health of Youth , Harr i s burg , Penn sy lvania; Ventura
Coun ty Health Department , Ventura , C a l i fornia ; and ,
National C ongre s s o f Parents and Teacher s , Chicago ,
I l l inoi s.
It i s with s incere apprec iat ion that the author
a cknowl edges the inva lu able help given by Dr . Edward F .
Gocha , We s tern Re search and Support Center and the S an
Fern ando Val ley S tate C o llege Facu lty , in preparing the
te s t re sul t s for coding , computerization , and analy s i s .
The author a l s o extend s her thank s to Mi s s Jane Hart ley
!
of We s tern Res earch and Support C enter , and to the Data
Proce s s ing Depar tment , S an Fernando Val ley State Col lege .
The author o f fer s recogn ition to Hari Pradhan ,
Devi Shres tha , and Anthony Lovecchio , a l l of whom
o f fered he lpful s ugge s t ions in the the s i s seminar; to
Mr s . Marcy S loan and Mr s . C l ay Lederer of the Dos Camino s­
Los Noga l e s Parent- Teacher As soci ation , Camar i l l o , who
p a i n s tak ingly p repared the printed material for the te s t ;
and , to Mr s . Donna Conant Agui lera , A s s i s tant Profe s sor
o f Nur s ing , Cal ifornia State Col lege at Los Ange le s , for
her suppo rt .
ix
The author i s indebted to Dr . John T . Fodor and
h i s a s soc iate s for granting permi s s ion to adapt the te s t
ins trument emp loyed in the ir smoking s tudy , for thi s
pro j ect .
And f inal ly , to Mi s s Judy Birke n , G S IA , Carnegie­
Mel lon Unive r s i ty , P i tt sburgh , Pennsylvania , and Dr .
Bernard Hane s , San Fernando Va l ley State Co l l ege , a very
s incere debt of grat i tude for their patience and indulgence
above and beyond
•
X
ABSTRACT
The purpos e o f th i s s tudy was to de termine if a
r e lation ship exi s ted betwe en the reported smok ing behav­
ior s o f s eventh and e ighth grade pup i l s in the Pleasant
Val ley Schoo l D i s tr i c t , Camar i l lo , Cal iforn i a , and their
knowledge o f the purported he alth haz ards of c igare tte
smoking .
The t e s t in s trument was admin i s tered to 9 1 7 pup i l s
in the two j unior h igh schoo l s .
The te s t was independent
o f any health in s truction in smoking and health .
Analy s i s of a random s amp ling of twen ty per c ent o f
t h e r e spondents w a s taken providing the s e conc lusion s :
1)
there was no s ign i f i can t d i f f erence in cognition
between the smoke r s and the non - smoker s , the exper imente r s
; and the smoke r s , nor be tween the exper imenters and the
non - smoker s ; 2 ) the groups r e sponded d i f ferently on
twe lve opinion que s tionnaire items .
xi
CHAPTE R I
INTRODUCT I ON
The gene s i s of thi s s tudy occurred when the author
' became awa r e o f the growing number of s eventh and e ighth
grade pup i ls who wer e be ing suspended from schoo l for
the inf ract ion o f smoking on s choo l property or carrying
c igarette s o n the ir person on s choo l property.
Admin i s trative per sonne l , teacher s , and the author ,
have become increas ingly aware of the upsurge in the
number o f c ig arette smokers among the young teenage and
pre- teenage popu latio n.
The concern of teache r s about
the smok i ng behavior o f young p eop l e , and the need for
! actual i n fo rmation about thi s behavior , provided the
impetu s for the s tudy.
Are more young teenager s smoking
becau s e of p arental smok ing pattern s , becau s e of peer
inf luence o r , becau s e they lack health knowledge and
f ac tual i n formation a s soc iated with smoking?
The hea lth education curri cu lum committee in the
s choo l d i s tr i c t in which thi s s tudy was under taken was
g iven the r e spo n s i b i l ity of d e s ign ing a comprehens ive
hea l th e ducation curriculum , one area of which would be
devoted to smoking and he a lth.
I t i s the opinion o f the
author that information about the purported health hazards
o f smoking should be introduced in the health curricu lum
pr ior to the s eventh and e i ghth grade leve l.
It i s felt
that e ar ly knowledge o f the purported health ha z ard s o f
smok ing may a c t a s a deterrent for young smoker s and
· 1
potential smoker s .
Health Educatio n
Teach ing about smoking and health i s but one
facet of a total he alth education program .
The phi�o sophy
J
i s the s ame , whe ther i t be for the face t , or the who l� .
The health educ ator' s f i r s t conc ern i s t he improvement
o f health practice s .
Hi s awarene s s of health knowledge
as the foundation upon which d e s irable hea lth attitude s
and practice s are bu i lt , and hi s awarene s s o f the gap
be twe en health knowledge and e f f ec tive health practice s
provide an area o f academic concern .
Unfortunate ly ,
e xpo sure to and the learning of health knowledge doe s
, not alway s re sult in e f fective health practice s .
Obe rteu f fer s tated that :
There i s far too muc h evidence today for
anyone to suppor t the o ld- f a shioned notion
that le arn i ng involv e s the •intel le ctr alone .
One doe sn ' t 'Pour knowledge into the child
to the l im i t s o f hi s ab sorptive capac i ty , '
a s one uninformed s c ienti s t told u s to do .
The brain doe s not operate a l l by i t s e l f .
Learning i s dependent upon the condition
o f the r e s t of the organ i sm a s we l l a s the
capacity of the inte l l igence .
Learning i s
a n interaction o f the child with hi s en­
viro nment , and if we try to te ach him some ­
thing about h i s hea lth , . . . , he will accep t
or rej ect , master or s lough off , in terms
of his hea l th , his emotiona l s tate , hi s
f e e l ing s , h i s morning break f a s t , h i s
amb i t io n , h i s everything . No part or
element within him i s unrelated to the
learning proce s s .
. . . He react s as a
total personal ity and thu s the study of
the dynam i c s o f individual ad j u stments
to environment , g ive s much l i ght on how
people c an learn and make s a total pro­
gram o f health educat ion of infinite
impo rt ance to all of education . ( 8 1 : 7 4)
Teenage smoking behavior goe s beyond the concern
of the family or the educator .
o f the c ommunity .
It ha s become the concern
Today ' s teenage r s are the community
adult s of tomorrow , and a s member s of tomorrow ' s adult
c ommunity it i s important that they be taught p o s it ive
health att itude s now , and cont inue the ir under stand ing
of health in order to relate the se concept s to the ir
future well-be ing .
In an addre s s to the Amer ican Publ ic
Health As s o c i atio n , Ander son stated that :
Publ ic Health i s an organ i z ed community
program de s i gned to prolong e f f i c ient
human l i f e .
It has no art i f i c ial limit­
at ions that would re str ict it s activit i e s
to certain typ e s of problems .
I t must
deal with and endeavor to combat tho s e
force s that tend to impa ir o r s horten
e f f i cient human l ife and must meet each
problem ac cording to it s parti cular need s .
( 2 : 1 3 6 8)
Educat i on about smok ing and health i s but one
a spect of the comprehens ive health education program , and
a health education program i s an important component o f
total educ ation .
Fodor and Dal i s have stated:
11A common
philo sophy o f educat ion encompa s se s health knowledge and
value s as important outcome s of education . 11
( 31 : 1 7)
4
The health o f young people , prior to the age group
unde r study , i s genera l ly supe rvi sed by parent s , and
young people usual ly accept this superv i s ion as pa s s ive
non-part ic ipants .
As young teenagers they should be
prepared to accept s ome respons ibi l ity for the ir own
we l l -being .
Frequently , there occur s a d ichotomy between
parental health supe rvi sion wh ich i s authoritat ive i n it s
r igid "Do ' s " and "Don ' ts " when smok ing i s involved , and
peer inf luence wh ich s anctions smok ing .
(21 : 1 4 )
It
f o l l ows that it now become s the re spon s ib i l ity o f the
h ealth educ ator in the s chool to a s sert h i s inf luence
toward the midd le of the cont i nuum by pre s enting factual ,
c l e arcut , c on s i s e informat ion about smok ing , and we l l
p l anned le arning opportun ities .
Conn stated that :
An educati onal program . . . d e s i gnated to reach
individua l s before they begin to smoke has
the great e st potent i a l for succe s s .
The
most e f fective approach to the problem of
reduc ing health h a z ard s due to cigarette
smoking i s to prevent young people from
acqu ir ing the hab it .
Thi s approach en­
c ourage s individual � e c i s ion-making on the
bas i s of what wi l l l ikely be the most
bene f i c i a l to one ' s hea lth .
(21 : 4 )
Conn further exp l ained :
. . . that it genera l ly i s eas ier to pr event
boys and g ir l s from deve loping the hab it
o f smoking than it i s to get them to qu it
smok ing once they have the habit .
(21 : 3 )
5
S cope and Del ineat i on o f the Study
It was proposed that d ata would be secured from
a l l male and femal e pupi l s , age s e leven to sixteen , in
the seventh and e ighth grade s of the Monte V i sta and Los
· Alto s Junior H igh School s , P l e a s ant Val ley School D i str ict ,
Camar i l l o , C a l i forn i a , who would be pre s ent on the day the
que stionna ire was admin i stered .
Only one que stion in the
inve stigat ive too l was des igned to c l a s s ify pup i l s according to the ir reported smoking habit s .
Other que stion s
. were related to knowledge o f the purported health hazards
!
1
o f smok ing .
Purpo s e ly omitted were que stion s r e l ated to
peer inf luence , parent a l smoking habit s , socio-economic
background , academi c standing , and athletic and s o c i a l
a ct ivit i e s in and out of schoo l .
The author doe s not
prec lude the important inference of the se items , however ,
it wa s f e lt t hat a subs equent study wou ld serve thi s
purpo se t o better advantage .
Purpo se
It wa s the purpo se of thi s study to inve st igate
the relationship between the reported smoking pract i c e s
o f s eventh a n d e ighth gr ade pup i l s a n d their knowledge
of the purported health ha zard s of smoking .
/
6
Terms and Def inition s
To facil i tate the unders tanding o f the terms used
in the text of thi s the s i s , the followi ng de finition s are
pre se nted .
Health .
Probably the f i r s t internati onally
accepted de f i ni tion of health appears in the Preamble
o f the Charter o f the World Health Organ i z ation .
Adopted in 1 9 48 , the Preamble s tated:
" Health i s a
s tate o f complete phy s ic al , mental , and social well-being
and not merely the absence o f di sease or infirmity " .
( 22 : 3 )
In
the twen ty ye ars s ince the Pre amble was
wr i tten , many educators have presented the ir own
interpretation o r elabor ation of thi s definiti on .
One
of the mor e recent def initions of health s tate s:
Health i s the qual i ty resulting from the
total functi oning of the individual in
h i s environment , that empowe r s him to
a ch ieve a personally sati s fying and
socially u s eful l i f e . ( 58 : 1 0 )
Health Education .
Thi s term i s used in many ways ,
and has dif ferent meanings to di fferent people .
There
may be an empha si s on educ ation or a proce s s by which
agent s o f education exert influence on an individual s o
a s to a f f e c t health behavior .
Health educ ation ha s been
d e f ined a s:
Health edu cation i s the proce s s o f pro­
viding learning experiences for the purpose
7
o f f avorably influenc ing knowledge ,
atti tude s , and pr actice s relating to
individual and communi ty health .
( 5 7: 2 2 )
H e alth Instructi on .
Fodor ' s earlier definition
o f Health I n s truction ( 3 0 : 5) has been s impl i f ied and has
now been de f ined in the se word s:
H e alth i n s truction refe r s to a plan that
provide s for the s equential arrangement o f
learning opportuni t i e s de s igned to favor­
ably influence health att i tude s , practice s ,
and cognitive skill s that are conduc ive to
the optimum developmen t o f the individual ,
the f amily , and the cow�unity . ( 3 1 : 1 9)
Health Educator .
The health educator , or a s
employed i n thi s s tudy , i s a te acher who teache s health
i n the publi c s chool s .
Leventhal s tated that:
" The
health educ ator evaluate s behavi or in terms of i t s e f fects
upon the he alth o f the ac tor . "
Heal th Knowledge.
( 67 : 17)
For the purpose of thi s s tudy ,
health knowledge i s equated with the cogn i t ive skill s .
Health knowledge related to factual
info rmat ion in the he alth and behavioral
s c i ence f ield s which i s le arned for the
purpose of modifying behavior in order
that the individual concerned may en j oy
a b e tter health and have a socially
u s e ful c oncept of health . ( 64 : 13)
H e alth Practice s .
He alth prac t i c e s are tho se
o b s e rvable behavi or s which may or may not influence
o ne ' s maximum heal th .
According to Fodor and Dal i s ,
8
the se may be:
1 ) suffic iently overt to be evaluated ;
2 ) obs ervab le but not conduc ive to sys temat ic
a s s e s sment in a c l a s sroom se tting ; and ,
3 ) tho s e pra ctice s which may not become part
of the individual's behavior pattern unti l
s ome future time .
( 3 1 : 19 )
School Hea lth Program .
A s chool he alth program
i s a pl anned cour s e o f activities dire cted toward promot ing
and/or improving the health of chi ldren and youth .
The purpose o f a s chool health program i s to
provide learning opportuniti e s , experienc e s ,
and an environment for chi ldren and youth
that wi l l f avorably influence tho s e attitude s ,
practice s , and c ognit ive sk i l l s which promote
individual , fami ly , and community health .
(31 : 18 )
Hea l th practice s , to be mo s t ef fective
Atti tude s .
and l a s ting , mu s t be cemented by we l l - e s tab l i shed att i tude s .
Sim i l a r ly , hea l th knowledge , to be mo s t
e f f e c tive , mu s t be app lied through proper health attitude s .
Ander son s tated :
An atti tude may be thought of a s a tendency
to react in a certain way in a given s i tuat i on .
( 1 : 2 7 7- 2 7 8 )
Fodor and Da l i s interpret attitude a s a re ferrent o f
affec tive behavior .
( 3 1 : 19 )
Cogn i t ive Ski l l s .
reca l l of facts .
sk i l l s.
Knowl edge i s more than a s imp le
I t invo lve s a hier archy of cognitive
Bloom has descr ibed the se components as recal l
or knowledge , c omprehen s ion , applica tion , ana ly s i s ,
9
synthe s i s , and evaluation .
(11 : 62 )
B loom o f fe r s the s e
s impl i f ied de f initions o f the component s of the c ogn i tive
s ki l l s.
Rec a l l or Knowled ge .
F or me asurement purpo s e s ,
the r e c a l l s ituation invo lves little more than
br inging to mind the appropr iate mater i a l .
( 11 : 2 0 1 )
Tran s lation or Comprehens ion .
The abi l i ty to
under s tand a c ommun ication and to make use of
the ma terial or idea by altering the form of
the original communi cat ion and retaining
accuracy . ( 1 1 : 2 0 4 )
The abi l ity to apply knowledge
Appl ication .
from one s ituation to an analogous s i tuati on .
( 11 : 2 0 5 )
Iden t i f i c ation o f the elements in
Analys i s .
a communication for the purpo s e of c larifying
the communication and e s tabl i s hing relationships
betwe e n the c omponent e lements. ( 1 1 : 2 0 5 )
The abi l i ty to arrange and corob ine
Synth e s i s .
elemen t s to create a pattern not c lear ly d e f ined
prev i ou s ly . ( 1 1 : 2 0 6 )
The abi l i ty to j udge or a s s e s s the
Eva luation .
value of mater i a l s for a g iven purpo s e . ( 1 1 : 2 0 7 )
C la s s i f i c ation o f Smoker s .
Briney has c l a s s i f ied
the smoker s in h i s h igh s chool s tudy into eight categor ie s , from thos e who smoke one pack of cigarette s a
day to tho s e who have never smoked at a l l .
The s e
c la s s i f ications are :
1.
2.
3.
4.
Smoke s
Smoke s
Smoke s
Smoke s
a day .
more than one pack of c igarettes a day .
about one pack a day .
between 1/2 pack to one pack a day .
regular ly but l e s s than a 1/2 pack
10
Smoke s c igarette s but not every day .
Have tr ied smoking cigarette s but don ' t
smoke n ow .
Smok e s but not cigarettes ( pipe or cigars
exclu s ively ) .
Have never smoked at all . ( 1 5 : 29 )
5.
6.
7.
8.
Sallek ' s s tudy o f j unior and senior high school pupils
• employed f our cla s s if ications of smoke r s .
The se are :
Non-Smoker : A youth who s tate s he has never
smok ed .
Experimenter : A youth who s tate s he has
smoked but has not smoked a s much a s 1
package of c igarette s , 2 cigar s , or 1
package of pipe tobacco .
C ompleted Experime nter: A youth who s tate s
he ha s at s ome time smoked at least 1 package
of c igarette s , 2 c igar s , or 1 package of p ipe
tobacco or more but doe s not meet the criteria
e s tabl i shed for a smoker .
Smoker : A youth who s tate s he has at some
t ime smoked at least 5 package s of c i gare tte s ,
5 0 c igar s , or 5 package s of pipe tobacco .
( 8 6 : 3 0 8 - 3 09 )
1.
2.
3.
4.
Salber and her a s s ociate s sele cted the se definitions for
the ir cla s s i f ications of smoke r s .
a non smoker wa s def ined a s a student who in
h i s l i f e time had smoked le s s than ten c igarette s .
A d i s continued smoker was one who had at s ome time
in the pa s t smoked ten or more c igarettes but who
s topped smoking and who did not at the time of the
que s tionnaire cons ider himsel f to be a smoker . A
smoker wa s a s tudent who had smoked at le a s t ten
c igarette s in the pa s t and who at the time o f the
que s t i onnai re cons idered h imsel f to be a smoker ,
regardle s s of the amount he smoked . ( 8 4 : 1 19 )
.
•
.
For the purp o s e o f thi s s tudy , seventh and e ighth grade
smoke r s have been arb i trarily cla s s i f ied as follows :
Smoker .
A pupil who smok e s almo s t every day .
Occa s ional Smoker . A pupil who smokes once in a
wh ile , but not every d ay .
11
D i s continued Smoker. A pup i l who smoked almo st
every day , but no longer smoke s.
D i scont inued Occas ional Smoker.
A pup i l who
smoked once in a whi le , but no longer smoke s.
Thi s category inc lude s those pup i l s
Non-Smoker.
who exper imented with a few cigarette s and who
do not now smoke , as we l l as tho se pup i l s who
have never smoked.
Purported Health H a z ar d s
( o f smoking ) .
The pur-
ported he a l th ha zards con s i dered in thi s s tudy are a s s oc i ated with the effects o n the re spir atory system , change s
i n the cardiova s cu l ar s y stem , and the introduction o f
carcinogeni c mater i a l s into the body .
CHAPTER I I
REV Imv O F LITERATURE
In th i s review o f the l i terature the development
of opinion s , ob servat ions , mea surements and analy se s of
the adult population , ha s been pre sented in a chronologi cal
sequence .
In the late 158 0 ' s , following a trip to the
c o lonie s , Sir Wal ter Ra le igh introduced toba cco to his
c ountrymen in Bri tain .
The use o f sever al forms o f
tobacco wa s quickly adopted b y both men and women , much
to the di smay of Rale igh ' s king , who in 1 6 0 4 , publ i s hed
hi s Counterbl a s te to Tobacco .
Jame s ' diatribe , probably
the e arl ie s t indictment against the use o f tobacco ,
concluded with the se word s:
Have you not reason then to bee a shamed and to
forbeare thi s f ilthie noveltie , s o ba sely ground­
ed , so fool i shly received , and so gro s sly m i s ­
taken in the r i ght u se there o f ?
In your abuse
there of s inning agains t God , harming your selve s
both in per son and in good s , and taking al s o
thereby the marke s and note s of vani tie upon
you: by the cu s tome there of mak ing your selve s
to be wondered at by all forra ine c ivil Nations ,
and by all stranger s that come amongst you , to
be s corned and c ontemned .
A cus tome loths ome
to the eye , hateful to the Nose , harmfull to
the br a i ne , dangerous to the Lungs , and the
blacke s ti nking fume there o f , neere s t resem­
bling the horr ible Stygian smoke o f the pit
that i s bottomele s se .
(55: 3 6 )
Few problems of publ ic concern have had as many
word s wr itten about i t , as many s tud ie s and as many
12
13
sta t i s tics reported about it a s c igarette smok ing .
The
problem , far from be ing s o le ly an Ameri can prob lem , has
Cig­
been and is be ing inve s t igated all over the wor ld .
arette smok i ng is no longer a concern of only the present
adu lt community ; . it ha s become a vital prob lem involving
the future adult communi ty .
A recent antho logy , Stud ie s and I s sue s in Smok ing
Behavior , edited by Zagona , contains twenty-one page s ,
doub le c olumned , of bibli ography .
There are abou t nine
hundred reference s in the bibl iography , and almo s t every
s ta te in the United S tate s i s repre sented as we l l a s
thi r ty foreign countr ie s .
More than th irty d i s cipl ine s
are repre sented , from Obstetrics to Ped iatric s t o Ger i­
atri c s , from Bu s ine s s to the M i l i tary , the Health Sciences ,
the Social S c ience s , and the Behavioral Science s , to
mention a few .
{1 0 6 )
In another pub l i c ation , Summary
of Re search , a report o f the Advi sory C o�mittee to the
Surgeon General of the Public Health Service, eighty-two
reference s are given for its f i f teen-p age report .
(95 )
Wi th the vas t amount o f material ava i l able , it
appeared tha t an in-depth review of l i terature re lat ive
to smok ing c ould be an Hercu lean undertak ing .
The pattern
for this review of l i terature , there fore , encompassed
three ma j or area s :
1 ) the purported he alth hazard s of
smok ing ; 2 ) teenage smok ing patterns and behavior , with
sub-head s :
a)
inf luence of parents and other adults ,
14
b ) peer inf l ue nce , and , c ) relationship o f knowledge o f
:the purported health haz ard s o f smok ing to the smoking
. behavior o f teenage r s ; and, 3 ) educ ational technique s in
the area of smok ing and health .
Although c i garette smoking i s a very real problem
among pre- teenager s and teenager s , i l l ne s se s , debi l i t ie s ,
·
and deaths attributed to smoking are not u sually ob servable and mea s urable unt i l adul thood .
The review o f
l i terature which f o l l ows , involve s the observation s ,
·mea surement s , and analyse s of the adult population .
Purported Hea l th Ha z a·r d s o f Smoking
a f ter a careful eva lua tion of evidence
in more than 1 0 , 0 0 0 s tudie s , i t i s summed up
in that sentence so fami l iar to u s a l l:
' c igare tte smoking i s a health haz ard of
suf f i c ient importance in the Un ited State s
t o warrant appropriate remedial action ' .
(65 : 1)
•
•
I n 1 89 5 , Mulhal l , a phy s i ci an and an admitted smoker of
twe nty- f ive year s , s tated that:
A few , who l ike my self , have made practical
ob servations will te l l you tha t they never
who u sed tobacco hab itual ly
s aw a ch i ld
whos e health wa s. not in some manner badly
imp ai red . What e l se would one expect the
tender growing organ i sm to do but wi l t under
the s te ady dai ly inf luence of a drug l ike
nicotine ? ( 7 6 : 7 1 6 )
.
•
•
Mu lha l l dec r ied the WCTU ' s attempt to crus h the cig arette
evi l by a s serting that opium and other narcotic s were
found in c igarette s .
" Vice cannot be cured by
mi s repre sentation , " Mulhal l s aid .
( 7 6 : 7 16 )
15
Mulhall reported that doctors were ab le to tel l
which of the i r patients smoked and wh ich did not , by
throat examination s .
They observed that profe s s ional
s inger s , to be in good voice , abs tained from smoking ,
e s pec ially be fore a c oncert .
Also observed wa s the fact
; that col lege s tudents who smoked had smal ler che s t expan s i ons than tho se who did not smoke .
The prac titioners
agreed that the:te wa s a " dearth of l iterature relat ive to
smoking and d i sease in med ical l i terature " .
(76 : 720)
Further Mu lha l l s tated that :
There i s no such ins truc tor o f the public a s
the pre s s , a n d I tru s t that our newspaper s
w i l l pub l i sh and broadcast such informat i on
a s thi s and kindred e s s ays may give them on
what is f a s t becoming a national vice in
Amer ican youth - the c igarette hab it .
( 7 6 : 717 )
In the late 19 2 0 ' s , Bogen , in one of his s tud ie s
on smoking , di s c l o sed that 2 8 6 brand s of c igarettes were
on the American marke t .
These were te s ted for " s trongne s s "
and " m i ldne s s " , and for nicotine conten t .
He noted that
d ome s tic brand s had a 2 . 5 0 per cent nicotine content , that
den icotinized c i garette s a 1 . 1 0 per cent nicotine content ,
and tobacco- free c i garette s , 0 . 0 0 per cent .
Bogen s tated
that nicotine wa s not the only dangerous agent to be found
i n c i garette s , and named " a ldehyde formed dur ing the
c ombu s tion , from ammonia produced from other ni trogenou s
subs tance s dur i ng the cour se of smoking " a s we ll as the
hea t from the smoke itself and " the irr itating tarry
16
subs tance compr i s ing the so-called tobacco oil " .
Bogen
found that many subs tance s in tobacco smoke are not always
found in the unsmoked tobacc o , and he strongly urged
further analys i s and i nve s tigation .
( 1 2 : 1 1 1 0- 1 1 1 2 )
Bogen noted that certain cond i tions were s o
fre quently a s so c i ated wi th c i garette smoking that " the
cau s al connection seems ind i sputable . "
Tho se he named
were cardiac arrhythmia s , shortne s s of breath , thromboang i i t i s obliteran s , nicotine amblyopia , and chronic
infl ammat i on o f the upper re sp iratory pas s age s .
" It
s t i ll rema ins for the smoker to decide whether he de s ire s
to pay th i s price for the enj oyment he der ive s from it . "
( 1 2 : 1 1 1 3)
Berk son , a phy s ici an-re searcher , s tated that:
The mo s t important known " c ause " o f cancer and
s ome other d i sease s , notably those of the c ardio­
v a scular s y s tem , is � We might s ay spec­
ulatively that smoking accelerate s the rate
o f l iving and advance s age and age cause s
c ancer . ( 8 : 3 3 9 - 3 4 0 )
In review, Berkson concluded that while he did not
f a i l to appreciate the " pioneering ef fort with which the
s t a t i s tical s tudie s on smoking and cancer repre sent " and
that he recogn ized the tentative evidence of relat ionship ,
none thele s s , he did not believe " caus ation had been
e s tabl i shed " and he wa s of the opin ion that there wa s
muc h work to be done , with adequate time for evaluation
be f o re f ind ings c ould be considered s ign i f i cant .
( 8 : 343)
17
A few year s later , Berkson opened an addre s s to
the Federation Internati ona le Pharmaceutique in Bru s se l s
·
with thi s statement:
"Accord ing to innumerable account s
it has b e e n conc lus ively e s tab l i s hed that smok ing
is an important c ause o f cancer of the lung . "
( 9: 2 0 6 )
He reported that i t had become extreme ly unpopular t o
que s tion the s e conc lus i on s .
que s tion them .
The re lationship between smoking and lung
c ancer , Berk s on s aid ,
had been " derived from " the re sults
· o f s tati s t i c a l s tud ie s .
'
Nonethe le s s , h e intended t o
Repor t s that lung cancer deaths
had incre ased in thi s s ame period led to the hypothe s i s
that cancer o f the lung " had been cau s ed by smok ing . "
; According to the s tudie s , Berk s on continued , the oretically
tobacco smoke contained known carc inogens and that the se
inha led produced pulmonary cancer .
( 9: 2 0 7 )
Stati s ti c al
s tud i e s by Doll and Hi l l in England and Hammond and Horn
in the Uni ted State s
Berk s on .
( 4 0 , 4 1 , 4 2 ) were reviewed by
On the base s o f the s e s tud i e s Berkson doubted
the validity of the interpretations and stated that cancer
of the lung was a " bio logic , not a s tati s t i cal prob lem . "
He noted that al though c ancer of the lung wa s higher among
smoke rs than among non- smoker s of the s ample populati ons ,
i t wa s , nonethe le s s , lower than the de ath rate from lung
cancer among the general population .
( 9: 2 0 8 )
Berk son , having s tated that in a selec ted s amp ling
a '' s pur ious s tati s t i c a l a s soc iation " could be produced ,
, .
18
exp l ained that the Hammond-Horn s tudy showed greater
; s e n s i t iv ity by examining factors other than lung cancer .
i
I n addition to a cigarette smoking re lation ship to lung
:cancer , Hanunond and Horn inve stigated the re lationship
between cigarette smoking and 1 ) coronary artery d i sease ,
2 ) o ther c ancer s , 3) cerebral vascular di se�se , 4 ) gastric
. and duodenal ulcer s , 5 ) c irrho s i s o f the l iver , and 6 ) all
other cause s o f death .
( 9 : 12 , 3 8 : 13 0 7 )
I n s ummation , Berk son s tated :
I t appears to me that hardly can there be any
se rious doubt that the de finitive impor tant
f inding of the se stati stical s tudies is not
that there i s an a s soci ation between smoking
and cancer of the lung , but that there is an
a s s o c i ation between smok ing and deaths from
all c au se s generally . ( 9: 2 2 4 )
l
:' I n the summary and conc lusion s o f the 1 95 1- 1 95 3 re search
•
on Smoking and Death Rate s , Hammond and Horn conc luded
i
tha t :
It wa s f ound that men with a h i s tory of regular
cigarette smoking have a cons iderably higher
dea th rate than men who have never smoked or
men who have smoked only cigars or p ipes .
( 4 0 : 13 2 8 )
I n this s tudy , inv o lv ing 1 8 7 , 7 6 6 Cauc a s ian ma le s between
· the age s of f i f ty and s ixty-n ine , it was found that 5 2
per cent mor e deaths oc curred among men with a background
o f regu lar smoki ng habi t s .
In a later report by Hammond and Horn , the s e
re s e arche r s conc luded that among men who smoked two pack s
of c igarette s a day , the death rate wa s 1 2 3 per cent
. •
19
h igher than among non- smokers; tha t regular cigar smokers
: had a 22 per cent higher dea th rate than non- smoker s;
're gular pipe smoker s were only 12 per cent higher than
men who had never smoked; and that the death rate of the
: o c c a s ional smoker wa s not s i gn i f i c antly d i f ferent f rom
non- smoker s .
( 4 1 : 11 7 2 )
Ab s tracting the Hammond and Horn s tudy Death Rate s
by Cause ( 4 2: 1 3 0 8 ) , thi s author found the se conclu s ions :
1 ) that relationships wi th smoking are ev ident , and there
i s an extremely high a s s oc i ation for a few d i se a se s , such
a s c ancer of the lung , c ancer of the e s ophagu s , and gastric
ulcer; 2 ) a very high a s s oc i ation for a few d i se a se s such
as pneumon ia and influenz a , duodenal ulce r , aortic
aneury sm , and cancer o f the bladder; 3 ) a high a s sociation
for a number of d i seases such a s coronary artery di sease ,
c ir rho s i s o f the l iver , and c ancer of several s ite s , a
moderate a s sociati on f or cerebral v a scular le s ions; and ,
4 ) li ttle or no a s sociation for a number o f d i sease s ,
i ncluding chronic rheumatic fever , hypertens ive heart
d i sea se , nephr i ti s , nephro s i s , diabete s , leukemia , c ancer
o f the rec tum , cancer of the c olon , and cancer of the
bra i n .
In a brief forward to the 195 0 - 19 6 4 Smoking and
Health report to the Surgeon General of the Publ i c Health
Serv ice , these s tatements appear :
The mortal i ty trend for lung c ancer continued
upward .
Cohort analy se s shows that more
20
recen t ly born cohorts ar e at a higher r i sk
o f dying from lung c ancer at young er age s
than were their predece s sor s .
and:
There wer e subs tant ial incr e a s e s dur ing
1 9 5 0 - 6 4 in mortal ity from three of the
e ight groups of d i s e a s e s a s s o ci ated with
but not c l e�rly c au s a l ly rel ated to smoking arte r i o s c lerotic he art d i s e a s e , inc luding
coronary d i s ea se , espec i a l ly in the male
popu lation; c irrho s i s of the l iver , wi th
the mos t marked increase for the non-white
popu l ation ; and emphy sema , e spec i a l ly for
the who le male popu l at i on .
( 9 2 : iv )
The Adv i s o ry Committee ' s 1 9 5 0-1 9 6 4 report was one
o f many o f the mor e recent s tud i e s that included the
fema l e popu l ation in i t s r e s e arch .
The c ommittee who
eva luated the d at a s t ated that the sex d i fferential for
smok ing had grown sma l ler over the years .
Male cohort s ,
born after 1 9 0 0 , began to smoke ear l ier in l i fe and wh i l e
l arge s c a l e c igarette smoking by women d id n o t occur unt i l
t h e 1 9 2 0 ' s and 1 9 30 ' s , 3 2 p e r cent of the female popu lation
w a s smoking by 1 9 5 5 a s compared to 6 5 per cent o f the mal e
popul ation .
The female smoking population , therefore , was
inc l uded in thi s r e s e arch s ince there is a r i se in morb id i ty from a number of cau s e s , inc luding lung cancer ,
among women , and the r i se in mortal ity from lung cancer
has been r e l ativ e ly greater than among ma le smoker s since
19 6 0 .
( 92 : 1)
The 1 9 5 0 - 1 9 6 4 report on Mort al ity From D i s ea s e s
A s s o c i ated With Smoking ( 7 5 )
i s a condens at ion of the
21
mo s t cogent data found in the detai led s tudy , Smoking and
He a l th .
(92)
Stud i e s were based on age , sex , color , and
smoking hab i t s .
The fir s t ,
Finding s were pre sented under two headin� .
" Morta l i ty From D i s ea s e s Cau s a l ly Re lated to
Smoking , " l i s t s c ancer of the lung ( 7 5:2 , 9 2 : 3 1 ) , cancer
.
o f the larynx ( 7 5 : 5 , 9 2 : 3 2 ) , cancer o f the lip ( 7 5 : 6 , 9 2 : 3 2 )
and chronic bronchi t i s and emphysema ( 7 5 : 7 , 9 2 : 3 1 ) .
Mortal ity from d i s e a s e s a s s o c i ated with , but not c lear ly
re l ated to smoking , al s o inc luded severa l condition s .
Although there were r e l atively high frequencie s , the
Advi s ory Commi ttee did not think the data adequate to
e s tab l i sh a cau s a l re l ation s hip .
The se di sease s are :
arter i o s c lerotic hear t di s e a s e , inc luding coronary
·ar tery d i s e a s e
( 7 5 : 9 , 9 2 : 3 2 ) , c irrho s i s o f the l iver
( 7 5 : 1 0 , 9 2 : 3 9 , 3 4 2 ) , and emphy sema
( 7 5 : 12 , 92 : 31 ) .
Noted
here i s the ob servation that the fema le population had the
greater re lative increase in mortal i ty from emphysema i n
the age group 6 5 - 7 4 year s .
In thi s age group the death
rate wa s about 1 2 time s higher in 1 9 6 4 than in 1 9 5 0 .
( 7 5 : 13 )
Al s o included in the a s sociated-but-not-clear ly-
re l ated-to- smoking d i sea s e s are :
ulcer o f the s tomach
( 7 5 : 1 5 , 9 2 : 3 9 ) , c ancer of the e sophagus
( 7 5 : 15 , 9 2 : 3 2 ) ,
cancer o f parts of the oral c avity other than the l ip
( 7 5 : 1 7 , 9 2 : 3 7} , c ancer o f the b l adder and other urinary
organ s
( 7 5 : 1 8 , 9 2 : 3 7 , 2 2 5 ) , and spe c i f i ed non-c oronary
22
cardiova scular d i s e a se s , inc lud ing hypertens ive he art
di s e a s e and general arter i o s c lero s i s . ( 7 5 : 1 9 , 9 2 : 4 3 , 3 2 6 )
I n the 1 9 6 4 report on Hea lth v s . c i·g arette Smoking
prepared for the governor of C a l i fornia , i t wa s s tated
tha t :
The markedly increas ing inc idence of lung cancer ,
a c ondi tion which today ranks a s the mo s t c ommon
form o f fatal c ancer , and wh ich in 1 9 6 3 c aused
the de ath o f more than 4 1 , 0 0 0 Amer ican s , may be
j us t ly de s cr ibed a s " ep idemic " . ( 4 4 : 3 )
A r e s o lution adopted by the C a l i f ornia State Board
of Hea lth in July 1 9 6 3 stated that in view of data
:pr e s ented in the f ive point s l i s ted be low , the State
' Board of Hea lth favored a state-wide campaign to control
i
! c igare tte smok ing .
The s e f ive points are :
1.
The r i sk of dying f rom lung cancer i s 14 t ime s
a s high among c i gare tte smoker s a s among
non- cigarette smoker s , and 2 6 time s higher for
tho s e who smoke two or more packs a day .
2.
I f the trend of lung cancer rate continu e s in
C a l i f ornia , 1 0 0 , 0 0 0 Cali fornia children now of
s chool age wi l l d i e from lung cancer before
r eaching the age o f 7 0.
3.
Deaths from c oronary he art di s e a s e are almo s t
twice a s h i gh among c i garette smoker s a s among
non- smoke r s .
4.
Men in the 2 5- 6 4 year age group who smoke
c igarette s suffer more activity- l imiting
chronic di s e a se and d i s ab i l i ty than
non- smoker s .
5.
According to a 1 9 5 5 survey , Californian s , both
male and female , smoke more c igare tte s than the
nation at large ; of particular s ign i f i cance i s
that smoking among per sons under 2 4 years of
age is substantially gre ater than in the nation
as a who l e . ( 4 4 : 5 )
23
The Cal i fornia Summary reported that the 1 9 60
c e n s u s o f s choo l-age chi ldren in Cali fornia reve aled that
in the age group f ive through seventeen , there were
1 , 8 9 0 , 2 0 9 ma le children and 1 , 8 2 0 , 0 4 2 fema le chi ldren
in the same age group .
Of the se numbers , the e s tima ted
lung cancer death s among the se chi ldren be fore they reach
age seventy are :
boy s - 4 4 , 4 5 5 and gir l s , 7 , 1 9 1 .
( 4� : 2 1 )
Many vo luntary and government organ i z ations vita l ly
concerned with the problems of smoking , contributed
s ta tements t o the C a l i f ornia s tudy .
There wa s a unanimity
of f indings and c oncern in the s tate , the country , and
abroad .
( 4 4 : 23- 2 6 )
Each report read by thi s wr i ter , pre sented addi-
t ional finding s based on newer s tudie s , and the Summary
o f the Surgeon Genera l ' s Committee wa s no exception .
L i s ted under " Other Cond i tion " wa s thi s observation :
'
Women
Ivlaternal Smoking and Infant B irth We ight .
who smoke cigarette s dur ing pregnancy tend to
have babi e s o f lower birth we ight s .
Information
is lack ing on the me chanism by which thi s decrease
in b ir th weight is produced .
It is not known
whether t_ h i s decrease in birth we ight has any
inf luence on the bio logic f itne s s of the newborn ;
and,
It i s more prudent to a s sume that the e stab l i s hed
a s s o c iation between cigare tte smok ing and coronary
d i se a s e ha s caus ative meaning than to suspend
j udgment unt i l no uncertainty remains . ( 9 2 : 1 0 )
Statements such a s tho s e noted above prompted thi s wri ter
to include in her s tudy the phrase " purported he a lth
24
h a z ards o f smok ing " rather than accept the he a l th hazards
:
'
o f smoking wi thout reservati ons .
Information in a pamphle t i s sued by the Nat ional
Tubercu lo s i s A s s o c iation in 1 9 6 6 , d i s c l o s ed that 7 0 mi l l i on
. Amer i cans smoked ; that 5 2 3 b i l l i on c igare tte s were purcha sed in 1 9 6 3 at a c o s t of about $ 7 , 0 0 0 , 0 0 0 , 0 0 0 ; and ,
that c igarette smoking may be re spon s ible for 1 2 5 , 0 0 0
dea th s a year , o r o ne every four minute s .
(19 )
With the wea lth o f overwhelming evidence aga i n s t
c igarette s and to avoid dup li c ation o f e f forts and to
pool the ir f inding s , the Amer i can Heart A s sociation ,
American Cancer Soc iety , Nationa l Tubercu l o s i s A s s o c i ation ,
the Ameri can Pub l i c Health Servi ce , the Ame rican Medical
A s s oc i ation , and the United State s Publ i c Health Service
have j oined forc e s in t ak ing an o f f i c i a l s tand on the
harmful e f fects o f c i garette smoking .
Except for the
Ame r i can Medi c a l A s s o c i ation , a l l have united to create
the Nationa l Interag ency Counc i l on Smoking and Health .
(10 : 8 )
Guthr i e i s o f the opinion that whi le more re search
r
i s needed , there i s a lre ady suf f i c ient evidence to s tart
thinking in terms of a good educ ational program .
To
re inforce a s ound educ ationa l program , more re search i s
indicated t o reve a l exactly wha t i n c i garette s c au s e s the
damage .
No further research i s needed , Guthr ie wrote , to
te l l how many Ame r i cans wi l l d i e prema tur e ly each year , or
.. •
25
t o explain d i sabil i ty caused by emphysema-bronchi t i s , both
c l o se ly ident if ied with smoking .
(37 : 1)
In 1 9 6 7 , the Department o f Health , Educ ation and
We l f are authored a new survey titled C igarette Smok ing and
Heal th Character i s ti c s .
I n an earlier s tudy , the pop­
u lation s tudied was twenty-f ive year s and over .
(75 : 1)
; The newer s tudy inc luded non- i n s titutiona l i zed persons
s eventeen ye ars and over .
(18 : 1)
I t was reported that
both ma le and female ci garette smoker s 11 reported a higher
rate of chronic c onditions than did persons who had never
smoked . 1 1
Thi s s tudy is as detai led as earlier studie s ,
and conditions and their analyse s , a s in earlier s tudie s ,
i n c luded :
he art conditions
( inc luding rheumatic heart
d i s e a se ) , hyperten s ion without heart invo lvement , chronic
bronchit i s and/or emphy s ema , chronic s inu s i ti s , peptic
u lcer , arthr i ti s , hearing impairments , and a l l other
c hronic cond i t i on s .
(18 : 10-11)
Hear ing imp a i rmen t i s another pos sible hazard o f
smoking .
In s umma ry , male smoker s and male non- smoker s
pre s ented the s ame rate o f hearing impairments .
However ,
the he avy smoker s , two packs and more per day , had an
; e s timated thirty - f our per cent higher rate of hearing
•
imp a i rments than the non- smoker s , with the dif ference
o ccurring among the 1 7 - 4 4 year age groups.
As smok ing
inc rea sed among fema le s , the prevalence of hearing
impa irments a l s o incre a s e d .
(18 : 16 )
26
The s urvey , which wa s taken in 1 9 6 4 - 1 9 6 5 , a l s o reported
that infect ive and para s itic d i s e a s e s occur more fre­
quently among smoker s and the relationship i s more apparent
among fema l e smoke r s .
In add i t i on , the re lationship
between inf luen z a and smok ing is more evident among ma les
than fema le s , and , there appear s to be some relati on ship
b e tween smok ing and i n j ur i e s .
Re s tri cted activity days(
bed d ay s , and work- le s s days were noticeably higher among
ma le a nd female smoker s than among ma le and fema le
non- smoker s .
(1 8 : 1 6 - 1 8 )
Wi l l i ams has s tated that i f the habit o f smoking i s
t o b e given up , i t mus t be given up for a good reason .
That rea son h a s been provided , Wi l l iams said , by the
d i s covery that " our chi e f cau s e o f dea th , arterio sc lero s i s ,
i s l i nked to c igarette smoking " and
accumu lating r ap id ly . "
" evidence i s
Further , i t has been s hown that
smoking can incre ase the tendency of b lood to c lot .
Nic­
o t i ne , Wi l l iams d i s c l o s e d , may c ause p late le t s to become
adherent ,
" thus imi tating thrombus forma tion . "
( 1 0 4 : 1- 2 )
Lar s o n , examining hi s own patient s ' case record s ,
f ound that among patient s wi th hi s tori e s of emphy sema ,
a lmo s t a l l were smoker s .
( 62 : 4 )
Micro s cop ic
examination s
have shown def inite changes in the cap i l lar i e s of the
a lveo lar wa l l s , and thi s may in turn , lead to the
de s truction of the a lveo lar wa l l s , a s sociated with
emphy sematous lung s .
(62 : 7 )
Thi s type of d e s truc tion i s
27
; p e rmanent , n o res torat ion i s pos s ible , and only the arre s t
o f the progre s s o f the d i s e a s e c an b e hoped for .
(62:10)
Linden , whos e s tudy wa s devoted to Cali forn i a
· women who smoked ,
s tated that in 1940, 13 0 Ca l i fornia
women died of lung c ancer .
In 1950, the number wa s 257,
and in 1960 the number had ri s en to 758, an increa s e of
over 3 00% in the latter four year period .
Linden oh -
s erved that when the t able s were adj u s ted for age groups ,
there o ccurred an inc r e a s ed death rate from lung c ancer
in the 3 5-64 age group , the group which inc luded young
, women who began to smoke in the pos t-World War I period
when smok ing among young adu l t femal e s became popularized .
(68:12)
Linden reconc i led the higher death rate from lung
c ancer in women in Cal i fornia with a proportionate ly
:h i gher number of fema le smokers in th i s s tate .
{68:16)
S tewar t , in an addre s s at an American Cancer
S o c i ety S c ience Wri ter s ' S eminar in 1966, reported that
the finding s in the 1964 Report o f the Surgeon General ' s
·
Advi s ory Commi ttee on Smok ing .and Health was based on an
evaluat ion of 11,000 s tudie s , and that s ince thi s report ,
1,300 addi tiona l s tudi e s have been pub l i shed .
(94:1)
S tewart told h i s audience that the National Center
For Health S tati s t i c s released thes e figure s , based on
a 1964-1965 study .
12,000,000 mo re chronic c ondi tion s reported
by Americans 17 years old and o lder than
wou ld be the c a s e i f everyone had the s ame
28
prevalence o f chronic c onditions as
non- smokers ;
3 0 0 , 0 0 0 extra c oronary attack s ;
1 , 0 0 0 , 0 0 0 extra c a s e s o f c hronic bronchitis
or emphys ema ;
nearly 2 , 0 0 0 , 0 0 0 extra c a s e s o f s inus iti s ;
more than 1:ooo , ooo extra c a s e s o f peptic
ulcer ;
there are 3 , 0 0 0 , 0 0 0 more man days o f re s tricted
ac tivi ty reported among c i garette smokers than
wou ld be the c a s e if a l l had the rates o f non­
c igarette smok e r s , and 9 0 0 , 0 0 0 more days spent
i l l in bed . (94 : 2 )
S tewart s aid that it c annot be s tated with
c e r tainty h ow much o f the a forementioned s ta ti s ti c s
r epre s ent " caus e-and-e ffect relationship s ub j ect t o
r educ tion by reduc ing c i gare tte smok ing .
(94 : 2 )
He i s
o f the op inion that there wou ld be a tremendous reduc tion
i n the s e f i gure s .
S tewart pres ented s ome he artening figure s :
there
a re 18 m i l l i on ex-smoker s ; tha t a sma l ler percentage o f
the ma le popu lation smoke c i gare ttes than at any time
during the pas t h a l f century ; that in the early 19 5 0' s
more than 6 0_per c e n t o f thi s country ' s phys i c i an s
smoked a n d today t h e number i s l e s s than 3 0 p e r cent .
(94 : 1 0 )
Davi s h a s reported that none o f the 1964 conelu s ions re lative to the hazard s of smok ing were " shaken " ,
but rathe r , were s trengthened by the more than 2 , 0 0 0
addi tiona l s tudie s .
The c o s t o f d i s ab i l i t i e s to the
29
S o c i a l Secur i ty Admini s tration for tho s e incapaci tated
by chronic bronchi t i s and emphys ema is second only to
that o f he art d i sea s e .
For men in the 3 5 - 5 9 age group ,
exce s s deaths among current c i gare tte smokers account
for one out of every three death s ; for women , one out o f
every f ourteen .
C e s s a tion of smoking , even mod ifying
smok ing hab i t s , and reduc i ng the dos age of tar and
n icotine , reduce r i sk s - " even for longtime , heavy
smoker s . "
(25 : 102)
In another pre s entation , Davi s r e lated that new
s tud i e s are inc lud ing f emale smoke r s .
In the past , the ir
morbidity and mor tality rate s have been far lower than
f o r male s , but with increa s ed smoking behavior , and at an
e ar l ier smoking age for fema le s , s hould it continue over
a long per i od of time , the d i f ference may s oon d i s appear .
(26 : 3 )
I t i s d i f f i cult to impre s s youth with the reported
h a z ard s of smoking .
Davi s s tated that s tudi e s are nO\.Z in
progr e s s to develop more u s e ful information about
immediate e f fects of smoking on the body s o
that new content and methods can be developed
So far , many boy s and gir l s
to reach youth .
s eem l i ttle inter e s ted in the long-range
imp l ication s . ( 2 6 : 7 )
C igarette Smoking Behavior and Patterns of Teenager s
The s econd s e ction o f thi s l iterature review
encompa s s e s three areas o f inter e s t re lative to the
30
smok ing hab i t s o f te enagers .
The s e areas are :
the
in fluence o f adu lts on the smok ing behavior o f young
peop l e; the inf luenc e of a teenager ' s peers on his
smoking behavior ; and , the rel ationship o f the knowledge
of hea l th h a z ards o f smok ing to the smok ing behavior o f
teena g e rs .
The Re l ation ship o f the Smoking Prac tices o f Parents and
, Other Adu lts to the Smoking Prac tic e s o f You th
I n 1 94 9 , Warner and Srole , inves ti gating the
s o c i a l s y s tems o f Amer ican ethn ic g roup s , l i s ted as par t
o f the d ata the amoun t o f money spent per year on
tobac c o .
They found that wi th the upper c la s s and the
lower upper c l a s s c on s tituting 3 . 0 0 per cent o f the
popu la tion s tud i ed , and the lower lower c l as s and the
upper l ower c l a s s 5 7. 8 2 per cent o f the population
s tudied, l ittle d i f ference was found in their tobacco
spend ing habits .
( 101 : 2 9 6 )
Employing Ho l l ingshead ' s
c la s s d i scrimination ( 4 5 : 6 9 -1 3 5} , Lampert and hi s
as s oc i a te s , in a 1 96 6 s tudy , found that in the lower
1
grade s, s ixth ,
s eventh , and e i ghth , a h i gher perc entage
of s tudents from the lower c la s s e s smoked .
Th i s d i f ference
in smoking hab i t s , by s o c i a l c l as s , d i s appeared in high
s choo l .
{61 : 3 7-38 )
An early s tudy by S a lber and MacMahon es tabli shed
a r ela t ionship between smok ing habits o f teenage rs and
31
s o c i a l habi t s ,
social c las s , and parental smok ing habits .
S ome o f the finding s indic ated that the he avy c igarette
smok e r s among youth , the five - packs- a- week smokers , were
found in the lowe s t s oc io-economic c ategory .
( 83 : 1 7 8 1 )
Furthe r , the authors s tated that smok ing i s related to
bo th s o c i a l c l a s s a nd parental smok ing patterns , and
s ince " .
.
. parenta l , or at leas t paternal smok ing
hab i t s thems e lve s are re lated to social c las s " the
r e l ati onship o f the s e two var iables were frequen t ly
examined s imu l taneous ly. ( 83 : 1 7 8 5 )
The re sult o f thi s
s tudy prompted the inves tigators to hypothes i z e that the
answer to the que s tion of whether there ex i s ts an as s oc i a tion o f s tudent smoking hab i t s with social c l a s s that
i s indep endent of a s s oc iation with parental smok ing
p atterns appeared le s s c lear .
( 83 : 1 7 8 7 )
I n summa r i z ing
thi s s tu dy , S a lber and MacMahon a s s erted that the two
a s s oc iation s , that i s ,
s o c i a l c l a s s and parental smoking
hab i t s , were independent of each other , but that each
wa s re lated to s tudent smoking habits when the othe r was
h e ld c on s tant. ( 83 : 1 7 89 )
A s omewhat analogous s tudy in 196 2 by Barrett ,
inc luded the inf luence o f each smoking parent on the
teenager.
Barrett reported that when the smok ing parent
was the father , the inc idence o f smok ing wa s greater in
m a l e chi l dren , and c onver s e ly , when the smoking parent
was the mother , the greater inc idence was found among
fema le ch i l dren. (E) : 59 1 )
. •
In the l ate 1 9 5 0 ' s independent s tudies by H aenz el
( 39 ) , Bothwe l l
5 2 , 53 )
( 1 4 ) , and Horn ( 4 6 , 4 7 , 4 8 , 4 9 , 5 0 , 5 1 ,
and the ir a s s oc i ate s , s tud ied the smok ing habits
o f a popu l at ion e i ghteen year s of age and over , and the
concen su s of opinion was that there exi s ted a s imi l arity
in the smok ing habi t s of high s chool s tudent s .
It was
s ugge s ted that future inve stigations s tudy younger age
group s .
In 1 9 6 1 , S a l l ek , wi th an anonymous que s t ionnaire
s tudy of 6 per cent o f a total s eventh through twe l fth
grade popu l ation in Erie County , N ew York , found that in
3 9 . 6 per cent of the home s both parent s or guardians
smoked ; in 3 5 . 6 per cent o f the home s , one parent or
guard ian smoked ; in 1 7 . 1 p er cent of the home s , neither
parent or guardian smoked .
O f the male and fema le pup i l s
in the s amp l ing , 7 1 . 8 p e r cent reported that the f ather
or male guardian smoked , and 4 7 . 0 per cent of the s ampl ing
ind icated that the mo ther or fema le guardian smoked .
The
data reported that of male s thirteen year s o ld or younger ,
9 . 3 per cent smoked at horne , and the proportion increased
to 4 8 per cent in the e ighteen ye ar o ld and o lder group .
Amo ng fema le s , the number increased from 5 . 5 per cent to
33 . 9 per c ent in the s ame age groups .
8 5 : 9- 1 0 )
( 8 6 : 3 0 9 -3 1 0 ,
In the analys i s o f the data , S a l lek stated
that the re i s
a de f inite a s s o c iat i on betwe en the smoking
practice s of s tudents and the ir parent s .
. •
33
The proportion o f youth s who se parents smoke
are more frequent ly smokers thems e lves than
are other c l a s s ifi c at i ons of youths .
Youths
who s e parents do not smoke are more frequent ly
non- smoker s than are other c l as s i f ication s o f
youth .
( 8 6 : 31 3 )
A 1 9 6 2 s tudy by Andrus and h i s a s soc iate s s t ated
that the c igarette smoking behavior o f chi ldren probably
is " inf luenced by teache r s , c lergymen , phy s ic ians , and
a l arge portion of the adu lt popu lation who smoke .
Probab ly the mo s t important i s the inf ltience of parent s . "
The s tudy r eported that both parent s o f 37 per cent o f
the smok ing pup i l s smoked and 4 6 per cent had a t l e a s t
o n e parent who smoked .
Seve nteen per cent of the pup i l s
who smoked reported no parental smoking .
( 3 : 2 4 6- 2 4 7 )
Horn , too , found that a child is more like ly to smoke i f
hi s parent s smoke than i f they do not smoke .
( 4 8 : 17 - 1 8 )
Horn ' s comments o n the inf luence o f adu l t s on
the smoking behavior o f youth have been re inforced by
o ther s invo lved in the total s tudy of smoking .
partic ipant s at
a
Several
Con ferenc e on the Behavioral Aspects
o f Smoking were o f the opin ion that phy s i c i an s , parent s ,
and teache r s may be inf luenc ing factors for , a s we l l a s
g iving u p smok ing .
It was , however , sugge s ted that " the
e f fect of a teache r ' s smoking behavior on h i s student s
has not been carefully explored . "
(72 : 16 )
The inf luence o f adu l t s and parents on the smoking
behavior o f youth has been examined too of ten to be
34
l ightly d i smi s sed .
An o f f i c i a l teaching gu ide for Smoking
and Hea l th in I l linoi s , labe l s smoking as a " ' contagious '
diseas e " .
Mos t smokers have one or more parents who
smok e , and " i t may have been part o f the i r environment
from in fancy on. "
Further , the parent , the phys ic ian ,
the S c out leader , the teacher , anyone in pos ition o f
leader ship , c an es tab l i sh smok ing image s which s ome ·
youth s are l ik e ly to imitate .
(5 : 15 )
The I l l inois Teaching Manual s tated that a s the
r e s u l t o f an education campai gn on smok ing , some par ents ,
when made aware o f the impact on the ir chi ldren , changed
their own smok ing behavio r .
The authors re stated the
importance o f a teache r ' s image and sugge s ted that a
teacher "might be expected to c ontrol hi s own habit , i f
need be , i n the intere s t s o f teaching acceptable habits
to h i s s tudents . "
(5 : 6 3 )
LeMa i s tre reported that a s tudy done by Pub lic
Hea l th S ervice and S tudent American Medical A s s oc i ation
revealed that the number o f phys ic ians smok ing today i s
2 2 . 5 p e r cent o f tho s e who responded , as again s t 6 0 per
cent f i fteen years ago .
Following thi s pattern are
denti s ts and med i c a l and dental s tudents .
Phy s i c i an s ,
Le Ma i s tre s a id , c an s e t the pac e for the ir pat ient s '
smok ing behavior , by the ir own behavior .
LeMais tre ' s
c ontention wa s that the smok ing problem w i l l not be
s o lved until the educ ation reache s the entire c ommuni ty.
35
When individua l s have been encouraged to give up smok ing ,
young peop le c an be enc ouraged not to s tart .
( 6 5 : 7 09 )
Horn , too , i s c oncerned with the adu lt smok ing
behavior as it a f fec t s young people .
It i s this " adu l t
behavior " that appeals t o young peopl e .
Iden t i f ic ation
and imitation of an admired adu lt who smoke s ,
is a s trong
f actor in the ons e t o f smoking prac tices for many
chi ldren .
( 52 :4)
Horn repeatedly s tated that a chi ld is more
l ikely to smoke if h i s parent s or o lder brothers or
s i s ters smoke than if they do not .
By the s ame token ,
s ome chi ldren o f smoking parents do not smoke .
!
Chi ldren
f requently emulate adu lts whom they admire and the example
of adu l t s , Horn c ontinued ,
" shou ld not be under e s t imated . "
Further , a parent , teacher , o r adult leader who i s a
c i garette smoker " c an inf luenc e the motivation of youth
to smoke , c an support the perceptions that might lead
to the dec i s ion to s tart . "
( 5 1 : 4-5 , 7 )
In another pre s entation , Horn repeated his
phi lo s ophy re lative to the influence o f c igarette
smoking adu l t s on youth .
H e s a id :
P erhaps the mo s t perva s ive thought . . . i s
the importance o f the personal behavior of
tho s e people who work with chi ldren .
One
can eas i ly s ee that smok ing by an adu lt
l eader c an inf luence the motivation for
smok ing by youth , c an suppor t the perc eptions
that might lead to the dec is ion to s tart ,
. ;
36
can enco u rage the learn ing to u s e the
c i ga re t te in a ffec t management , and can
prov ide s trong envi ronmenta l re-inforcement
of the behavior . (49 : 1 0 )
A rep l i ca tion o f the Horn S tudy i n Por tland in
19 5 8 , by Creswe l l and his a s socia te s in 19 6 7 in I l lino i s ,
inc luded a sec tion on pa renta l smoking behavior and its
The
r e lation ship t o the smoking behavior o f chi ldren .
s tudy showed tha t smok ing behavior o f j unior and s en ior
high s chool sb.l dents is rela ted to parental smoking
b ehavior and tha t the rate of smok ing among s tudents is
h ighe s t when both parents smoke .
When ne ither parent
smokes , the number o f young smokers i s sma l ler .
One
" ex - smoker " par ent a l s o redu c e s the number of young
smokers .
I f one or bo th parents have d i s continued
smoking , the rate o f s tudent smok ing is about as low a s
when neither parent ha s been a smoker .
Further , the
smok ing of boys c on forms more c l o s e ly to their fathers
w i th 2 2 . 7 per c e n t o f the regula r youth fu l smokers c oming
from home s where only the fathe r smoked , and 0 5 . 8 per
c en t from home s where only the mother smoked .
( 2 3 :9-10 )
S ega l p r e faced his paper by expla ining tha t h i s
inter e s t i n the smok ing habits o f young people is
two fold - pro f e s s iona l becau s e o f his tra ining and
pers ona l becau s e one of his chi ldren wou ld s oon be a
teenage r .
S e ga l wrote :
. n o matter how s ound a s chool or community
educa t i on program is . . . , the rea l ly potent
impact on the chi ld is made at home .
In the
37
deve lopment o f attitudes toward smok ing - as in
attitudes toward sex or re l igion - it is parental
guidance that matters mo s t . (88 : 4)
and :
. . your attempts to i n f luenc e your chi ldren
aga i n s t s tarting - or c ontinuing - to smoke ,
c l ea r ly have l e s s chanc e o f suc ce s s if you
smoke yours e l f .
" Do a s I s ay , not as I do , "
has never been a very produc tive l ine for
paren t s , and it i s l ik e ly to have l i ttle or
no e f fect in c ounterbalanc ing the powerfu l
p s ycho logi c a l pu l l the idea o f smoking exert s
on teenager s . ( 88:10)
Horn reported that when que s tions were a sk ed o f
adu l t s who smoked , about thei r reasons for smoking , the
r espon s e s were :
s oc i a l force s , interpersonal influenc e s ,
and exposure to ma s s media .
When the s ame que s tions were
asked o f young p e r s on s , the re spon s e s were :
exp loration ,
curios ity , adu l t emu lation , peer c on formity , rebell ion
agains t authority , identity s earching , and immediate
grati f ication .
( 5 3 : 6- 7 )
I t appears tha t youth and adults c l aim an ana logou s
i nfluenc e ; that o f interper s ona l in f luenc e for adu l t s ,
and peer c on formity for youth .
Re lation ship Between Smoking Behavior o f You th and
Smoking Prac tices of Peer s :
Behavior and I n f luence of
Peer Group
The s o c i o l ogi s t Borgatta , participating in the
Behavioral Aspec t s o f Smoking Confe renc e , reported that :
I f the facts are accurate and persons o f lower
educat ion and lower soc io-economic status are
38
the ones more l ik e ly to be the ear ly smoker ,
thi s i s not merely because they are l e s s " smart " .
They are more c oncerned with the immediate rewards
avai lab l e to them , particu larly from the ir peers .
From the point o f view o f person s who are re­
sponding to peer culture , being " adul t " i s really
( mi s ) - def ined a s be ing the k ind o f per s on who
It is not the
i s a leader o f the peer group :
acceptance o f adult normat ive standard s .
Very
o ften in 9ur youth cu lture being an adu lt is a
matter o f dec laring a form o f indepednc ence from
parenta l control rather than accepting adult
s tandards .
I n thi s era the norms o f society do not
r e f l ect stringent att itude s toward chi ld r earing
w ith consi derab l e attent ion to the undertak ing
Thi s , i f one wants
o f re spons ib i l ity by youth .
to cons ider the po s s ib i l ity o f c ounter ing the
e f fect s o f peer culture , one must really c on s ider
the problem of chang i ng the value s of s oc i ety as
a who le in the s e ma tters in o rder to change
the s e relat ively spe c i f i c things .
It i s doubtful
that mos t p lanners wou ld be prepared to undertak e
the changing o f the who le s tructure o f parent ­
child r e l ationships in o rder to c ontrol a behavior
l ik e smoking .
What c an change , however , is that
which i s cons idered appropriate in the peer
culture it s e l f . ( 1 3 : 9 )
S everal invest i gators , i n the past few year s , have
examined influence s other than parental and other adult s
on the smoking behavior o f youth .
Newer studi e s by
S a lbe r and her a s s oc i ate s , a s we l l a s other inve sti gators
revi ewed here , pres ented a change in investi gative
ob j ective s .
A 196 2 -19 6 3 study revealed a corre lat ion
between the peer group and smok ing behavior o f teenager s .
The rea s on s given by teenage smokers were :
becau se the
" gang " smoked ; to be the "bigshot " ; or , to impre s s the
g roup .
In summari z ing thi s s tudy , the authors s tated
39
11 c o nformity is the common reason " apparent in teenage
smoking behavior .
( 8 4 : 11 9 , 1 2 1 )
Review o f s ome o f the s tati s t i c s a s sociated with
teenage smok ing revealed that it has been r oughly
e s t imated that about 30 per c ent of American teenager s
smoke .
At the h i gh s chool l eve l , between 4 0 - 5 5 per cent
of twe l f th graders , are smok ing .
Reas o n s vary , but
s imp ly , it may be the " in " thing to do .
(90 : 9)
I n the 1 9 6 4 report to the Surgeon Gener a l , s tudent
smoking and the re lationship to peer s wa s noted .
Some s tudents o f smoking behavior have l ooked
at the interacting forces of dynamic s of " striv­
i ng for s tatu s " in a broader sense a s showing the
inter-re latedne s s of ba s i c p sycho- s o c i a l need s .
S ome of the s e are :
t o be accepted by one ' s
re ference per s on s , particularly one ' s peer groups ,
to develop s e l f - e s teem and an acceptab l e s e l f
image ; and to cope with painful f e e lings o f
i nadequacy .
O f the s e , s tr iv i ng f o r adu l t s tatus
i s only one aspect .
I t i s entire ly pos s ible
that if smoking is r e l ated to trying to gain
s ta tu s , it may be more in terms o f keeping
abr e a s t of o ne ' s peer s than in terms of
de l iberate ly wanting to be an adu l t .
At p r e sent , there i s per sua s ive , but not
convinc ing , evidence that smoking adole s cents
may , in many c a se s , be related to needs for
s tatus among peer s , s e lf - a s surance , and
str iving for adul t s tatus . ( 9 6 : 1 5 )
This observation and that o f Borgatta , mentioned above ,
s eem t o be in comp lete agreement .
Jus t a s a parent i s never " so c i a l i z e d "
( s i c ) only
· '
f or his role in the f ami ly , the child is never " so c i a l i zed "
only f or h i s role in the fami ly , bu t to s tructur e s
40
out s ide the fam i ly as we l l .
The child i s " s ociali zed "
for h i s role i n the fami ly , the s choo l , and in the peer
group .
(82 : 3 5 )
I n the s choo l , the generat i on l ine i s enhanced
b y pup i l-teache r role s ; in the peer group the dominant
c haracter i st i c i s the age l eve l , o ften with member ship
o f one s ex .
No adu lt author ity i s imp o s e d and within
the group there develops a d i ffer ent i ation o f role s ,
p a rticularly with r e s pect to leader ship .
( 8 2 : 1 15 )
In
the peer group , the chi ld enc ount er s for the first time ,
a s y st em ,
or s o c i ety , that i s not adu lt c ontro l led .
( 8 2 : 12 1 )
O n o c c a s ion , i n the peer group , one finds role
change s .
A chi l d who may have had a deferent role in
the fami ly c on st e l l at i on , may find hims e l f in a dominat ing
o r parenta l r o l e , i n the peer group .
(82 : 123)
Wh i le
most pre-ado l e s c ent peer group s t end to be structured
hor i z onta l ly , r ather than by strat i fication the
ado lesc ent peer group tends to be very s en s it ive as to
how , a s a group, they rat e , and whether the irs i s the
" ri ght crowd " .
(82 : 130)
Jan ning s ha s s t ated that chi ldren need approval
f rom others of thei r own age , pos s ibly more than approval
from the ir t eachers .
Occ a s i on a l ly when t eachers su spect
that group behav ior i s inter fering with c l a s s room wo rk ,
group s wi l l be s eparat e d .
Janning s felt that when
thi s i s don e , young peop l e learn to live two live s ; one
41
o ffic i a l ly and one under c over ,
" in order to s a ti s fy
the s o c i a l needs forb i dden by the schoo l . "
(56 : 5)
Jannings indicated that peer behavior or group
behavior can be taught , that i s , they
can be taught to
behave in a s o c i a l ly acc eptable manner .
S ince pup i l s
a r e taught i n group s , wha t i s learned i s bound to a f fec t
each o ther .
(56 :6)
Thi s i dea could prov i de the framework
for the s e l ec ti on o f curricular content to add to the
proc e s s o f " individual expres s ion " and " o f the way s in
which they app ly e l s ewhere. "
( 56 : 8 )
Taba and her as s oc i a te s a l s o h ave inve s ti gated
the s oc i a l needs o f the ado le scent soc iety , and have
reported that " chi ldren are tran s i ents in the c la s sroom. "
They are a f fec ted by the home , the neighborhood , peer s ,
group s in s choo l s , and group s out o f s cho o l , but daily
a s s oc iat ion o f a boy or a girl w i th others of his own
age - h i s peers - i s very imp ortan t .
( 98 : 9 - 1 0 )
belonging i s a psychological nec e s s ity.
Social
( 98 : 7 1 ) S ince
the s e boys and g i r l s are eager to be part o f a crowd ,
, they c o n form .
But ,
as one teacher reported , the s e young
peop le can learn to accep t and va lue d i f ferenc e s .
If
boys and g ir l s are to learn to respec t d i fferenc es o f
op inion ,
i f they a r e to be s ecure enough to be ab le to
be d i f ferent and to ac cept d i fferences in others ,
" we have
to p rov ide exp e r ienc e s to teach them the s e fee l ings and
sk i l l s. "
( 98 : 1 18 )
42
Coleman , another s tudent o f ado l e s cent soc iety
behavior, c oncurs with other inve s tiga tor s , that
ado les cents look to each other rather than the adu lt
community for the i r s o c i a l reward s .
Thi s s oc i a l
phenomenon ha s " s ign i f icant impl ications f o r educationa l
theory and prac tic e . "
(20 : 11)
Adu lt s , Co leman repor ted ,
mus t know how to shape the direc tion ado le s c ent s oc iety
take s , s ince the breaking down o f the ado les cent s oc iety
i n o r der to re-es tab l i sh o l d c ontro l s i s improbab le in
today • s s oc i ety .
Coleman sugges ted that the adu l t
s o c i e ty " learn how to c o ntr o l the ado l e s c ent communi ty
a s a c ommunity " and to u s e thi s to further a program
o f e ducation .
(20 : 12)
Coleman reported the re sul ts o f a ques tionnaire
a dmi n i s tered to boys and g i r l s in n i ne public s choo l s .
The que s tions were des igned to f in d out how many o f the
s tu dent s smoked , smoked regu larly , smoked occ a s iona l ly ,
o r never smoked .
The re spondent had been advi s ed that
n o one they knew wou ld ever s e e the que s tionnai re .
Co leman ob s e rved :
I t i s u s e fu l to point out that the princ ipal
protec tion again s t re spons e bias in a s e l f
admin i s tered qu e s tionnaire s eems t o l i e in
such guarante e s , r ather than i n the character­
i s t i c s of the admi n i s tration . A teenager may
unders tate h i s smok ing . . . i f parents or
teachers c ou ld s e e his respon s e s ; he may over­
s tate smoking
i f another teenager cou l d
s ee i t .
But i f only s trangers , whether adu l t
o r teenagers , s ee i t , h e wi l l l ikely respond
more truthfu l ly . ( 2 0 : 16 }
.
•
•
43
S a lber and her a s s oc iates found that reasons given
for smoking c ould be l i s ted under s even heading s .
are :
3)
The s e
1 ) c on formity to peer group ; 2 ) a du lt emu lation ;
to impre s s othe r s ; 4 ) curios ity and nove l exper ienc e ;
5 ) reb e l l i on aga ins t author ity ; 6 ) enj oyment and tens ion
r e l e as e ; and , 7 ) mi s c e l l aneous .
One item of inte r e s t
u n d e r mi s c e l l aneou s wa s " To l o s e weight . "
The s even
heading s given for not smoking , or for s topp ing smok ing ,
were :
1)
Hea l th ( items c l a s s i f i ed unde r this heading
wer e :
a)
hea l th hazard ; b)
lung c ancer c au s ed by
smoking ; c ) a ffec t s my a s thma ; d) c au s e s d i z z i ne s s ;
e)
s tunt s growth ; f ) c igarette smoke makes me i l l ;
g ) deve l op e d a cough . )
2 ) a thleti c s ; 3 ) money ; 4 ) influ ­
e n c e o f o th er s ; 5 ) mor a l or ae s thetic ob j ec tion s ;
6 ) d i s l ik e o r no en j oyment ; and , 7 ) mi s c e l laneous .
S everal respon s e s l i s ted under the mi s c e l laneou s item
were :
t o re s i s t being one o f the crowd ;
"becau s e my
father and s i s ter are chain smokers and I don ' t want to
be one " ; o r ,
( 84 : 1 1 9 - 1 2 0 )
s tudy was :
" not worth doing j u s t to ac t grown up . "
One o f the four c onc lu s ions i n thi s S a lber
" The i n fluence o f the peer group was s tated
to be a very importan t fac tor in initiating smoking . "
( 84 : 1 2 9 )
S e ga l , too , acknowledged the " herd ins tinc t . "
He wrote tha t more h i gh- school smoker s , when a sked why
they smok e d , s ai d they smoked to " go a long wi th the
44
c r owd " and " to keep from being d i f ferent . "
c en t , S egal c ontinued ,
The ado l e s -
"harbors an e spec ially s trong need
t o fee l acc epted by h i s friends and what they do . "
S egal i s o f the opinion that parents shou ld try to
point out that " th i s k ind of acc eptanc e i sn ' t worth
much , and that no ·great achi evement has eve r sprung
f r om 'blind con formity . "
Segal admitted that this kind
o f a dvice may not be the mos t e ffec tive , but encouragement to teenagers to deve lop tra its that wi l l make them
" s tand out " in the c rowd may have more pos i tive result s .
(88 : 8 )
We i r , in h i s s tudy o f Teacher- S tudent Perceptions
o f Smok ing , has s tated that everyone is conc erned about
a c curate s e l f-percepti on .
Teenagers are e spec i a l ly
concerned with thi s proc e s s plus accurate ly desc ribing
h ims e l f to others by h i s behavi o r .
We i r wrote :
for i t i s during the s e year s , that the
great e s t change s in one ' s s e l f image takes
p l ace .
Much of the ado l e s c ent ' s t ime and
energy i s expended in the o ften painful
proc e s s o f s e l f-de fin ition and description .
Change occurs in the image and the ado le s cent
w i shes to pro j e c t and he a l s o finds a new and
broadening spec trum of avai lable behaviors as
he pas s e s from chi ldhood to adu lthood .
Examples
o f the s e oppor tuni tie s are , the pos s e s s ion and
operation o f an automob i l e , part-time employment
w i th accompanying ec onomic independenc e , increas ing
authority in s e lection of dre s s and pers onal
groomin g , regu l a r smoking o f c i gare tte s , etc .
•
We b e l i eve the func tion s e rved by smoking for
many beginning smoker s is to expre s s certain s e l f­
perceptions and to lay c la im to characteri s tics
and tra i ts by which he wou ld l ike to be known .
{ 1 0 3 : 24 )
45
Dav i s ,
too , has noted the invo lvement o f youth
wi th the i r s e l f - image .
s ai d ,
Thi s i s espec i a l ly true , he
11When the ir image of be ing grown up and independent
inc luded the smok ing p ractice
.
.
.
.
..
{ 26 : 7 )
In another p ap e r , Davis s tated that i f pup i l s i n
the l ower grades were he lped t o deve l op ego s trength ,
the s e chi l dren could be aided in ., deve loping sk i l l s in
reaching their own dec is ions and not a lways going a long
wi th the gang . . .
{ 24 : 2 - 3 )
Lampert and his as s oc i ate s admin i s tered a ques ti onn a i re on smok ing to more than one thous and boys and g i r l s
i n grades s ix through twe lve .
The te s t was de s igned to
e l ic i t respon s e s o n three s c a le s :
fac t s .
mora l , peer , and
The s e res earchers found that non- smoke rs reported
11 l e s s fee l ing o f peer pre s sure t o smoke . . .
{61 : 36)
To chi ldren and teenagers death and d i s order
in a remot e and h a l f legendary condition
c a l l e d middle age are particularly unreal .
How c an i t c ompare wi th imp res s ing your friends
r i ght now ? ( 7 : 6 )
Thi s succ inct s tatement sums up rather we l l the problems
of he alth haz ards and peer inf luence and the ir
r e l a t i on ship to the smoking behavior o f youth .
Re lation ship o f Knowledge of Purported Hea lth Hazards
of Smoking to Smoking Behavior of Teenager s
Many inve s ti gator s o f smoking have inc luded i n
the i r s tudi e s que s tions de s i gned to a s s e s s the rel ati onship of youth and the ir s oc i o - ec onomic background ,
46
academic achi evement , participat ion in athletic s , and
the education leve l s achi eved by their parents .
s tudie s show s ome degree o f re lat ionship .
All
The s e re lation ­
ships , whi l e recogn i z ed a s integra l and important facets
o n any smok ing s tudy , have not been reviewed in thi s
paper .
Already reviewed have been the rel ationships
between p a rental and other adu lt s smoking behavior on
youth , and peer in fluence on the smoking behavior o f
youth .
I n this s ec tion a revi ew o f l iterature re ferrent
t o the smoking behavior of youth and the i r knowledge
of the purported health hazards of smoking is pres ented .
A l though there has been a tremendou s inc rea s e in
the l i terature r e l ated to educ a tional techniques for
teaching about health both i n the e l ementary and s enior
high schoo l s , there i s , nonethe l e s s , a pauc ity o f s tudies
which exp l or e the re lationship o f thi s knowledge to the
s moking habits o r behavi or o f young peop le .
Lampert and h i s a s s o c i a tes ,
in an attempt to
a s s e s s anti smok ing campaigns in pub l i c s chool s , te s ted
1002 pup i l s from three grade s choo l s and two high scho o l s
i n Mi s s ou l a , Montana .
The att i tudina l te s t que s tions
were pre s en ted in three areas :
( 6 1 : 34 )
mora l , peer , and facts .
The inve s t i gators f ound that tho s e who s c ored
h i gh on the moral s c a l e were very l ike ly to s c ore high
on peer and fac t s c a l e s .
(61 : 36 )
Lampert and h i s
a s s o c iates found l it t l e di f ferences o n the fact s c a le
47
among pupils in the lower grades, but found a difference
\,
among juniors and seniors, and they suggest that:
It is entirely possible that students in the
lower grades are either ignorant of the facts
(in fact, a few students in the lower grades
penciled in "?" after some of the items dealing
with "facts") or the items on facts do not seem
relevant to this group of students, who are, by
and large among the healthiest in the population.
(61:38)
Lampert and his associates agree that information gathered
from the fact scale is "not as conclusive" as the facts
from the moral or peer scales,
(61:38)
and their
suggestions for education are reviewed in the section
on education for smoking.
Salber and her associates, in their 1963 study in
the Newton, Massachusetts Schools, were interested in
gathering and categorizing the reasons given by high
school pupils for smoking.
One observation noted in this
study was that among students who had stopped smoking
there was "little social class difference in their
motivation for so doing, except that health reasons
appear to be less important in the lowest social groups."
(84:123-124)
The study does not indicate whether or
not health knowledge was a factor in the "health reasons".
On the evening of January 16, 1968, the Columbia
Broadcasting System presented the National Smoking Test.*
*Copies of the National Smoking Test, the transcript of the broadcast, and the results of the national
sampling were provided by Vern Diamond, Producer/Director
of the National Smoking Test, Columbia Broadcasting
System, New York, New York.
48
Of the eighteen True-False questions, three were directly
concerned with health knowledge.
sampling revealed ·that:
Data from the national
79 per cent of the respondents
were aware of lower death rates among long-time smokers
who had stopped smoking; 62 per cent knew that heart and
lung damage occurs less frequently among pipe and cigar
smokers; and only 45 per cent were correct in their
response of "False" to the question which stated that
"a cigarette smoker gets the greatest concentration of
tars and nicotines from the first few puffs."
The
studio audience which was composed of YMCA members from
New York, and employees from two telephone companies,
had an overall average on the True-False portion of 40 for
smokers and 35 for non-smokers.
(79:3-5)
Briney stated the purpose of his study was "to
investigate the relationship, if any, between knowledge
and behavior in respect to a specific area of health,
i.e., cigarette smoking."
The study was conducted in a
San Francisco Bay area suburban community.
The test
instrument was administered to 156 boys and 192 girls
in the senior class.
(15:28)
The study's discussion
notes that:
It is important to note, however, that there is
little difference between boys and girls in their
level of knowledge about the effects of smoking
as indicated by achievement test scores. (15:33)
49
Br iney sugge s ted that there may be other factors of
greater importance to boys and gir l s than knowledge
about the e f f e c t s of smoking and health , and he pres en ted the v i ewpoint of behavioral s c ienti s t Godfrey
M . Hochbaum , who s a i d :
unfortunat e ly , knowledge alone does
not motivate a per son to act in accordance
with it
( 1 5 : 33 )
•
•
•
•
•
•
•
I n summation , B r i ney s tated :
i t c ould be s aid that thi s s tudy showed
a lack o f s igni f i cant relati on ship between
knowledge and behavior in regard to cigarette
smoking for boys but a pos itive relation ship
f or gir l s , i . e . , girls who have higher knowledge
s cores about the ef f e c ts of smok ing are l e s s
l ike ly to be smokers than tho se with low
knowledge s core s ( 1 5 : 3 4 ) .
•
•
•
The purp o s e o f the Fodor-Glas s -Weiner s tudy was
" to d eve lop meaningful educational programs that w i l l
affect smoking b ehavior . "
Thi s mul t i - f aceted s tudy
involved me a surement s f rom " 4 0 0 hea l thy mal e s tudents at
S an Fernando Valley State Col lege
( 2 0 0 smoker s and 2 0 0
non- smoker s ) b e tween 1 7 and 2 2 ye ars o f age . "
(33 : 9 4 - 9 5 )
The s tudy inc luded extens ive phy s i ological te s t s , a
per s onal informat i on que s tionnaire , and a que s tionnaire
de s igned to te s t the sub j ects ' knowledge about smoking
and health .
The l a.t ter te s t was dev i s ed to mea sure
cogn i t ive ski l l s sugge s ted by Bloom . ( 11 : 2 0 1 - 2 0 7 )
The s e
50
cogni tive ski l l s wer e pre s ented in the Definition s in
Chapter I of thi s pap e r .
Fodor and h i s a s s o c iate s f ound that smoker s were
mor e informed about smoking and health than non- smoker s .
Emp loying Bloom ' s taxonomy , the s e inve s tigato r s found
that in the area of Reca l l non- smoker s knew that :
smoking
i s a s soc iated with emphy s ema and heart d i s e a s e ; that the
Heart As s ociation adv i s e s aga i n s t smoking ; and , that
smok ing incre a s e s the pul s e rate .
In the area o f
Ana ly s i s , fewer smoker s f e l t that carbon monoxide was
a harmfu l ingredien t i n c i garette smoke .
In Synthe s i s ,
fewer smoker s throught that increas ing the f i lter length
would s erve a s a prev ent ion f or the abs orption of n icotine .
I n Eva luation , the author s ' found that the more informed
smoker s f e l t it unne c e s sary for teenagers to worry about
smoking unt i l there i s more conclus ive evidence indicating
r e a l harmful effect s .
The s e re spondents al s o felt that
smok ing wa s no c au s e for worry for the normal , he althy
per son , that occas iona l smoking i s not harmful , that at
t ime s c igare tte smoking c an be bene f i ci a l , and that
smok ing may be a s ign of individua l i sm .
Fewer re spond­
ents were of the opi n i on that smok ing is a s ign of
weakne s s .
Re spon s e s to Appl i ca t ion s howed that among
the better informed r e sponden t s , few would advi se
young people not to smoke .
(33 : 96 )
51
The Fodor - Gl a s s -We iner s tudy reve aled that
knowledge and the c ogn i tive ski l l s do not d i s c ourage
smoker s from smok ing , nor from d i s c ouraging young
people who may be s tarting to smoke .
The authors
suggested that "mere ly d i s seminating informat ion "
about the e ffec t s o f smoking and health " may not
nece s s ar i ly a l ter smok ing behavi or " and that a new
c oncept in educ ationa l programs , health education
rather than smoking education , mus t be deve loped .
( 3 3 : 97 )
Educat ion for Smoki ng
Educ a tion for and about smok ing , to be e ffec tive ,
mus t confonn to the be s t educ ational techniques and
the s e techniqu e s shou ld re f lec t the phi l o s ophy of the
e duc ationa l envi ronmen t prosc ribed by the s chool di s tric t .
Les l i e and h i s a s s oc iates have s tated that :
" s choo l s
e xi s t t o imp rove s oc i ety , " and a s too l s o f soci ety
s choo l s are o n ly a s e f fective a s the c on tribution they
a re ab le to make toward " s oc i a l betterment " .
The author s
f urther s e t forth that s choo l s have the respon s ib i lity
and opportun i ty to "he lp protec t , ma inta in , and improve
the hea lth o f pup i l s " .
( 6 6 : 19 )
And e r s on i s o f the opinion that hea lth atti tude s ,
knowl edge , and prac t i c e s are " rec iproc a l and inter­
re lated " .
Hea l th atti tudes , he s a i d , are the result
o f knowledge and p rac tic e s .
( 1 : 277)
S tudents at the
52
junior high school level "need and are interested in
fundamental questions and problems, not detailed data."
Anderson warned against. insignificant questions and
often meaningless details.
Honest presentation of main
factors in a study will make a unit "comprehensive,
meaningful, and impressive to youngsters
11
•
(1:373)
Desirable attitudes should be recognized as
related to growth and accomplishment, rather than an
end in itself.
Since the abstraction "health
11
has little
meaning to young pupils, it may be difficult to design
a program that will induce them to follow a regime of
healthful living that will benefit them later.
(100:54)
At the junior high school level pupils may be less
willing to follow health practices introduced in the
curriculum, and may even reject rules of health learned
earlier.
(100 :399)
Oberteuffer and Beyrer have written that "one
important aspect of health education involves decision
making."
The educated person, the authors reported,
seeks optimum health and desires a better understanding
of himself in order to make changes when indicated, to
think critically about health, and "to feel secure in
the face of change." (81:48)
Oberteuffer and Beyrer
Grout concurred with
and stated that junior high
school classroom activities should be so designed as to
assist pupils in making decisions.
(35:256)
53
Swinehar t , i n an artic le which appeared in the
Amer ican Journa l o f Pub l i c Health in 19 6 6 , discus s ed
c hanges in pup i l reactions which had taken plac e s inc e
the Surgeon Genera l ' s Rep ort on Smok ing and Health had
been made pub l ic .
He was of " the opinion that there had
been li ttle change in the habits of the pupi l s .
As the
r e s u l t o f h i s i nves tigation, Swinehart pres ented his
" Imp lications for Hea l th Educ ation Programs . "
main points were :
Hi s three
1 ) me s s ages repeated too o ften b e c ome
ine ffective , and " the more the better " may have negative
c on s equenc e s , may produc e hos t i l i ty toward c ommunic ation ,
greater rigidity i n exi s t ing attitude s , and forgetting
or d i s torting ear l ier i n formation ; 2 } mes s ages which
s tr e s s p e r s onal and s oc ia l imp lic ati ons of hea lth damage
( c au s ed b y smok in g ) are more e ffec tive than tho s e which
s t re s s bodi ly damage , as s uch ; and , 3 }
" hea lth prob lems
which have not b e en experi enc ed lack s uffic ient real ity
to have much impac t on pres ent behavi or " , a l s o ,
" a r i sk
i s not a c ertainty and high expec tation o f health damage
may not be h i gh e nough t o require ac tion . "
(97 : 2025}
Davis has s a id :
Educ a ting individua l s to make a personal
dec i s i on to not d o s omething that about
1/2 the peop�do . . . is go ing to b e
tough .
Thi s i s partic u l a r ly true wi th
youth whe n thei r image o f b e �ng grown up
o r independent i nc ludes the smok ing
prac tic e ; when the i r friends , parents
o r other mo dels smok e , and when the un­
s avory re s u lts o f smok ing are c ompletely
beyond the i r immediate personal exper i enc e
54
Nonethe le s s , our task i s c lear .
Through educ a t i on we mus t find b etter
ways to reach y outh and adults with the
fac ts to motivate them to mak e w i s e
dec i s ions about ·the ir own prac tic es , and
to deve lop the inner s trength to c ope
w i th the c ontradic tory influenc e s which
surround them . ( 2 5 : 4 )
.
•
•
Dav i s reported th�t s choo l s with educ a tion programs for
smok ing and hea l th have shown l ittle evidenc e o f having
c hang ed the smok ing prac tice of pupi l s , or deterred
pup i l s f r om b e c oming s mokers .
Neverth e l es s , Davis
f e l t that s choo l s p lay an important role and s tated
tha t :
" the need to f i nd succ e s s fu l e duca tion approaches
i s very great . "
Fur the r , Dav i s s a id :
" I t is important
that we deve lop mor e v i ta l . meaningful ways to reach
teacher s , pupi l s , and adu l t s who work with youth . "
Davi s attack ed the frequently u s ed educ ation techni ques ,
and s a id " fai lure and d i s c ouragemen t " wou ld b e
encountered i f there were only " annual one- shot "
approach e s to pup i l s and facu l tie s ; i f a mora l i s tic
appro ach is u s ed ;
if the s ame material s and method s
are u s e d repeatedly ; and , i f b o th smokers and non - smokers
are approached in the s ame way .
tha t even " outstanding ,
(26 : 8 )
Dav i s admitted
imagin ative , creative , hard-
working , we l l - supported teachers and school curricu lum "
may f ind c ompetition from outs ide forc e s which encourage
youth ful smok ing b ehavior .
( 26 : 9 )
·· '
55
Davi s submi tted tha t a c l a s s room educ ation program
for health and smoking i s far from a uni l ateral endeavor .
Current pro j ects are exploring ways and means to improve
teaching methods , deve lop experienc e s and provide c l a s s room mate r i a l at d i f ferent grade level s .
One Un iver s i ty
i s attempting to reach students through i t s Greek letter
s oc ieties .
The Chi ldren ' s Bu reau i s interes ted in
approaching you th leaders and young people .
The Nationa l
4 - H Founda tion in s everal areas have deve loped programs
b e tween organ i z e d vo lun tary youth group s and voluntary
hea l th resourc e s .
The American Dental A. s s oc iation has
become interes ted in an educ ation program , as have the
American A.s s oc i ation for He alth , Phy s i c a l Education , and
Rec reation , and the National Congre s s of Parents and
Teacher s .
{ 26 : 12-13 )
Cre swe l l and hi s a s s oc i ate s found that a " s tudentc entered " approach is more suc c e s s ful in changing attitu­
.
des in regards to a te enager's . non - smoking po s ition , and ,
" s trong support i s given for introduc ing anti- smoking
e ducation programs into the j un ior high curriculum . "
( 23 : 19 )
The inv e s ti ga tors conc luded the d i s cus s ion o f
the ir inve s tigation wi th thi s sugge s t ion :
I t would appear that the remote theme which
emphas ized the relationship of lung c ancer
to c i garette smok ing in terms o f e f fects
l ater in l i fe , d i splays no current pers ona l
re l evanc e for the teenager o f today who i s
perhaps more concerned with the immediate
The c ontempor ary
prob lems o f h i s teen year s .
. •
56
approac h , howev er , appeal s to the teenager
on a more rational b a s i s particularly in
terms of its inherent impl ic ations for the
teen sub -c u l ture . ( 2 3 : 2 2 - 2 3 )
S everal obs erve r s o f pup i l s smok ing b ehavior have
indic ated that meaning ful educ ation shou ld b e introduced
in the lower grade s .
Leedham reported on a communication
w i th John W . Cra i l o f Lou i svi l le , Oh io .
Crail had
c omp leted a s tudy of grade - schoo l pupi l s , and as the
re su lt o f the s tu dy , was o f the opinion that me aningful
edu c ation for hea l th and smok ing mu s t be introduced in
the lowe r grade s .
( 6 3 : 13 5 )
Andru s also sugge s ted that
programs b e directed at " the younger pre- ado le scent age
group to deter the i r s tarting the smoking habit . "
( 3 : 24 7 )
S a l lek has recommended that " forma l and informal ins truct i on and guidanc e for youth shou ld b e undertaken in s ixth
or seventh grade ,
or b o th
II
(86 : 3 13 )
Horn admi tted that educ ator s are in a " rather new
area in smok ing educ ation , " and he ask e d the rhetor ical
que s tion :
"What a fter a l l are our goa l s in hea lth edu-
c ation ? "
Horn i s o f the opinion that the aim o f teachers
i s to teach chi l dren that the i r ac tions affec t the ir
l ive s , tha t their actions may c au s e the ir i l l he alth ,
and that every pers on has an ob l igation to hims e l f to
maintain good hea l th .
(52 :3)
Horn submi tted that expe-
r imentation wi th c u rricu lum changes and teacher - in- s ervice
e duc ation " when e f fectively tapped , c an be a s trong
potential in reduc ing the deve lopment of future c i garette
s mok ing . ., ( 5 2 :4 )_
57
" Knowledge i s not enough for b ehavior change
."
( 24 : 3 )
Educ ation i s the mean s by which the
r ec ipient i s helped to perce ive the prob lems o f smok ing
and hea l th , Davis s aid .
( 24 : 3 )
A framework , or mode l ,
o f smok ing b ehavior change shou ld b e conc erned wi th
mot ivati on , economi c s , s e l f- c ontro l , and the psycho­
l og i c a l factor s .
E f forts are b e ing made to adapt
p sychological f ac tors to the young smokers , bu t , Davi s
s aid ,
" more work wi l l have to b e done before it wi l l
have real u t i l i ty . "
E f fec tive preventive educ ation
approache s c an b e made b y the deve lopment o f content
and methodology , b a s e d on the psycho logical fac tors o f
smoking .
( 24 : 4 )
Un l ike Grou t , who sugge s ted the inc lus ion o f
pup i l-des i gned pos ter s a s part o f a n educ ationa l program
f o r smoking ( 3 5 : 2 5 6 } , Schwar tz and Dubitsky conceded
that po s ters and the l ike , have very l ittle e ffect on a
program .
Anti- smoking c ampaigns are not the an swer and
p r e s ent education a l programs have b een only s l i ghtly
e ffec tive .
Before an ef fective curricu lum c an b e
d eve lope d , educ ato r s mu s t explore and identi fy " the
needs and pres sure s fac ing the ado l e s c ent " and a program
p r epared wh ich the young pup i l " c an unders tand and
r e l ate to h i s own particular s i tuation . "
( 8 7 : 18 0 - 18 1 )
58
Many educ ators are f i rm in the ir convic tions
that new and meaningfu l hea l th education programs mu s t
b e deve l oped , programs bas ed o n updated theories o f educ ati on .
I n the meantime , o l d techniques ,
"while not
n ec e s s ar i ly inva l i d , mus t be s tudied carefu l ly be fore
we place too much faith in them . "
(48 : 18 )
Horn has
po inted out that s choo l s are currently interes ted ih
the " planning and deve lopment o f units within the schoo l
curriculum " which wi l l make u s e o f mater i a l s now
ava i l able .
Among are a s o f s tudy being prepared for
the s e units are phy s i o logy , pharmac ology , demons tration s ,
audio-vi sual aids , and con sumer he alth .
Consumer health
involves pup i l s in the d i s cu s s i on and analys i s o f
adverti s ing technique s .
(48 : 1 9 )
I n the 1 964 Report , the Adv i s ory Committee on
C igarette Smoking and Hea l th to the Governor of C a l i fornia ,
p r e s en ted twe lve recommendation s .
The fourth o f the s e
r e c ommendations s t ated :
4.
Educational e fforts to be concentrated
pr imar i ly on youn g s ters who have not ye t
s t ar ted to smoke c i gare tte s .
In particu lar ,
a.
The S tate should deve l op an exten s ive
educational pr ogram wi th sui table mater i a l s
a n d spe c i a l ly trained teaching per s onnel ,
focu sed primarily on young peopl e .
The
program shou ld inc lude tho s e engaged in
or training for the hea l th and teaching
pro fe s s ions , and adu l ts genera l ly .
59
The entire State health education
program s hould be s trengthened to
enhance the effectivene s s of spe c i f i c
e f fo r t s on c igarette smok ing and health .
A Framework i n Health I n s truction ,
providing continu i ty for all health
i n s truction , would enable the teaching
o f health principles to be improved
general ly . ( 4 4 : 8- 9 )
b.
In addition to Point 4 and the two sub-point s , the
c ommittee urged the amending of s everal education code s ,
a l l o f which would s tr engthen hea lth teaching and content
in the Cal i f orn i a pub l i c s choo l s .
The Adv i s ory Committee
a l so recommended greater State invo lvement in res earch ,
deve l opment o f education technique s , and the e s tabli shment o f " periodic C a l ifornia Youth Congr e s s e s on Smoking
and Hea lth
•
•
.
11 •
( 4 4 : 9-1 0 )
I n 1 9 6 4 , the Departments o f Pub l i c I n s truction
'
and Public Health , State o f I l l inoi s , d e s i gned a
f r amework for teaching about smoking and hea lth .
The
n i ne ty page guide provide s s c i enti f i c information
re lative to c igarette smoking as we l l a s ideas for
teaching about smoking and health .
The Appendix in-
e lude s a s tudent que s t i onnaire , and a ske letal
bibliography .
In 1 9 6 7 , the Pennsylvania Committee on Smoking
a nd the Health of Youth pre sented a compo s i te o f its
activitie s , t itled Smoking and Heal'th , The· Pennsylva·n·ia
S t ory .
Twenty - f ive s tate and voluntary organ i z ation s
60
c ontr ibuted time , e ffort , and f indings to the s tudy .
Sugge s tions for an educational approach were more
general than the I l linoi s Handbook mentioned above ,
but both efforts indicated the intere s t o f educ ators
and thos e profe s s iona l s in pub l i c health in providing
a framework for s chool cur r icula unt i l curriculum
c ommittee s o f s chool d i s tr i c t s are able to des ign one
that wi l l mee t the i r own requirements and f i t into
the ir exi s t ing educational programs .
Fodor and h i s a s s o c i ates have pointed out that :
' Smoking education ' , i n fact , mus t become
health educ ation , taking into con s i deration
the multip l i city o f f actors r el ated to smoking
and hea lth (phys ical , mental , and social ) .
( 33 : 9 7 )
The Fodor-Gla s s -We i ner s tudy revealed that smoker s
( at
the col lege leve l ) are more informed than non- smokers
about the health h a z ards a s s o c i ated with c i garette
smoking .
The hi erarchy of cognitive skil l s related to
smoking and health have not s erved as a deterrent to
smoking ,
smoke . "
" nor do the smoker s adv i s e young people not to
(33 : 9 7 )
The author s were o f the opinion that :
" The mo s t pertinent educational implication o f thi s
s tudy i s the a ttempt to devel op new teaching content
r e l ated t o smoking and health . "
( 33 : 9 6 )
As educator s
and re s earchers become more aware o f the immediacy of
the problem , the development o f thi s approach be come s
61
more meaningful .
o ther s
Fodor , Gla s s , and We i ner , a s we ll as
( 2 6 , 8 8 ) , are c ogni z ant o f the fact that young
people and youth are n ot concerned about po s s ible
inf irmi t i e s in thei r l ater year s .
Educational content
mus t therefore be concerned with providing information
about the immedia t e e ffects o f smok ing .
(33 : 9 6 )
The
authors further s tated tha t :
The educational program developed cannot deal
s ol e ly with c i garette smoking and its e f fect
o n a s ingle organ , or a number of organs . Any
a spect o f hea l th education mus t be re lated to
the total functioning and wel l be ing of
man .
.
( 33 : 9 8 )
The l i s t o f provocative pamphlets for pupils i s
endle s s , but the author would be remi s s i f she fai led to
acknowledge s everal s ources o f material des igned for the
pre- teenager and the teenager .
The s e are :
Chi ldren ' s
Bure au , Uni ted S tate s Depar tment o f Health , Education ,
and We l f are , the Heart A s s oc iation s , the Cancer Societies ,
and , the Tubercu lo s i s and Health A s s oc i ation s .
CHAPTER I I I
RESEARCH PROCEDURES AND DE S I GN
Meyer and He idgerkin , d i s cus s ing the app l icabi l ity
o f a r e s e arch d e s ign , s tate that a r e s earcher i s impe lled
by the need s of a prac tical s i tuation .
Thi s pract ical
s i tuation may emanate from an on- the - j ob occurrence , and
i t may s eek to te s t a hypothe s i s inspired from the practicill
s i tuation .
(74 : 373 ) .
The s election o f thi s inve s tigation me t the need s
sugge s ted by Meyer and Heidgerkin , and the reasons for
thi s s tudy were pre s ented in the Introduction of Chapter I .
To re cap itulate br i e fl y , an increas ing number o f seventh
and e i ghth grade pup i l s in the P l e a s ant Va lley School
D i s tr i c t were obs e rved smoking on or near the campi .
It
appeared that th i s wa s a mo s t opportune time to inve s tigate
the smoking habi t s o f the s e s eventh and e i ghth grade pup i l s .
and their pre s ent knowledge o f the he a l th ha z ard s o f
c i garette smoking .
Popu lation
Al l ma le and female pup i l s o f the s eventh and
e i ghth grade s , a total of 9 1 7 , iri the Los Altos and Monte
Vi s ta Junior High S c hool s , Camari l l o , C a l i f ornia , compr i sed
the population te s ted .
The re spondent s in thi s population
were categor i z ed a s f o l l ows :
Los Alto s , s eventh grade male,
s eventh grade fema l e , e ighth grade ma le , and e i ghth grade
62
..- �
63
female ; Monte Vi sta , seventh grade male , seventh gr ade
female , e i ghth gr ade male , and e i ghth grade female .
A
random s ampl ing o f twenty per cen t from each o f the se
categorie s wa s taken , providi ng a total o f 1 85 sub j ects
for analy s i s .
A breakdown of the random sampl ing i s
provided in Table I .
Que s t i onna ire
A mod i f ied que s t ionna ire , based oh the instrument
employed in the Fodo r - Gl a s s -Weiner* s tudy ( 15 , 3 2 , 7 4 ) was
u t ilized f or th i s pro j ect .
Thi s que s tionna ire met the
need s for determining whether or not there exi s ted a
relationship between the smoking hab i t s reported by
seventh and e i ghth grade pupil s in the Pleasant Valley
School D i s t r i c t and the ir knowledge of the purported
health hazard s of smoking .
The rev i sed Fodor-Gl a s s -We i ner que s ti onnaire , the
i n s tru c t ion s heet , and the answer sheet ar� i ncluded in
the Appendix .
Conference s
Th i s proj ect wa s pre sented to the Superintendent
and the D i rector of Educat ion in the Plea s ant Valley
S chool D i s tr ic t , Camarillo , C al i fornia .
The s teps in the
* The author grate fully acknowledge s the permi s s ion
granted by Dr . John Fodor for the mod i f i cati on of the
ques ti onnaire employed in the Fodor-Gla s s -Weiner s tudy .
64
propos ed procedure were exp lained in detai l .
The
Superintendent and th e D irector o f Education agreed to
the s tudy if the f i nd ings were made known to them and to
the he a l th educ ation curricu lum commi ttee a s s oon as
r e s u lt s were ava i l able .
Fu l l coopera tion wa s secured .
Next , the pro j e c t wa s pre s ented to the principa l s o f the
Lo s Altos and Monte Vi s ta Junior High Schoo l s , and
meetings were s chedu led with the facu lty of each schoo l .
Two meetings were held , one with each facu lty .
The purpose o f the s tudy was outl ined in detai l .
There
wa s a br ief review o f the que s t ionnaire , and in order to
e nsure a s tandard te s t admin i s tration , the instruction
sheet wa s reviewed several time s with the teacher s .
It
: wa s agreed that each teacher wou ld appoint a "monitor "
f r om h i s c l a s s .
The moni tor would c a l l for the te s t
mater i a l s for h i s room , and a t the c l o se of the te s t
per iod c o l l e c t the sealed answer sheets , p lace them in
the large enve l ope provided for th i s purpo s e , and del iver
the large envel ope , sealed , to the s chool nur se in the
health o f f i c e .
Th i s would el iminate , or at least reduce ,
the po s s ib i l i ty o f te acher invo lvement .
Thi s cour s e wa s
adopted to encourage pup i l s to re spond truthfu l ly , and
. wi thou t fear of d i s c ipl inary action .
Te acher s who lehe artedly endor sed the " non- invo lved "
idea .
One exception was agreed upon .
If pup i l s in the
. r emed i al read ing program , or pup i l s o f Mexican background
65
with a l anguage hand icap a sked for reading he lp , the
te acher could exp l a in or c l arify , as s imply as pos s ible ,
a que s tion a sked of him .
T e s t Schedule
The horne -ro om period wa s se le cted for the t e s t .
Thi s s e lect ion prevented communicat ion between pup i l s o f
the s ame scho o l and be tween s chool s .
Th i s period i s the
only per i od during the s chool day in wh ich a l l pup i l s are
in a c l a s s room and i s the f i r s t c l a s s of the s chool day .
Monte V i s ta gracious ly reversed the morning and af ternoon
s e s s ions , thu s permitting the author to trave l from Lo s
Altos to Monte Vi sta and prepare the te s t mater i a l s for
the s e rooms .
Exper imentation and pretesting a s sured the author
the test should take no l onger than one c l a s s per iod of
f o r ty minute s .
Principa l s vo luntarily o f fered a few
m i nutes " grace " o f the " p a s s ing time " between c l a s s e s , i f
needed .
Te s t Environment
At the conc lus ion of opening exerc i se s , each teacher
advi sed hi s pup i l s of the te s t , and appointed the monitor .
As soon a s the monitor d e l ivered the test mate r i a l s to h i s
r o om , teacher and pup i l s read the instruc tion sheet and
the teacher retired to his desk .
Sinc e th i s wa s not a
t imed te s t , pup i l s cou ld begin at once .
66
At the Monte Vista Jun ior High School , a deviation
f rom the usual c la s sroom c l imate occurred .
Becau se of
the absence of the pr inc ipal from the s chool , the teacher/
v i c e - principal served in thi s capacity .
c l a s s room without a teacher .
Thi s left h i s
A t h i s invitat ion , the
author s erved as te acher for his c l as s .
Over the inter­
c ommunication system , the ac ting principal expl ained. the
r e a son for the change in the morning and af ternoon programs,
and advi sed a l l pup i l s that teachers wou ld explain the test
procedure .
To h i s own room , he read the instruc tion s and
to ld hi s pup i l s to begin the test a s s oon a s they were
r e ady .
S ampl ing
In preparation for a random s amp l ing of the returned
an swer s he e t s , the s e a led enve lopes containing the an swer
sheets were removed from the l arge sealed enve lope s and
s orted into e ight group s , by schoo l , grade , and s ex , a s
d e s ignated in the upper right hand corner o f the individual
pup i l ' s enve lope .
Next , in each group , every sealed en­
v e l ope wa s numbered , beg inning wi th the number one , and
advancing cons ecutive ly .
Empl oying a table o f random dig i t s
( 1 0 5 : 2 8 7 ) twenty
per cent o f the responden ts in each group wa s drawn ,
total ing 1 8 5 re spondents .
are inc luded in Tab le I .
Data re levant to each group
67
TABLE I
DEMOGRAPHIC DATA OF RE SPONDENTS
Lo s
Alto s
Sex
Grade
Re spondents
F
M
F
M
7
7
8
8
121
124
97
95
6
8
9
9
F
M
F
M
7
7
8
8
115
146
98
121
917
6
3
10
6
51
Absent- Per cent
ee s
Te s ted
99 . 95
99 . 94
9 9 . 92
9 9 . 20
20%
Randomly
Se lec ted
24
25
20
20
Monte
V i s ta
·
99 . 95
99 . 98
99 . 90
99 . 96
99 . 946
23
29
20
24
185
Que s t ionnaire D e s ign
The que s tionnaire employed in thi s s tudy (Appendix C)
wa s adapted and modi f ied from the more c omprehens ive ins trument of the Fodor-Gl a s s -We iner smoki ng pro j ect at San
Fernando Val l ey S tate Col lege .
Que stions were chosen to
meet the criter ia o f cognition a s def ined by Bl oom ( 1 1 )
and pre sented in Terms and Def initions i n Chapter I .
Que s tions one through f ive were inc luded to identify
r e s pondent s by age , s ex , s choo l , grade and smoking behavior.
Que s t i ons s ix through twe lve were intended to test the
re spondent s ' recall of factua l informat ion ; thirteen
through e ighteen , tran s lation o� comprehens ion ; nineteen
through twenty- two , analy s i s ; twenty-three through
68
twenty- s even , eva luation ; and , twenty-eight through
thirty- four , synthe s i s .
Number s th irty-f ive and thirty-
six were e l iminated from the ana ly s i s becau se they were
irrelevant to the s tudy .
Preparation of Re spon s e s For Analy s i s
C onference wi th the the s i s committee chairman and
the newly appo i nted hie- s tat i s tic ian to thi s s tudy , res u l ted i n several change s and s imp l i f ications in the
preparation of the re spon s e s for the analy s i s .
Smoki ng behavior patterns were based on the
r e s pons e s of the 1 8 5 randomly se lected r e s pondents , and
the s tudents were c atego r i zed as shown in Table I I .
TABLE I I
RE SPONDENTS '· REPORTED SMOKING BEHAVIOR
Number
1.
2.
3.
4.
5.
I have never smoked c i garette s at a l l
I have tried c i gare tte s a few time s
j u s t to s e e what they were l ike
I u s ed to smoke once in a wh i l e
I u s ed t o smoke j u s t about every day . . . . . . . . . . . .
I smoke c igarette s once in a whi le ,
but not every day
I usual ly smoke j u s t about every day
.
6.
.
.
•
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
•
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
•
.
.
.
.
.
.
.
.
.
.
.
•
.
.
•
.
.
.
.
.
.
.
.
.
•
.
.
.
•
.
•
.
.
.
.
•
.
.
.
.
.
.
.
•
•
.
.
•
70
57
20
4
20
14
O n the ba s i s of the categor ie s in Tab le I I , data
were further s imp l i f ied i nto three c ategorie s , shown in
Table I I I .
The smoking behavior s were now a s s igned to
three c l a s s i f ications :
Group I , tho se who reported they
have never smoked ; Group I I
( formerly Group s 2 and 3 )
69
c o n s idered " exper imenter s " ; and , Group I I I
Group s 5 and 6 ) , current smoke r s .
o f the original Group 4 , N
=
( or i ginally
Wi th the e l imination
18 1 , the new grouping appears
a s f o l l ows :
TABLE I I I
NEW CLAS S IF I CAT ION OF REPORTED SMOK ING BEHAVIORS
Group I
Group I I
Group I I I
Never Smoked
Experimenter s
Smoker s
N
N
N
=
=
=
70
77
34
There are f i f ty-nine po s s ible correct an swers i n the
cognition area , que s tions f ive through twenty- seven , and
i nc luding number thirty-three .
Que s tions number twenty-
e ight through thirty- four r e f l e c ted the opinions of the
r e s pondent s , and the se respon s e s are pre s e nted in
percentages in Chapter IV , Table V .
CHAPTER IV
ANALYS I S OF THE DATA
Analy s i s o f the Data
Twenty-three i tems were used to obtain a total
knowl edge score .
The frequency d i s tr ibu tion o f re spon s e s
i s inc luded i n Appendix E .
Tab le IV provide s the pertin-
ent s tati s t i c s obtained for the three groups .
D i f ferenc e s
between means were inve s tigated by s tudent ' s t-te s t .
TABLE IV
SCORES OF KNOWLEDGE FOR THREE GROUPS
GROUP S
I
Never
Smoked
Mean
S tandard
Deviat ion
II
Experi­
menter s
Smoker s
26 . 00
25 . 76
23 . 99
6 . 90
5 . 77
5 . 86
III
S amp le
Size
70
77
34
M i nimum
S co re
10
13
10
Maximum
S c ore
39
42
36
There were no s tati s t i c a l ly s ign i f icant d i f ferenc e s at
the 0 . 0 5 level between the means of the three samp les .
70
71
The re sults i nd icate that there we re no s ign i f icant
d i f f erenc e s in the re spons e s between Group I , tho s e who
have never smoked , and Group I I I , the reported smokers ;
nor wa s there a s i gn if icant di fference in respon s e s
b e tween Group I I , the reported exper imenters , and Group
I I I , the reported smoker s .
Conc omi tantly , there was no
s igni f i c an t d i f ference in re spon s e s in Group I , the
reported non- smokers , and Group I I , the reported
experimente r s .
A non- smoothed ogive curve , F igure I , repr e s enting
cumulative percentage frequenc i e s o f the score s for re­
por ted non� smoker s , exper imenter s and smoker s , is pre sented
in Appendix F .
Opin ion Re spon s e s
Re spon s e s t o que s tions number twenty-e ight through
thirty- four but exc ludi ng number thirty-three , were con­
s idered opinion or a tti tude re spon s e s and were tabulated
in percentage s .
The s e results are shown in Tab le v.
The fol lowing set o f s tatement s are based upon
the percentage breakdown in Table V .
a.
Fewer smoker s were o f the opinion that smok ing
i s a s ign of weaknes s , th an were non- smokers
or exper imenter s .
b.
More smokers than non - smoker s or exper imenters
were o f the opinion that smok i ng i s a s i gn of
s trength .
72
TABLE V
OPINION RE SPONSES IN PER CENT
28 .
29 .
30 .
31.
When a per s on decides to
smoke , it is :
a.
A s i gn o f weakne s s
b.
A s ign o f conformity
c.
A s ign o f i ndividua l­
i sm
d . A s ign o f s trength
No response
Teenagers smoke because :
I t makes them feel
a.
important
b.
I t make s them feel
more adult
c.
They have nothing
e l s e to do
d . Adu l t s t e l l them
not to smoke
No re spon s e
When a per s on dec ide s to
s top smoking it i s :
a . A s ign of weakne s s
b.
A s i gn of i nd ividua l i sm
c.
A s ign of c onformity
d.
A s ign o f s trength
No re spon s e
Mo s t smokers :
a.
Enj oy smok i ng
b.
U s e smoking a s a
crutch
Can ' t break the hab it
c.
d.
Don ' t b e l i eve smok ing
is harmful
No response
I
Never
Smoked
N = 70
II
Experi­
menters
N = 77
Smokers
N = 34
4 8 . 57
31 . 4 3
41 . 5 6
24 . 6 9
8 . 82
32 . 35
11 . 4 3
00. 00
8 . 57
24 . 69
5 . 19
3 . 89
32 . 35
20 . 59
5 . 88
32 . 86
36 .3 6
35 . 30
44 . 28
31 . 17
23 . 53
1 . 44
6 . 49
5 . 88
14 . 2 9
7 . 14
19 . 48
6 . 49
26 . 47
8 . 82
10 . 0 0
5 . 19
23 . 53
8 . 57
10 . 0 0
65 . 71
5 . 71
19 . 4 8
6 . 49
63 . 64
5 . 20
20 . 59
5 . 88
44 . 12
5 . 88
7 . 14
13 . 0 0
23 . 53
20 . 00
61 . 43
24 . 68
45 . 45
00 . 00
58 . 82
8 . 59
2 . 86
14 . 2 9
2 . 60
8 . 82
8 . 82
III
73
32 .
34 .
When a person decides not
to s tart smoking , it i s :
A s i gn o f weakne s s
a.
b.
A s i gn o f individua l i sm
c.
A s ign of conf ormi ty
d.
A s ign o f s trength
No re spon se
The warn ing lable on
c i g arette package s , wh ich
read s " Caution :
Cigarette
Smoking May Be Ha z ardou s
To Your He alth " :
a.
Ha s not inf luenced my
dec i s ion to smoke
b.
Has inf luenced my
dec i s i on to s top
smok ing
c.
Has had no inf luence
on my dec i s ion to s top
smoking
d.
Has not inf luenced me
becau se I haven ' t paid
any attention to it
No re spon se
I
Never
Smoked
N = 70
II
Exper i ­
menters
N = 77
Smokers
N = 34
7 . 14
24 . 28
7 . 15
55 . 7 1
5 . 71
3 . 89
42 . 86
10 . 39
39 . 00
3 . 89
17 . 6 5
26 . 47
26 . 47
44 . 12
5 . 88
17 . 1 4
20 . 78
29 . 41
25 . 71
32 . 47
5 . 88
4 . 29
11 . 6 9
17 . 6 9
38 . 57
14 . 28
28 . 57
6 . 49
35 . 30
11 . 7 6
III
74
c.
Fewer smoke r s than non- smoker s or exper i ­
menter s fe l t smok ing i s a s ign of individua l i sm .
d.
Al l three smok ing behavior s had high per cent
re spon s e s to " I t makes them feel importan t "
and " I t makes them feel adul t " .
e.
More smoker s than non- smokers or experimenters
were o f the opinion that teenagers smoke
becau s e adul t s te l l them not to smoke .
f.
More exper imenters and smoker s were of the
opinion that to s to p smok ing i s a s ign of
individua l i ty than were smokers .
g.
All three behaviors had high per cent respon s e s
to a s i gn of s trength when a smoker d e c i d e s to
s top smok ing .
h.
Al l three behaviors had a h i gh per cent
re sponse to "Mo s t smoker s can ' t break the
hab i t " .
i.
More exper imenters than smokers or non- smokers
were of the opinion that not to s tart smok ing
is a s ign of i ndividual i sm .
j.
More smoker s than exper imenter s or ' non- smoker s
were of the opinion that not to s tart smok ing
i s a s ign of s trength .
k.
None o f the smoker s were of the opinion that
smoker s used smok ing as a crutch .
75
1.
More smoker s and non- smokers than experimenters
were of the opinion that the warn ing on cigar­
ette packages has had no inf luence on the ir
smoking behavior bec ause they haven ' t paid
any attention to i t .
76
CHAPTER V
SUMMARY AND CONCLUS IONS
Summary
I t was the purpose of thi s s tudy to de termine
whe ther or not there exi s ted a rela t ionship between the
repor ted smok ing hab i t s of seventh and eighth grade
pup i l s in the two j un ior high school s of the Pleasant
Va l ley School D i s tr ict , Camar i l lo , California , and the ir
knowledge and op inion s about the purported health haz ards
of smoking .
The mod i f icat ion o f the test ins trument and the
me tho d s o f ana l y s e s were the primary mean s o f rese arch
for the s tudy .
I tems on the ins trument were approved by
the que s tionnaire ' s autho r s and the the s i s committee , the
superintendent and the director of educ ation in the
P l e a s ant Val ley School D i s tr ic t .
From the analyse s , it wa s determined that in the
areas of cognition , there were no s i gnifi cant relationships between the reported smoking behaviors o f the
re spondents and their knowledge of the he alth hazards
of smoking .
In the area of opinions and attitude s , more
non- smokers and exper ime nters than smoker s were of the
-· ·
opinion that the dec i s ions to s tart smoking i s a s ign of
weakne s s .
More smoke r s and exper imen ter s were of the
I
opinion that smoking i s a s i gn of indiv idua l i sm , than
were non- smoker s .
More non- smoker s and experimenters
felt that smok ing makes the smokers fe e l more adul t ,
than d id smoker s .
All c l a s s e s were high in re spon s e to
" I t make s th�m fee l important " .
Al l three c l a s s e s had a higher re spon se to a feel­
ing of importance for smoker s , as we l l an an indication
o f s trength to s top smok ing .
A higher number of smokers
were of the opinion that mos t smokers enj oy smoking ,
than were non - smokers and exper imenters .
There were no
re spon s e s from smokers relative to the use of smoking a s
a crutch .
None o f the c l a s s e s have been a f fected b y the
warning which appear s on all c igarette package s .
Conc lu s i ons
1.
There wa s no s ign i f i cant d i f f erence in cog­
ni tion between the smoker s and the non- smokers ,
the exper imenters and the smokers , nor be tween
the exper imenter s and the non- smokers .
2.
The groups re sponded d i f ferently on twe lve
opinion que s t i onnaire items .
I
BI BLIOGRAPHY
79
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LeMai s tre , E . Harol d . " The Deve lopment of a Health
Behavior I nventory to Eva luate Health Education
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D i s s ertati on , Univer s ity o f C a l i fornia at Los
Ange l e s , 1 9 5 8 .
65 .
LeMa i s tr e , Charl e s A . " Where the Action i s on Smoking ."
A paper pre s ented at the National Interagency
Conference on Smoking and Health , C o l le ge Park ,
Maryland , May 1 , 1 9 6 6 .
66 .
Les l i e , Irwin w . , Harold Cornacchia , and We s ley M .
Staton . Health in the E l ementary Schoo l s . St .
Loui s :
c . V . Mo sby Company , 1 9 6 2 .
67 .
Leventhal , Howard . 1 1 E f f ec t of F ear Communicat ions in
the Ac ceptance of Prevent ive Health Practice s . "
Stud i e s and I s sue s in Smoking Behavior ,
Univers i ty
( S alvatore v . Z agon� editor ) , Tus con :
o f Ari z ona Pres s , 1 9 6 7 .
85
68.
i 69 .
•
Linden , George . " The Incre a s ing Rate o f Lung Cancer
Mor tal ity in Cali forn ia Women , " Cal ifornia School
Health , 2 : 1 2- 1 6 , January , 1 9 6 6 .
Lindly , Edith . " Teacher Education on Smoking and
Health , " Cal if orni a School Health , 2 : 4 0 - 4 3 ,
January , 1 9 6 6 .
70 .
Lordahl , Dan i e l S . Modern S tat i st ic s £or Behavibral
S c i enc e s . New York : The Ronald Pre �Company ,
1967 .
71.
Mausner , Bernard , and El len s . P l att . Behavioral
A Conference Report .
Aspe c t s of Smoking :
Soc iety o f Pub l i c Health Educator s , Inc . , New
York , 1 9 6 6 .
72.
Mausne r , Bernard , and E l len S . P latt . Behavioral
Aspec t s of Smoking :
A Conf erence Repor t .
Supplement No . 2 . New York :
Soc lety of Pub l i c
Health E duca tor s , Inc . , 1 9 6 6 .
73.
Mausner , Bernard , and E l l en s . P latt .
Behavioral
A Conference Report .
Society
A spe c t s o f Smoking :
o f Pub l i c Hea l th Educator s , Albany :
Fort Orange
Pre s s , I nc . , Supplement , 1 9 6 6 .
74 .
Meyer , Burton , and Loretta E . He idgerken .
Intro­
duction to Re s earch in Nur s ing . Phi ladelphia :
J . B . Lipp incott Company , 1 9 6 2 .
75 .
Mortal ity from D i s e a s e s As soc iated with Smok ing ,
1 9 5 0 - 1 9 � Uni ted States Department of' Health ,
Education , and Wel f are , Series 2 0 , No . 4 ,
Wa shington :
United S tates Print ing Offic e , 1 9 6 6 .
76 .
Mulha l l , J . C . " The C igarette Hab i t , " Annal s of
Otology , Rhinology and Laryngology , ( Repr int
of the original article that appeared in
Tran s ac t io n s of the .American Laryngo logical
Association , Vol . 1 7 : 1 9 2 , 1 8 9 5 ) , 5 2 : 7 1 4 - 7 2 1 ,
September , 1 9 4 3 .
77 .
� Dear , Thi s ' ll Ki ll You . National Tubercu l o s i s
78.
National Heart I n s t i tute . Smoking and the Hear-t .
United States Department o f Health , Education ,
and We l fare , Publ i c Health Service , Pub l ication
No . 1 1 0 3 - b , 1 9 6 4 .
As s o c i ation , Publ i catlon No . 7 2 , 1 9 6 6 .
86
79.
National Smoki n9 Te s t . Vern Diamond , Producer/
D ire c tor . Columbia Broadca sting System , New
York , New York .
80 .
Nyswander , Dorothy B . Solving Health Problems .
New York : The Commonwealth Fund , 1 9 4 2 .
81 .
Oberteuf fer , Delbert , and Mary K . Beyrer . s·c hool
Health Education . New York : Harper and Row , 1 9 6 6 .
82.
Par s on s , Talbo t , and Robert F . Bales ( in col labora­
tion with James O ld s , Morr i s Z elditch , Jr . , and
P hi l ip E . S later ) . F amily Soc i a l i z ation and
The
Interaction Proce s s . G lencoe , I l l ino i s :
Free Pres s , 1 9 5 5 .
83 .
Salber , Eva J . , and Bri an MacMahon . " C igarette
Smoking among High S chool S tudents Related to
S o c i a l C l a s s and P arental Smoking Habi t s , "
American Journal o f Public Health , 5 1 : 1 7 8 0 - 1 7 8 9 ,
December , 1 9 6 1 .
84 .
Salber , Eva J . , B . Wel s h , and s . v . Taylor . " Reasons
for Smoking Given by Secondary S chool Chi ldren , "
Journa l o f Health and Human Behavior , 4 : 1 1 8 - 1 2 9 ,
Summer , 1 9 6 3 .
85 .
Sallak , Victo r J . " What are the Facts on Teenage
Smok ing? " Nati onal Tuberculos i s A s s ociation
Bul l e tin , 4 6 : 9 - 1 0 , Oc tober , 1 9 6 0 .
86 .
S a l lek , Victor J . " A S tudy o f Smoking Practice s o f
Selected Group s o f Junior a n d Senior High Scho o l
S tudents in Pub l i c S chool s in Erie County , New
York , " Journal of School Hea l th , 3 1 : 3 0 7 - 3 1 4 ,
-November , 1 9 6 1 .
87 .
Schwar t z , Jerome and Mildred Dubits ky . " Reasearch in
S tudent Smoking Hab i t s and Smoking Contro l , "
Journal of School Health , 3 7 : 17 7 - 1 8 2 , Apr i l , 1 9 6 7 .
88 .
Sega l , Jul iu s . How to Kee12 Your Child from Smoking .
United S tate s Depar tment o f Hea l th , Education ,
and Wel f are , Pub l ic Health Service , Publi c ation
No . 1 4 11 , Was hington , D . C .
89 .
Sha l l I Smoke ? Amer ican Cancer Soc i e ty . Publ ication
No . -2 0 4 2- LE , 1 9 6 4 .
87
90.
Smok ing , Health and You .
Uni ted S tate s Department
of Health , Education , and Wel fare , Chi ldren ' s
Bureau Pub li ca tion No . 4 2 4 , 1 9 6 4 .
91 .
Smoking :
The Schoo·l ' s Re spon s ib i l i ty . Ameri can
A s s oc iation f or Health , Phy s ical Education ,
and Re creation , Was hington , D . C . ( n . p . ) ( n . d . )
92 .
Smoking and Health .
Report o f the Advi sory Committee
to the Surgeon General o f the Pub l i c Health
Service . United State s Department o f Health ,
Education , and Wel f are , Pub l i c ation No . 1 1 0 3 ,
Was hington : Government Printing Office , 1 9 6 4· .
93 .
Snede cor , George w . Stati stical Method s . Ame s ,
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94 .
S tewar t , Wil l i am H . Smok ing and Heal th : A Progre·s s
Report . Pre s ented a t the E i ghth Annual Ameri can
Cancer S o c i e ty Sc i ence Writer s ' Seminar ,
Phoenix , Ar i zona , March 2 9 , 1 9 6 6 .
95 .
Summary o f the Report o f · the Surgeon Gener·a l ' s
Advisory Committee on Smok 1ng and Health .
United S ta te s Department o f Health , Education ,
and Wel f are , Pub l ication No . 1 1 0 3 - D , Wa shington :
G overnment Pr inting O f f i ce , 1 9 6 4 .
·
96.
Summary o f Re s earch : Smok ing and Health . Report o f
the Advi s ory Committee t o the Surgeon General
of the Pub l i c Heal th Section , Cali fornia
Interagency Coun c i l on Cigarette Smok ing and
Health , 1 9 6 4 .
97 .
Swinehart , James w . " Change s Over Time in Student
Reactioris to the Surgeon General ' s Report
on Smoking and Health , " American Journal o f
Publi c Health , 5 6 : 2 0 2 3 - 2 0 2 7 , December , 1 9 66 .
98 .
Taba , Hilda , E l i z abeth Hal l Brady , John T . . Rob in son ,
and Wi l l i am E . Vi ckery . D iagnos ing Human
Relation Need s . Washington : American Counc i l
on Education , 1 9 5 1 .
99.
Tannenbaum , Rober t , and Fred Mas sarik . Leader ship :
A Frame o f Re ference . Los Ange le s ; University
o f Cal ifornia , Reprint No . 6 8 , 1 9 5 9 .
88
100 .
Turner , C . E . , C . Morley S e llery , and Sarah Loui s
Smith . · Schoo l Health and Health Educat ion . S t .
Loui s : C . V . Mosby Company , 1 9 6 1 .
101 .
Warner , L loyd , and Le o Srol e . The Social Systems o f
Ame r i can E thnic Group s . New Haven : Yale Univers i ty
Pre s s , 1 9 4 5 .
102 .
Warner , W . L l oyd , and Paul Lunt . Social Life o f a
Modern Communi ty . New Have n : Yale Univer s ityPre s s ,
195 0 .
103 .
Weir , John M . " Te acher- S tudent Perceptions o f
Smok ing , " C a l i f ornia S chool Heal th , 2 : 2 2 - 2 7 ,
January , 1 9 6 6 .
104 .
Wi l l iams , E dward K . " Cardiovas cular Effects o f
Smoking , " C a l i forn ia S chool Health , 2 : 1- 3 ,
January , 1 9 6 6 .
105 .
Wil s on , E . Bri ght . An Intr oduc tion to Sc ie·n·t·i·f i c
Re s earch . New York:McGraw- H i l l Book Company ,
Inc . , 1 9 5 2 .
106 .
Z agona , S alvatore V . ( e d . ) . S tudie s and -rs·sue s ·in
Smoking Behavior ,
Tus can : Univer s ity of Ari z ona
Pre s s , 1 9 6 7 .
89
APPENDI CE S
90
APPENDIX A
INSTRUCTIONS TO PUP I LS
91
IN STRUCTIONS
HEALTH INVENTORY QUESTIONNAIRE
Thi s que s tionnaire i s be ing admin i s tered by your
teacher .
I t i s part of a re s earch pro j ec t in hea l th
education , to determine how much information you have
about c igarette s and smoking .
P le a s e note that each of you ha s been given an
answer sheet with the que s ti onna ire , and a plain
e nvel ope .
When you have fini shed the que s tionnaire ,
FOLD YOUR ANSWER SHEET AND PLACE I T IN THE ENVELOPE ,
THEN SEAL THE ENVELOPE .
In the upper r i ght hand c orner
o f the envelope check for the appropriate information ,
that i s , whe ther you are mal e or fema l e , a s eventh or
e i ghth grade s tudent , attendi ng Lo s Altos or Monte Vi s ta
Junior High S choo l .
One o f your c l a s smates wi l l place a l l o f your
s ealed envel ope s in a l arge envelope , and this a l s o
wi l l b e sea led before i t leaves your c la s sroom .
The s e s tep s are taken to insure conf idence , s o
that you are free to re spond hone s tly .
I t i s important
that you an swer each que s tion as hone s tly a s po s s ib l e
because the an swers wi l l provide information to be used
in planning future programs .
92
APPENDIX B
93
ENVELOPE PROVIDED FOR THE ANSWER SHEET
UPPER RIGHT
HAND CORNER
I
I
MALE
/
I
FEMALE
II
7 th GRADE
I
I
8 th GRADE
I
LOS ALTOS
I
I
MONTE VI STA
I
94
APPENDIX C
QUESTIONNAIRE
95
QUE STIONNAIRE
INSTRUCTION :
ON THE ANSWER SHEET , C I RCLE THE NUMBER ,
LETTER OR LETTERS , THAT YOU THINK ARE THE BE ST ANS�'VERS .
'
1.
What i s your age ?
( The f i gure on the f i r s t line indicate s the year s ,
and the f i gure on the second l ine indicates the
number of months s i nce your l a s t b irthday . )
2.
a.
3.
What i s your grade ?
4.
Whic h s chool do you attend?
a.
5.
Male
L o s Alt o s
b.
a.
7 th
b.
Femal e
b.
8 th
Mon te V i s t a
Read thi s que s tion carefully , then check the ONE
statement , and only one , that be s t describes your
cigarette smoking behavior .
a.
b.
c.
d.
e.
f.
I u sual ly smoke cigarette s j us t about every
I smoke c igarette s once in a whi le , but not
day .
I u sed to smoke c i garette s j us t about every
I u sed to smoke once in a whi l e .
I have tr i ed c igarette s a few t ime s j u s t to
what they were l ike .
I have never smoked c igarettes at a l l .
day .
every
day .
see
THESE QUE STIONS WERE PLANNED TO F IND OUT WHAT YOU HAVE
LEARNED AND REMEMBERED ABOUT SMOKING AND HEALTH . QUE STIONS
MAY HAVE SEVERAL CORRECT ANSWERS .
C IRCLE ALL LETTERS YOU
THINK ARE THE RIGHT ANSWERS .
6.
The ingred ients reported to be found in cigarette
smoke are :
a.
b.
c.
d.
Carbon dioxide
Cho le s terol
Nicotine
Oxygen
e.
f.
g.
h.
Ar senic
Tar s
Lead
Carc inogen s
· '
96
, 7.
The ingredient in cigarette smoke whi ch has been
reported to affect heart action is the :
( CHOOSE ONE )
a.
b.
c.
d.
Ni cotine
N i trogen
Carbon monoxide
Oxygen
/'
8.
•.
e.
f.
g.
h.
Weed
Java
F ag
Cancer s tick
Increa s e s alertne s s e .
Ha s a c a lming e f fect f .
Aide s d ige s ti on
Give s s omething to
g.
do with the hand s
h.
I s grown-up
Re lieve s bad ta s te in
the mouth
Helps to c oncentrate
better
G ive s one someth ing to
do
Whi ch of the f o l l owing organi zations have adv i s e d
aga i n s t smoking ?
a.
b.
c.
d.
e.
f.
g.
h.
11 .
Cof f in n a i l
Mai n l iner
Butt
Reefer
Individua l s have r epor ted which of the following
reasons for smoking c igarette s ?
a.
b.
c.
d.
10 .
h.
Carbon dioxide
Tars
Re s idue from burned
c igare tte paper
Heat from the burning
tobacco
Which of the f o llowing have been u s ed a s " s lang "
name s for cigarette s ?
a.
b.
c
d.
9.
e.
f.
g.
Ameri can Medical As sociation
Amer ican Heart As sociation
Amer i can Cancer A s s oc ia tion
Tobacco Re search I n s t i tute
Pub lic Health Service
Amer i can Tobacco Sompany
Sur geon Genera l
National I n s t i tute s o f Health
Which o f the f o l l owing have been used in c igarette
adverti s ing ?
a.
b.
c.
d.
e.
f.
g.
h.
P inch the f i l ter
Real taste , sati s f i e s longer
I c ame back
What ' s up front that counts
For thos e who think young
Sold Amer ican
I ' l l eat my hat
Bet you can ' t . have j us t one
12 .
Individua l s have repor ted which of the fol lowing
reasons for not smoking c igarette s ?
a.
b.
.c .
d.
e.
f.
g.
h.
Smoking decrea s e s alertne s s
Give s i ndiges tion
T a s te s bad
Hinder s c o ncentration
Leave s a bad t a s te i n the mouth
Looks f unny
Cau s e s diz z ine s s
Stains f ingers
THE NEXT 6 QUESTIONS ARE TO BE ANSWERED " TRUE " OR " FALSE " .
C I RCLE THE CORRECT ANSWER ON THE ANSWER SHEET .
13 .
The term " he al th " me ans the absence of di s e a s e .
14 .
A " carc inogen " i s a sub s tance p r eventing the
formation o f c ancer .
15 .
The term " athero s c lero s i s " mean s di sease o f the
l iver .
16 .
The term " c ancer " means abnormal growth of c e l l s .
17 .
The endocr ine g l and that produce s " s tre s s " hormones
is c a l l e d the adrenal g land .
18 .
" Ha z ardou s " me ans harmfu l .
THE NEXT 4 QUESTION S MAY HAVE MORE THAN ONE CORRECT
READ EACH QUE ST ION CAREFULLY AND C I RCLE THE
ANSWE R .
CORRECT LETTER OR LETTERS .
19 .
Which o f the f o l l owing ingredients in cigarette
smoke are b e l ieved to b e harmfu l to man?
a.
b.
c.
d.
Carbon dioxide
Oxygen
N i troge n
Ar senic
e.
f.
g.
h.
Tar s
Carc inogens
N i cotine
Carbon monoxide
20 .
The ingredi ent s in c i gare tte smoke affect the
c ircul atory sy s tem by :
a.
b.
·c.
d.
e.
f.
21 .
Wh ich of the fol lowing ingredients in cigarette
smoke exert the greate st e f f ec t on the circulatory
s y s tem and he art?
a.
b.
c.
22 .
Enlarging blood ve s s e l s
Narrowing b lood ve s s e l s
Lowering b lood pr e s sure
Ra i s ing b lood pres sure
Decreas ing heart rate
Increas ing he art rate
Nicot ine
Tars
Carc inogen s
d.
e.
Ni trogen
Oxygen
Which of the f o l l owing ingredients in c igarette
smoke are mos t a s s oc iated with the deve lopment
o f lung cancer ?
a.
b.
c .
Nicoti ne
Tar s
N i tr ogen
d.
e.
Oxygen
Carbon monoxid e
THE FOLLOWING 5 QUE STIONS REQU IRE " TRUE " OR " FALSE "
ANSWERS AND HAVE BEEN INCLUDED TO GET YOUR OP INIONS
ABOUT SMOKING .
THERE ARE NO RIGHT OR WRONG ANSWERS ,
ONLY OP INIONS .
23 .
The only time a per son should real ly s top smoking
i s when h i s doctor tel l s him to s top .
24 .
I t i s unneces sary for teenagers to worry abou t
c igarette smoking unti l more conclus ive evidence
is presented indic ating real harmful ef fects .
25 .
Normal , heal thy people can smoke c i gare tte s without
worrying .
26 .
C igarette smok ing i s not harmful for the per son
who smokes o c c a s i on al ly .
27 .
At time s , c i garette smok ing may be bene f ic i al .
99
CHOOSE THE ONE AN SWER YOU THINK MAKES THE MOST SENSE IN
THE FOLLOWING 5 QUESTIONS .
28 .
When a per s on decides to smoke , it i s :
a.
b.
c.
d.
29 .
I t makes them f e e l impor tant
I t mak e s them f e e l mor e adult
They have noth i ng e l s e t o do
Adu l t s tell them not to smoke
A
A
A
A
s ign
s ign
s ign
s i gn
of
of
of
of
weakne s s
individua l i sm
c onformity
strength
En j oy smok ing
U s e smok ing as a crutch
Can ' t break the habit
Don ' t beli eve smok ing i s harmful
When a per s on decide s not to s tart smoking , it i s :
a.
b.
c.
d.
33 .
we akne s s
conformity
indiv idual i sm
s trength
Mo s t smoker s :
a.
b.
c.
d.
32 .
of
of
of
of
When a per son decide s to s top smoking , it i s :
a.
b.
c.
d.
31.
s i gn
s ign
s i gn
s ign
Teenager s smoke because :
a.
b.
c.
d.
30 .
A
A
A
A
A
A
A
A
s ign
s ign
s ign
s ign
of
of
of
of
weakne s s
ind ividua l i sm
conformity
s trength
You have le arned about heart di sease and your friend
ha s not .
What would you tell him to do to reduce
h i s chance of hav ing a hear t attack .
( C I RCLE THE
BE ST STATEMENTS . )
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Get s ome exerc i s e every day
Smoke f i l tered c igarettes
Avoid ten s i on
Get a phy s ical exam at lea s t once a year
S tay thin
Don ' t eat fatty food s
Stay calm
Exer c i s e vigorou s ly every day
Don � t smoke c igarette s
Don ' t inhale
100
34 .
The warning label on cigare tte package s , wh ich reads
" Caution :
Cigarette Smoking May Be Ha zardous to
Your Hea lth " :
a.
b.
c.
d.
35 .
Because I do not smoke , or because I have s topped
smoking , I wi l l be able to :
a.
b.
c.
d.
e.
36 .
s ave money
reduce the number of denta l cleanings
apply f or lowered insurance rate s from s ome
c ompani e s
none of the s e
a l l of the s e
I f you smoke one package o f c igarettes every day ,
how much money wi l l you " burn up " in a year ?
a.
b.
c.
d.
37.
ha s not inf luence s my deci s i on to smoke
has inf luenced my deci s i on to s top smok ing
has had n o inf luence on my d e c i s ion to s top
smoking
has not influenced me becau s e I haven ' t paid
any attention to it
$75 . 00
$110 . 50
$ 12 7 . 5 0
$165 . 00
Recently , a te l ev i s ion program wa s devoted :to
c igarette smoking .
I t s purpose wa s to find out
what information about c igarette smoking smokers
and non- smoker s have .
D id you s e e thi s program?
a.
b.
yes
no
101
APPENDI X D
ANSWER SHEET
FOR HEALTH QUESTIONNAIRE
102
ANSWER SHEET FOR QUESTIONNAIRE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10 .
11 .
12 .
13 .
14 .
15 .
16 .
17 .
18 .
19 .
20.
21.
22 .
23 .
24 .
25 .
26 .
27 .
28 .
29 .
30 .
31.
32 .
33 .
34 .
35 .
36 .
37 .
1 0 11
1
2
a
b
a
b
a
b
a
b
a
b
b
a
a
b
a
b
a
b
a
b
a
b
True
True
True
True
True
True
a
b
a
b
a
b
a
b
True
True
True
True
True
a
b
a
b
a
b
a
b
a
b
a
b
a
b
a
b
a
b
a
b
12
3
c
13
4
d
d
d
c
c
d
d
c
c
d
d
c
d
c
Fal s e
Fal s e
False
False
False
Fal s e
c
d
d
c
d
c
d
c
False
False
False
F al s e
Fal s e
d
c
d
c
c
d
d
c
d
c
d
c
d
c
c
d
d
c
c
14
5
15
6
16
7
e
e
e
e
e
e
e
e
f
f
f
f
f
f
f
f
g
g
g
g
g
g
g
h
h
h
h
h
h
h
e
e
e
e
f
f
g
h
e
f
g
h
e
9
8
i
10
j
11
103
APPENDIX E
FREQUENCY D I S TRIBUTION OF RE SPONSES OF REPORTED
SMOKERS , EXPERIMENTERS , AND NON- SMOKERS
104
FREQUENCY D I STRIBUT ION RE SPONSES OF REPORTED SMOKERS ,
EXPERIMENTERS , AND NON - SMOKERS
INTERVALS
NUMBER OF
SMOKERS
NUMBE R OF
EXPERIMENTERS
NUMBER OF
NON- SMOKERS
43-45
0
0
0
4 0- 4 2
0
1
0
3 7-3 9
6
4
0
3 4-3 6
4
4
1
31-3 3
11
7
3
28-3 0
14
11
6
25-27
4
13
6
22-24
8
14
10
19-21
11
13
2
16-18
8
6
2
13-15
2
4
2
10-12
2
0
2
TOTAL
70
77
34
105
APPEND IX F
CUMULAT IVE FREQUENCY CURVE
IN PER CENT
106
FI GURE I
CUMULATIVE FREQUENCY CURVE
IN PER CENT .
Smoke r s
Exp e r ime n te r s - - - Non- smoke r s -- -- --
100
80
8
:z;
p;:j
(.)
p::
p;:j
Pl
�
� --4-_--:*
�/ y -
60
40
.Jt- -.. .,...._.
�/ �
-
"-/'
.
2
0
I
12
115 18
I
415
3
I
21
S c or e s