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CHAPTER 1

THE PROBLEM AND ITS SCOPE

Rationale

Tobacco use, in any form, is deadly. Smoking kills one-third to one-half of all

lifetime users, and smokers die an average of 15 years earlier than non-smokers do. If

current trends continue, tobacco will kill 7 million people annually by 2020 and more

than 8 million people annually by 2030. Tobacco-attributable mortality is increasing

rapidly in developing countries, and by 2030, about 83 percent of the world’s tobacco

deaths will occur in low- and middle-income countries. (Dereje N, Abazinab S, Girma A

(2014) Prevalence and Predictors of Cigarette Smoking among Adolescents of Ethiopia:

School Based Cross Sectional Survey. J Child Adolesc Behav 3: 182.

doi:10.4172/2375-4494.1000182)

Another serious concern is that other tobacco products—including pipes,

hookahs, smokeless tobacco, or bidis—are commonly used by youth worldwide. In fact,

prevalence of use of these products is higher than that of cigarettes in many countries,

particularly in Southeast Asia, the Eastern Mediterranean, and sub-Saharan Africa.

(Tobacco Atlas, 2013) A sub-national survey among youth (ages 15-19) in Poland

showed an increase in last month e-cigarette smoking (6% to 30%), as well as an

increase in regular cigarette use (24% to 38%) and dual use of regular cigarettes and

e-cigarettes (4% to 22%) from 2010-11 to 2013-14. (ML, November 2014)

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In the United States, one in four individuals between the ages of 12 and 20

drinks alcohol on a monthly basis, and a similar proportion of 12th graders consumes

five or more drinks in a row at least once every two weeks (Newes-Adeyi, Chen,

Williams, & Faden, 2007). Several studies have reported that alcohol use during

adolescence affects educational attainment by decreasing the number of years of

schooling and the likelihood of completing school. (Chatterji & De Simone, 2005; Cook &

Moore, 1993; Gil-Lacruz & Molina, 2007; Koch & McGeary, 2005; McCluskey, Krohn,

Lizotte, & Rodriguez, 2002; NIDA, 1998; Renna, 2007; Yamada, Kendrix, & Yamada,

1996)

Furthermore, in the Philippines, the Global Youth Tobacco Survey reported

that more than one in four Filipino children ages 13-15 are smokers. Among those in this

age group who smoke, 17.5% are girls and 28.3% are boys. Not just that, alcohol

consumption among the youth is nearing an alarming level, the World Health

Organization stated that 75% of the youth in the region guzzling booze at an average of

two to three times a week. This is said to be increasing because of poor public

awareness of the harmful effects. It was also stated that heavy drinking leads to

high-risk behavior. (Prevalence of Current Use of Tobacco Products, 2014)

The main reason of why the researchers are conducting this study is to

examine teenagers who are engaged in smoking and drinking alcoholic drinks and if

there are effects of this to the behavior of the adolescents. The researchers believe that

aside from having health issues, there is a possibility that external factors such as school,

work or the society can be affected by the delinquency.

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It is also because of the increase of smokers and drinkers especially the ones

who are under-aged. Further, the findings from this study will be important for

awareness, prevention and recommendations that seek to reduce alcohol use, smokers

and adverse health and psychological consequences among youth.

THEORETICAL BACKGROUND

Related Theories

Environment plays a vital role in every aspect in our life and that it affects the

way an individual could live. The major theme of Bandura’s Social Learning Theory is

that people learn from one another, via observation, imitation, and modeling. The

theory has often been called a bridge between behaviorist and cognitive learning

theories because it encompasses attention, memory, and motivation. (Bandura, 1925)

Another facet of Bandura’s theory is he defines four requirements on learning

and modeling behavior wherein it composes of Attention, Retention, Reproduction and

Motivation. Attention to the modeling events in the environment and the characteristics

that influence the observer’s attention to those events (emotional, perceptual set,

arousal level). Retention, of which the cognitive component is remembering what one

observed and coding, organizing, and rehearsing it at the cognitive level. Reproduction

of or the ability to reproduce or copy the behavior, which includes observation of the

self-reproducing the behavior and feed-back on the accuracy of that reproduction.

Motivation or behavioral consequence that justifies wanting to adopt the behavior,

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which includes self-reinforcement. (Adolescent Development and Pathways to Problem

Behavior)

Bandura (1990) also believed in “reciprocal determinism”, that is, the world and

a person’s behavior cause each other, while behaviorism essentially states that one’s

environment causes one’s behavior. Bandura, who was studying adolescent aggression,

found this too simplistic, and so in addition he suggested that behavior causes

environment as well. Later, Bandura soon considered personality as an interaction

between three components: the environment, behavior, and one’s psychological

processes (one’s ability to entertain images in minds and language).

Social learning theory can be used to explain the development of deviant

behavior, substance use and abuse, and criminal conduct. Theoretically, if an individual

never observed these behaviors, then those behaviors would never be learned. The

important factor is that once the behavior is adopted, internally coded, and reproduced

in such a manner that it leads to some kind of positive reinforcement that behavior will

continue to be reproduced. The end-point of the behavior may be due to many

circumstances, one of which is punishment and other negative consequences that the

individual perceives to be undesirable.

Bandura’s theory serves as a foundation of this study where it gives emphasis to

the interaction of behavior to the environment and is completing to Fishbein’s Theory of

Reasoned Action.

Martin Fishbein’s theory of reasoned action (TRA), an extension of theory of

planned behavior (TPB) developed by Ajzen (1989, 1991, 2001), focuses on a person’s

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intention to behave in a certain way. The theory of reasoned action holds that the

intention (motivation) to perform a certain behavior is dependent on whether

individuals evaluate the behavior as positive (attitude) and if they judge others as

wanting them to perform the behavior (subjective norm). TPB builds on this theory and

holds that all behavior is not executed under purposeful control and that behaviors lie

on a continuum from total control to complete lack of control. Both internal factors

(cognitive skills, knowledge, emotions) and external factors (situations or environment)

determine the degree of control. TPB is based on the connection between attitudes and

behaviors. (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975)

For example, a person who is thinking about quitting smoking intends or plans

to quit, but may or may not actually follow through on that intent. To understand

behavioral intent, which is seen as the main determinant of behavior, the TRA looks at a

person’s (or population’s) attitudes toward that behavior as well as the subjective

norms of influential people and groups that could influence those attitudes.

According to TRA, attitudes and norms are the main influences on intention,

which, in turn, is the main motivator of behavior. The attitudes toward a particular

behavior are influenced by a combination of two related factors: the beliefs about the

outcome of the behavior (i.e., is the outcome likely or unlikely?) and the evaluation of

the potential outcome (is the outcome a good thing or a bad thing?). Fishbein (1975)

considers that the important aspect of our attitude is whether or not it is positive,

negative or neutral.

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Subjective norms are influenced by our perceptions of the beliefs of those

around us: parents, friend, colleagues, partners, etc. According to Fishbein, people have

a sense or belief about whether or not these individuals and groups would approve or

disapprove of the behavior. But people should have to factor on how motivated they are

to comply with their views. It could vary from one situation to another.

This theory also expanded that focusing on attitudes and norms, will provide a

framework for identifying and measuring the underlying reasons for a person’s intent to

behave a certain way (or not). Fishbein called this as Theory of Reasoned Action because

of the emphasis on understanding these reasons-- not because the beliefs and attitudes

themselves are necessarily reasonable or correct.

The more an individual understands about the attitudes and norms that

influence intent, the more accurately the interventions can be designed to influence

these in a desired direction-- toward a healthier behavior, for example. The flip side is by

ignoring these factors, one may inadvertently doom an intervention because it

overlooks the attitudes and norms that influence intent and motivate behavior (Fishbein,

M and Azjen, I. Belief, Attitude, Intention and Behavior: an Introduction to Theory and

Research. Reading, MA: Addison-Wesley, 1975.)

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Related Literature

In the environment, there are many aspects which could influence an individual

especially now that we are already in the 21st century; teenagers are having a hard time

to achieve the social norms and the increase of peer pressure. The present section will

be summarizing the different aspects from family to peers, schools, communities, and

media and technology which could influence adolescent behavior and risk-taking and

the interventions which could possibly made to make changes to delinquency of the

adolescents.

Social influences are among the most consistent and important factors

associated with adolescent smoking (Kobus 2003). Social influences are important with

respect to a wide range of health behaviors, including medication taking (Berkman

2000), diet (Larson, Neumark-Sztainer, Hannan, and Story 2007), sexual intercourse

(Henry, Schoeny, Deptula, and Slavick 2007), and substance use (Kobus 2003).

Adolescents may be particularly susceptible to social influences given their

developmental stage and the importance of school and peer groups in adolescent life

(Steinberg and Monahan 2007). Moreover, there may be uniquely social aspects of

adolescent smoking and other substance use, in that other adolescents provide access,

opportunity, and reinforcement (Kirke 2004; O'Loughlin, Paradis, Renaud, and Gomez

1998). Therefore, it should not be surprising that adolescent substance use and peer use

are highly associated. While the effects of peer groups on adolescent substance use

have been widely documented, much remains to be learned, especially regarding the

mechanisms of peer influence (Kobus 2003)

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Peer group influence also varies by individual characteristics including genetics,

which could influence exposure to substance-using friends (Cleveland, Wiebe, Rowe,

2005); and personal attributes such as competency skills (Epstein et al., 2007), or

perceptions of personal harm due to smoking (Rodriguez et al.,2007). Finally, peer

influences on smoking may be moderated by strong social bonds to school and family

(Ellickson, Perlman, Klein, 2003).

Parent influence has frequently been found to be associated with adolescent

smoking. However, associations have generally been modest (Avenevoli and Merikangas

2003). Household smoking has been identified as a modest predictor of adolescent

smoking (Hoffman, Monge, Chou, and Valente 2007; Kobus 2003). But it is not clear if

this effect is due to increased availability of cigarettes, modeling, or parenting practices.

Prospective studies have shown protective effects of a variety of positive parenting

practices (Simons-Morton and Haynie 2003a), including setting expectations (Abroms,

Simons-Morton, Haynie, and Chen 2005; Forrester, Biglan, Severson, and Smolkowski

2007; Simons-Morton 2004; Tucker, Klein, and Elliott 2004) parent support

(Simons-Morton 2007; Simons-Morton 2004; Wills, Resko, Ainette, and Mendoza 2004)

and parental monitoring (Dishion and Andrews 1995; Mounts and Steinberg 1995;

Simons-Morton 2007; Simons-Morton, Chen, Abroms, and Haynie 2004).

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Related Studies

According to the World Health Organization reports (WHO), 22% of the world's

population aged over 15 years is smokers and approximately six million people die from

tobacco use or exposure to tobacco smoke. Epidemiologic studies have traced the use

of alcohol, tobacco, and illicit substances among medical students and physicians.

(Taheri, 2014) The study of Ehsan Taheri is aimed to investigate the prevalence of

cigarette smoking and the related factors among the students of medical sciences in

Mashhad University of Medical Sciences, Mashhad, Iran.

The cross-sectional study was conducted on 946 health professional students in

Mashhad University of Medical Sciences (MUMS, Iran) in autumn 2008. A standard

self-administered questionnaire consisting of socio-demographic data, participant

smoking status, family and peer smoking, attitudes and beliefs about smoking,

awareness of cigarette negative effects and reasons for smoking cessation was used in

the current study. (Taheri, 2014)

Among the students, 18.3% reported having ever tried or experienced with

cigarette smoking. The overall prevalence of cigarette smoking was 9.8% with significant

differences in prevalence rates by gender, 17.6% among males and 4.2% among females.

Starting and continuing smoking was significantly correlated with the family cigarette

consumption habits. The most common reason to start smoking was friends (24.9%) and

the most important reason to continue smoking was personal life distress (17.6%). The

majority of participants (92.3%) reported that they were aware of the hazards of

smoking. A significant difference regarding awareness of smoking hazards was observed

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between smokers and non-smokers. The most important preventive factor for cigarette

smoking was religious beliefs (69.1%). (Taheri, 2014)

Taheri concluded that even if the prevalence of regular smokers among health

professions students of MUMS was lower than general populations, but this level is still

alarming and points at the rapid growth of cigarette use, especially among female

students. Medical schools should work harder to tackle this phenomenon and address it

more efficiently in their curricula.

Another study which tackles another vice is the one performed by Skala K (2013)

about adolescence and alcohol. He stated that up to two thirds of adolescents consume

alcohol and about a quarter engage in abusive behavior at some point. Many users

begin alcohol use at young ages, and binge drinking is a dominant pattern for a

proportion of youth. Because neurogenesis is inhibited by ethanol, consequences of

adolescent alcohol abuse include changes in brain development and impairment of

neurocognitive performance.

It results that a variety of mental and psychosocial problems are also often

witnessed in alcohol abusing youth. Apart from the influence exerted by genetic and

psychosocial factors, the chance of developing problematic alcohol consumption is

increased by consumption in a binge drinking manner and by first contact with alcohol

at a young age. Discrimination of alcohol consumption within the frames of normal

adolescent behavior from problematic use is still a challenging issue.

Different prevention programs provide treatment either directly to the

adolescent, in the context of the school, or within the frame of the adolescent's family.

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Although some of these efforts have been shown to be effective in reducing alcohol

misuse in youth, hardly any intervention reveals satisfactory outcomes in a long-term

prospect. Successful prevention strategies would need to comprise treatment of current

neuropsychological impairment as well as of comorbid mental health problems and

concurrent other substance misuse. (Skala K, 2013)

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CONCEPTUAL FRAMEWORK

Social Learning Theory Theory of Reasoned Action

QUESTIONNAIRES

1. Profile of teenagers engaged in smoking and


drinking in terms of:
1.1 Age
1.2 Gender
2. Influences them to engage on those vices.
2.1 Peer Influence
2.2 Family Member/s
3. Aspects that can be affected if teenagers
have these vices.

DATA GATHERING
ANALYZE AND INTERPRET

FINDINGS

CONCLUSION AND
RECOMMENDATIONS

Figure 1.1 Schematic Diagram

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This research is anchored to two theories which are Social Learning Theory by

Albert Bandura and Theory of Reasoned Action by Martin Fishbein. With the foundation

of theories, the researchers will develop questionnaires in order to get the respondents’

profiles. Afterwards, the data gathered will be analyzed and interpreted to create

findings. Then and only then, the researchers can give recommendations for the

respondents and conclude this study.

THE PROBLEM

Statement of the Problem

This paper aims to answer the following questions:

1) The percent of teenagers engaged in smoking, drinking and the combination of

both; based on their profiles in terms of:

1.1) age

1.2) gender

2) What influences them to smoke? Drink? Smoke and drink?

2.1) Peer Influence

2.2) Family Member/s

3) What are the aspects that can be affected if teenagers have these vices?

Hypothesis of the Study

HO1 There is no significant change in the behavior of teenagers if they engaged

in smoking and drinking.

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SIGNIFICANCE OF THE STUDY

The result of this study would greatly provide benefit to the following people:

Teenagers involved in smoking and Drinking. Since they are the center of this

study, the result of this would create a realization towards the lessening of their

addiction to their vices and soon, leave the bad habits.

Teenagers who are not involved. This paper is made to encourage them, in any

ways, to avoid on engaging on these vices (smoking and drinking) and educate them the

importance of living in a healthy life especially to the children wherein they should be

aware about the effects of these vices to their health.

Parents. This will serve as a guide to their children to develop a healthy

relationship with them and strengthen their communication skills where they serve as a

foundation of good values. On the other hand there are parents who are also smokers

and drinkers, so this paper will be a way of grasping enlightenment about the effects of

vices.

Teachers. Teachers may use this study to enrich the behavior of the students in a

way that they can’t be considered as a delinquent in the society.

Society. Society plays a vital role towards the social interaction of an individual.

Thus, when the population of the teenagers who are involved with these vices

decreases, the society and the youth will regain its image of being the hope of our

motherland.

Future Researchers. This study can help future researchers who share the same

goal, with the researchers, which is to lessen the teenagers who engaged in delinquency.

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It will provide the youth the learning, values and character formation and building trust

and confidence towards the improvement of individual and the development of the

society.

SCOPE AND DELIMITATION OF THE STUDY

This study will be conducted at Rosemont Hills Montessori College where all

pre-college students are the respondents. The inclusion criteria for the student to

partake in the analysis are (1) if the student has engaged to either smoking or drinking

alcoholic drinks and (2) if she/he ages from 13 to 19.

At the end of the study the researchers will achieve its main purpose which is to

find, create and suggest proper and effective measures to teenagers who are involved in

those vices, to lessen their bad habits and to let those who are not in use be aware of

what will be the effects of participating to misconduct to their individual life that they

are able to encourage others to maintain a healthy living.

The limitation of this study is if the researchers do not follow the inclusion

criterion. All information collected would be kept confidential for the sake of the

students.

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DEFINITION OF TERMS

The following terms are defined according to their usage in this study. The following

are:

Adolescents- young people developing into an adult and they belong to the ages 13 to

19.

Drinking Alcoholic Drinks- In this study, drinking alcoholic drinks refer to excessive and

moderate drinking wherein a person will lose his/her right state of mind for the alcohol

takes over the control.

Smoking- an act of putting cigarette or cigar in your mouth; act of producing black, gray

and white smoke. It may be electronic cigar or also known as vape or the traditional

tobacco.

Social Norms- average perception of the society on how they will accept you and if you

are asking an opinion, it depends if you will accept it or not.

Vices- it refers to smoking and drinking alcoholic drinks

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