Smoking cigarettes places a huge burden of ill-health on society. If people stopped smoking, there would be an enormous improvement in public health and huge amounts of money, currently expended on tobacco-related diseases, could be used to improve other areas of the health services. Teenagers continue to take up smoking in large numbers. If this trend were reversed, it would dramatically reduce the burden of tobacco on society. However, it seems this trend can only be reversed by the widespread exercise of responsible parental authority.
The two biggest killer-diseases in the developed world are cardiovascular disease and cancer. Cigarette-smoking plays a major role in causing both of these diseases. One in three of us will contract cancer and one in five will die of cancer. About one-quarter of all cancer deaths can be attributed to cigarettes. In particular, most lung cancers are caused by cigarettes.
In Ireland, about 1,500 people die annually from lung cancer. Smokers are more susceptible to damage from other inhaled pollutants, such as asbestos, compared to non-smokers. Smokers are also more at risk from the ubiquitous natural radioactive gas radon than are non-smokers.
Inhaled tobacco smoke contains hundreds of toxic substances and therefore almost all smokers suffer from some form of tobacco-induced disorder. A large-scale Japanese study, followed up over 17 years, showed that not only is the cigarette a powerful cancer-causing agent, but it also speeds up the ageing process. The ageing of tobacco-smokers was estimated to be increased by five years on average among adults.
Cigarettes became really popular during the 1940s and 1950s. At that time, about 55 per cent of all adults smoked and the habit was not known to be seriously harmful. The connection between cigarettes and disease had yet to be established. When this deadly link became apparent, governments launched large public programs to highlight the dangers of tobacco. Public-health programmes designed to educate people about the dangers of cigarettes, with a view to persuading smokers to give up preventing young people from starting, have had only limited success. About 30 per cent of adults still persist in smoking today, and people, particularly girls, continue to take up the habit in disturbingly large numbers.
More than a third of teenagers smoke despite knowing the health risks. There is no reason to think that continuing public education and anti-smoking campaigns, along the same lines as we have had to date, will make any further progress in lessening the public use of tobacco. A new approach is necessary.
Anti-smoking campaigns have mainly been targeted at adults who smoke or at children and adolescents, but not at parents. It has been found that, as well as peer-pressure, tolerance by parents is a strong predictor for the onset of smoking in children and young adolescents (see Behavioural Medicine, eds. A.A. Kaptein et al, John Wiley and Sons, 1990). From now on the antismoking campaigns should carry the message that responsible parents do not allow their children to smoke.
In addition to love, children need guidance and discipline from their parents, which means having rules and enforcing them where necessary. Parents know what is best for the child in a great many areas and have a primary responsibility to ensure that they develop along optimum lines. Parents' responsibilities to children in this respect apply over the age range from early childhood through the teenage years, but obviously the appropriate interaction between parents and children on discipline must match the age and maturity of the child.
With teenage children, parents should discuss and negotiate on many issues. However, even at that stage, some things must remain non-negotiable, and this includes smoking.
It is not uncommon nowadays for children to start smoking from about 10. All families should have a rule that children (at least to age 18) are not allowed to smoke while they re main living in the family home. (This will be a particularly difficult rule to stand over if the parents themselves smoke.) It should be just as unacceptable to a parent that a 12-year-old daughter would take up smoking as that she would join in cider-drinking sessions on weekends.
What are parents to do if they find out that their 13-year-old regularly smokes cigarettes with friends outside the home but denies this at home? Obviously this could be a difficult problem to solve. It should be dealt with efficiently, lovingly and patiently, and with the same resolution as you would handle the revelation that your child was regularly borrowing a powerful motorbike and taking high-speed trips down the motorway.
Parents should not feel that the battle is lost if the child is already an established smoker before they discover this fact. One approach to changing the child's behaviour would be to patiently discuss the matter and, if necessary, to offer concrete rewards in return for changed behaviour. The young person may need help to develop assertiveness skills to cope with peer pressure from valued friends who smoke.
All any parent can do is make their best effort, but the bottom line is that cigarettes are deadly and for a parent to allow a child to take up or to continue smoking is to neglect the child's welfare.
William Reville is a senior lecturer in biochemistry and director of microscopy at UCC