With a view to highlight the prevailing trend among smokers, the Ministry of Health has conducted a survey to find out the rate of tobacco smoking in different age groups. The result of this survey, conducted among the students in schools and colleges of Dubai, Abu Dhabi, Sharjah and Ras Al Khaimah, are given below in percentage:

Age Group Smokers belonging to each category Tobacco consumed by each age group

Quit attempts

13-16 5 12 217-20 35 37 7321-24 60 51 25

As a Chief Research Officer on behalf of the Ministry of Health, write a report on general trend in tobacco smoking among students, supporting your discussion with appropriate illustrations. The report is to be submitted to the Managing Director, Ministry of Health, DHA building, Deira, PO Box 4545, Dubai, UAE.

Report Number: 24565

MINISTRY OF HEALTHDHA Building, Deira

P.O.Box 4545Dubai, U.A.E

A REPORT

ON

GENERAL TREND IN TOBACCO SMOKING AMONG STUDENTS

Prepared forAhmed Shumayl

Managing Director

ByHassan Abdul Moeib

Chief Research Officer

Approved byHussein TaheriChief Executive Officer

December 14, 2013

Acknowledgements

Mere thanks in a few words would be inappropriate; however we would like to express our sincere gratitude to the volunteers from various schools who took the initiative to inspire their fellow class mates to respond to the survey. Further we show our sincere appreciation to the various organizations like WHO, BMP and CEITC whose surveys have been a major source of inspiration and support.

We thank all the respondents for the valuable information provided without which this survey would have been a failure. A special thanks to the Al Hammar Printing Press for offering to take up the printing of the report and the result of the survey.

Last but not the least I would like to thank Mr. Ahmed Shumayl, Managing director for whom this report has been prepared and Mr. Hussein Taheri, Chief Executive Officer for approving the survey.

TABLE OF CONTENTS

Acknowledgement

1. Introduction1.1 Authorization1.2 Historical background1.3 Objectives1.4 Scope1.5 Limitations1.6 Methodology1.7 Report Preview

2. Discussion 2.1 Percentage of Smokers 2.2 Percentage of Cigarettes Smoked Per Day 2.3 Quit Attempts

3. Conclusions

4. Recommendations 4.1 For Age group 13-16 4.2 For age group 17-20 4.3 For age group 21-24

1. INTRODUCTION 1.1 Authorization

The following report based on the General trend of tobacco smoking among students has been approved and authorized by Mr. Hussain Taheri, Chief Executive Officer of Ministry of Health, on December 10, 2013 .

1.2 Historical Background

Smoking tobacco is prevalent in adults and many confessed to have started at an early age. Young kids’ naïve experimentation frequently develops into regular smoking, which typically turns into a strong addiction—well before the age of 18—that can overpower the most well-intentioned efforts to quit. More than a third of all kids who ever try smoking a cigarette become regular, daily smokers before leaving high school. In fact, the addiction rate for smoking (the percentage of experimenters who ultimately become habitual users) is higher than the addiction rates for marijuana, alcohol or cocaine.

Research also shows that the earlier people begin smoking, the higher their risk of contracting lung cancer or experiencing a range of risk factors and health problems in adulthood. Overall, roughly one third of all kids who become regular smokers before adulthood will eventually die from smoking.

Evidence also shows that smoking can be a first step toward other substance abuse. Stopping or delaying that first step will reduce the risk that kids will progress to using other harmful substances.

In the background of above discussion a survey was conducted on the general trend in tobacco smoking among students.

1.3 Objectives

The report based on the data obtained through survey aims at:-

Ascertaining the percentage of smokers in each age group and their tobacco consumption as well as quit attempts

Recommending appropriate awareness programs and rehabilitation schemes

1.4 Scope

The survey was conducted in schools and colleges of Dubai, Abu Dhabi, Sharjah and Ras Al Khaimah .

Students of the age group 13-24 were surveyed on amount of tobacco consumed and quit attempts.

1.5 Limitations

As mentioned above the survey was limited to Dubai, Abu Dhabi, Sharjah and Ras Al Khaimah due to time constraints.

The data obtained on age group 13-16 may not be accurate as many are scared to reveal true fact while some are not mature enough to understand the significance of such a survey.

1.6 Methods and Sources of Data Collection

The present report is based on the data collected by means of a survey by questionnaire. A questionnaire (refer to Appendix A) containing twelve questions was distributed through mail to 70,000 students residing in the above-mentioned Emirates. The students belonging to all strata of the society (different income, religious, linguistic groups) were randomly selected. Out of 70,000 students 61,835 students in total returned the filled questionnaires.

Later, 4000 students out of 61,835 were interviewed that is 1000 from each Emirate.

1.7 Report Preview

Besides Introduction, the report contains three sections. Section 2 gives a detailed analysis of the trends in smoking prevalent among students. Section 3 sums up the discussion and shows the results whereas Section 4 contains suggestions and recommendations.

2. DISCUSSION 2.1 Smokers belonging to each category:

On analyzing the percentage of youth who smoke, it is found that the students belonging to the 21-24 age group constitute majority of smokers (60%). This is followed by 17-20 category, in which 35% (as shown in figure 1) of the students smoke tobacco. It appears that students belonging to the above mentioned age groups tend to smoke the most as a form of stress relief. Since they go through a period of transition from adolescence to adulthood, which comes with a lot of pressure to fit into the society and make important career-related decisions, they face a lot of stress. This makes them turn to tobacco smoking.

As expected, the percentage of smokers in the 13-16 age group is considerably lower, at about 5%. Media seems to play a role in creating smokers of this age. Studies have suggested that when young viewers see a main character smoking, they’re more likely to see smoking as something socially acceptable, stylish and

desirable. Also, they are easily influenced by peers to smoke, so that they are not seen as misfits.

5%

35%

60%

13-1617-2021-24

Figure 1. Percentage of Smokers

2.2 Tobacco consumed by each age group:

It is observed that the students in the 21-24 age group consume 51% of tobacco (as shown in figure 2), which amounts to an average of 22 cigarettes per day. Those in the 17-20 range are not far behind, with survey showing us that they consume about 17 cigarettes (37%), a little more than a packet, per day. In comparison, children between the ages of 13 and 16 consume just 12% of tobacco, that is, 3 to 8 cigarettes per day.

This trend can be related to ease of access to cigarettes. Students aged 18 and above can procure cigarettes legally and are also financially equipped to do so since most of them either work part time or are provided pocket money. Even though students below 17 years cannot buy cigarettes legally, some of them look old enough and since identity verification is not required for tobacco purchase, they get away with it. They might also have friends of the legal age group who are willing to buy it for them or sometimes even provide it for free. Younger kids are more likely to steal cigarettes, either from shops or from a parent who smokes.

Considering these factors, it can be concluded that roughly half of all youth smokers who regularly buy their own cigarettes consume considerably more than half of all youth-smoked cigarettes. They also supply a substantial portion of the cigarettes smoked by those youth smokers who typically buy or borrow their cigarettes from others.

12%

37%

51% 13-1617-2021-24

Figure 2. Percentage of Tobacco Consumed

2.3 Quit Attempts

A very small percentage of students (2%) between the ages of 13 and 16 actually attempt to quit smoking since they have only just begun smoking and are not mature enough to understand the consequences it might have on their mental and physical health. Further, studies show that some youth smokers do not see themselves as ‘smokers’, hence they do not find the need to attempt quitting. Survey shows that 73% (as shown in figure 3) of students in 17-20 category and 25% in the 21-24 category made quit attempts.

The maximum percentage of quit attempts has been observed among the students aged between 17 and 20 years. This is related to the fact that they now recognise themselves as smokers and have already started facing loss of stamina and lethargy due to smoking. In U.A.E, families are a close knit unit and smoking is not accepted. So the fear of being exposed and facing the repercussions often initiate attempts to quit. In contrast, only 25% of the youth aged 21-24 years make quit attempts because by this stage, they have become heavy chain smokers and this addiction makes quitting close to impossible. Also, quitting will lead to withdrawal symptoms which are much more severe, than if it was done in the earlier stages of smoking.

2%

73%

25%

13-1617-2021-24

Figure 3. Percentage of Quit Attempts among Youth Smokers

3. CONCLUSIONS

The report has brought out a distinct pattern in youth smokers of different age groups when we considered different categories related to tobacco smoking:

The students in the 13-16 range contribute the least to the smokers’ population at 5%. They also smoke the least amount of tobacco of them all because they are underage. The quit attempts in this age group is very low as they have not yet acknowledged themselves as smokers and are not old enough to understand the medical implications of smoking.

The 17-20 category (35% smokers) has the most percentage of quit attempts, with 73% of the smokers having tried to quit. The quit attempts is largest among them because they are more aware of the way smoking can affect their lives and realize that if they do not quit now, they would become chain smokers. Since these issues are addressed openly with people of this age, they take the initiative to approach professional help.

The maximum percentage of smokers belongs to the 21-24 age group. They smoke the most amount of tobacco since they are of legal age and also are financially able to support these expenses. In contrast, the quit attempts among them is lowest because by this age, they have already become chain smokers and find it extremely difficult to face the withdrawal symptoms of quitting. Also, they no longer have to fear being exposed to parents since they consider themselves to be independent adults capable of making decisions.

4. RECOMMENDATIONS

Based on the survey and the discussion the requirement for each age group to quit smoking is different. Mass media campaigns against tobacco use—most often TV ads—have proven very effective at helping prevent tobacco use by young people. Studies show that teens respond most to ads that trigger strong negative feelings, such as ads about how smoking and second-hand smoke harm health and ads that expose the tobacco industry’s marketing strategies that target young people. Even ads that are designed for adult audiences help reduce tobacco use among young people.

4.1 Age group 13-16

Every 3 or 4 years, new groups of children and teens reach the age where they are vulnerable to influences encouraging them to smoke. To be effective, mass media campaigns must be repeated so they will reach new vulnerable populations.

Schools should have strict tobacco-free policies. Parents should strictly abstain from tobacco and not allow its use at home or in their cars. They must know what they are doing and who their friends are. It would also help to network with other parents who can help you encourage teens to refuse tobacco.

4.2 Age group 17-20

Most students falling into this category are already started being addicted to tobacco. They require a more intense program to help them quit. An in depth awareness about the repercussions of smoking is a must. Coupled with it moral support from families and friends is also helpful. Helping students in this particular age group to relive stress and depression is also of great importance since they are young adults i.e. individuals with the responsibilities like those of adults but not the experience. Many at times rehabilitation is not required. Taking medical help should also be encouraged if required.

4.3 Age group 21-24

Most students in this category are chain smokers who have failed in the attempts of quitting and have either little or no hope of succeeding. They require medicinal help along with moral support and inspiration. Even though it is more difficult to quit at this age instilling in them a want to quit can work wonders. The consultation at a cardiopulmonary rehabilitation centre is always recommended .Keeping the family ties intact and having supporting parents as well as close social relations inspire good health and quit attempts.

APPENDIX A

Ministry of Health

Questionnaire

2013-2014

NAME: AGE: NAME OF SCHOOL/COLLEGE: NATIONALITY: GRADE:

Note: Please check () in the suitable boxes except where asked to indicate your answers otherwise

1. Are you aware about the health hazards of smoking? (Check all that apply)

a. Not Aware b. Sleeplessness c. Respiratory problems d. Lung cancer e. Heart Diseases f. Any other specify: ___________________________

2. From where did you learn about the hazards of smoking? (Check all that apply)a. Public welfare advertisements b. Documentary films c. Elders’ advice d. School e. Printed articles f. Others (Specify: ______________________________)

3. Have you ever smoked?a. Ever smoked b. Never smoked (Discard next qn. If ans. Is ‘Never smoked’ )

4. Do you still smoke?a. Yes b. No (Discontinue if ‘No’)

5. During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?

a. I did not smoke cigarettes during the past 30 days

b. Less than 1 cigarette per day

c. 2 to 5 cigarettes per day

d. 6 to 10 cigarettes per day

e. More than 10 cigarettes per day

6. Have you ever been advised by anyone against smoking or reprimanded for it? If yes, please identify the person and your relationship with him/her.__________________________________________________________________

7. Rank (1-4) the following as your most preferred to least preferred source to get money to buy cigarettes?a. Pocket moneyb. Ask extra moneyc. Borrow from friendsd. Steal

8. How easy do you think it is for students of your age to buy tobacco products in a store?a. Easyb. somewhat easyc. Not easy at all

9. Do you think smoking cigarettes makes young people look cool or fit in?a. Definitely yesb. Probably yesc. Probably notd. Definitely not

10. Does anyone who lives with you now…?(Choose all that apply)

a. Smoke cigarettesb. Use smokeless tobacco such as chewing tobacco, snuff, dip, or snusc. Smoke cigars, cigarillos, or little cigarsd. Use any other form of tobaccoe. no one who lives with me now uses any form of tobacco

11. Are you seriously thinking about quitting cigarettes? (Please choose the first answer that fits)a. I do not smoke cigarettesb. Yes, within the next 30 daysc. Yes, within the next 6 monthsd. Yes, within the yeare. No, I am not thinking about quitting cigarettes

12. Have you ever tried quitting before? a. Yesb. No

MINISTRY OF HEALTH

DHA Building, Deira

P.O.Box 4545

Dubai, U.A.E

Telephone:00971-4-2330000 Fax: 00971-4-2330444

Moh@gov.ae

www.moh.gov.ae

October 12,2013

Subject: Data for general trend in tobacco smoking among students

Dear Respondent

The Ministry Of Health is conducting a survey on the general trend of tobacco smoking prevalent among students aged 13-24 years .This survey aims at getting information on what age students start smoking , the amount of tobacco consumed and also their general views on smoking .

Your response will be our most valuable asset in suggesting methods of rehabilitation of chain smokers and to help making quit attempts successful. It further aims at obtaining clarity on this issue as it of great significance in improving the health of the younger generation as well as in bringing down the number of chain smokers. It is a prime step in preventing students from falling prey to the unhealthy practice. I call upon each of the respondent to co-operate by providing precise information without the fear of breach of privacy. Let us create healthier adults and safer environment for a better future.

A survey form with 12 questions is attached here with .You are requested to complete this survey form and send it back to surveyonsmokers@gmail.com before November 15,2013.Please be reassured that your answers will be treated in the strictest confidence and will be used only for the purpose stated above. The results of the survey will be published.

In case of inquiries, please contact : MOH - Ministry of Health Telephone: 00971-4-2330000 Fax: 00971-4-2330444 Moh@gov.ae

Thank you for giving us your valuable time.

Sincerely yours, Hassan Abdul Moeib Chief Research Officer

Enclosures: 1) A survey form

LIST OF REFERENCES

Sites referred:

http://health.howstuffworks.com/wellness/smoking-cessation/10-reasons-people-start-smoking13.htm

http://www.tobaccofreekids.org/facts_issues/fact_sheets/toll/tobacco_kids/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807205/

http://www.ncbi.nlm.nih.gov/pubmed/14507528

www.tobaccocontrol.bmj.com

www.cdc.gov

www.statcan.gc.ca

GLOSSARY

Addiction: - impaired control over substances or behavior, preoccupation with substance or behavior, continued use despite consequences, and denial. Habits and patterns associated with addiction are typically characterized by immediate gratification (short-term reward), coupled with delayed deleterious effects (long-term costs).

Chain smoking: - Smoking cigarettes in quick succession, consuming a large amount of tobacco.

Light smoking: - Smoking once in a while and consuming such a small amount of tobacco that many at times they are not even considered smokers.

Medical help: - in this context medical help refers to support in the form of a combination of medicines to enable quitting.

MOH: - Ministry Of Health.

Marijuana:- Cannabis, also known as marijuana (from the Mexican Spanish marihuana), ] is a preparation of the Cannabis plant intended for use as a psychoactive drug and as medicine . Cannabis is often consumed for its psychoactive and physiological effects, which can include heightened mood or euphoria, relaxation, and increase in appetite. Unwanted side-effects can sometimes include a decrease in short-term memory, dry mouth, impaired motor skills, reddening of the eyes, and feelings of paranoia or anxiety.

Rehabilitation:-  is a term for the processes of medical or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cocaine, heroin or amphetamines and tobacco. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse. 

Withdrawal symptoms: - Drug withdrawal is the group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs. In order to experience the symptoms of withdrawal, one must have first developed a physical and/or mental dependence (often referred to as chemical dependency). Withdrawal from Nicotine brings on irritability, fatigue, insomnia, headache, and difficulty concentrating.