CHAPTER 1

THE PROBLEM AND THE REVIEW OF RELATED LITERATURE

This chapter presents the introduction, the literature and studies related to the

study undertaken, the theoretical and conceptual framework, statement of the

problem, significance of the study, scope and limitation, and the definition of terms

relevant to the study.

Introduction

The majority of lifelong smokers begin smoking habits before the age of 24,

which makes the college years a critical time for tobacco companies to convince

college students to pick up the habit of cigarette smoking (UMSM, 2011) Cigarette

smoking in college is seen as a social activity by those who partake in it, and more

than half of the students that are users do not consider themselves smokers

(Levinson et al., 2007). This may be because most college students plan to quit

smoking by the time that they graduate (UMSM, 2011).

The prevalence of cigarette smoking by college students increased through

the 1990s, but has since leveled off and seen decreases in recent years (Ali, 2012).

Education on the dangers of cigarettes is seen as a leading cause for this decrease.

This activity is being seen as less socially acceptable than it was in the past (Ali,

2012)

Cigarette smoking on college campuses has become an important public

health issue and there has been increase in campus wide smoking bans and other

preventive programs to reduce the rates of students smoking. The cause of these
bans is now starting to be discovered and there is controversy that goes along with

implementing them across various schools in the United States (Massa, 2012). Some

smokers may also choose to neglect the bans and continue to smoke cigarettes

regardless (Ali, 2012)

This study emerged as a result of the researchers’ desire to understand how

and what might be the factors that encouraged them to smoke. The purpose of this

study aims to help researchers, teachers, and program heads in addressing smoking

practices among SEC college students.

Review of Related Literature and Studies

Smoking tobacco, either through a cigarette or other tobacco-based products,

has been part of the routine of a wider proportion of the population worldwide – this

includes college students who started smoking even before they hit the college-age

years (Bidstrup et al., 2009). Cigarette smoking on college campuses has become a

significant public health issue, and there has been an increase in campus-wide

smoking bans and other preventive programs to reduce the rates of students smoking

(Kavamahanga, 2010).

College students pose more threats to engaging in risky behavior since they

face greater stress levels and a higher prevalence of alcohol drinking than when they

were younger. It is worth investigating how these factors affect students’ tobacco

use. Several studies have shown that crucial differences exist between the two

groups regarding smoking behavior and opinions (Villanti et al., 2011).

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Stages of Smoking Initiation 

The progress of smoking initiation leading to smoking practices can be

gleaned in several stages (Colder et al., 2006; Flay, 1987). Attitudes and beliefs

about smoking are gradually formed during the preparatory or pre-contemplation

stage, the stage in which the young individual may begin to link smoking to several

functions, such as appearing mature or showing independence, coping with stress,

and bonding with a peer group. (Widome et al., 2007). The second stage, also

known as the trying stage, includes more frequent smoking from the young

individual, and it is usually linked to the encouragement of friends or persons

surrounding the individual.

The third stage, or the experimentation stage, includes repeated yet irregular

smoking of the individual and is generally in response to a particular situation (such

as a party or stress) or a particular person (such as a date). The fourth stage, regular

use, occurs when a young person smokes regularly and smokes in various settings

and with a variety of people. Physiological need characterizes the last stage of

addiction. This need includes tolerance of nicotine, withdrawal symptoms if the

adolescent tries to quit, and a high likelihood of relapse if the person does quit

(Flay, 2009).

Generally, it takes an average of 2 to 3 years from the time of a cigarette's

initial trial to the stage of regular use. This implies that it is essential to study the

risk factors related to first use and regular use. If a young person can become a

regular smoker in 2-3 years, then secondary school is the critical time in the life

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span for intervention programs for minimal risk of acquiring smoking practices

(Evans et al., 2002).

On the other hand, although college students and high school students have a

proximity age gap, their management level towards risky behaviors is different. The

social structure, mental capacity for decision-making, and risk assessment of those

at the college level seemed to be more developed than those at the high school level.

This leads to studying college students to determine how they handle peer pressure

and perception in initiating smoking behavior (Bektas & Ozturk, 2010).

According to the World Health Organization as of 2007, among the college

students, 18.3% reported having ever tried or experienced 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 between smokers and non-smokers. The most important

preventive factor for cigarette smoking was religious beliefs (69.1%) 

Smokeless Tobacco Use and Smoking Location

Various forms of advertising have promoted smokeless tobacco's benefits

with the implication that the use of these products is without danger, yet it is not.

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The health consequences of smokeless tobacco use among young people are

becoming better known.

The primary adverse consequences among adults include bad breath,

discoloration and abrasion of teeth, dental caries, gum recession, leukoplakia,

nicotine dependence, and oral cancer (USDHHS, 1996, 1992; World Health

Organization, 2004).

Early indicators of these conditions are found among young people who use

smokeless tobacco (USDHHS, 1994). Smokeless tobacco users also develop

nicotine dependency. The level of addiction is similar to that of smokers (Benowitz,

Porchet, Sheiner, & Jacob, 1998) since smokeless tobacco users absorb at least as

much nicotine as smokers do (Russell, Jarvis, & Feyerabend, 1995). The high pH of

saliva allows efficient absorption of nicotine through the oral mucosa. Adolescents

develop physical dependence from smokeless tobacco use, as shown by documented

withdrawal symptoms when they try to quit (Hatsukami, Gust, & Keenan, 1998).

Young people who use smokeless tobacco products are at greater risk of

smoking cigarettes than are non-users. Among smokeless tobacco users, 12 to 30%

also smoke cigarettes (Eakin, Severson, & Glasgow, 1999; Williams, 1992; CDC,

2001). For young people who use both smokeless tobacco and cigarettes, cessation

of one may lead to an increase in the other. Smokeless tobacco use is also predictive

of other drug use. Smokeless tobacco users are significantly more likely to use

cigarettes, marijuana, or alcohol than non-users (Ary, Lichtenstein, & Severson,

2000).

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 Also, 8.9 million Americans used smokeless tobacco, and 2.2 million

smoked tobacco in pipes in 2010 (Results from the 2010 National Survey).

Smokeless tobacco contains 28 known carcinogens; it also has adverse effects on

oral and reproductive health ("Smokeless Tobacco Facts" 2011).

College students were more likely to smoke in social settings than in private.

Some students smoke at their homes, school, work, friend’s house, sports events,

parties, dances, raves, or other social events, public places, and outdoors (Harris et

al., 2009; Alesci et al., 2003).

Cigars and Pipe Use

Pipe and cigar smokers often wave off worries that smoking is bad for their

health. They claim their habit is harmless and perpetuate the common misperception

that pipes and cigars are somehow safer than cigarettes. In reality,

these tobacco products carry the same health risks as cigarettes.

Cigars and pipes differ in design from cigarettes, which are made from

tobacco wrapped in thin paper. Cigars are wrapped in tobacco leaves, and unlike

cigarettes, they do not typically have filters. In pipes, the tobacco sits in a bowl at

the end, and a stem connects the bowl to the mouthpiece. Pipes can be equipped

with filters; however, another type of pipe, the water pipe, consists of a body filled

with water, a bowl in which the tobacco is placed, and an attached tube and

mouthpiece through which the pipe is smoked. Water pipes, or hookahs, originated

in ancient Persia and India about 400 years ago and are still popular today. Hookahs

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are filled with fragrant tobaccos in a variety of flavors, such as cherry, apple, or

mint (Chapman & Freeman, 2008)

Likewise, cigars, cigarillos, little cigars, and pipe tobacco contain the same

toxic and carcinogenic compounds found in cigarettes. They have also been found

to increase the risk of oral, respiratory, and cardiovascular diseases (Burns et al.

2008). Regardless of the method used to ingest tobacco, this lifestyle choice is a

prominent cause of preventable disease and death, and as such, it is an essential

topic for healthcare providers and educators.

Peer Behaviors

Tobacco industry studies have also identified a group of so-called "social

smokers" who smoke mainly in social situations, do not believe that they are

addicted to smoking, and are concerned about their smoking's social acceptability

(Ling, 2002). The importance of social influences in smoking initiation and

progression are well recognized (Sepe & Glantz, 2002).

It is found that the influence of peers, friends, and siblings is substantial in

the initiation of college students smoking; these influences are considered proximal

environmental factors. Peer associations and peer bonding in this age group;

smoking may be a shared behavior that certain groups use to differentiate

themselves from other peers and adults. College students usually try their first

cigarette with their peers; peers may provide expectations, reinforcement, and

opportunities for continuation. (Sussman, 2005). 

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Alcohol Use

Studies of college students reveal that their smoking is strongly associated

with alcohol use and attending social events. Social smoking was also strongly

associated with drinking alcohol, which also occurs in a social context among

college students. Previous studies demonstrated that college smoking is associated

with alcohol use and a lifestyle that values socializing and parties (Rigotti et al.,

2000; Johnston et al., 2001).

Alcohol consumption and tobacco use are closely linked behaviors. Thus,

not only are people who drink alcohol more likely to smoke (and vice versa), but

also people who drink larger amounts of alcohol tend to smoke more cigarettes.

Smoking rates among alcoholics have been estimated to be as high as 90 percent,

with approximately 70 percent of alcoholics smoking at least one pack of cigarettes

per day (National Institute on Alcohol Abuse and Alcoholism 1998).

Stress

College students note that smoking cigarettes reduces anxiety, and smoking

often occurs after stressful events or in stressful situations. Studies find

that depressed college students are more likely to smoke and have a more difficult

time quitting than non-depressed college students. College smokers attribute their

smoking behavior as a means to alleviate their depression. Depression is related to

lower self-efficacy, and depressed individuals are considered less able to resist

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smoking during times of low self-esteem, which leads to higher reports of smoking

among depressed individuals. Cigarette smoking on college campuses has become

an important public health issue and there has been an increase in campus-wide

smoking bans and other preventive programs to reduce the rates of students smoking

(Jarvik, 2008)

Smoking Practice of Youth in the Philippines

The Philippines has a moderate‐to‐high burden of tobacco use among its

youth and adult population. The 2015 Philippines Global Youth Tobacco Survey

(GYTS), a component of the Global Tobacco Surveillance System (GTSS), which

systematically monitors youth tobacco use among 13-15 years of age, highlighted

the following:16.0% of students, 22.2% of boys, and 10.4% of girls, currently use

any tobacco products,

 14.5% of students, 20.5% of boys and 9.1% of girls, currently smoke

tobacco,

 12.0% of students, 17.6% of boys and 7.0% of girls, currently smoke

cigarettes,

 2.5% of students, 2.9% of boys and 2.1% of girls, currently use smokeless

tobacco,

 79.4% of students who currently smoke cigarettes bought cigarettes from a

store, shop, street vendor or kiosk,

 47.5% of students who currently smoke cigarettes were not prevented from

buying cigarettes because of their age,

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  10.9% current cigarette smokers reported that their usual smoking place is in

school,

 35.9% of current smokers showed signs of smoking dependence

This results in a dire state that if many students already started dealing with

smoking practices when they were still in high school, how much more when they

are already admitted in the college. This makes this study relevant to see the current

profile of the respondent’s smoking practices.

Theoretical Framework

This study is guided by the Social Cognitive Learning Theory by Albert

Bandura and its tenets.

Social Cognitive Learning theory explains that social involvement and

environment affect the health status and personal characteristics. The theory implies

that it is not enough to change an individual's behaviors, but it is also essential to

change the social systems in which the individual operates. The theory emphasizes

simultaneous and reciprocal effects of environment and behavior and suggests that

behavior is affected by external stimuli and internal cognitive factors (Bandura,

1989; Bandura, 1997; Crain, 2005). Bandura (1989) identified the theory's basic

arguments as the following: (a) people learn behaviors through observation; (b)

learning is an internal process that leads to or does not lead to a change in behavior;

(c) the behavior is goal-oriented; (e) people can self-regulate their behaviors that is

why they can learn how to control and take responsibility for their behaviors; and (f)

Punishment and reward affect a particular behavior both directly and indirectly.

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Behaviors are more often affected by the punishment or reinforcement obtained

from previous experiences.

Bandura holds that individual factors, behaviors, and environment

reciprocally affect each other and that this interaction shapes an individual's

behaviors. The effect of these three factors in the emergence of a particular behavior

is not equal. Sometimes environment predominates in these factors, and at other

times individual factors can trigger the emergence or non-emergence of a specific

behavior (Bandura, 1998 Bandura, 1989).

Individuals' behavior is shaped by his/her physical characteristics such as

age, gender, race, expectations, beliefs, self-concept, situationally having either

internal or external locus of control, behavioral objectives, and intentions (Bandura,

1989; Bandura, 1994; Bandura, 1998).

Figure 1. The Social Cognitive Learning Theory by Albert Bandura

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Conceptual Framework of the Study

Following the Social Cognitive Learning Theory of Albert Bandura, the

researchers constructed a conceptual framework that suited the study variables. The

first box contains the demographic profile of the respondents understudied which

includes age, civil status, gender, ethnicity, religion, course, and year level. Their

differences in their profile will be contrasted by their smoking practices which

includes smoking initiation, usage of smokeless tobacco, usage of cigars and pipes,

smoking location, and peer pressure-related, alcohol-related and stress-related

smoking behavior variables.

Based on the explanation of Bandura, the three factors presented showed

how the respondents are currently dealing with their smoking practices, specifically

on those at the college level.

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 Figure 2. Conceptual Framework of the Study

 Statement of the Problem

The study aimed to determine the smoking practices among college students

at Surigao Education Center. Specifically, it aimed to know the:

1. What is the profile of the respondents in terms of:

1.1 age;

1.2 civil status;

1.3 gender;

1.4 ethnicity;

1.5 religion; and

1.6 course and year level?

2. What are the smoking practices among college students of SEC as to:

2.1 smoking initiation;

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 2.2 smokeless tobacco use;

2.3 smoking location;

2.4 cigars and pipe use;

2.5 peer behaviors;

2.6 alcohol-related smoking behavior; and

2.7 stress-related smoking behavior?

3. Based on the findings of the study, what intervention program may be

proposed?

Significance of the Study

The study seemed to be beneficial to the following:

College Students. This study's findings will give awareness to the students

on their current smoking practices status, which could be a basis on the proposed

and other possible interventions that came up right after the study.

College Instructors. They could help implement the proposed program and

intervention that would alleviate smoking practices among college students. They

could also help build up proper knowledge and skills for the student's behavioral

and social growth.

School Administration. This study's recommendations will give ideas to the

policymakers and school managers to promulgate appropriate policies and

interventions to address the problem.

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 Parents. The findings and conclusion of this study will provide information

about the current status of the smoking practices by college students. They can also

be an asset in promoting mitigations to this problem.

Other Researchers. The study can be used as a reference if other researchers

will deal with topics related to the topic presented by this study.

Scope and Limitation

The study focused entirely on the smoking practices of students in Surigao

Education Center. This study is composed of selected students currently enrolled in

the second semester, in any programs offered and in any year level, of the academic

year 2019-2020.

The study's sampling method was unable to give generalizations and

exposed to a high risk of selection bias and error (Saunders, 2012). It is only used

due to the limitations of responses because of the restrictions of the COVID19

pandemic.

Definition of Terms

The following words were operationally defined to fully understand the

study:

Alcohol-related Smoking Behavior. It refers to the initiation of smoking in

the presence of alcoholic beverages.

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 Cigars. Stuffed with dried tobacco leaves and, like cigarette but it is

wrapped with a paper and contains filters, wrapped in tobacco leaves and doesn’t

have a filter.

Peer-smoking Behavior. It relates to the presence of smoking initiation by

the influence of peers.

Pipes. Puffing tobacco by means of a device which includes the bowl for the

tobacco, stem, and a mouthpiece to smoke.

Smoking. The process of using tobacco-based products by means of inhaling

it, just like a cigarette, or by releasing it from the mouth, just like pipes and cigars.

Smoking Initiation. It refers to the situation in which a certain person drives

itself to light or puff a smoke or the transition from being a non-smoker to a smoker.

Smokeless Tobacco. A tobacco-based product, that instead of smoking it,

that can be take in through chewing, sniffing, and any other form but still having the

same experience as the one that literally smokes.

Stress-related Smoking Behavior. It refers to the drive to smoke due to the

presence of stress-related factors.

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