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A health behaviour is defined as a behaviour aimed at preventing disease, such as eating a healthy diet (Karl & Cobb, 1996). Health impairing habits are those that include the use of behaviour pathogens, such as smoking (Matarazzo, 1984). Studies have been done which look at the extent to which our own behaviour is responsible for our health. In 1979, McKeown stated that contemporary illness is influenced by the individuals own behaviour and it is on modification of personal habits that health primarily depends.
He also found that the main cause of death in affluent societies is peoples own behaviours and in 1981, Doll & Pet found that of all cancer deaths, around thirty percent can be directly attributed to the behavioural factor, tobacco smoking. It is now widely recognised that regular cigarette smoking is harmful to health and smoking cessation would have major and immediate health benefits for men and women of all ages (Novello, 1990). These include the risk of diseases such as lung cancer, first reported in 1954 (Doll & Hill), heart disease and emphysema (Pet et al. 1994). However, in spite of all the evidence about the detrimental effects of smoking, the world consumption of cigarettes is estimated at around six hundred billion cigarettes per year (Bawazeer et al. 1999). In Britain, the amount of cigarettes smoked per person, the prevalence of smoking, is decreasing, much more in men than women, but in comparison, women are starting to smoke more, therefore stopping more, whereas men may start less than women, but they are quitting less too (Ogden, 2000). A General Household Survey conducted in 1994 found that two-thirds of people want to give up smoking and the majority of people stated it is difficult to not smoke for the whole day.
Research investigating the reasons that people smoke has evaluated social, pharmacological and psychological factors. Recently there has been more focus on children and adolescents who smoke, since most try a puff of a cigarette (Ogden, 2000). It is difficult to distinguish between actual initiation and maintenance of smoking behaviour and in 1962, no common agreement on the reasons why people start to smoke had been reached. For the most part, the various explanations fell into the psychological realm (Seltzer, 1962).
Now, it is widely accepted that the factors that influence smoking initiation, or the onset of smoking, differ from those that influence maintenance of smoking behaviour. In 1996, the American Thoracic Society stated that psychological, social and familial factors seem to be particularly important in smoking initiation. Smoking by family members and friends is strongly associated with smoking initiation in adolescence, whereas nicotine dependence, genetic and psychosocial factors are relevant in the maintenance of smoking behaviour. Psychological, or cognitive, reasons for smoking still play a significant role in the initiation of smoking, as a health risk behaviour, and models of health behaviour, such as the Health Belief Model and the Theory of Planned Behaviour can be used to highlight the psychological predictors of smoking initiation (Sherman et al. 1982; Godin et al. 1992). Smoking mostly starts in childhood, fewer starting after the age of nineteen or twenty (Charlton, 1992). Many children try their first cigarette in primary school (Murray et al. 1984; Swan et al. 1991) and motivating factors range from the desire to appear more grown-up, or the wish for adult status, adolescent rebelliousness and striving for proper group status (Seltzer, 1962).
Older groups of smokers studied gave different reasons for smoking, such as the reduction of tension, novel experience, curiosity, peer orientation and personality inferiority. There is even the less examined suggestion of Freud, of the phallic significance of the cigarette, cigar and pipe. In 1995, Abernathy et al. found there is a strong relationship between peoples self-esteem and their future smoking behaviour. They interviewed over three thousand people from age ten to fifteen years.
They found that girls with low self-esteem in any given school year, especially between the ages ten and thirteen years, were around three times more likely to start smoking than girls at the same age with high self-esteem. This study did not find a link between level of self-esteem in boys and their probability of starting to smoke, so instead it highlights the current trend whereby girls are more likely to start smoking than boys, since self-worth or self-esteem is an interpersonal value, or a psychological state, which predicts the behaviour of adolescents going through significant changes, such as puberty (Abernathy et al. 1995). A study done by Bawazeer et al. in 1999, focused on cigarette smoking among secondary-school students in Yemen, and found that the main reason for starting smoking was to see what it was like, or curiosity, but a significantly higher proportion of girls than boys gave this as a reason. Among those aged fourteen years or under, the second reason expressed was to imitate the behaviour of others, while among the fifteen to nineteen year age group, it was due to the encouragement of others. Another study by Stanton, in 1993, found that boys generally have a worse attitude about smoking than girls and this initiates their use of cigarettes.
This means that, in terms of the Health Belief Model, they usually do not believe warnings from other people about the negative effects of smoking. These specific beliefs of reduced susceptibility, e. g. I will not get cancer from smoking since it does not run in my family are irrational and weak justifications for the onset of this health risk behaviour.
This is highlighted in the same study, by non-smokers, who had priorities that were more well reasoned, they appeared more mature and the reasons they gave for not smoking included social context, e. g. Smokers do not look good, and they also understood the short-term and long-term detrimental effects of smoking, such as bad breath, and future poor health prospects. Additional reasons or ideas that predict smoking behaviour are associations made by smokers, to fun and pleasure, calming nerves and building confidence (Ogden, 2000).
Pleasurable relaxation is the most significant positive use of cigarettes (Green, 1977). This includes smoking of a cigarette when you are not feeling down, in order to enhance enjoyment, and anecdotally, I have noticed in my own behaviour and that of others in university who began to smoke, that they started when going out to a bar or a club, in order to enjoy themselves more. Here, I would justify my use of cigarettes...
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