How smoking influences the young men’s lifestyle at the beginning of the 21st century

Summary

Theoretical background:
The goal of this work is to assess various factors of young men’s lives among smokers and non-smokers. A sample of young men, volunteers, conscripts (servicemen) at that time, was studied within the presented work.

Methods:
A questionnaire – screening protocol – was filled in by 104 young men, 83 of them subsequently underwent a clinical examination. The participants expressed their interest in the research and the chosen form of primary prevention during directed talks; 64 participants took part in these talks.

Results:
The analysis of the results showed that more than a half of young men smoke. There was a strong statistically significant association between smoking and incomplete households. 39.5 % of the research sample was addicted to nicotine. Smokers consume more coffee and those who smoke also drink more alcoholic beverages. Highly statistically significant association was demonstrated between smoking and especially wine-drinking, while a statistically significant association was also proven between smoking and drinking beer and liquors. It was also verified that smokers drink larger quantities of alcoholic beverages and inebriate more often. Greater use of marijuana and hashish along with using drugs even in the military was proven in smokers.

No link was discovered between smoking and BMI, but it was demonstrated that smokers have an average amount of physical activity and their weekly frequency of physical activity is lower than in non-smokers.

A strongly statistically significant association between smoking and lower age of first sexual intercourse and the number of sexual partners (smokers had 5.69 partners, non-smokers 3.29 partners on average).

Conclusions:
Smoking significantly affects the lifestyle of an individual in all aspects of life and lifestyle. The chosen method of work including the assessment and the possibility of making use of primary prevention should be reproducible and usable for a wide range of our young population.

Keywords:
young men, lifestyle, primary prevention, smoking

Introduction

The state of health of a population can be monitored and evaluated for various purposes. This paper is focused on verifying and obtaining deeper knowledge in terms of interrelationship among the health state, life conditions and lifestyle of young men. Many people, especially young population, are not aware of or disparage the impact of smoking, life conditions, eating habits and other factors on their health. On a selected group of young men, this paper presents an evaluation of many negative factors and their significant influence on health, which is primarily focused on the lifestyle of young male generation and its care of health.

The health state can be monitored and evaluated by a plethora of methods. Many studies (1-9) advert to frequent negative influences (e.g. smoking, drinking alcohol, eating habits, lack of exercises) that are considerably related to the lifestyle of young generation. Even though they are supplied with relatively sufficient and available information, young people mostly need clear recommendations and advice, which would in a simple manner summarize and sort out this information and provide them with guidance for using it in their life.

Primary care plays a key and irreplaceable role in the health care system.

Methodology

Prevalence of selected health indicators was found in a group of Czech young men. Our measurement is based on individual anamnestic and clinical examinations of volunteers – military conscripts. The method applied for this analysis is descriptive epidemiological study with use of anamnestic and simple screening examinations.

A. Sample

This study is based on the research sample of 104 young volunteers - male military conscripts at that time. Their selection was carried out with respect to organizational capabilities and specific methods. The following aspects were taken into consideration: military conscripts (hereinafter referred to as MC) are young men from the whole territory of the Czech Republic (which enables us to obtain the population sample of the entire country), their military service takes place at one unit and one location so as to minimize research costs. The study was implemented among the volunteering servicemen, as a part of their instruction on preventing undesirable social, health care and pathological phenomena. Voluntary participation and cooperation can also be obtained and respected at present.

Military service is physically and mentally challenging, therefore it requires a good physical and mental state. Within their recruitment process, all young men had to undergo medical examinations evaluated by a commission, which led to the assumption that only young healthy men were drafted to the Armed Forces.

B. Examination

The study is based on 1) the questionnaire (Preventive Examination Report) and 2) clinical examination itself, including the report that was elaborated with respect to the monitored signs, causes and relations.

The questionnaire (Preventive Examination Report) consisted of 71 questions and was subdivided by our individual research interests into the following parts: personal data, family information, family medical history, lifestyle, personal medical history, eating habits, sex life, psychical state and experiences. Lessons learned from similar studies, our practical experience and set research goals were used as ground materials for elaborating the questionnaire (10-16).

Prior to starting the examination, the needed amounts of questionnaires, instruction sheets, statements on approval and record sheets had been prepared. Examinations took place in study rooms of the military unit within three days.

At the beginning, the purpose of this study was explained to the participating volunteers chosen from military conscripts. Before commencing the examination, all MCs received oral introductory instruction to be followed by administering the statements on approval for reading and filling out, on the basis of which the cooperation with volunteers could continue. The questionnaire record sheets were handed out, followed by the filling out of the questionnaire (anonymous and in word formulations) - each participant could ask questions anytime about unclear items. Examinations were connected with filling out the questionnaire, which means that those who filled out the questionnaire underwent voluntarily the clinical examination on the same day.

C. Measurement

As regards to time and organization, the clinical examination, which included measurement of anthropometric data, blood pressure, deficiency of vitamins, and respiratory functions, is more demanding. 3 stations headed by 3 medical specialists were established.

All the prepared and elaborated materials and the entire study were submitted for approval to the Ethical Commission of Brno Masaryk University that subsequently endorsed them. All the anonymously measured values of the participants were recorded in the form Clinical Examination – Preventive Examination Report.

D. Intervention

As part of the study, the primary intervention was subsequently and fully separately (in other days) running in the form of a voluntary discussion that took 3 hours and was aimed at possible decreasing (or at least influencing) the prevalence of smoking among young men and enhance their knowledge about risk factors and healthy lifestyle. The educational publication titled “Vyber si zdraví a svobodu“ (Choose Health and Freedom), provided by the Institute of Preventive Medicine, MF MU Brno, was used for discussion (17).

All questions were answered and the aforementioned publication was given to each participant. In addition to that, debaters received booklets and guidance for keeping healthy lifestyle.

E. Evaluation

Questionnaire - Preventive Examination Report.

All answers recorded in individual questionnaires were thoroughly rewritten into the coding sheets, and then transferred to the computer and subsequently to the statistic software as input data. Dependence on nicotine (Fagerström Test) was analyzed in the questionnaire items and consequently calculated and evaluated (18).

Clinical Examination – Preventive Examination Report.

The records from individual sheets of clinical examination filled out by participants were also rewritten into the coding sheets, and then transferred to the computer and subsequently to the statistic software as input data.

Body Mass Index – BMI (19, 15), Waist-Hip Ratio – WHR (15), blood pressure values (measured, static mmHg) (20), Kasch Step Test, physical fitness test (21), respiratory functions (investigation of pulmonary functions, spirometry) (22), and deficiency of vitamins were evaluated by clinical symptoms (11).

All the results were evaluated en bloc, i.e. fully anonymously for the tested individuals. Evaluations were carried out in cooperation with the Research Center of Preventive and Social Pediatrics, FM MU Brno, and with use of their software. The below-stated results were obtained from questionnaires and clinical examination.

Regarding the large scope of the work, the following part includes a comparison of smokers and non-smokers and evaluation of statistically significant data.

Results

The Questionnaire - Preventive Examination Report was filled out by 104 young men ¨ (military conscripts at that time), of which 83 underwent clinical examination and 64 (more than 50 %) voluntarily took part in the follow-up discussions.

Smoking statistic data of our research sample are shown in Table 1.

First cigarette smoking experience by age categories and beginning of regular smoking by age categories are included in Table 2.

Out of all smokers (i.e. 63) or ex-smokers (16), 39 (ca. 50%) regard themselves as nicotine-dependent, and 40 nicotine-independent. As results from the Fagerström Test for Nicotine Dependence, 51.3% respondents are nicotine-dependent of which 1.3 % strongly dependent, 17.5% medium dependent, and 32.5% slightly dependent, see Table 3. These data show that both subjective estimates and evaluation based on the Fagerström Test for Nicotine Dependence provide very close results.

84.1% smokers and 100% non-smokers share joint households with parents, which is a statistically significant difference, see Table 4.

As for drinking coffee, we divided our respondents into two groups. The first one consisted of those who drank daily one and more cups of coffee, whereas the second one included those who drank less than one cup daily. Having compared these two groups, we have found an unambiguous statistically significant difference (see Table 5). Smokers drink much more coffee than non-smokers.

Smokers show strong dependence on drinking wine, beer and liquors, see Table 6.

The fact revealing that smokers consume considerably more alcoholic beverages has been proven both in frequency and quantities of consumed alcohol. Moreover, statistics show that smokers inebriate much more frequently than non-smokers. Absolutely clear and statistically highly significant difference between smokers and non-smokers is also apparent in using drugs. 14.3 % of smokers, in contrast with only 2.5 % of non-smokers, refused to answer the question on using drugs in the military service. 19.5 % of smokers and 7.5 % of non-smokers admitted using drugs in the military service. Smokers indicate statistical significance in using drugs in the Armed Forces (see Table 7).

Statistical analysis has not proven any link between smoking and BMI.

Non-smokers show a high physical activity (62.5 %), whereas smokers indicate only average physical activity (50.8 %). Statistical significance has been proven. In a week non-smokers reveal a considerably higher frequency of physical activity than smokers, as evidenced by the statistic significance shown in Table 8.

A strongly statistically significant relation between smoking and a lower age of the first sexual intercourse and the number of sexual partners (smokers - 5.69 partners, non-smokers - 3.29 partners at average) has been proven, see Table 9.

Discussion

More than fifty percent of the surveyed young men, in spite of a widespread preventive campaign and high prices for cigarettes, still smoke. Nonetheless, 15.4 % of ex-smokers quit smoking, which is a positive sign indicating that the young generation is thinking of the harmful effects of cigarettes. However, 75.4 % of the sample has some smoking experience, which is a high number. The comment to this problem stated by Kučerová et al. (6) is that “the percentage of smokers among the second grade students and apprentices was 40.2 % in 2005, which is a significant difference from 38.8 % recorded in 1995”; similarly Csémy et al. (1) highlights the proven fact that “in 2002 the proportion of regular smokers practically doubled, as contrasted with the percentage recorded in 1994. The steepest increase of smoking was noted in the category of fifteen-year old teenagers, revealing 30 % of smokers in 2002. Based on our findings, we can state with certainty that smoking has an increasing tendency among our adolescents.” Sovinová (24) claims that “the adult population of the Czech Republic includes almost thirty percent of smokers”. The Action Plan (24) summarizes that “in 1985 our country registered 45.4 % of regular smokers, but recent data show continuous, albeit slight, decrease of smoking, which is more apparent among men, as evidenced by only 32.2 % of male regular smokers in 1993. In the same spirit, Pecha (7) states “that even among athletes are 31 % of smokers, which is an alarming number”. Sovinová et al. (9) also writes that “by the research results from 2008, 24.0% of Czech citizens can be regarded as regular smokers, and 4.2% as irregular smokers. It means that 28.2% of 15 – 64 year-old Czech citizens, as found from their own statement in 2008, smoked and can be regarded as smokers. Furthermore, Hrubá (25) points out that “in the Czech Republic, similarly as in other developed countries, smoking of machine-produced cigarettes absolutely prevails. Based on recent surveys in the Czech Republic, 31% of men and 21% of women are regular smokers, and these numbers are augmented by a further 4% of occasional smokers. We can expect that more than 30% of our surveyed young men will smoke in their adult age.

41 of our young male smoking respondents (50%) are addicted to nicotine, but their addiction is different and also influenceable by a level self-knowledge, self-discipline and targeted prevention. Over fifty percent of active smokers (55.8%, independent and slightly dependent on nicotine) would be able to quit smoking without big problems or stress. Králíková et al. (26) adds that “a young smoker goes through the following three stages: 1. children smoke first cigarettes together (experimenting stage); 2. this group progressively narrows (stage of acquiring the habit); 3. individuals reach the final stage (addiction). Machová et al. similarly says that “the effort to release from the tobacco addiction is an extremely arduous process, as witnesses by a low efficiency of contemporary therapies. Therefore, it is better not to start smoking at all”. Hrubá (25) also states that “the first smoking experience has shifted to a lower age categories, which is a serious trend resulting in a higher risk of falling into addiction, developing diseases and early death. Since young organism has not yet developed fully efficient detoxifying mechanisms, it is more sensitive to harmful effects of smoking. In the Czech Republic around 20% of boys and 15% of girls in the 15 – 19 years age category are daily smokers. Most of young smokers indicate some level of addiction”. However, the chance to visit smoking treatment centers and take their advice remains unused, since they do not regard smoking as a problem and high risk to be solved right away.

Our results also confirm that smoking is a significant risk factor and the number of smokers is not decreasing. Hrubá in her publication (28) writes that “smoking is the most significant preventable risk factor of morbidity and mortality. 50% of smokers die of diseases associated with smoking, of which a half dies untimely in their middle age and loses 20 – 25 years of life. The mortality rate difference between smokers and non-smokers is epidemiologically visible already after 20 years of smoking, thus smoking is a chronic progressive and recurrent disease (diagnosis F17). It is not a social bad habit, but a strong addiction having pharmacological (to nicotine) and social-behavioral aspects.” Furthermore, Hrubá (25) states that “smoking is the most significant individual preventable factor connected with many diseases, including damage to ENT organs. A cigarette is the only kind of consumable goods which, if used as instructed, harms and kills, and is the only weapon that kills in its both ends, as smokers are dangerous to both themselves and non-smokers”.

In our work we have proven another well-known fact that smokers drink more alcoholic beverages. Nicotine and alcohol are still the most consumed and available drugs in the Czech Republic. Csémy et al. (1) confirms that “the result corresponds with those findings revealing that daily smokers are more often consumers of excessive quantities of alcohol; 31% of daily smokers admitted recurrent alcohol intoxication, which is in striking contrast with 5% of other respondents”. Pecha (7) discovered that the category of excessive alcohol drinkers was made of 13-20 year-old students and, according to results, three quarters of alcohol consumers did not reach 18 years of age. The research has also proven that athletes (probably not only them) show an increasing tendency to alcohol consumption in proportion to their age.” Kučerová et al. (6) highlights that “equally alarming situation, as found in 2005, is excessive alcohol consumption among pupils (16.2%), students and apprentices (68.8%). Bílek (29) also brings up the fact that “approximately 30% of young male respondents are excessive alcohol drinkers and, as for the preference to beverages, consumption of beer considerably prevails among Czech and Moravians as well. University students show a lower percentage of excessive alcohol drinkers, but the level of education, based on the research results, does not have a significant influence on consumption of alcohol. Foret et al. (3) states that “the consumption of alcohol in the Czech Republic remains almost unchanged and amounts to 188 liters per each citizen, which exceeds the average of the EU countries by 75 liters. The average consumption of beer, the field where we have achieved the world supremacy, makes up 87% of the total consumption of all alcoholic beverages. The data on consumption of alcohol in the Czech Republic have not even indicated any changes towards healthy lifestyle yet.”

A statistical significance in using drugs in the Armed Forces has been proven among smokers. Sovinová et al. (8) adds that “in 2002, 21% of 15-year-old respondents were daily smokers, which strikingly contrasts with only 8.8% in 1994”. Similarly, based on the latest research, the Sananim team confirms the fact that “the sooner people come into contact with alcohol and cigarettes, the higher probability is that they will later obtain illegal drugs” and Csémy et al. (2) says that “a higher occurrence of smoking was connected with the factors of incomplete or restructured family and smoking by close people (parents, peers). On a bigger scale, smokers were prone to psychosomatic symptoms, excessive consumption of alcohol, smoking marijuana and using ecstasy.” Kalina et al. (31) highlights the fact, which is stated in the EU Action Plan, that “risks of health damage are not merely limited to illegal drugs. Therefore, higher attention should be paid to other undesired phenomena, such as smoking tobacco products, consumption of alcoholic beverages in an early age, and first experiments with banned drugs”.

As results from our research, smokers show only an average physical activity with even lower weekly frequencies, lower age of their first sexual intercourse, and a higher number of sexual partners. These findings just confirm the well-known unhealthy lifestyle of smokers, which has a progressive tendency affecting the young generations of the 21^st century, in spite of all medial, educational and medical preventive efforts. According to Fiala (32), “an intensive physical activity is, together with a healthy diet (including non-smoking), the most important thing what can be done in the field of sickness prevention and health support. However, its potential is used absolutely insufficiently. A huge part of our population shows too low physical activity. The true meaning and effect of exercising is unfortunately underestimated by medical specialists, who do not appropriately apply it in their nonpharmacologic therapy.” Hrubá (25) also claims that “smoking is a separate independent risk factor adversely affecting sensory perception (hearing, smell, taste) and contributing to development of acute and chronic inflammatory diseases and mainly malign tumors in their locations. Adverse effects of smoking are potentiated primarily by consumption of alcohol. Smoking is accompanied with other unhealthy lifestyle phenomena (excessive consumption of alcohol, incorrect diet), which augment its harmful consequences.”

Young men, even though they were offered medical examinations, did not use this opportunity; however, more than fifty percent of our research sample took part in the discussions held in the form of an intervention as a part of primary prevention. Komárek et al. (33) also states that “the public interest in prevention is perfectly evidenced by a relatively high attendance at all group activities and demand for consulting. More people visit doctors to request preventive medical examinations.”

In order to improve this situation, some measures shall be taken. Campaigns running via media, billboards and internet would certainly be more efficient, if they were closely accompanied with individual and collective primary prevention. Žaloudíková et al. (34) says that “their study has proven that the program “Normální je nekouřit” (Non-smoking is Normal) presents an effective educational primary-preventive method for pupils at first grades of elementary schools.” Sovinová et al. (35) highlights the project “Přestaň a vyhraj” (Stop and Win), which is aimed at mitigating the tobacco pandemic. This competition is held regularly, and because of its effects it was included among the recommended steps of the “National Health Program” run by the CR Ministry of Health. In 2006 this project attracted mostly people from the category of 25 – 34 years of age. In order to check its efficiency, the verification study was launched in 2007, showing that one year after the competition at least 14 % of participants provably do not smoke. The competition gives a good reason for doing away with the addiction to tobacco products. Most of applicants joined the competition with the intention to use its period as the beginning of their new non-smoking life.” Zachovalová (36) writes in the same spirit that “their survey based on anonymous questionnaires revealed that the program successfully influenced behavior of children: the program participants noted a significant drop in the number of smokers during six months (from 18.7 % to 10.4 %), while the number of smokers in the reference group remained unchanged.” Pecha (7) states that “alcohol consumption and smoking are still big problems in our society. While developed countries show a striking tendency to protecting young people against alcohol and nicotine, our society seems to be too tolerant.” Csémy et al. (2) points out that “decreasing prevalence of smoking among children and adolescents after 2002 was influenced by regulatory measures pertaining to the availability of tobacco products (lawful age shift from 16 to 18 years, higher taxation of tobacco products), restrictions on promotion (ban on billboards and advertisement in journals), and improved preventive programs in schools”.

CONCLUSION

We suppose that this study, can provide valuable information, including ground materials for adopting preventive measures, and could become an initial stage for making more complex analyses (e.g. longitudinal).

List of Abbreviations

• MC – military conscripts
• CR – Czech Republic
• FM MU – Faculty of Medicine, Masaryk University
• BMI – Body Mass Index
• WHR – Waist-Hip Ratio
• EU – European Union

Submitted for publication: August 4, 2010

Iveta Marková M.D.
LF MU Brno
e-mail: ivetamarkova@tiscali.cz
Address (work):
Nemocnice Milosrdných bratří Brno
Polní 3
Brno 639 00