Dr. Val Farmer
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Study Links Teen Smoking And High Risk Sex Behavior

October 7, 1996

Which do you think comes first? Smoking or having sex? Tobacco dependence or alcohol dependence? Smoking or using other illicit drugs such as marijuana?

Which is the most addictive drug - tobacco or cocaine? Tobacco or alcohol? Which is the most life-threatening addiction in our society? Tobacco or heroin? Which is the gateway addiction that precedes other addictions?

It is smoking.

Despite overwhelming evidence of the addictive power of nicotine, a million teens start smoking each year or 3,000 a day. Teens who smoke feel more rejection from family, teachers and peers. They are more alienated and have lower self-esteem. They are less goal directed, more sensation seeking and have more mood disturbances at lower levels of stress.

Why do teens do it? Young people understand that smoking is dangerous. Trying it shows a psychological pattern of risk taking. Young people who smoke are willing to engage in high risk behaviors.

It is also about image. Teens adopt a behavior that is consistent with their self-image or an image that they want. Smoking communicates a rebellious, less virtuous image and a desire to be seen as older and more mature. Engaging in sexual behavior is another signal to others that they are less virtuous and more sophisticated.

Smoking and alcohol. In a 1990 conference report in the Journal of Addictions, psychologist Jack Hemingfield presented data on the relationship between smoking, alcohol and other illicit drug use.

Of those who never smoked, less than 3 percent drank five or more drinks in a row at least one day in the past thirty days. This compares with 39 percent who smoked daily. Only one-fifth of one percent of those who had never smoked used marijuana more than ten times, while 23 percent of the daily smokers had. Of those who had smoked in the last 30 days, 74 percent had used alcohol during that same time. This compared with 24 percent of the non-current smokers.

Smoking and teen sex. Psychologist Kenneth Carter of Emory University analyzed data from the nationwide 1991 Youth Risk Behavior Survey. The data came from a representative sample of all public and private students in grades 9 through 12. Carter compared data on students' smoking behavior with their sexual behavior. He classified the smokers in groups - non-smokers, less than one-a-day, one-a-day, two to five-a-day, six to 10-a-day, 11 to 20-a-day and more than 10-a-day. Twenty-five percent of the sample were smokers.

Here are some of his questions and the results.

Have you ever had sex? Non-smokers said yes at 49 percent, less than one cigarette-a-day were at 70 percent, one-a-day at 67 percent, two to five a day at 77 percent, six to 10 cigarettes at 86 percent and 11-to 20 at 92

percent. Only six percent of those that smoked more than 20 cigarettes a day answered no.

Carter notes that the big jump of those that have had sexual intercourse is between the non-smokers and smokers group. He feels that it is a big step to be experimental with something as obviously dangerous as cigarettes and it carries over to other high risk behaviors.

Did either you or your partner use condoms during your last sexual intercourse? Non-smokers had 75 percent condom use, less than one cigarette a day smokers went without at 41 percent, and 39 percent of the one-a-day smokers didn’t use them. Smokers of two to five cigarettes a day didn’t use them at 42 percent, six to 10 a day smokers at 47 percent and 11 to 20 a day smokers at 56 percent. Sixty-four percent of those who smoked more than 20 cigarettes a day didn’t use condoms.

Did you use drugs or alcohol before your last sexual intercourse? Only six percent of the non-smokers answered yes. Less than one-a-day smokers were at 17 percent, one-a-day at 18 percent, two to five a day at 27 percent, six to 10 a day cigarette smokers at 32 percent and 11 to 20 a day at 43 percent. Fifty-nine percent of those who smoked 20 or more cigarettes a day answered yes.

Have you ever been told by a doctor or a nurse that you have a sexually transmitted disease? Only four percent of the non-smokers answered yes. Those that smoked one cigarette a day or less were at 6 percent, two to five a day smokers were at 5 percent, 6 to 10 per day smokers at 7 percent, and 11 to 20 a day at 9 percent. Those that smoked more than 20 cigarettes a day answered yes at 24 percent.

Smoking as an assessment tool. Carter's most dramatic conclusion was that as the number of cigarettes increased, the adolescents who reported sexual behaviors increased in a direct, almost perfect stair-step fashion.

"How much do you smoke?" It is an easy question to ask and get an honest answer. By finding out how much a teen smokes, pediatricians, school counselors and parents have a non-intrusive marker for assessing sexual risk and other high risk behaviors. Teens who smoke could be targeted for intervention and prevention programs to prevent high risk sexual behaviors.

When commenting on the multiple risks involved with heavy smokers, Carter said, "The pack-a-day adolescent smokers are a scary bunch."

No kidding!

Prevention. Prevention efforts directed at identifying high risk youth at earlier ages and targeting the prevention of tobacco use would go a long way toward preventing a broad spectrum of social and health problems. Anything society can do to keep the young from starting to smoke has to be a big step in the right direction.