Stop Smoking Before It Starts: An Information Kit for Community Organizations Working with Adolescent Girls

Materials for Providors

• About this Kit - Who this kit is for, why it has been prepared, what it contains and how you can use it
• Adolescent Girls and Smoking: A Look at the Trends - An overview of recent trends in smoking among young girls; some facts and figures to support smoking prevention initiatives for this group
• What's at Risk: Health and Social Consequences - A summary of the health risks of smoking -- in general, for women/girls in their childbearing years, and from second-hand smoke - and a brief discussion of the social consequences of smoking
• Getting Started: Why Adolescent Girls Smoke -From weight control to peer pressure and the influence of the media and tobacco advertising -- a look at some of the reasons why young women take up smoking in the first place
• Staying Smoke-free: What Works for Young Girls - The good news: coping skills can help young girls stay smoke-free ... so can parents, friends and community leaders
• Some Positive Alternatives - Getting active, eating right and learning how to handle stress are important alternatives to smoking.

Materials for Participants

• To Smoke or Not to Smoke... - The "down" side of smoking -- including health and social consequences -- and one young girl's "testimonial" to Nick-O-Teen
• What's Wrong With this Picture? - Smoking advertisements promote an idealized image of women and girls.
• What's Your Smoke-Free Score? - A simple self-assessment questionnaire and scoring scheme on risk behaviours associated with smoking
• The Stress Factor - Some common stress situations facing young girls, together with a few ideas for managing them
• Canada's Food Guide to Healthy Eating - An easy-to-use resource to help young girls make healthy food choices

About this Kit

What it is:

Stop Smoking Before It Starts: An Information Kit for Community Organizations Working With Adolescent Girls is a resource on smoking prevention prepared with young girls in mind. It provides some food for thought, including facts, figures and activity suggestions on such topics as the social and personal pressures to smoke; equipping adolescent girls to resist those pressures; some model prevention programs; and ideas about where to go for more information. It includes materials for program providers and for young girls themselves.

Much of the information presented in the kit is based on research sponsored by Health Canada under its Tobacco Demand Reduction Strategy, including:

• research and fieldwork conducted by academics, tobacco control agencies and program providers
• in-depth consultations with women and adolescent girls
• consultations with non-traditional service providers (community-based women's groups and other organizations working with women and young girls)

What it isn't:

This kit is not intended to provide an in-depth review of the literature on adolescent girls and smoking. Nor is it meant to serve as a stand-alone program for providers to use in initiating comprehensive smoking prevention initiatives in their community group or organization.

Why young girls:

Why single out adolescent girls for initiatives designed to prevent smoking? For one thing, smoking is now the leading killer of Canadian women, claiming more than 15,000 lives annually. Many of the health risks related to smoking are unique to young girls and women. What's more, smoking affects far more than a woman's individual health -- smoking among pregnant women can cause a number of health problems for their babies.

We know that tobacco is an addictive drug -- once you start smoking it's extremely difficult to quit. We also know that if girls are not smoking by the time they're 19 or 20, it's unlikely that they will ever start. Yet smoking rates among young women are on the rise -- adolescent girls aged 15-19 now smoke more than boys their age.

"Mixed-gender" approaches to smoking prevention and cessation haven't been particularly successful with young girls. Adolescent girls smoke for different reasons than boys do, and they need different supports if they are to stay smoke-free. To be most effective, smoking prevention initiatives need to take into account the special experiences that young girls face as they move through adolescence.

Who it's for:

This kit is intended to be useful to a variety of program providers working with adolescent girls -- including those in women's centres and community agencies, as well as leaders of community groups and recreational programs. Many of these groups may not have made smoking prevention a priority in the past, but have been active in other areas promoting the health and well-being of adolescent girls and women. If you fall into this category, maybe it's time to put smoking prevention on your agenda. Think about it -- you can help make a difference.

How to use it

How you use the kit will depend on your own and your clients' particular needs and areas of interest. This kit includes eight information modules for providers, as well as supporting materials for young women -- any or all of these can be photocopied and distributed as required. It is designed to be flexible, so you can use the information in a number of ways:

• by building it into programs that you have under way in related areas; for example, informing young girls in your recreation programs about the short-term health impacts of smoking (e.g. shortness of breath, less stamina, etc.) or distributing fact sheets on the subject
• to respond to your clients' questions and concerns about smoking
• to help refer girls to other providers and prevention programs
• by making the information materials available to your clients (e.g. posting them on bulletin boards, inserting sections or useful facts into newsletters or information flyers)
• as a resource to find out how and where to get more information on preventing smoking among adolescent girls

Adolescent Girls and Smoking

A Look at the Trends (Plus Other Important Facts)

In recent years, efforts to prevent and reduce tobacco use have shown positive results. During the 1980s, smoking rates among Canadians (including young people) declined from about 38% to 31%. During the same period, the proportion of 15-19 year olds who smoked regularly dropped from about 43% to 23%. But by 1994, the number of teen smokers was on the rise. More than one-quarter (28%) of Canadian teenagers smoked, with young women smoking even more than young men (30% vs. 27%). (Health Canada, 1996)

Here is some important information on the smoking behaviours of young people in Canada, with a special emphasis on young women. It provides some useful context and supporting data for why smoking prevention initiatives should be directed at adolescent women.

Did you know ...?

• the only age group in which women's smoking rates are higher than men's is 15-19 year olds (Health Canada, 1996)
• approximately two-thirds of girls who smoke do so daily -- an average of 11 cigarettes per day (Health Canada, 1996)
• about one-third (29%) of adolescent girls tried to quit smoking at least once in the three months preceding an August 1994 survey (Health Canada, 1994)
• 26% of young women who smoke began before age 13; 83% before age 16; and almost all before age 18 (CAAWS, 1995)
• smoking rates are much higher in Northern remote areas -- in the Northwest Territories, more than one-quarter (26%) of girls aged 10 to 14 and almost two- thirds (62%) of those aged 15 to 19 are smokers (CAAWS, 1995)
• about 70% of girls who drop out of school smoke on a daily basis (CAAWS, 1995)
• between 28% and 42% of pregnant teens smoke -- most live in poor and sometimes violent environments (CAAWS, 1995)
• the highest rates of smoking among young people are in Manitoba and Quebec; the lowest are in British Columbia (Health Canada, 1996)
• most teenage girls start to smoke when they're between 12 and 14 (Health Canada, 1996)
• teenagers smoke more than a billion cigarettes each year -- resulting in retail sales worth more than $400 million (CAAWS, 1995)

References

• Canadian Association for the Advancement of Women and Sport and Physical Activity (CAAWS). (1995). Evening the Odds: Tobacco, Physical Activity and Adolescent Women.
• Health Canada. (1996). 1994 Youth Smoking Survey.
• Health Canada. (1996). Improving the Odds: A Tobacco-Use Prevention Resource for School Aged Youth 10-14.
• Health Canada. (1995). Research in the Areas of Social Science and Health Dealing with High Priority Adolescent Women and Smoking -- Final Report.
• The ACTION GUIDE for Smoke-Free High Schools. Prepared for the Tobacco Strategy Unit, Ontario Ministry of Health

What's at Risk

Health and Social Consequences

Smoking is now the leading preventable cause of serious illness and death in Canada. About four times as many people die from tobacco-related diseases as from traffic accidents, suicides, murder and AIDS combined. Worldwide, smoking kills six people every minute, or three million people every year -- a figure that is expected to rise to 10 million by the year 2025.

Some teenage girls stay smoke-free because of concerns about their health. But many others say "no" for more immediate and personal reasons. This section summarizes the short and long-term health risks of smoking -- for both men and women, for girls and women alone (i.e. in the childbearing years, during pregnancy) -- and the effects of second-hand smoke. It also highlights some of the "social consequences" of smoking -- issues that tend to carry the most weight with young girls.

In the Short Term

The health/physical impacts of smoking can be felt almost immediately. For example, young girls who smoke may experience:

• lower fitness levels (limiting their participation in physical and recreational activities)
• more coughing, phlegm, wheezing and chest colds
• increased symptoms and episodes of asthma
• raised blood pressure
• increased acids in the stomach
• dulled sense of smell and taste
• a feeling of being "up" (immediately after smoking a cigarette), then going "down"
• lower body temperature in the fingers and toes

Over the Long Term

An "equal opportunity" health risk, smoking has now overtaken breast cancer as the leading killer of women in Canada. Smoking significantly increases the probability that women will have:

• coronary heart disease
• lung cancer
• emphysema and chronic bronchitis
• cancer of the throat, mouth, larynx, esophagus, pancreas, kidney, bladder

(Like getting lung cancer, whatever else, there's so many cancers that you can get, whatever else you can see like your hair and the colour of your fingers and your teeth and everything. Institute for Social Research, 1995)

(I think some of it, they overuse the scare tactics ... they are just going so much the other way that I know a lot of people who just watch it and say yeah, right and do whatever. Institute for Social Research, 1995)

In the Childbearing Years

In addition to being at risk for the smoking-related diseases more often associated with men, women who smoke tend to have problems with their reproductive system. Smoking during pregnancy can also affect the health of the fetus and the pregnant woman. Women who smoke are at greater risk of:

• decreased fertility
• stroke (especially from combining smoking with birth control pills)
• cancer of the cervix (the opening to the womb)\
• weakening of the bones (osteoporosis)
• menstrual and menopausal difficulties
• miscarriage, premature births and stillbirths
• low birthweight babies
• reduced breast milk
• Sudden Infant Death Syndrome (SIDS), breathing difficulties and slowed growth in babies

Environmental Tobacco Smoke (ETS)

There is more and more evidence about the dangers of breathing second-hand or environmental tobacco smoke. At least 40 of the 4,000 chemicals contained in second-hand smoke are known to cause cancer, and others either help cancer to get started or make it grow faster. It's important for teenage girls to know about the health risks they, and others, face from ETS.

Did you know that ...

(Heart and Stroke Foundation: Behind the Smoke Screen)

• ETS causes headaches, nausea and dizziness, as well as irritation of the eyes, throat, nose and lungs?
• there is no "safe" level of exposure to ETS?
• an "idle" cigarette burning in the ashtray gives off more cancer-causing agents than when someone is smoking it?
• ETS can affect the fetus of a pregnant woman the same as if the mother smoked during pregnancy?
• lower tar and nicotine cigarettes don't reduce the amount of toxic chemicals put into the air?
• pipes, cigars and cigarettes all give off the same type and level of cancer-causing chemicals?
• non-smokers who are exposed to ETS for only a short time have measurable amounts of toxic substances in their blood, urine, saliva and breast milk?
• ETS increases the risk of death from heart disease by 20% to 30% for non-smokers married to smokers?

(... it's bad enough that they are doing all this stuff to themselves, putting different chemicals into their lungs ... but they come around people, they just smoke and they're killing us because of the carbon monoxide that comes out from the tip of their cigarette. Institute for Social Research, 1995)

For Discussion

Use the information in this chapter as a resource and get a discussion going on the health and social consequences of smoking, for example:

• What risks do women who smoke have that men don't?
• What can happen to people who live with someone who smokes? What can you do if your parents/brothers and sisters smoke?
• How can smoking affect your social relationship?

Not to Mention the Smell!

Teenage girls need to know about the serious health risks associated with smoking. But information has to be geared to the things young girls care about. During the teenage years, concerns about the long-term health risks of smoking may take a back seat to the short-term consequences -- especially the effects on social relationships. For that reason, you may want to focus your discussions where they are likely to have the most impact -- on the social consequences of smoking, such as:

• bad breath
• smelly clothes and hair
• appearing less attractive to boys
• getting into trouble (with parents, teachers and/or other adults)
• being rejected by friends who don't smoke

(She has to stop, stop dead. She can't be with me and smell like smoke because her clothes smell like smoke. When you kiss them after they've smoked, it's like ... It's a turn off. Institute for Social Research, 1995.)

Quick Facts:

• 90% of young people aged 10-19 believe that smoke can be harmful to the health of non-smokers
• girls aged 10-19 who smoke are more likely than their boys that age to believe that "occasional smoking endangers health"

References

• Health Canada. (1996). Improving the Odds: A Tobacco-Use Prevention Resource for School Aged Youth 10-14.
• Health Canada. (1994). Quit 4 Life (Facilitator's Guide). Minister of Supply and Services.
• Heart and Stroke Foundation. Environmental Tobacco Smoke: Behind the Smoke Screen (Fact Sheet). Cat. 34099512.
• Institute for Social Research. (1995). Gender Differences in Smoking Uptake and Tobacco Use Among Adolescents. York University.

Getting Started

Why Adolescent Girls Smoke

The decision to smoke isn't just a simple, personal choice -- it's the result of many complex factors working together. As young girls move through adolescence, they experience dramatic physical and psychological changes, social relationships become more complicated, and family relationships can become strained. Many young girls don't have the personal and social skills to cope.

In the face of these pressures, adolescent girls may start smoking. Once tobacco becomes a part of their routine, physical addiction is usually close behind. Most teen smokers underestimate how addictive nicotine is -- even five cigarettes a day are enough to keep the effects of nicotine in their bloodstream. With a learned dependence on cigarettes and a physical addiction to nicotine, young girls often continue to smoke well into adulthood.

For Discussion

To some extent, all teenage girls face social pressures and change -- many of these pressures are because of their age, others are because of their sex. Ask participants about the kinds of pressures they face every day. Are there any that can be added to this list?

• concerned about their image and identity as mature, attractive, confident, independent young adults
• concerned about what their peers think about them
• influenced by what their peers do
• stressed because of things happening at home, school or work
• worried about their relationships with parents, friends and teachers
• facing difficult financial and emotional issues

Personal Factors

Many teenage girls use cigarettes to deal with the personal pressures outlined above. Smoking is a tool to help them to deal with conflict and stress, feel more independent or look more mature. Some teenage girls smoke because it makes them feel comfortable in social groups -- it gives them something to do with their hands and makes them look in control. While boys smoke to look tough, girls smoke to make friends, to be part of a group or to give themselves an image. Girls (more than boys) also use cigarettes as a way of rebelling against their parents, school or society in general.

One of the reasons young girls most often give for smoking is that it helps them manage their weight. Maintaining an ideal weight is just one aspect of a larger issue for young women -- body image. Many girls develop a negative body image because they are continually comparing themselves to idealized images of women -- images that are promoted by tobacco advertising and through the media.

(I know some girls who smoke and other people tell me they started smoking 'cause they think it makes them look thinner ... most guys don't care about that as much as girls. Institute for Social Research, 1995)

Social and environmental influences

Parents, friends and other role models have a strong influence on what young girls think and how they act. That's why girls who live in homes or communities where smoking is a common and acceptable practice are more likely to use tobacco at a young age. In fact, teens who live with adult smokers are twice as likely to smoke as teens who live with non-smokers. Girls, more than boys, are influenced by whether family members smoke, and they more often have friends who smoke.

(Well, my mom ... her exact words were okay I know that I was probably the one to influence you smoking, but even if I take them away from you, I know that you'll do it ... so I'm just hoping that you'll learn so you won't turn out like me. Institute for Social Research, 1995)

(Maybe they start because of peer pressure and then afterwards they get addicted. ... I get the feeling like, you're under a lot of pressure to smoke, to have a cigarette and they do look cool when they're smoking, I guess. Institute for Social Research, 1995.)

Young girls may also take up smoking as a response to the pressures of gender inequities. As girls become more aware of the limits on their futures and cultural pressures on how they can behave, they feel less control over their lives and turn to smoking as a way to cope. Girls who live in poverty or face cultural, ethnic or other discrimination are even more vulnerable to pressures to smoke.

Advertising plays an important role in reinforcing smoking behaviours -- particularly with young girls. Cigarette manufacturers spend millions of dollars each year to convince young women that smoking will not only help keep them thin (and therefore attractive), it will also make them look independent, competent and mature.

(Like the media always advertising the perfect body, like when they do advertisements with women smoking ... they have women who are really professional looking ... she has it all sort of thing. Institute for Social Research, 1995)

Cost and accessibility factors are also important. Stopping sales of, and access to, tobacco products by minors and keeping costs high can help to put cigarettes out of reach for teenage girls.

(... most stores where I live don't sell them because they've gotten busted so many times by the cops but there's these two stores I usually buy them from ... they've sold me every single time I've gone in. Institute for Social Research, 1995)

Quick facts: (Youth Smoking Survey, 1994)

• "friends smoke/peer pressure" is by far the most frequent reason young women give for starting to smoke
• 54% of girls aged 10-19 feel that it is easy to buy cigarettes
• 85% of young smokers and 83% of non-smokers agree that billboards and signs for events sponsored by tobacco companies are ways of advertising cigarette brands
• three-quarters of high school students feel that school rules that ban smoking (partially or totally) are obeyed

Who is most at risk?

Some teenage girls are more likely to smoke than others. Here are some of the factors that place young girls at risk for smoking:

• lower self-esteem
• poor academic record
• less physically active
• smoking peer group
• smoking parents or siblings
• lower-income family
• less-educated family

What the Media Tell Young Girls

We are surrounded by media images of how women and young girls should look and act. As a result, young women develop unrealistic expectations about how much they ought to weigh and how they should look, both physically and socially. A recent study of the advertising and editorial content of magazines, newspapers, films and television programs available in Canada found that:

• anglo-Canadian girls and women are exposed to a large amount of advertising through American magazines -- most of which focuses on themes of freedom, weight control and odour control
• the media portrays contradictory messages about being female -- strength and independence on one hand, weakness and bodily imperfection on the other; products, including
• tobacco, are seen as solutions to imperfection
• newspaper articles do not address smoking as a women's issue
• French-language newspapers are more pro-tobacco than English media, sometimes taking a smoker's rights position against the anti-tobacco lobby
• French-language magazines appear to accept smoking as a way of life
• In television programming, tobacco use is portrayed as stress-related

For Discussion

Get a group discussion going by asking participants:

• how they feel about the way their bodies look
• what the media does to contribute to negative images women have of themselves

Young Women: A Well-Researched Market

Above all, tobacco companies are in the business of making money. That means doing everything they can to sell cigarettes -- for example, by making sure established customers don't switch brands and encouraging smokers of other brands to "cross over." But by far the biggest payoff for tobacco companies is in enticing new smokers onto the market. For many companies, the youth market -- and young women in particular -- represents their single most important target group.

Some of the strategies tobacco companies use to appeal to adolescent girls and young women are:

• marketing "slim" and "light" products that appeal to feminine tastes
• directing advertising messages to where young girls "live," by linking smoking with slimness, independence and control over their lives
• zeroing in on "culture" in marketing messages -- for example, Quebecois girls are seen by the industry as having distinct personality characteristics and cultural beliefs
• sponsoring events that appeal to a wide range of women's lifestyles and interests-from glamorous sports to dance, music and theatre

For Discussion

Try a group exercise focusing on the role tobacco companies play in promoting smoking, and how media advertising is designed to encourage teenage girls to smoke. Here are a few suggestions:

• Ask participants to go through old magazines and pick out smoking ads that focus on women. Have the group discuss what the underlying message is in each one -- i.e., how are women being portrayed?
• Prepare a collage of sports events pictures featuring women and sponsored by tobacco companies. Ask the group what kind of associations are being made?
• Ask participants what messages in smoking advertisements appeal to them?
• Start a group discussion about the ways tobacco companies try to get young girls to start smoking.

References

• Greaves, L. (1995). Mixed Messages: Women, Tobacco and the Media, Canada, 1989-1994. Prepared for the Health Promotion Branch, Health Canada.
• Health Canada. (1996). Improving the Odds: A Tobacco-Use Prevention Resource for School Aged Youth 10-14.
• Health Canada. (1995). Women and Tobacco: A Framework for Action. Ottawa.
• Health Canada. (1994.) Youth Smoking Survey.
• Heart and Stroke Foundation. Children and Tobacco: The Future on Fire (Fact Sheet). Cat. 34089512.
• Institute for Social Research. (1995). Gender Differences in Smoking Uptake and Tobacco Use Among Adolescents. York University.

Staying Smoke-free

What Works for Young Girls

At one time, smoking prevention meant getting information out to young people about the harmful effects of tobacco use. Today, the focus is on helping adolescents build the personal skills they need to resist smoking and on creating supportive environments that encourage healthy lifestyles.

Most women start smoking during their preteen and adolescent years -- at a time when they're also coping with self-awareness, self-esteem and body image issues; dropping out of physical activity programs and adopting unhealthy eating behaviours. Program providers, parents, peers, teachers and community leaders can help young women build the skills necessary to resist smoking and promote physical activity, healthy eating and stress reduction techniques as healthy alternatives to smoking.

Building the Skills to Stay Smoke-Free

Some people, more than others, are equipped to handle stressful situations. Why? Because they have resiliency skills. Resiliency is a person's ability to "bounce back" in the face of significant stress. Whether someone has the ability or not depends on many factors, including their learned skills and personality characteristics, and whether the environmental supports are in place.

For young girls to stay smoke-free, they need to develop skills to help them deal with the stress and social pressures of adolescence. These coping skills can act as a buffer against peer influences that encourage smoking.

For example, adolescent girls are less likely to smoke if they:

• have positive self-esteem and an optimistic outlook
• are members of a caring family
• are in contact with supportive adults outside their families

On the other hand, girls are more likely to smoke if they:

• have low self-esteem
• have few outside supports
• tend to use smoking as a social tool to shape their image or cope with stress

As a program provider, you can help empower girls by encouraging them to feel good about themselves -- including their abilities, image and potential.

For Discussion

• What do your parents and friends do to help you feel positive about your abilities?
• What past situations made you feel like you had accomplished something and made you feel proud of yourself -- something you did in which you followed through, made a tough decision or reached a goal?
• What qualities do you most admire in your friends?
• What are some of the ways you use to positively manage your stress?

Many life-skills programs for teens already build resiliency skills into their curricula. These programs emphasize skills such as problem solving, inter-personal development, and even stress management, and include family support, peer support and role modelling as important elements.

Community organizations that focus on young people -- in particular, on young girls -- (e.g., community centres, local Girl Guide chapters) can help to build resiliency skills among their members. By placing young people in challenging situations that require responsibility, teamwork and independence, program providers can help to instill self-confidence and a sense of personal competency in participants.

Other programs teach young people how to say "no" to negative peer pressure -- including the pressure to start smoking. By imagining and acting out situations that are likely to be stressful -- for example, where other young people are smoking or urging them to smoke -- young girls can practise their "refusal skills."

For Action

Divide the group into pairs or threes and ask them to brainstorm and act out a short skit about a situation they've actually been in, seen happen or can imagine happening, in which smoking is an issue. Ask them to take on different roles so that everyone has a chance to practise her refusal skills and say "no" to smoking.

With a Little Help From ...

It's important to engage the support of friends, family, and peer and adult role models in helping to keep adolescent girls smoke-free. Even more than boys their age, young girls are influenced by other people in their decision to smoke and are more likely to reach out to others in times of stress.

If you're a leader in a community organization, try enlisting peer leaders to strengthen the impact of your smoking prevention messages. Peers provide an important measure of credibility -- many young girls will be more comfortable and interested when "one of their own" is involved.

For Action

Select a topic for discussion and divide into small groups. Ask participants to select their own leader to direct the discussions and report on the group's findings to the larger group.

Identifying with non-smoking role models can help teenage girls to see themselves as non-smokers and strengthen their resolve to stay smoke-free. It's important for young girls know that they don't have to smoke in order to be respected or admired. Non-smoking role models that are attractive and confident help to reinforce that message. Remember that girls who are members of a minority ethnic, religious, racial, linguistic or spiritual background may respond better to role models who have a similar background.

For Discussion

Ask the group to think about non-smoking women they know (either personally or through the media) and admire. What makes them a good role model?

Parents/caregivers can play an important part in tobacco prevention initiatives by reinforcing non-smoking messages and providing insight on their own experiences with tobacco. Parenting style -- including whether parents take a strong stand against smoking -- can affect their children's smoking behaviour. Families that have positive ways of resolving conflict, and expect consistently mature behaviour from the children, generally have lower levels of risk. Children whose parents actively discourage smoking are also less likely to smoke even if the parents smoke themselves.

The mother-daughter relationship is an especially important one in the lives of adolescent girls and can be extremely influential in smoking behaviour. In choosing, developing or adapting programs for adolescent girls, program providers should consider:

• involving mothers and daughters early on (i.e. before girls reach puberty)
• incorporating a mother-daughter component into broad programs that do not focus solely on smoking prevention (e.g. healthy lifestyles)
• linking mother-daughter initiatives to broader community strategies that also include peers and community leaders (e.g. a "good neighbours" program)

Coaches and community leaders can also take action on tobacco by speaking out against tobacco use and encouraging young girls to explore healthy alternatives to smoking. The following chapter offers information on some specific steps that leaders can take.

References

Atlantic Health Promotion Research Centre. (1994). Resiliency: Relevance to Health Promotion. A Discussion Paper prepared for Health Canada.

Some Positive Alternatives

By offering some positive alternatives to smoking, program providers can encourage adolescent girls to take a healthy, constructive approach to dealing with everyday stresses and pressures. Learned early, many of these lessons will provide young girls with important coping tools well into adulthood.

Getting Active!

In theory, physical activity and sport could serve as ideal substitutes for smoking among adolescent girls. Girls who are physically active are less likely to smoke and, more importantly, physical activity can offer adolescent girls the same benefits as they think they get from smoking.

Perceived Benefits of Smoking

• Smoking is seen as a way to relax and deal with stress.
• Smoking is viewed as a way to make friends and be accepted by your peers.
• Smoking is viewed as a way to gain independence from parents and to rebel against social pressures to be feminine, perfect and nice.
• Many disadvantaged teen women see cigarettes as a status symbol. Cigarettes provide a substitute for a lack of material possessions and make them feel less deprived.
• Smoking is perceived as an appropriate way to control weight.

Known Benefits of Physical Activity

• Physical activity can help buffer the effects of stress, anxiety and depression.
• Group activities and team sports offer the chance to make friends and develop meaningful relationships with peers and caring adults.
• Sports such as rock and wall climbing, soccer, hockey, rowing and wind surfing and snow boarding offer a healthy way to rebel against societal pressures to assume a passive female role.
• Membership on a sport team or in a sports club offers status. Most teenagers perceive athletes to be successful and well liked. Participation in high school athletics may be particularly helpful to improving the status of teenage girls from minority groups.
• Regular physical activity is essential to maintaining a healthy weight.

(CAAWS, 1995)

In addition to the benefits described above, physical activity can have a positive influence on self-esteem. Not only do girls who take part in physical activity programs master important physical skills, they also improve their social skills and gain status among their peers.

What's holding them back?

At the same time adolescent girls start smoking, they're also likely to be opting out of most formal and informal physical activity programs. Consider the following:

• overall, girls and young women are not encouraged to be as active as boys and young men -- there are fewer and less varied opportunities for girls to participate, fewer role models and less parental support
• girls rank physical activity sixth among the factors that contribute to well-being; boys rank physical activity first
• three-quarters of Canadian women would like to be more active, but less than half of them give "pleasure" as the reason
• by the time they're six, girls have lower fitness levels and less skill competence than boys of the same age because of lack of encouragement and support

(Evening the Odds, 1995)

Eating right!

For many girls today, dieting and worrying about their weight is a full-time preoccupation. Idealized images of women in the media promote unrealistic weight standards. In fact, weight control is one of the reasons girls often give for why they start smoking in the first place. Eating disorders (anorexia and bulimia) are the extreme result of weight dissatisfaction and dieting.

On the other hand, girls and women who maintain a healthy body weight and practise healthy eating behaviours can reap the rewards, including:

• increased physical energy and endurance
• greater ability to concentrate
• generally look and feel better

Healthy eating means choosing from a wide range of enjoyable foods -- and emphasizing bread and other grain products, fruit and vegetables. It also means choosing lower fat foods more often, including lower-fat dairy products, leaner meats and foods prepared with little or no fat. Healthy eating practices -- especially in combination with regular physical activity -- help to keep weight at a healthy level and contribute to an overall sense of well-being.

Canada's Food Guide to Health Eating provides more detailed information on how to establish a healthy eating pattern. (See handout 5.)

Handling stress!

Young girls are confronted by significant challenges. Puberty takes them through dramatic physical and psychological changes. Social relationships -- with friends, family and boys -- get increasingly difficult. Sometimes these stresses are overwhelming and without the skills to cope, many young girls turn to smoking.

But stress is part of everyone's life. For most young women, the underlying sources of stress won't go away even as they move out of adolescence. The challenge is to develop strategies and methods of coping with stress -- without lighting up.

For example, try encouraging the members of your group to manage their stress by thinking about why they're stressed and how they can take positive steps to deal with it. One solution is to get away from the source of the stress by doing something else -- like going for a walk, taking a bath or talking to a friend.

For Discussion

• Ask groups to discuss the things that make them stressed, and how stress feels.
• Brainstorm about positive ways of responding to stress that don't involve smoking (e.g. going for a walk, exercising, deep breathing, taking a bath)

Prevention strategies...

... For Parents, Coaches, Teachers, Leaders and Organizations

Here are some steps you can take to help prevent young girls from starting to smoke -- by encouraging them to eat well, get involved in physical activity and feel good about themselves:

• stress non-competitive or non-traditional physical activities (e.g. climbing, orienteering, hiking, etc.) to attract girls who don't normally participate and may be at high-risk for smoking
• combine physical activity programs with a social activity and maybe even pizza
• offer activity programs that build young women's self-esteem, self-empowerment, independence and stress management skills
• go to the source! -- ask young women what kinds of activities they would like to try
• boycott sporting events that have tobacco sponsorship and encourage members of your group to join you
• counter tobacco ads by positioning physical activity as a means to acceptance, coping, success and healthy rebellion
• encourage girls to focus on what is unique and attractive about their bodies, and challenge common stereotypes about fat and thin
• emphasize personal development and realistic self-acceptance, rather than numbers on a scale
• show how physical activity can provide the same benefits as smoking
• encourage girls to accept a wider range of healthy weights and body sizes
• include relevant information on smoking in sport and active living newsletters and promotional material
• remove any emphasis on weight control and the "ideal" body in programs and activities
• demonstrate breathing and visualization techniques to your group
• encourage healthy eating, positive body image and enjoyable physical activity at home, at school and in the community
• provide facts on smoking and ETS -- do not tell them not to smoke, but let them make their own decision

Working with High-Risk Adolescent Girls

Discussions with program leaders and coordinators working with high-risk adolescent girls (e.g., pregnant girls, girls living on the streets) have highlighted some of the do's and dont's when working with these girls. Keep the following points in mind when designing or choosing effective programs for high-risk adolescent girls:

Do

• incorporate initiatives into broader health promotion programs (because smoking may take a back seat to other issues, such as drug use, living situation, parents' relationship, social life, etc.)
• emphasize the short-term impacts of smoking (e.g.smelly clothes, shortness of breath)
• involve peers and positive role models in delivering programs
• use strategies which "empower" high-risk girls to address smoking prevention and other health promotion issues (e.g. by increasing self-esteem or improving life skills)
• make your entire environment supportive of non-smoking
• deliver programs through groups/organizations that have established relationships with high-risk adolescent girls

Don't

• be judgmental or use a moralizing tone
• use fear tactics
• overemphasize the long-term risks to their health; and
• use highly structured programs (i.e. where the program includes scheduled appointments)

References

• Canadian Association for the Advancement of Women and Sport and Physical Activity. (1995). Evening the Odds.
• Health Canada. (1996). Improving the Odds: A Tobacco-Use Prevention Resource for School-Aged Youth 10-14.
• Health Canada. (1995). Research in the Areas of Social Science and Health Dealing with High Priority Adolescent Women and Smoking.

To Smoke or Not to Smoke...

Tobacco

(Adapted from: Noise. A newsletter from the Ontario Ministry of Health. (December, 1994).)

What it is:

What isn't it? Tobacco smoke is made up mainly of tar, nicotine and carbon monoxide. But it also contains poisons -- cyanide, arsenic, formaldehyde and ammonia, the stuff used for cleaning. A lighted cigarette gives off more than 4,000 chemicals. Two or three drops of pure nicotine can kill you.

How you feel:

Tobacco's a stimulant, so you'll feel up. The first time you smoke a cigarette, you may feel dizzy, hyper and nauseated.

What it does:

Tar builds up in your lungs. When you inhale cigarette smoke, you take in a lot of carbon monoxide -- the same stuff that comes out of car exhausts. Once you start smoking, it's really hard to stop. Tobacco is as addictive as heroine.

If you keep using it:

After you smoke for awhile, you'll find you have a lot more colds, coughs and sore throats than before. It can also make you look older. Smoking causes cancer in many people -- especially of their lungs, mouth and throat -- and contributes to heart disease and fatal lung diseases. It can also have a bad effect on babies, both before and after they're born. Girls who smoke can have trouble with their periods, and get weak bones when they're older.

It's not just about your health

Most kids don't think smoking is so cool -- in fact, smoking may leave you out in the cold with your friends. Think about it. Is smoking worth:

• having bad breath?
• having smelly clothes and hair?
• getting out of breath and tired during sports or recreation activities?
• being less attractive?
• getting into trouble with your teachers? your parents?
• being avoided by your non-smoking friends?
• A Dedication to Nick-O-Teen

(Written by Mary Eliot, a teen participant in a stop smoking program; included in CAAWS (1995) Evening the Odds.)

I can still remember when I first met Nick ... I thought I was so cool. All my friends hung out with him, so I thought I would too. First I'd get really choked up when he was around but as time went on, I really got hooked on him.

All I could see was good in everything he did when we were together. When I was sad, he comforted me. When I was angry, he helped me calm down. When I was tired he gave me a lift. I never felt lonely when Nick was nearby. Everyone told me that Nick was bad for me. I never listened.

It took a long time for me to know the truth. Finally, now I can say that I know Nick for what he really is: a lying, cheating, good-for-nothing creep!

He took all my cash ... even when I had no extra cash. He took advantage of my trust and got me addicted to poisons. He makes me sick! He stinks! And anyone hanging out with him stinks too! He tried to rob me of my future, but I didn't let him. I told him to BUTT OUT of my life. It may be hard to get on without Nick, but not nearly as hard as it was to have him around.

So I am here to say goodbye to Nick. So long, it's been bad to know you. Goodbye Nick-O-Teen. Rest in peace.

What's Wrong With This Picture?

Tobacco companies are in the business of selling cigarettes and teenage girls are their fastest growing market. To keep their profits up, tobacco companies need to replace customers that die or quit smoking. Smoking advertisements directed at girls and women link cigarettes with qualities like being independent, youthful and glamorous.

Try looking beyond the "smoke and mirrors" of this advertisement to see what tobacco companies are really selling.

(drawing of sample ad)

• What does the ad encourage you to believe about cigarettes?
• How does the ad give you that impression?
• Do you believe the messages you're being told? Why/why not?
• Do you agree with what tobacco companies do to make their cigarettes seem attractive to women and girls? Why/why not?

What's Your Smoke-Free Score?

(Adapted from Health Canada (1996). Improving the Odds: A Tobacco-Use Prevention Resource for School-Aged Youth 10-14.)

Do you know if you're "at risk" for smoking? Why not answer the following questions and see?

1. Have you ever tried smoking (even once)? _ yes _ no
2. Do you think smoking is cool? _ yes _ no
3. Do you think smoking is dangerous to your health? _ yes_ no
4. Do you think smoking is addictive? _ yes _ no
5. Do the people in your family smoke (parents, brothers, sisters)? _ yes _ no
6. Do you have many friends that smoke? _ yes _ no
7. Do you like the way your body looks? _ yes _ no
8. Are you physically active (i.e. take part in sports activities either on your own or in a group)?_ yes _ no

Give yourself 1 point for each "no" you answered to questions 3, 4, 7, 8.
Give yourself 1 point for each "yes" you answered to questions 1, 2, 5, 6.

A score of 3 or more means you may be at risk for smoking.

The Stress Factor

There are a thousand things out there that can cause you grief, if you let them. Here are just a few:

• studying for exams/getting a bad mark on an important test
• a first date with a boy/a last date with a boy
• giving a speech in front of the class
• arguing with friends/parents
• meeting new people
• getting a bad haircut

Stress Busters

(Adapted from: Ontario Ministry of Health. (December, 1994). Noise.)

Next time you're in a stressful situation or feel depressed, try one of the following stress busters.

1. Talk it over.

When Stephanie, 17, feels down or stressed out about something, she calls her two best friends. They're sympathetic and they give me good advice," she says. "I always feel better after I talk to them." Other people can help us see things from another angle, point out things we may be missing.

2. Make a plan.

If the boy you like likes someone else, start looking for someone new or spend some time with friends. If you're upset about a lousy mark, talk to your teacher about where you went wrong and what you can do to improve it. Then do it.

3. Do something.

This is part two of the "make a plan" strategy, and it's especially important for girls. Guys, it seems, deal with bad moods or stress through action, while girls may obsess about their moods. So get busy. Go dancing or to see a movie with a friend.

4. Be good to yourself.

Sometimes a little pampering is all you need to lift your spirits and get over being stressed. Treat yourself to a long bath or paint your nails.

5. Work up a sweat.

When you feel bad, all you want to do is crawl in bed with a big bag of chips. But you'll feel a hundred percent better if you force yourself to get up and get moving. Run, swim, rollerblade or do any other aerobic activity for about 25 minutes and your body will produce endorphins -- brain chemicals that act as mood lifters.

6. Try to keep things in perspective.

Remember that one bad haircut doesn't make you ugly or a "D" in geometry doesn't make you stupid. Concentrate on all the positive things in your life instead.

Canada's Food Guide to Healthy Eating

Canada's Food Guide to Healthy Eating tells you about the kinds of foods to choose for healthy eating. An easy-to-use resource to help young girls make healthy food choices.