CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

The purpose of this chapter is to review relevant literature and studies, both

local and foreign, which concerns about alcohol use and cigarette smoking,

particularly with adolescents to better improve and strengthen the researchers’

study and provide necessary framework for the research to hold onto.

Foreign Studies

Smoking and alcohol drinking among senior students have been the subject

of empirical inquiries in several parts of the world, primarily because of the life-

threatening risk and consequence of the said behaviors.

A research study by (Grant, Hasin, Chou, Stinson & Dawson, 2004)1 has

shown that relative to the general population, smokers are three times more likely

to drink alcohol, while alcohol drinkers are three times more likely to smoke.

Smoking and drinking often intertwine because they both affect the brain in

markedly similar ways.

Based on the study conducted by (Bien, 1990), smoking and drinking share

many detrimental effects, some of which operate synergistically. Over 90% of

alcoholic inpatients are smokers, with similar findings regarding outpatients. In the

general population, the relationship between smoking and drinking appears

positive but modest. Nicotine appears to facilitate ethanol consumption and vice

versa. While ample theoretical viewpoints exist to explain the covariance of alcohol

and cigarette consumption, conclusive data supporting one or another of these

views are lacking. The assumption that alcoholics should be discouraged from

quitting smoking as well as drinking is without empirical basis. Research should

ascertain whether problem drinkers with greater positive association between

alcohol and smoking benefit differentially from quitting both2.

Few studies have examined smoking and drinking as concurrent behaviors

among senior students. Another study on the topic by (Ritchey et al., 2001)

explains that those with lower grades, which means that students are less actively

engaged in curricular activities, and thus have more time for leisure activities are

prone towards smoking and drinking3.

A research study by (Ah, Ebert, Ngamvitroj, Park & Kang, 2005)4 pointed

out that students who reported lower levels of conscientiousness and self-efficacy

had a greater likelihood to had tried cigarette smoking. Also, students who had

lower levels of self-efficacy reported smoking more frequently and greater

quantities of cigarettes than students with higher levels of self-efficacy. Self-

efficacy was the most significant predictor of smoking behaviors. Health promotion

programs focused on self-efficacy may be an effective tool for reducing the

initiation, frequency, and amount of cigarette smoking among college students.

It is also reported that college-aged students have the most dramatic

increase in cigarette smoking. The findings suggest that college-aged student are

particularly at risk worldwide for initiating as well as becoming daily cigarette

smokers, alerting the increased need for setting up smoking prevention and

cessation programs in college and universities, in addition to those programs at K-

12 school system.
 A recent study by (Hallgren, 2012) reveals that alcohol remains the ‘drug of

choice’ for most young people and is responsible for a sizable proportion of deaths

and injuries every year5. In Sweden, total consumption and rates of heavy episodic

drinking have reduced over the past ten years. At the same time, the number of

adolescents admitted to hospital as a consequence of their drinking has risen. This

unexpected trend warrants explanation with empirical research. The recent

increase in serious alcohol-related harms also suggests there is more to learn

about what works in prevention, including the effects of community-based

approaches and targeted brief interventions.

They found significant increase in the dispersion of consumption over time,

indicating more heavy drinkers in the tail end of drinking distribution. Most

adolescent in Stockholm continue to drink more alcohol. Results concerning the

relationship between heavy drinking and risk factors were conclusive.

These just goes to show that alcohol consumption and cigarette smoking

offer devastating effects to the youth, especially the adolescents, with regards to

their overall health, be it physical, social, or mental. Such disruptions can

significantly affect their academic performances in school, thus could mean

problematic life statuses in their future.

Local Studies

A research study by (Swahn, Palmier, Segarra, & Sinson, 2013) pointed out

alcohol marketing as a major factor in students’ alcohol consumption and

drunkenness at an early age in the Philippines. Exposure to said ads in print media
and in sports events, concerts or fairs significantly contributed to increased reports

of drunkenness6.

Additionally, a study by (Furiscal, Keiwkarnka, & Pancharuniti, 2008)

conducted in one purposively selected high school in Baguio, Philippines recorded

that 30.8% of the students were drinkers, with male dominating over females with

47.1%.7 The study further verified that the ability to afford liquor and influence of

parents have statistically significant associations with alcohol drinking behavior 7.

This further asserts that in the Philippines alone, alcohol drinking is

becoming a part of the culture and a very common thing to do. Anyone 18 years

old or above can buy these liquors, but many minors often engage with said activity

even at very early ages.

In addition, smoking and alcohol drinking have been examined in the

context of students’ quality relationships (Roseberg & Pehler, 2011) of which

closeness with parents and closeness with peers are important indicators.

Philippine law sets the minimum legal drinking age at 18 but underage drinking is

widespread8. Most students get alcohol from home with or without their parent’s

permission.

Based on the study of (Garcia, 2013), Philippines has one of the highest

cigarette smoking rates in Southeast Asia, yet few studies have been published on

the smoking pattern or behaviors of Filipinos9. Garcia’s study aims to identify

environmental, demographic, cognitive, lifestyle and personal health factors

associated with smoking among men including being married and employed in
agriculture or blue-collar industry, while factors associated with smoking among

men include having less than a college degree and being older. Drinking alcohol

and the interaction effect of living in an urban community and having negative

attitude toward anti-smoking policies were associated with smoking for both men

and women. The study showed that there is a significant interaction between one’s

type of community and one’s attitude toward anti-smoking policies.

Program planners should develop interventions within the context of the

male and female perspective and the type of community they live in.

A research study by (Pamienta, 2007) identified the risk factors associated

with alcohol use among 10-16 year-old Filipinos. The researcher was able to

examine the prevalence of alcohol consumption on four public high schools from

Manila and Cavite through a cross-sectional study involving a total of 1370

participants. The following socio-demographic characteristics make a person at

risk for alcohol use: male sex, resident of urban areas, grade six (11-12 years old),

mothers with college degree and those whose families have no regular monthly

income. It was also found out that peer influence plays a major role in a teenager’s

risk in consuming alcohol, with 57.5% percent of the drinkers claiming they have

been influenced by friends10.

Foreign Literature

Cigarettes contain more than 4,000 chemical compounds and 400 toxic

chemicals that include tar, carbon monoxide, DDT, arsenic and formaldehyde 11.

The nicotine in cigarettes, in particular, makes them highly addictive. There are so
many diseases caused by smoking that it’s hard to decide where to begin (Chia,

2017).

A literature by the (Prime Minister’s Strategy Unit, 2004)12 reports that

alcohol misuse appears to be rising to the extent that the UK Government

considers tackling problem drinking as a social and health priority. On the other

hand, (Office for National Statistics, 2006)13 explain the alcohol-related death rate

in the UK has increased from 6.9 per 100,000 populations in 1991 to 12.9 in 2005.

While the dangers if binge drinking have been highlighted (e.g. Pincock, 2003) 14,

35% of all men (42% of those aged 16-24 years) and 20% of all women (36% of

those aged 16-24 years) still reported exceeding daily benchmarks on at least 1

day in the previous week to the 2005 Great Britain General Household Survey

(Goddard 2006)15.

Similarly, a recent government report by the (Prime Minister’s Strategy Unit,

2004) estimated the societal costs of heavy drinking, including costs to the NHS in

treating alcohol-related injuries and illnesses (estimated at £7.3 billion per year),

and costs due to the lost productivity through illness and absence from work

(estimated at up £6.4 billion per year)16. The latter estimate includes the costs to

the economy of alcohol related deaths. A further, less visible societal cost arises

because of alcohol-related impairment in the morning after an evening’s binge

drinking-due to the so- called alcohol hangover.

One survey conducted by the Centers for Disease Control (CDC) in 200817

has stated that there were 46 million adult smokers in the United States which

means 20.6 percent of people over 18 expose themselves to the disadvantages of

smoking cigarettes. Some are just inconveniences, while others are serious health

risks. Smokers face a host of disease and an increased death risk. Additionally, a

study by WHO (2010) has explained that, tobacco use is the biggest contributor to

the non-communicable diseases epidemic in the world. And among its effects

include heart attack, cancer, stroke and emphysema 18.

One study in the (Journal of the American Medical Association, ) showed

that, “Seventy-two percent of students reported experimenting with, formerly, or

ever smoking cigarettes, and 32% reported smoking in the past 30 days. Students

who had participated in interscholastic sports were less likely to be regular and

heavy smokers. Smoking initiation rates increased rapidly after age 10 and peaked

at age 13 to 14. Students who began smoking at age 12 or younger were more

likely to be regular and heavy smokers than were students who began smoking at

older ages19.

Academic performance in part is strongly related to socio-economic

opportunities later in life. The prevention of smoking in poorly performing

adolescents is therefore crucial in order to decrease smoking inequalities in adults

(Lorant et al., 2016)20. However, there is a lack of understanding why adolescents

who perform poorly in school are so much more likely to start smoking.

Discrimination and judgments are what confront every student who has

somewhat below average academic performance in school. Adolescents who

perform less well may feel marginalized by teachers and by their better performing

peers. They are less likely to receive social, emotional and academic support from

others (Elstad, 2010)21. This makes them more likely to cluster together and
engage in deviant behavior, such as violation of school rules and smoking, as a

way to create a social identity (Chen & Hsiao, 2009)22.

Local Literature

An article written by (Valbuena, 2001) for the Health Action Information

Network implied that data regarding alcoholism and alcohol abuse in the

Philippines appear scarcely, from little to none23. On the other hand, the radical

effects of such acts are readily seen in the community. Alcohol consumption has

also been greatly linked to crime and violence, evident with sexual and drug abuse

and suicide caused by drunkenness and alcohol intoxication. Valbuena further

asserted that Filipino youth starts to consume alcohol at ages 16 or 17, but traces

start as early as 12 years old.

The Philippine Global Adult Tobacco Survey conducted in 2009 (DOH,

Philippines GATS Country Report, March 16, 2010)24 revealed that 28.3% (17.3

million) of the population aged 15 years old and over currently smoke tobacco,

47.7% (14.6 million) of whom are men, while 9.0% (2.8 million) are women. Eighty

percent of these current smokers are daily smokers with men and women smoking

an average of 11.3 and 7 sticks of cigarettes per day respectively. The survey also

revealed that among ever daily smokers, 21.5% have quit smoking. Among those

who smoked in the last 12 months, 47.8% made a quit attempt, 12.3% stated they

used counseling and or advise as their cessation method, but only 4.5%

successfully quit. Among current cigarette smokers, 60.6% stated they are

interested in quitting, translating to around 10 million Filipinos needing help to quit

smoking as of the moment.

 A report by the (Philippine Daily Inquirer, 2012) discusses that the young

and the poor, who smoke and drink excessively, are dying every day 25. Ten

Filipinos die from tobacco use every hour, resulting in 240 deaths every day and

87,600 deaths every year. This could be blamed to the very low prices of such

products in the Philippines. The country has one of the lowest prices of the two

products in Southeast Asia. Because cigarettes are so cheap, the Philippines have

one of the highest smoking rates in the Western Pacific. A 2009 survey showed

that 28.3 percent of Filipinos were smokers. It is estimated that some 17.3 million

Filipinos who are 15 years old engage in smoking.

The Constitution has remained neutral on the use of cigarettes and alcohol

(Philippine Daily Inquirer, 2013). The Filipino citizens have the greatest freedom to

consume said products, and the magnates of the business world can freely sell

those items. Conversely, the Constitution proclaims health as a basic human right,

and can therefore structure certain laws that will protect the well-being of its

people. The issue rose to the fact that cigarettes contain around 70 carcinogenic

chemicals and that heart attack and stroke deaths commonly attribute smoking as

a risk factor.

This calls for more policies that will protect the Filipino citizens, especially

its youth, against the detrimental impacts of smoking to people’s health. (Bader,

et. al., 2011) explains that with regard to the youth, regardless of gender, the

government’s imposition of a minimum cigarette price can curb smoking since they

are not yet long-term smokers and people of higher socio-economic classes, price

floor policies will have little effect27.

 Cigarette smoking is the single most preventable cause of morbidity and

mortality (National Environmental Health Association, 2008)28. The overwhelming

spread and use of tobacco and alcohol to the general public raises concerns that

require holistic cooperation of all aspects of society, from the most basic unit, the

family to the profound actions of the Philippine government regarding these issues,

especially, that the health of the generations to come is at greatest stake.

 END NOTES

2 Bien TH and Burge R, “Smoking and drinking: a review of the literature.”

(1990).
https://www.ncbi.nlm.nih.gov/pubmed/2094682
4 Von Ah D, Ebert S, Ngamvitroj A, Park N, Kang DH, Factors related to
cigarette smoking initiation and use among college students.” (2005).
https://europepmc.org/abstract/med/19570288
5 Mats Hallgren, “Studies in youth alcohol consumption and prevention.”
(2012).
https://openarchive.ki.se/xmlui/handle/10616/41132
6 Monica Swahn, Jane Palmier, Agnes Benegas-Segarra, and Fe Sinson,
“Alcohol marketing and drunkenness among students in the Philippines: findings
from the nationally representative Global School-based Student Health Survey”
(2013).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890547/
7 Erwin Tano Furiscal, Boonyong Keiwkarnka, and Nonglak Pancharuniti,
“Alcohol Drinking Behavior Among High School Students In Low-Income Urban
Community Baguio City, Benguet Province, Philippines” (2008).
https://www.researchgate.net/publication/241036281_Alcohol_Drinking_Behavior
_Among_High_School_Students_In_Low-
Income_Urban_Community_Baguio_City_Benguet_Province_Philippines
8 Joyce P. Valbuena, “Alcohol and media: The situation in the Philippines.”
(2001).
http://www.ias.org.uk/What-we-do/Publication-archive/The-Globe/Issue-4-2001-
amp-3-2001/Alcohol-and-media-The-situation-in-the-Philippines.aspx
9 B. Bellew, M. Antonio, M. Limpin, L. Alzona, F. Trinidad, U. Dorotheo, R.
Yapchiongco, R. Garcia, A. Anden, and J. Alday, “Addressing the tobacco
epidemic in the Philippines: progress since ratification of the WHO FCTC!”
(2013).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463107/
10 Wymie C Pamienta, “Alcohol use among 10-16 year old Filipinos and its
associated risk factors.” (2007).
http://www.herdin.ph/index.php?view=research&cid=36574
11 Chia Stanley, “How Smoking and Drinking Affect the Body” (2017).
https://www.mountelizabeth.com.sg/healthplus/article/how-smoking-and-drinking-
affects-the-body
12 Stephens, Richard & Ling, Jonathan & Heffernan, Thomas & Heather,
Nick & Jones, Kate, “Review A review of the literature on the cognitive effects of
alcohol hangover.” (2008).
https://www.researchgate.net/publication/5612787_ReviewA_review_of_the_liter
ature_on_the_cognitive_effects_of_alcohol_hangover
17 Centerfor Disease Control, “Cigarette Smoking Among Adults and
Trends in Smoking Cessation --- United States, 2008” (2009).
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm
20 Jaana M. Kinnunen, Pirjo Lindfors, Arja Rimpelä, Katariina Salmela-Aro,
Katharina Rathmann, Julian Perelman, Bruno Federico, Matthias Richter, Anton
E.Kunst, and Vincent Lorant, “Academic well-being and smoking among 14- to
17-year-old school children in six European cities” (2016).
https://www.researchgate.net/publication/236990685_The_Extent_of_Influence_
of_Factors_on_Cigarette_Smoking_Among_Teenagers_in_Baguio_City_A_Cros
s-Sectional_Study
23 Joyce P. Valbuena, “Alcohol and media: The situation in the
Philippines.” (2001).
http://www.ias.org.uk/What-we-do/Publication-archive/The-Globe/Issue-4-2001-
amp-3-2001/Alcohol-and-media-The-situation-in-the-Philippines.aspx
24 Department of Health, “SMOKING CESSATION PROGRAM” (2009).
https://www.researchgate.net/publication/236990685_The_Extent_of_Influence_
of_Factors_on_Cigarette_Smoking_Among_Teenagers_in_Baguio_City_A_Cros
s-Sectional_Study
25 Sen. Miriam Defensor Santiago, “Protect young, poor from smoking”
(2012).
https://opinion.inquirer.net/39576/protect-young-poor-from-smoking
Bader, *David Boisclair, and Roberta Ferrence, “Effects of
26 Pearl

Tobacco Taxation and Pricing on Smoking Behavior in High Risk Populations: A

Knowledge Synthesis” (2011).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228562/
27 National Environmental Health Association, “Practical Stuff!” (2008).
https://www.researchgate.net/publication/236990685_The_Extent_of_Influence_
of_Factors_on_Cigarette_Smoking_Among_Teenagers_in_Baguio_City_A_Cros
s-Sectional_Study