94 T H E JOURNAL OF SCHOOL HEALTH

SMOKING BEHAVIOR, COGNITIVE SKILLS AND EDUCATIONAL IMPLICATIONS*

JOHN T. FODOR, ED.D. Associate Projessor, Depa,rtment of Health Science,

Sun Iternando Valley State College L. €1. GLASS, DR. P.H.

Professor, Department o j Health Science, S a n I'ernando Valley State College

and JUHN M. WEINER, Dr. P.H.

Assistant Professor of Medicine, University o j Southern Calijornia School of Medicine

This paper deals with one aspect of a major study on the immediate effects of smoking on young healthy males. The purpose of the overall study is to develop meaningful educational programs that will affect smoking behavior. The educational programs resulting from this study will eventually be designed to reach young people before they make the decision to smoke.

The first phase of the project dealt with securing information relative to the immediate effects of smoking on health. Selected measurements mere obtained from 400 healthy male students a t San Fernando Valley State College (200 smokers and 200 non-smokcrs) between 17 and 22 years of age.

All suhjects answered questionnaires concerning their smoking behavior, personal and social characteristics, and knowledge about smoking and health. The 200 smokers participated in clinical tests before and after smoking. The 200 non-smokers participated in the same clinical tests before and after a comparable rest period.

The clinical tests included:' Electrocardiogram during rest Blood tests (serum lipids and clotting time) Expired air test Human performance tests

The results of these tests were analyzed to determine the immediate effects of cigarette smoking. It is our hypothesis that the findings relative to the immediate effects of smoking will provide meaningful inforniation that can be applied to the development of educational programs aimed at affecting smoking behavior.

*A paper presented a t the Research Council-Scientific Forum of the American School Health Association, October 21, 1967, Miami Beach, Florida. The report is part of a project supported by a contract (PH 108-66-278) from the National Clearing- house for Smoking and Health, Public IIealth Service.

The authors wish to express their appreciation to the Biostatistics Research Laboratory, Inc., for their consultation and cooperation in various aspects of this project. Appreciation also is extended to D r . Wilfred Sutton, Dr. Ben Gmur, and Mr. Russell Purcey for their consultation regarding the educational implications of the project.

'The following participated in conducting clinical tests: Biostatistics Research Laboratory, Inc.; California Foundation for Medical Research; Human Performance Laboratory, San Fernando Valley State College; Student Health Service, SFVSC.

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The part of the study that will be discussed here focuses upon data from written questionnaires and expired air analysis.

Personal Information Questionnaire. This questionnaire was designed to elicit inforination concerning the subjects’ smoking behavior and selected personal and social characteristics. Specifically, questions were asked about the subjects’ academic background, religious practices, social activities, ways of handling problems and his own smoking behavior as well as the smoking behavior of his parents.

Cognitive Skills. A questionnaire was developed to probe an indi- vidual’s knowledge relative to smoking and health. Test items were devised to measure a hierarchy of cognitive skills similar to those suggested by Bloom, et a1 ( 2 ) . These cognitive skills include:

Recall-the ability to remember specific facts or statements. Translation-the ability to reword the idea from specific facts or statements. Analysis-the ability to identify separate elements of a main idea or to identify the relationships among these elements. Synthesis-the ability to put together the parts (elements of main ideas) into an existing concept or to construct a different concept. Eoaluation-the ability to put value judgments on ideas or con- cepts expressed. A pplication-the expression of behavior related to specific ideas or concepts.

Findings The analysis of the Personal

Information Questionnaire revealed differences between smokers and non-smokers. Statistically significant differences that were found include the following :

Academic Non-smokers reported that they:

1. had a greater unit load 2. spent more hours on studies 3. had fewer hours of leisure 4. had more academic problems in high school and college

Religious More non-smokers reported that they:

1. were religious 2. belonged to religious groups 3. were actively involved in religious groups

Social Fewer non-smokers reported that they:

1. belonged to high school groups 2. were actively engaged in high school social groups

More non-smokers reported that they: 1. belonged to sports groups 2 . were actively engaged in sports

1. 2 .

3.

3.

5.

6.

Personal Information Questionnaire.

Smoking Practices Fewer non-smokers reported that their:

1. fathers smoked 2. mothers smoked 3. brothers smoked

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4. sisters smoked Cognitive Skills. In general, analysis of the Cognitive Skills Test

revealed that smokers were more informed about smoking and health than non-smokers. Statistically significant differences were found with respect to the following cognitive skills:

Recall 1. More smokers knew that smoking was implicated with heart

disease and emphysema. 2 . More smokers knew that the Heart Association advised against

cigarette smoking. 3. More smokers knew that smoking increased pulse rate. Analysis 1. Fewer smokers felt that carbon monoxide was a harmful ingredient

in cigarette smoke. Synthesis 1. Fewer smokers felt that increasing the length of the filter would

prevent absorption of nicotine. Evaluation Even though smokers were more informed about smoking and health:

1. More felt that i t was unnecessary for teenagers to worry about cigarette smoking until more conclusive evidence is present- ed indicating real harmful effects. More felt that normal, healthy people can smoke cigarettes wilhout worrying. More felt that cigarette smoking is not harmful for the person who smokes occasionally. More felt that a t times cigarette smoking can be beneficial. More felt that smoking is a sign of individualism. Fewer felt that smoking is a sign of weakness.

2.

3.

4. 5. 6.

Application Even though smokers were more informed about smoking and health :

1. Fewer would advise young people not to smoke.

Summary and Educational Implications The most pertinent educational implication of this study is the attempt

to develop new teaching content related to smoking and health. Our hypothesis is that information regarding the immediate effects of smoking will be more meaningful to students than will information regarding the long range effects of smoking. It is hard to conceive of children and youth being overly concerned about the possibility of such things as lung cancer, heart disease, or emphysema some thirty years hence (6, 7). Therefore, the basic purpose of this project is educational, and our task is to collect scientific data and translate the data obtained into language understandable and meaningful to the student so that smoking behavior will be affected.

One of the most difficult tasks involved in evaluating a smoking education program ; however, is to determine whether or not actual smoking behavior has been affected. The expired air analysis of this study may help cope with this problem. Gas chromatographic patterns (GLC) of expired air prior to smoking were significantly different between smokers and non-smokers. Smokers’ patterns on the GLC showed the

THE JOURNAL OF SCHOOL IlEALTII 07

presence of chemicals not found in the expired air of non-smokers (5). If properly refined, this procedure might be used to determine if an individual is a smoker. In this regard, the procedure could be used directly to measure whether or not educational programs altered smoking behavior. The procedure also could be used to validate the findings of questionnaires designed to determine changes in smoking behavior. Refinements in GLC procedures are now being developed for this purpose.

With respect to data from the Personal Information Questionnaire, the following comments can be considered. While non-smokers report more academic pressure of varying kinds, they have not selected smoking as a means of alleviating these pressures. It would seem appropriate to delve more deeply into ways in which the non-smoker resolves pressure. It might then be possible to incorporate this information into educational programs. Of course, as indicated by the analysis of the PI&, the non- smokers in this study indicated that they were more actively engaged in sports and may be using sports as a means of reducing tension. Some educators have suggested that smoking may be reduced by encouraging smokers to use substitutes such as sports in place of smoking (1). This suggestion needs further investigation because the activities involved (smoking and sports) may not be related. The smoker simply may not be interested in sports activities.

Smokers indicated that they were more socially involved than were non-smokers. Although this finding needs to be further investigated, if valid, educational programs may need to be developed that indicate how an individual may become socially involved without smoking.

Non-smokers also seem to be more actively involved in religious groups. It would seem important to ascertain if this activity is a determining factor in their non-smoking behavior. If so, the question may be raised, as to whether or not there is some component within this religious activity that might be used in educational programs aimed at altering smoking behavior.

The information obtained from the Personal Information Questionnaire is incomplete. For that reason, efforts are being made this year to probe into the individuals’ personal and social characteristics. New test items, including problem solving situations, have been developed for this purpose.

In regard to the results of the Cognitive Skills Questionnaire, smokers seem to be more informed about the relationships of smoking to health and are able to utilize the range of cognitive skills that have been suggested as facilitating changes in behavior. Yet, this knowledge and these skills do not deter the smoker from smoking, nor do the smokers advise young people not to smoke. This reinforces the concept that merely disseminat- ing information about smoking and health does not necessarily alter smoking behavior, nor does the ability to utilize a range of cognitive skills. This further suggests that merely disseminating information relative to the immediate effects of smoking and health may not necessarily alter smoking behavior.

From the nature of our study and from our findings, educational programs t>hat are developed will, of necessity, have to deal with the totality of man as a complex being. “Smoking education”, in fact, must become health education, taking into consideration the multiplicity of factors related to smoking and health (physical, mental, and social).

This finding has been verified in other studies (3, 8, 9, 10).

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The educational program developed cannot deal solely with cigarette smoking and its effect on a single organ, or a number of organs. Any aspect of health education must be related to the total functioning and well being of man.

Before any educational program can be specified , greater sensitivity of certain instruments used must be established and the findings of this study must be verified; that is, the findings must be reproducible.

Once the more sensitive instruments have been utilized and the findings reproduccd, it then will be possible to develop specific educational pro- grams. These programs will be developed within a logical framework which includes :

1.

2.

3. 4.

5 .

6.

7.

Incorporating the research findings into an existing body of knowledge relative to smoking and health. Ordering and classifying areas in the body of knowledge and ranking areas according to importance. Identifying “Big Ideas” or concept)s relat,ive to each content area. Organizing specific content related to each big idea within a content area. Identifying specific instructional objectives related to specific content and related big idea. Selecting specific learning opportunities that will enable the learner to attain the specified objective and relatsd big idea. Selecting evaluative procedures that will enable the teacher to determine whether or not the student has attained the instructional obiective (4).

This fiamewoGk provides for the logical ordering of knowledge and specifies what is expected of the student; how to bring about desired outcomes and how to determine whether or not outcomes have been attained. It provides a ready-made mechanism for implementing the research findings of this study.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

REFERENCES Allen, William A., Gerhard Angerman, & William A. Fackler. Learning to Live Without Cigarettes, Health Department, Philadelphia, Pa., 1967. Bloom, Benjamin S. (editor). Taxonomy of Educational Objectives, Handbook I: Cognitive Domain. New York: David McKay Co., 1956. Cartwright, A., F. M. Martin, & J. G. Thompson. “Distribution and Develop- ment of Smoking Habits”, Lancet, 2: 725-7, 1959. Fodor, John T., & Gus T. Dalis. Health Instruction: Theory and Appl icat ion. Philadelphia: Lea & Febiger, 1966. Fodor. John T.. L. H. Glass. & John M. Weiner. T h e Immediate Ef fec ts o f Smok- ing on ’Young Hial thy Males. ‘ A paper presented a t the APHA Annual Coderence, Miami, Florida, October 26, 1967. Godber, Sir George E. T h e British Experience. A paper presented a t the World Conference on Smoking & Health, Waldorf-Astoria Hotel, New York, September 11, 1967. Gordon, Ira. Smoking Education: W h e n , Where , H o w . A paper presented a t the World Conference on Smoking & Health, Waldorf-Astoria Hotel, New York, September 11, 1967. Lawton, M. P., “Psycho-Social Aspects of Cigarette Smoking,” Journal of Health & H u m a n Behavior, 3: 163-70, 1962. National Research Conference on Smoking Behavior, Vol. I11 Research Reports. University of Arizona, March 30-April 1, 1966. Smoking & Health, Report of the Advisory Committee to the Surgeon General of the Public Health Service, Washington, D.C.: U. S. Department of Health, Education & Welfare, 1964.

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