Resilience Theory and the Implications for Smoking Prevalence in Adolescents

Resilience Theory and the Implications for Smoking Prevalence in Adolescents

As our scientific understanding of human development improves, it has become clearer that human behavior and disease can be greatly influenced by the complex and reciprocal relationship between the individual and his or her social environment. These environmental influences extend much deeper than the tangible hazards that have been well understood to threaten health—such as environmental pollution, toxic exposures, radiation, pathogens, and extreme temperatures—and include social environment elements that we have examined in depth during the last semester in Introduction to Social Medicine such as socioeconomic status, availability and accessibility of nutrition and healthcare, social and community cohesion, exposure to violence, immigration status, and countless other factors. Many of these risks are correlated with a slew of health and behavior problems that place a substantial financial burden on our healthcare system countrywide. One such problem that is illustrative of at least some of these broader environmental and social considerations is cigarette addiction.

The leading cause of cancer deaths in both men and women in the US is lung cancer, and the most salient cause of this prolific (yet preventable) disease that prematurely ends the lives of more than 165,000 people per year is cigarette smoking (ALA, 2008). Despite declining numbers of smokers over the last few decades (Mendez & Warner, 2004), a staggering 45.3 million people still smoke cigarettes in the US. Cessation of smoking is the most effective way to reduce the risk of developing lung cancer and those we do so before age 35 can increase their life expectancy by up to 8 years (Taylor et al, 2002). However, (Khuder et al, 1999) found that more than 66% of chronic smokers older than 35 began smoking before age 18 and that those who begin smoking earlier in life are less likely to successfully quit smoking. In light of this, prudent public policy should specifically target younger smokers (or those at risk of becoming smokers) to reduce their propensity to become lifelong smokers and potential victims of later deleterious health issues. Attempts to curtail adolescents from initiating smoking have seen mixed results, and although a modest decline has been observed in recent years it is evident that more profound reductions can only be achieved once we better understand the personal, familial, and communal context in which children become predisposed to smoking. One potential avenue to better framing how these contexts influence behavior is through the theoretical structure of resilience theory.

The term resilience refers to successful developmental outcomes in children who grow up in stressful or high-risk environments. Protective factors that increase the likelihood of positive developmental outcomes, as identified by longitudinal studies, include personal-level characteristics of autonomy, self-regulation, and problem-solving skills; family characteristics of warm but demanding relationships with parents, high parental expectations, and affectionate bonds with other family members; and community characteristics of social support, effective schools, and the availability of opportunities at major life transition points (Braverman, 1999). Resilience theory posits that an aggregation of risk factors—especially in the absence of concomitant protective factors—can give rise to maladaptive internalizing and externalizing behaviors (such as smoking) at the expense of positive coping mechanisms.