Category: Comparative Leading Causes of Death

Cause of Death in the United States: Tobacco Consumption

The different causes of death within the United States is a valuable subject for scientists to research in order to aim efforts at preventing these causes. Within the United States and other nations alike, scientists have recognized tobacco use and cigarette smoking to have major roots in the top causes of death for many nations: preventable cancers and cardiovascular diseases. Along with the ethical dilemmas that this issue brings up, tobacco use and dangers is worth further examination.

A vast array of scientific research has been conducted to discover the health effects of tobacco consumption and the death rates among users. At one point in history, lung cancer was a rare disease. Now, in both men and women, it is the number one cancer killer in the United States.[1] Of these deaths from lung cancer, 88% of male deaths and 71% of female deaths are attributed to smoking cigarettes.[2] Around 1,200 people in the US die each day from tobacco use, which amounts to about half of people that use it in the long-term. Tobacco use has become the leading preventable cause of death in the United States; it contributes to over 400,000 deaths each year, taking 18% of all deaths in the U.S. While many of these deaths come from different cancers, many also come from heart or respiratory diseases that are easily preventable for nonsmokers. On average, smoking removes 14 years from one’s life due to disease and disability.[3] This is a major cause of death in the United States and deserves to be unpacked and examined more closely.

The increase of deaths due to heart disease and cancer in the U.S., compared over the time span of 1900 to 2010.    https://demography.cpc.unc.edu/2014/06/16/mortality-and-cause-of-death-1900-v-2010/

Tobacco contains more than 5,000 chemicals and toxins as well as 60 carcinogenic chemicals. It is widely and readily available to most adults and young adults and additionally highly addictive. Marketing efforts are widely used to target people and get them to experiment with cigarettes, often pulling them in to become a long-term user.[4]

Consuming tobacco has many health risks that can lead to death or disease. Cancers that can come from smoking include cancers of the lip, mouth, stomach, esophagus, pancreas, pharynx, trachea, larynx, cervix, lung, bladder and kidney. In addition, long-term cigarette smoking dramatically increases the risk of colon, rectal and bladder cancer. Cigarette smoking can also cause cardiovascular and respiratory diseases/disorders, including coronary heart disease, abdominal aortic aneurysm, stroke, atherosclerosis, chronic obstructive pulmonary disease, pneumonia, and other respiratory symptoms. The health damages caused by cigarette smoking does not affect just the smoker themselves; secondhand smoke exposure can lead to bronchitis, reduced lung function or lung cancer, recurrent ear infections, phlegm, more severe asthma attacks, and in some cases death from disease.[5] Secondhand smoke exposure from cigarettes is not a rare occurrence, either. A study by the CDC found that one in four nonsmokers were exposed to secondhand smoke, including 2 out of every 5 children.[6] In addition to the long-term health effects that smoking has, it also generally degrades a smoker’s quality of life as well. It increases healthcare costs and the financial burden of someone before they pass away, and it raises the risk that a person would die from more common health events, such as routine surgeries, complications, or pneumonia.[7] A study done on the Republic of Ireland found that years of life lost due to premature mortality from cigarette smoking specifically significantly higher than alcohol consumption, in addition to its greater contributions to cancer and CVD. Tobacco consumption, along with alcohol consumption, was found to be one of the primary risk factors contributing towards non-communicable disease mortality around the world.[8]

Cancer death rates in the U.S. shown over the course of 81 years. Lung cancer has a sharp spike in both males and females around the time that cigarettes became popular and readily available in the U.S.     https://ourworldindata.org/cancer

Efforts to reduce cigarette smoking have made great strides in cutting down risk for cancers and diseases from tobacco. From 1990 to 2015, there was a reduction in smoking levels in 18 countries, most of which were using control interventions to encourage people not to start or to stop. Brazil, who had the largest reduction of smoking at 55%, banned cigarette advertising in all forms, mandated health warnings with photos be on each pack of cigarettes, and increased their price by taxing them at greater numbers.[9] In addition, the Center for Disease Control stated in a recent report that effective interventions at reducing smoking and risk of disease included price increases on tobacco, anti-tobacco media campaigns on a massive scale, and smoke-free policies in most public places. These efforts are intended to change the beliefs, attitudes and behaviors of people by providing them with more information on the negative health implications of smoking. Increasing the prices of tobacco reduces the amount that is consumed by smokers as well as discourages young people from beginning to smoke. Anti-smoking efforts also decrease the rates of secondhand smoke, which also has many negative health implications.[10] Additionally, a 2008 report issued on the national status of cancer by the Journal of the National Cancer Institute stated that the incidence and death rates of lung cancer among males was decreasing and was leveling out for females, largely due to state tobacco control programs conducted in the past.[11]

Within the US, widespread public health campaigns have provided the general public with knowledge about the health risks associated with smoking. These anti-smoking campaigns have helped shape the relationship between culture and smoking by making tobacco consumption something that is broadly discouraged. In 2014, an anti-tobacco public education campaign called Truth relaunched in the US. The new campaign targeted youth and young adults between the ages of 15 and 21 in hopes of curbing the ongoing tobacco epidemic that was present. Studies have found that public education mass media campaigns, like Truth, have significant social impacts. Research suggests that the Truth campaign helped change the attitudes and behaviors associated with tobacco consumption, especially among youth and young adults.[12] Like the US, a lot of other nations around the world also partake in anti-smoking actions at the governmental level, however, there are still many cultures present where smoking is the norm, especially for males.[13]

Cultural differences present in various parts of the world results in vastly disparate smoking rates.[14] Countries in Asia have the highest smoking rates, with fewer smokers in the Americas and Western Europe. Indonesia has the highest rates with 76.2 % of Indonesian men smoking, and Ethiopia has the lowest rates with only 8.9% of Ethiopian men smoking.[15] Results from a study conducted in 2013 on social influences of smoking among Chinese Americans and mainland Chinese, found many social factors influence smoking behavior which include cultural beliefs, gender roles, and family relationship dynamics. The study also found that current smokers in China were heavily influenced by their grandparents which further highlights the significance social relationships have on tobacco consumption.[16]

Cultural influences on smoking are also present through differences in smoking rates between genders. During the early twentieth century there was widespread social disapproval of women smoking in the US. Women were therefore less likely to smoke than men. It was not until the mid-twentieth century that women in the US gained enough social acceptance to feel comfortable smoking which contributed to an increase in smoking rates among women.[17] In other nations such as Africa, Southeast Asia, the western Pacific and the eastern Mediterranean, males are still more likely to smoke than females due to a lack of female social acceptance. Within these nations, smoking is viewed as a “manly” act and is often labeled as inappropriate for women.[18]

One significant cause of the link between smoking and culture is religion. Most religions value human well-being highly and although they do not prohibit smoking, they do disapprove of it.[19] Christianity, Judaism, Buddhism, Islam and Hinduism are all against smoking. In fact, many studies have shown that people who are involved in religious activities tend to have lower smoking rates than people who are not involved.[20] A study conducted in 2014 found that attending religious services once per week or greater as compared to never was significantly associated with smoking cessation over time among middle-aged, urban adults in Baltimore, Maryland.[21] These findings suggest that religious activities can both prevent and help stop the use of tobacco, further demonstrating the significance of social factors in relation to tobacco consumption.

            According to the CDC, African American youth and young adults have significantly lower prevalence of cigarette smoking than Whites. African Americans tend to smoke fewer cigarettes per day, and initiate smoking at a later age when compared to Whites.[22] These differences can be partially due to the different cultural norms present between the two groups. In African-American communities, cultural norms oppose youth smoking, and youth smoking is correspondingly lower in these communities. Studies have found that African-American households are more likely than white households to set explicit rules about smoking and to discuss these rules with their children. Compared to white parents, African-American parents also felt more empowered to affect their children’s behaviors and were more likely to actively participate in anti-tobacco socialization within the home. Among the African-American parents, 98% reported 18 years or older to be an appropriate age for teens to decide whether or not they want to start using tobacco, whereas 26% of white parents thought 16 years was an appropriate age.[23] Additionally, African-American children residing in African-American communities tend to have lower smoking rates than those residing in white communities.[24]

In 1950, the British Medical journal published one of the first widely recognized case control studies linking cigarettes and lung cancer. This ushered in a wave of research on the physiologically addictive nature of nicotine and the presence of carcinogens in cigarette smoke. In response to these studies, tobacco companies began running “pro-cigarette” campaigns throughout the 1950’s that aimed to challenge these reputable studies and claim that cigarettes do not cause cancer.[25] These campaigns denounced scientific studies that found connections between cigarettes and lung cancer. In the 21st century, the unethical nature of these advertisements is recognized and tobacco companies are forced to tell the truth about their products in advertisements/products. Many forms of tobacco products are labeled with a “Surgeon General’s Warning” in the United States. Some products may reference death or contain images of tar-filled lungs on their packaging. The fact that these efforts are not entirely successful is evidence of the addictive power of nicotine.

Despite stricter market regulations that prevent corporations from lying, claims like these still exist today in various forms. The tobacco corporations are infamous for valuing profit over the health of their customers. A recent study conducted by the IARC on the effects of secondhand smoking found a significant link between second hand smoke and lung cancer. Although the study was considered to be rigorous and sound, tobacco companies claim that it’s “false and misleading.”[26] The anti-smoking movement is relatively young compared to the history of smoking itself and it makes sense that tobacco companies try to challenge the authenticity of studies from an emerging field. Even though they must label their products with warnings of lung cancer, tobacco companies are constantly and maliciously looking for ways to make smoking seem healthier. A prominent example of this was the introduction of “light” cigarettes which were sold as healthier alternatives to traditional cigarettes. Of course, light cigarettes still expose users to cancer forming carcinogens, but it is easy to spread misinformation among a populace that is not likely to investigate. Yet, tobacco companies have been keen on subtly tricking smokers into thinking that lighter cigarettes are less likely to lead to cancer. Through this it is clear how these corporations view their customers as dispensable and this reveals a lack of value of life in corporate ethic.

Tobacco companies also target the nation’s youth as future customers via advertising techniques that normalize tobacco products and cater towards children. Since the average smoke obtains cigarettes in a retail environment, much of this marketing is conducted through retail displays which are bright, ornamented and prominently displayed on store walls[27]. The ethical implications of advertising a dangerous drug shift when children under the smoking age are being conditioned and psychologically invested in tobacco as a commodity. The majority of tobacco users begin smoking/experimenting at young ages and major tobacco companies will commoditize their product to appeal to younger demographics. Since older smokers are more likely to already be addicted, the tobacco companies are less worried about appealing to older customers rather than the newly recruited smokers who will become addicts in the future.[28]

In a capitalistic economy, it is legal and common for corporations to target specific demographic groups as potential customers. Yet the ethics of racial targeting comes into question when the product being sold is addictive and potentially lethal. Since the early 1980’s there has been substantial evidence that large tobacco companies intentionally market their products to minorities. In 1990, R.J. Reynolds Tobacco planned on releasing a cigarette called “Uptown” which was specifically developed and marketed towards the African American community in Philadelphia. It was designed to be a “classy” cigarette that served as a representation of higher living and success. A R.J Reynolds employee described how “Uptowns” created a “fantasy world that Black young adult smokers can be part of.” Although the controversial release of “Uptowns” was eventually halted, it is just one example of the thousands of tobacco products that are deliberately and carefully crafted to sell to a specific minority group[29]. While the tobacco company’s’ motives for targeting minorities with tobacco may seem purely economic, the ultimate means through which these tobacco products are tailored towards minorities exposes layers of systemic racism in the entire industry.

These targeted efforts have implications on the types of people that die as well as the number of people that are affected by the tobacco industry. Reviewing both the scientific, ethical, and cultural perspectives that surround death as a result of tobacco allows it to be revealed as a danger on all fronts. Although grouped in with the “easily” preventable ways to die, I think the numbers would suggest that this topic needs more discussion.

Amber Williams

Jared Goldberg

Cameron Beals

[1] Husten, C. “Tobacco Use.” Encyclopedia of Death and the Human Experience. Edited by Clifton D. Bryant and Dennis L. Peck. doi: http://dx.doi.org.libproxy.lib.unc.edu/10.4135/9781412972031.n315

[2] Kabir, Zubair, Gregory N. Connolly, Luke Clancy, Ahmedin Jemal, and Howard K. Koh. “Reduced Lung Cancer Deaths Attributable to Decreased Tobacco Use in Massachusetts.” Cancer Causes & Control 18, no. 8 (June 22, 2007): 833-38. Accessed April 4, 2019. doi:https://doi.org/10.1007/s10552-007-9027-3.

[3] Husten, C. “Tobacco Use.” http://dx.doi.org.libproxy.lib.unc.edu/10.4135/9781412972031.n315

[4] Husten, C. “Tobacco Use.” http://dx.doi.org.libproxy.lib.unc.edu/10.4135/9781412972031.n315

[5] Husten, C. “Tobacco Use.” http://dx.doi.org.libproxy.lib.unc.edu/10.4135/9781412972031.n315

[6] “Tobacco Control Interventions | Health Impact in 5 Years | Health System Transformation | AD for Policy | CDC.” Centers for Disease Control and Prevention. 2017. Accessed April 04, 2019. https://www.cdc.gov/policy/hst/hi5/tobaccointerventions/index.html.

[7] The Health Consequences of Smoking– 50 Years of Progress.Report. U.S. Department of Health and Human Services. 2014. Accessed April 4, 2019. https://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html.

[8] Chakraborty, S., K. Balanda, Ij Perry, and Z. Kabir. “P72 Cancer and Cardiovascular Disease (CVD) Burden Attributable to Tobacco Use and Alcohol Consumption in the Republic of Ireland between 1990 and 2013.” Journal of Epidemiology and Community Health70, no. Suppl 1 (September 13, 2016): A85-86. Accessed April 4, 2019. doi:10.1136/jech-2016-208064.171.

[9] Quora. “How The Tobacco Industry Has Changed Its Marketing Strategy Across The Globe.” Forbes. July 25, 2018. Accessed April 04, 2019. https://www.forbes.com/sites/quora/2018/07/25/how-the-tobacco-industry-has-changed-its-marketing-strategy-across-the-globe/.

[10] “Tobacco Control Interventions” CDC. 2017.

[11] Jemal, Ahmedin, Michael J. Thun, Lynn A. G. Ries, Holly L. Howe, Hannah K. Weir, Melissa M. Center, Elizabeth Ward, Xiao-Cheng Wu, Christie Eheman, Robert Anderson, Umed A. Ajani, Betsy Kohler, and Brenda K. Edwards. “Annual Report to the Nation on the Status of Cancer, 1975–2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control.” JNCI: Journal of the National Cancer Institute 100, no. 23 (December 2008): 1672-694. Accessed April 4, 2019. doi:10.1093/jnci/djn389.

[12] Vallone, Donna, Jennifer Cantrell, Morgane Bennett, Alexandria Smith, Jessica M. Rath, Haijun Xiao, Marisa Greenberg, and Elizabeth C. Hair. “Evidence of the Impact of the truth FinishIt Campaign.” Nicotine and Tobacco Research 20, no. 5 (2017): 543-551. https://www.ncbi.nlm.nih.gov/pubmed/28575421

[13] “Culture and Smoking: Do Cultural Norms Impact Smoking Rates?” Tobacco Free Life. Accessed April 08, 2019. https://tobaccofreelife.org/resources/culture-smoking/

[14] “Culture and Smoking.” Tobacco Free Life.

[15] “Prevalence of Tobacco Smoking.” World Health Organization. Accessed April 08, 2019. http://gamapserver.who.int/gho/interactive_charts/tobacco/use/tablet/atlas.html.

[16] Ma, Grace X., Steven E. Shive, Xiang S. Ma, Jamil I. Toubbeh, Yin Tan, Yajia J. Lan, Chengkai K. Zhai, and Xiaofang Pei. “Social influences on cigarette smoking among mainland Chinese and Chinese Americans: a comparative study.” American journal of health studies 28, no. 1 (2013): 12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914219/

[17] Waldron, Ingrid. “Patterns and causes of gender differences in smoking.” Social science & medicine 32, no. 9 (1991): 989-1005. https://www.ncbi.nlm.nih.gov/pubmed/2047903

[18] “Culture and Smoking.” Tobacco Free Life.

[19] Garrusi, Behshid, and Nouzar Nakhaee. “Religion and smoking: a review of recent literature.” The International Journal of Psychiatry in Medicine 43, no. 3 (2012): 279-292. doi: 10.2190/PM.43.3.g

[20] “Culture and Smoking.” Tobacco Free Life.

[21] Brown, Qiana L., Sabriya L. Linton, Paul T. Harrell, Brent Edward Mancha, Pierre K. Alexandre, Kuan-Fu Chen, and William W. Eaton. “The influence of religious attendance on smoking.” Substance use & misuse 49, no. 11 (2014): 1392-1399. doi: 10.3109/10826084.2014.912224

[22] “Smoking and Tobacco Use | African Americans and Tobacco Use.” Centers for Disease Control and Prevention. Accessed April 08, 2019. https://www.cdc.gov/tobacco/disparities/african-americans/index.htm#ref.

[23] Clark, Pamela I., Annemarie Scarisbrick-Hauser, Shiva P. Gautam, and Sarah J. Wirk. “Anti-tobacco socialization in homes of African-American and white parents, and smoking and nonsmoking parents.” Journal of Adolescent Health 24, no. 5 (1999): 329-339. https://www.ncbi.nlm.nih.gov/pubmed/10331839

[24] “Culture and Smoking.” Tobacco Free Life.

[25] Palazzo, Guido, and Ulf Richter. “CSR business as usual? The case of the tobacco industry.” Journal of Business Ethics 61, no. 4 (2005): 387-401. https://doi.org/10.1007/s10551-005-7444-3

[26] Ong, Elisa K., and Stanton A. Glantz. “Tobacco industry efforts subverting International Agency for Research on Cancer’s second-hand smoke study.” The Lancet 355, no. 9211 (2000): 1253-1259. doi: 10.1016/S0140-6736(00)02098-5

[27] Hoek, J., H. Gifford, G. Pirikahu, G. Thomson, and R. Edwards. “How do tobacco retail displays affect cessation attempts? Findings from a qualitative study.” Tobacco control 19, no. 4 (2010): 334-337. http://dx.doi.org/10.1136/tc.2009.031203

[28]Reid, Robert J., N. Andrew Peterson, John B. Lowe, and Joseph Hughey. “Tobacco outlet density and smoking prevalence: Does racial concentration matter?.” Drugs: education, prevention and policy 12, no. 3 (2005): 233-238. https://doi.org/10.1080/09687630500035485

[29] Balbach, Edith D., Rebecca J. Gasior, and Elizabeth M. Barbeau. “RJ Reynolds’ targeting of African Americans: 1988–2000.” American Journal of Public Health 93, no. 5 (2003): 822-827. doi: 10.5993/AJHB.42.1.11

Citations for Images:

[1] Tippett, Rebecca. “Mortality and Cause of Death, 1900 v. 2010.” Carolina Demography. June 16, 2014. Accessed April 04, 2019. https://demography.cpc.unc.edu/2014/06/16/mortality-and-cause-of-death-1900-v-2010/.

[2]Roser, Max, and Hannah Ritchie. “Cancer.” Our World in Data. July 03, 2015. Accessed April 4, 2019. https://ourworldindata.org/cancer.

[3]Keller, Kate. “Ads for E-Cigarettes Today Hearken Back to the Banned Tricks of Big Tobacco.” Smithsonian.com. April 11, 2018. Accessed April 07, 2019. https://www.smithsonianmag.com/history/electronic-cigarettes-millennial-appeal-ushers-next-generation-nicotine-addicts-180968747/.

Leading Causes of Death Among College Students

When you think of a college student the first thought that comes to mind is probably not what they are most likely to die from. According to the study Causes of Mortality Among College Students, the three most common causes of death among college aged students, ages 18 -24, are accidents, including alcohol related injuries, suicide, and cancer[1]. Here we examine the scientific, cultural, and ethical aspects of all of these, and how college students are affected by them.

Accidents are the most common cause of death among college age students and there are countless variations of these incidents, but the largest subgroup of accidents killing college age adults are alcohol related. Alcohol is a drug, specifically a depressant, consumed by over 60% of college students on at least a monthly basis[2]. Depressants are drugs that reduce the function of some aspect of the nervous system to levels below what normally occur when the body is not under the influence of a drug. Alcohol in particular is a deadly depressant because it affects our brain’s ability to complete more highly integrated tasks like driving a car or performing some other skilled task[3]. Even in the smallest of doses, an individual who consumes alcohol can be considered impaired because there is no threshold of Blood Alcohol Content, BAC, that once reached with induce impairment[4]. BAC measures the amount of alcohol in grams of ethanol per 100 millimeters of blood, but it is not a perfect measure because level of impairment can depend on age, weight, time period of consumption and a number of other factors[5].

Alcohol can kill both actively, in the sense that the alcohol itself does the killing, and passively, meaning that impairment due to alcohol leads to the death of an individual. In the passive sense of a car crash, reduced ability to drive can be caused by a BAC of 0.03% or less, the equivalent of 1 to 2 drinks[6] [7]. At a BAC level of 0.05% drivers start to ignore rules and instructions on the road, and at a level of 0.08% or higher impairment is clearly demonstrated in drivers[8]. In the active sense, alcohol can kill by impairing brain function to the point where actions that are necessary for survival, such as breathing or a functioning gag reflex, stop working, this condition, known as alcohol poisoning, can be brought about through binge drinking[9].

Binge drinking is considered 4 or more drinks for females, and 5 or more for males, in one sitting. Binge drinking has become the culture of many colleges in past decades, and continues to affect students across the nation. One study found that college students engage in binge drinking more than their same-age non-college peers, proving that alcohol is a central part of college culture. Another study done over 2 years found that over “500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/ assaulted by another drinking student”[10]. In 2002, the National Institute of Heath sent a task force to research drinking across campuses, resulting in the article, A Call to Action: Changing the Culture of Drinking on U.S. College Campuses[11]. Since then, there has been a downward trend in alcohol-related traffic deaths, but non-traffic deaths and hospitalizations for overdoses involving alcohol have risen significantly[12]. What is it about the culture of college that leads to such dangerous engagement with alcohol?

A study that examined colleges in three countries (America, Argentina and Spain), determined that all three held similar beliefs about alcohol being central to the college experience, but important cultural differences create discrepancies in the expectations of how alcohol is consumed. In Europe (and Argentina), many students live at home, not ‘on campus’, which leads to different meanings of ‘college parties’[13]. Furthermore, alcohol is deeply rooted in Argentinian and Spanish culture, but used more tamely for family gatherings, meals, and celebrations. While alcohol is perceived as ‘normal’ across college settings, the intent for which it is used has been found more dangerous in the US than some other cultures.

Our society and media has created the belief that binge drinking is a central focus of attending college. According to the author, Miller DeMond, “the focus of alcohol awareness explains to students as they are entering college that it is acceptable to drink, despite the illegality of underage drinking. Coming onto the college scene, where students experience freedom to act for themselves like adults, drinking is not only encouraged but expected in college culture”[14]. The dangerous drinking culture created in colleges is encouraged outside of the universities themselves, and our society has a responsibility to change the way heavy drinking is perceived.

Currently, there seems to be an attitude of “we know you’re doing it but don’t let us catch you” around underage drinking in college. The National Institute on Alcohol Abuse and Alcoholism, one of the National Institutes of Health, said “Drinking at college has become a ritual that students often see as an integral part of their higher education experience.” In a survey, the NIAA found that over half of respondents (college students, age 18-22) had alcohol in the past month, and ⅔ had engaged in binge drinking.[15] It is clear the colleges need to educate incoming students about alcohol, however alcohol education for college students seems to focus more on doing it safely rather than preventing it all together. Programs such as AlcoholEdu are often presented to first years as they enter college. The Everfi site, where you can access AlcoholEdu, describes it as “inspiring students to make healthier decisions related to alcohol and other drugs.” [16] Presenting programs like these to students as soon as they enter college gives the impression that drinking in college is expected, contributing to the drinking culture that surrounds college life. Giving students an online course also allows them to skip through the course without really paying attention to its message. Colleges could instead include education about alcohol in orientations, and make students aware of the drinking culture that exists on college campuses, as well as the consequences of underage drinking, including alcohol related accidents.

A diagram visualizing binge drinking. https://www.pumphreylawfirm.com/blog/binge-drinking-on-college-campuses-the-dangers-associated-with-drinking-to-excess/

Suicide is the second most likely cause of death among college aged students. Suicide is a general term to describe a person that takes their own life, but it can be brought on by a myriad of factors including mental disorders, which themselves are also caused by a number of factors like stress or anxiety.[17] In fact, over 90% of those who commit suicide have some sort of mental disorder at the time of their death, and depression is the most common of those mental illnesses.[18] Depression is a mental illness that can be caused by disturbances in brain chemistry and it can be associated with genetic as well as environmental factors.

The brain is an amazingly complex organ responsible for every function of the human body. The brain is made up of cells called neurons which are in constant communication with each other via electrical impulses so that the body can react to the environment around it. Neurons communicate with each other through the use of neurotransmitters which travel the distance of the tiny gap between neurons, the synapse, so the message can continue to its destination. Depression can be caused by an imbalance of those chemical messengers within the synapse, specifically Glutamate, Serotonin, and Dopamine.[19] Glutamate is responsible for getting the signals between neurons to transmit, serotonin helps to regulate functions like sleep, mood, and hunger, and dopamine is associated with feelings of pleasure and addiction, as well as movement.[20] College can be a stressful and demanding time for young adults and there is no cookie cutter definition of depression or combination of factors that will lead to depression and therefore could be avoided. It is important to note that depression is not solely caused by an imbalance in neurotransmitters, this is just one of the many factors that can cause depression, which if untreated, can lead to suicide.[21]

College creates a unique culture of pressure, expectations, and instability that can leave students prone to mental health problems. According to a New York Times article, anxiety and depression are the most common mental health diagnoses among college students.[22] The culture of higher education can create an atmosphere of pressure from parents, teachers, and society to be flawless. The same NYT article cites, “[a] perception that one has to be perfect in every academic, co-curricular and social endeavor, can manifest as demoralization, alienation or conditions like anxiety or depression.[23]” This culture poses potential danger to students, as they become afraid of failure, and sometimes define themselves by it. Unique to the university of Pennsylvania, but relatable to all college students, Penn Face, “describes the practice of acting happy and self-assured even when sad or stressed” and is, “a potentially life-threatening aspect of campus culture.” [24] The culture of perfectionism seen in many colleges creates concern for mental health issues, and self-harm.

Along with the pressure of perfectionism, the instability associated with college culture leaves students highly vulnerable. Dr. Uchida, of Fukushima University, quotes, “youths are expected to rapidly form their identities and are exposed to psychosocial risk factors such as academic stress and relationship troubles, which are associated with psychiatric difficulties and suicide.” [25] Being thrown into a culture of uncertainty while away from support systems can lead students to develop mental health issues they might not have at home. The American College Health Association administered a survey across the country and found that 28.4% of students, diagnosed or not, “felt so depressed that it was difficult to function.” [26] One Huffington Post headline says it all: In the Name of College! What Are We Doing to Our Children? [27]

While many college students today will experience a mental health crisis at some point, not all are aware of the resources available to them, or even the signs to look out for regarding their mental health and the mental health of their peers. According to a study done by the National Institute on Mental Illness (NAMI), of college students living with mental illness, 73% experienced a mental health crisis, yet 35% did not inform their school of the crisis.[28] When students enter college their freshman year, there is a lot of emphasis put on things like drinking, drugs, and sexual assault. These are all important topics, but it is also important that students be made aware of mental health. Students need to be educated on signs of mental illness in themselves and others, what to do, and where they can go for help. When asked about what mental health resources are needed on campus, one of the top things students listed was “Mental health information during campus tours, orientation, health classes and other campus-wide events.”[29]

According to the same NAMI study, over 45% of students who withdrew due to mental illness did not seek help for their conditions. The number one reason cited for not seeking help was fear of stigma[30]. Despite a growing awareness, there is still a stigma surrounding mental illness and its treatment. This stigma is even more pronounced around illnesses such as schizophrenia. The onset of schizophrenia typically occurs in the late teens to twenties or thirties[31], so it is important it be included in college students’ mental health education. A study done in the United Kingdom showed that 70% of people viewed individuals with schizophrenia as “dangerous or unpredictable.”[32] Another study showed that the stress caused by stigma may actually contribute to the transition to schizophrenia in young people who are at risk of a psychotic illness.[33] Of the mental health education that is available to students, most of it is focused on illnesses like depression and anxiety. While it is important to reduce stigma around all forms of mental illness, it is especially important with more serious conditions such a schizophrenia. Increasing awareness and removing the stigma will allow students to feel more comfortable seeking treatment and support, and hopefully reduce the number of young adults that die by suicide.

UNC Counseling and Psychological Services. https://www.dailytarheel.com/article/2018/01/higher-ed-suicide-0121

Cancer is the third most likely cause of death for college aged students with some of the most common diagnosis’s being brain cancer, leukemia and liver cancer[34]. Specific cancer such as the ones listed above have their own specific features and locations, but it is the basic function of the general cancer cell that can be associated with the majority of cancer related deaths[35]. Cancers form in a complicated process that starts with the genetic mutation of just one cell within the body. Every cell operates on some sort of ‘cell clock’ that dictates when a cell should or should not replicate based on the presence or absence of specific hormones. If this process is disturbed by some sort of factor, the cell could over replicate and form the foundations of a cancerous tumor[36]. Within the body of over-replicating cells, more genetic mutations can occur resulting in even more abnormal cells with broken replication functions[37]. If the tumor remains in this state of abnormal replication without breaking the barriers within the tissue then it might never affect the individual, this is known as a situ cancer[38]. It is when more mutations occur that cause the tumor to become malignant that puts a person at serious risk.

A tumor is considered malignant when it has mutated to the point where it has the ability to spread to other areas and organs within the body[39]. The highly prolific cells of the original tumor can establish themselves within another part of the body creating another deadly tumor. What actually causes death in an individual is when one of these malignant tumors causes a disruption in the function of an organ like the liver without which we cannot survive. Cancers are categorized into grades and stages based on their type, size, location(s), and a variety of other factors to give doctors and patients an idea on the severity of their condition[40].

When someone is diagnosed with a terminal illness, they may wish to hasten their death in order to die with dignity or not prolong suffering for them and their family. This process is called assisted suicide or assisted death. Right now, there are only seven states that allow assisted death, and one that allows physician-assisted death. In the states where it is legal, assisted death is available to anyone who is over 18, a legal resident of the state, mentally competent, and diagnosed with an illness that will lead to death in six months or less.[41]

There has been an improvement in cancer survival rates for children and adults in recent decades, but survival rates in young adults have not seen much of a change[42]. Treatments such as chemotherapy and radiation therapy can have both short and long-term side effects on young adults[43]. Cancer treatment is also expensive. It was found that patients receiving cancer treatment are 2.5 times more likely than healthy people to declare bankruptcy. Treatment can cost up to $150,000, and still runs around $4,000 with insurance[44]. This can cause more stress for the patient and the family, especially in college-age people as they are already worrying about cost of schooling. College students have already been trusted to decide where they want to attend school, what they want to major in, and what they want the path of their life to look like. They should also be trusted to decide how they want their life to end in the face of a terminal illness.

In college, students are often victims of the invincibility fable: that nothing bad will happen to themselves, or they are in other words, invincible. However, college culture can make adolescents ages 18-24 more prone to cancer than they might think. The culture of college can be one filled with bad health decisions, such as unhealthy eating and drinking alcohol or smoking. According to the National Institute of Health, “Tobacco use and poor nutrition are widely acknowledged as cancer risks”[45]. Furthermore, in a recent study, it was estimated that women who drink daily had a 13% increased risk for breast cancer[46]. Additionally, breast cancer is the number one cause of cancer fatalities in college aged women[47]. With all these risk factors, it is extremely important to educate students about cancer, and the ways in which college culture can put them at risk.

Here at UNC, we have a strong cultural presence of breast cancer awareness. The ZTA sorority promotes their national philanthropy, Think Pink, which seeks to raise awareness about breast cancer. They hold multiple events with the goal to, “spread education and awareness as ZTA members distribute ribbons, breast self-examination cards, and informational packets”[48]. While breast cancer awareness is prevalent on the UNC campus, as “pink ribbons adorn the backpacks of hundreds of students”, there could definitely be more cancer education surrounding the multiple other kinds, and risk factors college students are prone to[49].

Despite all this talk about the most likely causes of death in college students, college itself is not a deadly environment.  According to the original study, Causes of Mortality Among College Students, the numbers show that out of 100,000 college aged students, the mortality rates were 10.8 accident related deaths, 6.17 cancer related deaths, and 1.94 suicide related deaths.[50] It is important to be aware of these numbers so as to no become another statistic, but with safety, college is a time of great exploration and development for any young adult ages 18-24.

UNC Breast Cancer Philanthropy. http://unczta.com/wp-content/uploads/2018/05/IMG_5579.jpg

 

Footnotes:

[1] Turner, James C., E. Victor Leno, and Adrienne Keller. “Causes of Mortality Among American College Students: A Pilot Study.” Journal of College Student Psychotherapy 27, no. 1 (January 1, 2013): 31–42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4535338/.

[2] Delphi Behavioral Health Group. “College Alcoholism.” Alcohol Rehab Guide, December 10, 2018. https://www.alcoholrehabguide.org/resources/college-alcohol-abuse/.

[3] J.D. OGDEN, E., and H.  MOSKOWITZ. “Effects of Alcohol and Other Drugs on Driver Performance.” Traffic Injury Prevention 5, no. 3 (August 11, 2010): 185–198. https://www.tandfonline.com/doi/full/10.1080/15389580490465201?scroll=top&needAccess=true

[4] Ibid., 185-198

[5] Ibid., 185-198

[6] Ibid., 185-198

[7] Stim, Richard. “Blood Alcohol Level Chart: Are You Too Drunk to Legally Drive?” Driving Laws. NOLO, 2019. https://dui.drivinglaws.org/drink-table.php.

[8] J.D. OGDEN and MOSKOWITZ, “Causes of Mortality”, 185-198.

[9] Stanford University Student Affairs. “Alcohol Overdose/Poisoning.” Office of Alcohol Policy and Education. Stanford University, n.d. https://alcohol.stanford.edu/alcohol-drug-info/staying-safe/alcohol-overdosepoisoning.

[10] Hingson, Ralph, Timothy Heeren, Michael Winter, and Henry Wechsler. “MAGNITUDE OF ALCOHOL-RELATED MORTALITY AND MORBIDITY AMONG U.S. COLLEGE STUDENTS AGES 18-24: Changes from 1998 to 2001.” Annual Review of Public Health 26 (2005): 259–179. https://search-proquest-com.libproxy.lib.unc.edu/docview/235227942?pq-origsite=summon.

[11] Ibid., 259-179

[12] Hingson, Ralph, Wenxing Zha, and Daniel Smyth. “Magnitude and Trends in Heavy Episodic Drinking, Alcohol-Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations Among Emerging Adults of College Ages 18–24 in the United States, 1998–2014.” Journal of Studies on Alcohol and Drugs 78, no. 4 (2017). https://www-jsad-com.libproxy.lib.unc.edu/doi/10.15288/jsad.2017.78.540.

[13] Bravo, Adrian, Matthew  Pearson, Angelina Pilatti, Jennifer Read, Laura Mezquita, Manuel Ibáñez , and Generós Ortet. “Cross-Cultural Examination of College Drinking Culture in Spain, Argentina, and USA: Measurement Invariance Testing of the College Life Alcohol Salience Scale.” Drugs and Alcohol Dependence 180 (November 1, 2017): 349–55. https://www-sciencedirect-com.libproxy.lib.unc.edu/science/article/pii/S0376871617304477

[14] DeMond, Miller. Alcohol in Popular Culture : An Encyclopedia. Greenwood, 2010. http://vb3lk7eb4t.search.serialssolutions.com.libproxy.lib.unc.edu/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.title=Alcohol+in+Popular+Culture+%3A+An+Encyclopedia&rft.au=Miller%2C+DeMond&rft.au=Yelin%2C+Joel&rft.atitle=College+Drinking+Culture&rft.date=2010-01-01&rft.isbn=9780313380495&rft.spage=61&rft.epage=63&rft.externalDocID=CX1760300049&paramdict=en-US.

[15] “College Drinking.” National Institute on Alcohol Abuse and Alcoholism. Dec 2015. https://pubs.niaaa.nih.gov/publications/CollegeFactSheet/Collegefactsheet.pdf.

[16] “Alcohol Awareness, Prevention and Training for College Students.” Everfi. N.d. https://everfi.com/offerings/listing/alcoholedu-for-college/.

[17] National Institute of Mental Health. “Suicide in America: Frequently Asked Questions.” National Institute of Mental Health. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, n.d. https://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml.

[18] Caruso, Kevin. “Suicide Causes.” Suicide.org. Suicide.org, n.d. http://www.suicide.org/suicide-causes.html.

[19] Nucleus Medical Media. “Brain and Mental Health.” Youtube. Nucleus Health. May 15, 2015, https://www.youtube.com/watch?v=MyxCjnHqBq8.

[20] Ibid.

[21] Smith, Melinda, Lawrence Robinson, and Jeanne Segal. “Antidepressant Medication What You Need to Know About Depression Medication.” Help Guide, December 2018. https://www.helpguide.org/articles/depression/antidepressant-medication.htm/.

[22] Scelfo, Julia. “Suicide on Campus and the Pressure of Perfection.” The New York Times, July 27, 2015. https://www.nytimes.com/2015/08/02/education/edlife/stress-social-media-and-suicide-on-campus.html.

[23] Ibid.

[24] Ibid.

[25] Uchida, Chiyoko, and Mai Uchida. “Characteristics and Risk Factors for Suicide and Deaths Among College Students:  A 23-Year Serial Prevalence Study of Data From 8.2 Million Japanese College Students.” The Journal of Clinical Psychiatry 78, no. 4. Accessed April 7, 2019. https://www-psychiatrist-com.libproxy.lib.unc.edu/jcp/article/Pages/2017/v78n04/v78n0406.aspx.

[26] Castillo, Linda. “Introduction to the Special Issue on College Student Mental Health.” Journal of Clinical Psychology 69, no. 4 (March 21, 2013). https://onlinelibrary-wiley-com.libproxy.lib.unc.edu/doi/full/10.1002/jclp.21972.

[27] Scelfo, Suicide on Campus

[28] Gruttadaro, Darcy and Crudo, Dana. “College Students Speak: A Survey Report on Mental Health.” National Alliance on Mental Health. (2012).

[29] Ibid.

[30] Ibid.

[31] “Schizophrenia.” National Institute of Mental Health. May 2018. https://www.nimh.nih.gov/health/statistics/schizophrenia.shtml.

[32] Silva, R., Albuquerque, S., Muniz, A. V., Filho, P., Ribeiro, S., Pinheiro, P. R., and Albuquerque, V. “Reducing the Schizophrenia Stigma: A New Approach Based on Augmented Reality.” Computational Intelligence and Neuroscience (November 2017). Doi: 10.1155/2017/2721846.

[33] Ibid.

[34] National Cancer Institute. “Adolescents and Young Adults with Cancer.” National Cancer Institute. National Institute of Health, January 31, 2018. https://www.cancer.gov/types/aya.

[35] Weinberg, Robert A. “How Cancer Arises.” Scientific America 275, no. 3 (September 1996): 62–70. https://www.jstor.org/stable/24993349

[36] Ibid.

[37] Ibid.

[38] Ibid.

[39] National Cancer Institute, “Adolescents and Young Adults.”

[40] Cancer.net. “Stages of Cancer.” Cancer.net. ASCO, March 2018. https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/stages-cancer

[41] “How Death with Dignity Laws Work.” Death with Dignity. N.d. https://www.deathwithdignity.org/learn/access/.

[42] “Key Statistics for Cancers in Young Adults.” American Cancer Society. April 25, 2018. https://www.cancer.org/cancer/cancer-in-young-adults/key-statistics.html

[43] “How Are Cancers in Young Adults Treated?” American Cancer Society. April 25, 2018. https://www.cancer.org/cancer/cancer-in-young-adults/treating-cancers-in-young-adults.html

[44] Moore, Peter. “The High Cost of Cancer Treatment” The AARP Magazine

[45] Daher, M. “Cultural Beliefs and Values in Cancer Patients.” National Institute of Health. National Center for Biotechnology Information, April 2012. https://www.ncbi.nlm.nih.gov/pubmed/22628419

[46] Poon, Linda. “Can Fear Of Cancer Keep College Kids From Binge Drinking?” Radio. Public Health. National Public Radio, March 25, 2014.

[47] Ibid.

[48] “Chapter Philanthropy.” ZetaTauAlpha. Group Interactive Networks, 2019. http://unc.zetataualpha.org/chapter-philanthropy

[49] Ibid.

[50] Turner, Leno, and Keller, “Causes of Mortality,” 31-42.

 

By: Nick Belk, Katharine Degolian, Katie Barham

© 2019 Death & Dying III

Theme by Anders NorenUp ↑