Social Factors That Affect Good Health
Senior 1 · Biology
Social Factors That Affect Good Health
Lesson 5 of 5
25 min
At a family celebration in Rubavu, an older cousin hands 14-year-old Ishimwe a cup of banana beer and says, "Just one glass. Everyone here is drinking. Don't be a child." Later, behind the house, some older boys pass round a cigarette and something they call urumogi.
What would each of these do to a body that is still growing? And how can Ishimwe say no, and still enjoy the party with her family and friends? This lesson gives the biology first, then the law, then the skills.
Definition
Alcohol (ethanol, ): the psychoactive and toxic chemical in beer, wine, spirits and local brews such as urwagwa. It is a depressant and can cause dependence.
Tobacco: the dried leaves of the tobacco plant, smoked in cigarettes and pipes or used as snuff. Its smoke contains nicotine, a highly addictive stimulant, tar, a sticky mixture that causes cancer, and carbon monoxide, a poisonous gas that reduces the oxygen the blood can carry.
Cannabis (marijuana; urumogi in Kinyarwanda): preparations of the plant Cannabis sativa. Its main psychoactive chemical is THC (tetrahydrocannabinol).
Definition
Excessive use: using a substance so often or in such amounts that it damages health, relationships, school or work. Examples: heavy drinking on one occasion (binge drinking), or smoking every day.
Second-hand smoke: tobacco smoke breathed in by people near a smoker, who are harmed even though they do not smoke themselves.
Figure 1: Organs harmed by heavy or long-term use of alcohol (A), tobacco (T) and cannabis (C). Table 1 gives the effects.
Table 1: effects of heavy or long-term use, by body system
| Body system | Alcohol | Tobacco | Cannabis |
|---|---|---|---|
| Nervous (brain) | slows reactions, poor judgement and memory; dependence | nicotine is highly addictive and harms the developing adolescent brain (attention, learning) | impairs learning, memory and coordination; dependence; can worsen the mental illness schizophrenia |
| Respiratory (airways, lungs) | raises the risk of lung infections such as tuberculosis | chronic lung disease and lung cancer; second-hand smoke harms others | damages the windpipe and airways; bronchitis |
| Circulatory (heart, blood) | heart disease | heart disease and stroke | |
| Digestive (mouth to bowel, liver) | liver disease; cancers of the mouth, throat, oesophagus, liver and bowel | cancers of the mouth and throat; stained teeth and tooth decay | |
| Reproductive (fertility, pregnancy) | in pregnancy, lifelong harm to the baby's development | reduced fertility | in pregnancy, lower birth weight |
| Behaviour and safety | injuries, road crashes, violence, risky sexual behaviour | money spent on tobacco instead of food or school | road accidents; poor concentration at school |
An empty cell means the effect has not been well established, not that the drug is safe for that system. The WHO estimates that alcohol caused about 2.6 million deaths worldwide in 2019, and that tobacco kills more than 7 million people every year, including more than 1.6 million non-smokers exposed to second-hand smoke.
Worked example 1: reading Figure 1 and Table 1
(a) Which organ is tagged with all three substances in Figure 1? (b) Name one effect that harms people who do not use the drug themselves.
Answer: (a) the brain; (b) any one of these, e.g. second-hand smoke causes lung disease in non-smokers.
Worked example 2: what does smoking cost?
Suppose a packet of 20 cigarettes costs 1,500 Frw, and a man smokes 10 cigarettes a day. How much does he spend in a year?
Answer: about 274,000 Frw a year, money that a family could spend on food, school materials or health insurance. The WHO notes that tobacco pushes families into poverty in exactly this way. (The price is an example; real prices vary.)
If an adult offers you alcohol, cigarettes or drugs, they are breaking the law, not you. Tell a parent, teacher or another trusted adult. Crimes can also be reported to the Rwanda Investigation Bureau on its free line, 166.
Refusing is easier with a plan. There are three ways to respond when someone pushes you:
| Style | What it sounds like | Result |
|---|---|---|
| Passive | "Well... maybe just a little." (no eye contact) | you give in and feel bad |
| Aggressive | "Get away from me, you idiot!" | a fight; the friendship is hurt |
| Assertive | "No thanks, I don't drink. Let's go and dance." (calm voice, eye contact) | you keep your choice and your friends |
Assertive refusal in four steps: (1) say no clearly; (2) give a short reason if you want to ("I have a match tomorrow"); (3) suggest an alternative ("Let's get a soda"); (4) if the pressure continues, leave and join friends who respect your choice. You can repeat the same "No thanks" as many times as needed; you do not owe anyone a long explanation.
Definition
Assertiveness: stating your own choice or feelings clearly, calmly and respectfully, without giving in (passive) or attacking the other person (aggressive).
Refusal skills: ways of saying no to pressure, such as a clear "no", giving a reason, suggesting an alternative and walking away.
Worked example 3: Ishimwe's reply
Back to the celebration. Her cousin says, "Just one glass. Don't be a child." Plan an assertive reply using the four steps.
Why it works: she keeps her decision without insulting him, gives him an easy way to accept it, and moves to people who support her. Being asked to do something illegal or harmful is never a test of maturity.
How do cigarettes affect the body? (TED-Ed, 5 min). Watch for the effects on the mouth, lungs, heart and blood vessels shown in Figure 1, and for what happens in the body in the minutes, months and years after someone stops smoking.
In pairs, one person plays a friend who offers a cigarette at a football match, and the other refuses using the four steps. Then swap roles and try the other scenario: an older student offering cannabis on the way home from school. Afterwards, discuss: which words felt natural? Which reply would work best in your community?
Warning
Stay safe. Never get into a car or onto a moto with a driver who has been drinking or using drugs. If a friend has drunk so much alcohol that they cannot be woken, are vomiting or are breathing slowly, get an adult and medical help at once. Do not leave them alone.
Tip
Memory hook: "No, Reason, Other, Go." Say No, give a Reason, offer an Other activity, and Go if the pressure does not stop.
Practice: alcohol, tobacco and cannabis
Key points
Further reading for this unit
Sources and credits
Written by Ganzaa: the lesson text, Figure 1, the tables, the worked examples, the role-play and the practice questions.
