Correlates of Current Cigarette Smoking Among In-School Adolescents in Kut City

Issam S. Ismail, Khalida Abdul-Sattar*, Hassan A. Baey**
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Keywords : Correlates of Current Cigarette Smoking ,School Adolescents in Kut City
Medical Journal of Babylon  8:1 , 2014 doi:1812-156X-8-1
Published :2011

Abstract

Background : Cigarette smoking is a major ‘preventable’ cause of morbidity and mortality worldwide. Most adult smokers start smoking regularly some time before 18 years of age. Objectives : This study aimed at identify the prevalence of, and determine some of socio-demographic correlates of current cigarette smoking among in-school adolescents in Kut City. Methodology : We carried out a cross-sectional survey of 1067 students in classes 7th to 11th (ages: 13 to 20 years) in 14 intermediate and secondary schools in Kut City, Wasit Province in 2007, by using multistage probability sampling technique (stratified – simple), an anonymous self-completion questionnaire as a part of Global School-based Student Health Survey ‘GSHS’ questionnaire was used. Results : Results shows that cigarette smoking prevalent among male school students only, where 22.6% (140 student of 619) stated that they had smoked at least once and (13.4%, 83 student of 619) stated that they were currently smoking, so the data analysis involve male students only (sample size = 619). The percentage of students who were currently smoking increased gradually with age: 7% in 13-14 years old, 16% in 15-17 years old to 29% in 18-20 years old. Findings indicates that adolescents who had parents who smoked, were more likely to be smokers compared to adolescents who did not have parents who smoked ‘P <0.05’ this suggests that parents imitation plays an important role in initiation of smoking in adolescents. Fortunately, students who perceived parental supervision were less likely involved in smoking behavior ‘P <0.05’. Conclusion : Smoking is highly prevalent among secondary school male students in Kut City, while, there are no smokers among female students, and this is due to the behavior of a socially acceptable habit of smoking for men only and is not acceptable for women, and this gives immunity against the prevalence of smoking among female students. The smoking behavior of adolescents influenced by complicated interactions of varying sets of factors such as age, gender, parental smoking and parental supervision.

Introduction

about one in three or 1.1 billion people worldwide smoke. Among these, about 80% live in low and middle-income communities. By 2020, the tobacco epidemic is expected to kill more people than any single disease. By 2020, tobacco use will cause about 18% of all deaths in developed countries and about 11% of all deaths in developing countries. Tobacco use is a known or probable cause of about 25 diseases including : heart disease, cancer, stroke, and chronic obstructive pulmonary disease [1]. Cigarette smoking is considered the single most significant cause of preventable mortality and morbidity [2]. Tobacco smoking among adolescents is of public concern because of the immediate and long-term health sequel such as asthma, chronic cough, cancers, chronic obstructive airways disease and cardiovascular diseases [3]. If regular cigarette smoking is started at a very young age, e.g. in early teens, there is a 50% chance of early death as a result of cigarette-related mortality. Smokers who cease smoking at a younger age are safe from all smoking-related complications [4]. It is notable that, the younger the age at which smoking is initiated, the greater is the chance of becoming a heavy smoker, dying of cigarette-related diseases and suffering from stroke or lung cancer at a younger age. It has been noted that young individuals become addicted to cigarettes after only few cigarettes (for example less than 5 cigarettes). It has been demonstrated in different studies that young people consider smoking as a way of fighting and overcoming their problems and increasing their self-assurance and selfconfidence [4]. Many studies have shown significant association between smoking habit of family members especially that of the father’s smoking habit on a student’s smoking habit [5-8]. Furthermore, adolescents who have their peers or parents who also smoke may be living in environments that is more tolerant towards smoking [9]. Parental smoking could influence the availability and access to cigarette by the adolescent as well as affect tolerance to smoking by the parent. Adolescents who have parents who are less tolerant to smoking are less likely to smoke themselves [10]. Current smoking in youths was independently associated with parental smoking [11]. It is recognized that as the life expectancy of societies improve, the prominence of non-communicable chronic diseases, many of which are associated with cigarette smoking, will gain greater prominence. About 25% of all adolescents who experiment with cigarette smoking become regular smokers, and among the smokers, about one-third will die from a smokingrelated health disease [12]. This study aimed at identify the prevalence of, and determine some of socio-demographic correlates of current cigarette smoking among in-school adolescents in Kut City.

Materials and methods

Study Setting and Sampling
Technique
A school-based cross-sectional study
was conducted on school students in 7th
through 11th classes (ages: 13 to 20
years) in 14 intermediate and secondary
schools in Kut City/Iraq in 2007, by
using a self-completed questionnaire. A
multistage, probability sampling
technique was used, in which schools,
classrooms and students selected
randomly. The overall response rate was
90% (N = 1067), few students refused
participation, while the most were
excluded because of missing values.
Instrument
The questionnaire used in this study was
the Arabic version of Global Schoolbased
Student Health Survey ‘GSHS’
questionnaire. The students were asked
about their age, and smoking status :
How old were you when you first tried a
cigarette? coded as (0=I have never
smoked cigarettes to 6= 16 years old or
older). The second question was about
current cigarette smoking: During the past 30 days, on how many days did you
smoke cigarettes? coded as (0= 0 day to
6=all 30 days), (Cronbach ? .69). These
codes were collapsed into dichotomous
categories for purpose of analysis), and
the smoking status of their parents
(Parents cigarette smoking present : no,
yes). Perceived parental supervision:
During the past 30 days, how often did
your parents or guardians really know
what you were doing with your free
time? This question has 5-point Likert
scale coded as (0=never, 1=rarely,
2=sometimes, 3=most of times,
4=always). Responses were collapsed
into three levels for final analysis.
Data collection
Written consent was sought from The
General Directorate for Education in
Wasit Province and school management
and verbal consent from all study
participants. Students were briefed about
the purpose of the study, encouraged to
participate and to express their
experiences. After the students were
informed about the anonymity of the
survey, the questionnaire was
administered to the students in their
classrooms.
Statistical analysis
Data were entered into SPSS version
10.0 software for analysis. Descriptive
statistics, and the chi-squared test to
analyze the correlation between
variables, were used. P-value of less than
0.05 was considered significant.


Results

Results shows that cigarette smoking prevalent among male school students only, so the data analysis involve male students only (sample size = 619). Of the 619 male students aged 13-20 years who answered the questionnaire, 22.6% (140 student of 619) stated that they had smoked at least once in their life [Table 1], and 13.4% (83 student of 619), (59.3% of smokers) stated that they were currently cigarette smoking [Table 2].

Discussions

Prevalence of current cigarette smoking among the male school students in Kut City was 13.4%. Our estimates are greatly different from those reported by Seter et al. in the Kurdistan-Iraq as a part of Global Youth Tobacco Survey, so the prevalence of current cigarette smoking was 25.1% among male school adolescents [10]. Our prevalence is much lower than the prevalence of current cigarette smoking in USA, 22.9 % of male students had smoked cigarettes, a nationwide survey [14]. Emmanuel et al. indicates that of the Thai male school adolescents 22.0% reported being current smokers[9]. Also, Mehmet et al. suggests that of the 1113 Turkish highschool students, aged 12-18 years, the prevalence of male current cigarette smokers was 19.6% [2]. On the other hand our estimate were more higher than other settings, in Punjab, 3.3% (67 out of 2014) of Indian in-school adolescents were current cigarette smokers [3]. Current cigarette smoking among Ethiopian in-school adolescents was 4.5% among boys in 2003 [15]. Of 1872 school-age adolescents in Kafue, Zambia, 10.4% of males were current cigarette smokers [7]. This varying in prevalence suggests that socioeconomic, cultural factors impact on smoking may be different from one setting to another. Also, some methodological disparity must be considered in interpretation of these results. In our study with increasing age, the prevalence of cigarette smoking is also increasing, the same findings were suggested by N. Al-Haddad and R.R. Hamadeh. in their study in Bahrain where: the prevalence of cigarette smoking was 20.4%, 24.3% and 37.8% for those aged 13-15, 16-17 and 18-20 years respectively [12], the USA nationwide survey shows an increasing in smoking behavior with increasing age among school adolescents [14], also smoking behavior among Irish schoolchildren were increased with increasing the student’s age [16]. Unfortunately, and as has been consistently demonstrated elsewhere [3- 11, 13], analysis of this study indicates that parental smoking was associated with current smoking status among inschool adolescents. This suggests that imitation plays an important role in initiation of smoking in adolescents. In addition, parental smoking could influence the availability and access to cigarette by the adolescent as well as affect tolerance to smoking by the parent. Analysis shows significant negative association between good parental supervision and student’s smoking. Non-smokers perceived their parents knew of their where about more often than smokers. Perceived strong parental supervision will decrease their chances of being involved in smoking, our results supported by previous study [5]. Limitations of the study Our study has several limitations. Firstly, due to the cross sectional nature of the design, the factors that have been identified as associated with current cigarette smoking cannot be described in causative terms. Secondly, findings of the study may also be limited by not controlling for unmeasured confounders and effect measure modifiers. Thirdly, the study also recruited only school going adolescents in the study area, findings may therefore be representative of the in-school adolescents in Kut but not those out of school adolescents. Fourthly, our study was based on self report and therefore subject to respondent recall and deliberate misreporting. However the use of standardized terms and classifications will help ensure that the data collected are both valid and reliable

Conclusions

Current cigarette smoking is highly prevalent among secondary school students in Kut City. Parental smoking increases the risk of current cigarette smoking among school students, whilst parental supervision was a protective factor against cigarette smoking. Smoking behavior was increased with age. In this study it was observed that smoking may start as early as seven years of age and this shows us efforts to prevent smoking must be started in the preschool period and continued in schools from primary school in a regular program. Large-scale studies are needed to estimate smoking behavior among school students according to residency (urban vs. rural). Annual surveillance is very important to make a base-line data and to evaluate the effective of any preventive programs or interventions

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