1 Division of Epidemiology and Bio Statistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
Correspondence: Shafquat Rozi, Division of Epidemiology and Bio Statistics, Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan E-mail: shafquat.rozi@aku.edu
SirsTobacco use is the single most important preventable cause of disease and causes 3.5 million premature deaths worldwide. Tobacco use primarily begins in early adolescence, reportedly before the time of high school graduation.1 Factors that commonly play a role in initiation of smoking among adolescents include social factors, smoking among family members, peers, teachers, psychological relaxation, pleasure, and economic factors.2,3 In this communication we report the prevalence of and factors associated with smoking among adolescents in inner city Karachi, Pakistan. Self-reported smoking status was assessed based on a 30-day prevalence of cigarette smoking (whether or not one had smoked a cigarette in the past 30 days).4 A two-stage cluster sample stratified by school type was used. We recruited 772 male secondary school students from 33 schools (17 public and 16 private) in inner city Karachi. A structured questionnaire was administered by trained data collectors.
Mean (±SD) age (years) of students was 14.8 (±0.1). The mean (±SD) age (years) of smoking initiation was 13.1 (±0.2). The overall prevalence of smoking among school-going male adolescents was 13.7%. Prevalence of smoking among male students in public and private schools was 18.3% and 8.1%, respectivelyperhaps because of improved information dissemination and greater stress on health education in private schools compared with public schools. In all, 62% of adolescents reported their reason for smoking as enjoyment, while 18% claimed to have been influenced by advertisements to begin smoking. The majority of students (61.3%) were smoking with their friends. In this study adolescents also reported family tobacco use: father 19.8%, mother 27.8%, brother 21.0%, and uncle 27.1%. Multiple logistic regression analysis of factors associated with smoking revealed that after adjustment for age, ethnicity, and place of residence, students in public schools were more likely to be smokers compared with those in private schools (adjusted odds ratio [OR] = 1.6; 95% CI: 1.0, 2.7). Adolescents were more likely to be smokers if their peers were smokers (adjusted OR = 6.2; 95% CI: 3.91, 9.9). Boys who spent most of their leisure time outside their homes were more prone to smoke cigarettes (adjusted OR = 3.9; 95% CI: 1.2, 13.2) as were those who had a smoker in the family (adjusted OR = 1.7; 95% CI; 1.1, 2.8). During adolescence, tobacco use by peers may create a positive image of smoking and create easy access to cigarettes, especially in developing countries where there are no restrictive laws on the sale of cigarette to minors. The findings presented in this study are consistent with other studies conducted on adolescent smoking behaviour, which showed that parents, siblings, and peers are powerful influences for adolescent smoking.5 Smoking is usually initiated during adolescence and being amenable to behaviour modification it should become a public health priority to educate adolescents and parents regarding hazards of smoking in Pakistan and other developing countries.
References
1 Tobacco use among school personnel in Bihar, India. Tobacco Control 2002;11:8285.
2 Avenevoli S, Merikangas KR. Familial influences on adolescent smoking. Addiction 2003;98(Suppl.1):120.[Medline]
3 Sussman S, Dent CW, Stacy AW et al. Peer-group association and adolescent tobacco use. J Abnorm Psychol 1990;99:34952.[CrossRef][ISI][Medline]
4 Rigotti NA, Regan S, Majchrzak NE, Knight JR, Wechsler H. Tobacco use by Massachusetts public college students: long term effect of the Massachusetts Tobacco Control Program. Tobacco Control 2002;11(Suppl.2):2024.
5 Avenevoli S, Merikangas KR. Familial influences on adolescent smoking. Addiction 2003;98(Suppl.1):120.[Medline]
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