Predictors of smoking among primary and secondary school students in Botswana

Assessing the Impact of a Health Education Anti-Smoking Program for Students: A Follow-Up Investigation

In this follow-up study, we aimed to assess the effectiveness of the "I do not smoke, I exercise" anti-smoking preventive health education program. The program was based on the theory of planned behavior supplemented with life skills teaching and targeted at high school students. The intervention comprised ten one-hour online sessions, administered by physical education instructors. The study cohort comprised 222 students (109 boys, 113 girls) from 11 secondary schools, with an average age of 16.42 ± 1.36 years. Data collection involved pre- and post-intervention self-assessment questionnaires. The examined variables included attitudes towards smoking, intention to smoke, subjective norm, perceived behavioral control (PBC), knowledge about smoking, smoking behavior, exercise behavior, attitudes toward the program's implementation, and satisfaction with the program. A separate paired samples t-test revealed a significant improvement in students' knowledge about smoking (t217 = -5.605, p < 0.001, d = 0.38) and perceived behavioral control (t220 = -2.166, p < 0.05, d = 0.15) following the intervention. However, no significant changes were observed in the remaining variables. In addition, students' overall satisfaction with the implementation of the present health education program was high (M = 5.72 ± 1.39). These findings suggest that the health education smoking prevention intervention incorporates techniques and strategies that influence the perceived behavioral control variable, emphasizing students' strong interest in educationally theorized programs integrating technology into their design. Future studies should consider further examination of tobacco control strategies within the high school context.

Prevalence and predictors of suicidal behaviours among primary and secondary school going adolescents in Botswana

BACKGROUND

There is a scarcity of studies on the prevalence and predictors of suicide behaviors among primary and secondary school going adolescents aged 10-19 years in Botswana hence, this study would fill that gap.

METHODS

This study used cross-sectional secondary data from Botswana Youth Risk Behavior and Biological Surveillance Survey (BYRBBSS), 2010. Multivariable binary logistic regression models were used to investigate the predictors of suicide behaviours.

RESULTS

The study shows that 51.5% of the respondents reported having ever contemplated suicide while 40.1% of the respondents attempted suicide in the last 12 months before the survey. The study found that male learners (AOR = 0.61, 95% CI = 0.44-0.83), learners who were not attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.17-0.72), who were not bullied (AOR = 0.22, 95% CI = 0.13-0.39), and who were confident of themselves (AOR = 0.55, 95% CI = 0.39-0.76) were less likely to contemplate suicide. Whereas learners with primary school level education were more likely to contemplate suicide (AOR = 2.12, 95% CI = 1.14-3.95). Males were less likely than their female counterparts to attempt suicide (AOR = 0.68, 95% CI = 0.47-0.97). Regarding attempt, learners who had self-confidence (AOR = 0.35, 95% CI = 0.24-0.50), not being bullied (AOR = 0.20, 95% CI = 0.11-0.35), not being attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.18-0.69), not engaging in a physical fight that led to injury (AOR = 0.34, 95% CI = 0.19-0.61) were less likely to attempt suicide. Whereas being at primary school (AOR = 5.29, 95% CI = 2.58-10.86), and missing classes once or more in a week (AOR = 1.70, 95% CI = 1.05-2.76) were associated with increased likelihood of suicide attempt.

CONCLUSION

The study shows that suicide behaviours as big challenges in Botswana among primary and secondary school going adolescents aged 10-19 years. Thus, the study recommends policy interventions aiming at including education on peer bullying or fighting or attack at primary and secondary education levels if not already in existence. There should also be interventions aiming at educating guardians and teachers on consequences of bullying or fighting so that they should consistently remind their children not to bully and for them to open up if they are being bullied. The study further recommends that schools and communities at large should have a psychosocial system for bullying or fighting reporting, follow-up, and appropriate corrective interventions for the offenders. There should also be self-confidence instilling education as well as sex/gender-specific interventions for instance girls can be given platform (private if necessary) to express peculiar problems to them that need specific help.

Lifestyle habits among Najran University students, Najran, Saudi Arabia

Background

Unhealthy lifestyles have been linked to increased cardiovascular disease, diabetes, and other non-communicable diseases. University students have been reported to adopt unhealthy lifestyles and undesirable eating choices.

Objectives

The study aimed to estimate the prevalence of healthy eating habits; determine the prevalence of physical activity habits; to estimate the smoking habits among male health sciences college students at Najran University, Najran, Saudi Arabia.

Methods

The present questionnaire-based descriptive cross-sectional study (convenient sample) was carried out among undergraduate male students enrolled in the health sciences colleges at Najran University, Najran, Saudi Arabia, from 1st May to 31st May, 2019. Around 500 students were recruited and were requested to answer a self-administered questionnaire about eating habits, physical activity, and tobacco smoking habits. Descriptive results were summarized in percentage and frequency. Cross tabulation using chi-square test was performed to measure the impact of demographic variable on eating pattern, physical activity and smoking behavior. Pearson's correlation was done using two tailed tests to determine the type of relationship between different variables. The SPSS (version 26) was used to perform statistical analysis.

Results

A total of 454 complete responses from the male students from Najran University were obtained. The majority (74%) were aged 21 years and above, unmarried (94.9%), had healthy BMI (47.4%), and suffered mild (41.4%) to moderate (32.4%) levels of stress during the previous month. The study findings showed a low daily frequency of consumption of vegetables and fruits. There was a low prevalence of daily consumption of vegetables (16%) and fruits (9%). More than 10% of all students reported no consumption of fruits and vegetables. Students who felt severely stressed during the previous month were significantly not eating any vegetables (p = 0.022) and fruits (p < 0.001), and had high salt intake (p = 0.045). Married participants had a significantly (p = 0.03) higher servings of vegetables per day. Furthermore, 32.15% of participants were not practicing 30 min of physical activity 5 days per week. The study showed a low prevalence (47.57%) of physical activity among the participants. However, none of the participants' variables were significantly associated with routine physical activity. In addition, the study showed a relatively high prevalence of smoking (25.77%) among Najran university male students. The participants' age (p 0.01), overall health (p = 0.02) and level of stress (p = 0.001) experienced during the last month were significantly associated with the length of exposure to secondhand smoke. Whereas, smoking any kind of tobacco daily (25.77%) was significantly (p = 0.005) related to the age of participants. A high number of participants aged 21 years and above (52.72%) were significantly (p = 0.019) exposed to secondhand smoke.

Conclusion

To conclude, the study findings showed a low daily frequency of consumption of vegetables and fruits, a relatively high prevalence of smoking and a low level of awareness regarding the health risks of smoking; and a large number of participants were physically inactive among male university students. Intervention programs in university students should concentrate on improving nutrition attitudes and knowledge toward good diet, tobacco-smoking cessation strategies, and structured intervention programs to encourage physical activity. However, these interventions should be pilot-tested for feasibility and acceptability before implementation.

Influence of Personal, Environmental, and Community Factors on Cigarette Smoking in Adolescents: A Population-Based Study from Taiwan

Understanding the factors that influence cigarette smoking among adolescents is critical. We identified personal, community, and environmental factors associated with current cigarette smoking among adolescents. This population-based cross-sectional analysis study was conducted using the 2012 Taiwan Global Youth Tobacco Survey and the sociodemographic statistics of the city or county from Taiwan’s Ministry of the Interior. A total of 27,524 participants (age: 12–18-years) was included. The associated factors were identified through logistic regression. A path analysis was performed to examine the pathway from the associated factors to current cigarette smoking. According to this analysis, the following factors were prominently and positively associated with adolescent cigarette smoking: one personal factor (pocket money), five environmental factors (home secondhand smoke (SHS) exposure, smoker friends, outside SHS exposure, school SHS exposure, and smoker parents), and two community factors (free cigarettes from tobacco companies and indigenous population). By contrast, five personal factors (feeling less comfortable smoking at social occasions, feeling indifferent about smoking or not smoking at social occasions, female sex, feeling that quitting is difficult, and feeling that quitting after having smoked is harmful to health) and one environmental factor (school antismoking education) had negative effects. Thus, comprehensive interventions promoting the perception of harm caused by smoking and interrupting access to cigarettes through social networks can reduce cigarette smoking in adolescents.

Multivariate Analysis of the Predicted Probability of Smoking Behavior of Foster Care Minors: Results of a Study from Romania

Background: There are a multitude of factors that influence smoking status, and minors from the social protection system are a vulnerable category in terms of smoking. Methods: The objective of this research was to assess the degree of smoking dependence and to identify potential predictors of smoking status in foster care teenagers. Smoker status was confirmed by dosing CO in the exhaled air, and the degree of dependence was assessed using the Fagerström score. We performed a multivariate logistic regression analysis. Results: From the 275 foster care minors, 22.5% were current smokers. Exhaled CO was not influenced by general demographic factors, was associated with the frequency of smoking, and was positively correlated with the estimated number of cigarettes consumed daily and with the Fagerström score. The calculated probability of being a smoker was less than 20.4% in 75% of nonsmokers, whereas 75% of actual smokers had a predicted probability higher than 30.3%. Conclusions: In addition to age, gender, social environment, previous exposure to secondhand smoking, and residential type of foster care system, the expressed opinions regarding the health effects of tobacco use were associated with smoking in foster care teenagers.

Prevalence and predictors of susceptibility and future intention to smoke cigarettes among school-going adolescents in Ibadan, Nigeria

Introduction

the tobacco control interventions targeted at preventing the initiation of tobacco habits are crucial to effective control of tobacco use among adolescents. An understanding of the predictors of smoking susceptibility and future intention to smoke is important in developing effective intervention programmes. This study, therefore, assessed the prevalence and predictors of susceptibility and future intention to smoke cigarettes among school-going adolescents in Ibadan, Nigeria.

Methods

a cross-sectional study among 830 school-going, non-smoking adolescents, who were randomly selected from 18 secondary schools in Ibadan, Nigeria. Using a self-administered, structured questionnaire, information on socio-demography, tobacco attitudes and habits were collected and analyzed using SPSS version 25.

Results

the prevalence of susceptibility and future intention to smoke cigarette were 25.9% and 6.3%, respectively. Predictors of susceptibility were low social-class (aOR:1.68; 95%CI:1.01-2.80); cigarette sale near schools (aOR:2.04; 95%CI:1.16-3.61); poor attitude (aOR:1.93; 95%CI:1.29-2.89); no harm-perception to smoking (aOR:3.55; 95%CI:2.13-5.92), exposure to secondhand smoke (SHS) (aOR:2.31; 95%CI:1.52-3.50) and perceived safety of short-term smoking (aOR:1.59; 95%CI:1.02-2.44). Predictors of future intention to smoke were: ever-tobacco smoking (aOR:2.05; 95%CI:1.003-4.170); cigarette sale near schools (aOR:1.79; 95%CI:1.09-2.94); poor attitude (aOR:1.95; 95%CI:1.31-2.88), no harm perception to smoking (aOR:3.87; 95%CI:2.38-6.31), exposure to SHS (aOR:2.45; 95%CI:1.64-3.67) and perceived safety of short-term smoking (aOR:1.59; 95%CI:1.05-2.44).

Conclusion

a significant proportion of the population had high susceptibility to smoke as well as high future intention to smoke. Sales of cigarettes near schools, poor attitude and poor perception about the harm from smoking and exposure to SHS were important predictors of both susceptibility and future intention to smoke among respondents.

The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana

Background

Behavioral intentions (motivational factors), attitudes, subjective norm (social pressures), and perceived behavioral control promote or discourage smoking behavior among adolescents.

Objective

To assess students’ behavioral intentions, attitudes, subjective norms and perceived behavioral control on smoking using the Theory of Planned Behavior. The prevalence of smoking among the adolescents is also calculated.

Methods

In this cross-sectional study, structured self-administered questionnaires were used to collect data from adolescents in primary and secondary schools. Data on demographics, behavioral intentions, attitudes, subjective norms, and perceived behavioral control towards smoking were collected. Pearson product moment correlations and logistic regression models were used to determine factors associated with current smoking.

Results

A total sample of 2554 (mean age = 15; Range = 12–18 years) students participated in the study. Twenty-nine percent (n = 728) of the students had tried smoking at least once. Smoking was predicted by attitudes, subjective norms, perceived behavioral control and intention.There was a strong association between having a parent or guardian, caregiver or close friend who smoked (p < 0.001) and being a smoker. The majority of students (57%) conveyed that adults talked to them about the harmful effects of cigarette smoking and 50% had discussed smoking concerns with their friends. Students who had positive attitudes towards smoking like “smoking makes you confident” were more likely to be current smokers (OR: 1.63, 95% CI: 1.03–2.59). The feeling or conviction that they could refuse a cigarette if offered was an impediment from smoking (OR: 0.18, 95% CI: 0.13–0.26).

Conclusions

Attitudes, subjective norms, and perceived behavioral control contributed significantly to the students' smoking. Right attitudes must be cultivated and behavioral control must be strengthened for early effective interventions to curtail smoking among adolescents.

Cannabis Use Disorder Among First-Year Undergraduate Students in Gaborone, Botswana

Cannabis use disorder (CUD) poses major clinical and public health concerns globally. It is a growing problem among the youth in Botswana, yet little research has been done on this subject. The present study hoped to address this gap in knowledge by determining the prevalence and associated factors of CUD among first-year university students in Botswana. A cross-sectional study was conducted among 410 first-year university undergraduates, using a modified version of the 37-item World Health Organization (WHO) drug questionnaire and DSM-5 criteria for CUD. The mean age of the respondents was 20.8 (SD = 1.5) years, and the male to female ratio was 1:1.1. Of the 401 students whose responses were analyzed, 37(9,2%) had used cannabis at least once in the last 12 months, but only 19 (4.7%) met the DSM-5 criteria for CUD. After binary regression analysis, difficulty in coping with the new environment/academic activities, receiving more than 150 USD monthly were positively associated with CUD, while regular participation in religious activities was negatively associated. CUD was found among the first-year undergraduates studied. Promoting protective activities such as religious activities and strengthening programs that teach students how to cope with academic stress and a new environment would be helpful.

Current and former smokers among adolescents aged 12-17 years in Iran: a systematic review and meta-analysis

Background

Smoking, especially among adolescents, is considered a serious public health concern worldwide being associated with increased mortality. The present study was designed as the first systematic review and meta-analysis of the prevalence of current and former smoking behavior among adolescents in Iran.

Methods

Seven international scholarly databases, namely Scopus, Embase, Pubmed/Medline, ISI/Web of Science (WOS), the Cochrane Library, Psyc Info and Cinahl, were extensively searched from January 2000 to September 18, 2019. Google Scholar was also mined. Iranian databases were searched as well (namely, MagIran, Scientific Information Database (SID), and Barakatkns). The DerSimonian-Laird’s approach, via the Freeman-Tukey double arcsine method, was used to synthesize the prevalence estimates.

Results

The prevalence of current smokers among Iranian adolescents was estimated to be 9% (95% CI: 7 to 10). Stratifying based on gender, the prevalence was 12% among boys (95% CI: 10 to 14) and 6% among girls (95% CI: 5 to 8). The prevalence of former smokers among Iranian adolescents using the random-effect model was computed to be 24% (95% CI: 21 to 27).

Conclusion

The findings of this study showed that the prevalence of current and former smoking behavior among Iranian adolescents is a relevant public health concern. The country’s young population should be given more attention by health policy- and decision-makers and implementation of ad hoc prevention and control policies should be on their agenda.

Current Cigarette Smoking and Its Predictors among School-Going Adolescents in East Africa: A Systematic Review and Meta-Analysis

BACKGROUND

In developing countries, tobacco smoking has its own contribution to the burden of noncommunicable causes of morbidity and mortality. Studies estimated the burden of cigarette smoking among school-going adolescents in different geographical areas of East Africa. However, due to discrepancies found among those different findings, there is no representative data about the burden of smoking in the continent.

OBJECTIVES

This systematic review and meta-analysis aimed to assess the pooled prevalence of current cigarette smoking and its associated factors among school-going adolescents in East Africa.

METHODS

PubMed, Google Scholar, and the Web of Science Library were searched to access included articles. A weighted inverse-variance random-effects model was used to estimate the prevalence of current cigarette smoking. Variations in the pooled estimates of the prevalence were adjusted through subgroup analysis according to the specific country, where the study was conducted. Funnel plot and Egger's regression test were used to check publication bias. STATA version 14 statistical software was used for meta-analysis.

RESULTS

A total of 26,875 school-going adolescents were included. The pooled prevalence of current cigarette smoking among school-going adolescents in East Africa was found to be 9.02% (95%CI: 6.34-11.70). Based on the subgroup analysis, current cigarette smoking among school-going adolescents was estimated at 9.8% in Kenya, 7.72% in Ethiopia, 10.83% in Uganda, 13.6% in Sudan, and 4% in Tanzania.

CONCLUSIONS

This meta-analysis revealed that the prevalence of current cigarette smoking is increasing among school-going adolescents in East Africa. Therefore, countries have to realize sale prevention policies, establishing and/or strengthening antismoking campaigners designed for school-going adolescents, and providing training for teachers to be antismoking campaigners.

Prevalence of smoking among male secondary school students in Arar City, Saudi Arabia

INTRODUCTION

Tobacco is one of the leading preventable cause of death worldwide. Tobacco consumption among teenagers is a major public health problem, especially in developing countries. Younger smokers are more liable to smoking complications. The objectives were to evaluate the prevalence of smoking among male secondary school students in the Northern Borders region, KSA.

METHODS

A cross-sectional study was conducted in Arar city. Four schools were chosen randomly from 21 secondary schools. A total of 240 students responded to the pre-designed questionnaire. The questionnaire included questions on demographic factors, smoking behavior and knowledge about smoking hazards.

RESULTS

Prevalence of current smoking among male secondary school students is 40.8%. Cigarette smoking was the most common type (67.3%) followed by Shish smoking (22.4%). Few students (2.1%) reported other forms of smoking, example (Hashish). Of the studied group, 39.8% smoke on a daily basis with 29.6% of them smoke more than five cigarettes per day.

CONCLUSION

Smoking is a prevalent habit among teenagers. Special concern should be directed to smoking cessation campaigns with behavioral, legal and economic interventions.

Prevalence and predictors of alcohol and drug use among secondary school students in Botswana: a cross-sectional study

BACKGROUND

Alcohol and illicit drug use has been recognized as a growing problem among adolescents in Botswana. Little is known about factors affecting alcohol and drug use among Botswana's secondary school students. To aid the design and implementation of effective public health interventions, we sought to determine the prevalence of alcohol and drug use in secondary school students in urban and peri-urban areas of Botswana, and to evaluate risk and protective factors for substance use.

METHODS

We performed a 72-item cross-sectional survey of students in 17 public secondary schools in Gaborone, Lobatse, Molepolole and Mochudi, Botswana. The World Health Organization's (WHO) Alcohol Use Disorder Identification Test (AUDIT) was used to define hazardous drinking behavior. Using Jessor's Problem Behavior Theory (PBT) as our conceptual framework, we culturally-adapted items from previously validated tools to measure risk and protective factors for alcohol and drug use. Between-group differences of risk and protective factors were compared using univariate binomial and multinomial-ordinal logit analysis. Relative risks of alcohol and drug use by demographic, high risks and low protections were calculated. Multivariate ordinal-multinomial cumulative logit analysis, multivariate nominal-multinomial logit analysis, and binominal logit analysis were used to build models illustrating the relationship between risk and protective factors and student alcohol and illicit drug use. Clustered data was adjusted for in all analyses using Generalized Estimating Equations (GEE) methods.

RESULTS

Of the 1936 students surveyed, 816 (42.1%) reported alcohol use, and 434 (22.4%) met criteria for hazardous alcohol use. Illicit drug use was reported by 324 students (16.7%), with motokwane (marijuana) being the most commonly used drug. Risk factors more strongly associated with alcohol and drug use were reported alcohol availability, individual and social vulnerability factors, and poor peer modeling. Individual and social controls protections appear to mitigate risk of student alcohol and drug use.

CONCLUSIONS

Alcohol and illicit drug use is prevalent among secondary school students in Botswana. Our data suggest that interventions that reduce the availability of alcohol and drugs and that build greater support networks for adolescents may be most helpful in decreasing alcohol and drug use among secondary school students in Botswana.

School-based behavioral intervention to reduce the habit of smokeless tobacco and betel quid use in high-risk youth in Karachi: A randomized controlled trial

There have been recent surges in the use of smokeless tobacco (SLT) and betel quid (BQ) chew among adolescents in South East Asian countries, with an increase, on average, of 7% to 15% between 2004 and 2013, necessitating interventional investigations to modify this behavior. The current intervention was aimed towards changing adolescents' perceptions regarding the harmful effects of SLT and BQ use and encouraging them to quit. This randomized control trial involved 2140 adolescents from 26 private and public-sector schools in Karachi, Pakistan. After randomization, 1185 individuals were placed in the intervention group and administered a behavior changing intervention (BCI), while 955 individuals constituted the control group. A generalized estimating equation was employed to measure differences in repeated measures for both groups. The beta coefficients were reported after adjusting the covariates with the 95% confidence interval, and the p-value was considered significant at <0.050. Cohen's d was employed to report the effect size of the intervention. The BCI resulted in a 0.176-unit (95% CI 0.078-0.274, p-value <0.001) increase in knowledge scores regarding the health hazards of SLT and BQ, a 0.141-unit (95% CI 0.090-0.192, p-value <0.001) increase in use perception scores, and a 0.067-unit (95% CI 0.006-0.129, p-value 0.031) increase in quit perception scores in the intervention group compared with those in the control group. A knowledge related module (p-value 0.024) and quit preparation module (p-value 0.005) were found to be helpful by adolescents in either changing their perceptions regarding SLT and/or BQ chew use or in quitting. The role of BCI is promising in improving adolescents' knowledge and changing their perceptions in a positive manner regarding their harmful SLT and BQ use. Convincing results may be achieved if interventions are tailored, with an emphasis on the identification of the products that are used by adolescents in addition to highlighting their ill effects and how students may manage to quit them. If included in the schools' curricula, this BCI method may help in developing schools that are free of SLT and BQ use. Trial registration: ClinicalTrials.gov NCT03488095.

Tobacco Control Law awareness, enforcement, and compliance among high school students in Myanmar

In Myanmar, the Control of Smoking and Consumption of Tobacco Products Law (Tobacco Control Law; TCL), which covers the prohibition of sale of tobacco to minors and all forms of tobacco advertisement, was enacted in 2006. This study aimed to examine the awareness of the TCL among high school students. A cross-sectional study was conducted in November 2015. Participants were 1,339 high school students (554 boys and 785 girls) from two regions and two states of Myanmar. Data were collected using anonymous self-administered questionnaires and revealed that 78.0% of boys and 86.5% of girls responded the sale of tobacco products in or within 100 feet from school, and 83.4% of boys had ever seen someone selling tobacco products to minors. More than half of the students had ever seen minors selling or distributing tobacco products, and had knowledge about the TCL, while only 9.7% knew about the penalties. The adjusted odds ratio (95% confidence interval) of awareness of the TCL was 2.12 (1.35-3.31) for students who had ever received tobacco products free of charge, or seen/heard about their distribution free of charge, 1.86 (1.20-2.89) for current smokeless tobacco users, and 0.58 (0.43-0.77) for students who had ever seen someone selling tobacco products to minors. The majority of high school students did not know that the violation of the TCL could be punished with a fine and/or imprisonment. These findings suggest that awareness of the TCL was very low among high school students, highlighting that TCL enforcement and compliance, and tobacco-related health education programs are not satisfactory in Myanmar.

Prevalence and predictors of tobacco use among Bhutanese adolescents

Purpose

The purpose of this paper is to examine the prevalence of tobacco use and associated factors influencing the use of tobacco among adolescents in a school setting.

Design/methodology/approach

A cross-sectional descriptive study was conducted amongst Bhutanese adolescents studying at high schools in the district of Wangdue Phodrang in May 2016. A total of 378 eighth-grade students from four schools participated in the study. A self-administered questionnaire was used to collect data. Bivariate and multivariate logistic regressions were carried out to describe the predictors of tobacco use.

Findings

Of the 378 student participants, 52.90 percent were girls and 47.10 percent boys. The age ranged from 11 to 19 years, and the majority lived in school hostels (82 percent). The prevalence of smoking was 10.80 percent while smokeless tobacco users constituted 11.10 percent in the month preceding the study. Gender, tobacco use by siblings and friends, ever having tried alcohol, consumption of alcohol in the last 30 days, previous experimentation with cigarettes/bidi and smokeless tobacco/baba (p-value <0.05) were significantly related to the use of tobacco among students. In multivariate analysis, tobacco use by friends (AdjOR=1.09; 95%CI=0.01–2.48), ever having tried alcohol (AdjOR=2.24; 95%CI=1.75–3.72), current alcohol use (AdjOR=2.63; 95%CI=1.52–4.31), experimentation with cigarettes/bidi (AdjOR =39.46; 95%CI=11.91–90.63) or with smokeless tobacco/baba (AdjOR=32.61; 95%CI=11.78–90.30) were observed as the strong predictors of current tobacco use among adolescents.

Originality/value

These study results re-emphasized the rising public health concern of tobacco use among younger boys and girls. The findings may help the Bhutanese policy makers and managers to better understand the present situation of adolescent tobacco use and its associated determinants, and formulate appropriate tobacco control strategies for adolescents.

The association between school bullying victimization and substance use among adolescents in Malawi: the mediating effect of loneliness

Background and objectives Research has shown an increased prevalence of substance use among adolescents in countries in Sub-Saharan Africa. Peer affiliation, bullying, and psychological stress are significantly associated with substance use. This study empirically tested theoretical frameworks linking peer affiliation, bullying victimization, loneliness and substance use (specifically tobacco or alcohol use) among adolescents. Materials and methods Data were obtained from the 2009 Malawi Global School-based Health Survey (GSHS) with a representative sample of 2359 students aged 13-17 years in Malawi, Sub-Saharan Africa. Missing data were handled using multiple imputation. The study conducted path analyses using Mplus to test the conceptual models of tobacco use and alcohol use. Results The results showed that loneliness partially mediated the association between bullying victimization and tobacco use in the first model, as well as the relationship between bullying victimization and alcohol use in the second model. Results indicated statistically significant indirect paths from bullying victimization to tobacco use and alcohol use through the mediation of loneliness. However, peer affiliation did not directly predict bullying victimization in the two path models; it directly predicted tobacco use only. Conclusions These findings have important implications in early intervention for health practitioners in school and mental health settings to prevent feelings of loneliness and substance use among adolescents who have experience with bullying victimization but no experience with depression, alcohol use or tobacco use.