Tobacco use among adolescent students and the influence of role models

Tobacco use and its associated factors among students of medical college at tertiary care center of Eastern Nepal

BACKGROUND

Despite declining smoking prevalence globally, South Asia faces a rising burden. In Nepal, existing tobacco control laws haven't curbed use, with 28.9% of young adults engaging in tobacco use. This study investigates tobacco use and associated factors among medical, dental, and nursing students at a Nepalese tertiary care center.

OBJECTIVE

We aimed to assess tobacco use prevalence and identify factors associated with it among future healthcare professionals, considering their distinct roles in tobacco control. Medical students can contribute through clinical counseling and public health advocacy, dental students through oral health education, and nursing students through patient education and community outreach.

METHODS

A cross-sectional study involving 427 medical, dental, and nursing students was conducted. Data was collected using online questionnaires distributed via email and social media. Descriptive statistics and Chi-square tests were used for analysis.

RESULTS

The study found that 45% of participants were aged 22-25, with females comprising the majority (53.2%). Nearly half (49.2%) belonged to the medical faculty, and 24.4% were in their first year. Furthermore, among those who smoke, 53% reported smoking less than 5 cigarettes daily. The analysis revealed significant associations between smoking with age (p = 0.01), year of study (p = 0.001), parental smoking history (p = 0.001), and having friends who smoke (p = 0.001).

CONCLUSION

Our findings highlight the moderate prevalence of cigarette smoking among medical students, with family and friends emerging as major influences. Stress relief was a common reason, particularly among young females and first-year students. These results emphasize the urgent need for comprehensive tobacco control programs within medical institutions to equip future healthcare professionals to effectively address smoking issues.

Factors sustaining legitimacy of smoking in Vocational Education and Training (VET) schools: a qualitative needs assessment

BACKGROUND

Most adult smokers started smoking in their teenage years, which increases the risk of nicotine dependence. In Denmark, there is a high prevalence of youth smoking among students in Vocational Education and Training (VET). However, reducing and preventing smoking in this group is a major challenge. This article presents a needs assessment aimed to explore factors sustaining legitimacy of smoking in VET schools and consider the measures needed to prepare VET schools' implementation of smoking reduction and prevention interventions.

METHODS

Participant observations were conducted in four VET classes representing three VET schools in Denmark with a duration of four days each. Individual, semi-structured interviews were conducted with teachers, managers, and a student advisor, as well as four focus groups with a total of 20 students. Interviews were audio-taped, transcribed, and the data material was analyzed following Malterud's systematic text condensation.

FINDINGS

Factors that helped sustain legitimacy of smoking in VET schools included a positive and normalized attitude towards smoking at home and among friends, an understanding of smoking as an integral and expected practice in VET professions and schools, a perceived reliance on smoking as an icebreaker in new social relations and as a pedagogical tool, and smoking as a habit and a means to deal with boredom and stress relief.

CONCLUSIONS

The factors sustaining legitimacy of smoking in VET schools are reciprocal and call for smoking reduction and prevention intervention efforts which consider and address social influence, habitual behavior, and psychological needs, as well as changes at the policy level.

Tobacco Use and Its Associated Factors among Undergraduate Public Health Students in Kathmandu Valley, Nepal

Background

Despite the crucial role of public health students in tobacco control, there is a paucity of information regarding tobacco use among this population in Nepal. This study aims to assess the prevalence of tobacco use among undergraduate public health students in Kathmandu valley, Nepal.

Methods

A web-based survey was conducted among 386 undergraduate public health students in Kathmandu valley, Nepal, using the Global Health Professions Student Survey (GHPSS) questionnaire. Associated factors were examined using multivariate logistic regression analyses at the level of significance of 0.05.

Results

A total of 16.8% of students were current cigarette smokers, 39.9% had ever smoked cigarettes, and 62.2% had smoked their first cigarettes during adolescence. Among the participants, 11.7% currently used other tobacco products. Male students (aOR: 15.4; 95% CI: 4.9-47.8), students with higher age (aOR: 2.4; 95% CI: 1.0-5.4), students belonging to non-Brahmin/Chhetri ethnic group (aOR: 2.3; 95% CI: 1.2-4.4), and those staying without family (aOR: 2.0; 95% CI: 1.1-5.0) had higher odds of being current smoker. Similarly, students with a parental history of tobacco use (aOR: 2.4; 95% CI: 1.3-5.0) and friends with smoking habits (aOR: 7.9; 95% CI: 2.3-27.0) were more likely to be a current smoker.

Conclusion

There is a notable prevalence of tobacco use among public health students in Kathmandu valley, Nepal. Concerned stakeholders should work jointly to implement a cessation program to discourage tobacco use among these populations who have a potential role in educating communities about the hazards of tobacco smoking, tobacco use prevention, and control.

Depression and Behavioral Problems Among Adolescent Girls and Young Women Employees of the Textile Industry in India

Stress and depression are common in textile industry employees due to inadequate working conditions and challenging socioeconomic conditions. The objective of the study was to assess depression and mental health among adolescent and young females currently employed in a textile factory located in Tamil Nadu compared with past employees and women who have never been employed. This cross-sectional study included a total of 107 participants in each study group who were interviewed. The Patient Health Questionnaire-9 and Strengths and Difficulties Questionnaire were administered to screen participants for depression and mental health. More current employees (16.82%) and past employees (15.88%) suffered from depression severe enough to require treatment compared with never employed girls and young women (2.8%). Of the study participants, 59.8% of current employees, 63.6% of past employees, and 32.7% of never employed women had mental health or behavior problems. In the regression model, history of abuse was significantly associated with depression. Participants who were current employees and reported family debt and a history of abuse were significantly more likely to have mental health or behavior problems. Mental health issues such as depression and behavior problems were more likely among adolescent girls currently employed in textile industries. Further studies into the causes of this phenomenon are needed.

Craving for cigarette smoking among male adolescents in Isfahan based on mindfulness and emotional self-regulation

Background Cigarette smoking among adolescents and its consequences are categorized as serious health problems. Cigarette craving is influenced by various psycho-social factors. Objective This study aimed to investigate desire and intention to smoke based on mindfulness and emotional self-regulation in adolescents. Methods In this correlational study conducted based on structural equation modeling, a sample of 350 male students was randomly selected from different schools of education districts in Isfahan. Three questionnaires, including Hooked on Nicotine Checklist, emotional regulation inventory, and Mindful Attention Awareness Scale were employed. Data were analyzed using χ2, correlation coefficient and structural modeling tests. In this regard, SPSS and AMOS software were used. Results The results showed that 62% of male students had experienced cigarette smoking at least once. There was a significant inverse correlation between cigarette craving and emotional reappraisal (r = -0.48), expressive suppression (r = -0.58) and mindfulness (r = -0.55), respectively (p < 0.01). In addition to the direct effect, mindfulness through emotional self-regulation had indirect effects on nicotine craving. A total of 58% of the variance in nicotine craving was explained by the study variables. Conclusion The results showed that the high percentage of male students hooked on smoking is an important issue. In this regard, students' psychological issues such as efficient mechanisms of emotional regulation and their knowledge of the risks of smoking must be addressed by authorities and families.

Adolescents' knowledge and opinions about smoking: a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal

BACKGROUND

The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents' smoking behavior and their views, knowledge and experiences are scarce.

OBJECTIVE

To gain a deep understanding of Nepalese adolescents' knowledge and opinions about smoking and reasons for smoking initiation.

SUBJECTS

Adolescents from four secondary schools in the Bhaktapur district, Nepal.

METHODS

Eight focus-group discussions were conducted with 71 adolescents aged 13-16 years and from grades 8-10. Data were analyzed using manifest qualitative content analysis.

RESULTS

The participants knew that smoking represents health risks as well as socio-economic risks, but few described the addictive nature of tobacco and health risks related to passive smoking. Most participants related smoking initiation to the smoking behavior of peers and family members, but easy accessibility to cigarettes, ineffective rules and regulations, and exposure to passive smoking also created environments for smoking. Some expressed confidence to resist peer pressure and refuse to start smoking, but also expressed the need for prevention strategies in schools and for governmental initiatives, such as more strict implementation of tobacco control and regulations to prevent and reduce smoking.

CONCLUSION

Curbing the tobacco epidemic in Nepal requires healthy public policies and multifaceted interventions to address the knowledge gap on health consequences associated with smoking among adolescents, teachers and parents/adults.

Psychosocial Determinants of Intention to Use Tobacco Among Adolescents in India

Aim

The present study aims to determine the psychosocial factors associated with ‘intention to use tobacco’, because it is influenced by social norms and beliefs about smoking.

Method

A cross-sectional survey on a random sample of 665 individuals, aged 15-20 years, was conducted using a pretested questionnaire. Three logistic regression models were constructed to identify determinants of ‘intention to use tobacco’, with the total sample, with respondents under 18 years old, and with respondents 18 years old and above.

Results

Odds of intention to use tobacco were higher when friends used tobacco products, and perceived no negative effects on health. Parental use of tobacco increased the odds of intention to use tobacco, and a similar effect was observed when a celebrity was followed as a role model. Approval of occasional use of tobacco increased the odds of intention to use tobacco. Communication with parents about harmful effects of tobacco reduced the odds of intention to smoke among respondents younger than 18 years old.

Conclusion

Social factors and perception of risk significantly influenced the intention to use tobacco. Study results are useful in designing interventions for prevention of tobacco use among adolescents.

Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There's an App for That

Background

Ecological momentary assessment (EMA) uses real-time data collection to assess participants’ behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults.

Objective

Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries.

Methods

Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data.

Results

The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion.

Conclusions

This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection.

Psychosocial Determinants of Tobacco Use among School Going Adolescents in Delhi, India

Background. Tobacco use is one of the major preventable causes of premature death and disease in the world. Many psychosocial factors were found to influence tobacco use. Therefore the present study was designed to determine the role of psychosocial factors associated with tobacco use among school going adolescents in Delhi, India. Methods. Cross-sectional study was conducted from February 2013 to September 2013 in four government schools in South district of Delhi, India. The questionnaire contains questions adapted from GYTS (Global Youth Tobacco Survey) to find the prevalence and pattern of tobacco use among adolescents. Data were analyzed using SPSS version 21. Results. The prevalence of ever and current tobacco use was found in 16.4% and 13.1%. Current smoking and current tobacco chewing were found in 10.2% and 9.4% students, respectively. The risk of current tobacco use was found to be higher among males (P value = 0.000) and in those who got higher pocket money (P value = 0.000). Psychosocial factors like lower general self-efficacy and maladjustments with peers, teachers, and schools were also found to be significant predictors of current tobacco use. Conclusion. The study has revealed higher prevalence of ever and current tobacco use among adolescent students in Delhi, India.

Correlates of smoking susceptibility among adolescents in a peri-urban area of Nepal: a population-based cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site

Background

Susceptibility to smoking is defined as an absence of firm commitment not to smoke in the future or when offered a cigarette by best friends. Susceptibility begins in adolescence and is the first step in the transition to becoming an established smoker. Many scholars have hypothesized and studied whether psychosocial risk factors play a crucial role in preventing adolescent susceptibility to smoking or discourage susceptible adolescents from becoming established smokers. Our study examined sociodemographic and family and childhood environmental factors associated with smoking susceptibility among adolescents in a peri-urban area of Nepal.

Design

We conducted a population-based cross-sectional study during October–November 2011 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) located in a peri-urban area near Kathmandu, the capital city of Nepal, where tobacco products are easily available. Trained local enumerators conducted face-to-face interviews with 352 respondents aged 14–16. We used stepwise logistic regression to assess sociodemographic and family and childhood environmental factors associated with smoking susceptibility.

Results

The percentage of smoking susceptibility among respondents was 49.70% (95% CI: 44.49; 54.93). Multivariable analysis demonstrated that smoking susceptibility was associated with smoking by exposure of adolescents to pro-tobacco advertisements (AOR [adjusted odds ratio] =2.49; 95% CI: 1.46–4.24), the teacher (2.45; 1.28–4.68), adolescents attending concerts/picnics (2.14; 1.13–4.04), and smoking by other family members/relatives (1.76; 1.05–2.95).

Conclusions

Smoking susceptible adolescents are prevalent in the JD-HDSS, a peri-urban community of Nepal. Several family and childhood environmental factors increased susceptibility to smoking among Nepalese non-smoking adolescents. Therefore, intervention efforts need to be focused on family and childhood environmental factors with emphasis on impact of role models smoking, refusal skills in social gatherings, and discussing harmful effects of smoking with family members and during gatherings with friends.

Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: a cross-sectional questionnaire survey

INTRODUCTION

The tobacco use among the youth, in both smoking and smokeless forms, is quite high in the South East Asian region. Tobacco use is a major proven risk factor and contributes substantially to the rising epidemic of non-communicable diseases.

OBJECTIVES

To estimate the prevalence of tobacco use and determine associated factors among adolescent students of Dharan municipality.

DESIGN

Cross-sectional study.

SETTING

Secondary and higher secondary schools of Dharan municipality in Sunsari district of Nepal.

PARTICIPANTS

Students in middle (14-15 years) and late adolescence (16-19 years) from grades 9, 10, 11 and 12 were included.

PRIMARY OUTCOME MEASURE

Ever tobacco use which was defined as one who had not used any form of tobacco in the past 1 month but had tried in the past.

METHODOLOGY

Self-administered questionnaire adapted from Global Youth Tobacco Survey was used to assess tobacco use among the representative sample of 1312 adolescent students selected by stratified random sampling from July 2011 to July 2012.

RESULTS

Out of 1454 students, 1312 students completed the questionnaires with a response rate of 90.23%. Prevalence of ever use of any tobacco product was 19.7% (95% CI 17.7 to 21.6). More than half of the tobacco users (51.9%) consumed tobacco in public places whereas almost a third (75.6%) of the consumers purchased tobacco from shops. Multivariate analysis showed that tobacco use was associated with late adolescence (OR: 1.64; 95% CI 1.17 to 2.28), male gender (OR: 12.20; 95% CI 7.78 to 19.14), type of school (OR=1.72; 95% CI 1.01 to 2.94), Janajati ethnicity (OR: 2.05; 95% CI 1.39 to 3.01) and receiving pocket money ≥Nepalese rupees 500/month (OR: 1.45; 95% CI 1.04 to 2.03).

CONCLUSIONS

Tobacco-focused interventions are required for school/college going students to promote cessation among users and prevent initiation, focussing on late adolescence, male gender, government schools, Janajati ethnicity and higher amount of pocket money.