This study identified several predictors of cigarette smoking among high school students. The overall prevalence of prior experience with smoking in the surveyed students was 43.3% (56.4% of the male students and 31.3% of the female students). Moreover, 19.3% of the students reported having smoked at least one cigarette in the previous 30 days (30.6% of the male students and 8.9% of the female students), which is consistent with international data reporting that two of every ten students currently smoke.[17
] The issue of smoking among high school students has received little national attention and is limited to a few reports with inconsistent methodologies.[18
] These reports have shown a variable prevalence of current smokers, ranging from 12.0% to 22.3% of high school students and 2.40% to 37.00% of university students.[17
] To our knowledge, this study is the first to systematically address this health problem among high school students from the KSA by utilizing the GYTS. Al-Badah et al
. utilized GYTS to address the smoking prevalence among students aged 13 to 15 years and identified a prevalence of “ever smoked” of 26.1% (39.5% of the male students and 16.1% of the female students).[10
] Their data were reported from different parts of the KSA with the limitation that it did not differentiate between cities and did not clearly define what designated a student as a “current smoker” to allow comparison with our findings. A modified GYTS that was conducted at a university in Riyadh in 2009 showed the current smoking prevalence to be 14.5% (32.7% of the male students and 5.9% of the female students).[22
] These alarming figures reflect the tobacco industry's focused advertising in developing countries that have not yet enacted strict antismoking policies.[23
Addressing a problem of this magnitude necessitates enhancing existing knowledge of the factors that predict smoking. Male gender was significantly associated with smoking. However, this strong association should not hide the fact that smoking is also prevalent among female students. This finding is supported by different studies and can be explained by societal restrictions on women, which may limit continual smoking but may not prevent them from occasionally trying cigarettes.[6
] Thus, steps must be taken to reduce the impact of smoking on women's health.[24
] Our findings also show that smoking prevalence significantly increased as high school students progressed in their studies. These findings, especially those reporting a significant association with the students’ grade, agree with a previous survey of medical students from Riyadh.[11
] This is supported by the finding that almost half of the students believed that they were taught about smoking dangers in their curricula. Our study is also consistent with a report from Lebanon and probably reflects the slow changes in the curricula as a shared concern in the region.[25
] Furthermore, the finding that the surveyed students believed that smoking was harmful and indicated a desire to quit smoking supports the importance of strengthening antismoking curricula in schools.[26
Although having either a parent, both or another household member who smokes was associated with smoking, a smoking parent was associated with a student being a “current smoker.” The strongest influencing factor for “ever smoked” status was related to friends who smoke or having been offered cigarettes. This finding is supported by previous literature from the KSA and the region.[6
] Studies from Pakistan and China also showed a strong peer effect of smoking, which may reflect the limited interaction between teenagers and their family.[30
Lack of age restrictions for selling cigarettes was another factor associated with both “ever smoked” and “current smoking” status. This is despite the fact that the KSA has prohibited smoking in public places and has restricted tobacco sales to teenagers.[32
] Our finding is consistent with GYTS results from throughout the region, which showed that nine of ten students have bought cigarettes without restriction.[34
] Therefore, there is an immediate need to enforce these laws to protect the younger generations.
There are some limitations to this study. The first is related to the GYTS that inquired the reply for smoking at least on cigarettes in the past 30 days. The CDC has defined current smoking to be a smoker of at least 100 cigarettes.[35
] Therefore, this may lead to overestimation of the prevalence of current smokers. Second, although the GYTS questionnaires were anonymous, it is expected that some students, especially females, may avoid revealing their smoking status.
In conclusion, having parents or friends who smoke is strongly and significantly associated with “ever smoked” and continual smoking. Although male gender and having a parent or friend who smokes have previously been considered to be predictive factors for smoking, this study showed that peer smoking and lack of restrictions for selling cigarettes to teenagers are the strongest predictive factors for smoking. A similar effect was observed for students who had smoked in the previous 30 days, with the strongest predictive factors being male gender, parental smoking, and friend smoking. These findings would necessitate increasing the awareness of banning smoking at home. Moreover, there is an immediate need to escalate health promotion campaigns regarding smoking and to enhance these opinions in the curricula by revisiting this issue frequently through a spiral approach. These steps may reduce the increased smoking prevalence observed as students’ progress in their level of education.